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PubMed1992

In vitro validation of three-dimensional intravascular ultrasound for the evaluation of arterial injury after balloon angioplasty.

OBJECTIVES: The hypothesis of this study was that three-dimensional ultrasound imaging would facilitate the evaluation of arterial dissection after balloon angioplasty. BACKGROUND: The presence and extent of arterial dissection occurring at the time of balloon angioplasty may be important predictors of abrupt vessel closure or late restenosis. METHODS: Forty-one human arterial segments obtained after death were imaged in an in vitro system at physiologic pressure (80 to 100 mm Hg) before and after balloon angioplasty. Images were acquired with a 20- to 30-MHz mechanical intravascular ultrasound imaging system (Cardiovascular Imaging Systems) with a constant pullback technique (1 mm/s). Standard 0.5-in. (1.27-cm) video tapes were used for data storage and later playback for analog to digital conversion. Digitized data were reconstructed to three-dimensional images with use of voxel space modeling. The vessels were opened longitudinally and subjected to pathologic examination, photographed and classified histologically as normal, fibrous or calcified. Dissection was defined as a disruption and separation of components of the arterial wall. The length and depth of arterial dissection were evaluated grossly and microscopically. RESULTS: Of the 41 arteries studied, 36 (88%) exhibited dissection on pathologic examination after balloon angioplasty. Three-dimensional reconstruction of intravascular ultrasound images identified dissection in 11 (92%) of 12 normal, 8 (100%) of 8 fibrous and 11 (69%) of 16 calcified arteries. Excellent agreement between ultrasound and pathologic findings was achieved in the evaluation of length and depth of dissection for histologically normal and fibrous arteries (kappa = 0.72 to 1.0). When the vessels were severely calcified, the agreement was not as good (kappa = 0.27 to 0.56), particularly in detection of small, non-raised intimal flaps. CONCLUSIONS: This histopathologic validation study suggests that three-dimensional intravascular ultrasound imaging facilitates the evaluation of both quantitative and morphologic features of arterial dissection induced by balloon angioplasty. The advantage of three-dimensional intravascular ultrasound is its ability to assess the length and morphology of arterial injury over an entire vessel segment.

Angioplasty, Balloon, Coronary↗
PubMed1988

Expert system for pathologists to generate an image analysis program for tumor grading.

The pathologist is usually not an expert in engineering or image analysis. We have, therefore, developed an expert system, entitled PARTICLE, to help pathologists producing image analysis programs by which to tackle problems in histological pathology, including tumor grading. The PARTICLE expert system is based on karyometric data, using the AMBA/R dialogue and programming system.

Diagnosis, Computer-Assisted↗
PubMed1998

Tracheal neoplasms in children.

Primary tracheal neoplasms are extremely rare lesions in the pediatric age group. This study reviews the English-language literature to better characterize these lesions in children and reports 2 additional patients. Reports of only 36 infants and children through adolescence with primary tracheal neoplasms were discovered after an exhaustive literature review of the last 30 years. The data are analyzed with regard to pathology, demographics, symptomatology, site, and percent luminal obstruction. We report 2 additional patients with photographic documentation, imaging studies, and histopathology. Of the 36 previously reported lesions, 64% were characterized as benign and 36% as malignant. Fifty-six percent of all lesions were initially misdiagnosed as asthma. The most common site was the posterior membranous wall of the cervical trachea. In 14 (39%) of the 36 patients, the lesions obstructed more than 50% of the lumen at the time of diagnosis. The timely diagnosis of tracheal masses depends upon maintaining a high index of suspicion and conducting an efficient workup, including definitive evaluation by bronchoscopy. The evaluation and the differential diagnosis of tracheal neoplasms in the pediatric population is discussed.

Adolescent↗
PubMed2005

Imaging procedures in adrenal pathology.

Imaging plays a vital role in the evaluation of adrenal pathology. The most widely used modalities are computed tomography and magnetic resonance imaging. Alone or in conjunction with appropriate clinical and biochemical data, imaging can provide specific diagnoses that preclude the need for tissue sampling. This article reviews imaging features of normal and diseased adrenals, from both benign and malignant causes.

Adrenal Gland Diseases↗
PubMed2005

Characterization of breast masses with sonography: can biopsy of some solid masses be deferred?

OBJECTIVE: To determine whether sonography can be used to categorize some solid breast masses as probably benign so that biopsy can be deferred. METHODS: We prospectively characterized 844 sonographically visible solid breast masses referred for biopsy. Mammographic and sonographic features of the masses were recorded, and all masses were categorized by American College of Radiology Breast Imaging Reporting and Data System classification before biopsy. Of the 844 masses, 148 were categorized as probably benign (Breast Imaging Reporting and Data System category 3). Sonographically guided biopsy (n = 804) or fine-needle aspiration (n = 40) was performed for pathologic correlation. RESULTS: Of the 148 masses that met the sonographic criteria for probably benign masses, there was 1 malignancy, for a negative predictive value of 99.3%. CONCLUSIONS: Follow-up can be an acceptable alternative to biopsy for sonographically probably benign solid masses.

Adolescent↗
PubMed2000

MRS methodology.

There are several options in the MRS methods that require consideration before proceeding with the acquisition of the data. The decision to select a nucleus should be based solely on the metabolic information sought. For instance, if an investigator is interested in the effects of medication on the bioenergetic status of the brain, then 31P MRS is indicated. Similarly, selecting the TE for 1H MRS should be based on the metabolite sought. Resonances assigned to myo-In and Glx can only be detected at short TE. Selecting between single-voxel and spectroscopic imaging depends on the requirements of the study. For example, if spatial information is needed, then MRS data ought to be acquired via spectroscopic imaging. However, if the spatial resolution is not critical and interest is to compare a pathologic area with a contralateral VOI, then the acquisition of two single-voxel spectra may be preferred. MRS is widely used. All major vendors of MRI instruments provide some spectroscopic capabilities as a commercially available package with their equipment. Its application to epilepsy has been significant, to which the 40 plus research papers from more than a dozen centers around the world attest.

Epilepsy↗
PubMedDate not supplied

[Applied anatomy for the radiologic and computed tomography study of the paranasal sinuses].

The current diagnosis by images has a significant importance in the medical and/or surgical treatment of the sinusal incidences due to its great sensibility to detect local pathological signs, their limits and neighboring relations. These data are of unvaluable importance at the moment of a therapeutical decision and should be based upon common interests among otorrhinolaringologists and neuroradiologists, speaking the common language given by a firm and shared knowledge of regional anatomy. This presentation is based on the comparison between drawings which show the essential anatomical data and the computed tomography findings, supplying the necessary technical data to obtain veracious images which coincide with the surgeons' angle of view in the direct as well as in the endoscopic approach.

Humans↗
PubMed1993

Fat absorption in patients with functional intestinal lymphangiectasia and lymphangiectic cysts.

Nine patients with endoscopically identified dilated lacteals of the duodenum were studied for evidence of pathologic intestinal lymphangiectasia. Three of the nine patients also had lymphangietic cysts in association with dilated lacteals. Duodenal biopsies, laboratory data, and imaging studies were performed in each patient. In addition, a 14C triolein fat absorption study was performed to assess subclinical malabsorption. Biopsies revealed dilated lymphatic channels in all patients, but laboratory studies failed to suggest intestinal losses of protein or fat, and radiographic abdominal imaging failed to define any of the causes of secondary lymphangiectasia. Eight of the nine patients had adequate fat absorption as measured by the 14C triolein breath test. Our data suggest that patients with incidentally discovered dilated lacteals and no clinical evidence of malabsorption may have a functional intestinal lymphangiectasia. Follow-up endoscopy probably is not warranted in this population.

Biopsy↗
PubMed2006

Application of three-dimensional rendering in joint-related ganglion cysts.

The origin of para-articular cysts is poorly understood and controversial. The relatively common, simple (extraneural) cysts are presumed to be derived from joints, although joint connections are not always established. Rarer complex cysts are thought by many to form de novo within nerves (intraneural ganglion cysts) or within vessels (adventitial cysts) (degenerative theory). We believe that these simple and complex ganglion cysts are joint-related (articular theory). Joint connections are often not readily appreciated with routine imaging or at surgery. Not identifying and/or treating joint connections frequently leads to cyst recurrence. More sophisticated imaging may enhance visualization of these joint connections. We created a 3D rendering technique to assess potential joint connections of simple and complex cysts localized to the knee and superior tibiofibular joints in patients with fibular (peroneal) neuropathy. Two- and three-dimensional data sets from MRI examinations were segmented semiautomatically by signal intensity with further refinement based on interaction with the user to identify specific anatomic structures, such as small nerves and vessels on serial images. The bone, cysts, nerves, and vessels were each assigned different color representations, and 3D renderings were created in ANALYZE using the data sets closest to isotropic (voxel with equal length in all dimensions) resolution as the primary background rendering. We selected four cases to illustrate the spectrum of pathology. In all of these cases, we demonstrated joint connections and correlated imaging and operative findings. Surgery addressing the cyst and the joint connection resulted in excellent outcomes; postoperative MRIs done more than 6 months later confirmed that there was no recurrence. In addition to highlighting the important relationship of these cysts to neighboring anatomic structures, this 3D technique allows visualization of "occult" connections not readily appreciated with standard MR imaging. We believe that these joint-related cysts have a common pathogenesis; they dissect through a capsular rent and follow the path of least resistance; they may form simple cysts by dissecting out into the soft tissue, or more complex cysts by dissecting within the epineurium of nerves or adventitia of vessels (along an articular branch), or various combinations of all of these types of cysts. Understanding the pathogenesis for cyst formation will improve surgical management and outcomes. We have adapted this 3D technique to enhance the visualization of cysts occurring at other joints.

Adult↗
PubMedDate not supplied

Preoperative image fusion of fluoro-2-deoxy-D-glucose-positron emission tomography and computed tomography data sets in oral maxillofacial carcinoma: potential clinical value.

OBJECTIVE: The aim was to evaluate the clinical and therapeutic value of digital image fusion of 2-[18]-fluoro-2-deoxy-D-glucose (F18-FDG) positron emission tomography (PET) and computed tomography (CT) in patients suffering from an oral maxillofacial carcinoma. METHODS: Seventeen patients (11 male, 6 female; age range: 45-89 years) suffering from an oral maxillofacial carcinoma underwent CT and F18-FDG-PET (333-370 MBq). The data of the 2 imaging modalities were fused on an image workstation. This image fusion was then visualized in the axial, coronal, and sagittal planes. RESULTS: PET showed a high pathologic FDG uptake in the tumor in 17 of 17 patients. CT detected the tumor in 12 of 17 patients. The image fusion of FDG-PET and CT showed the tumor in 17 of 17 patients. The final diagnosis was carcinoma of the mandible in 9 of 17 patients, carcinoma of the mouth floor in 3 of 17 patients, carcinoma of the tongue in 3 of 17 patients, carcinoma of the roof of the mouth in 1 of 17 patients, and carcinoma of the parotis gland in 1 of 17 patients. CONCLUSIONS: Preoperative image fusion of FDG-PET and CT data sets in oral maxillofacial carcinoma is possible in the clinical routine. Combined morphologic (CT) and functional (PET) imaging improves tumor localization even if the tumor is hardly visible on CT because of the artefacts of dental metallic implants (3/17 patients) or because of the small size of the tumor (2/17 patients). Image fusion is helpful for planning possible surgery (visual models) or radiotherapy (exact region of interest).

Aged↗
PubMed2005

Toward automated segmentation of the pathological lung in CT.

Conventional methods of lung segmentation rely on a large gray value contrast between lung fields and surrounding tissues. These methods fail on scans with lungs that contain dense pathologies, and such scans occur frequently in clinical practice. We propose a segmentation-by-registration scheme in which a scan with normal lungs is elastically registered to a scan containing pathology. When the resulting transformation is applied to a mask of the normal lungs, a segmentation is found for the pathological lungs. As a mask of the normal lungs, a probabilistic segmentation built up out of the segmentations of 15 registered normal scans is used. To refine the segmentation, voxel classification is applied to a certain volume around the borders of the transformed probabilistic mask. Performance of this scheme is compared to that of three other algorithms: a conventional, a user-interactive and a voxel classification method. The algorithms are tested on 10 three-dimensional thin-slice computed tomography volumes containing high-density pathology. The resulting segmentations are evaluated by comparing them to manual segmentations in terms of volumetric overlap and border positioning measures. The conventional and user-interactive methods that start off with thresholding techniques fail to segment the pathologies and are outperformed by both voxel classification and the refined segmentation-by-registration. The refined registration scheme enjoys the additional benefit that it does not require pathological (hand-segmented) training data.

Algorithms↗
PubMed1995

Telepathology: a tool to aid in diagnosis and quality assurance in cervicovaginal cytology.

The purpose of this study is to evaluate the use of a Teletransmission System with regard to quality of diagnosis and screening so as to establish its potential role in gynaecological cytology. Three aspects of its use in cytopathology have been considered: diagnosis, training, and quality control. The circumstances in which the system may be used for diagnosis, together with its advantages and disadvantages, are examined and discussed. In general, the cost/benefit in diagnostic use related to the experience of both the expert and the peripheral pathologist. The system may also contribute to training and quality assessment, particularly if combined with other automated services, such as image data bank.

Education, Medical, Continuing↗
PubMed1999

[A pathological study on indirect optic nerve injury in rabbit eyes].

OBJECTIVE: To study the pathological changes after indirect optic nerve injury. METHODS: Animal models (72 rabbits, 144 eyes) for intracanalicular optic nerve injury was developed by keeping the optic canal intact. The pathological changes of optic nerve were observed under light microscope and transmission electron microscope and the number of myelinated axons was enumerated by computer-aided image analyzer. The data were analyzed by using variance of SAS software. RESULTS: The model contributed much valuable information regarding nerve edema, loss of myelin, myelin regeneration and changes of axons. The edematous area in the optic nerve injury was reduced (P < 0.01) by treating with prednisone. The counted number of myelinated fibers showed more in the group treated by prednisone than that in the group without treatment. CONCLUSIONS: Significant changes of optic nerve after indirect injury are edema, demyelination and the change of axon amount. The effects of prednisone on reducing these pathological changes are demonstrated in this study.

Animals↗
PubMed1998

Use of endorectal MR imaging to predict prostate carcinoma recurrence after radical prostatectomy.

PURPOSE: To determine the ability of endorectal magnetic resonance (MR) imaging to help predict postprostatectomy disease recurrence and, thereby, patient outcome. MATERIALS AND METHODS: The authors evaluated 116 patients referred for prostate MR imaging during 1991 and 1992 who subsequently underwent radical prostatectomy and for whom follow-up data through 1996 could be obtained. The MR reports, clinic charts, and pathology reports were reviewed. Disease recurrence was established by means of detectable levels of serum prostate-specific antigen (PSA) after surgery. RESULTS: Thirty-four patients (29%) had postoperative disease recurrence. Patients with recurrence had higher preoperative PSA values (P < .0001). These patients also more frequently had positive surgical margins (P = .0005), transcapsular tumor spread (P < .0001), seminal vesicle involvement (P = .0012), and tumors of advanced stage (P < .0001) and high grade (P = .0058). Of 13 patients whose MR examinations showed definite extracapsular disease, eight (62%) had disease recurrence. The recurrence rate when MR imaging indicated limited disease (24%) was similar to that when MR imaging showed possible microscopic extension (27%). An MR finding of definite extracapsular disease was 24% sensitive and 94% specific for the prediction of disease recurrence. CONCLUSION: MR imaging findings of definite extracapsular spread of disease helped predict prostate tumor recurrence with high specificity, although with low sensitivity.

Case-Control Studies↗
PubMed1990

Evaluation of encephalic ventricular volume from the magnetic resonance imaging scans of thirty-eight human subjects.

Accurate volume determination of the encephalic ventricles is of importance in several clinical conditions, including Alzheimer's presenile dementia, schizophrenia, and benign intracranial hypertension. Previous studies have investigated the accuracy with which magnetic resonance imaging (MRI) can be used in clinical practice to evaluate the encephalic ventricles. However, adequate evaluation of pathological conditions depends on a sufficient amount of morphometric data from normal subjects. To begin establishing this data base for "normal" subjects, we evaluated the MRI scans of 38 subjects found to have no apparent pathology and calculated the ventricular volume in each case by using methods previously developed in our laboratory. The results were then compared with published volumes determined from studies that used either ventricular casts or computerized tomographic scans. The average total ventricular volume for all 38 subjects was 17.4 cm3, while that for males was 16.3 cm3 and that for females was 18.0 cm3. A small but significant correlation was found between age of subject and ventricular volume, with ventricular size increasing with age.

Cerebral Ventricles↗
PubMed2003

[The sphenoid: tumoral pathology].

The interest and difficulty of sphenoid tumor imaging relate mainly to its great diversity. Detection may be difficult due to variable tumor size and often misleading clinical data. Because the sphenoid is located at the center of the skull base, tumor extension may be quite variable and difficult to assess, requiring sufficient knowledge of anatomy and imaging features to detect tumor spread, especially retrograde perineural spread, since this has a negative impact on prognosis.

Diagnosis, Differential↗
PubMedDate not supplied

[Magnetic resonance imaging in the diagnosis of nonorganic hydatid disease].

This article evaluates MRI diagnostic value in discovering of the non-organic hydatid disease. MRI data of 21 patients, suffering from parasite pathology of liver (n = 12), liver and peritoneum cavity (n = 2), liver and retroperitoneal space (n = 2), liver and thigh's muscles (n = 1), peritoneum cavity (n = 2), retroperitoneal space (n = 1), spine and paravertebral area (n = 1) were analyzed. Based on histopathological results, features of unusually localized hydatid cysts (HC) MRI- semiotics are described in detail and compared with liver echinococcosis. MRI technique for identification of some hydatid cyst's structures is shown. The authors discuss the MRI reliability in differential diagnosis of non-organic HC and several disorders (non-parasite congenital and acquired cysts, hematoma, abscess, metastasis) of the same anatomical region. They underline some MRI advantages in GD disclosing comparing with ultrasonography and computed tomography. However, serological tests are needed for diagnosis verification. The authors also postulate the importance of clinical data being taken into account for radiological conclusion.

Adult↗