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We report a case of pleomorphic sarcoma in a 42-year-old man with adult polycystic kidney disease [APKD]. Abdominal ultrasonography, computed tomography and MRI scans have revealed heterogenous bilateral renal cysts with a voluminous mass in the upper pole left kidney. Radical left nephrectomy with histopathologic and immunohistologic examination have confirmed the diagnosis of pleomorphic sarcoma. Sarcoma associated with adult polycystic kidney disease is extremely rare and does not have particular radiological or biological features when compared to primary renal sarcoma.

Resume Objectif – rapporter le polymorphisme radiologique des angiomyolipomes (AML). Materiel et methodes – etude retrospective de huit cas d'AML explores par echographie et tomodensitometrie retenus sur l'aspect radiologique dans sept cas et sur une confirmation histologique dans un cas. Resultats – la decouverte etait fortuite dans cinq cas. Une sclerose tubereuse de Bourneville (STB) a ete notee dans cinq cas. L'âge moyen etait de 37 ans avec une predominance feminine sept fois sur huit. Les AML etaient multiples dans la moitie des cas, tous atteints de la STB. La taille etaient variable entre 5 mm et 20 cm. L'echographie a montre un aspect hyperechogene homogene dans six cas et heterogene dans deux cas. La TDM a montre des lesions tissulaires d'aspect variable et polymorphe. La composante graisseuse des AML a ete retrouvee chez sept patients. Un saignement intratumoral a ete note dans un cas. Conclusion – l'aspect radiologique des AML est variable en fonction de la taille tumorale. Il est evocateur devant la presence d'une tumeur renale avec un contingent graisseux. L'association a une STB est un argument diagnostique supplementaire.

The main advantage of recognition and diagnosis of SAPHO syndrome is the avoidance of unnecessary prolonged antibiotic treatment and repeated invasive procedures. The combination of synovitis, acne, pustulosis, hyperostosis and aseptic osteitis is known as SAPHO syndrome. The most common site of the disease is the upper anterior chest wall, characterized by predominantly osteosclerotic lesions, hyperostosis, and arthritis of the adjacent joints. Osteosclerosis of the vertebral bodies, hyperostosis, and erosions of the vertebral plates are rarely encountered. We present a case of SAPHO syndrome with C1-C2 spondylodiscitis. Diagnosis of SAPHO syndrome was established using Khan et al. criteria (Schilling, SAPHO syndrome, Encyclopedie Orphanet, 2004). CT showed osteosclerotic lesions of dens axis. MRI sequences reveal inflammatory bone marrow oedema. Radiologists should be aware of this unusual syndrome to avoid misdiagnosis (tumour/infection), unnecessary surgery, and antibiotic therapy.

Resume Les teratomes sacrococcygiens sont des tumeurs congenitales rares, observees le plus souvent en periode neonatale et rarement chez l’enfant. L’exerese tumorale doit etre radicale pour eviter la recidive, qui se fait volontiers sous une forme maligne. Nous rapportons une observation d’une fille de 8 ans, sans antecedents pathologiques, qui presentait depuis l’âge de 2 ans une tumefaction sacree d’installation progressive sans deficit neurologique. L’imagerie par resonance magnetique montrait une volumineuse lesion sacrococcygienne en hyposignal T1, hypersignal T2 et sans prise de contraste. La tumeur a ete enlevee en totalite, l’aspect peroperatoire etait celui d’une tumeur kystique a contenu visqueux. L’etude histologique montrait qu’il s’agissait d’un teratome.

Internal hernias, including paraduodenal (traditionally the most common), pericecal, foramen of Winslow, and intersigmoid hernias, account for approximately 0.5-5.8% of all cases of intestinal obstruction and are associated with a high mortality rate, exceeding 50% in some series. We report an extremely rare case of an internal abdominal hernia, through the right mesocolon, in a young woman with a right colon with no peritoneal fixation. This hernia was revealing by abdominal pain, nausea, and vomiting. The diagnosis of internal hernia was suggested by computed tomography (CT), but the exact type of internal hernia was confirmed by surgical exploration. The postoperative course was uneventful and the patient fully recovered after 3 days. The patient is free from symptoms and from recurrence, after 12 months of follow-up.

Background Isolated central nervous system (CNS) tuberculoma is rare. Central nervous system tuberculosis (TB) is associated with high morbidity and mortality despite modern methods of detection and treatment. The authors report a case of a giant cerebellar tuberculoma mimicking a malignant tumor and review the literature. Observation A six-year-old girl, with no past medical history, vaccinated for her age, presented with a three-month history of occipitocervical cephalalgia, complicated by gait disturbances. The MRI showed a left cerebellar tumor suggestive of a medulloblastoma. At surgery, a nodular, avascular lesion was found and pathological examination confirmed tuberculoma. Intracranial tuberculoma is an uncommon variety of central nervous system tuberculosis. The prognosis is related to the rapidity of diagnosis, surgical resection and the complementary antituberculosis treatment. Conclusion Intracranial tuberculoma is an uncommon variety of central nervous system infection. Prognosis is improved by a quick diagnosis, surgical removal, and associated antituberculoma therapy.

A 47-year-old man with a history of lung adenocarcinoma presented a red and painful right eye with loss of visual acuity after the 5th course of chemotherapy. The ophthalmologic exam showed visual acuity at 3/10 and diffuse iris nodular lesions in the same eye. The fundus was not visible. The controlateral eye was normal. The ocular scan showed iris tumors without choroidal metastasis. Systemic medical evaluation demonstrated no other metastases. The patient died 1 year later.

The aim of our study was to evaluate the incidence of orthodontically induced root resorption during the tooth alignment and leveling phase, and to assess the impact of the variables age, sex and degree and direction of incisor displacement. We studied a consulting population at the dentofacial orthopaedics unit of the Dental Consultation and Treatment Centre (DCTC), Casablanca. Our sample was composed of 30 exposed cases and 30 non-exposed cases, followed up for a period of 8 months. A survey document was drawn up for data collection, and retro-alveolar radiographic imaging was used to evaluate resorption. Our results showed that the patients receiving orthodontic treatment all developed minor root resorptions during the alignment and levelling phase in the incisor group. We found that the central incisors underwent greater resorption than the lateral incisors.

Gingival hyperplasia is a relatively frequent pathologic condition during orthodontic treatment. Oral hygiene can be easily altered in such cases because of additive and irritative effects of orthodontics appliances. So, adequate control of the gingival inflammation is required. The present case reports on a 13-year-old boy who developed, during orthodontic treatment, a gingival hypertrophy that was successfully treated with periodontal surgery consisting on an apically positioned flap procedure. For this purpose, multidisciplinary approach involving orthodontist and periodontist was crucial in the perspective of optimal clinical issues.

Based on the principle of the sphere of MONSON, the Broadrick flag technique constitutes a relatively simple means to determine the plan of occlusion, by using a radius fixes of 104 mm. The theory of MONSON was debated a long time. Our work consists of a clinical study realized in the CCTD of Casablanca, on 31 completely toothed cases normocclusion. Its objective was triple: to calculate on the profile teleradiographies, the anatomical and geometrical rays used for the construction of SPEE curve, to see if there is concordance between these two rays and finally to compare them with the theoretical value of 104 mm. From the obtained results it would seem that: The 104 mm value, cannot be considered as a standard average to be used to determine the curve of occlusion, also the articulator such as it is designed currently cannot be used in all the patient's about is the values of their rays. In the absence of molars, the anatomical radius cannot be used in place of the geometrical radius to determine the curve of occlusion. The measured gap between the obtained curve and the plan of occlusion remains not insignificant, he can reach 3 mm for the anatomical radius and 3,5 mm for the geometrical radius. In the total edentate, the cephalometric determination of occlusion plane, by basing itself on the anatomical radius or the geometrical radius is not possible.

The daily business of every orthodontist is to correct malocclusions and the patient's accompanying unesthetic appearance, thus enhancing his/her social integration and boosting their self-esteem. Consequently, we considered it necessary to have the facial esthetics of the Moroccan population assessed by two panels, one a lay group representing the general public, the other a panel of professionals. We conducted a transverse descriptive inquiry on 100 students from the Casablanca School of Dental Medicine. Views showing the full face, profile and three-quarters smile were submitted for evaluation by the lay and professional panels. Statistical comparison showed a significant correlation between the two panels. Cephalometric findings of the eight cases judged to be the most attractive were compared with Steiner analysis and showed concordance for the majority of the measurements studied. Likewise, comparison of the opinions of the male and female sections of the panels demonstrated significant concordance.

Introduction Ewing's sarcoma of the calcaneus is rare. About thirty cases with calcaneus involvement have been reported in the literature. Talus skip metastases have rarely been described in the available literature Case presentation We report a case of a 14-year-old Moroccan boy, who presented with Ewing's sarcoma of his right calcaneus, diagnosed by swelling of the calcaneus evolving over a year. Radiography, computed tomography and magnetic resonance imaging showed an important tumoral process of the calcaneus and talus skip metastases. The diagnosis was confirmed with histology after a biopsy. In spite of amputation and postoperative chemotherapy, our patient died six months later due to secondary respiratory distress after lung metastasis. Conclusion Imaging, especially magnetic resonance, is important in the diagnosis of Ewing sarcoma and skeletal skip metastases. Treatment of Ewing's sarcoma consists of chemotherapy, radiation therapy and surgical resection depending on the stage and extent of the disease. With the exception of lesions in the calcaneus, the prognosis for disease-free survival of Ewing's sarcoma of the foot is excellent.

Multibracket orthodontic appliances increase dental plaque retention and make teethbrushing more difficult for patients. As a result, advice from the orthodontist on oral hygiene along with patient motivation regarding teethbrushing are particularly important. The aim of this study was to compare the efficacy of electric toothbrushes with that of manual brushing associated with mouth-rinses comprising chlorhexidine (0.12%) and 0% alcohol. To this end, 84 patients receiving current orthodontic treatment were randomly selected from patients treated at the Dento-Facial Orthopedics department in the Casablanca Dental Consultation and Treatment Center. Selected patients were divided into three groups: Group 1: manual teethbrushing; Group 2: electric teethbrushing; Group 3: manual brushing combined with mouth rinse. Oral hygiene was assessed using the Loe-Silness plaque and gingival indices. Measurements were made before and 4 weeks after the observation period. Results were subjected to statistical comparison in order to determine the group showing greatest improvement and to deduce the best means of controlling bacterial plaque. The electric toothbrush and the chlorhexidine mouth rinse appear to control dental plaque more effectively than manual teethbrushing alone. Following this study, patients receiving multibracket treatment were invited to combine manual brushing with short clinical mouth-rinsing sessions or to use an electric toothbrush.

Orthodontic-Surgical Treatment: Electromyographic and Electrognatographic Evaluation with Three Electromyographic Instruments

To illustrate the value of cross-sectional imaging (CT, MRI) for the diagnosis and follow-up of intracranial hydatid cysts in children.Retrospective study of 9 cases of intracranial hydatid cysts in children seen over a period of 8 years. Precontrast and postcontrast 5 mm thick axial CT images were obtained in 7 cases. Noncontrast sagittal, axial and coronal T1W and T2W images were obtained in 2 cases.Mean patient age was 7.5 years. Intracranial hypertension was the main presenting clinical symptom. A single supratentorial cyst with significant mass effect upon the ventricular system and midline structures was observed in all cases. All patients underwent surgery with good outcome in all cases.CT is the imaging modality of choice for diagnosis and postoperative follow-up of intracranial hydatid cysts in children. MRI is most helpful for further characterization when multiple or atypical cysts are present to optimize management.

Chromomycosis is a chronic infection caused by various fungi. Bone involvement is exceptional. The purpose of this report is to describe a case of chromoblastomycosis localized on the tarsal bone in a 27-year-old man from southern Morocco. The patient was a former barefoot long-distance runner. He presented with thickening of the skin with a cutaneous fistula on the left forefoot. These manifestations had been ongoing for 2 years. Imaging demonstrated scattered lytic lesions involving tarsal bone and the base of the third metatarsus. Definitive diagnosis was based on direct mycological examination and anatomopathology. Medical and surgical treatment led to stabilization of the lesions. No recurrence was observed during follow-up examination two years later.

Patients undergoing orthodontic treatment can experience an unpleasant painful sensation. This has been proven by several studies. Controling pain during orthodontic treatment is in the interest of both practitioner and patient. The aim of this study was to compare the effect of ibuprofen and paracetamol on orthodontic pain. To this end, a sample of 56 patients was divided into two groups: Pain levels were assessed using the visual analog scale at 2h, 6h, 24h, day 2, day 3 and day 7 after insertion of the first archwire. Results show that there is no significant difference between ibuprofen and paracetamol regarding control of orthodontic pain except during the first two hours after archwire insertion when paracetamol was observed to be slightly more effective than ibuprofen. Comparison by age and gender revealed no significant differences. Thus, we can conclude that paracetamol and ibuprofen are painkillers of choice in the relief of orthodontically-related pain.

Temporal bone trauma is frequent but difficult to assess due to the diversity of clinical presentations and complex anatomy. We have sought to assess the different types of fractures and complications on high-resolution CT. Materials and methods. Descriptive retrospective study over a 24 month period performed in the ENT radiology section of the Mohammed VI university medical center in Marrakech. A total of 38 cases of temporal bone trauma were reviewed. All patients underwent ENT evaluation and high-resolution CT of the temporal bone using 1mm axial and coronal sections.Mean patient age was 33 years (range: 14-55 years) with male predominance (sex ratio: 36/2). Clinical symptoms were mainly otorrhagia and conductive hearing loss. Oblique extra-labyrinthine fractures were most frequent. Two cases of pneumolabyrinth were noted. Management was conservative in most cases with deafness in 3 cases.High-resolution CT of the temporal bone provides accurate depiction of lesions explaining the clinical symptoms and helps guide management. MRI is complimentary to further assess the labyrinth and VII-VIII nerve complex.

Primitive internal hernias are a rare cause of intestinal obstruction. They are often paraduodenal even transmesocolic, but only rarely transomental. We present a rare case of an internal abdominal hernia in a young man. The small bowel was strangulated by an intra mesenteric appendicitis. This hernia was revealed by abdominal pain, nausea and vomiting. Plain X-ray of the abdomen showed dilated jejunal and ileal loops with multiple air-fluid levels. The diagnosis of appendicitis was suggested by ultrasound but the internal hernia was found only upon surgical exploration. An appendicectomy and adhesiolysis were performed. The patient recovered fully after 3 days, and had an uneventful postoperative course. The authors discuss the possible cause of this rare intestinal obstruction.

Emphysematous cystitis is a rare disease caused by gas-forming bacterial and fungal pathogens. It complicates urinary tract infections, especially in diabetic patients. Because clinical symptoms are not specific, the diagnosis is often made incidentally on radiography. We report the case of a 34-year-old woman who presented with fever, frequency, urgency and gross hematuria. CT scan of the pelvis revealed emphysematous cystitis which resolved after antibiotic treatment and bladder drainage.

Sacrococcygeal teratomas are rare congenital tumors, generally discovered at birth. These tumors are seldom observed in children. Radical resection must be performed to avoid potentially malignant recurrence even if the primary lesion is benign. We report a case in an 8-year-old girl who did not have a past medical history. Since the age of 2 years, she presented a progressive sacral tumefaction with no neurological deficit. The MRI showed a large sacrococcygeal cyst in hypointense-signal T1-weighted imaging with no contrast enhancement, and a hyperintense signal in T2-weighted imaging. At surgery, the tumor was totally removed. The intraoperative aspect was that of a viscous cyst. The histological study showed a sacrococcygeal teratoma.

A 47-year-old man with a history of lung adenocarcinoma presented a red and painful right eye with loss of visual acuity after the 5th course of chemotherapy. The ophthalmologic exam showed visual acuity at 3/10 and diffuse iris nodular lesions in the same eye. The fundus was not visible. The controlateral eye was normal. The ocular scan showed iris tumors without choroidal metastasis. Systemic medical evaluation demonstrated no other metastases. The patient died 1 year later.

Les tumeurs fi breuses solitaires sont des tumeurs mésenchymateuses qui se développent à partir du tissu conjonctif. Les localisations rénales sont exceptionnelles et à notre connaissance seuls 11 cas ont été rapportés dans la littérature. Nous rapportons une nouvelle observation d\'une tumeur fi breuse solitaire découverte chez une patiente âgée de 60 ans à l\'occasion d\'un seul épisode de colique néphrétique. La tomodensitométrie abdominale a révélé une tumeur développée aux dépens du hile rénal. Une néphrectomie élargie a été réalisée et l\'analyse anatomopathologique a mis en évidence une prolifération tumorale fusocellulaire d\'aspect fi breux. L\'immunohistochimie a confi rmé le diagnostic en montrant un marquage positif pour le CD 34 et le bcl-2. African Journal of Urology Vol. 14 (1) 2008: pp. 50-53

To assess the indication for operative and nonoperative management of renal stab wounds in patients hospitalised over the last six years.Retrospectively studied of 20 cases over the last six years with penetrating kidney trauma, managed in two urologic departments of Marrakech and Casablanca. We studied the signs on admission (haematuria, blood pressure, haemoglobin and serum creatinine), associated lesions, treatment and complications. The imaging procedures comprised abdomen ultrasonography and abdomen computed tomography scan (CT).The mean age was 25-year-old (range: 14-50 years), macroscopic hematuria was present in 95%. The weapon introduction site was the left lumbar fossa in 15 cases, the right lumbar fossa in four cases and the left flank in one case. Six patients (30%) presented with haemodynamic instability. Anaemia (10g/dl) was found in 14 cases (70%) and blood transfusion was necessary in eight cases (40%). According to the American Association of Trauma Surgery (AATS) classification of kidney trauma, our patients were classified as follows: Grade I (two cases), Grade II (four cases), Grade III (six cases), Grade IV (five cases) and Grade V (three cases). The conservative management was adopted for 15 patients (75%), and two patients had a double pigtel ureteric stent for an important leakage of the contrast product. A CT scan was systematically performed ten days after the trauma and the kidney traumas lesions were often stabilized. Nephrectomy was performed for 5 patients (25%) grade IV (two cases) and grade V (three cases). The patients were discharged after a mean period of 12 days (six to 33 days).The development of interventional radiology, endourological drainage techniques and medical intensive care helps to limit the complications and to manage conservatively with a correct resuscitation for selected patient. A grade V is a surgical indication.

Isolated central nervous system (CNS) tuberculoma is rare. Central nervous system tuberculosis (TB) is associated with high morbidity and mortality despite modern methods of detection and treatment. The authors report a case of a giant cerebellar tuberculoma mimicking a malignant tumor and review the literature.A six-year-old girl, with no past medical history, vaccinated for her age, presented with a three-month history of occipitocervical cephalalgia, complicated by gait disturbances. The MRI showed a left cerebellar tumor suggestive of a medulloblastoma. At surgery, a nodular, avascular lesion was found and pathological examination confirmed tuberculoma. Intracranial tuberculoma is an uncommon variety of central nervous system tuberculosis. The prognosis is related to the rapidity of diagnosis, surgical resection and the complementary antituberculosis treatment.Intracranial tuberculoma is an uncommon variety of central nervous system infection. Prognosis is improved by a quick diagnosis, surgical removal, and associated antituberculoma therapy.

Spinal tuberculosis is a frequent skeletal involvement in tuberculosis. We report 122 cases between 1983 and 1998 of Pott's disease explored by plain radiographies in all cases, CT-scan in 22 cases and MRI in 6 cases. The lesion involved one localization in 98 cases, two localizations in 9 cases and multiple localizations in 15 cases. The usual form associating the discal and vertebral involvement was noted in 70%. Unusual forms were seen in 30% of the cases The localizations were: posterior arch (20 cases), centrosomatic (10 cases), suboccipital (4 cases) and subligamentar (2 cases). In addition, the CT scan noted vertebral lesion with soft tissue abscess in all cases and epidural lesion in 9 cases. MRI performed in 6 cases showed epidural lesions in 4 cases: epiduritis (2 cases) and abscess (2 cases). The disco-vertebral puncture-biopsy, performed in 12 cases, confirmed the diagnosis in 7 cases. The diagnosis of Pott's disease was confirmed biologically in 30 cases. Radiographic exploration of Pott's disease is improved by the contributions of CT and MRI which can identify sequestra, perilesional sclerosis and epidural or soft tissue abscesses. Discovertebral aspiration biopsy provides the key to diagnosis.

Authors report spontaneous necrosis of a sellar hemangiopericytoma, in a 44 year old man, revealed by a right cavernous syndrome. The initial CT scan showed a right sellar and parasellar spontaneous hyperdense process, intensely and homogeneously enhanced by contrast-agent. This process invaded the right cavernous sinus and extended to the sphenoid sinus. Magnetic resonance imaging showed a lesion in isointense on T1-weighted sequence and slightly hyperintense on T2-weighted sequence, with an intense and homogenous enhancement. The follow-up CT scan performed 6 months later, showed a total necrosis of the lesion. Angiography showed a slightly vascularised process, with mass effect on the carotid and sylvian vessels. The sellar and parasellar localization of hemangiopericytoma is rare. The spontaneous necrosis is exceptional, but it enabled us to distinguish it from meningioma.

The authors report a case of an heterotopic pregnancy where the transabdominal US was more useful than endovaginal US. The embryon in this case was located in upper zone of the right iliac fossa, inaccessible to endovaginal US. Both methods are complementary.

The authors report a case of bilateral malignant teratoma of the mediastinum in a 40 year old female presenting with chest pain. Two separate bilateral soft tissue masses were noted in the mediastinum at imaging. On the right side, the mass was heterogeneous with large calcification and infiltration of the pericardium. On the left side, the mass was well defined, heterogeneous and without evidence of local invasion. The analysis of samples obtained by US guided puncture biopsy and surgical specimen of the two masses confirmed the diagnosis of pluricellular malignant teratoma. Mediastinal malignant teratomas represent 1 to 5% of all mediastinal tumors. To our knowledge, no case of synchronous bilateral mediastinal teratoma has never been reported.

To report the radiological polymorphism of angiomyolipoma (AML).[corrected] A retrospective series of eight cases of AML explored by US and CT scan. The diagnosis was radiological in seven cases and histopathological in one case.Five cases of AML were discovered fortuitously. The tuberous sclerosis of Bourneville disease (TSB) was noted in five cases. The cverage age was 37 years with female predominance noted in seven cases. The AML were multiple in half cases all of thein had TSB. The tumoral size ranged from 0.5 cm and 20 cm. The US showed an homogenous hyperechogenique mass in six cases and heterogenous in two cases. The CT scan showed polymorph parenchymal lesions. The fatty component was detected in seven cases. An intratumoral bleeding was noted in one case.The radiological feature of AML is variable, related to tumoral size. It's typical when a tumor of kidney contains fat. An association with TSB is a supplementary argument of diagnosis.

We report a series of 10 cases of centrosomatic tuberculosis of the spine. The mean age of the patients was 36 years. Plain x-rays of the spine showed isolated defects in 3 cases, a defect with wedge fracture in 3 and a wedge fracture alone in 2. A sequestrum was found in 2 cases and bony condensation around the defect in 6. A CT scan performed in 3 cases showed, in addition to the bone lesions, a perilesional bony condensation in all cases. Soft tissue abscess formation was noted in 1 case and epidural involvement in the 2 others. MRI performed in 2 cases evidenced an alteration of the vertebral body signal with localized anterior epiduritis at the site of a small epidural abscess. CT scan and MRI contribute usefully to the radiographic diagnosis of centrosomatic tuberculosis, evidencing sequestra, bony condensation at the periphery of defects, and the presence of soft tissue abscesses and or epidural involvement. When these signs are absent, the differential diagnosis may be difficult with other causes of tumor formation, requiring vertebral biopsy.

Analysis of imaging features of malignant stromal tumors of the small bowel and review of literature.9 cases of malignant stromal tumor of the small bowel with histological proof were imaged at US (8 cases), small bowel series (9 cases) and CT scan (3 cases).There were 6 cases of leiomyosarcoma and 3 cases of malignant schwannoma. Tumors involved the jejunum in 3 patients, the ileum in 4 patients, and the duodenum in 2 patients. The main clinical presentation was an abdominal mass (8 cases), which appeared heterogeneous and hypoechoic with eccentric lumen at US confirming its GI origin (7 cases). Small bowel series showed a bulky cavitary mass opacified via a thin fistula (7 cases), an ileo-ileal intussusception (1 case) and enlarged duodenal lumen (1 case). CT performed in 3 cases showed an intraperitoneal mass with soft-tissue density. A communication with the GI tract was noted in 1 case, and in another case, it showed an intestinal intussusception. US guided biopsy performed in 3 cases provided diagnosis in 2 cases (malignant schwannoma, leiomyosarcoma). Tumor growth was exophytic in 8 cases and dumbbell-shaped in 1 case.The imaging features of malignant stromal tumors of the small bowel are similar. It varies with the type of tumor growth and its size. The diagnosis may be suggested based on imaging features.