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Massive localized lymphedema of the thigh: Pseudosarcoma of the morbidly obese 大腿局部淋巴水肿:病态肥胖的假肉瘤
Pub Date : 2024-03-12 DOI: 10.14312/2399-8172.2024-1
Husain Zsm, Driweesh Asa
Massive localized lymphedema (MLL) is a recently described clinical condition characterized by lymphedema resulting from focally disrupted lymphatic drainage in morbidly obese patients. These patients typically present with long-standing, painless, slow-growing, ill-defined soft tissue masses. The masses are often found in the inner thigh and may resemble liposarcoma both clinically and histologically. Due to its challenging imaging characteristics, MLL poses diagnostic difficulties for clinicians and pathologists. As the global obesity epidemic persists, the incidence of MLL is expected to rise, necessitating awareness and appropriate management strategies. In this context, we present a case of MLL affecting the thigh in a morbidly obese patient. The final diagnosis was given based on patient’s demographics and the presence of lymphedema in other parts of the body.
大块局部淋巴水肿(MLL)是最近描述的一种临床病症,其特点是病态肥胖患者的淋巴引流发生局部破坏而导致淋巴水肿。这些患者通常表现为长期、无痛、生长缓慢、界限不清的软组织肿块。肿块通常出现在大腿内侧,在临床和组织学上都可能与脂肪肉瘤相似。由于其影像学特征具有挑战性,MLL 给临床医生和病理学家带来了诊断上的困难。随着全球肥胖症的持续流行,MLL 的发病率预计会上升,因此有必要提高人们的认识并采取适当的管理策略。在此背景下,我们介绍了一例影响大腿的病态肥胖患者的 MLL。最终诊断是根据患者的人口统计学特征和身体其他部位的淋巴水肿情况做出的。
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引用次数: 0
Further development of the preceding Gaussian-pencil-beam-model used for calculation of the in-water dose caused by clinical electron-beam irradiation 用于计算临床电子束辐照引起的水中剂量的先前高斯笔状束模型的进一步发展
Pub Date : 2023-08-01 DOI: 10.14312/2399-8172.2023-1
I. A, Terashima S, K. S, Sutoh K, K. K, Hosokawa Y, M. M
Purposes: We perform further development for our previous Gaussian-pencil-beam-model used for calculating the electron dose in water under clinical electron-beam irradiation. The main purpose is to evaluate accurately the parallel beam depth-doses at deep depths beyond about the extrapolated range (Rp) under an infinite field. Methods: Sets of parallel beam depth-doses under an infinite field were reconstructed for beams of E=6, 12, and 18 MeV in light of the electron Monte Carlo (eMC) datasets reported by Wieslander and Knöös (2006), separating the datasets into the direct electron beam and direct-plus-indirect electron beam groups. The datasets at the deep depths were then reconstructed using each factor of R_scale^OAD. Results and conclusions: The following results were obtained by comparing the calculated datasets of depth dose (DD) and off-axis dose (OAD) with the eMC datasets: (i) The further revised Gaussian pencil beam model is of practical use without using complicated correction factors; and (ii) The DD and OAD datasets are yielded effectively over wide ranges of depths and off-axis distances.
目的:我们对以前用于计算临床电子束照射下水中电子剂量的高斯笔束模型进行了进一步的发展。主要目的是准确评估在无限场下超过外推范围(Rp)的深度处的平行光束深度剂量。方法:根据Wieribrian和Knös(2006)报道的电子蒙特卡罗(eMC)数据集,重建E=6、12和18MeV光束在无限场下的平行光束深度剂量集,将数据集分为直接电子束组和直接加间接电子束组。然后使用R_scale^OAD的每个因子重建深部的数据集。结果和结论:通过将深度剂量(DD)和离轴剂量(OAD)的计算数据集与eMC数据集进行比较,获得了以下结果:(i)进一步修正的高斯笔束模型在不使用复杂校正因子的情况下具有实用性;以及(ii)DD和OAD数据集在宽范围的深度和离轴距离上有效地产生。
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引用次数: 0
A revised Gaussian pencil beam model for calculation of the in-water dose caused by clinical electron-beam irradiation 用于计算临床电子束照射引起的水中剂量的修正高斯铅笔束模型
Pub Date : 2022-12-01 DOI: 10.14312/2399-8172.2022-1
I. A, Terashima S, K. S, S. K., K. K, Hosokawa Y, M. M, Tabata T
Purposes: The dose in water caused by clinical electron-beam irradiation is mainly composed of the doses due to the direct electrons, the indirect electrons, and the contaminant X-rays. In this paper, an analytical method for 3-dimensional (3D) dose calculation in water for the direct electrons and for the direct-plus-indirect electrons is proposed in light of the electron Monte Carlo (eMC) datasets. Methods: The dose calculation was performed for square fields, based on a revised Gaussian pencil beam model, where the parallel beam depth-dose dataset under an infinitely large field was reconstructed from the depth-dose dataset of a fan beam with a finite field. We used a semi-infinite water phantom, setting the beam incident surface on the isocenter plane that is perpendicular to the beam axis. The dose calculation model sets an effective field at each dose calculation depth, where the effective field is larger than the geometrical field that the electron applicator forms on the basis of its divergent spread under the effective source-surface distance (SSDeff). Results and conclusions: By comparing the calculated datasets of depth dose (DD) and off-axis dose (OAD) in water with the eMC datasets for electron beams of E=6, 12, and 18 MeV by Wieslander and Knöös (2006), it has been found that the revised Gaussian pencil beam model is of practical use and has a bright prospect to give almost the same calculation results as the eMC datasets.
用途:临床电子束辐照引起的水中剂量主要由直接电子、间接电子和污染物X射线引起的剂量组成。本文根据电子蒙特卡罗(eMC)数据集,提出了一种计算水中直接电子和直接加间接电子的三维(3D)剂量的分析方法。方法:基于修正的高斯笔状光束模型,对方形场进行剂量计算,其中从具有有限场的扇形光束的深度剂量数据集重建无限大场下的平行光束深度剂量数据组。我们使用了一个半无限水模型,将光束入射面设置在垂直于光束轴的等中心平面上。剂量计算模型在每个剂量计算深度设置一个有效场,其中有效场大于电子施加器基于其在有效源表面距离(SSDeff)下的发散扩展而形成的几何场。结果与结论:通过将水中深度剂量(DD)和离轴剂量(OAD)的计算数据集与Wieribrian和Knös(2006)的E=6、12和18MeV电子束的eMC数据集进行比较,发现修正后的高斯铅笔束模型具有实用性,并具有与eMC数据集中几乎相同的计算结果的光明前景。
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引用次数: 1
Fast magnetic resonance arthrography of the labrum 快速关节唇核磁共振成像
Pub Date : 2021-07-02 DOI: 10.14312/2399-8172.2021-3
English Cl, Shannon Fj, Bergin D
Research question: Short volumetric interpolated breath hold exam (VIBE) 3D gradient echo sequences are comparable to T1 spin echo (SE) sequences for evaluating the shoulder labrum using arthroscopy as a gold standard. Methods: 24 patients with suspected labral tears had magnetic resonance (MR) arthrography of the shoulder using 1.5T MR scanner. Coronal oblique 3D VIBE FS sequences were performed and reconstructed in axial and sagittal oblique planes and compared with standard T1 SE sequences. Presence and location of labral tear and rotator cuff tears were noted. Findings were correlated with surgery where available. Time to obtain T1 SE sequences versus 3D VIBE acquisition was recorded. Results: Of 24 patients, 54% had arthroscopy. Sensitivity and positive predictive value (PPV) of both T1 SE and VIBE sequences for labral tears was 92%. 100% agreement for diagnosis of labral tear by readers between both sequences was noted. Specific labral tear location was accurate in 75% for both sequences. The mean time to obtain T1 SE sequences was 13.5 mins and 7.5 minutes for 3D VIBE sequences. Conclusion: Fast MR arthrography using 3D VIBE sequences shows excellent concordance with standard T1-FS sequence for diagnosis of labral tears. With shorter acquisition time and high diagnostic sensitivity 3D VIBE sequences maybe used as an alternative to standard sequences. Level of evidence: Level III retrospective diagnostic study.
研究问题:短体积内插屏气检查(VIBE)3D梯度回波序列与T1旋转回波(SE)序列相当,可用于使用关节镜作为金标准评估肩唇。方法:对24例疑似唇撕裂的患者,用1.5T磁共振(MR)肩关节成像仪进行检查。在轴向和矢状倾斜平面上执行和重建冠状倾斜三维VIBE FS序列,并与标准T1 SE序列进行比较。注意到唇撕裂和肩袖撕裂的存在和位置。研究结果与可用的手术相关。记录获得T1 SE序列与3D VIBE采集的时间。结果:24例患者中,54%接受了关节镜检查。T1-SE和VIBE序列对唇撕裂的敏感性和阳性预测值(PPV)均为92%。两个序列的读者对唇撕裂的诊断结果100%一致。两个序列的特定唇撕裂位置准确率均为75%。获得T1 SE序列的平均时间为13.5分钟,3D VIBE序列为7.5分钟。结论:使用三维VIBE序列的快速MR关节造影显示出与标准T1-FS序列在诊断唇撕裂方面的良好一致性。3D VIBE序列具有较短的采集时间和较高的诊断灵敏度,可以用作标准序列的替代品。证据级别:III级回顾性诊断研究。
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引用次数: 0
Analytic continuation and incomplete data tomography. 解析延拓与不完全数据层析。
Pub Date : 2021-03-01 Epub Date: 2021-03-04 DOI: 10.14312/2399-8172.2021-2
Gengsheng L Zeng, Ya Li

A unique feature of medical imaging is that the object to be imaged has a compact support. In mathematics, the Fourier transform of a function that has a compact support is an entire function. In theory, an entire function can be uniquely determined by its values in a small region, using, for example, power series expansions. Power series expansions require evaluation of all orders of derivatives of a function, which is an impossible task if the function is discretely sampled. In this paper, we propose an alternative method to perform analytic continuation of an entire function, by using the Nyquist-Shannon sampling theorem. The proposed method involves solving a system of linear equations and does not require evaluation of derivatives of the function. Noiseless data computer simulations are presented. Analytic continuation turns out to be extremely ill-conditioned.

医学成像的一个独特特点是被成像的物体有一个紧凑的支撑。在数学中,一个有紧支持的函数的傅里叶变换是一个完整的函数。理论上,整个函数可以由它在一个小区域内的值唯一地确定,例如使用幂级数展开。幂级数展开式需要计算函数的所有阶导数,如果函数是离散采样的,这是不可能完成的任务。在本文中,我们提出了一种利用Nyquist-Shannon抽样定理对整个函数进行解析延拓的替代方法。所提出的方法涉及求解一个线性方程组,而不需要求函数的导数。给出了无噪声数据的计算机模拟。解析延拓是极端病态的。
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引用次数: 3
Scattered radiation during osteosynthesis of the distal radius: A phantom study 桡骨远端骨固定过程中的散射辐射:一项假体研究
Pub Date : 2021-01-04 DOI: 10.14312/2399-8172.2021-1
Legerstee Iwf, Oosterveer Ttm, Molenaar Ma, Rasenberg Dwm, Spoon Eqw, Verhoeven Vwj, van der Velden Em
Modern fracture surgery requires an increasing number of operative procedures utilising radiological control. During osteosyntheses patients receive scattered radiation when fluoroscopy is used. Unlike operating-room staff, patients are not protected during these procedures. The aim of this study was to measure the amount of scattered radiation in the phantom plane during a simulated osteosynthesis in order to evaluate the patient’s need for protection. A lower arm anthropomorphic phantom was irradiated with the use of a Philips BV Pulsera C-arm. The amounts of scattered radiation at distances from 10 to 160 cm and angles of 0 to 180 degrees in the phantom plane were measured with a real-time dosimeter. The same amount of measurements was repeated with a fixation plate on top of the phantom to simulate a fracture reduction operation. The maximum amount of scattered radiation was 1.63 µSv at a distance of 10 cm from the edge of the radiation beam. This phantom study shows that scattered radiation during osteosyntheses of the distal radius is negligible and therefore no patient protection is needed. The results should be interpreted carefully as this is a phantom study.
现代骨折手术需要越来越多的手术程序利用放射控制。在骨融合术中,当使用透视时,患者接受散射辐射。与手术室工作人员不同,患者在这些过程中没有受到保护。本研究的目的是在模拟植骨过程中测量假体面散射辐射的量,以评估患者对保护的需求。使用Philips BV Pulsera c型臂照射下肢拟人化假体。用实时剂量计测量了幻影平面内10 ~ 160 cm距离和0 ~ 180度角的散射辐射量。在假体顶部用固定钢板重复相同量的测量,以模拟骨折复位手术。在距离辐射束边缘10 cm处,散射辐射量最大为1.63µSv。该假体研究表明,桡骨远端成骨过程中的散射辐射可以忽略不计,因此不需要患者保护。由于这是一项虚幻研究,因此应仔细解释结果。
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引用次数: 0
Fast filtered backprojection algorithm for low-dose computed tomography. 低剂量计算机断层扫描的快速滤波反投影算法。
Pub Date : 2020-12-01 Epub Date: 2020-11-30 DOI: 10.14312/2399-8172.2020-7
Gengsheng L Zeng

Low-dose computed tomography (CT) can produce noisy images that may contain streaking artifacts. Removal of streaking artifacts normally requires iterative algorithms that model the transmission noise physics. A fast filtered backprojection (FBP) algorithm is introduced in this short paper. This algorithm is very simple and effective in removing the streaking artifacts in low-dose CT.

低剂量计算机断层扫描(CT)可以产生可能包含条纹伪影的噪声图像。去除条纹伪影通常需要对传输噪声物理建模的迭代算法。本文介绍了一种快速滤波反投影(FBP)算法。该算法简单有效地消除了低剂量CT的条纹伪影。
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引用次数: 0
Iterative versus non-iterative image reconstruction methods for sparse magnetic resonance imaging. 稀疏磁共振成像的迭代与非迭代图像重建方法。
Pub Date : 2020-08-01 DOI: 10.14312/2399-8172.2020-5
Gengsheng L Zeng, Edward V DiBella

Magnetic resonance imaging (MRI) using under-sampled k-space data is a common method to shorten the imaging time. Iterative Bayesian algorithms are usually used for its image reconstruction. This paper compares an iterative Bayesian image reconstruction method that uses both spatial and temporal constraints and a non-iterative reconstruction algorithm that does not use temporal constraints. Three patient studies are performed. It is interesting to notice that the images reconstructed by the iterative Bayesian algorithm may introduce more bias than the non-iterative algorithm, even though the images provided by the iterative Bayesian algorithm look less noisy. The bias can be reduced by decreasing the influence of the temporal constraints.

利用欠采样k空间数据进行磁共振成像(MRI)是缩短成像时间的常用方法。其图像重建通常采用迭代贝叶斯算法。本文比较了同时使用时空约束的迭代贝叶斯图像重建方法和不使用时间约束的非迭代重建算法。进行了三个患者研究。有趣的是,尽管迭代贝叶斯算法提供的图像看起来噪音更小,但迭代贝叶斯算法重建的图像可能比非迭代算法引入更多的偏差。可以通过减小时间约束的影响来减小偏差。
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引用次数: 1
Lack of clinically meaningful anatomical variations in bone marrow apparent diffusion coefficient in diffuse pattern myeloma allows untargeted sampling to confirm disease burden 弥漫性骨髓瘤中骨髓表观扩散系数缺乏临床意义的解剖变化,允许非靶向取样来确认疾病负担
Pub Date : 2020-07-01 DOI: 10.14312/2399-8172.2020-4
K. A., O’Connor S, Boyd K, K. M, Blackledge M, Koh Dm, Messiou C
Posterior iliac crest trephine may result in sampling error and incorrect measures of disease burden in patients with multiple myeloma. This may influence the decision to treat. To compare the regional apparent diffusion coefficient of bone marrow in patients with multiple myeloma without focal bone lesions and their correlation with indices of disease burden, whole-body diffusion weighted imaging of 48 patients with diffuse myeloma were retrospectively reviewed. Three regions of interest were drawn over four anatomical sites on apparent diffusion coefficient maps and average values recorded. Apparent diffusion coefficient values were compared using the Wilcoxon signed-rank test with p-value < 0.0125 (Bonferroni correction) taken as statistical significance. Average apparent diffusion coefficient values were correlated with age-adjusted marrow cellularity and plasma cell proportion at histopathology, and international staging system scores. There was no significant difference in the apparent diffusion coefficient of bone marrow in the left ilium (754 × 10 -6 mm 2 /s), right ilium (733 × 10 -6 mm 2 /s) and T6 (701 × 10 -6 mm 2 /s) but it was significantly lower in L3 (636 × 10 -6 mm 2 /s) (p-value < 0.0125). However, the variance of apparent diffusion coefficient across all sites were within limits of measurement repeatability (15%). No correlation was found between per-patient average apparent diffusion coefficient with age-adjusted marrow cellularity (p=0.7), proportion of plasma cells (p=0.2) or ISS scores (p=0.5). There was no clinically meaningful difference in apparent diffusion coefficient values across anatomical sites in diffuse myeloma. Untargeted bone marrow biopsy is likely to be representative in this patient group.
后髂骨环甲可能导致抽样误差和不正确的测量疾病负担的多发性骨髓瘤患者。这可能会影响治疗的决定。为比较无局灶性骨髓瘤患者骨髓区域表观弥散系数及其与疾病负担指标的相关性,回顾性分析48例弥漫性骨髓瘤患者的全身弥散加权成像。在四个解剖部位绘制了三个感兴趣的区域,并记录了表观扩散系数图和平均值。表观扩散系数值的比较采用Wilcoxon符号秩检验,p值< 0.0125 (Bonferroni校正)为有统计学意义。平均表观扩散系数值与年龄调整后的组织病理学骨髓细胞和浆细胞比例以及国际分期系统评分相关。骨髓表观扩散系数在左髂骨(754 × 10 -6 mm 2 /s)、右髂骨(733 × 10 -6 mm 2 /s)和T6 (701 × 10 -6 mm 2 /s)无显著差异,但在L3 (636 × 10 -6 mm 2 /s)显著降低(p值< 0.0125)。然而,所有地点的表观扩散系数方差均在测量可重复性的限制范围内(15%)。每位患者平均表观扩散系数与年龄调整后的骨髓细胞数量(p=0.7)、浆细胞比例(p=0.2)或ISS评分(p=0.5)无相关性。弥漫性骨髓瘤各解剖部位的表观扩散系数值无临床意义差异。非靶向骨髓活检可能在该患者组中具有代表性。
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引用次数: 2
Whole-body magnetic resonance imaging for detection of malignant disease: A head-to-head-comparison with whole-body 18F-FDG-PET/CT as the reference standard 全身磁共振成像检测恶性疾病:与全身18F-FDG-PET/CT作为参考标准的头部对比
Pub Date : 2020-04-02 DOI: 10.14312/2399-8172.2020-3
Brix L, Ejlersen Ja, Fledelius J, Makieva I, Thylin Esg, Hansen J, Ha Lk, Gerke O, Isaksen C
Introduction: The combined use of 18 F-FDG-PET and computed tomography (CT) scans is an integrated part of diagnosing and staging patients with suspected malignancy or other pathologies. Magnetic resonance imaging (MRI) has proven its use as a non-ionizing imaging alternative for identifying potential malignancy in specific organs. Objective: To investigate the clinical value of whole-body MRI in detection of suspicious lesions, we compared 1.5T MRI findings to those obtained from a whole-body 18 F-FDG-PET/CT scan, the latter serving as the reference standard. Finally, the findings were compared with histology if available. Materials and methods: Twenty-five patients (9 women and 16 men, mean age ± SD: 64.5 ± 11.8 years; range: 34±85 years) with suspected malignancy or other pathologies were enrolled. All patients were scanned using both modalities. Imaging included the head, torso and extremities. Images were scored blinded by experienced readers: two radiologists and two nuclear medicine physicians. Statistical tests included weighted kappa for measuring interobserver reliability and Wilcoxon signed-rank test for detection differences between paired observations. Results and discussion: Interobserver reliability between each pair of specialists was fair-to-strong (Weighted kappa). Statistically significant differences between the findings of the two modalities were found in the colon (p=0.016), soft tissues of the extremities (p=0.002) and skeleton of the extremities (p=0.008). Twelve patients had histology available. WB-MRI and whole-body 18 F-FDG-PET/CT found 10 of these cases (sensitivity: 83.3%, 95% CI: 55.2%-95.3%). Conclusion: The diagnostic value of WB-MRI equaled whole-body 18 F-FDG-PET/CT. The MRI approach could therefore be considered in patients unsuitable for 18 F-FDG-imaging e.g. younger patients, during pregnancy or dysregulated diabetics.
简介:18次F-FDG-PET和计算机断层扫描(CT)的联合使用是诊断和分期疑似恶性肿瘤或其他病理患者不可或缺的一部分。磁共振成像(MRI)已被证明是一种用于识别特定器官潜在恶性肿瘤的非电离成像替代方法。目的:探讨全身MRI对可疑病变的临床诊断价值,将1.5T MRI结果与全身18 F-FDG-PET/CT扫描结果进行比较,后者作为参考标准。最后,如果有的话,将结果与组织学进行比较。材料与方法:25例患者(女性9例,男性16例),平均年龄±SD: 64.5±11.8岁;年龄范围:34±85岁),怀疑为恶性或其他病理。所有患者均采用两种方式进行扫描。成像包括头部、躯干和四肢。图像由经验丰富的读者(两名放射科医生和两名核医学医生)进行盲法评分。统计检验包括衡量观察者间信度的加权kappa检验和成对观察之间检测差异的Wilcoxon符号秩检验。结果和讨论:每对专家之间的观察者之间的信度是公平到强的(加权kappa)。在结肠(p=0.016)、四肢软组织(p=0.002)和四肢骨骼(p=0.008)两种方式的结果之间存在统计学差异。12例患者有组织学资料。其中WB-MRI和全身18 F-FDG-PET/CT发现10例(敏感性:83.3%,95% CI: 55.2%-95.3%)。结论:WB-MRI的诊断价值与全身18f - fdg - pet /CT相当。因此,对于不适合18 f - fdg成像的患者,例如年轻患者、妊娠期患者或糖尿病失调患者,可以考虑采用MRI方法。
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引用次数: 0
期刊
Journal of radiology and imaging
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