Exploring Radiomics for Classification of Supraglottic Tumors: A Pilot Study in a Tertiary Care Center.

Accurate classification of laryngeal cancer is a critical step for diagnosis and appropriate treatment. Radiomics is a rapidly advancing field in medical image processing that uses various algorithms to extract many quantitative features from radiological images. The high dimensional features extracted tend to cause overfitting and increase the complexity of the classification model. Thereby, feature selection plays an integral part in selecting relevant features for the classification problem. In this study, we explore the predictive capabilities of radiomics on Computed Tomography (CT) images with the incidence of laryngeal cancer to predict the histopathological grade and T stage of the tumour. Working with a pilot dataset of 20 images, an experienced radiologist carefully annotated the supraglottic lesions in the three-dimensional plane. Over 280 radiomic features that quantify the shape, intensity and texture were extracted from each image. Machine learning classifiers were built and tested to predict the stage and grade of the malignant tumour based on the calculated radiomic features. To investigate if radiomic features extracted from CT images can be used for the classification of laryngeal tumours. Out of 280 features extracted from every image in the dataset, it was found that 24 features are potential classifiers of laryngeal tumour stage and 12 radiomic features are good classifiers of histopathological grade of the laryngeal tumor. The novelty of this paper lies in the ability to create these classifiers before the surgical biopsy procedure, giving the clinician valuable, timely information.

Rajyoga meditation induces grey matter volume changes in regions that process reward and happiness.

Studies provide evidence that practicing meditation enhances neural plasticity in reward processing areas of brain. No studies till date, provide evidence of such changes in Rajyoga meditation (RM) practitioners. The present study aimed to identify grey matter volume (GMV) changes in reward processing areas of brain and its association with happiness scores in RM practitioners compared to non-meditators. Structural MRI of selected participants matched for age, gender and handedness (n = 40/group) were analyzed using voxel-based morphometric method and Oxford Happiness Questionnaire (OHQ) scores were correlated. Significant increase in OHQ happiness scores were observed in RM practitioners compared to non-meditators. Whereas, a trend towards significance was observed in more experienced RM practitioners, on correlating OHQ scores with hours of meditation experience. Additionally, in RM practitioners, higher GMV were observed in reward processing centers-right superior frontal gyrus, left inferior orbitofrontal cortex (OFC) and bilateral precuneus. Multiple regression analysis showed significant association between OHQ scores of RM practitioners and reward processing regions right superior frontal gyrus, left middle OFC, right insula and left anterior cingulate cortex. Further, with increasing hours of RM practice, a significant positive association was observed in bilateral ventral pallidum. These findings indicate that RM practice enhances GMV in reward processing regions associated with happiness.

Association of vascular calcification of breast with carotid intima media thickness.

PURPOSE: To assess the relationship between breast arterial calcification (BAC) on mammography and carotid intima medial thickness (C-IMT) by comparing these patients with healthy control subjects. MATERIAL AND METHODS: The study included 100 women divided into two groups based on presence of BAC on mammography using the WIPRO GE - DMR PLUS mammography unit. The groups included 50 BAC(+) (case group) and 50 BAC(-) (control group). BAC is defined as two linear calcific deposits forming the rail-road track pattern, with ring-like appearance in cross section. Relevant previous clinical and surgical history was taken and C-IMT was measured using B-mode ultrasonography Aplio XG (Toshiba medical systems corp., Japan) using an 8-13 MHz linear transducer within 1 cm from the proximal and distal portion of the common carotid artery and the mean value was taken. RESULTS: All the participants included in this study were within the age group of 40-70 years. Mean age with BAC(+) was 59.18 ± 8.59 years and BAC(-) was 50.70 ± 7.93 years. Mean C-IMT in the BAC(+) group was 0.86 ± 0.21 mm vs. 0.71 ± 0.12 mm in the BAC(-) group. Chi-square test, independent t test and Spearman's rho correlation to assess the association of the breast arterial calcification were performed. The study showed significant difference in mean C-IMT between two groups (p value < 0.001) when correlated with age, diabetes, hypertension, presence of BAC and history of surgery and drug intake. CONCLUSIONS: BAC in mammography is independently associated with C-IMT. Furthermore, apart from age and menopausal status a statistically significant positive correlation with C-IMT was observed.

Diagnostic reliability of the Thyroid Imaging Reporting and Data System (TI-RADS) in routine practice.

PURPOSE: To evaluate the diagnostic reliability of Thyroid Imaging Reporting and Data System (TI-RADS) classifications described by American College of Radiology (ACR) and Kwak et al. by calculating the risk of malignancy, to assess the role of TI-RADS in reducing fine-needle aspiration cytology (FNAC) of benign lesions. MATERIAL AND METHODS: This was a prospective study during the period from December 2017 to August 2018. Thyroid nodules were classified using ACR TI-RADS and TI-RADS proposed by Kwak et al. The TI-RADS categorisations were compared to the final diagnosis obtained by cytopathological/histopathological analysis. The risk of malignancy for each category was calculated. Sensitivity, specificity, and positive and negative predictive values for individual suspicious ultrasound features were also assessed. RESULTS: We evaluated a total of 127 thyroid nodules. The risk of malignancy was 0% in ACR TR1, 0% in ACR TR2, 6.9% in ACR TR3, 29.2% in ACR TR4, and 80% in ACR TR5 categories. The risk of malignancy for TI-RADS according to Kwak et al. were 0%, 0%, 21.5%, 32.4%, 100% for TI-RADS 2, 3, 4A, 4B, and 4C categories, respectively. Kwak TI-RADS 2 and 3 had higher sensitivity in predicting benignity compared to ACR TR1 and 2 (35.4% vs. 25.9%). CONCLUSIONS: We found TI-RADS classification to be a reliable, non-invasive, and practical method for assessing thyroid nodules in routine practice. TI-RADS can safely avert avoidable FNACs in a significant proportion of benign thyroid lesions.

Role of Diffusion Tensor Imaging in renal parenchymal changes.

CONTEXT: Diffusion Tensor Imaging (DTI) is a reliable noninvasive tool to assess renal function with medullary Fractional Anisotropy (FA) values showing the most consistent results. AIMS: Evaluation of FA, Apparent Diffusion Coefficient (ADC) for detecting diabetic nephropathy (DN) using 1.5-Tesla magnetic resonance imaging (MRI). To determine FA and ADC values in chronic kidney disease (CKD) patients and controls, and comparing these with estimated glomerular filtiration rate (eGFR) and categorizing the stage of CKD. PATIENTS AND METHODS: Thirty nondiabetic volunteers underwent DTI. The study included 83 diabetics, 30 frank urine proteinuric, 30 micro-albuminuric, 23 normo-albuminuric with only raised blood sugar patients. Patients were stratified by eGFR into groups: eGFR <60 and eGFR>60ml/min. ADC and FA values in cortex and medulla were compared between controls and study groups. STATISTICAL ANALYSIS USED: Analysis of variance and Pearson correlation using SPSS 16 were performed. RESULTS: There was significant difference of FA medulla in controls versus albuminuric and micro-albuminuric versus frank proteinuric patients (P < 0.001). Also, there was significant difference between cortical ADC values between normal, microalbuminuric/proteinuric groups (P = 0.010, P =0.000, respectively). Significant difference between medullary FA values of patients with eGFR >60 and eGFR < 60 versus normal controls (P < 0.001) was noted. With declining renal function from normal to CKD category 5, a negative correlation between medullary FA (r= -0.785, P = 0.001) and ADC cortex values (r= -0.436, P = 0.001) was noted. A strong positive correlation between medullary FA and cortex ADC with eGFR (r = 0.598 and 0.344, respectively) was noted. CONCLUSION: Medullary FA of diabetics with relatively intact kidney function were significantly lower than those of controls. Hence, drop in medullary FA values can be an indicator of early nephropathy/patients at risk where eGFR is in near normal range. Cortical ADC and medullary FA demonstrated a significant correlation with eGFR with the latter showing a stronger positive correlation.

Hepatic tuberculosis: a multimodality imaging review.

OBJECTIVES: We aim to illustrate the multimodal imaging spectrum of hepatic involvement in tuberculosis (TB). Whilst disseminated tuberculosis on imaging typically manifests as multiple small nodular lesions scattered in the liver parenchyma, isolated hepatic tuberculosis remains a rare and intriguing entity. METHODS: Indubitably, imaging is the mainstay for detection of tubercular hepatic lesions which display a broad spectrum of imaging manifestations on different modalities. While sonography and computed tomography (CT) findings have been described in some detail, there is a paucity of literature on magnetic resonance imaging (MRI) features. Due to a significant overlap with other commoner and similar appearing hepatic lesions, hepatic tuberculosis is often either misdiagnosed or labelled as indeterminate lesions. This article is a compendium of cases highlighting the spectrum of imaging patterns that can be encountered in patients with isolated primary hepatic tuberculosis as well as disseminated (secondary) disease. Rare patterns of primary disease such as tubercular cholangitis, hypervascular liver masses, and those with vascular complications are also illustrated and discussed. CONCLUSIONS: Imaging plays a valuable role in the detection of tubercular hepatic lesions. Also, imaging can be helpful in their characterisation and for assessing associated complications. TEACHING POINTS: • Hepatic TB has myriad imaging manifestations and is often confounded with neoplastic lesions. • Imaging patterns include miliary TB, macronodular TB, serohepatic TB and tubercular cholangitis. • Concurrent splenic, nodal or pulmonary involvements are helpful pointers towards the diagnosis. • Miliary calcifications along the bile ducts are characteristic of tubercular cholangitis. • Histological/microbiological confirmation is often necessary to confirm the diagnosis.

Telltale signs of peripheral neurogenic tumors on magnetic resonance imaging.

Peripheral nerve sheath tumors are categorized into benign and malignant forms, comprising of neurofibroma and schwannoma in the benign category and malignant peripheral nerve sheath tumors in the malignant category. Magnetic resonance imaging plays an important role in the diagnosis of these lesions. The various imaging features and signs that help to identify and characterize a nerve sheath tumor are, distribution of the tumor along a major nerve, an entering or exiting nerve sign, target sign, a fascicular sign and a split-fat sign.

A rare coronary artery anomaly: duplication of right coronary artery with separate ostium on 64-row multidetector computed tomography

Coronary artery anomalies are rare, and their incidence varies from 0.6% to 1.3%. Conventional angiography is a commonly used modality for the assessment of coronary artery anomalies, but it may not identify and define the anatomy of anomalous arteries due to the complexity of the course and three-dimensional orientation of the arteries. We present a rare case of duplicated right coronary artery (RCA) with separate ostium on 64-row multidetector computed tomography (MDCT). MDCT is better than conventional angiography in cases where selective catheterisation of either a single artery or ostium during catheter angiography has resulted in missing an important vessel. So far, 13 cases of duplicated RCA have been reported in the literature, and the features on MDCT were described only in three cases.