Search

Breast cancer is a strong risk factor of cancer amongst women. One in eight women suffers from breast cancer. It is a life-threatening illness and is utterly dreadful. The root cause which is the breast cancer agent is still under research. There are, however, certain potentially dangerous factors like age, genetics, obesity, birth control, cigarettes, and tablets. Breast cancer is often a malignant tumor that begins in the breast cells and eventually spreads to the surrounding tissue. If detected early, the illness may be reversible. The probability of preservation diminishes as the number of measurements increases. Numerous imaging techniques are used to identify breast cancer. This research examines different breast cancer detection strategies via the use of imaging techniques, data mining techniques, and various characteristics, as well as a brief comparative analysis of the existing breast cancer detection system. Breast cancer mortality will be significantly reduced if it is identified and treated early. There are technological difficulties linked to scans and people's inconsistency with breast cancer. In this study, we introduced a form of breast cancer diagnosis. There are different methods involved to collect and analyze details. In the preprocessing stage, the input data picture is filtered by using a window or by cropping. Segmentation can be performed using k -means algorithm. This study is aimed at identifying the calcifications found in bosom cancer in the last phase. The suggested approach is already implemented in MATLAB, and it produces reliable performance., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Sushovan Chaudhury et al.)

Background: Cholesterol gallstones account for over 80% of gallstones, and the pathogenesis of gallstone formation involves genetic and environmental factors. However, data on the evolution of cholesterol gallstones with various densities are limited. This study aimed to determine the roles of microbiota and mucins on the formation of calcified cholesterol gallstones in patients with cholelithiasis., Methods: Paired gallbladder tissues and bile specimens were obtained from cholelithiasis patients who were categorized into the isodense group and calcified group according to the density of gallstones. The relative abundance of microbiota in gallbladder tissues was detected. Immunohistochemistry and enzyme-linked immunosorbent assay were performed to detect the expression levels of MUC1, MUC2, MUC3a, MUC3b, MUC4, MUC5ac and MUC5b in gallbladder tissues and bile. The correlation of microbiota abundance with MUC4 expression was evaluated by linear regression., Results: A total of 23 patients with gallbladder stones were included. The density of gallstones in the isodense group was significantly lower than that of the calcified group (34.20 ± 1.50 vs. 109.40 ± 3.84 HU, P < 0.0001). Compared to the isodense group, the calcified group showed a higher abundance of gram-positive bacteria at the fundus, in the body and neck of gallbladder tissues. The concentrations of MUC1, MUC2, MUC3a, MUC3b, MUC5ac and MUC5b in the epithelial cells of gallbladder tissues showed no difference between the two groups, while the concentrations of MUC4 were significantly higher in the calcified group than that in the isodense group at the fundus (15.49 ± 0.69 vs. 10.23 ± 0.54 ng/mL, P < 0.05), in the body (14.54 ± 0.94 vs. 11.87 ± 0.85 ng/mL, P < 0.05) as well as in the neck (14.77 ± 1.04 vs. 10.85 ± 0.72 ng/mL, P < 0.05) of gallbladder tissues. Moreover, the abundance of bacteria was positively correlated with the expression of MUC4 (r = 0.569, P < 0.05) in the calcified group., Conclusions: This study showed the potential clinical relevance among biliary microbiota, mucins and calcified gallstones in patients with gallstones. Gram-positive microbiota and MUC4 may be positively associated with the calcification of cholesterol gallstones., (Copyright © 2020. Published by Elsevier B.V.)

In the progression of osteoarthritis, pathological calcification in the affected joint is an important feature. The role of these crystallites in the pathogenesis and progression of osteoarthritis is controversial; it remains unclear whether they act as a disease initiator or are present as a result of joint damage. Recent studies reported that the molecular mechanisms regulating physiological calcification of skeletal tissues are similar to those regulating pathological or ectopic calcification of soft tissues. Pathological calcification takes place when the equilibrium is disrupted. Calcium phosphate crystallites are identified in most affected joints and the presence of these crystallites is closely correlated with the extent of joint destruction. These observations suggest that pathological calcification is most likely to be a disease initiator instead of an outcome of osteoarthritis progression. Inhibiting pathological crystallite deposition within joint tissues therefore represents a potential therapeutic target in the management of osteoarthritis., (© 2020 Cambridge Philosophical Society.)

High-grade ductal carcinoma in situ (DCIS) requires resection due to the high risk of developing invasive breast cancer. The predictive powers of noninvasive predictors for high-grade DCIS remain contradictory. This study aimed to explore the predictive value of calcification for high-grade DCIS in Chinese patients.This was a retrospective study of Chinese DCIS patients recruited from the Women's Hospital, School of Medicine, Zhejiang University between January and December 2018. The patients were divided into calcification and non-calcification groups based on the mammography results. The correlation of calcification with the pathologic stage of DCIS was evaluated using the multivariable analysis. The predictive value of calcification for DCIS grading was examined using the receiver operating characteristics (ROC) curve.The pathologic grade of DCIS was not associated with calcification morphology (P = .902), calcification distribution (P = .252), or breast density (P = .188). The multivariable analysis showed that the presence of calcification was independently associated with high pathologic grade of DCIS (OR = 3.206, 95% CI = 1.315-7.817, P = .010), whereas the age, hypertension, menopause, and mammography BI-RADS were not (all P > .05) associated with the grade of DCIS. The ROC analysis of the predictive value of calcification for DCIS grading showed that the area under the curve was 0.626 (P = .019), with a sensitivity of 73.1%, specificity of 52.2%, positive predictive value of 72.2%, and negative predictive value of 53.3%.The presence of calcification is independently associated with high pathologic grade of DCIS and could predict high-grade DCIS in Chinese patients.

Background: Compared to high gradient aortic stenosis (AS), patients with low-flow, low-gradient AS have higher mortality after transcatheter aortic valve replacement (TAVR), but distinct outcome predictors in this patient subset are yet to be determined. The present study investigated the prognostic impact of aortic valve calcification (AVC) in patients with low-flow, low-gradient AS undergoing TAVR., Methods: This retrospective single-center analysis includes all patients undergoing TAVR for severe low-flow, low-gradient AS (n = 526), ie, low EF low gradient AS (LEF-LG AS; n = 290) and paradoxical low-flow, low-gradient AS (PLF-LG AS; n = 236), in whom AVC was quantified from contrast-enhanced multislice computed tomography images. AVC density was defined as calcium volume per annulus area. Patients were trichotomized according to sex-specific AVC density tertiles in both subgroups. All-cause mortality was assessed by Kaplan-Meier analyses and independent outcome predictors were determined by multivariable analyses., Results: In both subgroups, patients with high AVC density had higher mean transvalvular gradients at baseline and higher rates of PVL after TAVR. High AVC density was associated with lowest 1- and 3-year mortality after TAVR in the LEF-LG AS but not in the PLF-LG AS group. According to multivariable analysis AVC density was independently associated with better survival in LEF-LG AS patients (HR 0.73 [0.60-0.88], P = .0011), but not in those with PLF-LG AS (HR 0.91 [0.73-1.14], P = .42)., Conclusions: Quantification of AVC may not only be of diagnostic but also of prognostic value, as it facilitates the selection of LEF-LG AS patients with higher probability of beneficial outcome after TAVR., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this investigation is to assess the incidence of rotator cuff tears in cases of calcific tendonitis and evaluate for differences in the incidences of rotator cuff tears by magnetic resonance imaging (MRI) between calcific lesions of different morphology, size, or location., Methods: This single-center study involved a retrospective chart review searching for patients from January 2010 to April 2017 with a diagnosis of calcific tendonitis of the shoulder based on review of all MRI reads done on patients with shoulder pain. Anteroposterior radiographic and MRI studies were reviewed by a musculoskeletal radiologist to assess calcific tendonitis morphology, size, distance from cuff insertion, and any rotator cuff tear. An additional radiologist evaluated calcific tendonitis size, morphology, and location to evaluate the reliability of these variables., Results: In the final cohort of 318 shoulders with calcific tendonitis, the incidence of concomitant rotator cuff tears was 56%. Of all 177 tears, 164 (93%) were partial-thickness and 13 (7%) were complete. Type III calcification morphology (cloudy with soft contour) was most frequently associated with rotator cuff tears and demonstrated an increased odds of tear by a factor of 1.8 (CI 95% 1.1-2.9).There was no statistical difference regarding calcification size or location prognosticating rotator cuff tears or tear thickness. Intraclass correlation coefficients for calcification size, morphology, and location were 0.78, 0.30, and 0.50, respectively., Conclusions: The incidence of rotator cuff tears in cases of calcific tendonitis in this cohort of patients who underwent MRI is higher than previously reported. Cloudy-appearing calcified lesions showed a significant association with rotator cuff tears with an odds ratio of 1.8. Specific locations or sizes of calcified lesions do not appear to be reliable factors to predict concomitant rotator cuff tears. Interobserver agreement for these radiographic variables ranged from fair to substantial and prompt a cautious interpretation of these results., Level of Evidence: IV Retrospective Case Series., (Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Calcifying fibrous tumour (CFT) has some of the histopathological features, such as abundant plasma cells and stromal fibrosis, that are exhibited by IgG4-related diseases (IgG4-RD). The possible role of IgG4-positive plasma cells in calcifying fibrous tumour was investigated. The aim of this study was to determine any potential relationship between IgG4-RD and CFT. Thirteen cases with a total of 16 CFTs were reviewed. Lesion samples were immunostained with anti-IgG4 and anti-IgG antibodies. The number of IgG4-positive and IgG-positive plasma cells (IgG + PC) and their ratios were estimated. Plasma cells were found in all tumours. IgG4-positive plasma cells ranged from 0 to 71 per high-power field (HPF; mean 17.8/HPF), and IgG + PC ranged from 2 to 93/HPF (mean 42.6/HPF). The IgG4/IgG ratio ranged from 0% to 80% (mean 29%). There were seven tumours with the ratio of IgG4/IgG + PC that exceeded 40%. Various degrees of stromal fibrosis were present in eight tumours. All tumours have variable calcification. The histopathological features of CFT were found to be similar to those of IgG4-RD. Some CFT also showed a high number of IgG4-positive plasma cells, and the ratio of IgG4/IgG + PC exceeded 40%, most notably in patients with concomitant inflammatory or autoimmune disease. The long-term follow-up showed no evidence of IgG4-RD in any of these patients. Our findings suggest that while CFT overlaps morphologically with IgG4-RD, it probably should not be classified as an IgG4-RD., (©2020 Company of the International Journal of Experimental Pathology (CIJEP).)

BACKGROUND The aim of this study was to assess a radiomic scheme that combines image features from digital mammography and dynamic contrast-enhanced MRI to improve classification accuracy of nonpalpable breast lesion (NBL) with Breast Imaging-Reporting and Data System (BI-RADS) 3-5 microcalcifications-only in mammography. MATERIAL AND METHODS This retrospective study was approved by the Internal Research Review and Ethical Committee of our hospital. We included 81 patients who underwent a three-dimensional digital breast X-ray wire positioning for local resection between October 2012 and November 2016. All patients underwent breast MRI and mammography before the treatment, and all obtained pathological confirmation. According to the pathological results, 41 patients with benign lesions were assigned to the benign group and 40 patients with malignant lesions were assigned to the malignant group. We used the random forest algorithm to select significant features and to test the single and multimodal classifiers using the Leave-One-Out-Cross-Validation method. An area under the receiver operating characteristic curve was also used to evaluate its discriminating performance. RESULTS The multimodal classifier achieved AUC of 0.903, with a sensitivity of 82.5% and a specificity of 80.48%, which was better than any single modality. CONCLUSIONS Multimodal radiomics classification shows promising power in discriminating malignant lesions from benign lesions in NBL patients with BI-RADS 3-5 microcalcifications-only in mammography.

Objectives: The significance of conventional neuroimaging features for predicting molecular diagnosis and patient survival based on the updated World Health Organization (WHO) classification remains uncertain. We assessed the relevance of neuroimaging features (ring enhancement [RE], non-ring enhancement [non-RE], overall gadolinium enhancement [GdE], and intratumoral calcification [IC]) for molecular diagnosis and survival in glioma patients., Patients and Methods: We evaluated 234 glioma patients according to the updated WHO classification. Isocitrate dehydrogenase (IDH), H3F3A, BRAF hotspot mutations, TERT promotor mutation, and chromosome 1p/19q co-deletion were examined. RE, non-RE, GdE, and IC were evaluated as significant neuroimaging findings. Kaplan-Meier analyses were performed to evaluate overall survival (OS) and the correlations of prognostic factors were evaluated by log-rank tests. Univariate and multivariate analyses were performed to detect prognostic factors for OS., Results: A total of 207 patients were eligible. In 110 patients presenting RE, 102 (93%) were glioblastoma (GBM), IDH-wild type. In 97 patients without RE, presence of GdE or IC were not significantly different between IDH-mutant and -wild type tumors, whereas presence of GdE was a significant indicator of higher WHO grades. IC was the only significant finding for 1p/19q co-deleted tumors. TERT promoter mutation was observed in 7/17 patients with diffuse astrocytic glioma, IDH-wild type; recently-defined as "molecular GBM." IC, RE, and GdE were observed with lower prevalence in molecular GBMs. While presence of RE, GdE, and absence of IC were significant factors of OS in overall cohort, presence of GdE was not significant in OS in cases without RE, and IDH-mutant tumors. IC was a significant predictor of favorable OS in cases without RE and IDH-wild type tumors. Multivariate analysis also validated these findings., Conclusion: GdE alone is not a significant predictor of IDH mutation status, but the pattern of enhancement is a significant predictor with RE demonstrating high sensitivity and specificity for GBM, IDH-wild type. Predicting "molecular GBM" by conventional neuroimaging is difficult. Moreover, GdE is not a significant factor of survival analyzed with pattern of enhancement or molecular stratifications. IC is an important radiographic finding for predicting molecular diagnosis and survival in glioma patients., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory spondyloarthropathy identified radiographically by calcification of the ligaments and/or entheses along the anterolateral aspect of the vertebral column. The etiology and pathogenesis of calcifications are unknown, and the diagnosis of DISH is currently based on radiographic criteria associated with advanced disease. To characterize the features of calcifications associated with DISH, we used micro-computed tomographic imaging to evaluate a cohort of 19 human cadaveric vertebral columns. Fifty-three percent of the cohort (n = 10; 3 females, 7 males, mean age of death = 81 years, range 67-94) met the radiographic criteria for DISH, with calcification of four or more contiguous vertebral segments. In almost all cases, the lower thoracic regions (T8-12) were affected by calcifications, consisting primarily of large, horizontal outgrowths of bony material. In contrast, calcifications localized to the upper thoracic regions demonstrated variability in their presentation and were categorized as either "continuous vertical bands" or "discontinuous-patchy" lesions. In addition to the variable morphology of the calcifications, our analysis demonstrated remarkable heterogeneity in the densities of calcifications, ranging from internal components below the density of cortical bone to regions of hyper-dense material that exceeded cortical bone. These findings establish that the current radiographic criteria for DISH capture heterogeneous presentations of ectopic spine calcification that can be differentiated based on morphology and density. These findings may indicate a naturally heterogenous disease, potential stage(s) in the natural progression of DISH, or distinct pathologies of ectopic calcifications. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res., (© 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.)

Objective: To compare the performance of synthetic mammography (SM) and digital mammography (DM) with digital breast tomosynthesis (DBT) or alone for the evaluation of microcalcifications., Methods: This retrospective study includes 198 mammography cases, all with DM, SM, and DBT images, from January to October 2013. Three radiologists interpreted images and recorded the presence of microcalcifications and their conspicuity scores and final BI-RADS categories (1, 2, 3, 4a, 4b, 4c, 5). Readers' area under the ROC curves (AUCs) were analyzed for SM plus DBT vs. DM plus DBT and SM alone vs. DM alone using the BI-RADS categories for the overall group and dense breast subgroup., Results: Conspicuity scores of detected microcalcifications were neither significantly different between SM and DM with DBT nor alone (p>0.05). In predicting malignancy of detected microcalcifications, no significant difference was found between readers' AUCs for SM and DM with DBT or alone in the overall group or dense breast subgroup (p>0.05)., Conclusions: Diagnostic performances of SM and DM for the evaluation of microcalcifications are not significantly different, whether performed with DBT or alone., Key Points: • In DBT-imaging, SM and DM show comparable performances when evaluating microcalcifications. • For BI-RADS classification of microcalcifications, SM and DM show similar AUCs. • DBT with SM may be sufficient for diagnosing microcalcifications, without DM.

Background: This paper attempts to pinpoint different techniques for Pectoral Muscle (PM) segmentation, Microcalcification (MC) detection and classification in digital mammograms. The segmentation of PM and detection of MC and its classification are mostly based on image processing and data mining techniques., Discussion: The review centered on major techniques in image processing and data mining that is employed for PM segmentation, MC detection and classification in digital mammograms. Breast cancer is one of the significant causes of death among women aged above 40. Mammography is considered the most successful means for prompt and timely detection of breast cancers. One notable visual indication of the malignant growth is the appearance of Masses, Architectural Distortions, and Microcalcification Clusters (MCCs). There are some disadvantages and hurdles for mankind viewers, and it is hard for radiologists to supply both precise and steady assessment for a large number of mammograms created in extensive screening. Computer Aided Detection has been employed to help radiologists in detecting MC and MCCs. The automatic recognition of malignant MCCs could be very helpful for diagnostic purpose. In this paper, we summarize the methods of automatic detection and classification of MCs in digitized mammograms. Pectoral muscle segmentation techniques are also summarized., Conclusion: The techniques used for segmentation of PM, MC detection and classification in a digitized mammogram are reviewed., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

This paper addresses the automated detection of microcalcification clusters from mammogram images by enhanced preprocessing operations on digital mammograms for automated extraction of breast tissue from background, removing artefacts occurring during image registration using X-rays, followed by fractal analysis of suspicious regions. Identification of breast of either left or right and realigning them to a standard position forms a primitive step in preprocessing of mammograms. As the next step in the process, pectoral muscles are separated. Suspicious regions of microcalcifications are identified and are subjected to further analysis of classifying it as benign or malignant. Texture features are representative of its malignancy and fractal analysis was carried out on extracted suspicious regions for its texture features. Principal Component Analysis was carried out to extract optimal features. Ten features were found to be an optimal number of reduced texture features without compromising on classification accuracy. Scaled conjugate Gradient Back propagation network was used for classification using reduced texture features obtained from PCA analysis. By varying hidden layer neurons, accuracy of results achieved by proposed methods is analysed and is calculated to reach maximum accuracy with an optimal level of 15 neurons. Accuracy of 96.3% was achieved with 10 fractal features as input to neural network and 15 hidden layer neurons in neural network designed. The design of architecture is finalised with maximised accuracy for labelling microcalcification clusters as benign or malignant., (Creative Commons Attribution License)

Breast cancer is one of the major causes of death in women. Computer Aided Diagnosis (CAD) systems are being developed to assist radiologists in early diagnosis. Micro-calcifications can be an early symptom of breast cancer. Besides detection, classification of micro-calcification as benign or malignant is essential in a complete CAD system. We have developed a novel method for the classification of benign and malignant micro-calcification using an improved Fisher Linear Discriminant Analysis (LDA) approach for the linear transformation of segmented micro-calcification data in combination with a Support Vector Machine (SVM) variant to classify between the two classes. The results indicate an average accuracy equal to 96% which is comparable to state-of-the art methods in the literature. Graphical Abstract Classification of Micro-calcification in Mammograms using Scalable Linear Fisher Discriminant Analysis.

Purpose: The aim of this study was to compare the distribution patterns of microcalcifications in thyroid cancers with benign cases., Methods: In total, 358 patients having microcalcifications on ultrasonography were analysed. Microcalcifications were categorised according to the distribution patterns: (I) microcalcifications inside one (a) or more (b) suspected nodules, (II) microcalcifications not only inside but also surrounding a suspected single (a) or multiple (b) nodules, and (III) focal (a) or diffuse (b) microcalcifications in the absence of any suspected nodule. Differences in distribution patterns of microcalcifications in benign and malignant thyroid lesions were compared., Results: We found that the distribution patterns of microcalcifications differed between malignant (n = 325) and benign lesions (n = 117) (X 2 = 9.926, p < 0.01). Benign lesions were classified as type Ia (66.7%), type Ib (29.1%) or type IIIa (4.3%). The specificity of type II and type IIIb in diagnosing malignant cases was 100%. Among malignant lesions, 172 locations were classified as type Ia, 106 as type Ib, 12 as type IIa, 7 as IIb, 7 as type IIIa and 19 as type IIIb. Accompanying Hashimoto thyroiditis was most frequent in type III (51.6%)., Conclusions: Types II and IIIb are highly specific for cancer detection. Microcalcifications outside a nodule and those detected in the absence of any nodule should therefore be reviewed carefully in clinical practice., Key Points: • A method to classify distribution patterns of thyroid microcalcifications is presented. • Distribution features of microcalcifications are useful for diagnosing thyroid cancers. • Microcalcifications outside a suspicious nodule are highly specific for thyroid cancers. • Microcalcifications without suspicious nodules should also alert the physician to thyroid cancers.

Objective: The human placenta is known to calcify with advancing gestational age, and, in fact, the presence of significant calcifications is one of the components of grade III placenta, typical of late gestation. As such, the presence of significant placental calcifications often prompts obstetric providers to expedite delivery. This practice has been attributed, in part, to the presumed association between grade III placenta and adverse pregnancy outcomes. Such approach, however, can be the source of major anxiety and may lead to unnecessary induction of labor, with its associated predisposition to cesarean delivery as well as a myriad of maternal and neonatal morbidities. The objective of this study was to examine the association between grade III placental calcifications and pregnancy outcomes., Materials and Methods: A systematic review of the literature was performed for studies evaluating the association between grade III placenta and a number of pregnancy outcomes, including labor induction, fetal distress (abnormal fetal heart tracing), low Apgar score (less than 7 at 5 min), need for neonatal resuscitation, admission to the Neonatal Intensive Care Unit, perinatal death, meconium liquor, and low birth weight., Results: There was a five-fold increase in risk of labor induction with the presence of grade III placenta (OR 5.41; 95% CI 2.98-9.82). There was no association between grade III placenta and the incidence of abnormal fetal heart tracing (OR 1.62; 95% CI 0.94-2.78), low Apgar score of less than 7 at 5 min (OR 1.68; 95% CI 0.84-3.36), need for neonatal resuscitation (OR 1.08; 95% CI 0.67-1.75), and admission to the Neonatal Intensive Care Unit (OR 0.90; 95% CI 0.21-3.74). In turn, the incidence of meconium liquor was higher in the setting of grade III placentae (OR 1.68; 95% CI 1.17-2.39). Similarly, a positive association between grade III placental calcifications and low birth weight (OR 1.63; 95% CI 1.19-2.22) and perinatal death (OR 7.41; 95% CI 4.94-11.09) was identified., Conclusion: The study alerts us to a significant association between grade 3 placental calcifications and labor induction, although it demonstrates that these sonographic findings do not appear to predispose to fetal distress, low Apgar score, need for neonatal resuscitation, or admission to the NICU.

Background The BI-RADS provides descriptors for microcalcifications based on morphology and distribution. However, the descriptor for category 4A microcalcifications is not specified in the 5th BI-RADS nor in the prior editions. Purpose To investigate how the category 4A assessment is applied to suspicious microcalcifications, and the appropriate descriptors for category 4A assessment for microcalcifications seen on mammography. Material and Methods From June 2008 to November 2011, 296 women with 305 suspicious microcalcifications that were assessed as BI-RADS category 4A, who underwent imaging-guided biopsy or surgery, were included. Mammograms were reviewed and imaging features were analyzed according to the morphology and distribution descriptors of the 5th edition of BI-RADS. Pathological results were considered as the reference standard. Positive predictive values were calculated and compared between morphology and distribution descriptors. Results The overall positive predictive value (PPV) of category 4A microcalcifications was 17.7% (54/305). Most common descriptors for category 4A microcalcifications were amorphous morphology (73.1%) and grouped distribution (71.1%). PPVs of individual morphology descriptors were as follows: amorphous = 7.2%; coarse heterogeneous = 12.8%; fine pleomorphic or fine linear/fine linear branching = 91.4% ( P < 0.001). PPVs of distribution descriptors were as follows: regional = 13.2%; grouped = 16.1%; linear/segmental = 54.5% ( P < 0.001). For morphology and distribution descriptors combinations, PPVs for amorphous/regional and amorphous/grouped microcalcifications were 6.8% and 6.9%, while PPVs of other combinations were higher than 10%, respectively. Conclusion Common descriptors used in category 4A assessment for microcalcifications are amorphous morphology and grouped distribution. PPV of amorphous/regional and amorphous/grouped microcalcifications were suitable for category 4A assessment.

Background: Crowned dens syndrome (CDS) is a radioclinical entity defined by calcium deposition on the transverse ligament of atlas (TLA). In this study, the novel semi-quantitative diagnostic criteria for CDS to evaluate the degree of calcification on TLA by cervical CT are proposed., Method: From January 2010 to September 2014, 35 patients who were diagnosed with CDS by cervical CT were adopted as subjects in this study. Based on novel criteria, calcium deposition on TLA was classified into "Stage" and "Grade", to make a score, which was evaluated semi-quantitatively. The correlation between calcification score and CRP level or pain score, and the effects of treatments, such as NSAIDs and corticosteroids, were statistically analyzed., Results: The total calcification score from added "Stage" and "Grade" scores demonstrated a significantly strong and linear correlation with CRP level (R 2 =0.823, **p<0.01). In the multiple comparison test for the treatment effects, significant improvement of the CRP level and pain score were demonstrated after corticosteroid therapy (**p<0.01) compared with NSAIDs. In the conditional logistic regression analysis, the rapid end of corticosteroid therapy was an independent risk factor for relapse of cervico-occipital pain [OR=50.761, *p=0.0419]., Conclusion: The degree of calcification on TLA evaluated by the novel semi-quantitative criteria significantly correlated with CRP level. In the treatment of CDS, it is recommended that a low dosage (15-30mg) of corticosteroids be used as first-line drugs rather than conventional NSAID therapy. Additionally, it is also recommended to gradually decrease the dosage of corticosteroids., (Copyright © 2017 Elsevier B.V. All rights reserved.)

We investigate the use of energy dispersive x-ray coherent scatter computed tomography (ED-CSCT) as a non-invasive diagnostic method to differentiate between type I and type II breast calcifications. This approach is sensitive to the differences of composition and internal crystal structure of different types of microcalcifications. The study is carried out by simulating a CSCT system with a scanning pencil beam, considering a polychromatic x-ray source and an energy-resolving photon counting detector. In a first step, the multidimensional angle and energy distributed CSCT data is reduced to the projection-space distributions of only a few components, corresponding to the expected target composition: adipose, glandular tissue, weddellite (calcium oxalate) for type I calcifications, and hydroxyapatite for type II calcifications. The maximum-likelihood estimation of scatter components algorithm used, operating in the projection space, takes into account the polychromatic source, the detector response function and the energy dependent attenuation. In the second step, component images are reconstructed from the corresponding estimated component projections using filtered backprojection. In a preliminary step the coherent scatter differential cross sections for hydroxyapatite and weddellite minerals were determined experimentally. The classification of type I or II calcifications is done using the relative contrasts of their components as the criterion. Simulation tests were carried out for different doses and energy resolutions for multiple realizations. The results were analyzed using relative/receiver operating characteristic methodology and show good discrimination ability at medium and higher doses. The noninvasive CSCT technique shows potential to further improve the breast diagnostic accuracy and reduce the number of breast biopsies.

Objective: To retrospectively analyse the features of calcinosis in a cohort of SSc patients., Methods: Charts of SSc patients attending the Ulcer Unit of the Rheumatology Department, University of Florence and presenting a clinical suspicion of calcinosis were considered in the study. Data on clinical history, including recent skin changes, and clinical examination of all areas with suspected calcinosis, radiological imaging of the calcinotic area, demographics and SSc-related organ involvement and pain measured by a visual analogue scale were recorded., Results: In 52 of 112 SSc patients, a total of 316 calcinoses were recorded and were divided into visible and palpable {154 [47.4%], clustered according to their macroscopic features as mousse [49 (31.8%)] and stone [: 105 (68.2%)]} and non-visible but palpable {: 162 [52.6%]: net [5 (3%)], plate [22 (13.8%)] and stone [135 (83.2%)]}. The X-ray-based classification of all calcinoses, both visible and non-visible, was as follows: stone, 289 (91.4%); net, 12 (3.8%) and plate, 15 (4.8%). Skin ulcers complicated 154 of 316 calcinoses (48.7%). Mousse calcinosis was associated with pulmonary arterial hypertension, the stone subset was suggestive of pulmonary involvement and justified further investigation and the net subset was the slowest to heal., Conclusion: Our data indicate that calcinosis may be classified in SSc as mousse, stone, net and plate according to its clinical and X-ray features. This classification awaits validation for a possible use in clinical practice and to support early treatment and prevention of complications., (© The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Different patterns of flow and valve gradients can lead to diagnostic uncertainty about the severity of aortic stenosis (AS). Consecutive patients with severe AS (valve area <1 cm(2)) underwent echocardiography and computed tomography. Patients were classified into 4 groups (high-gradient/normal flow [HGNF], high-gradient/low flow [HGLF], low-gradient/normal flow [LGNF], and low-gradient/low flow [LGLF]). Low flow was defined as stroke volume index <35 mL/m(2) and low gradient as a mean aortic gradient <40 mm Hg. Aortic valve calcification (AVC) was calculated using the Agatston score. Of 181 patients, 56, 30, 46, and 49 had HGNF, HGLF, LGNF and LGLF with median AVC of 2048, 2015, 1366, and 1178 AU/m(2) (P < .0001) and valvuloarterial impedance of 4.5, 6.4, 4.2, and 5.9, respectively (P < .0001). Among those with LGLF, AVC was lower in patients with preserved compared to reduced left ventricular ejection fraction (1018 vs 2550 AU/m(2); P < .0001), but valvuloarterial impedance was similar (P = .33). The LGLF AS with preserved ejection fraction is associated with lower AVC and may identify patients with less severe AS in association with an adaptive ventricular response to high afterload., (© The Author(s) 2015.)

In this paper, we present a novel cascaded classification framework for automatic detection of individual and clusters of microcalcifications (μC). Our framework comprises three classification stages: i) a random forest (RF) classifier for simple features capturing the second order local structure of individual μCs, where non-μC pixels in the target mammogram are efficiently eliminated; ii) a more complex discriminative restricted Boltzmann machine (DRBM) classifier for μC candidates determined in the RF stage, which automatically learns the detailed morphology of μC appearances for improved discriminative power; and iii) a detector to detect clusters of μCs from the individual μC detection results, using two different criteria. From the two-stage RF-DRBM classifier, we are able to distinguish μCs using explicitly computed features, as well as learn implicit features that are able to further discriminate between confusing cases. Experimental evaluation is conducted on the original Mammographic Image Analysis Society (MIAS) and mini-MIAS databases, as well as our own Seoul National University Bundang Hospital digital mammographic database. It is shown that the proposed method outperforms comparable methods in terms of receiver operating characteristic (ROC) and precision-recall curves for detection of individual μCs and free-response receiver operating characteristic (FROC) curve for detection of clustered μCs.

Calcinosis cutis (CC) is defined as the deposition of calcium salts in the skin. The condition is divided into 5 types: calciphylaxis and dystrophic, metastatic, idiopathic, and iatrogenic CC. Dystrophic CC is the most common form and usually occurs in association with autoimmune diseases. CC can be treated surgically or with the use of drugs such as diltiazem, bisphosphonates, warfarin, ceftriaxone, probenecid, minocycline, or aluminum hydroxide. Calciphylaxis is defined as calcification of the media of small- and medium-sized blood vessels in the dermis and subcutaneous tissue. Clinically, calciphylaxis causes livedo racemosa, which progresses to retiform purpura and skin necrosis. First-line treatment is with sodium thiosulfate. We present a review of the calcifying disorders of the skin, focusing on their diagnosis and treatment., (Copyright © 2015 Elsevier España, S.L.U. and AEDV. All rights reserved.)

Objectives: Calretinin is expressed in many tumors. However, the role of calretinin in craniopharyngiomas (CPs) remains unknown., Patients and Methods: The study included 77 adamantinomatous CP (ACP). ACP calcification was divided into several categories on the basis of the incidence and extent of the calcium deposits evident on computed tomography (CT) images. The presence and expression pattern of calretinin were investigated using immunohistochemistry and western blotting. CP cell culture and small interfering (si)RNA of calretinin transfection was also carried out to clarify the role of calretinin in ACP calcification., Results: 61 cases exhibited calcification on CT, and 63 samples were immunopositive to calretinin. The western blotting results were consistent with the immunohistochemical findings. Calretinin expressions differed significantly among ACP groups basing on calcification degree, and a positive correlation was observed between calretinin expression and calcification degree (r=0.853, P<0.001). Calretinin siRNA transfection further demonstrated the role calretinin played in ACP calcification., Conclusions: Calretinin is expressed in the tumor stoma of calcified ACP, and its expression correlated with calcification degree. Drugs that target calretinin to reduce calcification and improve the postoperative function of ACP patients should be further researched., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Purpose: Owing to advances in ultrasound (US) technology, optimal US techniques with a high-frequency transducer can identify more and more breast lesions. However, some lesions show up as non-mass-like lesions, which are difficult to be correctly identified and often result in missed diagnosis and misdiagnosis. The purpose of the present study was to develop a classification of the US features of non-mass-like breast lesions correlated with pathology, so as to improve the diagnostic accuracy of US in non-mass-like breast lesions., Materials and Methods: A total of 854 breast lesions in 836 consecutive women scheduled for US-guided core-needle biopsy or US-guided vacuum-assisted biopsy between May 2008 and October 2011 were initially included in this study. Finally, 80 breast lesions in 78 women were classified as non-mass-like lesion and included in this study. The US features of the 80 non-mass-like breast lesions were classified and their correlation with pathology was analysed., Results: Of the 80 non-mass-like breast lesions, 43 cases (53.8 %) were malignant and 37 cases (46.2 %) were benign. Fifty-two cases (73.7 %) appeared as a hypoechoic area, 22 cases (21.1 %) appeared as a hypoechoic area with sporadic or clustered microcalcification, four cases appeared as architectural distortion, and two cases appeared as solid echogenicity within a duct. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of US for non-mass-like breast lesions were 71.25, 95.35, 43.24, 66.13 and 88.89 %, respectively. The finding of a hypoechoic area with microcalcification showed a statistically significant association with malignant lesions and its positive predictive value for carcinoma was 78.26 %., Conclusion: Non-mass-like breast lesions usually appeared as a hypoechoic area or a hypoechoic area with microcalcification. The finding of a hypoechoic area with microcalcification had a close correlation with malignant lesions. US had a high sensitivity but a low specificity in the diagnosis of non-mass-like breast lesions and a definitive diagnosis requires a US-guided biopsy.

Purpose: To describe distinct enhanced depth optical coherence tomography patterns of sclerochoroidal calcification and their correlation to clinical features., Methods: Retrospective chart review of 67 eyes of 46 patients with spectral domain optical coherence tomography imaging., Results: The mean patient age at diagnosis was 68 years. There were 20 (43%) men and 26 (57%) women of white (n = 45, 98%) or Hispanic (n = 1, 2%) heritage. The most prominent sclerochoroidal calcification lesions were located in the superotemporal quadrant (n = 57, 85%) between the temporal arcades and the equator (n = 58, 87%). On enhanced depth optical coherence tomography, the sclerochoroidal calcification was located within the sclera in all cases and the inner surface topography assumed specific "mountain-like" patterns, including flat (Type 1) (n = 9) at median thickness of 1.2 mm, rolling (Type 2) (n = 28) at 1.4 mm thickness, rocky-rolling (Type 3) (n = 21) at 2.1 mm thickness, and table mountain (Type 4) (n = 9) at a thickness of 1.9 mm. The retinal layers were undisturbed in flat lesions, and outer retinal abnormalities were found in all other types. A comparison of the 4 types revealed that Type 3 lesions were thickest (P < 0.001), showing abnormalities in the retinal pigment epithelium, ellipsoid region, and external limiting membrane most commonly (P < 0.05) and demonstrating the most dramatic thinning of the overlying choroid (P < 0.01) and retina (P < 0.05). Type 4 lesions showed greatest basal diameter (P < 0.01) and least outer retinal abnormalities (P < 0.05) or choroid thinning (P < 0.05)., Conclusion: In this report, enhanced depth optical coherence tomography has demonstrated that sclerochoroidal calcification is a scleral-based disease and can be classified based on four "mountain-like" topographic patterns, associated with variable effects on the choroid and retina.

Filariasis is a parasitic disease with a benign course caused by nematodes. Filariasis is endemic in some tropical regions, and immigration has made it increasingly common in some centers in Spain. The death of the parasites can lead to calcifications that are visible in mammograms; these calcifications have specific characteristics and should not be confused with those arising in other diseases. However, the appearance of calcifications due to filariasis is not included in the most common systems used for the classification of calcifications on mammograms (BI-RADS), and this can lead to confusion. In this article, we discuss the need to update classification systems and warn radiologists about the appearance of these calcifications to ensure their correct diagnosis and avoid confusion with other diseases., (Copyright © 2014 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Goal: The presence of microcalcification clusters is a primary sign of breast cancer; however, it is difficult and time consuming for radiologists to classify microcalcifications as malignant or benign. In this paper, a novel method for the classification of microcalcification clusters in mammograms is proposed., Methods: The topology/connectivity of individual microcalcifications is analyzed within a cluster using multiscale morphology. This is distinct from existing approaches that tend to concentrate on the morphology of individual microcalcifications and/or global (statistical) cluster features. A set of microcalcification graphs are generated to represent the topological structure of microcalcification clusters at different scales. Subsequently, graph theoretical features are extracted, which constitute the topological feature space for modeling and classifying microcalcification clusters. k-nearest-neighbors-based classifiers are employed for classifying microcalcification clusters., Results: The validity of the proposed method is evaluated using two well-known digitized datasets (MIAS and DDSM) and a full-field digital dataset. High classification accuracies (up to 96%) and good ROC results (area under the ROC curve up to 0.96) are achieved. A full comparison with related publications is provided, which includes a direct comparison., Conclusion: The results indicate that the proposed approach is able to outperform the current state-of-the-art methods. Significance: This study shows that topology modeling is an important tool for microcalcification analysis not only because of the improved classification accuracy but also because the topological measures can be linked to clinical understanding.

Objective: To evaluate the prevalence and to classify prostatic calcification on transrectal ultrasonography (TRUS) and correlate the findings with histology., Methods: A prospective, blinded study of men undergoing TRUS and prostatic biopsy was designed. A standardized reproducible technique was used with a BK 7.5- to 12.5-MHz multiplanar probe. Representative images of the calcification in the sagittal and transverse planes were captured. Blind analysis by an experienced observer was performed. TRUS findings were categorized using a novel classification and correlated with histologic data., Results: A total of 274 patients (58.8%) had prostate cancer, 88 patients (18.9%) inflammation, and 104 patients (22.3%) had benign pathology. Interface calcification was present in 42.3% of patients. Peripheral or transitional zone calcification was unusual (6.8% and 9.0%, respectively). Of the peripheral zone calcification group patients, 78.1% had cancer on histology examination (P = .020)., Conclusion: Prevalence and characteristics of prostatic calcification have been described using this novel and practical classification. Although interface calcification is common and not associated with any particular pathology, peripheral zone calcification appears to be strongly associated with prostate cancer., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: To determine the intervendor variability of Agatston scoring determined with state-of-the-art computed tomographic (CT) systems from the four major vendors in an ex vivo setup and to simulate the subsequent effects on cardiovascular risk reclassification in a large population-based cohort., Materials and Methods: Research ethics board approval was not necessary because cadaveric hearts from individuals who donated their bodies to science were used. Agatston scores obtained with CT scanners from four different vendors were compared. Fifteen ex vivo human hearts were placed in a phantom resembling an average human adult. Hearts were scanned at equal radiation dose settings for the systems of all four vendors. Agatston scores were quantified semiautomatically with software used clinically. The ex vivo Agatston scores were used to simulate the effects of different CT scanners on reclassification of 432 individuals aged 55 years or older from a population-based study who were at intermediate cardiovascular risk based on Framingham risk scores. The Friedman test was used to evaluate overall differences, and post hoc analyses were performed by using the Wilcoxon signed-rank test with Bonferroni correction., Results: Agatston scores differed substantially when CT scanners from different vendors were used, with median Agatston scores ranging from 332 (interquartile range, 114-1135) to 469 (interquartile range, 183-1381; P < .05). Simulation showed that these differences resulted in a change in cardiovascular risk classification in 0.5%-6.5% of individuals at intermediate risk when a CT scanner from a different vendor was used., Conclusion: Among individuals at intermediate cardiovascular risk, state-of the-art CT scanners made by different vendors produced substantially different Agatston scores, which can result in reclassification of patients to the high- or low-risk categories in up to 6.5% of cases., (© RSNA, 2014.)

Objective: Microcalcification is strongly correlated with papillary thyroid cancer. It is not clear whether macrocalcification is associated with malignancy. In this study, we aimed to assess the result of fine needle aspiration biopsies (FNAB) of thyroid nodules with macrocalcifications., Subjects and Methods: We retrospectively evaluated 269 patients (907 nodules). Macrocalcifications were classified as eggshell and parenchymal macrocalcification. FNAB results were divided into four groups: benign, malignant, suspicious for malignancy, and non-diagnostic., Results: There were 79.9% female and 20.1% male and mean age was 56.9 years. Macrocalcification was detected in 46.3% nodules and 53.7% nodules had no macrocalcification. Parenchymal and eggshell macrocalcification were observed in 40.5% and 5.8% nodules, respectively. Cytologically, malignant and suspicious for malignancy rates were higher in nodules with macrocalcification compared to nodules without macrocalcification (p = 0.004 and p = 0.003, respectively). Benign and non-diagnostic cytology results were similar in two groups (p > 0.05). Nodules with eggshell calcification had higher rate of suspicious for malignancy and nodules with parenchymal macrocalcification had higher rates of malignant and suspicious for malignancy compared to those without macrocalcification (p = 0.01, p = 0.003 and p = 0.007, respectively)., Conclusions: Our findings suggest that macrocalcifications are not always benign and are not associated with increased nondiagnostic FNAB results. Macrocalcification, particularly the parenchymal type should be taken into consideration.

Aim: To determine specific cell types and pathways involved in calcification of the developing brain., Method: We examined the detailed histopathology of samples from 28 autopsied brains aged from 22 weeks' gestation to 14 years. The samples were selected because they showed calcification associated with a range of different diseases. Samples were examined with routine stains as well as stains to show calcification and specific markers for endothelium and macrophages., Results: Our observations indicate that calcification develops via two main pathways: dystrophic and vascular. Dystrophic calcification results from membrane disruption and uncontrolled calcium entry into necrotic (dead) cells in ischaemia and infections. Vascular calcification appears to be initiated in protein globules, sometimes intracellular, but outside the endothelium of small vessels. One case with mutation of the occludin gene, implicating impaired endothelial integrity, showed this pattern, but identical vascular calcification was seen in other conditions, including Sturge-Weber syndrome. Another form of vascular calcification involved the adventitia of arteries; the endothelium was always spared., Interpretation: Calcification in the developing brain that is not associated with tissue necrosis is initiated in cells associated with blood vessels. Calcium incrustation of blood vessels imposes rigidity, reduced vascular compliance, and altered permeability. This would explain associated atrophy, gliosis, and (in the developing brain) malformations of the cortex. Our findings suggest that pericytes initiate non-dystrophic brain calcification, but further studies are needed to explore this possibility., (© 2014 Mac Keith Press.)

Microcalcifications are actually indirect signs of pathological processes, and only a few of these processes may be correctly correlated to the morphologic pattern of calcifications. This is true of the microcalcifications typically classified as benign by the 4th edition of the BI-RADS Atlas, except for round and punctuate microcalcifications. This is also the case of polymorphous fine and linear fine microcalcifications most often, but not exclusively, associated with DCIS with necrosis. For other types of microcalcifications, other parameters are analyzed in a more global approach: the associated clinical or mammographical signs; the context, especially genetic; the spatial distribution; the number; the evolution over time. The radiologist should compare the images with the anatomy of the terminal ductal-lobular unit, from where most cancers arise, and estimates the risk by taking into account the clinical context and the antecedents., (Copyright © 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Lithopaidion, or stone child, is generally a single rare asymptomatic formation that evolves from an undiagnosed and untreated advanced abdominal pregnancy. The dead fetus is retained in the maternal abdominal cavity, which causes calcification. In this paper, we review the literature on the epidemiology, etiopathogenesis and clinical features of lithopaidion and report a unique case of lithokelyphos in a patient with an ectopic fallopian pregnancy. We propose a model to unify the data. The new word 'lithopaidion' can be utilized instead of lithopedion., (© 2014 S. Karger AG, Basel.)

Introduction: Peyronie's disease (PD) is a connective tissue disorder of the penis in which a fibrous scar in the tunica albuginea can result in multiple penile deformities., Aim: The study aims to investigate the prevalence and time to identification of plaque calcification (PC) in our PD patient population and whether stratification of calcification based on severity seen on ultrasound would serve as a predictor of treatment progression to surgery., Methods: A retrospective review of 1,041 men presenting with PD from 1993 to 2009 was performed. Eight hundred thirty-four underwent penile duplex ultrasound., Main Outcome Measures: PC was graded as: grade 1 (<0.3 cm), grade 2 (>0.3 cm, <1.5 cm), grade 3 (>1.5 cm; or ≥ 2 plaques >1.0 cm). A matched control group with noncalcified plaques (n = 236) was selected for comparison., Results: Two hundred eighty-four men (34%) were found to have PC noted on ultrasound, and 98 had fully documented dimensions of the PC. Forty-one percent were found to have grade 1, 28% grade 2, and 32% grade 3. When analyzed by grade and progression to surgery, 23% of grade 1, 32% of grade 2, and 55% of grade 3 patients had surgery. Those with grade 3 PC were more likely to undergo surgical intervention for PD (OR 2.28 95% CI 1.07-4.86) and more likely to undergo a grafting procedure than control patients (P < 0.0001)., Conclusions: Men with PC are not more likely to undergo surgery than those without PC (OR 0.95, 95% CI 0.58-1.57). PC is not uncommon, as it was found in 34% of our cohort. PC does not appear to be an indication of mature or stable disease, as it was identified by ultrasound in 37% of patients less than 12 months after onset of symptoms. Men with grade 3 PC have an increased likelihood of progression to surgical intervention and a higher likelihood of undergoing a grafting procedure., (© 2013 International Society for Sexual Medicine.)

Background: Detailed multimodality assessment of subclinical atherosclerosis in asymptomatic subjects referred for risk stratification has not been performed. We analyzed the detection of early atherosclerosis using 3 imaging modalities: coronary artery calcium (CAC) scoring, carotid ultrasound (US), and coronary computed tomography angiography (CCTA)., Methods: Asymptomatic subjects free of known vascular disease scheduled to undergo a carotid US for risk stratification were invited to undergo CCTA/CAC. Subjects taking lipid-lowering medication were excluded. All images were assessed by experienced core laboratory personnel. Carotid intima media thickness ≥ 75th percentile for age and sex, CAC > 0, and detection of either carotid or coronary artery plaque were indicators of atherosclerosis., Results: Fifty patients were included with a median age of 53 years. Atherosclerosis was observed in 28%, 78%, and 90% of subjects using CAC, CCTA, and carotid US, respectively. All subjects showed atherosclerosis on at least 1 modality. In 36 patients with a CAC score = 0, 69% and 86% had atherosclerosis on CCTA and carotid US, respectively., Conclusions: In this detailed analysis, all subjects identified to warrant further risk stratification had subclinical atherosclerosis on at least 1 imaging modality. Concordance between modalities was highly variable, dependent on the specific definition of atherosclerosis used. Carotid US and CCTA detection of plaque were significantly more sensitive than CAC > 0 in this middle-aged population. Considering the prevalence of subclinical disease on carotid US and CCTA, the threshold at which to treat warrants further research., (Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Background: The presence of microcalcification is highly suggestive of malignancy; however, the association of macrocalcification with cancer remains unclear and controversial. The purpose of this study was to evaluate the diagnostic yield and accuracy of ultrasound (US)-guided fine-needle aspiration (FNA) of thyroid nodules with macrocalcifications and to investigate the association between macrocalcification subtype and malignancy risk., Methods: We retrospectively reviewed sonographic findings and pathologic results of thyroid nodules with macrocalcification in patients who underwent US-guided FNA in our hospital from January 2009 through December 2010. Inclusion criteria were as follows: (i) malignant or benign nodules confirmed on histologic examination of surgical specimens after US-guided FNA and (ii) nodules not histologically confirmed that were subjected to FNA at least twice and follow-up US examinations for 2 years. Thyroid nodules with macrocalcification were classified into four groups: smooth total (eggshell) calcification, smooth partial calcification, irregular calcification, and nodular calcification. The diagnostic yield of FNA for thyroid nodules with macrocalcification was determined by cytology. Sensitivity, specificity, and diagnostic accuracy of preoperative FNA cytology were calculated and compared with those of histologic examination of surgical specimens., Results: There were 188 nodules with macrocalcification in 167 patients; of these, 95 were benign, 80 were malignant, and 13 were nondiagnostic. The diagnostic yield of FNA for thyroid nodules with macrocalcification was 93.08%. Sensitivity, specificity, positive predictive value, and negative predictive value were 98.51%, 90.91%, 95.65%, and 96.77%, respectively. The false-positive value and false-negative value were 9.09% and 1.49%, respectively. The diagnostic accuracy was 96%. There was no statistically significant difference in the association between macrocalcification subtype and malignancy risk (p > 0.05)., Conclusions: Macrocalcification associated with thyroid nodules is not a reliable criterion for malignancy. FNA of thyroid nodules with macrocalcification had a high diagnostic yield and a reliable accuracy. Consistency between cytology and histology was almost perfect. Therefore, FNA is a good screening method for malignancy of thyroid nodules with macrocalcification.

Purpose: To use a systematic review and meta-analysis to determine the predictive value of five suspicious type descriptors of microcalcifications, with special focus on round/punctate microcalcifications because of controversy., Materials and Methods: We performed a literature search using three databases and one search engine. We screened citations for malignancy rates of type descriptors. We regarded malignancy rates below 2% (BI-RADS 3) and above 95% (BI-RADS 5) as clinically significant threshold values for suspicion (BI-RADS 4)., Results: Forty studies from 14 countries with a total of 10,665 microcalcification lesions were included. The pooled malignancy rates were: coarse heterogeneous, 13% (95% confidence interval (95%-CI): 7 - 20%); amorphous or indistinct, 27% (95%-CI: 21-33%); pleomorphic, 50% (95%-CI: 43-58%); linear, 78% (95%-CI: 68 - 86%). The pooled malignancy rate of all round/punctate microcalcifications was 9% (95%-CI: 6-13%), for the subgroup follow-up it was 0,5% (95%-CI: 0.08-2.57%), and with histological verification it was 14% (95%-CI: 11-19%). Woman selection and consideration of additional suspicious image findings were reasons for between-study heterogeneity. Addition of ACR distribution descriptors diversified risk stratification, but did not alter BI-RADS assessment category., Conclusion: All suspicious type descriptors including round/punctate microcalcifications as well as combinations of type with suspicious distribution descriptors fell into BI-RADS assessment category 4. Exclusion of suspicious adjunct factors can direct clustered, round/punctate microcalcifications to a lower BI-RADS assessment category., (© Georg Thieme Verlag KG Stuttgart · New York.)

Serum uric acid (SUA) level is a marker of endothelial dysfunction and oxidative stress. Consecutive patients (n = 64) with normal coronary angiography who demonstrated calcific aortic stenosis (AS) by transthoracic echocardiography were included in the study. The patients were categorized into 3 groups: 23 mild AS (12 males), 21 moderate AS (10 males), and 20 severe AS cases (10 males). Fasting SUA level was significantly higher in the severe AS group than in the moderate and mild AS groups (severe AS, 6.3 ± 1.6; moderate AS, 4.9 ± 1.3; mild AS; 4.6 ± 1.4 mg/dL; P < .001, respectively). There was a positive correlation between SUA level and maximum as well as mean aortic gradient (r = .521, P < .001 and r = .526, P < .001, respectively). There was a negative correlation between SUA level and aortic valve area (r = -.447, P < .001). Levels of SUA were increased in calcific AS cases. In addition, there was a positive correlation between severity of calcific AS and SUA levels.

Purpose: To discuss a new classification and the treatment principles of synovial chondromatosis (SC) in the inferior compartment of the temporomandibular joint (TMJ)., Patients and Methods: Five cases of SC in the inferior compartment were treated in an open manner between January 2008 and May 2011. Each case had different clinical and radiologic aspects and was treated with different surgical therapies. SC in the inferior compartment of the TMJ is classified into 3 stages. All patients were evaluated by computed tomography, magnetic resonance imaging, and clinical manifestations preoperatively and postoperatively., Results: There were 3 kinds of manifestation modes from radiologic findings. Case 1 was in stage 1, in which multiple loose bodies are noted without bony erosion. This patient was treated by removal of loose bodies and affected synovium. Case 2 was in stage 2, in which multiple calcified nodules were conglutinated to the condyle; the condyle was enlarged with pressure erosions. This patient was treated by condylectomy and reconstruction with costochondral graft. Case 3, case 4, and case 5 were all in stage 3, in which the condyle was destroyed as a result of pressure erosions or by direct bony invasion of the mass and the inferior surface of the disc was involved. These patients were treated by condylectomy together with discectomy, as well as reconstruction with costochondral graft and pedicled deep temporal fascial fat flap. No recurrence occurred. The height of the ramus and the occlusion were maintained in the same condition as preoperatively., Conclusions: Our new classification of SC in the inferior compartment of the TMJ can better guide clinical treatment., (Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Abdominal aortic calcifications (AAC) predict cardiovascular mortality. A new scoring model for AAC, the Morphological Atherosclerotic Calcification Distribution (MACD) index may contribute with additional information to the commonly used Aortic Calcification Severity (AC24) score, when predicting death from cardiovascular disease (CVD). In this study we investigated associations of MACD and AC24 with traditional metabolic-syndrome associated risk factors at baseline and after 8.3 years follow-up, to identify biological parameters that may account for the differential performance of these indices., Methods: Three hundred and eight healthy women aged 48 to 76 years, were followed for 8.3 ± 0.3 years. AAC was quantified using lumbar radiographs. Baseline data included age, weight, blood pressure, blood lipids, and glucose levels. Pearson correlation coefficients were used to test for relationships., Results: At baseline and across all patients, MACD correlated with blood glucose (r(2) = 0.1, P< 0.001) and to a lesser, but significant extent with traditional risk factors (p < 0.01) of CVD. In the longitudinal analysis of correlations between baseline biological parameters and the follow-up calcification assessment using radiographs we found LDL-cholesterol, HDL/LDL, and the ApoB/ApoA ratio significantly associated with the MACD (P< 0.01). In a subset of patients presenting with calcification at both baseline and at follow-up, all cholesterol levels were significantly associated with the MACD (P< 0.01) index. AC24 index was not correlated with blood parameters., Conclusion: Patterns of calcification identified by the MACD, but not the AC24 index, appear to contain useful biological information perhaps explaining part of the improved identification of risk of cardiovascular death of the MACD index. Correlations of MACD but not the AC24 with glucose levels at baseline suggest that hyperglycemia may contribute to unique patterns of calcification indicated by the MACD.

In this study, we explore a mathematical model to characterize the clustered microcalcifications on mammograms for predicting the pathological classification and grading. Our database consists of both retrospective cases (78 cases) and prospective cases (31 cases) with pathologically diagnosed clusters of microcalcifications on mammograms. The microcalcifications were divided into four grades: grade 0, benign breast disease including mastopathies (n = 12) and fibroadenomas (n = 20); grade 1, well-differentiated infiltrating ductal carcinoma (n = 12); grade 2, moderately differentiated infiltrating ductal carcinoma (n = 38); grade 3, poorly differentiated infiltrating ductal carcinoma (n = 27). A feature parameter, defined as the pattern form factor of microcalcification cluster θ by us, combines five computer-extracted image parameters of microcalcification clusters of those mammograms. In every case, only one imaging was selected for modeling analysis. A total of 109 imagings were adopted in current study. We find the existence of a positive relationship between the feature parameter θ and pathological grading G of microcalcifications in retrospective cases, which was expressed as G =  6.438 + 1.186 ×  Ln <θ>. The model above has been verified further by the prospective study with a comparative evaluation accuracy of approximately 77.42%. The binary predication simply for both benignancy and malignancy was also included using same but reshuffled data, and the receiver operating characteristic (ROC) analysis was performed with ROC value 0.74351∼0.79891. As one candidate for feature parameter in computer-aided diagnosis, the pattern form factor θ of clustered microcalcifications may be useful to predict the pathological grading and classification of microcalcification clusters on mammography in breast cancer.

A content-based mammogram retrieval system can support usual comparisons made on images by physicians, answering similarity queries over images stored in the database. The importance of searching for similar mammograms lies in the fact that physicians usually try to recall similar cases by seeking images that are pathologically similar to a given image. This paper presents a content-based mammogram retrieval system, which employs a query example to search for similar mammograms in the database. In this system the mammographic lesions are interpreted based on their medical characteristics specified in the Breast Imaging Reporting and Data System (BI-RADS) standards. A hierarchical similarity measurement scheme based on a distance weighting function is proposed to model user's perception and maximizes the effectiveness of each feature in a mammographic descriptor. A machine learning approach based on support vector machines and user's relevance feedback is also proposed to analyze the user's information need in order to retrieve target images more accurately. Experimental results demonstrate that the proposed machine learning approach with Radial Basis Function (RBF) kernel function achieves the best performance among all tested ones. Furthermore, the results also show that the proposed learning approach can improve retrieval performance when applied to retrieve mammograms with similar mass and calcification lesions, respectively., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: To develop a standardized system for analyzing and reporting thyroid ultrasound, or Thyroid Imaging Reporting and Data System (TIRADS), in order to improve the management of patients with thyroid nodules., Materials and Methods: An atlas of imaging features, a standardized vocabulary, a report template and TIRADS categories 0 to 6 were defined, based on the BI-RADS system used for mammography. The diagnostic efficacy of the system was tested by a retrospective review of 500 nodules (159 cancers and 341 benign nodules) and comparing US imaging features to histological findings., Results: Five signs allow accurate detection of 90% of thyroid cancers. The score of a nodule can be easily defined by using an organigram. Sensitivity, specificity and odds-ratio of the score were respectively 95%, 68% and 40., Conclusion: TIRADS is a quality assurance tool for thyroid ultrasound. It contains an image atlas, a standardized report and categories to evaluate thyroid nodules to easily assess the risk of individual nodules being cancers and facilitate patient management., (Copyright © 2011 Elsevier Masson SAS and Éditions françaises de radiologie. All rights reserved.)