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Background: The precise identification of the position and form of a tumor mass can improve early diagnosis and treatment. However, due to the complicated tumor categories and varying sizes and forms, the segregation of brain gliomas and their internal sub-regions is still very challenging. This study sought to design a new deep-learning network based on three-dimensional (3D) U-Net to address its shortcomings in brain tumor segmentation (BraTS) tasks., Methods: We developed a 3D dilated multi-scale residual attention U-Net (DMRA-U-Net) model for magnetic resonance imaging (MRI) BraTS. It used dilated convolution residual (DCR) modules to better process shallow features, multi-scale convolution residual (MCR) modules in the bottom encoding path to create richer and more comprehensive feature expression while reducing overall information loss or blurring, and a channel attention (CA) module between the encoding and decoding paths to address the problem of retrieving and preserving important features during the processing of deep feature maps., Results: The BraTS 2018-2021 datasets served as the training and evaluation datasets for this study. Further, the proposed architecture was assessed using metrics such as the dice similarity coefficient (DSC), Hausdorff distance (HD), and sensitivity (Sens). The DMRA U-Net model segments the whole tumor (WT), and the tumor core (TC), and the enhancing tumor (ET) regions of brain tumors. Using the suggested architecture, the DSCs were 0.9012, 0.8867, and 0.8813, the HDs were 28.86, 13.34, and 10.88 mm, and the Sens was 0.9429, 0.9452, and 0.9303 for the WT, TC, and ET regions, respectively. Compared to the traditional 3D U-Net, the DSC of the DMRA U-Net increased by 4.5%, 2.5%, and 0.8%, the HD of the DMRA U-Net decreased by 21.83, 16.42, and 10.00, the Sens of the DMRA U-Net increased by 0.4%, 0.7%, and 1.4% for the WT, TC, and ET regions, respectively. Further, the results of the statistical comparison of the performance indicators revealed that our model performed well generally in the segmentation of the WT, TC, and ET regions., Conclusions: We developed a promising tumor segmentation model. Our solution is open sourced and is available at: https://github.com/Gold3nk/dmra-unet., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-24-779/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Background: Evaluation of mitral (MA) and tricuspid annuli (TA) in the same healthy subject in a non-invasive way in real-life clinical settings makes an opportunity to compare their dimensions and derived functional properties. The purpose of the present cohort study was to investigate whether there are any differences in the three-dimensional speckle-tracking echocardiography- (3DSTE-) measured size and derived functional characteristics of the MA and TA in the same healthy adults., Methods: The study comprised 248 healthy adults, in which 3DSTE was performed to determine MA and TA dimensions and functional properties. Due to insufficient image quality, 89 cases were excluded, therefore the remaining population consisted of 159 subjects (age: 35.6±12.9 years, 76 males). Subjects were enrolled on a voluntary basis consecutively between January 2011 and November 2017 in the outpatient clinic of the tertiary cardiology center at the Department of Medicine, University of Szeged, Hungary. Data were analyzed by Student's t -test, analysis of variance (ANOVA) test, Fischer's exact test, Pearsons' correlations, interclass correlations and Bland-Altman tests., Results: Same-side MA/TA end-diastolic annular dilation is associated with simultaneous MA/TA end-systolic dilation and vice versa. MA dilation in end-diastole and end-systole results in MA functional improvement/deterioration. Dilation of end-diastolic TA dimensions does not obviously entail differences in TA function. However, similar to MA, more dilated TA in end-systole is associated with impaired TA function. Dilated MA dimensions (end-diastolic MA area: 4.31±0.62 vs. 10.89±1.18 cm 2 , P<0.05) are not obviously associated with dilated end-diastolic TA dimensions (area: 7.05±1.42 vs. 7.81±1.48 cm 2 , P=ns) and functional improvement/impairment (fractional area change: 27.5%±10.8% vs. 25.2%±10.6%, P=ns)., Conclusions: Dilation of MA and TA is associated with different contralateral responses in morphology and function., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-24-630/coif). A.N. serves as an unpaid editorial board member of Quantitative Imaging in Medicine and Surgery. The other authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Background: During the heart cycle, the left ventricle (LV) not only shows a contraction-relaxation pattern, but LV has a rotational mechanics, as well. It is a known fact that certain pathologies may be associated with an absence of LV twist, when LV basal and apical regions rotate in the same clockwise (cw) or counterclockwise (ccw) direction called LV 'rigid body rotation' (LV-RBR), but it can also occur in healthy subjects. The present cohort study aimed to examine LV strains in healthy subjects with LV-RBR versus with normally directed LV rotational mechanics by three-dimensional speckle-tracking echocardiography (3DSTE)., Methods: The study consisted of 181 healthy individuals, from which 171 cases had normally directed LV rotational mechanics (mean age: 32.5±12.3 years, 79 males) and 10 healthy subject showed LV-RBR (mean age: 35.4±11.3 years, 3 males). Complete two-dimensional (2D) Doppler echocardiography and 3DSTE were performed in all healthy individuals., Results: None of routine 2D Doppler echocardiographic parameters showed differences between the groups examined. There were no subjects with ≥ grade 1 regurgitation on any valves or with significant stenosis on any valves. 3DSTE-derived LV volumes, global and mean segmental strains did not differ between the groups examined. Apical anterior and lateral segments showed reduced segmental LV circumferential strain (CS) (-18.9%±8.5% vs. -26.7%±10.7%, P=0.02; -27.3%±12.6% vs. -34.8%±13.2%, P=0.08, respectively) and LV area strain (AS) (-26.8%±9.8% vs -36.8%±12.0%, P=0.01; -35.7%±13.2% vs. -45.0%±14.6%) in healthy subjects having LV-RBR as compared to cases with normally directed LV rotational mechanics. These abnormalities were present only in subjects having cwLV-RBR., Conclusions: Although global LV deformation is normal in the presence of LV-RBR in healthy adults, reduction of apical anterior and lateral LV-CS (and LV-AS) are present in cases with cwLV-RBR only suggesting segmental deformation abnormalities., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-24-140/coif). A.N. serves as an unpaid editorial board member of Quantitative Imaging in Medicine and Surgery. The other authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Background: There is a close relationship between volumes of the right atrium (RA) and dimensions and derived functional sphincter-like features of the tricuspid annulus (TA). However, its relation to longitudinal TA motion is not clear, which can even be considered to be a characteristic of the longitudinal shortening of the right ventricle (RV) and represented by TA plane systolic excursion (TAPSE). Therefore, the aim of this cohort study was to perform a detailed analysis of the relationship of three-dimensional speckle-tracking echocardiography (3DSTE)-derived RA volumes and RV longitudinal shortening in healthy individuals. These parameters were also examined in case of average values and larger/smaller than mean values., Methods: The present study comprised 93 healthy adults (mean age: 27.7±6.3 years, 46 men), who participated in a complete medical investigation including two-dimensional, TAPSE, Doppler and 3DSTE-derived RA volumetric echocardiographic assessments., Results: RA volumes, stroke volumes and emptying fractions were not related to TAPSE. In case of low, mean and high TAPSE, maximum [50.4±22.4 vs. 49.5±15.5 vs. 49.0±15.8 mL, P= not significant (ns)], preatrial contraction (36.9±16.8 vs. 34.5±10.4 vs. 35.6±10.5 mL, P= ns) and minimum (28.7±13.6 vs. 27.2±9.4 vs. 26.6±9.3 mL, P= ns) RA volumes did not differ. Higher RA volumes showed no associations with TAPSE either., Conclusions: 3DSTE-derived RA volumes and M-mode echocardiography-derived TAPSE representing RV longitudinal shortening are not associated in healthy adults. None of the RA volumes showed correlations with TAPSE., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-24-223/coif). A.N. serves as an unpaid editorial board member of Quantitative Imaging in Medicine and Surgery. The other authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Background: Intraventricular hemorrhage (IVH) after intracerebral hemorrhage (ICH) is a strong independent predictor of poor outcomes. Although the location and volume of ICH are associated with IVH, our knowledge concerning the mechanism of IVH after ICH is still limited. This study aimed to investigate the relationship between hematoma morphology and IVH in patients with supratentorial deep ICH., Methods: We retrospectively analyzed adult patients (aged ≥18 years) with spontaneous supratentorial deep ICH who underwent computed tomography (CT) within 48 h after ICH symptom onset in Peking University First Hospital between January 2017 and August 2022. We collected the clinical and imaging data of the patients and assessed hematoma morphology using several quantitative radiological parameters including hematoma volume, sphericity index, A/B ratio (A: the largest area of hematoma; B: the largest diameter 90° to A on the same slice), and our newly proposed largest diameter-midline angle (LMA). Multivariable logistic regression analysis was used to analyze the relationship between these parameters and the presence of IVH on the initial CT scan., Results: Among 114 patients with spontaneous supratentorial deep ICH, 41 (36.0%) had IVH. In patients with IVH, the sphericity index was lower than that in individuals without IVH, while the LMA was larger. Multivariate logistic regression analysis showed that sphericity index [0.1-unit odds ratio (OR) =0.252; 95% CI: 0.089-0.709; P=0.009] and the LMA (10-unit OR =1.281; 95% CI: 1.007-1.630; P=0.04) were independently associated with the presence of IVH in patients with supratentorial deep ICH. Univariate analyses showed that hematoma volume, A/B ratio, sphericity index, and the LMA were significantly associated with poor outcomes at discharge., Conclusions: Two quantitative parameters of hematoma morphology, sphericity index and the LMA, were significantly associated with the presence of IVH in patients with supratentorial deep ICH. Further prospective studies with larger sample sizes are needed to validate our results., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-266/coif). The authors have no conflicts of interest to declare., (2023 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Background: Three-dimensional (3D) surface imaging and morphometrics are becoming the preferred craniofacial surface imaging modality. However, as a unique advantage of 3D imaging, areal and volumetric measurements have been rarely conducted and validated for evaluating soft tissue change in the periocular region, especially the upper eyelids. Therefore, based on an existing periocular landmark identification strategy, we proposed a novel modified method to define a standardized upper eyelid region for areal and volumetric measurements and validate its reliability for future clinical application., Methods: Forty-four healthy adult volunteers were enrolled in this cross-sectional study. Three-dimensional facial images were taken with a 3D imaging system. Subsequently, the upper eyelid region selection and areal and volumetric measurements were conducted using a modified landmarks localization strategy to evaluate their intrarater, interrater, and intramethod reliability., Results: Areal measurement of the upper eyelid revealed highly reliable outcomes for intraclass correlation coefficient (ICC), mean absolute difference (MAD), relative error measurement (REM), technical error of measurement (TEM), and relative technical error of measurement (%TEM) of 0.982, 0.1620 cm 2 , 2.9%, 0.1510 cm 2 , and 2.7% for intrarater reliability, respectively; 0.969, 0.2076 cm 2 , 3.7%, 0.1930 cm 2 , and 3.5% for interrater reliability, respectively; and 0.917, 0.3636 cm 2 , 6.5%, 0.3354 cm 2 , and 6.0% for intramethod reliability, respectively. Unsatisfactory results were found for the volumetric measurement of the upper eyelid: the ICC, MAD, REM, TEM, and %TEM estimates for intrarater reliability were 0.992, 0.2299 mL, 10.3%, 0.2414 mL, and 10.8%, respectively; for interrater reliability, these values were 0.985, 0.2749 mL, 12.3%, 0.3253 mL, and 14.6%, respectively; and for intramethod reliability, these values were 0.433, 1.6716 mL, 77.9%, 2.0615 mL, and 96.1%, respectively., Conclusions: This is the first study to propose a standardized upper eyelid region selection strategy and simultaneously validate its reliability for 3D areal and volumetric measurements. This study confirmed the high-level reliability of areal measurement and poor reliability of volumetric measurement based on direct measurements using a single image, which may provide better results when this method is combined with the image overlapping and registration procedure. However, this is subject to further validation. Nonetheless, this method could provide quantitative areal and volumetric data on the upper eyelids and might have widespread application potential in the future., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-22-589/coif). The authors have no conflicts of interest to declare., (2023 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Background: With larger blood volume flowing into a cardiac chamber, by stretching muscle fibers, increased contraction force could be detected. This phenomenon is called Frank-Starling mechanism, allowing the output of a cardiac chamber to be synchronized without external regulation. The purpose of the present study was to investigate the Frank-Starling mechanism in the right atrium (RA) represented by its volumes, volume-based functional properties and strains respecting the cardiac cycle in healthy adults by three-dimensional (3D) speckle-tracking echocardiography (3DSTE)., Methods: The present single center retrospective cohort study comprised 179 healthy adult volunteers (mean age: 33.2±12.0 years, 92 males), in whom complete two-dimensional Doppler echocardiography with 3DSTE was performed. Subjects were divided into 3 groups according to the mean value of maximum RA volume (V max ) ± standard deviation: V max <30 mL, 30 mL ≤ V max <60 mL and V max ≥60 mL., Results: All RA volumes respecting the cardiac cycle of all subjects and calculated separately for females and males and their indexed equivalents increased with V max . RA stroke volumes increased with V max regardless of the phase it was measured in. While total atrial emptying fraction representing the reservoir phase remained unchanged with the increase of V max , a significant increase in passive atrial emptying fraction representing the conduit phase could be detected, in case of V max >60 mL (28.9%±15.1% vs. 32.5%±12.6%, P<0.05). Active atrial emptying fraction representing the booster pump function did not change with the increase of V max . Most global and mean segmental peak RA strains did not show significant changes with increasing RA volumes except for the RA area strain, it was the largest when V max was larger than 60 mL (64.7%±44.9% vs. 83.3%±49.4%, P<0.05). RA circumferential, longitudinal and area strains at atrial contraction decreased with increasing V max , RA radial and 3D strains did not change significantly with increasing V max ., Conclusions: Increasing RA volumes do not cause significant increase in RA contractility represented by strains, but reduction in strains in longitudinal and circumferential directions could be detected in end-diastolic booster pump function. In contrast to the left atrium, obvious signs of Frank-Starling mechanism could not be detected in case of the RA., Competing Interests: Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-22-307/coif). AN serves as an unpaid editorial board member of Quantitative Imaging in Medicine and Surgery. The other author has no conflicts of interest to declare., (2023 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Background: Hemophilia is an X-linked inherited disorder primarily affecting males, its major types are type A (deficiency in factor VIII) and B (deficiency in factor IX), and is considered to be the most common severe congenital coagulation factor deficiency. The present study was designed to test whether any differences in left ventricular (LV) rotational mechanics could be demonstrated between male patients with hemophilia and healthy controls using three-dimensional speckle-tracking echocardiography (3DSTE)-derived virtual LV models., Methods: The present study consisted of 17 patients with hemophilia, however, 3 patients were excluded due to insufficient image quality. In the remaining patient population, 12 patients had hemophilia A and 2 patients had hemophilia B (mean age: 42.2±18.9 years, all males). The control group comprised 16 age-matched healthy subjects (46.0±5.9 years, all males)., Results: None of the routine two-dimensional echocardiographic data differ between patients with hemophilia and controls. None of the patients and controls showed ≥ grade 1 valvular regurgitations and had valvular stenoses. In one subject, the near absence of LV twist called as LV "rigid body rotation" could be detected, data of which were managed separately. While 3DSTE-derived apical LV rotation was 3.65 degrees, basal LV rotation proved to be 3.57 degrees leading to 0.08-degree LV apico-basal gradient suggesting counterclockwise LV "rigid body rotation". In the remaining patients, both LV apical rotation (7.25±6.20 vs. 10.39±4.16 degrees, P<0.02) and LV twist (10.24±5.60 vs. 14.38±3.93 degrees, P<0.003) showed significant impairment in patients with hemophilia., Conclusions: LV rotational abnormalities are present in hemophilia with reduced LV apical rotation and twist., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/qims-21-30). AN serves as an unpaid editorial board member of Quantitative Imaging in Medicine and Surgery. The other authors have no conflicts of interest to declare., (2022 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Background: It is extremely important to understand the local anatomy prior to performing appropriate and efficient robot-assisted partial nephrectomies (RAPNs)., Methods: We developed a personalized three-dimensional printed kidney model of square-block type to enhance our knowledge and understanding on the underlying anatomy during RAPN, and we consequently applied this model to six initial cases of RAPN., Results: The mean warm ischemic time was 18 minutes and the mean estimated blood loss was 59 mL. Only one patient presented with a minor complication, whereas all six patients included in this study were surgical margin negative., Conclusions: We believe that this cost-effective model helped us in understanding the underlying local anatomy and facilitating an increased efficiency in the related surgery. Further studies are required to validate our preliminary results., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tau.2019.12.31). The authors have no conflicts of interest to declare., (2020 Translational Andrology and Urology. All rights reserved.)

Background: Kidney transplantation (KTx) is the preferred treatment for virtually all suitable candidates with end-stage renal disease. There is limited information on left ventricular (LV) rotational mechanics post-KTx, therefore the present study aimed to assess it and to compare it to that of age- and gender-matched healthy controls., Methods: The present study comprised 42 KTx patients, from which 4 patients were excluded due to insufficient image quality (mean age: 46.3±8.2 years, 29 males). Control group consisted of 81 age- and gender-matched healthy individuals (mean age: 43.5±10.8 years, 51 males). All KTx patients and healthy controls successfully underwent transthoracic two-dimensional (2D) Doppler echocardiography and three-dimensional speckle-tracking echocardiography (3DSTE)., Results: Significant differences could be demonstrated in LA diameter, LV end-diastolic diameter and volume, interventricular septum, LV posterior wall thickness, LV ejection fraction and early and late filling transmitral flow velocities and in their ratio between KTx patients and controls; none of the subjects examined showed grade 2-4 mitral and/or tricuspid regurgitations. Three patients following successful KTx showed near absence of LV twist called as LV 'rigid body rotation' (RBR) movement. When the remaining 35 post-KTx patients were analysed separately, reduced basal LV rotation could be demonstrated in post-KTx patients with tendentious increase in apical LV rotation resulting in an unchanged LV twist., Conclusions: KTx is associated with alterations in LV rotational mechanics with unchanged LV twist suggesting a remodelling of this sort of movement. The near absence of LV twist (LV-RBR) could be demonstrated in some post-KTx cases., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

The right atrium (RA) is the most under-evaluated heart chamber in the clinical practice. Three-dimensional (3D) speckle-tracking echocardiography (STE) merges the benefits of 3D echocardiography and STE: volumetric and strain assessment of the RA can be performed at the same time from the same digitally acquired 3D echocardiographic dataset with a special equipment using a virtual 3D model of the RA. A diagnostic focused study is under way at the Second Department of Medicine and Cardiology Center, University of Szeged, Hungary to assess 3D-STE-derived RA variables in different patient populations, which serves as a substudy of Motion Analysis of the heart and Great vessels bY three-dimensionAl speckle-tRacking echocardiography in Pathological cases (MAGYAR-Path) Study. The aim of the present review is to summarize these early results., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Cardiac amyloidosis (CA) is an infiltrative disease primarily caused by extracellular tissue deposition of amyloid fibrils in the myocardial interstitium. The aim of the present study was to examine left ventricular (LV) rotational mechanics in biopsy-proven CA by three-dimensional (3D) speckle-tracking echocardiography (STE). Ten patients (65.3±11.5 years, 6 males) with CA entered the study. The mean basal LV rotations were 0.3±3.8°, while mean apical LV rotations proved to be 7.0±3.3°. LV basal and apical rotations were in the same counterclockwise direction in 6 out of 10 CA patients demonstrating near absence of LV twist [LV rigid body rotation (RBR)]. Apico-basal difference was near 3 or less degrees in three patients with LV-RBR, and 6-10 degrees in the other three subjects with LV-RBR. One another patient showed normal rotational mechanics, while two patients had significant hyporotations and one had significant hyperrotations in normal directions. To conclude with, different patterns of LV rotational mechanics could be demonstrated in CA. LV RBR, the near absence of LV twist seems to be a frequent phenomenon in CA.