ABSTRACT
OBJECTIVE@#To explore the integration method and technical realization of artificial intelligence bone age assessment system with the hospital RIS-PACS network and workflow.@*METHODS@#Two sets of artificial intelligence based on bone age assessment systems (CHBoneAI 1.0/2.0) were developed. The intelligent system was further integrated with RIS-PACS based on the http protocol in Python flask web framework.@*RESULTS@#The two sets of systems were successfully integrated into the local network and RIS-PACS in hospital. The deployment has been smoothly running for nearly 3 years. Within the current network setting, it takes less than 3 s to complete bone age assessment for a single patient.@*CONCLUSIONS@#The artificial intelligence based bone age assessment system has been deployed in clinical RIS-PACS platform and the "running in parallel", which is marking a success of Stage-I and paving the way to Stage-II where the intelligent systems can evolve to become more powerful in particular of the system self-evolution and the "running alternatively".
Subject(s)
Humans , Age Determination by Skeleton , Artificial Intelligence , Bone and Bones , Hospital Information Systems , Hospitals , Radiology Information Systems , Systems IntegrationABSTRACT
The aim of this study is to evaluate the value of multi-slice spiral CT （CT） and multi-planar reconstruction （MPR） in the diagnosis of children with parotid cleft deformity. The CT images of 55 cases of branchial cleft deformity confirmed by surgery and pathology were retrospectively analyzed. CT examination showed that 37 cases had strip-like, tubular fistula or cystic mass located in the anterior cervical triangle, anterior margin of sternocleidomastoid muscle, and 2 of them had bilateral fistula structure. In 16 casescystic mass and tubular fistula were found in the parotid gland or at the edge of the parotid gland. One case was accompanied by atresia of the lateral auditory meatus. After contrast enhancement, the cystic wall（tube wall） of 55 patients were enhanced. In 9 patients with infection, the boundary of the lesion was blurred, and the density of the cyst or lumen increased after contrast enhancement. MSCT diagnosed 6 cases of parotid cleft cyst with fistula, 35 cases of branchial cleft cyst, 13 cases of parotid fistula, and 1 case misdiagnosed as lymphadenitis. Among all the cases, 15 were type Ⅰ, 36 were type Ⅱand 4 were type Ⅲ. Compared with the results of pathological diagnosis and clinical operation, the accuracy of qualitative diagnosis and localization was 99.9% and 100.0%. Multi-slice spiral CT thin-slice images combined with MPR image post-processing technology can better display the location of branchial cyst and the course of branchial fistula.
ABSTRACT
Objective@#The aim of this study is to evaluate the value of multi-slice spiral CT （CT） and multi-planar reconstruction （MPR） in the diagnosis of children with parotid cleft deformity.@*Method@#The CT images of 55 cases of branchial cleft deformity confirmed by surgery and pathology were retrospectively analyzed. @*Result@#CT examination showed that 37 cases had strip-like, tubular fistula or cystic mass located in the anterior cervical triangle, anterior margin of sternocleidomastoid muscle, and 2 of them had bilateral fistula structure. In 16 casescystic mass and tubular fistula were found in the parotid gland or at the edge of the parotid gland. One case was accompanied by atresia of the lateral auditory meatus. After contrast enhancement, the cystic wall（tube wall） of 55 patients were enhanced. In 9 patients with infection, the boundary of the lesion was blurred, and the density of the cyst or lumen increased after contrast enhancement. MSCT diagnosed 6 cases of parotid cleft cyst with fistula, 35 cases of branchial cleft cyst, 13 cases of parotid fistula, and 1 case misdiagnosed as lymphadenitis. Among all the cases, 15 were type Ⅰ, 36 were type Ⅱand 4 were type Ⅲ. Compared with the results of pathological diagnosis and clinical operation, the accuracy of qualitative diagnosis and localization was 99.9% and 100.0%. @*Conclusion@#Multi-slice spiral CT thin-slice images combined with MPR image post-processing technology can better display the location of branchial cyst and the course of branchial fistula.
ABSTRACT
Objective@#To detect the feasibility and efficiency of bone age(BA) artificial intelligence(AI) estimation based on deep learning features from traditional regions of interest(ROI) in hand digital radiographs(DR).@*Methods@#BA dataset of left hand DR with 11 858 subjects aged from 0 to 18 years in Children′s Hospital of Shanghai were split to training(80.0%) and validation (20.0%) set in this study. An improved regression convolutional neural networks and extreme gradient boosting decision tree method were utilized for the BA analysis based on traditional ROIs in the images. Another set of BA data with 1 229 subjects also in the hospital was adopted for test. Mean average precision(mAP) and mean absolute error(MAE) were used to assess model accuracy of detection and BA prediction, respectively.@*Results@#The mAP of ROIs detection of the model was 0.91,and MAE of all male and female subjects was 0.461 and 0.431 years respectively in validation and test sets. The difference less than 1 year in test accounted for 90.07% between BA assessment of the model and of the peadiatric radiologists, with an accuracy rate of 96.67%.The difference over 1 year was 9.03% (with underestimation of 6.43% and overestimation of 2.60%), in which corresponding age data was of being less in training set or sesamoid nearby adductor pollicis or fusion of epiphysis appeared in test set.@*Conclusion@#An AI model based on deep learning of traditional ROIs′ features in hand DR images is initially achieved to automatically predict BA rapidly and effectively, yet it still needs further optimization.
ABSTRACT
s] Objective To detect the feasibility and efficiency of bone age(BA) artificial intelligence(AI) estimation based on deep learning features from traditional regions of interest(ROI) in hand digital radiographs(DR). Methods BA dataset of left hand DR with 11 858 subjects aged from 0 to 18 years in Children′s Hospital of Shanghai were split to training(80.0%) and validation (20.0%) set in this study. An improved regression convolutional neural networks and extreme gradient boosting decision tree method were utilized for the BA analysis based on traditional ROIs in the images. Another set of BA data with 1 229 subjects also in the hospital was adopted for test. Mean average precision(mAP) and mean absolute error(MAE) were used to assess model accuracy of detection and BA prediction, respectively. Results The mAP of ROIs detection of the model was 0.91,and MAE of all male and female subjects was 0.461 and 0.431 years respectively in validation and test sets. The difference less than 1 year in test accounted for 90.07% between BA assessment of the model and of the peadiatric radiologists, with an accuracy rate of 96.67%.The difference over 1 year was 9.03% (with underestimation of 6.43% and overestimation of 2.60%), in which corresponding age data was of being less in training set or sesamoid nearby adductor pollicis or fusion of epiphysis appeared in test set. Conclusion An AI model based on deep learning of traditional ROIs′features in hand DR images is initially achieved to automatically predict BA rapidly and effectively, yet it still needs further optimization.
ABSTRACT
Objective To investigate the clinical value of chest CT in assessment and diagnosis of mass in breast area in children. Methods The chest CT data of 30 cases under 16 year-old with breast area mass confirmed by surgery and pathology were analyzed retrospectively.Of 30 patients,28 also underwent contrast enhanced CT scan,and 4 underwent both CT and MRI.Results CT detected all the 37 masses in the 30 cases with the diagnostic sensitivity and accuracy of 100% and 78.38%,respectively.The long diameter of masses were from 9 mm to 80 mm (average 34.5 mm).CT also detected accurately the intrathoracic invasion,rib and lung metastases, lymph nodes enlargement,patent ductus arteriosus and postoperative changes of lung congenital cystic adenomatoid malformation. Conclusion Chest CT is useful in the assessment and diagnosis of mass in breast area in children.
ABSTRACT
Objective To investigate the CT features of benign and malignant thyroid nodules in children and their correlation with histopathology of thyroid nodules.Methods The clinical data of 28 children with thyroid nodules confirmed by pathological diagnosis in Shanghai Children's Hospital from June 2014 to October 2017 were retrospectively analyzed.The CT imaging features and pathological results were compared and analyzed.Results The thyroid nodules of benign,malignant and uncertain malignant potential nodules in this group respectively were 35 nodules (11 cases),15 nodules (10 cases) and 8 nodules (7 cases) respectively,with a total of 58 nodules.Benign and uncertain malignant potential nodules were all(100.0％) enveloped,4 nodules(11.4％,4/35 nodules) were benign nodules and 1 nodule (12.5％,1/8 nodules) was uncertain malignant potential nodules and its capsule was incomplete.There were 11 nodules (73.3％,11/35 nodules) malignant nodules without capsule and 4 nodules(26.7％,4/15 nodules) were malignant nodules with incomplete capsule.In the benign nodules,9 nodules(25.7％,9/35 nodules) of them were cystic,and the others were solid or solid cystic (74.3 ％,26/35 nodules).All of the malignant nodules and uncertain malignant potential nodules were solid or solid cystic nodules.Benign nodules and uncertain malignant potential nodules were mostly had clear edges,but the edges of malignant nodules were not clear.There were 2 cases (18.2％,2/ll cases) of the benign nodules which had calcification,8 cases(80.0％,8/10 cases) of the malignant nodules had calcification,and 3 cases (42.9％,3/7 cases)of the uncertain malignant potential nodules had calcification.There was no lymph node metastasis in the patients with benign and uncertain malignant potential nodules.In the malignant nodules,there were 7 cases with lymph node metastasis,accounting for 70.0％ (7/10 cases).It had certain reference value for the differentiation of benign and malignant nodules to know whether the boundary of the mass was clear or not,whether the capsule was intact or not,and whether there was calcification or not.The surrounding lymph node enlargement had certain reference value for the differential diagnosis of benign and malignant nodules.The diagnostic results of CT and the coincidence rate of pathological histological diagnosis after operation,the benign nodules and malignant nodules,and also the uncertain malignant potential were respectively 61.1％ (11/18 cases),90.0％ (9/10 cases) and 14.3％ (1/7 cases).The thyroid nodules of uncertain malignant potential CT imaging were lack of specificity,and definite diagnosis should be based on pathology.Conclusions There is a certain relationship between CT imaging features and pathology of thyroid nodules,which is of great value for the diagnosis and differential diagnosis of thyroid nodules in children.
ABSTRACT
Objective To investigate the clinical value of 3.0T magnetic resonance cholangiopancreatography (MRCP) in diagnosis of congenital biliary malformation in children.Methods Magnetic resonance imaging (MRI)and MRCP images,including the source image data and maximum intensity projection (MIP) reconstruction images,were analyzed retrospectively in 83 children with congenital biliary malformation diagnosed at Shanghai Children's Hospital,and their operative results and intraoperative cholangiopancreatography images were compared.Two experienced radiologists independently reviewed the images then they reached diagnostic conclusions by consensus.Eighty-three patients included 35 boys and 48 girls,aged from 20 days to 14 years.Results The MRCP indicated that 69 cases with choledochal cysts were consistent with intraoperative cholangiopancreatography findings,and the common bile duct showed different degrees of saccular and fusiform or columnar expansion with different types(Todani classification type Ⅰ 59 cases,type Ⅱ 1 cases,type Ⅳ a 7 cases,and type V 2 cases).The accuracy of localization and quality were 100％.MRCP demonstrated the anomalous junction of pancreaticobiliary duct in 14 cases.MRCP in 19 cases detected by intraoperative cholangiopancreatography with a sensitivity of 79％ and a specificity of 100％.Among 13 cases of biliary atresia,including 1 case accompanied with peritoneal organ inversion proved by MRI,11 cases of the entire extra—hepatic bile duct could not be completed visually,and 2 cases of small or small triangular signals were seen near the hepatic portal area,with the portal vein,and the left or right branches with 100％ accuracy of localization and quality including 1 case accompanied with peritoneal organ inversion proved by MRI.Congenital absence of gallbladder accompanied with duodenal obstruction was seen in 1 case,no gallbladder was found in the gallbladder fossa by MRCP,but the proximal duodenum was obviously dilated.Surgery confirmed that it was complicated and annular pancreas without gallbladder congenitally.Conclusion 3.0T MRCP is a noninvasive and effective method for diagnosis of congenital biliary malformation in children.It can be used as the preferred technique for diagnosis and long-term follow-ups.
ABSTRACT
Objective To investigate the clinical value of 3.0T magnetic resonance cholangiopancreatography (MRCP) in diagnosis of congenital biliary malformation in children.Methods Magnetic resonance imaging (MRI)and MRCP images,including the source image data and maximum intensity projection (MIP) reconstruction images,were analyzed retrospectively in 83 children with congenital biliary malformation diagnosed at Shanghai Children's Hospital,and their operative results and intraoperative cholangiopancreatography images were compared.Two experienced radiologists independently reviewed the images then they reached diagnostic conclusions by consensus.Eighty-three patients included 35 boys and 48 girls,aged from 20 days to 14 years.Results The MRCP indicated that 69 cases with choledochal cysts were consistent with intraoperative cholangiopancreatography findings,and the common bile duct showed different degrees of saccular and fusiform or columnar expansion with different types(Todani classification type Ⅰ 59 cases,type Ⅱ 1 cases,type Ⅳ a 7 cases,and type V 2 cases).The accuracy of localization and quality were 100％.MRCP demonstrated the anomalous junction of pancreaticobiliary duct in 14 cases.MRCP in 19 cases detected by intraoperative cholangiopancreatography with a sensitivity of 79％ and a specificity of 100％.Among 13 cases of biliary atresia,including 1 case accompanied with peritoneal organ inversion proved by MRI,11 cases of the entire extra—hepatic bile duct could not be completed visually,and 2 cases of small or small triangular signals were seen near the hepatic portal area,with the portal vein,and the left or right branches with 100％ accuracy of localization and quality including 1 case accompanied with peritoneal organ inversion proved by MRI.Congenital absence of gallbladder accompanied with duodenal obstruction was seen in 1 case,no gallbladder was found in the gallbladder fossa by MRCP,but the proximal duodenum was obviously dilated.Surgery confirmed that it was complicated and annular pancreas without gallbladder congenitally.Conclusion 3.0T MRCP is a noninvasive and effective method for diagnosis of congenital biliary malformation in children.It can be used as the preferred technique for diagnosis and long-term follow-ups.
ABSTRACT
Objective To discuss CT,MRI features of fibrous hamartoma of infancy (FHI) compared with pathology.Methyls Cinical data,CT and MRI findings,as well as pathological results of 15 patients with FHI were retrospectively analyzed.Results Totally,there were 17 lesions of FHI in 15 cases,including 13 cases with single lesion and 2 cases with double lesions.The lesions manifesting as subcutaneous-,skin-and mixed-type on CT or MR images accounted for 58.82％ (10/17),17.65％ (3/17) and 23.53％ (4/17),respectively.The subcutaneous-and mixed-type lesions showed " cloud sign" (including "thin-cloud sign" and "thick-cloud sign").The thin-cloud sign lesions composed mainly of mature adipose tissue,while the triphasic composition ratio of adipose,fibrous and primitive mesenchymal cells were relatively consistent in the lesions with thick-cloud sign.The skin-type lesions showed "mountain-inverted sign",which composed mainly of immature mesenchymal component.Conclusion CT and MRI features of FHI are complex,yet have certain characteristics,which can preferably reflect the histopathological features of FHI.
ABSTRACT
ObjectiveTo evaluate the past 5 years' clinic experience of diagnosis and treatment of the pediatric soft-tissue foreign body (STFB),and to probe new strategies for its clinical management.MethodsTotally 165 consecutive children with small radiopaque STFB were involved.All the children were diagnosed with X-rays.CT (enhanced CT in 9 children)and virtual anatomy imaging (VAI) were performed in 40 children.Percutaneous foreign body forceps removal guided with C-arm video-fluoroscopy was performed and the effect was evaluated.ResultsThe longest dimension of STFB ranged from 1 mm to 40 mm,and the shortest dimension ranged from 1 mm to 5 mm,including scrap-iron,broken iron nails and needles,and glass pieces embedded in soft tissues under surface of the limbs,neck,chest,abdomen and pelvis.Seventy-six (76/165,46.06 ％) children received interventional therapy,and 73 were completely cured (73/76,96.05 ％),2 were partially cured (2/76,2.63 ％),and 1 was failed (1/76,1.32 ％).VAI accurately depicted STFB closely to large vessels even associated vascular complication with local large hematomas or pseudoaneurysms,helped to select the treatment methods and the forceps removal roads.Hematoma,infection,neural damages and other serious complications did not occur during and after operation.ConclusionVideo-fluoroscopy-guided percutaneous foreign body forceps removal is minimally invasive,safe and effective for small radiopaque STFBs,but may not suitable for the one very close to large blood vessels with or without vascular injuries complications.Preoperative CT VAI is helpful to locate STFB within complicated anatomic structures,selecting optimal intervention pathway and assessing the risk of intervention.
ABSTRACT
Objective To study the influence of traction on the blood circulation of femur head and its evaluation by DSA. Methods Using micro-catheter, transfemoral selective femoral circumflex arteriography in 22 healthy dogs was performed in unilateral hip before (Group A,n =22) and immediately (Group B,n=22) ,30( Group D,n =22) ,60(Group E,n=20) ,90( Group F,n = 10),120 (Group G,n=10) minutes during 2 kg skin hip traction, and immediately after traction removal (Group H,I,J,L and 0), and 30 minutes after traction removal with 60,90 and 120 minutes continuous traction(Group K,M and P),and 60 minutes after traction removal with 90 and 120 minutes continuous traction(Group N and Q). DSA was also performed immediately during 4 kg weight traction before continuous traction in 12 hips( Group C).Blood circulation of the femoral head was evaluated mainly by observing its perfusion and time of circulation. Femur head perfusion was assessed as good scoring 3,poor scoring 2 and extremely poor scoring 1. Femur head circulation time was assessed as normal scoring 3 .prolonged scoring 2 and remarkably prolonged scoring 1. Analysis of variance was employed for analysis of the angiographic findings between different groups.Results Good femoral head perfusion in Group A to Q was 22,0,0,0,0,0,0,22,22,1,18,0,0,8,0,0 and 1 hips respectively, poor one was 0,22,8,22,15,4,1,0,0,15,2,4,6,2,1,3 and 8 hips, respectively,extremely poor one was 0,0,4,0,5,6,9,0,0,4,0,6,4,0,9,7 and 1 hips, respectively; and normal femoral head blood circulation time was 22,0,0,0,0,0,0,22,22,1,18,0,0,8,0,0 and 1 hips, respectively, prolonged one was 0,22,9,22,15,4,2,0,0, 15,2,5,7,2,2,4 and 8 hips, respectively, remarkably prolonged one was 0,0,3,0,5,6,8,0,0,4,0,5,3,0,8,6 and 1 hips, respectively. F value of femoral head perfusion among group A and B,group B and C,group B,D,E,F and G,Group H,I,J,L and O,group K,M and P,Group N and Q was 437. 48,30. 25,29. 04,132. 69,143. 73,25.20, respectively, and their P value was all <0. 01. F value of femoral head circulation time among group A and B,group B and C,group B,D,E,F and G,Group H,I,J,L and O,group K,M and P,Group N and Q was 386. 26,31. 83,22.43,141. 94,119.69,21.68, respectively, and their P value was all < 0.01. Conclusions Traction could lead to ischemic response and circulation disorder of canine femoral head. The longer the traction time or the bigger the traction weight was, the poorer the femoral head perfusion and the longer the femoral head circulation time were, and the slower they recovered. DSA could directly reflect these changes in the femoral head with these angioarchitectural and hemodynamic indexes.
ABSTRACT
Objective To investigate the possibility to obtain the cranial subtraction computed tomography perfusion imaging (sCTP) from the CTP examination, and to explore preliminary application value of sCTP. Methods Cerebral sCTP obtained from source imaging data of 11 patients (10 with stroke and 1 with brain tumor) were analyzed with subtraction software and perfusion 3 software at GE AW4.2 workstation. The parametric maps and region of interest (ROI) value of blood flow (BF), blood volume (BV), mean transit time (MTT) and/or permeability surface (PS) were generated from the CTP and sCTP imaging data respectively. Results ①The technical success rate of cranial sCTP created from CTP sources imaging data was 100%, and the post-processing time of sCTP was about from 1.0 to 2.5 h. The mappings and values of BF, BV, MTT and PS of ROI were all successfully obtained from sCTP and CTP imaging data. ②The cerebral mappings of BF, BV, MTT and PS obtained from sCTP were similar to those from CTP, which all depicted accurately the lesions and their microcirculation hemodynamics changes. ③Just like those from CTP, the values of BF, BV, MTT and PS of nidus obtained from sCTP were significantly different from those of the near and the contralateral corresponding cerebral tissues (P<0.025). Conclusion sCTP can be generated successfully with subtraction and perfusion imaging software. It is an alternative solution for functional diagnosis of stroke and brain neoplasms.
ABSTRACT
Objective To investigate the technical protocols and feasibility of subtraction computed tomography perfusion imaging (sCTP) on observation of ischemic necrosis of femoral head (ANFH) on dog. Methods Sixteen laboratory canines underwent CT perfusion imaging (CTP) of femoral head before and after selective femoral circumflex artery embolization, and ANFH were observed. Then new sequence imaging data, created by sources imaging of CT perfusion scan using subtraction software, were analyzed at workstation (AW 4.2) with CT perfusion 3 analysis program, and data of sCTP were obtained. The parametric maps and indexes of capillary-level hemodynamics including blood volume (BV), blood flow (BF) and mean transit time (MTT) of CTP and sCTP were compared. Results ①The technical success rate of sCTP post-processing created from CTP sources imaging data was 100%. The values and mappings of BF, BV and MTT of region of interest (ROI) were all obtained from subtraction sequence images data. The post-processing time of sCTP was about 1-5 h. ② sCTP depicted ANFH well, though the values and mappings of BF, BV and MTT were different from those obtained with conventional bone CTP. Conclusion sCTP can be generated with subtraction and perfusion analysis program and techniques. It can be applied to bone CT perfusion imaging and early quantitative diagnosis of necrosis.
ABSTRACT
Objective To explore the clinical value and the difference of bone mineral density(BMD) in every vertebra of lumbar spine in middle old-aged Chinese female with quantitative computed tomography (QCT).Methods The BMD in every vertebra of lumbar spine was investigated by QCT in 725 healthy females aged from 35 to 98 years. They were divided into groups every five years.The BMD in vertebra of lumbar spine (L 1～L 4) were measured by QCT and the groups tested for significant differences,using SPSS10.0 software for the analysis.Results Lumbar spine (L 1～L 4) BMD declined with aging. The bone quantity was predominantly declined in group of 50 to 54 years (?