Texture Analysis of Supraspinatus Ultrasound Image for Computer Aided Diagnostic System / 대한의료정보학회지

OBJECTIVES: In this paper, we proposed an algorithm for recognizing a rotator cuff supraspinatus tendon tear using a texture analysis based on a histogram, gray level co-occurrence matrix (GLCM), and gray level run length matrix (GLRLM). METHODS: First, we applied a total of 57 features (5 first order descriptors, 40 GLCM features, and 12 GLRLM features) to each rotator cuff region of interest. Our results show that first order statistics (mean, skewness, entropy, energy, smoothness), GLCM (correlation, contrast, energy, entropy, difference entropy, homogeneity, maximum probability, sum average, sum entropy), and GLRLM features are helpful to distinguish a normal supraspinatus tendon and an abnormal supraspinatus tendon. The statistical significance of these features is verified using a t-test. The support vector machine classification showed accuracy using feature combinations. Support Vector Machine offers good performance with a small amount of training data. Sensitivity, specificity, and accuracy are used to evaluate performance of a classification test. RESULTS: From the results, first order statics features and GLCM and GLRLM features afford 95%, 85%, and 100% accuracy, respectively. First order statistics and GLCM and GLRLM features in combination provided 100% accuracy. Combinations that include GLRLM features had high accuracy. GLRLM features were confirmed as highly accurate features for classified normal and abnormal. CONCLUSIONS: This algorithm will be helpful to diagnose supraspinatus tendon tear on ultrasound images.

A Case of Pulmonary Artery Intimal Sarcoma Diagnosed with Multislice CT Scan with 3D Reconstruction

Pulmonary artery intimal sarcoma is a rare highly lethal disease, with additional retrograde extension to pulmonic valve and right ventricle being an extremely rare condition. It is frequently mistaken for pulmonary thromboembolism. We report a case of 64-year-old woman with progressive dyspnea initially suspected and treated for pulmonary thromboembolism. Her helical chest CT scan with 3 dimensional (3D) reconstruction combined with echocardiography revealed a compacting main pulmonary artery mass extending to the right ventricular outflow tract and the right pulmonary artery. After excision of the mass, the patient's condition improved dramatically, and the pathologic findings revealed pulmonary intimal sarcoma. This report emphasizes that helical chest CT with 3D reconstruction can be an important tool to differentiate the characteristics of pulmonary artery lesions, such as intimal sarcoma and thromboembolism.

A case of acute mesenteric infarction following coronary artery bypass graft / 대한내과학회지

Acute mesenteric ischemia leading to massive bowel infarction following cardiac surgery particularly coronary artery bypass graft (CABG), is reported to be a very rare but serious life-threatening complication. In this case, a 55-year-old female underwent CABG and complained of abdominal pain on the first postoperative day, which was thought to be nonspecifically related to the operation wound. In the further hospital course, the patient was found to have extensive acute mesenteric infarction due to thromboembolism of superior mesenteric artery. This is a valuable educational case, since only high index of suspicion does not delay making a diagnosis especially in the patients with risk factors of acute mesenteric ischemia after cardiac surgery requiring cardiopulmonary bypass. On suspicion of acute mesenteric ischemia, an aggressive diagnostic and therapeutic approach should be performed immediately.

A Case of Antiphospholipid Antibody Syndrome Accompanied by Valvular Heart Disease and Moya Moya Syndrome

A case of antiphospholipid antibody syndrome, accompanied by valvular heart disease and Moya moya syndrome, has never been reported. Here, we report on a case that had mitral regurgitation and Moya moya syndrome, associated with antiphospholipid antibody syndrome secondary to systemic lupus erythematosus. This patient underwent a mitral valve replacement for mitral valve regurgitation. The postoperative course was uneventful, and the pathological findings of the mitral valve showed a degenerative change, due to chronic inflammation, a proliferative fibrous change and calcification, but without thrombus formation. However, the patient returned to the hospital with a cerebral hemorrhage, which was caused by Moya moya syndrome. Surgical drainage was performed, and the patient was discharged without any complications. The patient is on anticoagulation and immunosuppression drugs, with no problems to date.

B-Type Natriuretic Peptide Predicts Clinical Presentations and Ventricular Overloading in Patients with Heart Failure

Brain natriuretic peptide (BNP), a neurohormone secreted from the ventricular myocardium in response to hemodynamic load/wall stress, in congestive heart failure (CHF). This study was performed to evaluate the correlation between BNP level and clinical presentations and hemodynamic parameters obtained by echo-Doppler (echo-Doppler) analysis, and its relation with disease severity and ventricular load/wall stress. CHF patients (n=246) were subgrouped by clinical presentations and echo-Doppler findings into 4 groups: diastolic HF only, chronic HF, acute HF, and chronic HF with acute exacerbation. A BNP level of 81.2 pg/ml showed a sensitivity/ specificity of 53.3%/98.4% for detecting CHF (AUC, 0.882; p< 0.0001), and was found to be closely related with the NYHA classification (p< 0.0001). Log BNP was related with LVEF (r2=0.3015, p< 0.0001) and the Meridional wall stress index (r2=0.4052, p< 0.0001). The difference between the BNP levels of the subgroups and BNP control was significant (p< 0.0001), exept between the HF group and the controls; control (n=114, 20.9 +/- 31.4pg/ml), only diastolic HF (n=84, 89.8 +/- 117.6pg/ml), chronic HF (n=60, 208.2 +/- 210.2pg/ml), acute HF (n=28, 477.9 +/- 498.4 pg/ml), chronic HF with acute exacerbation (n= 74, 754.1 +/- 419.2pg/ml). The BNP level was significantly higher in the only diastolic HF group than in the asymptomatic control group with diastolic dysfunction (89.8 +/- 12.8 vs. 22.8 +/- 5.1pg/ml, p< 0.0001). BNP may be a good indicator for the differential diagnosis of a broad spectrum of heart failures. And, elevated BNP might help to diagnose diastolic HF in patients with diastolic dysfunction.

Hemodynamic Effects on Atherosclerosis-Prone Coronary Artery: Wall Shear Stress / Rate Distribution and Impedance Phase Angle in Coronary and Aortic Circulation

The objective of the present study was to evaluate the hemodynamic characteristics of an atherosclerosis-prone coronary artery compared to the aorta. We describe three- dimensional spatial patterns of wall shear stress (WSS) according to the impedance phase angle in pulsatile coronary and aorta models using in vivo hemodynamic parameters and computed numerical simulations both qualitatively and quantitatively. Angiography of coronary arteries and aortas were done to obtain a standard model of vascular geometry. Simultaneously to the physiologic studies, flow-velocity and pressure profiles from in vivo data of the intravascular Doppler and pressure wire studies allowed us to include in vitro numerical simulations. Hemodynamic variables, such as flow-velocity, pressure and WSS in the coronary and aorta models were calculated taking into account the effects of vessel compliance and phase angle between pressure and flow waveforms. We found that there were spatial fluctuations of WSS and in the recirculation areas at the curved outer wall surface of the coronary artery. The mean WSS of the calculated negative phase angle increased in the coronary artery model over that in the aorta model and the phase angle effect was most prominent on the calculated amplitude of WSS of the coronary artery. This study suggests that the rheologic property of coronary circulation, such as the fluctuation of WSS/WSR induces several hemodynamic characteristics. A separation of flow-velocity, a difference in phase between pressure conductance and blood flow and prominent temporal and/or spatial oscillatory fluctuations of the shear forces as a function of pulsatile flow might be important factors in atherogenesis and progression of atherosclerosis.