A multicenter clinical AI system study for detection and diagnosis of focal liver lesions.

Early and accurate diagnosis of focal liver lesions is crucial for effective treatment and prognosis. We developed and validated a fully automated diagnostic system named Liver Artificial Intelligence Diagnosis System (LiAIDS) based on a diverse sample of 12,610 patients from 18 hospitals, both retrospectively and prospectively. In this study, LiAIDS achieved an F1-score of 0.940 for benign and 0.692 for malignant lesions, outperforming junior radiologists (benign: 0.830-0.890, malignant: 0.230-0.360) and being on par with senior radiologists (benign: 0.920-0.950, malignant: 0.550-0.650). Furthermore, with the assistance of LiAIDS, the diagnostic accuracy of all radiologists improved. For benign and malignant lesions, junior radiologists' F1-scores improved to 0.936-0.946 and 0.667-0.680 respectively, while seniors improved to 0.950-0.961 and 0.679-0.753. Additionally, in a triage study of 13,192 consecutive patients, LiAIDS automatically classified 76.46% of patients as low risk with a high NPV of 99.0%. The evidence suggests that LiAIDS can serve as a routine diagnostic tool and enhance the diagnostic capabilities of radiologists for liver lesions.

Target Density Effects on Charge Transfer of Laser-Accelerated Carbon Ions in Dense Plasma.

We report on charge state measurements of laser-accelerated carbon ions in the energy range of several MeV penetrating a dense partially ionized plasma. The plasma was generated by irradiation of a foam target with laser-induced hohlraum radiation in the soft x-ray regime. We use the tricellulose acetate (C_{9}H_{16}O_{8}) foam of 2 mg/cm^{3} density and 1 mm interaction length as target material. This kind of plasma is advantageous for high-precision measurements, due to good uniformity and long lifetime compared to the ion pulse length and the interaction duration. We diagnose the plasma parameters to be T_{e}=17 eV and n_{e}=4×10^{20} cm^{-3}. We observe the average charge states passing through the plasma to be higher than those predicted by the commonly used semiempirical formula. Through solving the rate equations, we attribute the enhancement to the target density effects, which will increase the ionization rates on one hand and reduce the electron capture rates on the other hand. The underlying physics is actually the balancing of the lifetime of excited states versus the collisional frequency. In previous measurement with partially ionized plasma from gas discharge and z pinch to laser direct irradiation, no target density effects were ever demonstrated. For the first time, we are able to experimentally prove that target density effects start to play a significant role in plasma near the critical density of Nd-glass laser radiation. The finding is important for heavy ion beam driven high-energy-density physics and fast ignitions. The method provides a new approach to precisely address the beam-plasma interaction issues with high-intensity short-pulse lasers in dense plasma regimes.

Analysis of degradation kinetic modeling and mechanism of chlorinated-halonitromethanes under UV/monochloramine treatment.

Chlorinated-halonitromethanes (Cl-HNMs) including chloronitromethane (CNM), dichloronitromethane (DCNM), and trichloronitromethane (TCNM) are nitrogenous disinfection by-products, which have high cytotoxicity and genotoxicity to human. This study aimed to investigate the degradation kinetic modeling and mechanism of Cl-HNMs under monochloramine activated by ultraviolet of 254 nm (UV/NH2Cl) treatment. The first-principle kinetic model of UV/NH2Cl process was developed to simulate Cl-HNMs degradation. Of note, the second-order rate constants of Cl-HNMs reacting with HO• (∼108 M-1 s-1), Cl• (kCl•,CNM or DCNM = âˆ¼1010 M-1 s-1, kCl•,TCNM = âˆ¼102 M-1 s-1), Cl2•- (kCl•,CNM or DCNM = âˆ¼109 M-1 s-1, kCl•,TCNM = âˆ¼101 M-1 s-1), ClO• (∼105-106 M-1 s-1) and CO3•- (∼106-107 M-1 s-1) were obtained by the first-principle kinetic model. Overall, Cl-HNMs degradation under UV/NH2Cl treatment was successfully predicted by the kinetic model under various conditions. It was found that UV (>60%) was dominant in Cl-HNMs degradation, followed by HO• (3.8%-24.5%), reactive chlorine species (RCS, 0.9%-28.8%) and CO3•- (0-26.1%). Among the contributions of RCS, Cl• and Cl2•- were main radicals in the degradation of CNM and DCNM, while ClO• was responsible for the abatement of TCNM. The minimum EE/O values under UV/NH2Cl treatment were approximately 30% lower than those under UV treatment. Finally, the possible degradation pathways were proposed, including hemolytic/heterolytic cleavage of Cl-HNMs by UV irradiation, hydrogen abstraction/electron transfer of CNM and DCNM and adduct reaction of TCNM by free radicals. This study based on the kinetic model is beneficial to predict and control the concentrations of Cl-HNMs under UV/NH2Cl treatment.

An Unsupervised 3D Image Registration Network for Brain MRI Deformable Registration.

In recent years, deep learning has made successful applications and remarkable achievements in the field of medical image registration, and the method of medical image registration based on deep learning has become the current research hotspot. However, the performance of convolutional neural networks may not be fully exploited due to neglect of spatial relationships between distant locations in the image and incomplete updates of network parameters. To avoid this phenomenon, MHNet, a multiscale hierarchical deformable registration network for 3D brain MR images, was proposed in this paper. This network was an unsupervised end-to-end convolutional neural network. After training, the dense displacement vector field can be predicted almost in real-time for the unseen input image pairs, which saves a lot of time compared with the traditional algorithms of independent iterative optimization for each pair of images. On the basis of the encoder-decoder structure, this network introduced the improved Inception module for multiscale feature extraction and expanding the receptive field and the hierarchical forecast structure to promote the update of the parameters of the middle layers, which achieved the best performance on the augmented public dataset compared with the existing four excellent registration methods.

Undifferentiated carcinoma of the pancreas with osteoclast like giant cells: Literature review with CT/MR imaging findings in 3 cases.

Undifferentiated carcinoma with osteoclast-like giant cells of pancreas (UCOGCP) is a relatively rare tumor worldwide. Its accurate preoperative diagnosis is extremely difficult. Because the mass is usually large and closely related to neighboring structures, it is difficult to locate the tumor and it is often misdiagnosed as pancreatic cancer, neuroendocrine tumor or gastrointestinal stromal tumor. Combining literature to analyze UCOGCP clinical features (including age of onset, prevalent location) and imaging features (including lesion size, mass nature), to explore the value of preoperative CT and MRI in the diagnosis and differential diagnosis of UCOGCP and hope to help clinical diagnosis and treatment.

A Medical Image Registration Method Based on Progressive Images.

BACKGROUND: Medical image registration is an essential task for medical image analysis in various applications. In this work, we develop a coarse-to-fine medical image registration method based on progressive images and SURF algorithm (PI-SURF) for higher registration accuracy. METHODS: As a first step, the reference image and the floating image are fused to generate multiple progressive images. Thereafter, the floating image and progressive image are registered to get the coarse registration result based on the SURF algorithm. For further improvement, the coarse registration result and the reference image are registered to perform fine image registration. The appropriate progressive image has been investigated by experiments. The mutual information (MI), normal mutual information (NMI), normalized correlation coefficient (NCC), and mean square difference (MSD) similarity metrics are used to demonstrate the potential of the PI-SURF method. RESULTS: For the unimodal and multimodal registration, the PI-SURF method achieves the best results compared with the mutual information method, Demons method, Demons+B-spline method, and SURF method. The MI, NMI, and NCC of PI-SURF are improved by 15.5%, 1.31%, and 7.3%, respectively, while MSD decreased by 13.2% for the multimodal registration compared with the optimal result of the state-of-the-art methods. CONCLUSIONS: The extensive experiments show that the proposed PI-SURF method achieves higher quality of registration.

Chronic enteropathy associated with SLCO2A1 gene: A case report and literature review.

A case of chronic enteropathy associated with SLCO2A1 gene (CEAS) is presented. The female patient was readmitted four times during a three-year follow-up period for intractable dropsy and anemia. Multiple ulcers of small bowel wall were revealed by endoscopic examination. Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) showed the segmental wall thickening of the small bowel. Hepatosplenomegaly and increased bone density of spine and pelvis suggested the diagnosis of myelofibrosis. X-ray films showed the cortical thickening of tibiofibula. The mutations of SLCO2A1 gene were revealed by gene test and the diagnosis of CEAS was confirmed. According to our case report, imaging examinations, including CTE, MRE and X-ray films provide additional valuable information during the diagnostic procedure of CEAS.

Deep imaging in scattering media with selective plane illumination microscopy.

In most biological tissues, light scattering due to small differences in refractive index limits the depth of optical imaging systems. Two-photon microscopy (2PM), which significantly reduces the scattering of the excitation light, has emerged as the most common method to image deep within scattering biological tissue. This technique, however, requires high-power pulsed lasers that are both expensive and difficult to integrate into compact portable systems. Using a combination of theoretical and experimental techniques, we show that if the excitation path length can be minimized, selective plane illumination microscopy (SPIM) can image nearly as deep as 2PM without the need for a high-powered pulsed laser. Compared to other single-photon imaging techniques like epifluorescence and confocal microscopy, SPIM can image more than twice as deep in scattering media ( ? 10 times the mean scattering length). These results suggest that SPIM has the potential to provide deep imaging in scattering media in situations in which 2PM systems would be too large or costly.

Gadolinium-Loaded Solid Lipid Nanoparticles as a Tumor-Absorbable Contrast Agent for Early Diagnosis of Colorectal Tumors Using Magnetic Resonance Colonography.

Magnetic resonance (MR) contrast agents focusing on special functions are required to improve cancer diagnosis, particularly in the early stages. Here, we designed multifunctional solid lipid nanoparticles (SLNs) with simultaneous loading of gadolinium (Gd) diethylenetriaminepentaacetic acid (Gd-DTPA) and octadecylamine fluorescein isothiocyanate (FITC) to obtain Gd-FITC-SLNs as a tumor-absorbable nanoparticle contrast agent for the histological confirmation of MR imaging (MRI) findings. Colorectal tumors were evaluated in vitro and in vivo via direct uptake of this contrast agent, which displayed reasonable T1 relaxivity and no significant cytotoxicity at the experimental concentrations in human colon carcinoma cells (HT29) and mouse colon carcinoma cells (CT26). In vitro cell uptake experiments demonstrated that contrast agent absorption by the two types of cancer cells was concentration-dependent in the safe concentration range. During in vivo MRI, transrectal infusion of Gd-FITC-SLNs showed more significant enhancement at the tumor site compared with the infusion of Gd-DTPA in female C57/BL mice with azoxymethane/dextran sulfate sodium-induced colorectal highgrade intraepithelial neoplasia. Subsequent confocal fluorescence microscopy demonstrated Gd-FITC-SLNs as highly concentrated green fluorescent spots distributed from the tumor capsule into the tumor. This study establishes the "proof-of-principle" of a new MRI technique wherein colorectal tumors are enhanced via direct absorption or uptake of the nanoparticle contrast agent.

[Evaluation of Crohn's disease activity with multi-slice CT enterography].

OBJECTIVE: To discuss the diagnostic value of Crohn's disease activity with multi-slice CT enterography. METHODS: MSCTE examination data of 88 cases of CD patients by clinical, endoscopy, pathology confirmed in Sir Run Run Shaw Hospital from January 2013 to June 2014 were analysed. According to the Harvey-Bradshaw index, all of CD patients were divided into the active phase group and remission phase group. Imaging findings of two groups were compared. To explore the relationship between MSCTE findings and CRP/ESR of CD patients. RESULTS: The wall thickness (8.2 ± 2.6) mm and enhancement degree (112 ± 16) HU in active phase group were higher than the wall thickness (5.4 ± 1.6) mm and enhancement degree (93 ± 17) HU in the remission phase group (P < 0.01). The incidences of intestinal wall stratification enhancement, comb sign, swollen lymph nodes, phlegmon, intestinal fistula, intestinal stenosis in active phase group (88.5%, 72.1%, 77%, 45.9%, 26.2%, 65.6%) were significantly higher than those in remission phase group (29.6%, 18.5%, 25.9%, 0, 3.7%, 37%) (P < 0.05). The incidences of intestinal wall homogeneous enhancement in remission phase group (70.4%) were higher than those in active phase group (11.5%) (P < 0.01). There was no significant difference in the incidences of abscesse in two groups (P > 0.05). CRP was correlated with the wall thickness and enhancement degree, abnornlal mesentery vascularity, lymph node enlargement, phlegmon, intestinal fistula (r > 0.2, P < 0.05). ESR was correlated with the wall enhancement degree, abnormal mesentery vascularity, lymph node enlargement and phlegmon (r > 0.2, P < 0.05). CONCLUSION: CT enterography can adequately demonstrate mural abnormalities and assess the presence of extramural complications, which are helpful in evaluating the activity of Crohn's disease.

CT features of focal organizing pneumonia: an analysis of consecutive histopathologically confirmed 45 cases.

OBJECTIVE: To study the CT characteristics of solitary focal organizing pneumonia (FOP). MATERIALS AND METHODS: Chest CT of consecutive 45 patients (34 males and 11 females, median age: 56 years) with confirmed FOP were analyzed. The CT features between large FOP (>3 cm, n=27) and small FOP (≤ 3 cm, n=18) were compared. RESULTS: FOP lesions predominately located in peripheral lungs (86.7%), with the right lower lobe being most common lobe (44.4%). No lesion mainly located in the inner 1/3 of lungs. All large lesions were polygon in shape and had an irregular margin, while small lesions were more likely to be round or oval with an irregular or smooth border. Air bronchogram or small bubble-like lucency was present in majority of the lesions. 42.2% of lesions had incompact internal structure with inhomogeneous density besides air component. Most lesions were associated with a contraction or convergence of surrounding vessels; while no pulmonary vessel was interrupted abruptly by a small FOP lesion. Majority of large lesions had broad contact with the pleura, while only one patient had mild pleural effusion. Mild mediastinal lymph nodes enlargement was present in about 1/5 of the patients. CONCLUSION: Compared with the known CT features of lung cancer, our results suggest differential diagnosis can often be made for large FOP, while small FOP may resemble lung cancer.

CT and MR features of xanthogranulomatous cholecystitis: an analysis of consecutive 49 cases.

OBJECTIVE: To study the CT and MR features of xanthogranulomatous cholecystitis (XGC). MATERIALS AND METHODS: 49 patients had pathologically confirmed XGC. All patients underwent contrast enhanced CT, and 10 patients had additional plain MRI. The CT and MRI results were retrospectively analyzed. RESULTS: On CT, all patients had thickening of gallbladder wall, with 87.8% cases showed diffuse thickening. 85.7% cases had intramural hypo-attenuated nodules in the thickened wall. Continuous mucosal line and luminal surface enhancement were noted in 79.6% and 85.7% cases, respectively. Gallbladder stones were seen in 69.4% patients. The coexistence of the above 5 CT features was seen in 40% cases, and 80% cases had the coexistence of ≥ 4 features. Diffused gallbladder wall thickening in XGC is more likely to have disrupted mucosal line, and XGC with disrupted mucosal line is more likely to be associated with liver infiltration. In 60% patients the inflammatory process extended beyond gallbladder, with the interface between gallbladder and liver and/or the surrounding fat blurred. 40% cases had an early enhancement of liver parenchyma. Infiltration to other surrounding tissues included bowel (n=3), stomach (n=2), and abdominal wall (n=1). On MR images, 7 of 9 intramural nodules in 7 subjects with T1-weighted dual echo MR images showed higher signal intensity on in-phase images than out-of-phase images. CONCLUSION: Coexisting of diffuse gallbladder wall thickening, hypo-attenuated intramural nodules, continuous mucosal line, luminal surface enhancement, and gallbladder stone highly suggest XGC. XGC frequently infiltrate liver and surrounding fat. Chemical-shift MRI helps classifying intramural nodules in the gallbladder wall.

A pomegranate heart.

Sacrococcygeal teratomas are common in infants while a buttock terotoma is extremely rare in adults. Herein we report a 30-year-old female complaining of left hip swelling and pain for 2 weeks. Ultrasonography demonstrated a subcutaneous cystic mass with multiple dense echo spots inside. MR showed a heart-shaped mass in the left buttock, with multiple "pomegranate seeds" inside, which showed hyperintensity on diffusion weighted imaging. The mass was resected and a buttock terotoma containing yellow sebum-like materials and hairs was confirmed pathologically. A thick walled cystic mass on CT or MR images, which contains multiple small solid nodules or fat, indicates the diagnosis of a terotoma. Timely diagnosis and complete resection bring good prognosis. Adequate follow-up is necessary.

[Multi-slice computed tomography for diagnosis of mucinous cystic neoplasms and serous cystadenomas of the pancreas].

OBJECTIVE: To assess the value of multi-slice computed tomography (MSCT) in the diagnosis and differential diagnosis of pancreatic mucinous cystic neoplasms and serous cystadenoma. METHOD: The MSCT images were reviewed for 19 pathologically confirmed cases of pancreatic mucinous cystadenomas and 13 cases of pancreatic serous cystadenomas (n=13) treated in our center between July, 2003 and December, 2009. The CT features were analyzed including the tumor location, contour, dimension of the largest cyst, cystic wall, septation, presence of calcification, solid component, pancreatic atrophy, main pancreatic duct dilatation, and lesion margins. RESULTS: Significant differences were found between the two groups in lesion diameter (P=0.009), cyst distribution of the largest cyst (>2 cm) (P=0.01), and the presence of solid component (P=0.02). CONCLUSION: MSCT can be of important value in the diagnosis and differential diagnosis of pancreatic mucinous cystic neoplasms and serous cystadenomas.

Image quality and dose performance of 80 kV low dose scan protocol in high-pitch spiral coronary CT angiography: feasibility study.

To investigate the image quality and dose performance of 80 kV high-pitch spiral (HPS) coronary CT angiography (CCTA). 106 patients consecutively enrolled into prospectively ECG-triggering HPS CCTA (pitch = 3.4) exam using kV/ref. mAs = 80/400, 100/370, and 120/370 when patient BMI was ≤22.5 (n = 40), between 22.5 and 27.5 (n = 53) and >27.5 kg/m² (n = 13). Image quality was assessed per-segment by two observers independently using a 4-point scale (1-excellent, 4-non-diagnosable). Image noise and signal-to-noise ratio (SNR), contrast-to-noise ratio were measured. Diagnostic image quality was obtained in 503 of 507, 687 of 693, 164 of 167 coronary segments in 80, 100, 120 kV groups without significant difference (P = 0.482). The proportions of segments with score 1-4 were not significantly different among three kV groups (all P > 0.05). Image noise were significantly higher in 80 kV group than 100 and 120 groups (P < 0.001), while SNR was not (P = 0.097). The effective dose of 80 kV group (0.36 ± 0.03 mSv) was significantly lower than that of 100 kV group (0.86 ± 0.08 mSv) and 120 kV group (1.77 ± 0.18 mSv). The mean ± SD of HR in all patients was 54.8 ± 5.1 bpm. 80 kV HPS CCTA is feasible for patient with BMI ≤ 22.5 kg/m² which can save 58% dose than 100 kV group, while maintain diagnosable image quality.

Bimodal visualization of colorectal uptake of nanoparticles in dimethylhydrazine-treated mice.

AIM: To investigate colorectal uptake of solid lipid nanoparticles (SLNs) in mice receiving different doses of 1,2-dimethylhydrazine (DMH) using magnetic resonance (MR) and laser-scanning confocal fluorescence microscope (LSCFM) imaging. METHODS: Eight mice were sacrificed in a pilot study to establish the experimental protocol and to visualize colorectal uptake of SLNs in normal mice. Gadopentetate dimeglumine and fluorescein isothiocyanate (FITC)-loaded SLN (Gd-FITC-SLN) enemas were performed on mice receiving DMH for 10 wk (group 1, n = 9) or 16 wk (group 2, n = 7) and FITC-SLN enema was performed on 4 DMH-treated mice (group 3). Pre- and post-enema MR examinations were made to visualize the air-inflated distal colorectum. Histological and LSCFM examinations were performed to verify colorectal malignancy and to track the distribution of SLNs. RESULTS: Homogeneous enhancement and dense fluorescence (FITC) deposition in colorectal wall were observed in normal mice and 1 DMH-treated mouse (group 1) on fluid attenuated inversion recovery (FLAIR) and LSCFM images, respectively. Heterogeneous mural enhancement was found in 6 mice (4 in group 1; 2 in group 2). No visible mural enhancement was observed in the other mice. LSCFM imaging revealed linear fluorescence deposition along the colorectal mucosa in all groups. Nine intraluminal masses and one prolapsed mass were detected by MR imaging with different enhancement modes and pathologies. Interstitial FITC deposition was identified where obvious enhancement was observed in FLAIR images. Bladder imaging agent accumulations were observed in 11 of 16 DMH-treated mice of groups 1 and 2. CONCLUSION: There are significant differences in colorectal uptake and distribution of SLNs between normal and DMH-treated mice, which may provide a new mechanism of contrast for MR colonography.

Development of nanoparticle-based magnetic resonance colonography.

This study was to develop a novel method of nanoparticle-based MR colonography. Two types of solid lipid nanoparticles (SLNs) were synthesized with loading of (a) gadolinium (Gd) diethylenetriaminepenta acetic acid to construct Gd-SLNs as an MR T1 contrast agent and (b) otcadecylamine-fluorescein-isothiocyanate to construct Gd-fluorescein isothiocyanate (FITC)-SLNs for histologic confirmation of MR findings. Through an in vitro experiment, we first evaluated the size distribution and gadolinium diethylenetriaminepenta acetic acid entrapment efficiency of these SLNs. The SLNs displayed a size distribution of 50-300 nm and a gadolinium diethylenetriaminepenta acetic acid entrapment efficiency of 56%. For in vivo validation, 30 mice were divided into five groups, each of which was administered a transrectal enema using: (i) Gd-SLNs (n=6); (ii) Gd-FITC-SLNs (n=6); (iii) blank SLNs (n=6); (iv) gadolinium diethylenetriaminepenta acetic acid (n=6); and (v) water (n=6). T1-weighted fluid-attenuated inversion-recovery MRI was then performed on mice after transrectal infusion of Gd-SLNs or Gd-FITC-SLNs, which demonstrated bright enhancement of the colonic walls, with decrease in T1 relaxation time. When Gd-FITC-SLNs were delivered, green fluorescent spots were visualized in both the extracelluar space and the cytoplasm through colonic walls under confocal microscopy and fluorescence microscopy. This study establishes the "proof-of-principle" of a new imaging technique, called "nanoparticle-based MR colonography," which may provide a useful imaging tool for the diagnosis of colorectal diseases.