Role of 18 F-FDG PET/CT in Erdheim-Chester Disease in the Era of Multimodality Imaging.

Erdheim-Chester disease is a rare disease with systemic non-Langerhans cell histiocytosis, the diagnosis of which with conventional imaging modalities is challenging. We describe a case of a 73-year-old woman who was referred with a progressive history of bilateral proptosis. The magnetic resonance imaging (MRI) orbit demonstrated bilateral orbital masses with optic nerve encasement. A subsequent 18F-FDG PET/CT scan showed multi-organ disease with involvement of the orbits, pericardium, aorta, pararenal fascia, and appendicular bones. Metabolically active, easily accessible areas were selected for CT-guided biopsy. The biopsy showed sheets of foamy histiocytes with the expression of CD 68 and CD 163 consistent with a diagnosis of Erdheim-Chester disease. The FDG PET/CT played a pivotal role in establishing the diagnosis with the assessment of disease extent and further guided in the targeted biopsy.

Spectrum of intracranial complications of rhino-orbito-cerebral mucormycosis - resurgence in the era of COVID-19 pandemic: a pictorial essay.

Rhino-orbito-cerebral mucormycosis (ROCM) has regained significance following its resurgence in the second wave of the COVID-19 pandemic in India. Rapid and progressive intracranial spread occurs either by direct extension across the neural foraminae, cribriform plate/ethmoid, walls of sinuses, or angioinvasion. Having known to have a high mortality rate, especially with intracranial extension of disease, it becomes imperative to familiarise oneself with its imaging features. MRI is the imaging modality of choice. This pictorial essay aims to depict and detail the various intracranial complications of mucormycosis and to serve as a broad checklist of structures and pathologies that must be looked for in a known or suspected case of ROCM.

Characterization of chronic liver disease based on ultrasound images using the variants of grey-level difference matrix.

Chronic liver diseases are fifth leading cause of fatality in developing countries. Early diagnosis is important for timely treatment and to salvage life. Ultrasound imaging is frequently used to examine abnormalities of liver. However, ambiguity lies in visual interpretation of liver stages on ultrasound images. This difficult visualization problem can be solved by analysing extracted textural features from images. Grey-level difference matrix, a texture feature extraction method, can provide information about roughness of liver surface, sharpness of liver borders and echotexture of liver parenchyma. In this article, the behaviour of variants of grey-level difference matrix in characterizing liver stages is investigated. The texture feature sets are extracted by using variants of grey-level difference matrix based on two, three, five and seven neighbouring pixels. Thereafter, to take the advantage of complementary information from extracted feature sets, feature fusion schemes are implemented. In addition, hybrid feature selection (combination of ReliefF filter method and sequential forward selection wrapper method) is used to obtain optimal feature set in characterizing liver stages. Finally, a computer-aided system is designed with the optimal feature set to classify liver health in terms of normal, chronic liver, cirrhosis and hepatocellular carcinoma evolved over cirrhosis. In the proposed work, experiments are performed to (1) identify the best approximation of derivative (forward, central or backward); (2) analyse the performance of individual feature sets of variants of grey-level difference matrix; (3) obtain optimal feature set by exploiting the complementary information from variants of grey-level difference matrix and (4) analyse the performance of proposed method in comparison with existing feature extraction methods. These experiments are carried out on database of 754 segmented regions of interest formed by clinically acquired ultrasound images. The results show that classification accuracy of 94.5% is obtained by optimal feature set having complementary information from variants of grey-level difference matrix.

Preliminary Study of Chronic Liver Classification on Ultrasound Images Using an Ensemble Model.

Chronic liver diseases are fifth leading cause of fatality in developing countries. Their early diagnosis is extremely important for timely treatment and salvage life. To examine abnormalities of liver, ultrasound imaging is the most frequently used modality. However, the visual differentiation between chronic liver and cirrhosis, and presence of heptocellular carcinomas (HCC) evolved over cirrhotic liver is difficult, as they appear almost similar in ultrasound images. In this paper, to deal with this difficult visualization problem, a method has been developed for classifying four liver stages, that is, normal, chronic, cirrhosis, and HCC evolved over cirrhosis. The method is formulated with selected set of "handcrafted" texture features obtained after hierarchal feature fusion. These multiresolution and higher order features, which are able to characterize echotexture and roughness of liver surface, are extracted by using ranklet, gray-level difference matrix and gray-level co-occurrence matrix methods. Thereafter, these features are applied on proposed ensemble classifier that is designed with voting algorithm in conjunction with three classifiers, namely, k-nearest neighbor (k-NN), support vector machine (SVM), and rotation forest. The experiments are conducted to evaluate the (a) effectiveness of "handcrafted" texture features, (b) performance of proposed ensemble model, (c) effectiveness of proposed ensemble strategy, (d) performance of different classifiers, and (e) performance of proposed ensemble model based on Convolutional Neural Networks (CNN) features to differentiate four liver stages. These experiments are carried out on database of 754 segmented regions of interest formed by clinically acquired ultrasound images. The results show that classification accuracy of 96.6% is obtained by use of proposed classifier model.

Computer-aided Characterization and Diagnosis of Diffuse Liver Diseases Based on Ultrasound Imaging: A Review.

Diffuse liver diseases, such as hepatitis, fatty liver, and cirrhosis, are becoming a leading cause of fatality and disability all over the world. Early detection and diagnosis of these diseases is extremely important to save lives and improve effectiveness of treatment. Ultrasound imaging, a noninvasive diagnostic technique, is the most commonly used modality for examining liver abnormalities. However, the accuracy of ultrasound-based diagnosis depends highly on expertise of radiologists. Computer-aided diagnosis systems based on ultrasound imaging assist in fast diagnosis, provide a reliable "second opinion" for experts, and act as an effective tool to measure response of treatment on patients undergoing clinical trials. In this review, we first describe appearance of liver abnormalities in ultrasound images and state the practical issues encountered in characterization of diffuse liver diseases that can be addressed by software algorithms. We then discuss computer-aided diagnosis in general with features and classifiers relevant to diffuse liver diseases. In later sections of this paper, we review the published studies and describe the key findings of those studies. A concise tabular summary comparing image database, features extraction, feature selection, and classification algorithms presented in the published studies is also exhibited. Finally, we conclude with a summary of key findings and directions for further improvements in the areas of accuracy and objectiveness of computer-aided diagnosis.

Primary hepatic (extranodal) lymphoma: utility of [(18)F]fluorodeoxyglucose-PET/CT.

Primary hepatic lymphoma is extremely rare. Although the utility of fluorodeoxyglucose (FDG)-positron emission tomography (PET) for imaging extranodal lymphoma has been reported, there is very little literature describing its use in primary hepatic lymphoma. This case report demonstrates the effect of FDG-PET/computed tomography (CT) in a case of unifocal primary hepatic lymphoma and its usefulness in the assessment of treatment response.