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Congenital agenesis of major salivary glands is considered a very infrequent condition and typically appears to be a coincidental finding. It can be present as sporadic case or may be combined with aplasia or hypoplasia of other salivary glands or the lacrimal glands, or as a part of syndromes. Only 23 cases documented in the literature to date, while the youngest patient was 50 days old. Plenty of radiographic useful techniques and treatment is closely related to the clinical manifestations; therefore. We present a case of 52 year old female who was referred to our radiology department for recurrent numbness of the left upper limb, experienced over the previous three months. Complete absence of the left parotid gland was incidentally demonstrated at the brain MRI scan. Based on the patient's past medical history, physical examination and demonstrated radiographic techniques it was an asymptomatic, no-syndromic and no-familious unilateral aplasia of the parotid gland. In the present report, we aimed to underline that this rare condition may be asymptomatic and co-exist with other medical conditions and syndromes.

A reverse micelle method was used for the synthesis of water-soluble silica hybrid, spin-crossover (SCO) nanoparticles (NPs). MRI experiments provided temperature dependent T2 values, indicating their potential use as smart MRI agents, while lyophilization of NP dispersions in water yielded powders with a preserved but modified thermal hysteretic magnetic profile.

To present the anatomical variations of vidian canal (VC) and sphenoid sinus (SS), relative to other anatomical landmarks of skull base area, which may be helpful for safer surgical approach to this area. MDCT scans (128-row MDCT system) of 90 patients (mean age 62 years) and six cadaveric heads were studied, and the following parameters were evaluated: mean length and types of VC, distance between VC and foramen rotundum (FR) and optic canal (OC), position of the VC regarding the lateral pterygoid plate (MPTG) and petrous ICA, pneumatization of SS, position of intrasinus septum regarding ICA and OC, bone dehiscence and protrusion of ICA and OC into SS. Six cadaveric heads underwent MDCT and endoscopic dissection, and the type and length of VC were evaluated. The statistical significance was assessed using Chi-square (χ2) test. Significance level was set at p

Background Apparent diffusion coefficient (ADC) measurements are not incorporated in BI-RADS classification. Purpose To assess the probability of malignancy of breast lesions at magnetic resonance mammography (MRM) at 3 T, by combining ADC measurements with the BI-RADS score, in order to improve the specificity of MRM. Material and Methods A total of 296 biopsy-proven breast lesions were included in this prospective study. MRM was performed at 3 T, using a standard protocol with dynamic sequence (DCE-MRI) and an extra echo-planar diffusion-weighted sequence. A freehand region of interest was drawn inside the lesion, and ADC values were calculated. Each lesion was categorized according to the BI-RADS classification. Logistic regression analysis was employed to predict the probability of malignancy of a lesion. The model combined the BI-RADS classification and the ADC value. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. Results In total, 153 malignant and 143 benign lesions were analyzed; 257 lesions were masses and 39 lesions were non-mass-like enhancements. The sensitivity and specificity of the combined method were 96% and 86%, respectively, in contrast to 95% and 81% with BI-RADS classification alone. Conclusion We propose a method of assessing the probability of malignancy in breast lesions by combining BI-RADS score and ADC values into a single formula, increasing sensitivity and specificity compared to BI-RADS classification alone.

Hepatic arterial variations are relatively common, but usually overlooked by radiologists, leading to iatrogenic complications or prolonging interventional or surgical procedures. Michels in 1966 classified hepatic arterial variations in 10 categories, based on a cadaveric study. Establishment of multidetector computed tomography (MDCT) provides useful anatomical information. The purpose of our study is to highlight these variations and to propose of a user-friendly algorithm when studying a CT examination. We studied 1,520 contrast-enhanced CTs (16-row MDCT system) during arterial phase and searched for hepatic arteries and celiac trunk (CTr) variations. CT images were postproccessed using multiplanar reconstruction, maximum intensity projection and volume rendering techniques in axial, sagittal, and coronal planes. Our results were organized according to Michels' classification. Normal anatomy was found in 72.89% of the cases and variations classified in Types II-X in 22.24%. However, 4.87% of the cases could not be classified in Michels' types. A single arterial variation was found in 22.89% of the cases and multiple arterial variations were found in 4.21% of the cases. We examined first the aorta for supernumerary branches and then checked the fissure between right and left liver lobe, following porta hepatis, and finally the CTr and superior mesenteric artery. Hepatic arteries and CTr variations are relatively common (27.11%) and should be identified by the radiologists when studying CTs as their recognition provides better surgical planning, preventing iatrogenic complications. Imaging in coronal plane was helpful for end branches, while sagittal plane was better for aortic branches. Clin. Anat., 33:1091-1101, 2020. © 2019 Wiley Periodicals, Inc.

Aims and objectives To investigate the value of advanced multiparametric MR imaging biomarker analysis based on radiomic features and machine learning classification, in the non-invasive evaluation of tumor heterogeneity towards the differentiation of Low Grade vs. High Grade Gliomas. Methods and materials Forty histologically confirmed glioma patients (20 LGG and 20 HGG) who underwent a standard 3T-MRI tumor protocol with conventional (T1 pre/post-contrast, T2-FSE, T2-FLAIR) and advanced techniques (Diffusion Tensor and Perfusion Imaging, 1H-MR Spectroscopy), were included. A semi-automated segmentation technique, based on T1W-C and DTI, was used for tumor core delineation in all available parametric maps. 3D Texture analysis considered 12 Histogram, 11 Co-Occurrence Matrix (GLCM) and 5 Run Length Matrix (GLRLM) features, derived from p, q, MD, FA, T1W-C, T2W-FSE, T2W-FLAIR and raw DSCE data. Along with 1H-MRS metabolic ratios and mean rCBV values, a total of 581 attributes for each subject were obtained. A Support Vector Machine – Recursive Feature Elimination (SVM-RFE) algorithm and SVM classifier were utilized for feature selection and classification, respectively. Results Three different SVM classifiers were evaluated with consecutively SVM-RFE feature subsets. Linear SMO classifier demonstrated the highest performance for determining the optimal feature subset. Finally, 21 SVM-RFE top-ranked features were adopted, for training and testing the SMO classifier with leave-one-out cross-validation, achieving 95.5% Accuracy, 95% Sensitivity, 96% Specificity and 95.5% Area Under ROC Curve. Conclusion Results demonstrate that quantitative analysis of phenotypic characteristics, based on advanced multiparametric MR neuroimaging data and texture features, utilizing state-of-the-art radiomic analysis methods, can significantly contribute to the pre-treatment glioma grade differentiation.

Purpose The aim of this retrospective study was to present the frequency and MDCT appearances of sternal variations and anomalies, as well as to highlight their clinical significance. Methods This retrospective study was carried out on 1150 patients, who underwent chest MDCT. Axial planes, multiplanar and curved-planar reconstructed images were studied. Age and sex distribution of the variations was evaluated. Results Anatomical variations of the sternum were found in 74.1%. The most frequent variation was the double-ended xiphoid process (36.9%), followed by the single xiphoidal foramen (25.8%) and the sternal sclerotic band (12.8%). Other variations observed were: sternal notch (10.1%), xiphoidal ligament calcification (8.3%), sternal foramen (4.9%), complete manubriosternal fusion (4.1%) and sternoxiphoidal fusion (4.1%), triple-ended xiphoid process (3.7%), sternal cleft (1.5%), whereas the rest of the variations including sternoxiphoidal junction pseudoforamen, suprasternal bone, pseudocleft, suprasternal tubercle and absence of xiphoid process were in less than 1%. In our subjects, sternal and xiphoidal foramina were adjacent to: the pericardium (37.14%), the diaphragm (22.9%), the mediastinal fat (17.1%), the liver (11.4%), the lung (8.5%) and to the stomach (2.9%). Conclusions Sternal variations are frequent, asymptomatic, detected incidentally at cross-sectional imaging and may be confused with pathologic conditions. Radiologists should be familiar with these variations in order to discriminate them from pathologies and avoid complications during interventional procedures. Advances in knowledge This study presents thoroughly the sternal variations’ MDCT appearance, detected in a Greek population, correlates them with age and gender and discuss their clinical significance in detail.

Epitope H contains an O-linked N-acetylglucosamine (O-GlcNAcH) residue in a specific conformation and/or environment recognized by the mouse monoclonal antibody H. O-GlcNAcH is present in several types of cells and in several polypeptides, including cytokeratin 8 and vimentin, on the latter in cells under stress. In the present work, we examined the expression of the O-GlcNAcH in 60 cases of endometrial curettings from missed miscarriage cases containing normal and simple hydropic degenerated chorionic villi in each case, using monoclonal antibody H and indirect immunoperoxidase and Western blot immunoblot. In all cases examined the expression of the O-GlcNAcH was cytoplasmic as follows: (1) syncytiotrophoblastic cells showed very low expression in chorionic villi (CV) with nonhydropic degeneration (NHD) and high expression in hydropic degenerated (HD) CV; (2) cytotrophoblastic cells showed low expression in CV with NHD and high expression in HD CV; (3) fibroblastic cells showed high expression in CV with NHD and very low expression in HD CV; (4) histiocytes showed very low expression in both types of CV; (5) endothelial cells showed high expression in both types of CV. An immunoblot of CV from one case of a legal abortion from a normal first-trimester pregnancy showed 5 polypeptides with 118.5, 106.3, 85, 53, and 36.7 kD bearing the epitope H and the 53 kD corresponded to cytokeratin 8. The expression of the O-GlcNAcH is upregulated in the trophoblastic cells and downregulated in the fibroblastic cells in the HD CV in comparison to the NHD CV.

Purpose To identify intra-lesion imaging heterogeneity biomarkers in multi-parametric Magnetic Resonance Imaging (mpMRI) for breast lesion diagnosis. Methods Dynamic Contrast Enhanced (DCE) and Diffusion Weighted Imaging (DWI) of 73 female patients, with 85 histologically verified breast lesions were acquired. Non-rigid multi-resolution registration was utilized to spatially align sequences. Four (4) DCE (2nd post-contrast frame, Initial-Enhancement, Post-Initial-Enhancement and Signal-Enhancement-Ratio) and one (1) DWI (Apparent-Diffusion-Coefficient) representations were analyzed, considering a representative lesion slice. 11 1st-order-statistics and 16 texture features (Gray-Level-Co-occurrence-Matrix (GLCM) and Gray-Level-Run-Length-Matrix (GLRLM) based) were derived from lesion segments, provided by Fuzzy C-Means segmentation, across the 5 representations, resulting in 135 features. Least-Absolute-Shrinkage and Selection-Operator (LASSO) regression was utilized to select optimal feature subsets, subsequently fed into 3 classification schemes: Logistic-Regression (LR), Random-Forest (RF), Support-Vector-Machine-Sequential-Minimal-Optimization (SVM-SMO), assessed with Receiver-Operating-Characteristic (ROC) analysis. Results LASSO regression resulted in 7, 6 and 7 features subsets from DCE, DWI and mpMRI, respectively. Best classification performance was obtained by the RF multi-parametric scheme (Area-Under-ROC-Curve, (AUC) ± Standard-Error (SE), AUC ± SE = 0.984 ± 0.025), as compared to DCE (AUC ± SE = 0.961 ± 0.030) and DWI (AUC ± SE = 0.938 ± 0.032) and statistically significantly higher as compared to DWI. The selected mpMRI feature subset highlights the significance of entropy (1st-order-statistics and 2nd-order-statistics (GLCM)) and percentile features extracted from 2nd post-contrast frame, PIE, SER maps and ADC map. Conclusion Capturing breast intra-lesion heterogeneity, across mpMRI lesion segments with 1st-order-statistics and texture features (GLCM and GLRLM based), offers a valuable diagnostic tool for breast cancer.

Breast cancer is a highly heterogeneous disease, exhibiting substantial spatiotemporal variations in gene expression, biochemistry, histopathology, and macroscopic structure. The complexities in the evaluation of malignant tumor heterogeneity, are pushing current clinical examinations to their limits and accounting for most of the failures of targeted therapies, and uncertainties in the clinical outcome among breast cancer patients. The incorporation of state-of-the-art image analysis methods, and emerging machine learning techniques, is providing the application of detailed data-driven quantitative studies of imaging phenotypes, termed Radiomics. Specifically, an immense number of quantifiable imaging features, are extracted with high-throughput computing from medical images, and correlated with other clinical data, for unraveling the complex underlying pathophysiological mechanisms which are potentially reflected in tissue macroscopic phenotype. Therefore, radiomic analysis is holding a key role in the future of clinical decision support, as it provides powerful tools for assessing the spatiotemporal heterogeneity of breast cancer, aiming at increasing the diagnostic accuracy and predicting patient's outcome toward individualized therapy planning.

Infertile couples with low oocyte yield in combination with abnormal semen parameters may experience intra-cytoplasmic sperm injection (ICSI) failure. An established factor associated with ICSI failure is oocyte activation deficiency (AOD). The latter originates from seminal contributors, such as phospholipase C-zeta (PLCζ) that is not adequate to produce calcium (Ca2+) oscillations for oocyte activation. Apart from this natural activator, other stimulants, such as A23187, ionomycin, strontium chloride or even electric pulses, have been used in embryological laboratories to overcome AOD and ICSI failure. The aim of the present narrative review is to discuss the role of Ca+2 oscillations in oocyte activation and summarize the evidence concerning the use of oocyte activators as agents for artificial oocyte activation (AOA). Studies in humans and animals have emerged many physiological, pathophysiological and ethical aspects of AOA. In conclusion, in mammalian eggs, the cytosolic Ca+2 oscillations derive from a periodic release of Ca+2 from intracellular pools. PLCζ, as well as artificial stimulants, have been used to produce Ca+2 oscillations for AOA. As the latter may increase the risk of epigenetic induced malformations, further studies are required to clarify whether AOA constitutes an effective and safe method to overcome ICSI failure. Abbreviations: AOA: artificial oocyte activation; AOD: oocyte activation deficiency; Ca+2: Calcium; CAMKII: Ca+2/calmodulin-dependent protein kinase II; CICR: calcium-induced calcium-release; DAG: diacylglycerol; GM-CSF: granulocyte-macrophage colony-stimulating factor; ICSI: intra-cytoplasmic sperm injection; InsP3R: inositol-trisphosphate receptor; IP3: inositol 1,4,5-trisphosphate; IVF: in vitro fertilization; MAP: mitogen-activated protein; MII: metaphase II; NADP: nicotinic acid adenine dinucleotide phosphate; NO: nitric oxide; PAWP: post-acrosomal WW-binding domain protein; PIP2: phosphatidylinositol 4,5-bisphosphate; PLC: phospholipase C; PLCζ: phospholipase C-zeta; SOAFs: spermatozoon-released oocyte-activating factors; Sr+2: strontium; TFF: total fertilization failure.

Objective. To assess body composition in adult male and female patients with thalassemia major by dual-energy X-ray absorptiometry (DXA) and to compare the findings with a group of healthy age-matched controls. Methods. Our study group included sixty-two patients (27 males, mean age 36 years, and 35 females, mean age 36.4 years) and fifteen age-matched healthy controls. All patients had an established diagnosis of thalassemia major and followed a regular blood transfusion scheme since childhood and chelation treatment. Fat, lean, and bone mineral density (BMD) were assessed with dual-energy X-ray absorptiometry. Ferritin levels and body mass index of all patients and controls were also recorded. Student t-test and Wilcoxon test were performed and statistical significance was set at p<0.05. Results. BMD and whole body lean mass are lower in both male and female adult patients compared with controls (p<0.01 in both groups), whereas whole body fat mass was found to have no statistically significant difference compared to controls. Regional trunk fat around the abdomen was found to be lower in male patients compared to controls (p=0.02). Conclusion. Severe bone loss and diminished lean mass are expected in adult male and female patients with thalassemia major. Fat changes seem to affect mainly male patients.

Background Conventional breast magnetic resonance imaging (MRI), including dynamic contrast-enhanced MR mammography, may lead to ambiguous diagnosis and unnecessary biopsies. Purpose To investigate the contribution of quantitative diffusion tensor imaging (DTI) in the discrimination between benign and malignant breast lesions at 3 T MRI. Material and methods The study included a total of 86 lesions (44 benign and 42 malignant) in 58 women (34 with malignant lesions, 23 with benign lesions and 1 with both types of lesions). All patients were examined on a 3 T MRI scanner. Fractional Anisotropy (FA), Mean Diffusivity (MD), Apparent Diffusion Coefficient (ADC), as well as eigenvalues (λ1, λ2, λ3) were calculated and compared between benign and malignant lesions using two different software packages (GE Functool and ExploreDTI). Results Malignant lesions exhibited significantly lower ADC values compared to benign ones (ADCmal = 1.06 × 10−3 mm2/s, ADCben = 1.54 × 10−3 mm2/s, p-value Conclusion The addition of eigenvalue analysis improves DTI's ability to differentiate between benign and malignant breast lesions.

Over the years, MR systems have evolved from imaging modalities to advanced computational systems producing a variety of numerical parameters that can be used for the noninvasive preoperative assessment of breast pathology. Furthermore, the combination with state-of-the-art image analysis methods provides a plethora of quantifiable imaging features, termed radiomics that increases diagnostic accuracy towards individualized therapy planning. More importantly, radiomics can now be complemented by the emerging deep learning techniques for further process automation and correlation with other clinical data which facilitate the monitoring of treatment response, as well as the prediction of patient’s outcome, by means of unravelling of the complex underlying pathophysiological mechanisms which are reflected in tissue phenotype. The scope of this review is to provide applications and limitations of radiomics towards the development of clinical decision support systems for breast cancer diagnosis and prognosis.

The purpose of this study is to identify the prevalence of osteoporosis in male patients with chronic obstructive pulmonary disease (COPD) by dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) and to compare the diagnostic abilities of the above methods. Thirty-seven male patients with established COPD were examined with DXA and standard QCT in lumbar spine, including L1, L2, and L3 vertebrae. T-scores and bone mineral density values were calculated by DXA and QCT method, respectively. Comparative assessment of the findings was performed and statistical analysis was applied. QCT measurements found more COPD patients with impaired bone mineral density compared to DXA, namely, 13 (35.1%) versus 12 (32.4%) patients with osteopenia and 16 (43.2%) versus 9 (16.2%) patients with osteoporosis (p = 0.04). More vertebrae were found with osteoporosis by QCT compared to DXA (p = 0.03). The prevalence of osteoporosis among male patients with COPD is increased and DXA may underestimate this risk. QCT measurements have an improved discriminating ability to identify low BMD compared to DXA measurements because QCT is able to overcome diagnostic pitfalls including aortic calcifications and degenerative spinal osteophytes.

Purpose: Segmentation of microcalcification (MC) clusters in x-ray mammography is a difficult task for radiologists. Accurate segmentation is prerequisite for quantitative image analysis of MC clusters and subsequent feature extraction and classification in computer-aided diagnosis schemes. Methods: In this study, a two-stage semiautomated segmentation method of MC clusters is investigated. The first stage is targeted to accurate and time efficient segmentation of the majority of the particles of a MC cluster, by means of a level set method. The second stage is targeted to shape refinement of selected individual MCs, by means of an active contour model. Both methods are applied in the framework of a rich scale-space representation, provided by the wavelet transform at integer scales. Segmentation reliability of the proposed method in terms of inter and intraobserver agreements was evaluated in a case sample of 80 MC clusters originating from the digital database for screening mammography, corresponding to 4 morphology types (punctate: 22, fine linear branching: 16, pleomorphic: 18, and amorphous: 24) of MC clusters, assessing radiologists’ segmentations quantitatively by two distance metrics (Hausdorff distance—HDIST{sub cluster}, average of minimum distance—AMINDIST{sub cluster}) and the area overlap measure (AOM{sub cluster}). The effect of the proposed segmentation method on MC clustermore » characterization accuracy was evaluated in a case sample of 162 pleomorphic MC clusters (72 malignant and 90 benign). Ten MC cluster features, targeted to capture morphologic properties of individual MCs in a cluster (area, major length, perimeter, compactness, and spread), were extracted and a correlation-based feature selection method yielded a feature subset to feed in a support vector machine classifier. Classification performance of the MC cluster features was estimated by means of the area under receiver operating characteristic curve (Az ± Standard Error) utilizing tenfold cross-validation methodology. A previously developed B-spline active rays segmentation method was also considered for comparison purposes. Results: Interobserver and intraobserver segmentation agreements (median and [25%, 75%] quartile range) were substantial with respect to the distance metrics HDIST{sub cluster} (2.3 [1.8, 2.9] and 2.5 [2.1, 3.2] pixels) and AMINDIST{sub cluster} (0.8 [0.6, 1.0] and 1.0 [0.8, 1.2] pixels), while moderate with respect to AOM{sub cluster} (0.64 [0.55, 0.71] and 0.59 [0.52, 0.66]). The proposed segmentation method outperformed (0.80 ± 0.04) statistically significantly (Mann-Whitney U-test, p < 0.05) the B-spline active rays segmentation method (0.69 ± 0.04), suggesting the significance of the proposed semiautomated method. Conclusions: Results indicate a reliable semiautomated segmentation method for MC clusters offered by deformable models, which could be utilized in MC cluster quantitative image analysis.« less

Incisional hernia is one of the most frequent complications of abdominal surgery [1–3] with a reported prevalence from 0.5% to 13.9% for abdominal operations but may be as high as 41% after aortic ...

The role of magnetic resonance angiography (MRA) in the evaluation of patients with blunt vertebral artery has not been fully established. Our aim is to define the diagnostic accuracy of MRA in comparison to digital subtraction angiography (DSA) for the detection of blunt vertebral artery injury in trauma patients. A computer-assisted literature search of the PubMed, Scopus, Highwire, Web of Science, and LILACS was conducted, in order to identify studies reporting on the sensitivity and specificity of MRA in comparison to DSA for the detection of blunt vertebral artery injury in trauma patients. The Database search retrieved 91 studies. Five studies fulfilled our eligibility criteria. Two authors assessed the risk of bias and applicability concerns using QUADAS-2. Two-by-two contingency tables were constructed on a per-vessel level. Heterogeneity was tested by the statistical significance of Cochran's Q, and was quantified by the Higgins's I2 metric. The pooled estimates of sensitivity and specificity for blunt vertebral artery injury detection with MRA in comparison to DSA were calculated based on the bivariate model. The meta-analysis was supplemented by subgroup and sensitivity analysis, as well as analysis for publication bias. There was significant clinical heterogeneity in the targeted population, inclusion criteria, and MRA related parameters. The reporting bias and applicability concerns were moderate and low, respectively. In the overall analysis, the sensitivity ranged from 25% to 85%, while the specificity varied from 65% to 99%, across studies. According to the bivariate model, the pooled sensitivity and specificity of MRA in the evaluation of patients with blunt vertebral artery was as high as 55% (95% CI 32.1%-76.7%), and 91% (95% CI 66.3%-98.2%), respectively. Subgroup analysis in terms of MRA sequence sensitivity of phase, the contrasted MRA (75% [95% CI 43%-92%]) seemed to be superior to the TOF MRA (46% [95%CI 20%-74%]). The addition of contrast enhancement did not seem to improve the diagnostic yield of MRA. The Egger's test did not identify any significant publication bias (p=0.2). An important limitation of the current meta-analysis is the small number of eligible studies, as well as the lack of studies on newer, high-field MR scanners. We concluded that MRA has a moderate diagnostic accuracy in the diagnosis of blunt vertebral artery injuries. Further studies on high-field magnetic resonance scanners are recommended.

Brain tumors represent a vast group of lesions, originating from different neuronal cells with different degrees of aggressiveness. Despite some technological advances either pre or post-treatment, these tumors may share similar imaging findings and properties, rendering diagnosis/prognosis, an ambiguous process. Gadolinium-enhanced magnetic resonance imaging remains the gold standard for providing detailed morphologic information, but presents several limitations due to the overlap of findings, in cases such as progressive tumor and post-radiation related effects. Tumor cellularity, vascularity, proliferative activity, metabolic and functional profiles are a few of many characteristics that may further support tumor classification, but cannot be assessed by conventional imaging alone. We review the aforementioned factors and indicate how they improve tumor characterization and grading in order to design the optimal treatment strategy and better evaluate post treatment efficacy.

The purpose of this study is to identify the prevalence of osteoporosis in male patients with chronic obstructive pulmonary disease (COPD) by dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) and to compare the diagnostic abilities of the above methods. Thirty-seven male patients with established COPD were examined with DXA and standard QCT in lumbar spine, including L1, L2, and L3 vertebrae.T-scores and bone mineral density values were calculated by DXA and QCT method, respectively. Comparative assessment of the findings was performed and statistical analysis was applied. QCT measurements found more COPD patients with impaired bone mineral density compared to DXA, namely, 13 (35.1%) versus 12 (32.4%) patients with osteopenia and 16 (43.2%) versus 9 (16.2%) patients with osteoporosis (p=0.04). More vertebrae were found with osteoporosis by QCT compared to DXA (p=0.03). The prevalence of osteoporosis among male patients with COPD is increased and DXA may underestimate this risk. QCT measurements have an improved discriminating ability to identify low BMD compared to DXA measurements because QCT is able to overcome diagnostic pitfalls including aortic calcifications and degenerative spinal osteophytes.

Synovial plicae are normal anatomical structures of the knee that may become symptomatic. MRI is an established technique for evaluating the anatomy of the knee, and it is a valuable tool for detecting plicae because of its high resolution resulting in increased tissue characterisation. At MRI, knee plicae appear as low-signal-intensity structures of variable size and thickness, and they are better visualised at fluid-sensitive sequences with or without fat suppression. The combined use of clinical examination and MRI may also facilitate the diagnosis of fibrotic or inflamed plicae that may be symptomatic. Arthroscopy remains the gold standard for recognition and repair of knee plicae in cases of knee dysfunction.

Background Conventional breast magnetic resonance imaging (MRI), including dynamic contrast-enhanced MR mammography (DCE-MRM), may lead to ambiguous diagnosis and unnecessary biopsies. Purpose To investigate the contribution of proton MR spectroscopy (1H-MRS) combined with diffusion tensor imaging (DTI) metrics in the discrimination between benign and malignant breast lesions. Material and Methods Fifty-one women with known breast abnormalities from conventional imaging were examined on a 3T MR scanner. DTI was performed during breast MRI, and fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured in the breast lesions and the contralateral normal breast. FA and ADC were compared between malignant lesions, benign lesions, and normal tissue. 1H-MRS was performed after gadolinium administration and choline peak was qualitatively evaluated. Results In our study 1H-MRS showed a sensitivity of 93.5%, specificity 80%, and accuracy 88.2%. FA was significantly higher in breast carcinomas compared to benign lesions. However, no significant difference was observed in ADC between benign and malignant lesions. The combination of Cho presence and FA achieved higher levels of accuracy and specificity in discriminating malignant from benign lesions over Cho presence or FA alone. Conclusion In conclusion, applying DTI and 1H-MRS together, adds incremental diagnostic value in the characterization of breast lesions and may sufficiently improve the low specificity of conventional breast MRI.

The purpose of the present study was to evaluate the visibility and the image quality of the biliary and pancreatic duct system on magnetic resonance cholangiopancreatography (MRCP) images based on two breath-hold (BH) methods using array spatial sensitivity technique: a single-shot fast spin-echo (SS-FSE) sequence and a three-dimensional single slab fast spin-echo (3D-FSE) sequence.In the present prospective comparative study, 47 patients (22 male and 25 female, mean age=50 years, age range=22-82 years) that were referred for MRCP during a 12-month period are included. All of them were referred with suspected pancreaticobiliary disease. All patients underwent MRCP with both a SS-FSE BH sequence and a 3D-FSE BH sequence. Qualitative evaluation regarding the depiction of three segments of the pancreaticobiliary tree and the frequency of artifacts was performed. Two radiologists graded each sequence of the obtained studies in a blinded fashion. Quantitative evaluation including calculation of relative signal intensity (rSI) and relative contrast (RC) ratios at seven segments of the pancreaticobiliary tree between fluid-filled ductal structures and organ parenchyma at the same ductal segments was performed. In order to evaluate the parameters' differences of the two sequences, either in qualitative or in quantitative analysis, the Wilcoxon paired signed-rank test was performed.On quantitative evaluation, both rSI and RC ratios of all segments of the pancreaticobiliary tree at SS-FSE BH sequence were higher than those at 3D-FSE BH sequences. This finding was statistically significant (P.01). On qualitative evaluation, the two radiologists found intrahepatic ducts and pancreatic ducts to be better visualized with SS-FSE BH than with 3D-FSE BH sequence. This finding was statistically significant (P.02). One of them found extrahepatic ducts to be significantly better visualized with SS-FSE BH sequence. Moreover, the frequency of artifacts was lower in the SS-FSE sequence, a finding that was of statistical significance. Interobserver agreement analysis found at least substantial agreement (κ0.60) between the two radiologists.The SS-FSE sequence is performed faster and significantly improves image quality; thus, it should be included into the routine MRCP sequence protocol at 3.0 T. Furthermore, we recommended SS-FSE BH MRCP examination to be applied to uncooperative patients or patients in emergency because of its short acquisition time (1 s).

The purpose of this study is to evaluate the ability of T2 turbo spin echo (TSE) axial and sagittal BLADE sequences in reducing or even eliminating motion, pulsatile flow and cross-talk artifacts in lumbar spine MRI examinations. Forty four patients, who had routinely undergone a lumbar spine examination, participated in the study. The following pairs of sequences with and without BLADE were compared: a) T2 TSE Sagittal (SAG) in thirty two cases, and b) T2 TSE Axial (AX) also in thirty two cases. Both quantitative and qualitative analyses were performed based on measurements in different normal anatomical structures and examination of seven characteristics, respectively. The qualitative analysis was performed by experienced radiologists. Also, the presence of image motion, pulsatile flow and cross-talk artifacts was evaluated. Based on the results of the qualitative analysis for the different sequences and anatomical structures, the BLADE sequences were found to be significantly superior to the conventional ones in all the cases. The BLADE sequences eliminated the motion artifacts in all the cases. In our results, it was found that in the examined sequences (sagittal and axial) the differences between the BLADE and conventional sequences regarding the elimination of motion, pulsatile flow and cross-talk artifacts were statistically significant. In all the comparisons, the T2 TSE BLADE sequences were significantly superior to the corresponding conventional sequences regarding the classification of their image quality. In conclusion, this technique appears to be capable of potentially eliminating motion, pulsatile flow and cross-talk artifacts in lumbar spine MR images and producing high quality images in collaborative and non-collaborative patients.

Background Assessment of breast lesions with magnetic resonance imaging (MRI) provides a means for lesion detection and diagnosis. Proton (hydrogen-1) magnetic resonance spectroscopy (1H-MRS) has been proposed as a useful diagnostic technique in providing metabolic information of suspicious breast lesions. Purpose To determine the clinical significance of in-vivo single voxel 1H-MRS at 3T in the assessment of benign and malignant breast lesions in combination with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Material and Methods Twenty-four women with known breast abnormalities from conventional imaging (mammography, ultrasonography) underwent DCE-MRI at a 3T MR scanner and 26 breast lesions were detected. Breast lesions were assessed according BI-RADS classification. Single voxel 1H-MRS was performed after gadolinium administration and choline peak was qualitatively evaluated. All lesions were confirmed histologically from the surgically excised specimens. Sensitivity, specificity, and accuracy of the 1H-MRS, of the BI-RADS classification and of their combination (DCE-MRI + 1H-MRS) were calculated. Results Fifteen out of 26 lesions proved to be malignant and 11 proved to be benign. In our study 1H-MRS showed sensitivity 80%, specificity 81.8%, and accuracy 80.7%. DCE-MRI showed sensitivity 100%, specificity 63.6%, and accuracy 84.6%. The combination of DCE-MRI and 1H-MRS provided higher accuracy (96.4%), as well as higher specificity 81.8% compared to BI-RADS classification. Conclusion The combined use of 1H-MRS and DCE-MRI found to have improved diagnostic performance in the assessment of equivocal breast lesions. 1H-MRS can be used as a useful adjunct during lesion characterization in clinical routine in cases classified as BI-RADS 3 and 4.

Adequately designed multiresponsive water-soluble graft copolymers were used to serve as a multifunctional polymeric platform for the encapsulation and transfer in aqueous media of hydrophobic magnetic nanoparticles (MNPs). The backbone of the graft copolymers was composed of hydrophilic sodium methacrylate units, hydrophobic dodecyl methacrylate units, and luminescent quinoline-based units, while either the homopolymer poly(N-isopropylacrylamide) or a poly(N,N-dimethylacrylamide-co-N-isopropylacrylamide) copolymer was used as thermosensitive pendent side chains. The polymeric platform forms micellar-type assemblies in aqueous solution, and exhibits pH-responsive luminescent properties and a lower critical solution temperature behavior in water. Depending on the design of the side chains, the cloud point temperatures were determined at 38 and 42 °C, close or slightly above body temperature (37 °C). Above the critical micelle concentration (CMC), both graft copolymers can effectively stabilize in aqueous media as magnetic colloidal superparticles (MSPs), oleylamine-coated MnFe

Parapneumonic effusions in children are usually associated with pneumococcal infections. In Greece, the 7-valent pneumococcal conjugate vaccine was replaced by higher-valent pneumococcal conjugate vaccines (PCVs); 10-valent was introduced in May 2009 and 13-valent (PCV13) in June 2010. Since July 2010, PCV13 has been the most commonly used PCV. In a study conducted at the University General Hospital of Larissa, Central Greece, from January 2012 to January 2016, 85.7% of children born after the implementation of PCV13 and aged 24-59 months had received the complete series (3 + 1 immunization schedule) of PCV13.We studied all paediatric community-acquired pneumonia cases with empyema hospitalized at the University General Hospital of Larissa from January 2008 to January 2016.There were 30 cases of parapneumonic empyema. Among 27 empyema cases of known aetiology, 19 (70.4%) were due to Streptococcus pneumoniae (identifiable serotypes 3, 19A, 7F, and 9N/L). After September 2011, no more cases caused by serotypes 7F and 19A were observed, whereas serotype 3 emerged as the predominant pathogen of pneumococcal empyema (9 of 11 cases). Serotype 3 continued to cause empyema despite vaccination with PCV13 either fully with a 3 + 1 schedule (n = 3) or with one booster dose at the age of 21 months (n = 1).In Central Greece during the first five years of high coverage with PCV13, serotype 3 was the only PCV13 serotype that clearly persisted in children with empyema.

Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) with gadolinium constitutes one of the most promising protocols for boosting up the sensitivity in breast cancer detection. The aim of this study was twofold: first to design an image processing methodology to estimate the vascularity of the breast region in DCE-MRI images and second to investigate whether the differences in the composition/texture and vascularity of normal, benign and malignant breasts may serve as potential indicators regarding the presence of the disease. Clinical material comprised thirty nine cases examined on a 3.0-T MRI system (SIGNA HDx; GE Healthcare). Vessel segmentation was performed using a custom made modification of the Seeded Region Growing algorithm that was designed in order to identify pixels belonging to the breast vascular network. Two families of features were extracted: first, morphological and textural features from segmented images in order to quantify the extent and the properties of the vascular network; second, textural features from the whole breast region in order to investigate whether the nature of the disease causes statistically important changes in the texture of affected breasts. Results have indicated that: (a) the texture of vessels presents statistically significant differences (p

Purpose: The assessment of the morphology and dimensions of the craniocervical ligaments using a 3 Tesla (T) Magnetic Resonance (MR) scanner, the correlatation of our results with those from cadaveric and other MR studies and the detection of the most appropriate sequence for the best imaging of the craniovertebral junction ligaments. Methods: 58 healthy volunteers (mean age 45 years) underwent a Magnetic Resonance Imaging (MRI) of the cervical spine at 3T MR unit. The MRI protocol included axial, coronal and sagittal Proton-Density (PD) sequences and sagittal T1 Fluid Attenuated Inversion Recovery (FLAIR) and T2 sequences. The images were evaluated by two radiologists and the posterior atlantoocipital ligament, the anterior atlantoocipital ligament, the transverse ligament and the apical ligament were anatomically detected, described and measured. Results: The transverse ligament was identified at 93.1%, the apical ligament was identified at 60.34%, the posterior at- lantooccipital membrane was identified at 94.8% and the anterior atlantooccipital membrane was identified at 96.5% of the cases. All ligaments appeared with low signal intensity, except the anterior atlantooc-cipital ligament which appeared with intermediate signal intensity. Their length, width and thickness were measured and, in general, correlated well with other anatomic and MR studies. Conclusion: Reliable assessment of the morphology and signal intensity of the craniocervical ligaments can be achieved with PD sequence at 3T MR imaging. The sagittal plane provides better delineation of the craniocervical (CC) ligaments but the axial and coronal planes are of paramount importance in the assessment of the transverse and apical ligaments.

Epitope H contains an O-linked N-acetylglucosamine (O-GlcNAc) residue in a specific conformation and/or environment recognized by mouse IgM monoclonal antibody H (mabH). Epitope H is present in several types of cells and in several polypeptides outside the CNS. Previous results have shown that in the adult human brains, epitope H is confined mostly to a minority of fibrous astrocytes, and it is greatly upregulated in the reactive astrocytes. Post-translational modification with O-GlcNAc occurs on many proteins involved in several cell processes, such as cell cycle progression, apoptosis, proteasome degradation pathways, and modulation of cellular function in response to nutrition and stress. Hypoxia is one of the major causes of cellular stress. Therefore, in this study, we used the mAbH and the indirect immunoperoxidase method to investigate the expression of epitope H in ependymal cells in brains of persons who died with signs of hypoxic encephalopathy. The results of the present study showed that practically all ependymal cells showed cytoplasmic staining for epitope H in supranuclear cytoplasm in the brain of two premature neonates and in ten infants who died with signs of hypoxic encephalopathy. However, the overwhelming majority of ependymal cells of the nine human embryos taken from legal abortions, ranging from 26 days until 13 weeks of gestational age, and of the ten infants' brains without any sign of hypoxic encephalopathy remained negative. Only occasionally did the ependymal cells show weak cytoplasmic staining in some foci. In addition, the reactive astrocytes in the hypoxic brains showed strong cytoplasmic staining, confirming previous results.

Purpose To explore the correlation of morphological and kinetic DCE-MRI features with histopathological prognostic factors of invasive breast cancer. Material and methods Fifty-one women with 57 cancerous lesions underwent DCE-MRI prior to surgery. DCE-MRI findings were interpreted with a multifactorial classification system that included morphological (shape, margins and pattern of enhancement) and kinetic characteristics (initial signal increase and post-initial behaviour of the time-signal intensity curve). Each morphological and kinetic parameter was scored with 0, 1 or 2 points and the total score was estimated. Finally each lesion was classified into one of the five categories that correspond to the five ACR BI-RADS categories. Statistical analysis was performed to correlate DCE-MR imaging parameters and histopathological findings using Fisher's exact test and stepwise multiple regression analysis. Results Increase of the signal intensity at the initial phase >100% was strongly correlated with positive lymph nodes (p = 0.008, OR 0.054). Types I and II time-signal intensity curves at the post-initial phase were associated with a fourfold increase in the likelihood of progesterone receptors positivity (p = 0.022, OR 4). Finally, high total score was positively correlated with affected lymph nodes (p = 0.033, OR 0.29). There was a trend regarding ill-defined margins of the tumor (p = 0.08) and vascular infiltration and also high score and neural infiltration (p = 0.072). Conclusion A multivariate interpretation model for DCE-MRI that includes morphological and kinetic characteristics has prognostic value for invasive breast cancer. Early initial contrast agent uptake and a high overall score are associated with poor prognostic factors.

Digital processing of MRI images aims to provide an automatized diagnostic evaluation of regular health screenings. Cancerous lesions are proven to cause an alteration in the vessel structure of the diseased organ. Currently there are several methods used for extraction of the vessel network in order to quantify its properties. In this work MRI images (Signa HDx 3.0T, GE Healthcare, courtesy of University Hospital of Larissa) of 30 female breasts were subjected to three different vessel extraction algorithms to determine the location of their vascular network. The first method is an experiment to build a graph over known points of the vessel network; the second algorithm aims to determine the direction and diameter of vessels at these points; the third approach is a seed growing algorithm, spreading selection to neighbors of the known vessel pixels. The possibilities shown by the different methods were analyzed, and quantitative measurements were performed. The data provided by these measurements showed no clear correlation with the presence or malignancy of tumors, based on the radiological diagnosis of skilled physicians.

Cavernous hemangiomas are the most common benign tumors of the liver [1–3]. The origin of these tumors is a subject of debate. Some authors consider them hamartomatous in origin, present at birth and growing slowly thereafter, while others consider them to be true vascular neoplasms [4]. Most of them are small (

Assessment of breast lesions with magnetic resonance imaging (MRI) provides a means for lesion detection and diagnosis. Proton (hydrogen-1) magnetic resonance spectroscopy ((1)H-MRS) has been proposed as a useful diagnostic technique in providing metabolic information of suspicious breast lesions.To determine the clinical significance of in-vivo single voxel (1)H-MRS at 3T in the assessment of benign and malignant breast lesions in combination with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Twenty-four women with known breast abnormalities from conventional imaging (mammography, ultrasonography) underwent DCE-MRI at a 3T MR scanner and 26 breast lesions were detected. Breast lesions were assessed according BI-RADS classification. Single voxel (1)H-MRS was performed after gadolinium administration and choline peak was qualitatively evaluated. All lesions were confirmed histologically from the surgically excised specimens. Sensitivity, specificity, and accuracy of the (1)H-MRS, of the BI-RADS classification and of their combination (DCE-MRI + (1)H-MRS) were calculated.Fifteen out of 26 lesions proved to be malignant and 11 proved to be benign. In our study (1)H-MRS showed sensitivity 80%, specificity 81.8%, and accuracy 80.7%. DCE-MRI showed sensitivity 100%, specificity 63.6%, and accuracy 84.6%. The combination of DCE-MRI and (1)H-MRS provided higher accuracy (96.4%), as well as higher specificity 81.8% compared to BI-RADS classification.The combined use of (1)H-MRS and DCE-MRI found to have improved diagnostic performance in the assessment of equivocal breast lesions. (1)H-MRS can be used as a useful adjunct during lesion characterization in clinical routine in cases classified as BI-RADS 3 and 4.

The purpose of this study, is to compare the sequences: 1) proton density (PD) BLADE (BLADE is a PROPELLER-equivalent implementation of the Siemens Medical System) with fat saturation (FS) coronal (COR), 2) PD FS COR, 3) multi-planar reconstruction (MPR) with 3mm slice thickness and 4) multi-planar reconstruction (MPR) with 1.5mm slice thickness, both from the T2 3D-double-echo steady state (DESS) with water excitation (WE) sagittal (SAG), regarding their abilities to identify changes in the femorotibial condyle cartilage in knee MRI examinations. Thirty three consecutive patients with osteoarthritis (18 females, 15 males; mean age 56years, range 37-71years), who had been routinely scanned for knee examination using the previously mentioned image acquisition techniques, participated in the study. A quantitative analysis was performed based on the relative contrast (ReCON) measurements, which were taken both on normal tissues as well as on pathologies. Additionally, a qualitative analysis was performed by two radiologists. Motion and pulsatile flow artifacts were evaluated. The PD BLADE FS COR sequence produced images of higher contrast between Menisci and Cartilage, Fluid and Cartilage, Pathologies and Cartilage as well as of the Conspicuousness Superficial Cartilage and it was found to be superior to the other sequences (p

Introduction Diffusion Weighted Imaging (DWI) has demonstrated increased potential in identifying imaging-based biomarkers for cancer diagnosis, prognosis and monitoring response to therapy. Purpose This study investigates the feasibility of apparent diffusion coefficient (ADC) histogram statistics in identifying highly aggressive breast carcinomas, by investigating correlation to established prognostic indices. Materials and methods The dataset consists of 43 histologically verified invasive ductal carcinomas (IDC) of patients undergoing breast DW-MRI at 3 T (b-values 0, 900 s/mm2). ADC maps were generated for a slice representative of lesion largest diameter. An expert radiologist delineated lesion contour on ADC map, defining the lesion region of interest to be subjected to histogram analysis. Feature extraction considered mean, standard deviation, skewness, kurtosis, entropy, maximum, minimum and range of ADC. The ability of ADC histogram features in identifying tumor grade, estrogen receptor (ER) and progesterone receptor (PR) status was investigated. Results Median value of feature ADC mean was 1.034 × 10−3 mm2/s, 0.869 × 10−3 mm2/s and 0.971 × 10−3 mm2/s in grade I, grade II and grade III lesions, respectively. Median value of ADC kurtosis was 0.176, 1.165 and 1.289 in grade I, grade II and grade III lesions, respectively. ER positive lesions demonstrated increased median value of ADC entropy (5.828), reflecting increased ADC heterogeneity, as compared to ER negative ones (5.480). Median value of ADC entropy was 5.842 and 5.486 in PR positive and PR negative lesions, respectively. Conclusion ADC histogram analysis may contribute in breast cancer prognosis by identifying high grade tumors and predicting ER and PR status.

The aim of the present study is to investigate means for the reduction or even elimination of enhancement kinetic curve errors due to breast motion in order to avoid pitfalls and to increase the sensitivity and specificity of the method.115 women underwent breast Magnetic Resonance Imaging (MRI). All patients were properly immobilized in a dedicated bilateral phased array coil. A magnetic resonance unit 3-Tesla (Signa, GE Healthcare) was used. The following sequences were applied: (I) axial Τ2-TSE, (II) axial STIR and (III) Vibrant axial T1-weighted fat saturation (six phases). Kinetic curves were derived semi-automatically using the software of the system and manually by positioning the regions of interest (ROI) from stable reference points in all the phases.376 abnormalities in 115 patients were investigated. In 81 (21.5%) cases, a change of the enhancement kinetic curve type was found when the two different methods were used. In cases of large fatty breasts, a change of the enhancement kinetic curve type in 13 lesions was found. In cases of small and dense breasts, only in 4 lesions the kinetic curve type changed, whereas in cases of small and fatty breasts, the kinetic curve type changed in 64 lesions (50 were observed in left breasts and 14 in right breasts).The derivation of enhancement kinetic curves should be performed by controlling and verifying that the ROIs lay at the same location of the lesion in all the phases of the dynamic study.

To evaluate the post-operative gastric anatomy depicted by upper gastrointestinal gastrografin swallow studies (UGI) and report radiological work-up and management of complications following laparoscopic sleeve gastrectomy (LSG). The study included 85 consecutive patients who underwent LSG for the treatment of morbid obesity. In all patients, a UGI was routinely performed on POD 3 to exclude early complications. In patients with suspected complications, further radiological evaluation with computed tomography (CT) was performed. The anatomy of the gastric remnant depicted by UGI was retrospectively evaluated in all patients. The patterns of the gastric remnant identified were the tubular (65.9%), the superior pouch (25.9%), and the inferior pouch pattern (8.2%). Three patients had small superior pouches that resembled leaks, and the diagnosis was based on clinical symptoms. Post-operative complications were observed in 12.9% and included leaks (3.5%), hemorrhages (3.5%), strictures (2.3%), pulmonary embolism (1.2%), trocar site hernia (1.2%), and hematoma of the rectus abdominal muscle (1.2%). No mortality was noted. Post-operative radiological evaluation by UGI and CT is important for diagnosis and management of complications following LSG. Familiarity with the anatomy of the gastric remnant at UGI is essential for correct image interpretation.