Empowering brain cancer diagnosis: harnessing artificial intelligence for advanced imaging insights.

Artificial intelligence (AI) is increasingly being used in the medical field, specifically for brain cancer imaging. In this review, we explore how AI-powered medical imaging can impact the diagnosis, prognosis, and treatment of brain cancer. We discuss various AI techniques, including deep learning and causality learning, and their relevance. Additionally, we examine current applications that provide practical solutions for detecting, classifying, segmenting, and registering brain tumors. Although challenges such as data quality, availability, interpretability, transparency, and ethics persist, we emphasise the enormous potential of intelligent applications in standardising procedures and enhancing personalised treatment, leading to improved patient outcomes. Innovative AI solutions have the power to revolutionise neuro-oncology by enhancing the quality of routine clinical practice.

Morphometric analysis of the inferior vena cava and its clinical correlations using abdomino-pelvic computed tomography: Series from a Jordanian population.

INTRODUCTION AND IMPORTANCE: This study aimed to determine the impact of DM, HTN and age on IVC dimensions as measured by CT scan relevant to guide interventions in a Jordanian population. PRESENTATION OF CASES: Two hundred patients were selected from those referred to the Radiology Department, Jordan University Hospital, Amman, Jordan for clinical evaluation. Patients were divided into three age subgroups. Age, sex, and comorbidities such as DM and HTN were identified and saved for later use. All dimensions of the IVC were measured using an abdomino-pelvic CT scanner. CLINICAL DISCUSSION: A full morphometric analysis of the IVC would provide a better understanding of the dynamicity of the IVC in relation to its blood flow. Our results revealed that the length of the IVC was significantly shorter with age (P = 0.003). DM significantly affected the length of the IVC (P = 0.044). Hypertension also significantly affected the length of the IVC (P = 0.031), but it did not significantly affect the anterio-posterior or the transverse diameters of the IVC. CONCLUSION: The length of the IVC was significantly shorter with age, DM and hypertension. Morphometric measures of the IVC are of great clinical importance as they may assist in medical or surgical intervention and follow-up.

Unpaired MR-CT brain dataset for unsupervised image translation.

The data presented in this article deals with the problem of brain tumor image translation across different modalities. The provided dataset represents unpaired brain magnetic resonance (MR) and computed tomography (CT) image data volumes of 20 patients. This includes 179 two-dimensional (2D) axial MR and CT images. The MR cases are acquired using Siemens Verio scanner, while the CT images with a Siemens Somatom scanner. The MR and CT tumor volumes were collected, diagnosed and annotated by experienced radiologists specialized in oncology and radiotherapy. The collected image volumes can be useful for researchers working in the field of artificial intelligence (AI) applications for brain tumor detection, classification and segmentation in MR and CT modalities. The provided tumor masks per each tumor volume can assist data scientists with limited background in cancer imaging. Moreover, clinical interpretation is given per each tumor volume, which can assist in deep learning model training with multiple source data (non-imaging or textual data) as well. The provided dataset can facilitate for annotation-efficient lesion segmentation using bidirectional MR-CT cross-modality image translation.

Paired-unpaired Unsupervised Attention Guided GAN with transfer learning for bidirectional brain MR-CT synthesis.

Medical image acquisition plays a significant role in the diagnosis and management of diseases. Magnetic Resonance (MR) and Computed Tomography (CT) are considered two of the most popular modalities for medical image acquisition. Some considerations, such as cost and radiation dose, may limit the acquisition of certain image modalities. Therefore, medical image synthesis can be used to generate required medical images without actual acquisition. In this paper, we propose a paired-unpaired Unsupervised Attention Guided Generative Adversarial Network (uagGAN) model to translate MR images to CT images and vice versa. The uagGAN model is pre-trained with a paired dataset for initialization and then retrained on an unpaired dataset using a cascading process. In the paired pre-training stage, we enhance the loss function of our model by combining the Wasserstein GAN adversarial loss function with a new combination of non-adversarial losses (content loss and L1) to generate fine structure images. This will ensure global consistency, and better capture of the high and low frequency details of the generated images. The uagGAN model is employed as it generates more accurate and sharper images through the production of attention masks. Knowledge from a non-medical pre-trained model is also transferred to the uagGAN model for improved learning and better image translation performance. Quantitative evaluation and qualitative perceptual analysis by radiologists indicate that employing transfer learning with the proposed paired-unpaired uagGAN model can achieve better performance as compared to other rival image-to-image translation models.

Objective and subjective improvement in children with idiopathic detrusor overactivity after intravesical botulinum toxin injection: A preliminary report.

OBJECTIVE: The purpose of this study is to evaluate the effect of Intravesical Botulinum toxin injection on the symptoms and urodynamic parameters in pediatric patients with idiopathic overactive bladder (iOAB) refractory to medical treatment. MATERIALS AND METHODS: The study was designed as an open-label uncontrolled therapeutic clinical trial. The eligible patients who underwent Intravesical botulinum toxin injection were evaluated before treatment. The evaluation included a 7-day paper bladder diary to assess OAB symptoms (frequency, urgency urinary incontinence (UUI) and nocturnal enuresis (NE)), filling the Arabic International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI short form), and conducting urodynamic study. The Urodynamic parameters obtained were the maximum filling detrusor pressure, cystometric bladder capacity, and compliance. After 12 weeks of the intravesical injection, the patients were revaluated and the results were compared using paired samples t-test. RESULTS: The study enrolled 75 patients. And of those, statistical analysis was done on 46 patients who did follow the study protocols. The mean age was 8.9 years and male to female ratio was 1:4. There was a statistically significant improvement in overactive bladder symptoms and urodynamic parameters in the patient injected with botulinum toxin with minimal side effects. CONCLUSION: The evidence in this study would support the safety and efficacy of Intravesical botulinum toxin injection in children with refractory idiopathic OAB with significant improvement of symptoms, quality of life, as well as urodynamic parameters. TYPE OF STUDY: Open-label uncontrolled therapeutic clinical trial. LEVEL OF EVIDENCE: III.

Diagnosis of mesenteric panniculitis in the multi-detector computed tomography era. Association with malignancy and surgical history.

OBJECTIVES: To assess the prevalence and associations of mesenteric panniculitis (MP) using multi-detector CT (MDCT). METHODS: This retrospective study included 4758 consecutive patients who underwent abdomino-pelvic MDCT between January 2012 and December 2014 at Jordan University Hospital, Amman, Jordan. Radiological database was searched for MP diagnosis and patients with suspected MP were re-evaluated by an experienced radiologist to confirm the diagnosis. Data on all patients with confirmed MP diagnosis were subsequently collected and analyzed. RESULTS: Computed tomography features of MP were identified in 90 patients (41 males, 49 females), a prevalence of 1.9%. Mesenteric panniculitis was identified in both asymptomatic and symptomatic patients. Malignancy was found in 28 MP patients (31%) and 44 of the MP patients (49%) had prior history of abdomino-pelvic surgery. Mesenteric panniculitis was significantly more frequently associated with prior abdomino-pelvic surgery (p=0.0001) and the likelihood of associated malignancy in patients with MP was 2.1-fold higher than in patients without MP (p=0.0013). Conclusion: Mesenteric panniculitis can be reliably diagnosed by MDCT due to its typical CT appearance. Its identification is important because of its significant association with malignancy and because it represents one of the differential diagnoses in patients with nonspecific symptoms referred for abdomino-pelvic CT.

Incidence and anatomical variations of accessory navicular bone in patients with foot pain: A retrospective radiographic analysis.

The accessory navicular (AN) is an accessory ossicle anatomically located on the medial side of the foot, proximal to the navicular and continuous with the tibialis posterior tendon. It is occasionally a source of pain and local tenderness. Knowledge of the AN and its morphological variations can help identify the source of a patient's symptoms and prevent misinterpreting them as fractures. Foot radiographs from 1,240 patients who presented in two centers with chronic foot pain, or persistent pain developed after trauma, were retrospectively reviewed to determine the incidence and variations of the AN in relation to gender. The AN was found in 20.9% (259/1240). Among 259 feet with AN, Type 1 was identified in 25.4% (66/259), Type 2 in 42.4% (110/259) (20.0% (52/259) Type 2 A and 22.4% (58/259) Type 2B), and Type 3 in 32.0% (83/259). After 13 patients with incomplete medical records had been excluded, the remaining records showed that foot pain was associated with an AN in 10.6% of patients (26/246). In 1.2% of cases, two additional ossicles were found proximal to the navicular, possibly the result of multiple ossification centers that did not unite at the time of development. Patient symptomatology was related to the presence of an AN in 2% of patients with chronic foot pain. The AN could vary morphologically. Our data can enhance our diagnostic skills in detecting these ossicles. Clin. Anat. 30:436-444, 2017. © 2017 Wiley Periodicals, Inc.

Testicular microlithiasis: Correlation with doppler sonography of testicular arteries and sperm function.

PURPOSE: To determine the prevalence of testicular microlithiasis and its correlation with Doppler parameters of testicular arteries and sperm function. METHODS: Reports of 1,200 consecutive scrotal sonographic examinations performed at our hospital were reviewed. Patients diagnosed with testicular microlithiasis were recalled for detailed scrotal sonographic examination, including Doppler sonography and sperm function. The same examinations were performed in an age-matched control group and the findings compared. RESULTS: Testicular microlithiasis was found in 64 cases (5.3%). Doppler sonography showed mean resistance index, Vmax, and Vmin of 61.1 ± 9.3%, 18.2 ± 4.7 cm/s, and 7.7 ± 2.3 cm/s, respectively, in the testicular microlithiasis group versus 62.4 ± 10.4%, 18.4 ± 5.7 cm/s, and 7.3 ± 2.4 cm/s, respectively, in the control group (p = 0.49, 0.84 and 0.35, respectively). Sperm function tests demonstrated sperm count, motility, and normal morphology (normal oval head) of 29.6 ± 20.4 × 10(6) /mL, 35.3 ± 16.2%, and 44.4 ± 12%, respectively, in patients with testicular microlithiasis versus 54.3 ± 22.4 × 10(6) /mL, 50.2% ± 14.4%, and 66.4 ± 11.6% in control subjects (p < 0.02). CONCLUSIONS: Prevalence of testicular microlithiasis of 5.3% in Jordanian patients is similar to what has been reported in the literature. Testicular microlithiasis does not have a significant effect on Doppler parameters of testicular arteries. The apparent impairment of sperm function in patients with testicular microlithiasis warrants further studies. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:474-479, 2016.

Ultrasonographic assessment of splenic volume and its correlation with body parameters in a Jordanian population.

OBJECTIVES: To estimate normal linear dimensions and volume of spleen in Jordanians using ultrasonography, and to correlate splenic volume with age and body parameters: height, weight, body surface area (BSA), and body mass index (BMI). METHODS: A prospective pilot study was conducted on 205 volunteers (115 males and 90 females) not known to have any conditions likely to be associated with splenomegaly. The study was performed at the Radiology Department, Jordanian University Hospital, Amman, Jordan, between December 2013 and August 2014. All linear dimensions of spleen were measured, and splenic volume (index) was calculated using the standard prolate ellipsoid formula (length × width × depth × 0.523). The splenic volume was then analyzed with age and body parameters using the Pearson's correlation coefficient. RESULTS: The mean (± SD) splenic dimensions were 10.72±1.37 cm in length, 7.40±1.52 cm in width, 4.40±1.47 cm in depth, and 184.15±79.56 cm3 in volume. Men had larger spleens than women (p less than 0.0001). Age had no significant effect on spleen volume (r=0.11, p=0.12). There was a significant moderate positive correlation (p less than 0.0001), using Pearson's correlation coefficient, between the spleen volume, and other parameters (height, weight, BSA, and BMI), with correlation coefficients exceeding 0.3. CONCLUSION: A local reference of spleen dimensions was established with a different range of values reported previously.

Chronic gastritis in a gastric diverticulum misdiagnosed as a left adrenal mass.

Gastric diverticula are rare and usually asymptomatic. They are most frequently located on the posterior wall of the stomach. Many of them were reported as adrenal masses. Here, we present a 48-year-old male with a gastric fundus diverticulum that was misdiagnosed as a left adrenal mass on magnetic resonance imaging (MRI). Laparoscopic resection of the diverticulum was successfully performed, and histopathological examination revealed a true gastric diverticulum with moderate chronic gastritis. Although most cases of gastric diverticula are asymptomatic, to the best of our knowledge, this is the first reported case of chronic gastritis that developed in a gastric diverticulum.

Utility of free prostate specific antigen serum level and its related parameters in the diagnosis of prostate cancer.

We evaluated the role of free prostate specific antigen (f-PSA) serum level and its related parameters in detecting prostate cancer. This retrospective study was conducted between January 2006 and March 2008. Transrectal ultrasound guided prostate biopsy was performed for 107 patients who had total PSA (t-PSA) level of either >4 ng/mL with or without palpable nodule or ≤4 ng/mL with palpable nodule on digital rectal examination. The performance measurements for f-PSA, percent free PSA (%f-PSA) and free PSA density (f-PSAD) were determined and compared with those for t-PSA and total PSA density (t-PSAD). Descriptive statistics for all variables of interest were calculated, and receiver operating characteristic curves were generated. Nine patients (8.4%) had normal histology, 69 patients (64.4%) had benign disease and 29 patients (27.1%) had prostate cancer. The performance of f-PSA in PCa detection was better than other evaluated parameters. The largest area under the curve for patients in the gray area (t-PSA range 4.1-10 ng/mL) was for f-PSA, with a value of 0.64 and a sensitivity and specificity of 44% and 87%, respectively. For %f-PSA, these values were 0.59, 63% and 62%, respectively. For patients with a t-PSA level of 10.1-20 ng/mL, they were 0.68, 67%, and 81%, respectively, for f-PSA, and 0.64, 67%, and 76%, respectively, for %f-PSA. In conclusion, f-PSA serum levels performed better than free to total PSA ratio and t-PSA for prostate cancer screening. It is of clinical value which could affect the biopsy decision avoiding unnecessary interventions.

Factors affecting urinary calculi treatment by extracorporeal shock wave lithotripsy.

Extracorporeal Shock Wave Lithotripsy (ESWL) is still the treatment of choice for most renal and upper ureteric stones; however the outcome depends on multiple factors. The objective of this study was to investigate the effects of stone density, as measured by Hounsfield Units (H.U) by non-contrast Computerized Tomography (CT), stone size and stone location on ESWL treatment outcome of urinary calculi in Jordanian patients. 65 patients underwent clinical, biochemical and radiological assessments followed by ESWL treatment. Statistical analyses including chi-square, analysis of variance (ANOVA), correlation, regression were performed for statistical significance between ESWL treatment, stone fragmentation and stone density, size and location in the renal pelvis. ESWL success rate was high (94%) for low density stones (< 500 Hounsfield units). In general CT densities of 750 Hounsfield units or less were almost always successfully treated by ESWL. An inverse association between ESWL treatment outcome and stone size was also documented. CT stone density and stone size combined account for nearly 73% of the variation in the number of shock waves required to attain fragmentation. Stones located in lower calyceal area had less success rates. In conclusion, stones with higher density, large size and lower location may better be managed by percutaneous nephrolithotomy.

The role of B-mode ultrasonography in the detection of urolithiasis in patients with acute renal colic.

This study was conducted to assess the diagnostic yield of B-Mode Ultrasonography compared to unenhanced helical CT scan in detecting urinary stones in patients with acute renal colic. This retrospective study comprised of 156 patients who underwent unenhanced urinary tract CT scan and ultrasonography for suspicion of urolithiasis. Both techniques were used to determine the presence or absence, site, size, and number of urinary stones, as well as presence of any other intra-abdominal pathology. For statistical analysis, the sensitivity, specificity, predictive values, and diagnostic accuracy of ultrasonography were measured considering unenhanced CT scan as a gold standard. Unpaired two-tailed student's t-test was used for comparison between mean size of true positive, false positive, and false negative stones. There were 68 patients having 115 urinary stones. Ultrasound identified 54 stones, missed 43, and falsely diagnosed 18 stones. The mean size of true positive, false positive, and false negative stones were 4.8 +/- 3.3 mm, 6 +/- 1.8 mm and 4.18 +/- 3 mm, respectively. There were 23 patients with other intra-abdominal pathologies, equally detected by both techniques. Ultrasound helped in identifying the cause of acute flank pain in 62% of cases. The overall sensitivity, specificity, positive and negative predictive values, and accuracy of ultrasonography in the diagnosis of renal stone disease were 58%, 91%, 79%, 78%, and 78%, respectively. Our study suggests that, despite its limited value in detecting urinary stones, ultrasonography should be performed as an initial assessment in patients with acute flank pain. Unenhanced helical CT should be reserved for patients in whom ultrasonography is inconclusive.

Pituitary magnetic resonance imaging experience in Jordan.

OBJECTIVE: To assess the pituitary findings as demonstrated on MRI and to compare the results with the data published in the literature. METHODS: One thousand, one hundred and thirty-eight pituitary MRI`s with and without intravenous contrast media (gadolinium) were performed over 6 years from 2001 to 2007 in the Department of Diagnostic Radiology, Jordan University Hospital, Amman, Jordan. The patients were referred from various departments and were evaluated for pituitary, other sellar, and juxtasellar abnormalities. The results were compared with those in the published literature. RESULTS: Four hundred and eight-three normal scans were excluded from the study. The remaining 655 were abnormal, pituitary adenoma was detected in 327 (49.9%), microadenoma was present in 213 (32.5%), and macroadenoma in 114 (17.4%). Partial empty sella was seen in 157 (24%), diffuse pituitary gland enlargement in 98 (14.9%), ectopic pituitary posterior lobe in 13 (2%), and other findings in 31 (4.7%). CONCLUSION: The incidence of pituitary adenoma was equal in both genders; however, microadenoma was more common, affected a younger age group, and was predominately seen in females. The other parameters showed agreement with the published literature.

Macrodystrophia lipomatosa with syndactyly.

Macrodystrophia lipomatosa (MDL) is a rare form of congenital localized gigantism characterized by hypertrophy of all mesenchymal tissues of the affected digits, with particular overgrowth of fat. Syndactyly is a rare association. We report a case of MDL associated with syndactyly affecting the hand. We describe the characteristic radiographic and MRI findings that distinguish the abnormality from other causes of localized gigantism.

Value of serum bilirubin levels in selecting patients for magnetic resonance cholangiopancreatography.

BACKGROUND/AIMS: To determine the value of serum bilirubin levels in selecting patients for MRCP. METHODOLOGY: The medical records of 142 patients who underwent MRCP between January 2002 and December 2004 were retrospectively reviewed. Clinical features, serum bilirubin levels, and MRCP results were recorded. The patients were categorized into 4 groups, according to serum bilirubin levels and MRCP findings. Bilirubin levels were considered elevated above 23.9 micromol/L for total bilirubin and above 6.8 micromol/L for direct bilirubin. Sensitivity, specificity, accuracy, and predictive values of serum bilirubin levels in identifying pancreatobiliary duct diseases were assessed. RESULTS: Complete medical records were found for 135 patients. Abnormal MRCP results were found in 75 patients (56%). Choledocholithiasis and both malignant and benign bile duct strictures represented 40%, 28%, and 23% of abnormal MRCP findings, respectively, with mean values of total and direct serum bilirubin levels of 77.9 +/- 51.6 microM and 34.7 +/- 30.3 microM (for choledocholithiasis), 170 +/- 115 microM and 56 +/- 40 microM (for malignant bile duct stricture), and 44 +/- 32 microM and 20 +/- 16 microM (for benign bile duct stricture), respectively. Sensitivity, specificity, and accuracy of serum bilirubin level tests, for the diagnoses of pancreatobiliary duct diseases, were 77%, 80%, and 79%, respectively; the positive and negative predictive values were 83% and 74%, respectively, and the corresponding likelihood ratios were 3.8 and 0.3. CONCLUSIONS: Serum bilirubin level tests alone are not sufficiently accurate for the diagnoses of pancreatobiliary duct diseases, and hence, such tests are of low importance in selecting patients for MRCP.

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.

Brown tumor of the femur associated with double parathyroid adenomas.

Severe parathyroid bone disease is a rare clinical presentation of primary hyperparathyroidism. Double parathyroid adenomas are even more rare cause of primary hyperparathyroidism. The authors present a case of double parathyroid adenomas in a 48-year-old man, who presented with painful left lower limb swelling, which was slowly growing in size in the last 20 years. Magnetic resonance imaging revealed a cystic bony lesion and coincidentally, a urinary bladder calculus. Biopsy of the mass revealed giant cell lesion. Laboratory investigations showed hypercalcemia and hypophosphatemia with elevated parathyroid hormone level. A computerized tomography scan of the neck delineated an adenoma of the left superior parathyroid gland, which was surgically removed. The left inferior parathyroid was also enlarged and was removed. Histological diagnosis confirmed double parathyroid adenomas. The rarity and the interesting clinical presentation of such association are discussed.

Multiple enchondromatosis Ollier's disease with two primary brain tumors.

A rare case of multiple enchondromatosis associated with 2 primary brain tumors is reported. A 21-year-old female who has diagnosed as Ollier's disease at the age of 9-years was admitted to the hospital with complaint of diplopia and progressive right upper and lower limb weakness. Magnetic resonance imaging of the brain depicted 2 intra-axial mass lesions. Stereotactic biopsy showed low grade fibrillary astrocytoma in both lesions. This report emphasizes that patients with Ollier's disease are at a higher risk for primary brain tumors than has been previously recognized.