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BMJ Case Rep ; 14(3)2021 Mar 16.
Article En | MEDLINE | ID: mdl-33727290

We present a case of a giant ovarian cyst in a 20-year-old woman who presented atypically at our Emergency Department with left-sided back pain followed by acute left leg swelling. Blood tests showed significantly raised C-Reactive Protein and D-Dimer. CT-Abdomen-Pelvis demonstrated a large mass in the region of the right ovary with suspicious heterogeneous filling defects in the left external iliac vein, confirmed as a left-sided deep-vein thrombosis on ultrasound Doppler. MRI revealed the lesion to be cystic and the deep venous thrombosis was treated with twice-daily Clexane. Prior to removal of the cyst, an Inferior Vena Cava Filter was placed to reduce thromboembolic risk. The cyst was resected without complication and the postoperative period was uneventful. This case occurred while face-to-face services were limited by COVID-19 and illustrates the need for robust systemic measures to safeguard patients against the emergency sequelae of insidious gynaecological pathology.

Back Pain/etiology , Diagnostic Imaging/methods , Ovarian Cysts/complications , Ovarian Cysts/diagnostic imaging , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/etiology , Adult , Diagnosis, Differential , Enoxaparin/therapeutic use , Female , Fibrinolytic Agents/therapeutic use , Humans , Leg , Magnetic Resonance Imaging , Ovarian Cysts/surgery , Ovary/diagnostic imaging , Ovary/surgery , Tomography, X-Ray Computed , Ultrasonography, Doppler , Venous Thrombosis/drug therapy , Young Adult
Lancet Digit Health ; 3(1): e51-e66, 2021 01.
Article En | MEDLINE | ID: mdl-33735069

Health data that are publicly available are valuable resources for digital health research. Several public datasets containing ophthalmological imaging have been frequently used in machine learning research; however, the total number of datasets containing ophthalmological health information and their respective content is unclear. This Review aimed to identify all publicly available ophthalmological imaging datasets, detail their accessibility, describe which diseases and populations are represented, and report on the completeness of the associated metadata. With the use of MEDLINE, Google's search engine, and Google Dataset Search, we identified 94 open access datasets containing 507 724 images and 125 videos from 122 364 patients. Most datasets originated from Asia, North America, and Europe. Disease populations were unevenly represented, with glaucoma, diabetic retinopathy, and age-related macular degeneration disproportionately overrepresented in comparison with other eye diseases. The reporting of basic demographic characteristics such as age, sex, and ethnicity was poor, even at the aggregate level. This Review provides greater visibility for ophthalmological datasets that are publicly available as powerful resources for research. Our paper also exposes an increasing divide in the representation of different population and disease groups in health data repositories. The improved reporting of metadata would enable researchers to access the most appropriate datasets for their needs and maximise the potential of such resources.

Databases, Factual , Datasets as Topic , Diagnostic Imaging/methods , Eye Diseases/diagnostic imaging , Ophthalmology , Humans , Metadata/standards
Bull Cancer ; 108(4): 424-434, 2021 Apr.
Article Fr | MEDLINE | ID: mdl-33722379

Two forms of bone lymphomas can be distinguished: the primary bone lymphoma (PBL) and the secondary bone lymphoma (SBL). PBL is a rare disease with a good prognosis. Clinical manifestations and imaging findings are usually non-specific. Patient can present with pain, swelling of affected bone or pathologic fracture. Positron emission tomography-CT scan is a sensitive imaging modality and very useful for staging, restaging, surveillance of recurrence, and monitoring of treatment response of lymphoma. The diagnosis of PBL is often difficult and made after biopsy examination. Most patients have diffuse large B-cell lymphoma. Patients have been treated with radiotherapy, chemotherapy or combination of both. Localized disease, low IPI (International Prognostic Index) and complete remission after initial treatment were associated with a better outcome. Management of late sequelae deserves particular attention. SBL is more common than PBL; this is a disseminated lymphoma with concomitant involvement of the skeleton. We review the clinical, imaging and pathologic features of bone lymphomas; and discuss therapeutic modalities as well as prognosis of these lymphomas in the era of immunochemotherapy.

Bone Neoplasms , Lymphoma, Non-Hodgkin , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Neoplasms/classification , Bone Neoplasms/diagnosis , Bone Neoplasms/secondary , Bone Neoplasms/therapy , Central Nervous System Neoplasms/prevention & control , Central Nervous System Neoplasms/secondary , Combined Modality Therapy , Diagnostic Imaging/methods , Female , Fractures, Spontaneous/etiology , Fractures, Spontaneous/surgery , Humans , Lymphoma, Non-Hodgkin/diagnosis , Lymphoma, Non-Hodgkin/pathology , Lymphoma, Non-Hodgkin/therapy , Male , Organ Specificity , Prognosis , Radiotherapy/methods , Recurrence
Indian J Ophthalmol ; 69(3): 734-738, 2021 Mar.
Article En | MEDLINE | ID: mdl-33595513

Purpose: The study uses principles of liquid and gas mechanics to verify and quantify the generation of aerosols in oculoplastic procedures, namely surgery using a scalpel, electrosurgical device, and a mechanized drill. Methods: Surgical techniques were performed ex vivo using the electrosurgical device, scalpel, and mechanized drill on the muscle and bone of commercially available chicken. The liquid and gas dynamics were observed using a high-speed high-resolution Photron SA5 camera (0.125 to 8 ms temporal resolution, 0.016 to 0.054 mm/pixel spatial resolution) and stroboscopic lighting (Veritas 120 E LED Constellation). The analysis was performed using in-house algorithms and ImageJ software. Results: The use of a mechanized drill at 35000 rpm and a 3 mm fluted burr generated aerosol with particle size 50 to 550 microns with a spread of 1.8 m radius. Surgical smoke was generated by an electrosurgical device in both cutting and coagulation modes. Dispersion of the smoke could be controlled significantly by the use of suction, mean smoke spread ratio being 0.065 without suction and 0.002 with use of suction within 2 cm. Conclusion: The quantification of the aerosol generation will help surgeons take practical decisions in their surgical techniques in the pandemic era.

Aerosols/adverse effects , Diagnostic Imaging/methods , Eye Diseases/epidemiology , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Ophthalmologic Surgical Procedures/methods , Pandemics , Personal Protective Equipment , Reconstructive Surgical Procedures/adverse effects , Risk Assessment/methods , Comorbidity , Eye Diseases/diagnosis , Eye Diseases/surgery , Humans , India
Radiol Clin North Am ; 59(2): 155-168, 2021 Mar.
Article En | MEDLINE | ID: mdl-33551078

Prevascular mediastinal masses include a wide range of benign and malignant entities. Localization of mediastinal masses to specific compartments together with characteristic imaging findings and demographic and clinical information allows formulation of a focused differential diagnosis. Radiologists may use these methods to distinguish between surgical and nonsurgical cases and thus inform patient management and have an impact on outcomes. Treatment of choice varies based on the pathology, ranging from no intervention or serial imaging follow-up to surgical excision, chemotherapy, and/or radiation.

Diagnostic Imaging/methods , Mediastinal Neoplasms/diagnostic imaging , Mediastinum/diagnostic imaging , Humans
Radiol Clin North Am ; 59(2): 169-182, 2021 Mar.
Article En | MEDLINE | ID: mdl-33551079

Thymic epithelial neoplasms, as classified by the World Health Organization, include thymoma, thymic carcinoma, and thymic carcinoid. They are a rare group of tumors and are often diagnosed incidentally in the work-up of parathymic syndrome, such as myasthenia gravis, or when mass effect or local invasion causes other symptoms. In each of these scenarios, understanding the radiologic-pathologic relationship of these tumors allows clinical imagers to contribute meaningfully to management decisions and overall patient care. Integrating important imaging features, such as local invasion, and pathologic features, such as necrosis and immunohistochemistry, ensures a meaningful contribution by clinical imagers to the care team.

Diagnostic Imaging/methods , Neoplasms, Glandular and Epithelial/diagnostic imaging , Neoplasms, Glandular and Epithelial/pathology , Thymus Neoplasms/diagnostic imaging , Thymus Neoplasms/pathology , Humans , Thymus Gland/diagnostic imaging , Thymus Gland/pathology
Radiol Clin North Am ; 59(2): 183-192, 2021 Mar.
Article En | MEDLINE | ID: mdl-33551080

Thymic epithelial neoplasms are a group of malignant tumors that includes thymoma, thymic carcinoma, and thymic neuroendocrine tumors. Although several staging systems have been developed over the years for use with these cancers, they have been interpreted and implemented in a nonuniform manner. Recently, the International Association for the study of Lung Cancer and the International Thymic Malignancy Interest Group developed a tumor-node-metastasis staging system that has been universally accepted and correlates with patient survival and outcomes. Although pathologic staging is determined by histologic examination of the resected tumor, imaging plays an important role in clinical staging and is important for informing therapeutic decisions.

Diagnostic Imaging/methods , Lymphatic Metastasis/diagnostic imaging , Neoplasms, Glandular and Epithelial/diagnostic imaging , Neoplasms, Glandular and Epithelial/pathology , Thymus Neoplasms/diagnostic imaging , Thymus Neoplasms/pathology , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Neoplasm Staging , Thymus Gland/diagnostic imaging , Thymus Gland/pathology
Radiol Clin North Am ; 59(2): 193-204, 2021 Mar.
Article En | MEDLINE | ID: mdl-33551081

The visceral mediastinum contains important vascular and non-vascular structures including the heart, great vessels, lymph nodes, and portions of the esophagus and trachea. Multiple imaging modalities, including chest radiography, computed tomography, MR imaging, and nuclear medicine studies, can be used to detect, diagnose, and characterize masses in this compartment. Lymphadenopathy is the most common process involving the visceral mediastinum and can be seen with a wide variety of diseases. Less commonly seen entities include foregut duplication cysts, neoplasms and other lesions arising from the trachea and esophagus, paragangliomas as well as other mesenchymal tumors.

Diagnostic Imaging/methods , Mediastinal Neoplasms/diagnostic imaging , Humans , Mediastinum/diagnostic imaging
Radiol Clin North Am ; 59(2): 205-217, 2021 Mar.
Article En | MEDLINE | ID: mdl-33551082

The epidemiology and clinical management of esophageal carcinomas are changing, and clinical imagers are required to understand both the imaging appearances of common cancers and the pathologic diagnoses that drive management. Rare esophageal malignancies and benign esophageal neoplasms have distinct imaging features that may suggest a diagnosis and guide the next steps clinically. Furthermore, these imaging features have a basis in pathology, and this article focuses on the relationship between pathologic features and imaging manifestations that will help an informed imager maintain clinical relevance.

Diagnostic Imaging/methods , Esophageal Neoplasms/diagnostic imaging , Esophagus/diagnostic imaging , Humans
Radiol Clin North Am ; 59(2): 219-229, 2021 Mar.
Article En | MEDLINE | ID: mdl-33551083

Esophageal cancer is an uncommon malignancy that ranks sixth in terms of mortality worldwide. Squamous cell carcinoma is the predominant histologic subtype worldwide whereas adenocarcinoma represents the majority of cases in North America, Australia, and Europe. Esophageal cancer is staged using the American Joint Committee on Cancer and the International Union for Cancer Control TNM system and has separate classifications for the clinical, pathologic, and postneoadjuvant pathologic stage groups. The determination of clinical TNM is based on complementary imaging modalities, including esophagogastroduodenoscopy/endoscopic ultrasound; endoscopic ultrasound-fine-needle aspiration; computed tomography of the chest, abdomen, and pelvis; and fluorodeoxyglucose PET/computed tomography.

Diagnostic Imaging/methods , Esophageal Neoplasms/diagnostic imaging , Esophageal Neoplasms/pathology , Lymphatic Metastasis/diagnostic imaging , Lymphatic Metastasis/pathology , Esophagus/diagnostic imaging , Esophagus/pathology , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Neoplasm Staging
Radiol Clin North Am ; 59(2): 231-242, 2021 Mar.
Article En | MEDLINE | ID: mdl-33551084

Cardiac neoplasms are a diagnostic challenge on many levels. They are rare, their clinical presentation may mimic other much more common cardiac diseases, and they are at an uncommon intersection of oncologic and cardiac imaging. The pathology of primary cardiac neoplasms explains their varied imaging features, for example, calcification in primary cardiac osteosarcomas and T2 hyperintensity in myxomas. Integrating the imaging and pathologic features of cardiac tumors furthers our understanding of the spectrum of appearances of these neoplasms and improves the clinical imager's ability to confidently make a diagnosis.

Diagnostic Imaging/methods , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/pathology , Heart/diagnostic imaging , Humans , Myocardium/pathology
Radiol Clin North Am ; 59(2): 279-290, 2021 Mar.
Article En | MEDLINE | ID: mdl-33551087

Chest computed tomography (CT) is the modality of choice for mediastinal imaging. The high-resolution images provided by multi-detector CT result in routine visualization of normal anatomic structures, which can be confused with pathology. In addition, many mediastinal abnormalities are discovered incidentally, with a routine chest CT protocol which may be insufficient for definite diagnosis. Awareness of the spectrum of potential pitfalls of mediastinal imaging, artifacts related to flow, motion, and solutions to mitigate these problematic issues is important in accurate interpretation. The purpose of this review is to highlight and discuss potential pitfalls in the imaging of the mediastinum.

Diagnostic Errors/prevention & control , Diagnostic Imaging/methods , Mediastinal Neoplasms/diagnostic imaging , Humans , Mediastinum/diagnostic imaging
J Med Internet Res ; 23(2): e24266, 2021 02 22.
Article En | MEDLINE | ID: mdl-33503002

BACKGROUND: Transition to digital pathology usually takes months or years to be completed. We were familiarizing ourselves with digital pathology solutions at the time when the COVID-19 outbreak forced us to embark on an abrupt transition to digital pathology. OBJECTIVE: The aim of this study was to quantitatively describe how the abrupt transition to digital pathology might affect the quality of diagnoses, model possible causes by probabilistic modeling, and qualitatively gauge the perception of this abrupt transition. METHODS: A total of 17 pathologists and residents participated in this study; these participants reviewed 25 additional test cases from the archives and completed a final psychologic survey. For each case, participants performed several different diagnostic tasks, and their results were recorded and compared with the original diagnoses performed using the gold standard method (ie, conventional microscopy). We performed Bayesian data analysis with probabilistic modeling. RESULTS: The overall analysis, comprising 1345 different items, resulted in a 9% (117/1345) error rate in using digital slides. The task of differentiating a neoplastic process from a nonneoplastic one accounted for an error rate of 10.7% (42/392), whereas the distinction of a malignant process from a benign one accounted for an error rate of 4.2% (11/258). Apart from residents, senior pathologists generated most discrepancies (7.9%, 13/164). Our model showed that these differences among career levels persisted even after adjusting for other factors. CONCLUSIONS: Our findings are in line with previous findings, emphasizing that the duration of transition (ie, lengthy or abrupt) might not influence the diagnostic performance. Moreover, our findings highlight that senior pathologists may be limited by a digital gap, which may negatively affect their performance with digital pathology. These results can guide the process of digital transition in the field of pathology.

/epidemiology , Clinical Competence , Diagnostic Imaging/methods , Diagnostic Imaging/standards , Image Processing, Computer-Assisted/methods , Image Processing, Computer-Assisted/standards , Pathology, Clinical/methods , Pathology, Clinical/standards , Bayes Theorem , Disease Outbreaks , Humans , Internship and Residency/methods , Internship and Residency/standards , Italy/epidemiology , Microscopy , Surveys and Questionnaires
Nat Methods ; 18(1): 43-45, 2021 01.
Article En | MEDLINE | ID: mdl-33398191

Deep learning is transforming the analysis of biological images, but applying these models to large datasets remains challenging. Here we describe the DeepCell Kiosk, cloud-native software that dynamically scales deep learning workflows to accommodate large imaging datasets. To demonstrate the scalability and affordability of this software, we identified cell nuclei in 106 1-megapixel images in ~5.5 h for ~US$250, with a cost below US$100 achievable depending on cluster configuration. The DeepCell Kiosk can be downloaded at ; a persistent deployment is available at .

Cell Nucleus/chemistry , Deep Learning , Diagnostic Imaging/methods , Image Processing, Computer-Assisted/methods , Software , Algorithms , Cloud Computing , Humans , Workflow
Methods Mol Biol ; 2190: 209-228, 2021.
Article En | MEDLINE | ID: mdl-32804368

With rapid advances in experimental instruments and protocols, imaging and sequencing data are being generated at an unprecedented rate contributing significantly to the current and coming big biomedical data. Meanwhile, unprecedented advances in computational infrastructure and analysis algorithms are realizing image-based digital diagnosis not only in radiology and cardiology but also oncology and other diseases. Machine learning methods, especially deep learning techniques, are already and broadly implemented in diverse technological and industrial sectors, but their applications in healthcare are just starting. Uniquely in biomedical research, a vast potential exists to integrate genomics data with histopathological imaging data. The integration has the potential to extend the pathologist's limits and boundaries, which may create breakthroughs in diagnosis, treatment, and monitoring at molecular and tissue levels. Moreover, the applications of genomics data are realizing the potential for personalized medicine, making diagnosis, treatment, monitoring, and prognosis more accurate. In this chapter, we discuss machine learning methods readily available for digital pathology applications, new prospects of integrating spatial genomics data on tissues with tissue morphology, and frontier approaches to combining genomics data with pathological imaging data. We present perspectives on how artificial intelligence can be synergized with molecular genomics and imaging to make breakthroughs in biomedical and translational research for computer-aided applications.

Genomics/methods , Machine Learning , Neoplasms/diagnostic imaging , Neoplasms/pathology , Algorithms , Artificial Intelligence , Diagnostic Imaging/methods , Humans , Precision Medicine/methods , Prognosis
Methods Mol Biol ; 2158: 257-268, 2021.
Article En | MEDLINE | ID: mdl-32857379

The quantification of cell cycle activity is a prerequisite to defining the dynamics and scope of organ development or regeneration. Multi-isotope imaging mass spectrometry (MIMS) merges stable isotope tracers with an imaging mass spectrometry platform called NanoSIMS, which can quantitatively measure the incorporation of stable isotope tracers with high precision in suborganelle domains. MIMS has been applied to quantify the dynamics of postnatal cardiogenesis and mammalian cardiomyocyte regeneration during aging or in response to injury. Here, we present an approach to the conduct of MIMS experiments, with an emphasis on the application to the field of cardiac regeneration; however, the approach is also applicable, with, at most, minor modifications to broader biological questions.

Cell Cycle , Diagnostic Imaging/methods , Isotope Labeling/methods , Mass Spectrometry/methods , Myocytes, Cardiac/physiology , Regeneration , Animals , Cell Division , Mice , Myocytes, Cardiac/cytology
Br J Radiol ; 94(1117): 20200726, 2021 Jan 01.
Article En | MEDLINE | ID: mdl-33090880

Gallbladder cancer is the most common malignancy of the biliary tract. It is also the most aggressive biliary tumor with the shortest median survival duration. Complete surgical resection, the only potentially curative treatment, can be accomplished only in those patients who are diagnosed at an early stage of the disease. Majority (90%) of the patients present at an advanced stage and the management involves a multidisciplinary approach. The role of imaging in gallbladder cancer cannot be overemphasized. Imaging is crucial not only in detecting, staging, and planning management but also in guiding radiological interventions. This article discusses the role of a radiologist in the diagnosis and management of gallbladder cancer.

Diagnostic Imaging/methods , Gallbladder Neoplasms/diagnostic imaging , Gallbladder/diagnostic imaging , Gallbladder/pathology , Gallbladder Neoplasms/pathology , Humans , Neoplasm Staging
Methods Mol Biol ; 2201: 59-70, 2021.
Article En | MEDLINE | ID: mdl-32975789

Sensitive and long-term fluorescence imaging of G-protein-coupled receptors enables exploration of molecular level details of these therapeutically relevant proteins, including their expression, localization, signaling, and intracellular trafficking. In this context, labeling these receptors with bright and photostable fluorescent probes is necessary to overcome current imaging problems such as optical background and photobleaching. Here, we describe the procedures to functionalize nanoruby (and other similar nanoparticles) with NeutrAvidin (a streptavidin analog) and to apply this bioconjugate for ultrasensitive, long-term imaging of µ-opioid receptors heterologously expressed in AtT-20 cells. The receptor targeting is mediated via a biotinylated primary antibody, rendering this methodology extendable to other G-protein-coupled or, more generally, cell-surface receptors. Nanoruby-based time-gated imaging enables indefinitely long visualization of single particles even in high-autofluorescence media, such as serum, by completely suppressing autofluorescence and any laser backscatter.

Avidin/chemistry , Diagnostic Imaging/methods , Receptors, Opioid, mu/metabolism , Biotinylation/methods , Fluorescence , Fluorescent Dyes , Humans , Nanoparticles , Receptors, G-Protein-Coupled/metabolism , Receptors, Opioid/metabolism , Streptavidin
Br J Radiol ; 94(1120): 20201019, 2021 Apr 01.
Article En | MEDLINE | ID: mdl-33332985

OBJECTIVE: The purpose of this study was to describe the imaging appearance, diagnosis, and management of mammary and extramammary myofibroblastoma (MFB) in a series of 23 patients. METHODS AND MATERIALS: Following institutional review board approval, cases were identified by searching for "myofibroblastoma" in radiology reports. Multimodality imaging and pathological features were assessed. RESULTS: 23 cases of myofibroblastoma were identified in 15 males and 8 females. Most cases were in the breast (20/23, 87%), presenting as a palpable mass or discovered incidentally on mammography in females or chest CT in males. Extramammary MFB lesions (3/23, 13%) presented with symptoms related to mass effect. At imaging, MFB most often demonstrated an oval or irregular mass that was hypoechoic or heterogeneously echogenic with variable margins. MRI showed T2 hyperintensity, diffusion restriction, and plateau kinetics. Extramammary MFB appeared as an enhancing mass with variable fat content and T2 intensity. CONCLUSION: Here we describe imaging and clinicopathological features of mammary and extramammary myofibroblastoma. ADVANCES IN KNOWLEDGE: Imaging description of this rare tumor is limited in the literature, and to date this is the largest case series describing the imaging findings.

Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Diagnostic Imaging/methods , Multimodal Imaging/methods , Neoplasms, Muscle Tissue/diagnostic imaging , Neoplasms, Muscle Tissue/pathology , Aged , Aged, 80 and over , Breast/diagnostic imaging , Breast Neoplasms/therapy , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging/methods , Male , Mammography/methods , Middle Aged , Neoplasms, Muscle Tissue/therapy , Positron Emission Tomography Computed Tomography/methods , Radiography, Thoracic , Tomography, X-Ray Computed/methods , Ultrasonography/methods
Br J Radiol ; 94(1117): 20200975, 2021 Jan 01.
Article En | MEDLINE | ID: mdl-32941736

Artificial intelligence (AI) has received widespread and growing interest in healthcare, as a method to save time, cost and improve efficiencies. The high-performance statistics and diagnostic accuracies reported by using AI algorithms (with respect to predefined reference standards), particularly from image pattern recognition studies, have resulted in extensive applications proposed for clinical radiology, especially for enhanced image interpretation. Whilst certain sub-speciality areas in radiology, such as those relating to cancer screening, have received wide-spread attention in the media and scientific community, children's imaging has been hitherto neglected.In this article, we discuss a variety of possible 'use cases' in paediatric radiology from a patient pathway perspective where AI has either been implemented or shown early-stage feasibility, while also taking inspiration from the adult literature to propose potential areas for future development. We aim to demonstrate how a 'future, enhanced paediatric radiology service' could operate and to stimulate further discussion with avenues for research.

Artificial Intelligence , Diagnostic Imaging/methods , Pediatrics/methods , Radiology/methods , Child , Clinical Decision-Making , Humans , Image Interpretation, Computer-Assisted/methods