This retrospective study aimed to develop and validate a deep learning model for the classification of coronavirus disease-2019 (COVID-19) pneumonia, non-COVID-19 pneumonia, and the healthy using ...chest X-ray (CXR) images. One private and two public datasets of CXR images were included. The private dataset included CXR from six hospitals. A total of 14,258 and 11,253 CXR images were included in the 2 public datasets and 455 in the private dataset. A deep learning model based on EfficientNet with noisy student was constructed using the three datasets. The test set of 150 CXR images in the private dataset were evaluated by the deep learning model and six radiologists. Three-category classification accuracy and class-wise area under the curve (AUC) for each of the COVID-19 pneumonia, non-COVID-19 pneumonia, and healthy were calculated. Consensus of the six radiologists was used for calculating class-wise AUC. The three-category classification accuracy of our model was 0.8667, and those of the six radiologists ranged from 0.5667 to 0.7733. For our model and the consensus of the six radiologists, the class-wise AUC of the healthy, non-COVID-19 pneumonia, and COVID-19 pneumonia were 0.9912, 0.9492, and 0.9752 and 0.9656, 0.8654, and 0.8740, respectively. Difference of the class-wise AUC between our model and the consensus of the six radiologists was statistically significant for COVID-19 pneumonia (p value = 0.001334). Thus, an accurate model of deep learning for the three-category classification could be constructed; the diagnostic performance of our model was significantly better than that of the consensus interpretation by the six radiologists for COVID-19 pneumonia.
Muscle aging such as sarcopenia adversely affects motor activities. However, few studies have elucidated the aging physiological mechanism of tongue concerted with the changes muscle composition. The ...present study aimed to examine the tongue composition changes to detect the effect of tongue fat mass on tongue pressure and swallowing function with aging. Twenty community-dwelling elderly without head and neck cancer, stroke, or neuromuscular disease and 20 healthy young were included. Tongue volume, tongue fat mass, tongue lean muscle mass, and tongue fat percentage were evaluated with 3D magnetic resonance imaging (MRI) and Dixon MRI. Tongue pressure was also measured. Swallowing function among elderly individuals was assessed via videofluorography, which was evaluated using the penetration–aspiration scale (PAS) and normalized residue ratio scale (NRRS). Tongue fat mass and tongue fat percentage significantly increased with aging. The tongue fat percentage of elderly participants was 20%, which was two times greater than that of young participants. No significant difference was observed in tongue volume and tongue lean muscle mass. A significantly negative correlation was observed between tongue fat mass and tongue fat percentage as well as tongue pressure. Conversely, tongue volume was not significantly correlated with tongue pressure. Tongue muscle composition exhibited no effect in the PAS and NRRS. Increase of fat mass is a major change in tongue composition with aging, which is associated with low tongue pressure. Thus, attention must be paid not only to tongue quantity but also to the quality of tongue muscles.
Endovascular therapy is strongly recommended for acute cerebral large vessel occlusion (LVO) with an Alberta stroke program early computed tomography score (ASPECTS) ≥6 due to occlusion of the ...internal carotid artery or M1 segment of the middle cerebral artery. However, the effect of endovascular therapy for patients with a large ischemic core with an ASPECTS ≤5 (0–5) was not established. A multicenter, randomized, open-label, parallel-group trial was conducted to investigate the superiority of endovascular therapy over medical therapy without endovascular therapy for a large ischemic core with ASPECTS (3–5). Patients were randomly assigned to receive endovascular therapy or without endovascular therapy at a ratio of 1:1. The primary outcome was a moderate functional outcome, defined as a modified Rankin scale (mRS; scores ranging from 0 no symptoms to 6 death) ≤3 after 90 days. The secondary outcomes were defined as ordinal mRS, good functional outcome (mRS ≤2), excellent functional outcome (mRS ≤1), mRS shift analysis after 90 days, and early improvement of neurological findings at 48 hours. A total sample size of 200 was estimated to provide a power of 0.9 with a two-sided alpha of 0.05, for the primary outcome, considering a 15% dropout rate. This randomized clinical trial reported the applicability of endovascular therapy in patients with acute cerebral LVO with a large ischemic core.
To evaluate the diagnostic performance of our deep learning (DL) model of COVID-19 and investigate whether the diagnostic performance of radiologists was improved by referring to our model. Our ...datasets contained chest X-rays (CXRs) for the following three categories: normal (NORMAL), non-COVID-19 pneumonia (PNEUMONIA), and COVID-19 pneumonia (COVID). We used two public datasets and private dataset collected from eight hospitals for the development and external validation of our DL model (26,393 CXRs). Eight radiologists performed two reading sessions: one session was performed with reference to CXRs only, and the other was performed with reference to both CXRs and the results of the DL model. The evaluation metrics for the reading session were accuracy, sensitivity, specificity, and area under the curve (AUC). The accuracy of our DL model was 0.733, and that of the eight radiologists without DL was 0.696 ± 0.031. There was a significant difference in AUC between the radiologists with and without DL for COVID versus NORMAL or PNEUMONIA (p = 0.0038). Our DL model alone showed better diagnostic performance than that of most radiologists. In addition, our model significantly improved the diagnostic performance of radiologists for COVID versus NORMAL or PNEUMONIA.
Numerous reports have described the semi-jailing technique (SJT) using a closed-cell stent for stent-assisted coil embolization, revealing issues including poor expansion and thrombotic complications ...in curved vessels. This paper reports preliminary experience with SJT using an open-cell stent, a novel type of stent allowing stent placement from a microcatheter.
First, this research investigated differences between open- and closed-cell types in SJT using silicone vessel models. Next, 43 patients who underwent SJT for the internal carotid artery were divided into 2 groups to investigate treatment outcomes: 24 patients with placement of an open-cell stent (open-cell group) and 19 patients with closed-cell stents (closed-cell group).
In the silicone vessel model, coils could be placed with the open-cell stent deployed with a shorter length than the closed-cell stent. No significant differences were found between groups in terms of maximum diameter of the aneurysm or dome-neck ratio. The open-cell group showed a trend toward higher complete embolization immediately after surgery (54.2% vs. 26.3%, P = 0.06), with few cases of stent malapposition (0% vs. 31.6%, P < 0.01). However, 1 case of ischemic complication in the closed-cell group and 1 case of hemorrhagic complication in open-cell group occurred. All cases of modified Rankin Scale scores at discharge were 0–1.
Although the open-cell stent carries the disadvantage of an unresheathable design, coil placement with a shorter stent deployment length may be advantageous during SJT for internal carotid artery aneurysm embolization with favorable consequences for excellent vessel wall apposition.
Abstract Background One of the disadvantages of carotid artery stenting (CAS) is high incidence of distal embolism (DE) during or after the procedure. It has been reported that unstable plaque cases ...are at high risk of DE and plaque protrusion (PP) after stent placement which will become a cause of post procedural ischemic complications. Objective The purpose of this study was to compare the rate and size of PP between CASPER stent which is a new generation double-layer micromesh stent and conventional stents detected by optical frequency domain imaging (OFDI) and to evaluate the efficacy of CAS with CASPER stent for cases with unstable plaque. Methods Forty-six consecutive patients with unstable plaque defined as magnetic resonance imaging undergoing CAS with OFDI image acquisition were enrolled in this study. Cross-sectional OFDI images within the stented segments were evaluated at 0.125mm intervals and compared the rate and size of PP between CASPER stent and conventional stents. Results CASPER stent was used in 9 patients. No procedural complications occurred. With OFDI analysis, presence of PP was apparently lower in CASPER stent group than conventional stents group (44% vs 88%, p=0.022). Also, mean PP area was significantly smaller in CASPER stent group than conventional stents group (Mean PP area: 0.013 ± 0.034 mm2 vs 0.057 ± 0.09 mm2 , p=0.006). Conclusion Using OFDI evaluation after CAS, the degree of PP was significantly smaller in CASPER stent than conventional stents. This result indicates new insights of CAS for the treatment of carotid artery stenosis with unstable plaque.
Foreign body granulomas following endovascular treatment are rare complications and are mostly reported in the brain or cutaneous vascular tissues. To the best of our knowledge, no study to date has ...reported on foreign body granulomas in the abdomen after injection of N-butyl-2-cyanoacrylate (NBCA)-lipiodol mixture into the abdominal arteries. This study reports a case of foreign body granuloma that appeared 12 months after the embolization of a right internal iliac artery aneurysm using an NBCA-lipiodol mixture, which posed challenges in differentiation from malignant tumors. We present a 77-year-old man who underwent embolization of a right internal iliac artery aneurysm and open surgical repair of an abdominal aortic aneurysm. A contrast-enhanced CT performed 12 months postoperatively revealed a right-sided retroperitoneal mass surrounding the iliopsoas muscle. The mass contained multiple, small, hyperdense areas, suggesting the migration of the NBCA-lipiodol mixture casts from the embolized right internal iliac artery aneurysm. The differential diagnosis included foreign body granuloma, lymphoma, and sarcoma. A biopsy of the lesion revealed a granuloma with various stages of inflammation, no hemosiderin deposition, multinucleated giant cells, and foam cells containing fat, and was diagnosed with a foreign body granuloma. Special staining for microorganisms revealed no findings suggestive of infection. Because the patient was asymptomatic, no treatment was administered. Contrast-enhanced CT at 24 months postoperatively showed shrinkage of the mass, with no change in size noted at 48 months postoperatively. This report highlights a foreign body granuloma that mimicked malignant tumors. Extravascular migration of the NBCA-lipiodol mixture casts likely contributed to granuloma formation. Radiologists should consider foreign body granulomas after embolization using NBCA into the abdominal arteries.
Background
This study aimed to assess the effectiveness and versatility of an intentional early detachment technique with detachable coils in addressing challenging vascular embolization scenarios. ...This novel approach aims to provide an alternative method for achieving precise coil placement when standard methods of detachable coil placement are ineffective owing to vascular anatomy or limited available equipment.
Materials and methods
This retrospective study included 11 patients (nine males and two females; median age, 77 years) who underwent embolization procedures between October 2021 and December 2023 using the intentional early detachment technique through 1.6-Fr or 1.3-Fr microcatheters. In this technique, detachable coils were intentionally detached within the microcatheter and placed through saline flushing. The technique’s technical success, complications, and clinical success were evaluated.
Results
The technique was applied in three distinct scenarios: tortuous vascular anatomy (four cases), inadequate system backup (three cases), and 1.3-Fr microcatheter use (four cases). The technical and clinical success rates were 100%. No complications were observed, and no cases of coil migration or malpositioning.
Conclusion
The intentional early detachment technique is valuable for interventional radiologists and offers a solution for challenging vascular embolization scenarios. Its application is limited to specific circumstances; however, it can significantly enhance coil placement in complex cases, thereby contributing to improved patient care.
Graphical Abstract
Purpose
To evaluate the frequency, characteristics, and clinical significance of transient hyperintensity foci on T1-weighted images (T1WI) in acute disseminated encephalomyelitis (ADEM).
Materials ...and methods
Patients diagnosed with ADEM underwent MR studies at the time of disease onset and every 3 months or more often thereafter. The frequency and appearance timing of abnormal signals including T1WI and their morphological characteristics were evaluated. Relations between patient symptoms and abnormal signals on MRI were also evaluated.
Results
Five ADEM patients were included in this study. Linear (
n
= 2) or nodular (
n
= 1) T1-hyperintensity foci appeared in 3 patients (60%, 3/5). Locations of T1-hyperintensity foci were both cortical/subcortical region and basal ganglia (
n
= 1), subcortical region alone (
n
= 1), and internal capsule (
n
= 1). Those T1-hyperintensity foci were located within the T2-weighted image (T2WI) and fluid-attenuated inversion recovery (FLAIR) hyperintensity foci on initial MRI. Some T1-hyperintensity foci also showed hyperintensity on diffusion-weighted image (DWI) and contrast enhancement. T1-hyperintensity appeared at 14–43 days (median, 28 days), and disappeared in 2 patients at 91 days and 627 days after disease onset. There were no neurological sequelae remained in any patients.
Conclusion
T1-hyperintensity foci is not a rare finding (60%) and it can be observed after improvement in symptoms in ADEM.
Background
Texture features reflecting tumour heterogeneity enable us to investigate prognostic factors. The R package
ComBat
can harmonize the quantitative texture features among several positron ...emission tomography (PET) scanners. We aimed to identify prognostic factors among harmonized PET radiomic features and clinical information from pancreatic cancer patients who underwent curative surgery.
Methods
Fifty-eight patients underwent preoperative enhanced dynamic computed tomography (CT) scanning and fluorodeoxyglucose PET/CT using four PET scanners. Using
LIFEx
software, we measured PET radiomic parameters including texture features with higher order and harmonized these PET parameters. For progression-free survival (PFS) and overall survival (OS), we evaluated clinical information, including age, TNM stage, and neural invasion, and the harmonized PET radiomic features based on univariate Cox proportional hazard regression. Next, we analysed the prognostic indices by multivariate Cox proportional hazard regression (1) by using either significant (
p
< 0.05) or borderline significant (
p
= 0.05–0.10) indices in the univariate analysis (first multivariate analysis) or (2) by using the selected features with random forest algorithms (second multivariate analysis). Finally, we checked these multivariate results by log-rank test.
Results
Regarding the first multivariate analysis for PFS after univariate analysis, age was the significant prognostic factor (
p
= 0.020), and MTV and GLCM contrast were borderline significant (
p
= 0.051 and 0.075, respectively). Regarding the first multivariate analysis of OS, neural invasion, Shape sphericity and GLZLM LZLGE were significant (
p
= 0.019, 0.042 and 0.0076). In the second multivariate analysis, only MTV was significant (
p
= 0.046) for PFS, whereas GLZLM LZLGE was significant (
p
= 0.047), and Shape sphericity was borderline significant (
p
= 0.088) for OS. In the log-rank test, age, MTV and GLCM contrast were borderline significant for PFS (
p
= 0.08, 0.06 and 0.07, respectively), whereas neural invasion and Shape sphericity were significant (
p
= 0.03 and 0.04, respectively), and GLZLM LZLGE was borderline significant for OS (
p
= 0.08).
Conclusions
Other than the clinical factors, MTV and GLCM contrast for PFS and Shape sphericity and GLZLM LZLGE for OS may be prognostic PET parameters. A prospective multicentre study with a larger sample size may be warranted.
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