Wavelet radiomics features from multiphase CT images for screening hepatocellular carcinoma: analysis and comparison.

Early detection of liver malignancy based on medical image analysis plays a crucial role in patient prognosis and personalized treatment. This task, however, is challenging due to several factors, including medical data scarcity and limited training samples. This paper presents a study of three important aspects of radiomics feature from multiphase computed tomography (CT) for classifying hepatocellular carcinoma (HCC) and other focal liver lesions: wavelet-transformed feature extraction, relevant feature selection, and radiomics features-based classification under the inadequate training samples. Our analysis shows that combining radiomics features extracted from the wavelet and original CT domains enhance the classification performance significantly, compared with using those extracted from the wavelet or original domain only. To facilitate the multi-domain and multiphase radiomics feature combination, we introduce a logistic sparsity-based model for feature selection with Bayesian optimization and find that the proposed model yields more discriminative and relevant features than several existing methods, including filter-based, wrapper-based, or other model-based techniques. In addition, we present analysis and performance comparison with several recent deep convolutional neural network (CNN)-based feature models proposed for hepatic lesion diagnosis. The results show that under the inadequate data scenario, the proposed wavelet radiomics feature model produces comparable, if not higher, performance metrics than the CNN-based feature models in terms of area under the curve.

Primary immature teratoma of the liver in an adult: Case report.

Teratoma is an uncommon germ cell tumor and develops from at least 2 of the 3 germ cell layers: ectoderm, mesoderm, and endoderm. The origin of teratoma is primordial germ cells that migrate from the allantois to the gonadal ridges during embryogenesis. The teratomas can be intragonadal or extragonadal. Primary extragonadal teratoma is defined as if there is no evidence of a primary tumor in the testicles or ovaries. Common extragonadal sites include the anterior mediastinum, retroperitoneum, sacral region, and intracranial cavity. Primary intrahepatic teratomas are extremely rare, accounting for less than 1% of all teratoma cases. Hepatic teratomas are more common in children than in adults. We present a case of an immature primary hepatic teratoma in an adult woman.

Preoperative magnetic resonance imaging of anal fistulas with scrotal extension: a retrospective study.

Introduction: This study aimed to elucidate the magnetic resonance (MR) characteristics of anal fistulas extending to the scrotum, and the applicable rules, and to correlate MR features with surgical findings. Methods: We conducted a retrospective study in 150 consecutive patients with anal fistulas extending into the scrotum, who were diagnosed and underwent surgery at University Medical Center Ho Chi Minh City between January 2017 and April 2022. MR findings were evaluated and compared with surgical findings using Cohens kappa coefficient (k) with a 95% confidence interval. Results: 150 patients (mean age 37.6 ± 10.9 years) with 166 fistulas, including 150 anal fistulas with scrotal extension. Most fistulas were low transsphincteric (80.0%, 120/150 patients). There was a strong agreement for primary tract classification and detecting the location of internal openings between MRI and surgical findings with k = 0.83 (0.780.87) and k = 0.89 (0.85 0.93) (p<0.001), respectively. There is a significant correlation between the location of internal openings and the type of fistula (p<0.05). Low transsphincteric fistulas were predominant in the anterior group (103/122 patients vs. 10/19 patients), while in the posterior group, it was more common in the high transsphincteric fistulas (7/19 patients vs. 14/122 patients), and the intersphincteric fistulas (1/19 patients vs. 5/122 patients); and the suprasphincteric fistulas were only seen in the posterior group (1 patient). Conclusion: Anal fistulas with scrotal extension are exceptions to Goodsalls rule. Albeit long-tract fistulas, most are low transsphincteric and have anterior internal openings.

Acute onset of diabetes and rapid cognitive decline in a patient with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome.

Summary: Mitochondrial diseases are a group of rare diseases presenting with heterogeneous clinical, biochemical, and genetic disorders caused by mutations in the mitochondrial or nuclear genome. Multiple organs can be affected, particularly those with high energy demand. Diabetes is a common endocrine manifestation of mitochondrial diseases. The onset of mitochondrial diabetes can be latent or acute, and the presenting phenotype can be type 1- or type 2-like. Studies show that diabetes ais associated with latent progression of cognitive decline in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome. Herein, we report a case of rapid cognitive decline after the acute onset of diabetes in a patient with MELAS syndrome. The patient was a 36-year-old woman who was hospitalized due to hyperglycemic crisis and seizures. She was diagnosed with MELAS syndrome two years previously, and had gradually progressing dementia and hearing loss. However, following the acute onset of diabetes, she developed rapid cognitive decline and loss of ability to perform daily activities. In conclusion, the acute onset of diabetes could be an associated risk factor for rapid cognitive decline in patients with MELAS syndrome. Thus, these patients as well as healthy carriers with related genetic mutations should undergo diabetes education and screening tests. Moreover, clinicians should be aware of the possibility for acute onset of hyperglycemic crisis, particularly in the presence of triggering factors. Learning points: Diabetes is a common endocrine manifestation of mitochondrial diseases, presenting with a type 1- or type 2-like phenotype depending on the level of insulinopenia. Metformin should be avoided in patients with mitochondrial diseases to prevent metformin-induced lactic acidosis. Mitochondrial diabetes can manifest before or after the onset of MELAS syndrome. In patients with MELAS syndrome, diabetes can initially manifest with a life-threatening severe hyperglycemic crisis and can cause rapid cognitive decline. Diabetes screening tests (e.g. hemoglobin A1c, oral glucose tolerance test, or random blood glucose level measurement) should be performed either systematically or in the presence of symptoms, particularly after triggering events. Genetic testing and counseling should be provided to patients and their families for the purpose of better understanding the inheritance, progression, and possible outcomes of the disease.

The Role of Magnetic Resonance Pulse Sequences in the Diagnosis of Acute Appendicitis in Pregnant Women.

INTRODUCTION: Acute appendicitis (AA) is one of the most common surgical emergencies, with a lifetime risk estimated at 7-8%. Pregnant women with appendicitis can have a difficult diagnosis because many signs and symptoms could overlap with other causes of acute abdominal pain. Although magnetic resonance imaging (MRI) is not contraindicated at all gestational ages for units with a field strength of three Tesla or less, there is still much discussion regarding the best protocol to follow in order to minimize survey time and maximize diagnostic efficiency. The purpose of this study was to assess how well different MR pulse sequences can diagnose AA. METHODS: This retrospective study involved 179 pregnant females. All patients treated and admitted to the University Medical Center, Ho Chi Minh City, Vietnam, between January 2016 and October 2023 had their MR scans and medical data examined. MRI results were assessed and compared with surgical and histopathological findings. RESULTS: The mean age of the population was 29.7 ± 4.8 years (range, 18-46 years). On T1-weighted (T1W) and T2-weighted (T2W) sequences, the appendix was clearly visualized at rates of 81.8% and 89.9%, respectively. The sensitivity and specificity of the T2W in diagnosing AA were 93.5% and 92.3%, and when combined with T1W and diffusion-weighted (DW) images, the sensitivity and specificity further increased, being 96.8% and 94.9%, respectively. The predictive value of non-AA of the T1 bright appendix sign was 95.6%. CONCLUSION: Our study supports the use of MRI as an imaging test to identify appendicitis during pregnancy, as it has been shown to be a useful method for diagnosing the condition in pregnant women. The T2W pulse sequence is a useful tool for diagnosing appendicitis because of its high sensitivity and specificity. When identifying appendicitis from T2W alone proves challenging, T1W with the T1 bright sign and DW to take advantage of the appendix lumen and/or wall's diffusion features can yield additional information and boost diagnostic confidence.

Diffuse axonal injury: a case report and MRI findings.

Diffuse axonal injury (DAI) is one of the most severe types of primary traumatic brain injury. In recent years, MR imaging has been gaining popularity as an adjunctive imaging method in patients with DAI. In this case report, we describe MRI findings of an 11-year-old male patient diagnosed with DAI and discuss the role of different sequences in the evaluation of DAI.

Bilateral adrenal masses due to tuberculosis: how to diagnose without extra-adrenal tuberculosis.

SUMMARY: Primary adrenal insufficiency is a rare disease and can masquerade as other conditions; therefore, it is sometimes incorrectly diagnosed. Herein, we reported the case of a 39-year-old Vietnamese male with primary adrenal insufficiency due to bilateral adrenal tuberculosis. The patient presented to the emergency room with acute adrenal crisis and a 3-day history of nausea, vomiting, epigastric pain, and diarrhoea with a background of 6 months of fatigue, weight loss, and anorexia. Abdominal CT revealed bilateral adrenal masses. Biochemically, unequivocal low morning plasma cortisol (<83 nmol/L) and high plasma adrenocorticotropic hormone levels were consistent with primary adrenal insufficiency. There was no evidence of malignancy or lymphoma. As the patient was from a tuberculosis-endemic area, extra-adrenal tuberculosis was excluded during the work up. A retroperitoneal laparoscopic left adrenalectomy was performed, and tuberculous adrenalitis was confirmed by the histopathological results. The patient was started on antituberculous therapy, in addition to glucocorticoid replacement. In conclusion, even without evidence of extra-adrenal tuberculosis, a diagnosis of bilateral adrenal tuberculosis is required. A histopathological examination has a significant role along with clinical judgement and hormonal workup in establishing a definitive diagnosis of adrenal tuberculosis without evidence of active extra-adrenal involvement. LEARNING POINTS: Primary adrenal insufficiency can be misdiagnosed as other mimicking diseases, such as gastrointestinal illness, leading to diagnostic pitfalls. Adrenal insufficiency can be confirmed with significantly low morning plasma cortisol levels of <83 nmol/L without a dynamic short cosyntropin stimulation test. Tuberculous adrenalitis is an uncommon treatable condition; however, it remains an important cause of primary adrenal insufficiency, especially in developing countries. In the absence of extra-adrenal involvement, adrenal biopsy plays a key role in the diagnostic process. Alternatively, adrenalectomy for histopathological purposes should be considered if CT scan-guided fine needle aspiration is infeasible in cases of small adrenal masses.

Corrigendum to 'Adult-onset mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome with progressive sensorineural hearing loss: A case report [Radiology Case Reports 16 (2021) 1865-1869].

[This corrects the article DOI: 10.1016/j.radcr.2021.04.049.].

The role of magnetic resonance imaging in the preoperative evaluation of anal fistulas.

This study aimed to determine the role of magnetic resonance imaging (MRI) in diagnosing and describing the characteristics of fistula-in-ano, and the agreement between MRI and operative findings. We conducted a retrospective study in 367 patients with fistula-in-ano who were diagnosed and had an operation at the University Medical Center between January 2016 and January 2018. MRI findings were evaluated and compared with surgical findings using the kappa coefficient (k) method. 367 patients (327 male and 40 female, mean age 39.3 ± 12.4 years). A total of 411 primary fistulas were found during surgery. There was a strong agreement between MRI and surgery for classifying primary tracts (k = 0.89) and detecting secondary tracts (k = 0.94). While the sensitivity and specificity of MRI for detecting internal openings were 99% and 85.2% respectively; these rates were 100% for abscesses. Both T2-weighted turbo spin-echo (T2W TSE) and postcontrast fat-saturated T1-weighted turbo spin-echo (FS T1W TSE) sequences showed high sensitivity (96.6% and 98.4% respectively) and specificity (92.6% and 81.5% respectively) for depicting internal openings and secondary tracts. Post-contrast FS T1W TSE sequence was very effective in detecting abscesses with an accuracy of 100%. In conclusion, MRI can be considered an accurate tool for the preoperative evaluation of fistula-in-ano, which is a major determinant of the surgical outcome. Both T2W TSE and post-contrast FS T1W TSE sequences are highly accurate in depicting the features of fistula-in-ano. If there are no contraindications, contrast administration is recommended to differentiate abscesses from active inflammation.

Non-Hodgkin lymphomas recurrence in central nervous system

A retrospective study was carried out on 32 patients with non Hodgkin lymphomas (NHL) in order to evaluate incidence rate, outcome and risk factors of central nervous system (CNS) recurrence. The results showed that: 1 patient had general manifestation and local CNS symptoms, 3 patients had CNS recurrence later on. The cumulative risk of CNS recurrence in 4 years was 19%. The CNS recurrence risk was 39% in high grade NHL, occurring usually in the first 14months, 22% in moderate grade NHL, occurring usually in the first 6 years and 7% in low grade NHL with higher degree of malignancy. In multi value analysis, NHL with high and moderate grades were independent risk factors for CNS recurrence. There are no clear evidences about role of CNS prophylaxis in patients with moderate and high grade of NHL. The survival time is 1-2 months

Special histopathological features of the uncinate processes

The study was carried out on 39 patients (18 male, 21 female, mean ages: 36.3 years old). Total of uncinate processes samples were 49. Of 39 patients, 29 patients were removed uncinate processes in one side and 10 patients were removed uncinate processes in two sides. The mean time of sinusitis was over 3 months in 32 cases (82%), 1 to 3 months in 3 cases (7.7%), and under 1 month in 4 cases (10.3%). 10 samples from uncinate processes in two side had the same histopathological lesions

The relationship of abnormal ultrasonographic findings and karyotype analysis in prenatal diagnosis

Analyse the abnormal ultrasonographic findings of 112 pregnant women who were indicated for amniocentesis at Tu Du Obstetrics and Gynecology Hospital and Hung Vuong Hospital from February 2004 to September 2005. Abnormal ultrasonographic findings were divided into two groups: one group of major abnormalities that were significant relations to chromosomal abnormalities including atrio-ventricular channel and diaphragmatic hernia; the other group of minor abnormalities that were significant relations to chromosomal abnormalities and other small ultrasonographic abnormalities, major ultrasonographic abnormalities, biochemical analyses of maternal blood and age, etc. The results showed significant relations between the number and the categories of abnormal ultrasonographic findings and chromosomal abnormalities

The relationship between clinical types of sinusitis and microscopic lesion features of uncinate processes

Study on 39 patients (18 males, 21 females, mean age: 36.3 years old) with chronic or recurrent anterior sinusitis, with or without nasal polyps, who were undergone naso-sinus endoscopies at Gia Dinh Hospital and HCMC University Medical Center from January to July 2004. Results: there was a change in microscopic imagines of uncinate processes like imagines of typical polyps although uncinate processes degeneration couldn’t be found. Polyps were common in chronic sinusitis, the rate of polyps increased along with the years of sinusitis

Reproductive factors and risk of intermediate and high grade B-cell non-Hodgkin's lymphomas

To interview 60 female patients with intermediate and high grade B-cell non-Hodgkin's lymphomas (NHL), each patient was paired with a control who is a neighbour on the age factor. Females who use oral contraceptive pills have a high risk in intermediate and high grade B-cell non-Hodgkin's lymphomas compared to controls. Among the mothers, those using anti-lactating drugs have a lower risk of NHL compared to controls. Menopausal patients have a higher NHL risk compared to women in the reproductive years, whereas menopausal women on hormone replacement therapy have a lower risk compared to controls

Sex chromosomal aneuploidy in spermatozoa of non-hodgkin lymphoma (NHL) patient before therapy

Evaluation the ratio of sex chromosomal aneuploidy in NHL patient before therapy spermatozoa by FISH (Fluorescent Insitu Hybridization) technique. Comparison semen of four NHL patients before chemotherapy or irradiation with semen of four controls in the sperm bank. No statistically significant changes in semen in patient group compared to controls. The abnormal ratio with two somatic chromosome 8-8-X or 8-8-Y and diploidy X-Y-8-8 are higher than controls. The rate of aneuploidy in sex chromosome can increase if used in assisted fecundation

The immunologic response of T-cell in large B-cell non Hodgkin lymphoma

The authors conducted a retrospective study including 72 patients with non-Hodgkin lymphoma (NHL) with large B cell, to determine the percentage of CD3+, CD4+, CD8+, and natural killer cells by flow cytometry from the biopsy specimens before treatment, and compared these results to the patients’ outcomes. Results: the increased percentage of CD4 T cell in pretreated biopsy specimens correlated significantly to the patients’ outcomes. Patients with increased CD4+ had better 5-year survival than the others. Over 20% CD4+ cell infiltrated in the pretreated biopsy specimens were independent factors of non-recurrence. The increasing of active CD4+ in large B cell NHL offered a better prognosis, and was a background in immunologic therapy of B cell NHL