Idiopathic granulomatous mastitis: clinical, histopathological, and radiological characteristics and management approaches.

Idiopathic Granulomatous Mastitis (IGM) is an infrequent, benign breast disease that primarily affects women during their childbearing years and can be mistaken for breast cancer. This study aimed to review the clinical, radiological, and histopathological findings of patients with IGM in addition to management and outcome. Retrospective cross-sectional study of biopsy-confirmed IGM at an academic medical center and a private hospital in Amman, Jordan. Fifty-four patients were included, with a mean age of 37.0 ± 9.04 years, mostly presenting with a breast lump (n = 52, 96.3%) and breast pain (n = 45 patients, 84.9%). Approximately half of the patients (51.9%) were parous, and 50% had breastfed for an average duration of 30.37 ± 22.38 months. Most of the patients had either solitary or multiple abscesses on breast ultrasound. Histopathological analysis (n = 35) showed mostly either moderate inflammation (n = 16, 45.7%) or severe inflammation (n = 14, 40%). Two-thirds of the patients underwent surgical interventions at the time of diagnosis, mostly incision and drainage (n = 16, 29%) or surgical excision (n = 7, 13%), and no mastectomies were performed. The most common medical treatment included a combination of antibiotics, corticosteroids, and methotrexate (n = 21, 38.8%). After follow-up, 31 patients remained in remission, 3 experienced relapses, and 3 had a chronic course. The use of corticosteroids was significantly associated with remission (p = 0.035). The presentation and demographics of IGM patients in Jordan were consistent with the existing literature. Prospective research is needed to explore different treatment options and disease outcomes.

An Edge-Based Selection Method for Improving Regions-of-Interest Localizations Obtained Using Multiple Deep Learning Object-Detection Models in Breast Ultrasound Images.

Computer-aided diagnosis (CAD) systems can be used to process breast ultrasound (BUS) images with the goal of enhancing the capability of diagnosing breast cancer. Many CAD systems operate by analyzing the region-of-interest (ROI) that contains the tumor in the BUS image using conventional texture-based classification models and deep learning-based classification models. Hence, the development of these systems requires automatic methods to localize the ROI that contains the tumor in the BUS image. Deep learning object-detection models can be used to localize the ROI that contains the tumor, but the ROI generated by one model might be better than the ROIs generated by other models. In this study, a new method, called the edge-based selection method, is proposed to analyze the ROIs generated by different deep learning object-detection models with the goal of selecting the ROI that improves the localization of the tumor region. The proposed method employs edge maps computed for BUS images using the recently introduced Dense Extreme Inception Network (DexiNed) deep learning edge-detection model. To the best of our knowledge, our study is the first study that has employed a deep learning edge-detection model to detect the tumor edges in BUS images. The proposed edge-based selection method is applied to analyze the ROIs generated by four deep learning object-detection models. The performance of the proposed edge-based selection method and the four deep learning object-detection models is evaluated using two BUS image datasets. The first dataset, which is used to perform cross-validation evaluation analysis, is a private dataset that includes 380 BUS images. The second dataset, which is used to perform generalization evaluation analysis, is a public dataset that includes 630 BUS images. For both the cross-validation evaluation analysis and the generalization evaluation analysis, the proposed method obtained the overall ROI detection rate, mean precision, mean recall, and mean F1-score values of 98%, 0.91, 0.90, and 0.90, respectively. Moreover, the results show that the proposed edge-based selection method outperformed the four deep learning object-detection models as well as three baseline-combining methods that can be used to combine the ROIs generated by the four deep learning object-detection models. These findings suggest the potential of employing our proposed method to analyze the ROIs generated using different deep learning object-detection models to select the ROI that improves the localization of the tumor region.

Breast Tumor Classification in Ultrasound Images Using Combined Deep and Handcrafted Features.

This study aims to enable effective breast ultrasound image classification by combining deep features with conventional handcrafted features to classify the tumors. In particular, the deep features are extracted from a pre-trained convolutional neural network model, namely the VGG19 model, at six different extraction levels. The deep features extracted at each level are analyzed using a features selection algorithm to identify the deep feature combination that achieves the highest classification performance. Furthermore, the extracted deep features are combined with handcrafted texture and morphological features and processed using features selection to investigate the possibility of improving the classification performance. The cross-validation analysis, which is performed using 380 breast ultrasound images, shows that the best combination of deep features is obtained using a feature set, denoted by CONV features that include convolution features extracted from all convolution blocks of the VGG19 model. In particular, the CONV features achieved mean accuracy, sensitivity, and specificity values of 94.2%, 93.3%, and 94.9%, respectively. The analysis also shows that the performance of the CONV features degrades substantially when the features selection algorithm is not applied. The classification performance of the CONV features is improved by combining these features with handcrafted morphological features to achieve mean accuracy, sensitivity, and specificity values of 96.1%, 95.7%, and 96.3%, respectively. Furthermore, the cross-validation analysis demonstrates that the CONV features and the combined CONV and morphological features outperform the handcrafted texture and morphological features as well as the fine-tuned VGG19 model. The generalization performance of the CONV features and the combined CONV and morphological features is demonstrated by performing the training using the 380 breast ultrasound images and the testing using another dataset that includes 163 images. The results suggest that the combined CONV and morphological features can achieve effective breast ultrasound image classifications that increase the capability of detecting malignant tumors and reduce the potential of misclassifying benign tumors.

Thromboembolism and Major Bleeding in Patients with Atrial Fibrillation and EHRA Type 2 Valvular Heart Disease: The Jordan Atrial Fibrillation (JoFib) Study.

Aim: The risks of thromboembolism and major bleeding in atrial fibrillation (AF) patients were assessed according to the "Evaluated Heartvalves, Rheumatic or Artificial" (EHRA) classification. Additionally, the safety and efficacy of vitamin K antagonists (VKAs) and non-VKA oral anticoagulants (NOACs) were compared in AF patients with EHRA type 2 valvular heart disease (VHD) versus those with no VHD. Methods: AF patients enrolled in the "Jordan Atrial Fibrillation (JoFib)" study were followed up for thromboembolic events and major bleeding at 30, 180, and 365 days. Patients in the EHRA type 2 VHD and non-VHD groups were sub-grouped to compare different OACs. Results: 2020 AF patients were recruited. The thromboembolic risk was higher in EHRA type 2 VHD patients compared to non-VHD controls. Major bleeding also occurred at higher rates in EHRA type 2 patients. In addition, NOACs were more effective in preventing thromboembolic events than VKAs and non-anticoagulation in EHRA type 2 VHD patients. Furthermore, EHRA type 2 VHD patients taking rivaroxaban had significantly less thromboembolic risk than their non-anticoagulated counterparts. At the same time, apixaban and warfarin did not significantly lower the risk of thromboembolism compared to non-anticoagulation. Conclusion: AF patients with EHRA type 2 VHD are at significant risk of thromboembolism and major bleeding. Furthermore, NOACs were more effective than VKAs in preventing thromboembolic events in this group of patients without conferring an added risk of major bleeding. Moreover, rivaroxaban appears to be particularly efficacious.

Clinical Outcomes and Cardiovascular-Related Events in Young Diabetic Patients with Acute Coronary Syndrome.

BACKGROUND: Diabetes mellitus (DM) is considered a risk and prognostic factor for elderly patients with the acute coronary syndrome (ACS). However, less is known about the characteristics of this relationship among younger patients in the Middle Eastern population. OBJECTIVE: To explore the Clinical outcomes of cardiovascular-related events in young DM patients (≤50 years of age) during hospitalization and up to one year of follow-up. METHODS: We compared the clinical features, in-hospital and one-year outcomes in young ACS diabetic patients with young ACS non-diabetic patients in 12 tertiary care centers in Jordan. RESULTS: A total of 3517 ACS patients were included initially, 1031 of whom (29.3%) were <50-year-old. Of those, 385 (37.3%) had DM. Compared with young non-diabetic patients, young diabetic patients were more likely to have a worse clinical baseline profile, which includes hypertension (53.2% vs 26.0%, p < 0.001), dyslipidemia (32.5% vs 19.5%, p < 0.001), and multivessel coronary artery disease (40.9% vs 32.0%, p = 0.03). Furthermore, the diabetic group had more females than males (14.0% vs 5.9%, p < 0.001) and a higher mean body mass index (28.8+4.7 kg/m 2 vs 27.9+4.0 kg/m2, p < 0.001). There were no differences between the two groups in the mortality rates during index hospitalization (0.39% vs 0.28%, p = 0.63) or at one-year follow-up (1.6% vs 0.6%, p = 0.41). Also, no significant differences were observed in the rates of stent thrombosis (1.95% vs 1.97%, p = 0.78) or readmission for ACS or coronary revascularization (10.8% vs 7.6%, p = 0.14). CONCLUSION: Despite a worse baseline clinical profile, young diabetic ACS patients did not have higher risks for in-hospital or one-year adverse cardiovascular events compared with the young non-diabetic ACS patients.

MRI Evaluation of Mullerian Duct Anomalies: Practical Classification by the New ASRM System.

Objective: To describe variable mullerian duct anomalies using magnetic resonance imaging (MRI) and to classify these anomalies according to the available classification systems, namely the American Fertility Society (AFS) system, the European Society of Human Reproduction and Embryology (ESHRE) system, and the new American Society for Reproductive Medicine (ASRM) system. Design: Retrospective chart review. Subjects: The pelvic MRI studies and the clinical records of 64 females with mullerian congenital anomalies were retrospectively reviewed between January 2010 and December 2021. The mean age was 22 years (age range 2-63 years). Main Outcome Measures: Detailed imaging findings were recorded, and the resulting mullerian anomalies were then classified according to the three classification systems of interest. Results: Variable mullerian anomalies were found among patients with multiple frequencies. Mullerian agenesis and hypoplasia were found in 12 patients (19%) and 16 patients (25%), respectively. Uterus didelphys was found in 5 patients (8%). Twelve (19%) patients had septate uterus, while 8 (12.5%) had a bicornuate anomaly. Unicornuate uterus was present in 7 patients (11%). Isolated vaginal anomaly was diagnosed in 4 patients (6%). Renal/urinary tract imaging was available for 27 (42%) patients, and accompanying urinary tract anomalies were noted in 10 of them (37%). Few ovarian and other extra-renal anomalies were observed. Conclusion: MRI could efficiently delineate the mullerian anomalies regardless of their complexity. Most of these anomalies were more efficaciously categorized by the ESHRE and the new ASRM systems, compared to the originally widely used AFS system. The new ASRM classification was found to be more practical as it is a modification of the original AFS system, using drawings with clear descriptions instead of symbols. This is particularly helpful in the radiological era, saving time and effort.

Pseudoaneurysm of the breast after blunt trauma: successful treatment with ultrasound-guided compression.

We present a case of breast pseudoaneurysm following a blunt trauma in a 58-year-old woman. Few cases of breast pseudoaneurysm have been reported in the literature, and most of these are related to previous interventional procedures. Pseudoaneurysm was suspected on real-time sonography and confirmed with color Doppler and spectral wave analysis, which revealed a characteristic to-and-fro pattern. Unlike previously reported cases, treatmentwith ultrasound-guided compression was successful.

The usefulness of MR defecography in the evaluation of pelvic floor dysfunction: our experience using 3T MRI.

PURPOSE: To assess the usefulness of MR defecography in evaluating pelvic floor dysfunction, and to correlate several pelvic organ abnormalities with each other and with patients' symptoms and characteristics. METHODS: MR defecographic examinations performed in 3T MRI machine of 95 patients (70 females, 25 males; mean age 48) were retrospectively reviewed. Pelvic organ abnormalities from all three compartments were recorded, including the anorectal junction descent, anterior rectocele, and cystocele. These were graded according to the known HMO system in relation to the pubococcygeal line. The correlation between these different abnormalities and their relation to patient symptoms and characteristics were evaluated. RESULTS: Anorectal junction descent and anterior rectocele were most commonly observed, predominantly manifesting in female patients. Both were associated with abnormalities from all compartments. The middle compartment was the least affected, and its abnormality of uterine/vaginal descent tended to occur in association with the anterior compartment abnormality (cystocele). Anismus was low in incidence, and was not associated with other compartments abnormalities. Both enterocele/peritoneocele and intussusception were uncommon. CONCLUSION: MR defecography is the modality of choice in assessing pelvic floor dysfunction, because it can neatly show various pelvic organ abnormalities from all compartments in a dynamic fashion, which are frequently coexistent. It can even show clinically silent or unsuspected abnormalities which can impact the management of patients.

Intra-articular injection of expanded autologous bone marrow mesenchymal cells in moderate and severe knee osteoarthritis is safe: a phase I/II study.

BACKGROUND: Knee osteoarthritis (KOA) is a major health problem especially in the aging population. There is a need for safe treatment that restores the cartilage and reduces the symptoms. The use of stem cells is emerging as a possible option for the moderate and severe cases. This study aimed at testing the safety of autologous bone marrow mesenchymal stem cells (BM-MSCs) expanded in vitro when given intra-articularly to patients with stage II and III KOA. As a secondary end point, the study tested the ability of these cells to relieve symptoms and restore the knee cartilage in these patients as judged by normalized knee injury and Osteoarthritis Outcome Score (KOOS) and by magnetic resonance imaging (MRI). METHODS: Thirteen patients with a mean age of 50 years suffering from KOA stages II and III were given two doses of BM-MSCs 1 month apart totaling 61 × 106 ± 0.6 × 106 by intra-articular injection in a phase I prospective clinical trial. Each patient was followed for a minimum of 24 months for any adverse events and for clinical outcome using normalized KOOS. Cartilage thickness was assessed by quantitative MRI T2 at 12 months of follow-up. RESULTS: No severe adverse events were reported up to 24 months follow-up. Normalized KOOS improved significantly. Mean knee cartilage thickness measured by MRI improved significantly. CONCLUSION: BM-MSCs given intra-articularly are safe in knee osteoarthrosis. Despite the limited number of patients in this study, the procedure described significantly improved the KOOS and knee cartilage thickness, indicating that they may enhance the functional outcome as well as the structural component. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02118519.

A Fusion-Based Approach for Breast Ultrasound Image Classification Using Multiple-ROI Texture and Morphological Analyses.

Ultrasound imaging is commonly used for breast cancer diagnosis, but accurate interpretation of breast ultrasound (BUS) images is often challenging and operator-dependent. Computer-aided diagnosis (CAD) systems can be employed to provide the radiologists with a second opinion to improve the diagnosis accuracy. In this study, a new CAD system is developed to enable accurate BUS image classification. In particular, an improved texture analysis is introduced, in which the tumor is divided into a set of nonoverlapping regions of interest (ROIs). Each ROI is analyzed using gray-level cooccurrence matrix features and a support vector machine classifier to estimate its tumor class indicator. The tumor class indicators of all ROIs are combined using a voting mechanism to estimate the tumor class. In addition, morphological analysis is employed to classify the tumor. A probabilistic approach is used to fuse the classification results of the multiple-ROI texture analysis and morphological analysis. The proposed approach is applied to classify 110 BUS images that include 64 benign and 46 malignant tumors. The accuracy, specificity, and sensitivity obtained using the proposed approach are 98.2%, 98.4%, and 97.8%, respectively. These results demonstrate that the proposed approach can effectively be used to differentiate benign and malignant tumors.

Sporadic Lateral Ventricular Hemangioblastoma presenting with Intraventricular and Subarachnoid Haemorrhage.

Intraventricular hemangioblastoma (HB) is very rare; few cases of intraventricular HB have been reported in the literature, either sporadically or in association with von Hippel-Lindau disease. Furthermore, the incidence of ventricular haemorrhage from HB seems to be uncommon. We report a unique case of sporadic HB of the right lateral ventricle presenting with intratumoural and intraventricular haemorrhage in addition to multifocal intracranial superficial siderosis, indicating the presence of a subarachnoid haemorrhage (SAH) as well. Such a combination has not been reported before. In the future, the detection of an intraventricular mass in association with ventricular haemorrhage, with or without SAH, should include HB as a differential diagnosis, particularly when the imaging appearances are not typical of the more common intraventricular tumours.

Primary extensive pyomyositis in an immunocompetent patient: case report and literature review.

Pyomyositis is a suppurative infection of the skeletal muscle; it mainly occurs in immunocompromised patients or, exceptionally, in immunocompetent patients in tropical or other areas. We present a 24-year-old immunocompetent lady with bilateral thigh myalgia and fever. Upon investigation, extensive multifocal bilateral fluid collections involving the extensor muscles of both thighs were demonstrated. Pus aspirate from the involved muscles proved the presence of Staphylococcus aureus. Incision and drainage of the involved muscles were performed with successful and complete recovery.

Arachnoid granulations in the cerebral dural sinuses as demonstrated by contrast-enhanced 3D magnetic resonance venography.

INTRODUCTION: Identification of normal filling defects within the intracranial dural sinuses reduces the erroneous diagnosis of the presence of an intrasinus pathologic process. The aim of this prospective study was to assess the prevalence, distribution, and morphological characteristics of arachnoid granulations (AGs) in the dural sinuses. METHODS: This prospective study was carried out on 110 patients who had both normal conventional brain MRI and contrast-enhanced (CE) 3D turbo flash magnetic resonance venography (MRV). The dural sinuses were viewed on MRV images for the presence of filling defects. The prevalence, site, size, number, shape, outlines, internal structure, and presence of associated cortical vein were determined. RESULTS: One hundred and twenty-six AGs were observed among 71 patients. The superior sagittal sinus was the most common site of filling defects (58 AGs). The mean size of AGs was 6.45 +/- 3.55 mm. Eighty-three percent of AGs were round or oval, with sharp outlines and homogeneous internal structure; of these 81% were associated with cortical vein. CONCLUSIONS: In the majority of cases, the identification of AGs can be facilitated by their characteristic appearances: rounded or oval shaped, well-defined outlines and homogenous intensity. The presence of an adjacent cortical vein can be considered as an additional supportive element.