Risk factors for opioid-induced constipation in cancer patients: a single-institution, retrospective analysis.

PURPOSE: To identify risk factors for opioid-induced constipation (OIC). METHODS: This study retrospectively analyzed 175 advanced cancer patients who were receiving pain treatment with opioids and were newly prescribed laxatives for OIC at Seirei Hamamatsu General Hospital between November 2016 and June 2021. For the regression analysis of factors associated with OIC, variables were extracted manually from clinical records. The effect of newly prescribed laxatives for OIC was evaluated as "effective" in cases where the number of spontaneous bowel movements increased at least once in the first 3 days. The OIC was defined based on Rome IV diagnostic criteria. Multivariate logistic regression analysis was performed to identify risk factors for OIC. Optimal cutoff thresholds were determined using receiver operating characteristic analysis. Values of P < 0.05 (two-tailed) were considered significant. RESULTS: Significant factors identified included body mass index (BMI) (odds ratio [OR] = 0.141, 95% confidence interval [CI] = 0.027-0.733; P = 0.020), chemotherapy with taxane within 1 month of evaluation of laxative effect (OR = 0.255, 95% CI = 0.068-0.958; P = 0.043), use of naldemedine (OR = 2.791, 95% CI = 1.220-6.385; P = 0.015), and addition or switching due to insufficient prior laxatives (OR = 0.339, 95% CI = 0.143-0.800; P = 0.014). CONCLUSION: High BMI, chemotherapy including a taxane within 1 month of evaluation of laxative effect, no use of naldemedine, and addition or switching due to insufficient prior laxatives were identified as risk factors for OIC in advanced cancer patients with cancer pain.

The diagnostic utility of submandibular gland sonography and labial salivary gland biopsy in IgG4-related dacryoadenitis and sialadenitis: Its potential application to the diagnostic criteria.

Objectives: In this study, we investigated the diagnostic utility of submandibular gland (SMG) sonography and labial salivary gland (LSG) biopsy as a less invasive procedure for diagnosing IgG4-related dacryoadenitis and sialadenitis (IgG4-DS)Methods: Sixty-eight patients with suspected IgG4-DS by presenting swelling of elevated serum IgG (>1747 mg/dl) and/or swelling glands underwent SMG sonography, LSG biopsy and measurement for serum IgG4. SMG sonographic diagnosis was determined by the following characteristic changes; 'hypoechoic areas of a nodal pattern with high vascularity' and/or 'hypoechoic areas of a reticular pattern in the superficial part'.Results: Thirty-one patients were diagnosed with IgG4-DS, 5 with IgG4-RD unaccompanied by lacrimal and salivary gland lesions, 28 with Sjögren's syndrome, and 4 with malignant lymphoma. The sensitivity, specificity, and accuracy of SMG sonography and LSG biopsy were 100%, 83.8%, 91.2% and 64.5%, 73.8%, 75.0%, respectively. Moreover, those of SMG sonography and LSG biopsy combined with serum IgG4 concentration (>135 mg/dl) were 100%, 94.6%, 97.1% and 64.5%, 91.9%, 79.4%, respectively.Conclusion: LSG biopsy needs to be extremely careful to diagnose IgG4-DS because of its low sensitivity. SMG sonography is sufficient for the diagnosis of IgG4-DS, especially when combined with serologic analysis. Thus, SMG sonography could adapt to the diagnostic criteria of IgG4-DS as a non-invasive method.

A case of marginal zone B cell lymphoma mimicking IgG4-related dacryoadenitis and sialoadenitis.

BACKGROUND: IgG4-related dacryoadenitis and sialoadenitis (IgG4-DS), so-called Mikulicz's disease, is characterized by elevated serum IgG4 and infiltration of IgG4-positive plasma cells in glandular tissues. Recently, several studies reported both malignant lymphoma developed on the background of IgG4-associated conditions and IgG4-producing malignant lymphoma (non-IgG4-related disease). CASE PRESENTATION: We report on the case of a 70-year-old man who was strongly suspected IgG4-DS because of high serum IgG4 concentration (215 mg/dl) and bilateral swelling of parotid and submandibular glands. Biopsies of cervical lymph node and a portion of submandibular gland were performed. These histopathological findings subsequently confirmed a diagnosis of marginal zone B cell lymphoma. CONCLUSION: Differential diagnosis of IgG4-DS is necessary from other disorders, including Sjögren's syndrome, sarcoidosis, Castleman's disease, Wegener's granulomatosis, lymphoma, and cancer. We suggest that biopsy of swollen lesions is important for a definitive diagnosis of IgG4-DS and discuss the mechanism of development in this case.

A case of mantle cell lymphoma presenting as IgG4-related dacryoadenitis and sialoadenitis, so-called Mikulicz's disease.

BACKGROUND: Mantle cell lymphoma (MCL) is a relatively uncommon type of non-Hodgkin lymphoma. It develops in the outer edge of a lymph node called the mantle zone. In contrast, IgG4-related dacryoadenitis and sialoadenitis (IgG4-DS) is characterized by elevated serum IgG4 and persistent bilateral enlargement of lacrimal glands (LGs) and salivary glands (SGs), with infiltration of IgG4-positive plasma cells. Recent studies indicated the importance of differentiation between IgG4-DS and malignant lymphoma. CASE PRESENTATION: An 82-year-old man was suspected of IgG4-DS because of a high serum IgG level (2174 mg/dL) and bilateral swelling of LGs and SGs. Lip biopsy and fine needle biopsy of submandibular gland were performed, and subsequently, MCL was diagnosed through the histopathological findings. CONCLUSIONS: MCL most commonly occurs in the Waldeyer ring, but rarely in the stomach, spleen, skin, LG, and SG. We report an unusual case of MCL involving LGs and SGs mimicking IgG4-DS, which suggests that IgG4 testing may be useful in the differentiation of IgG4-DS in the presence of bilateral swelling of LGs or SGs.

Clinical characteristics of Mikulicz's disease as an IgG4-related disease.

OBJECTIVES: Mikulicz's disease (MD) was considered to be a subtype of Sjögren's syndrome (SS), based on histopathological similarities. However, recent studies have indicated that patients with MD show high serum IgG4 concentration, and suggested that MD is one of "IgG4-related disease" and distinguishable from SS. Therefore, we clinically and histopathologically examined the disease states of MD and SS in detail. MATERIALS AND METHODS: Twenty patients with Mikulicz's disease and 18 with SS were comparatively studied to determine clinical characteristics in MD patients. RESULTS: Sialography in MD patients did not show the "apple-tree sign" typically seen in SS. Serologically, high serum IgG4 levels but not anti-SS-A or anti-SS-B antibodies were observed in MD. SS showed lymphocytic infiltration of various subsets with atrophy or severe destruction of the acini, while MD showed selective infiltration of IgG4+ plasma cells with hyperplastic germinal centers and mild acini destruction. Corticosteroid treatment of MD reduced IgG and IgG4 levels and improved salivary function. A negative correlation between disease duration and increasing rate of salivary flow was observed in MD. CONCLUSIONS: These results suggested that the pathogenesis of MD might be different from those of SS. CLINICAL RELEVANCE: early diagnosis and treatment of MD is important for the improvement of salivary function.

Calibration experiments for radon in drinking water measurements using portable-type electrostatic-collection radon monitors.

Portable-type electrostatic-collection radon monitors (RAD7) are often used for in-situ measurements of radon in water. In this study, we evaluated the calibration factors and their uncertainties for two RAD7 monitors based on comparative measurements with the liquid scintillation counting method. In the first experiment, we found that both RAD7 monitors had relatively large uncertainties due to leakage of radon gas that bubbled from the gaps between the lids of the desiccant container and the glass vial. Therefore, for the second experiment, these gaps were closed as much as possible using parafilm and clay, respectively. As a result, the relative uncertainties for both RAD7 monitors were significantly decreased. Furthermore, we collected spring water samples to confirm the reliability of radon concentrations. After closing the leakage point, the uncertainty of radon concentrations in spring water we measured using the typical protocol of the RAD7 were significantly lower, which improves the measurement.

1,8-cineole, a TRPM8 agonist, is a novel natural antagonist of human TRPA1.

BACKGROUND: Essential oils are often used in alternative medicine as analgesic and anti-inflammatory remedies. However, the specific compounds that confer the effects of essential oils and the molecular mechanisms are largely unknown. TRPM8 is a thermosensitive receptor that detects cool temperatures and menthol whereas TRPA1 is a sensor of noxious cold. Ideally, an effective analgesic compound would activate TRPM8 and inhibit TRPA1. RESULTS: We screened essential oils and fragrance chemicals showing a high ratio of human TRPM8-activating ability versus human TRPA1-activating ability using a Ca2+-imaging method, and identified 1,8-cineole in eucalyptus oil as particularly effective. Patch-clamp experiments confirmed that 1,8-cineole evoked inward currents in HEK293T cells expressing human TRPM8, but not human TRPA1. In addition, 1,8-cineole inhibited human TRPA1 currents activated by allyl isothiocyanate, menthol, fulfenamic acid or octanol in a dose-dependent manner. Furthermore, in vivo sensory irritation tests showed that 1,8-cineole conferred an analgesic effect on sensory irritation produced by TRPA1 agonists octanol and menthol. Surprisingly, 1,4-cineole, which is structurally similar and also present in eucalyptus oil, activated both human TRPM8 and human TRPA1. CONCLUSIONS: 1,8-cineole is a rare natural antagonist of human TRPA1 that has analgesic and anti-inflammatory effects possibly due to its inhibition of TRPA1.

Factors associated with non-response to naldemedine for opioid-induced constipation in cancer patients: A subgroup analysis.

BACKGROUND: Opioid-induced constipation (OIC) is one of the most common adverse events of opioid therapy and can severely reduce quality of life (QOL). Naldemedine is the orally available peripheral-acting µ-opioid receptor antagonist approved for OIC treatment. However in daily clinical practice, some cancer patients show insufficient control of OIC even while receiving naldemedine. OBJECTIVE: To identify factors associated with non-response to naldemedine in cancer patients. METHODS: This study retrospectively analyzed 127 cancer patients prescribed naldemedine at Seirei Hamamatsu General Hospital in Japan between November 2016 and June 2021. For the regression analysis of factors associated with OIC, variables were extracted manually from electronic medical records. Naldemedine had been prescribed by the attending physician after the presence of OIC had been defined with reference to Rome IV diagnostic criteria. Naldemedine was evaluated as "effective" in cases where the number of defecations increased at least once in the first 3 days after starting naldemedine. Multivariate logistic regression analysis was performed to identify factors associated with non-response to naldemedine. The data used were from the group of patients who received naldemedine in our previous study. RESULTS: Factors significantly associated with non-response to naldemedine included chemotherapy with taxanes within 1 month of evaluation of naldemedine effect (odds ratio [OR] = 0.063; 95% confidence interval [CI] = 0.007-0.568), and addition of or switching to naldemedine due to insufficient efficacy of prior laxatives (OR = 0.352, 95% CI = 0.129-0.966). CONCLUSION: The identification of factors associated with non-response to naldemedine prescribed for OIC may help improve QOL among cancer patients.

Effects of 1 year of training on the performance of ultrasonographic image interpretation: A preliminary evaluation using images of Sjögren syndrome patients.

PURPOSE: This study investigated the effects of 1 year of training on imaging diagnosis, using static ultrasonography (US) salivary gland images of Sjögren syndrome patients. MATERIALS AND METHODS: This study involved 3 inexperienced radiologists with different levels of experience, who received training 1 or 2 days a week under the supervision of experienced radiologists. The training program included collecting patient histories and performing physical and imaging examinations for various maxillofacial diseases. The 3 radiologists (observers A, B, and C) evaluated 400 static US images of salivary glands twice at a 1-year interval. To compare their performance, 2 experienced radiologists evaluated the same images. Diagnostic performance was compared between the 2 evaluations using the area under the receiver operating characteristic curve (AUC). RESULTS: Observer A, who was participating in the training program for the second year, exhibited no significant difference in AUC between the first and second evaluations, with results consistently comparable to those of experienced radiologists. After 1 year of training, observer B showed significantly higher AUCs than before training. The diagnostic performance of observer B reached the level of experienced radiologists for parotid gland assessment, but differed for submandibular gland assessment. For observer C, who did not complete the training, there was no significant difference in the AUC between the first and second evaluations, both of which showed significant differences from those of the experienced radiologists. CONCLUSION: These preliminary results suggest that the training program effectively helped inexperienced radiologists reach the level of experienced radiologists for US examinations.

Support activities in Namie Town, Fukushima undertaken by Hirosaki University.

This paper does not necessarily reflect the views of the International Commission on Radiological Protection.Several radiation monitoring research projects are underway on dose assessment, biological analysis, and risk communication under an agreement with Namie Town. Indoor radon and thoron progeny concentrations have been measured using passive-type monitors to estimate internal doses due to inhalation. In addition, airborne radiocaesium concentrations at five points in Namie Town have been analysed using a high-purity germanium detector to estimate internal doses for comparison with radon. External radiation doses from natural and artificial radionuclides have also been estimated using an in-situ gamma-ray spectrometer. Other support activities are mentioned briefly in this article.

Discriminative Measurement of Absorbed Dose Rates in Air from Natural and Artificial Radionuclides in Namie Town, Fukushima Prefecture.

Ten years have elapsed since the accident at the Fukushima Daiichi Nuclear Power Plant in 2011, and the relative contribution of natural radiation is increasing in Fukushima Prefecture due to the reduced dose of artificial radiation. In order to accurately determine the effective dose of exposure to artificial radiation, it is necessary to evaluate the effective dose of natural as well as artificial components. In this study, we measured the gamma-ray pulse-height distribution over the accessible area of Namie Town, Fukushima Prefecture, and evaluated the annual effective dose of external exposure by distinguishing between natural and artificial radionuclides. The estimated median (range) of absorbed dose rates in air from artificial radionuclides as of 1 April 2020, is 133 (67-511) nGy h-1 in the evacuation order cancellation zone, and 1306 (892-2081) nGy h-1 in the difficult-to-return zone. The median annual effective doses of external exposures from natural and artificial radionuclides were found to be 0.19 and 0.40 mSv in the evacuation order cancellation zone, and 0.25 and 3.9 mSv in the difficult-to-return zone. The latest annual effective dose of external exposure discriminated into natural and artificial radionuclides is expected to be utilized for radiation risk communication.

Isolation and characterization of a virus (CvV-BW1) that infects symbiotic algae of Paramecium bursaria in Lake Biwa, Japan.

BACKGROUND: We performed an environmental study of viruses infecting the symbiotic single-celled algae of Paramecium bursaria (Paramecium bursaria Chlorella virus, PBCV) in Lake Biwa, the largest lake in Japan. The viruses detected were all Chlorella variabilis virus (CvV = NC64A virus). One of them, designated CvV-BW1, was subjected to further characterization. RESULTS: CvV-BW1 formed small plaques and had a linear DNA genome of 370 kb, as judged by pulsed-field gel electrophoresis. Restriction analysis indicated that CvV-BW1 DNA belongs to group H, one of the most resistant groups among CvV DNAs. Based on a phylogenetic tree constructed using the dnapol gene, CvV was classified into two clades, A and B. CvV-BW1 belonged to clade B, in contrast to all previously identified virus strains of group H that belonged to clade A. CONCLUSIONS: We conclude that CvV-BW1 composes a distinct species within C. variabilis virus.

Usefulness of a deep learning system for diagnosing Sjögren's syndrome using ultrasonography images.

OBJECTIVES: We evaluated the diagnostic performance of a deep learning system for the detection of Sjögren's syndrome (SjS) in ultrasonography (US) images, and compared it with the performance of inexperienced radiologists. METHODS: 100 patients with a confirmed diagnosis of SjS according to both the Japanese criteria and American-European Consensus Group criteria and 100 non-SjS patients that had a dry mouth and suspected SjS but were definitively diagnosed as non-SjS were enrolled in this study. All the patients underwent US scans of both the parotid glands (PG) and submandibular glands (SMG). The training group consisted of 80 SjS patients and 80 non-SjS patients, whereas the test group consisted of 20 SjS patients and 20 non-SjS patients for deep learning analysis. The performance of the deep learning system for diagnosing SjS from the US images was compared with the diagnoses made by three inexperienced radiologists. RESULTS: The accuracy, sensitivity and specificity of the deep learning system for the PG were 89.5, 90.0 and 89.0%, respectively, and those for the inexperienced radiologists were 76.7, 67.0 and 86.3%, respectively. The deep learning system results for the SMG were 84.0, 81.0 and 87.0%, respectively, and those for the inexperienced radiologists were 72.0, 78.0 and 66.0%, respectively. The AUC for the inexperienced radiologists was significantly different from that of the deep learning system. CONCLUSIONS: The deep learning system had a high diagnostic ability for SjS. This suggests that deep learning could be used for diagnostic support when interpreting US images.

Variations in circulating osteoprotegerin and soluble RANKL during diurnal and menstrual cycles in young women.

BACKGROUND/AIMS: Physiological bone turnover shows diurnal variations and changes within the menstrual cycle. The aim of this study was to assess the variability of osteoprotegerin (OPG) and soluble RANKL (sRANKL) serum levels during diurnal and menstrual cycles. METHOD: Blood was collected from 15 young women at 6-hour intervals between 08.00 and 20.00 h during the follicular phase. Moreover, to compare the follicular and luteal phases, blood was also collected at 14.00 h during the luteal phase. Serum bone-specific alkaline phosphatase (BAP), N-telopeptide of type I collagen (NTX), OPG and free sRANKL were measured. RESULTS: No diurnal variations in BAP, OPG, sRANKL and sRANKL/OPG ratio were detected. NTX was significantly higher in the morning than in the afternoon and at night (p = 0.02). There were no menstrual variations in either. CONCLUSIONS: The consistent absence of diurnal variations in circulating OPG and sRANKL levels may reflect the absence of diurnal variation in their expression in the bone microenvironment. In this case, the nocturnal rise and the fall in bone resorption in the luteal phase should be accounted for by other factors than RANKL/OPG-mediated factors. Timing of sampling is unlikely to influence the results of circulating OPG and sRANKL measurement.

Sonographic diagnosis in the head and neck region: from an educational lecture presented at the 56th General Assembly and Annual Scientific Congress of the Japanese Society for Oral and Maxillofacial Radiology.

Sonography is a simple, inexpensive, and non-invasive diagnostic modality. Although tissues behind bony structures and deep tissues are not delineated, sonography can depict superficial soft tissues very clearly. In the head and neck region, however, it has not yet been used widely, as the anatomical structures are complicated, and considerable experience is needed both to perform an examination and to make a diagnosis. To perform examinations efficiently, operators must be familiar with the sonographic system in use, and take images at standard planes. To make a correct diagnosis, operators require knowledge of the sonographic anatomy on standard planes, representative sonographic signs and artifacts, and common diseases and their typical sonographic findings. In this paper, we have explained the sonographic anatomy on standard planes, and the sonographic findings of common diseases in the oral and maxillofacial region.

Evaluation of cone-beam computed tomography diagnostic image quality using cluster signal-to-noise analysis.

OBJECTIVES: (1) We sought to assess correlation among four representative parameters from a cluster signal-to-noise curve (true-positive rate [TPR] corresponding to background noise, accuracy corresponding to background noise, maximum TPR, and maximum accuracy) and the diagnostic accuracy of the identification of the mandibular canal using data from observers in a previous study, under the same exposure conditions. (2) We sought to clarify the relationship between the hole depths of a phantom and diagnostic accuracy. METHODS: CBCT images of a Teflon plate phantom with holes of decreasing depths from 0.7 to 0.1 mm were analyzed using the FindFoci plugin of ImageJ. Subsequently, we constructed cluster signal-to-noise curves by plotting TPRs against false-positive rates. The four parameters were assessed by comparing with the diagnostic accuracy calculated from the observers. To analyze image contrast ranges related to detection of mandibular canals, we determined five ranges of hole depths, to represent different contrast ranges-0.1-0.7, 0.1-0.5, 0.2-0.6, 0.2-0.7 and 0.3-0.7 mm-and compared them with observers' diagnostic accuracy. RESULTS: Among the four representative parameters, accuracy corresponding to background noise had the highest correlation with the observers' diagnostic accuracy. Hole depths of 0.3-0.7 and 0.1-0.7 mm had the highest correlation with observers' diagnostic accuracy in mandibles with distinct and indistinct mandibular canals, respectively. CONCLUSIONS: The accuracy corresponding to background noise obtained from the cluster signal-to-noise curve can be used to evaluate the effects of exposure conditions on diagnostic accuracy.

Determination of optimum exposure parameters for dentoalveolar structures of the jaws using the CB MercuRay system with cluster signal-to-noise analysis.

OBJECTIVE: To determine the optimum cone beam computed tomography exposure parameters for specific diagnostic tasks. METHODS: A Teflon phantom attached to a half-mandible in a large container was scanned in dental (D), implant (I), and panoramic (P) modes. An identical phantom in a small container was scanned in D mode. Both were scanned at 60, 80, 100, and 120 kV. We evaluated the image quality of five anatomical structures [dentinoenamel junction (1), lamina dura and periodontal ligament space (2), trabecular pattern (3), cortex-spongy bone junction (4), and pulp chamber and root canal (5)] and analyzed the diagnostic image quality with cluster signal-to-noise analysis. We then evaluated correlations between the two image qualities and calculated the threshold of acceptable diagnostic image quality. Optimum exposure parameters were determined from images with acceptable diagnostic image quality. RESULTS: For the small container, the optimum exposure parameters were D mode, 80 kV for (1), (3), and (4) and D mode, 100 kV for (5). For the large container, they were D mode, 120 kV for (1), (3), and (5) and D mode, 100 kV for (4). I mode, 120 kV reached the acceptable level for (4). No images reached the acceptable level for (2). CONCLUSIONS: No optimum exposure parameters were identified for the evaluation of the lamina dura and periodontal ligament space. D mode was sufficient for the other structures; however, the tube voltage required for each structure differed. Smaller patients required lower tube voltage. I mode, 120 kV may be used for larger lesions.

Tissue-infiltrating immune cells contribute to understanding the pathogenesis of Kimura disease: A case report.

RATIONALE: Kimura disease (KD) is a rare, chronic inflammatory disorder characterized by subcutaneous granuloma in the head and neck region, as well as increased eosinophil counts and high serum immunoglobulin E (IgE) levels. Kimura disease is suspected to be an IgE-mediated disease, associated with an allergic response, in which antigen-specific B cells are stimulated to undergo specific IgE class switching with disease-specific CD4+ T (Th) cells help. Thus, exploration of the Th cells in affected tissues with KD is a highly promising field of the investigation. However, there have been no reports with direct evidence to implicate Th cells in affected lesions with KD. Here we quantitatively demonstrate that CD4+ GATA3+ T cells and interleukin (IL)-4+ IgE+ c-kit+ mast cells prominently infiltrate in affected lesion with KD. PATIENT CONCERNS: A 56-year-old Japanese man who exhibited painless swelling in the left parotid region. DIAGNOSES: Diagnosis of KD was made based on characteristic histopathologic findings, in conjunction with peripheral eosinophilia and elevated serum IgE levels. INTERVENTIONS: The patient underwent corticosteroid therapy and had been followed for 2 years. OUTCOMES: We report a rare case of KD of the parotid region in a 56-year-old man, followed by corticosteroid therapy for 2 years. The mass decreased in size and skin itchiness decreased after therapy. He was discharged without any complications. Furthermore, we quantitatively demonstrate the dominance of CD4+ GATA3+ T cells in affected tissues of KD and detect IL-4+ IgE+ c-kit+ mast cells in lesions by multicolor staining approaches. LESSONS: The findings from this case suggest that peripheral blood eosinophilia might serve as a marker of recurrent disease, long-term follow-up is necessary due to the possibility of recurrent. Interactions among expanded IgE+ B cells, CD4+ GATA3+ T cells, eosinophils, and activated mast cells might play a critical role in the pathogenesis of KD.

Poly[[{µ(3)-tris-[2-(4-phenyl-1,2,3-triazol-1-yl)eth-yl]amine}silver(I)] hexa-fluorido-phosphate].

The title compound, {[Ag(L)]PF(6))(n) {L is tris-[2-(4-phenyl-1,2,3-triazol-1-yl)eth-yl]amine, C(30)H(30)N(10)}, consists of alternating two-dimensional cationic layers of [Ag(L)](+) and anionic PF(6) (-) layers. Each Ag(I) atom is three coordinated in a T-shaped geometry by three N atoms from three ligands. Each ligand links three Ag(I) atoms, generating a two-dimensional network structure with two different metallacycles, A and B. In A, eight coordination units from four ligands connect four Ag(I) atoms, forming a 48-membered ring. In B, four coordination units from two ligands link two Ag(I) atoms, forming a 24-membered ring. Each B ring is surrounded by four A rings, and each A ring has four A and four B rings as neighbours. This cationic layer thus generates a 4.8(2) topology network, with each Ag(I) centre and ligand acting as a three-connected topological node.

Cluster signal-to-noise analysis for evaluation of the information content in an image.

OBJECTIVES: (1) To develop an observer-free method of analysing image quality related to the observer performance in the detection task and (2) to analyse observer behaviour patterns in the detection of small mass changes in cone-beam CT images. METHODS: 13 observers detected holes in a Teflon phantom in cone-beam CT images. Using the same images, we developed a new method, cluster signal-to-noise analysis, to detect the holes by applying various cut-off values using ImageJ and reconstructing cluster signal-to-noise curves. We then evaluated the correlation between cluster signal-to-noise analysis and the observer performance test. We measured the background noise in each image to evaluate the relationship with false positive rates (FPRs) of the observers. Correlations between mean FPRs and intra- and interobserver variations were also evaluated. Moreover, we calculated true positive rates (TPRs) and accuracies from background noise and evaluated their correlations with TPRs from observers. RESULTS: Cluster signal-to-noise curves were derived in cluster signal-to-noise analysis. They yield the detection of signals (true holes) related to noise (false holes). This method correlated highly with the observer performance test (R2 = 0.9296). In noisy images, increasing background noise resulted in higher FPRs and larger intra- and interobserver variations. TPRs and accuracies calculated from background noise had high correlation with actual TPRs from observers; R2 was 0.9244 and 0.9338, respectively. CONCLUSIONS: Cluster signal-to-noise analysis can simulate the detection performance of observers and thus replace the observer performance test in the evaluation of image quality. Erroneous decision-making increased with increasing background noise.