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TORELLA, Maria Constanza, Belén DUARTE, Mariano VILLARROEL, Juan LASA, and Ignacio ZUBIAURRE. "INCREASED RISK OF SYNCHRONOUS COLORECTAL LESIONS IN PATIENTS REFERRED FOR ENDOSCOPIC MUCOSAL RESECTION OF LATERAL SPREADING TUMORS." Arquivos de Gastroenterologia 56, no. 3 (September 2019): 276–79. http://dx.doi.org/10.1590/s0004-2803.201900000-52.
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ABSTRACT BACKGROUND: Endoscopic mucosal resection is one of the most frequent therapeutic alternatives for large colorectal lateral spreading tumors. There are few data on the prevalence of synchronous lesions on these patients. OBJECTIVE: To describe the prevalence of synchronous colorectal lesions in patients referred for endoscopic mucosal resection of lateral spreading tumors >20 mm. METHODS: We reviewed the endoscopic database of our Department and identified adult patients who were referred for the resection of a colorectal lateral spreading tumor >20 mm and had a diagnostic colonoscopy performed up to six months before. The proportion of patients with at least one synchronous lesion was estimated. The following features were compared between patients with and without synchronous lesions: age, gender, bowel preparation quality and cecal intubation on index colonoscopy and therapeutic colonoscopy, serrated adenoma as index lesion. RESULTS: From December 2016 to November 2017, we identified 70 patients who fulfilled inclusion criteria. Median size of lesions was 25 mm (20-45). Eighty percent were located in the right colon and 35.71% were serrated adenomas. Synchronous lesion rate was 38.57%. Bowel preparation quality was similar in both groups when comparing both index and therapeutic colonoscopies. Patients with synchronous lesions had a higher proportion of serrated adenoma as index lesion than patients without synchronous lesions [51.85% vs 25.58%, OR 3.13 (1.13-8.68), P=0.03]. CONCLUSION: We found a high prevalence of synchronous lesions among patients with a large colorectal lateral spreading tumor. This risk seems to be increased if index lesions are serrated adenomas.
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Schiemanck, S. K., M. W. M. Post, Th D. Witkamp, L. J. Kappelle, and A. J. H. Prevo. "Relationship between Ischemic Lesion Volume and Functional Status in the 2nd Week after Middle Cerebral Artery Stroke." Neurorehabilitation and Neural Repair 19, no. 2 (June 2005): 133–38. http://dx.doi.org/10.1177/154596830501900207.
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Objective. To examine the relationship between the volume of the middle cerebral artery stroke lesion and functional status in the subacute phase of stroke. Methods. Infarctvolumes of 94 patients with a 1st middle cerebral artery stroke assessed on conventional MRI scans obtained in the 2nd week poststroke were related to a clinical measure of stroke severity (National Institutes of Health Stroke Scale [NIHSS]) and to functional status: motor impairment (Motricity Index [MI]) and limitation in activities (Barthel Index [BI] and modified Rankin Scale). Separate correlations were computed for patients with large (>30 ml) and small (30 ml) lesions, and to investigate the influence of lesion location on the relationship between volume and functional status, correlations were computed for patients with left and right hemisphere lesions and for patients with cortical and subcortical lesions. Results. Lesion volume correlated strongly with NIHSS scores (R = 0.61) and moderately with the patient’s functional status (MI [R between -0.42 and - 0.49], BI [R = -0.43], and Modified Rankin Scale [R = 0.45]). Right hemisphere lesions and cortical lesions had a stronger correlation with functional status. In patients with small lesion volumes (0-30 ml), no relationship between lesion volumes and functional status was seen at all. Conclusions. Lesion volume is moderately to strongly related to the functional status in the 2nd week poststroke.
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Hálková, Tereza, Renata Ptáčková, Anastasiya Semyakina, Štěpán Suchánek, Eva Traboulsi, Ondřej Ngo, Kateřina Hejcmanová, et al. "Somatic Mutations in Exon 7 of the TP53 Gene in Index Colorectal Lesions Are Associated with the Early Occurrence of Metachronous Adenoma." Cancers 14, no. 12 (June 7, 2022): 2823. http://dx.doi.org/10.3390/cancers14122823.
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(1) Background: this prospective study was focused on detailed analysis of the mutation heterogeneity in colorectal lesions removed during baseline (index) colonoscopy to identify patients at high risk of early occurrence of metachronous adenomas. (2) Methods: a total of 120 patients after endoscopic therapy of advanced colorectal neoplasia size ≥10 mm (index lesion) with subsequent surveillance colonoscopy after 10–18 months were included. In total, 143 index lesions and 84 synchronous lesions in paraffin blocks were divided into up to 30 samples. In each of them, the detection of somatic mutations in 11 hot spot gene loci was performed. Statistical analysis to correlate the mutation profiles and the degree of heterogeneity of the lesions with the risk of metachronous adenoma occurrence was undertaken. (3) Results: mutation in exon 7 of the TP53 gene found in the index lesion significantly correlated with the early occurrence of metachronous adenoma (log-rank test p = 0.003, hazard ratio 2.73, 95% confidence interval 1.14–6.56). We did not find an association between the risk of metachronous adenomas and other markers monitored. (4) Conclusions: the findings of this study could lead to an adjustment of existing recommendations for surveillance colonoscopies in a specific group of patients with mutations in exon 7 of the TP53 gene in an index lesion, where a shortening of surveillance interval may be warranted.
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Cai, Zheng, Sainan Li, Qi Zhang, Chenyuan Wang, Zhen Jin, Ming Fu, Shuai Zhang, Ming Liang, Zulu Wang, and Yaling Han. "Derivation and Verification of the Relationship between Ablation Index and Baseline Impedance." Cardiology Research and Practice 2021 (July 12, 2021): 1–6. http://dx.doi.org/10.1155/2021/5574125.
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Objective. To explore the quantitative adjustment of ablation index (AI) under different baseline impedance to achieve similar lesion dimensions. Methods. (1) Keeping the AIs relatively constant, the lesion dimensions in different baseline impedances were studied. (2) According to Joule's law, Q = I2RT, keeping the current (I) unchanged, the powers corresponding to different baseline impedances can be obtained. Under different baseline impedances and corresponding powers, the swine hearts were ablated for 30 s in simulated human circumstances. The baseline impedances, the lesion dimensions, and AIs were recorded. And the derivation of empirical formula was achieved according to the AIs and baseline impedance values in similar lesions dimension. (3) Basic AI and baseline impedance (AI0/R0) were set as 400/120 Ω in the common AI groups and 550/120 Ω in the high AI groups, AI values in different baseline impedances were calculated using the empirical formula, and the corresponding lesion dimensions were measured to verify this formula. Results. (1) Higher baseline impedances were related to smaller lesion dimensions at similar AIs. (2) The lesion dimensions were roughly the same after modulating the baseline impedance and power to keep the electric current relatively constant. The relationship between AI and R fitted with experimental data is AI = 1.9933R + 203.61 (r = 0.9649), and the formula derived is ΔAI = (AI0 − 203)/R0 × ΔR. (3) Under the guidance of the empirical formula, there was no significant difference in lesion dimensions between the standard group and the formula guiding groups when AI0 = 400, but there was a shrinking tendence when AI > 700. Conclusion. The lesion depths are negatively correlated with baseline impedance at a certain AI. The relationship between baseline impedance and AI is “ΔAI = (AI0 − 203)/R0 × ΔR”. It is verified that when the AI is not too high, the empirical formula can be used to guide the quantitative adjustment of AIs at different baseline impedance, and the lesion depths achieved are roughly the same.
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Sen Saxena, Vivek, Prashant Johri, and Avneesh Kumar. "AI-Enabled Support System for Melanoma Detection and Classification." International Journal of Reliable and Quality E-Healthcare 10, no. 4 (October 2021): 58–75. http://dx.doi.org/10.4018/ijrqeh.2021100104.
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Skin lesion melanoma is the deadliest type of cancer. Artificial intelligence provides the power to classify skin lesions as melanoma and non-melanoma. The proposed system for melanoma detection and classification involves four steps: pre-processing, resizing all the images, removing noise and hair from dermoscopic images; image segmentation, identifying the lesion area; feature extraction, extracting features from segmented lesion and classification; and categorizing lesion as malignant (melanoma) and benign (non-melanoma). Modified GrabCut algorithm is employed to generate skin lesion. Segmented lesions are classified using machine learning algorithms such as SVM, k-NN, ANN, and logistic regression and evaluated on performance metrics like accuracy, sensitivity, and specificity. Results are compared with existing systems and achieved higher similarity index and accuracy.
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Giannainas, Nikolaos, Lalaj Ruchiranga Sembakuttige, and Moloy Das. "Radiofrequency Lesion Quality Markers: Current State of Knowledge." European Journal of Arrhythmia & Electrophysiology 8, no. 1 (2022): 2. http://dx.doi.org/10.17925/ejae.2022.8.1.2.
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The long-term efficacy of radiofrequency catheter ablation is highly dependent on the location and size of the lesions delivered via the ablation catheter. This is particularly the case for radiofrequency ablation for atrial fibrillation, where contiguous, transmural lesions are required for durable pulmonary vein isolation. Therefore, reliable lesion quality markers that accurately relate to lesion size in the context of 3D mapping have been sought to improve the reliability of conduction block. Force–time integral, Ablation Index and Lesion Size Index are metrics currently used in clinical practice. Several studies have shown better clinical outcomes using these indices compared with using contact force alone or no marker at all. A theoretical limitation of these composite lesion indices is that they rely on input values such as contact force, application duration and power. A recent technology assessessing local tissue impedance (an output measure) has shown promising results. Temperature, another output measure, is not routinely used due to the significant impact of catheter irrigation on readings, but two recent catheter technologies have sought to overcome this obstacle. This paper provides an update on the current knowledge on these lesion quality markers.
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Sousa, Duarte, Catarina Souto, Tiago Carvalho, Hélder Pereia, and José Muras Geada. "Lesão de Lisfranc: Alta Suspeição para Evicção de Sequelas Catastróficas." Revista de Medicina Desportiva Informa 14, no. 1 (January 1, 2023): 11–14. http://dx.doi.org/10.23911/cc_lesao_lisfranc_2023_jan.
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Lisfranc lesion is often neglected, requiring a high index of suspicion for its diagnosis. The authors present three clinical cases, where it can be seen the wide spectrum of lesions that can be included in the definition of Lisfranc lesion. This article aims to alert to the need to recognize this pathology and presents the basic principles of its etiopathogeneses and treatment.
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Møller, Jakob M., Caroline M. Andreasen, Thomas W. Buus, Susanne J. Pedersen, Mikkel Østergaard, Henrik S. Thomsen, and Anne G. Jurik. "Diffusion-weighted MR imaging in chronic non-bacterial osteitis: Proof-of-concept of the apparent diffusion coefficient as an outcome measure." Acta Radiologica Open 10, no. 9 (September 2021): 205846012110444. http://dx.doi.org/10.1177/20584601211044478.
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Background The apparent diffusion coefficient (ADC), as determined by whole-body diffusion-weighted MRI, may be useful as an outcome measure for monitoring response to treatment in chronic non-bacterial osteitis. Purpose To test and demonstrate the feasibility of ADC-measurement methods for use as outcome measure in chronic non-bacterial osteitis. Materials and Methods Using data from a randomized pilot study, feasibility of change-score ADC between baseline and second MRI (ΔADC12) and third MRI (ΔADC13) as outcome measure was assessed in three settings: “whole-lesion,” “single-slice per lesion,” and “index-lesion per patient”. Bone marrow edema lesions were depicted on short tau inversion recovery sequence at baseline and copied to ADC maps at the three time-points. Correlations between the three settings were measured as were analysis of variances. Discriminant validity was assessed as inter- and intra-observer reproducibility and smallest detectable change. Results 12 subjects were enrolled, and MRI was performed at baseline and weeks 12 and 36. Pearson correlation was high ( r > 0.86; p ≤ 0.01) for ΔADC between single-slice—whole-lesion and whole-lesion—index-lesion and tended to be significant for single-slice—index-lesion settings ( p = 0.06). For ΔADC12 and ΔADC13, Bland–Altman plots showed small differences (0.02, 0.03) and narrow 95% limits-of-agreement (−0.13–0.09, −0.07–0.05 μm2/s) between whole-lesion and single-slice ROI settings. Inter-observer reproducibility measured by intra-class correlation coefficient was poor-to-fair (range: 0.09–0.31), whereas intra-observer reproducibility was good-to-excellent (range: 0.67–0.90). Smallest detectable changes were between 0.21–0.28 μm2/s. Conclusion ADC change-score as outcome measure was feasible, and the single-slice per lesion ROI setting performed almost equally to whole-lesion setting resulting in reduced assessment time.
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Fascelli, Michele, Thomas P. Frye, Arvin Koruthu George, Steven Abboud, Raju Chelluri, Richard Ho, Sandeep Sankineni, et al. "MRI/US fusion-guided biopsy to detect clinically significant prostate cancer in the central gland correlating with index lesion." Journal of Clinical Oncology 33, no. 7_suppl (March 1, 2015): 44. http://dx.doi.org/10.1200/jco.2015.33.7_suppl.44.
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44 Background: Central gland (CG) prostate cancers (CaP) are reported with lesser incidence and smaller tumor volume compared to the peripheral zone (PZ). Index tumor lesions defined by highest grade may be missed when in the CG. MRI/US fusion-guided biopsy allows targeting of lesions, potentially identifying cancer outside the traditional TRUS biopsy template. Methods: Retrospective review of 1,003 patients who underwent multiparametric MRI (mpMRI) found 2,119 suspicious lesions. Targets were biopsied and stratified by zonal distribution, CG or PZ. Cancer detection rates (CDR) were tabulated by location and correlated with PSA, Gleason score, prostate volume and MRI suspicion. Results: Fusion-guided biopsy targeted lesions in the central (711, 34%) or peripheral (1408, 66%) prostatic zones. CDR was similar between zones: 35.2% CG compared to 33.6% PZ (Table). CDR of clinically significant disease (Gleason >4+3) was similar in the CG and PZ despite higher prostate volume in those with CG lesions. In contrast to TRUS biopsy, upgrading occurred in 18.5% of CG patients versus 13.3% PZ (p=0.024). 36.6% (77/210) of CG lesions represented the highest risk lesion on MRI, translating to 13% (77/592) of the biopsy-proven CaP cohort. Conclusions: CG cancers occur at a similar frequency as PZ CaP. CG lesions were more likely to be upgraded from TRUS biopsy, frequently representing the index lesion. In upgraded patients, CG targets constituted the index lesion in a third of all males. MRI/US fusion-guided biopsy identifies clinically significant disease of the CG not captured on traditional biopsy. [Table: see text]
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Stanek, Jerzy. "Diagnosing Placental Membrane Hypoxic Lesions Increases the Sensitivity of Placental Examination." Archives of Pathology & Laboratory Medicine 134, no. 7 (July 1, 2010): 989–95. http://dx.doi.org/10.5858/2009-0280-oa.1.
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Abstract Context.—Two relatively unknown and recently described placental membrane hypoxic lesions (laminar necrosis and microscopic chorionic pseudocysts) have never been compared with time-honored, focal (infarction), and diffuse hypoxic lesions of placental parenchyma. Objective.—To compare the effect on placental diagnosis of the above placental membrane hypoxic lesions and chorionic disc hypoxic lesions (infarctions and global hypoxic pattern of placental injury). Design.—Twenty-three clinical (maternal and fetal) and 32 gross and microscopic placental features were retrospectively compared in 4590 placentas from a placental database built during a 13-year period: 168 placentas with at least one hypoxic disc lesion (infarct or global hypoxia) and at least one membrane lesion (microscopic chorionic pseudocysts or laminar necrosis (group 1), 750 placentas with at least one hypoxic villous lesion but no membrane lesion (group 2), 480 placentas with at least one membrane lesion but no villous lesion (group 3), and 3192 placentas with no hypoxic villous or membrane lesions (group 4). Results.—Several clinical and fetal conditions and placental features known to be associated with in utero hypoxia had a statistically significant correlation with the index hypoxic placental lesions, both villous and membranous. Of placentas from patients associated with clinical conditions at risk for hypoxia, 15% featured only hypoxic membrane lesions without a chorionic disc hypoxic lesion. Conclusions.—Recognizing placental membrane hypoxic lesions increases the sensitivity of placental examination in diagnosing placental hypoxia by at least 15%. The risk of in utero hypoxia is increased when microscopic chorionic pseudocysts and laminar necrosis occur in conjunction with villous hypoxic lesions.
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Nowak, Dennis A. "The Thumb Rolling Test: A Novel Variant of the Forearm Rolling Test." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 38, no. 1 (January 2011): 129–32. http://dx.doi.org/10.1017/s0317167100011173.
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Abstract:Background:Neurologists use a variety of tests to detect subtle upper motor neuron lesion causing a mild motor impairment of the upper limb. The forearm and index finger rolling tests are some of these. Their sensitivity varies, but in general these tests appear to be more likely to be abnormal in mild motor impairment of the arm and hand due to a cortico-spinal tract lesion than tests of power, muscle tone or reflexes. Thumb rolling involves more distal limb segments than forearm rolling and distal limb segments are typically more affected than proximal limb segments after cerebral lesions to the cortico-spinal tract.Methods:Thumb rolling was tested, in comparison to pronator drift, forearm rolling and index finger rolling, for its sensitivity to detect a cerebral lesion of the cortico-spinal tract in 17 consecutive patients with mild pure motor stroke affecting only one arm and hand.Results:Thumb rolling is more sensitive (88%) than pronator drift (47%), forearm rolling (65%) and index finger rolling (65%) to detect a cerebral lesion of the cortico-spinal tract in mild pure motor stroke of the upper limb.Conclusion:The thumb rolling test may be a valuable adjunct clinical test to detect a subtle lesion of the cortico-spinal tract causing mild pure motor stroke of the arm and hand when the remainder of routine neurological examination is unremarkable.
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Rossi, Farli. "APPLICATION OF A SEMI-AUTOMATED TECHNIQUE IN LUNG LESION SEGMENTATION." Jurnal Teknoinfo 15, no. 1 (January 15, 2021): 56. http://dx.doi.org/10.33365/jti.v15i1.945.
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Segmentation is one of the most important steps in automated medical diagnosis applications, which affects the accuracy of the overall system. In this study, we apply a semi-automated technique that combines an active contour and low-level processing techniques in lung lesion segmentation by extracting lung lesions from thoracic Positron Emission Tomography (PET)/Computed Tomography (CT) images. The lesions were first segmented in Positron Emission Tomography (PET) images which have been converted previously to Standardised Uptake Values (SUVs). The segmented PET images then serve as an initial contour for subsequent active contour segmentation of corresponding CT images. To measure accuracy, the Jaccard Index (JI) was used. Jaccard Index (JI) was calculated by comparing the segmented lesion to alternative segmentations obtained from the QIN lung CT segmentation challenge, which is possible by registering the whole body PET/CT images to the corresponding thoracic CT images. The results showed that the semi-automated technique (combination techniques between an active contour and low-level processing) in lung lesion segmentation has moderate accuracy with an average JI value of 0.76±0.12.
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Levit, Elle, Andrew Bouley, Ursela Baber, Ina Djonlagic, and Jacob A. Sloane. "Brainstem lesions are associated with sleep apnea in multiple sclerosis." Multiple Sclerosis Journal - Experimental, Translational and Clinical 6, no. 4 (October 2020): 205521732096795. http://dx.doi.org/10.1177/2055217320967955.
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Background Studies linking MRI findings in MS patients with obstructive sleep apnea severity are limited. Objective We conducted a retrospective study to assess MRI abnormalities associated with obstructive sleep apnea (OSA) in patients with multiple sclerosis (MS). Methods We performed retrospective chart review of 65 patients with multiple sclerosis who had undergone polysomnography (PSG) for fatigue as well as brain MRI. We measured the number of lesions in the brainstem and calculated the standardized third ventricular width (sTVW) as a measure of brain atrophy, and subsequently performed correlation analyses of the apnea-hypopnea index (AHI) with brainstem lesion location, sTVW, and Expanded Disability Status Scale (EDSS). Results MS Patients with OSA were significantly older and had a higher body mass index (BMI) and higher AHI measures than patients without OSA. After adjustment for covariates, significant associations were found between AHI and lesion burden in the midbrain (p < 0.01) and pons (p = 0.05), but not medulla. Conclusions Midbrain and pontine lesions burden correlated with AHI, suggesting MS lesion location could contribute to development of OSA.
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Sigounas, Dimitrios, Amanullah Shams, Peter Hayes, and John Plevris. "Endoscopic ultrasound assessment of gastrointestinal polypoid lesions of indeterminate morphology in patients with portal hypertension." Endoscopy International Open 06, no. 03 (March 2018): E292—E299. http://dx.doi.org/10.1055/s-0043-124363.
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Abstract Background and study aims Polypoid lesions found during upper gastrointestinal endoscopy (UGIE) are occasionally found in patients with portal hypertension (PH). This study aimed to assess the true nature of such polypoid lesions using endoscopic ultrasound (EUS) and determine the accuracy of UGIE in differentiating between vascular and non-vascular lesions in PH. Patients and methods We retrospectively assessed all patients with PH referred for EUS due to polypoid lesions of unknown nature at UGIE over a 7-year period. Cases of known varices were excluded. UGIE findings were compared to EUS findings. Results 66 patients were included (26 male). Commonest UGIE findings were: possible varices (19.4 %), polypoid/neoplastic lesion (52.8 %) and submucosal lesion (16.7 %). After EUS, the final diagnoses were: varices in 25 %, polypoid lesion with underlying vessel/varix in 27.8 % and non-vascular lesion or submucosal lesion in 47.2 %. The diagnostic accuracy of UGIE was suboptimal, since 28.6 % of possible varices were eventually found to be non-vascular, while 15.8 % of polyp/neoplastic looking lesions proved to be varices and 42.1 % were lesions with underlying vessel/varix. 50 % of submucosal lesions were eventually found to be varices. Conclusion Endoscopists should have a high index of suspicion of varices or polyps related to varices when assessing atypical looking polypoid lesions in patients with PH. In such cases EUS should be considered before obtaining biopsies.
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Ivan Mangunsong, Albert, Sawkar Vijay Pramod, Ferry Safriadi, and Bethy S. Hernowo. "PREDICTION OF HYPOECHOIC LESIONS ON ULTRASOUND OF PROSTATE CANCER BASED ON PSA INTERVAL AND GLEASON GROUP." Indonesian Journal of Urology 28, no. 2 (July 15, 2021): 129–34. http://dx.doi.org/10.32421/juri.v28i2.676.
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Objective: To evaluate hypoechoic lesion in transrectal ultrasonography of prostate (TRUS-P) predictive value on prostate cancer based on PSA Interval and Gleason Group. Material & Methods: An observational analytic study with a cross-sectional design take place from January 2015 to December 2018 analyzing patients who had undergone TRUS-P Biopsy at Hasan Sadikin Hospital. Patients are divided into several subgroups according to different PSA levels. A p-value < 0.05 was considered statistically significant. PPV, NPV, and Youden’s index were all indexes reflecting the performance of a diagnostic test. Results: There were 35 cases (49.3%) with a visible hypoechoic lesion in TRUS and 36 cases (41.7%) without a visible hypoechoic lesion. In our study, 23.9% of the patients with hypoechoic lesions were diagnosed with prostate cancer on TRUSP-Biopsy. The results of the analysis with Youden’s index show that PSA at intervals of 10-20 is the best predictor of diagnostic values. Then we analyzed the overall detection rate based on PSA interval. Patients with PSA > 20 ng/ml, hypoechoic lesions were significantly associated with Gleason Group. Conclusion: We concluded in our study that the hypoechoic lesion in transurethral ultrasonography of prostate could improve the predictive efficacy for diagnosing prostate cancer.
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Chowdhury, Mohammod Abu Hena, Shameem Al Mamun, Mohammad Jamal Uddin, Rashed Md Khan, M. Mujibul Hoque, and Md Akramullah Sikder. "Oral Azithromycin Pulse Therapy and Daily Topical Adapalene in the Treatment of Acne Vulgaris: An Open Randomized Noncomparative Study." Medicine Today 28, no. 2 (June 13, 2017): 52–56. http://dx.doi.org/10.3329/medtoday.v28i2.32925.
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The safety and efficacy of oral azithromycin and topical adapalene are well documented. In this study, concomitant use of oral azithromycin pulse therapy and daily topical adapalene in the treatment of acne vulgaris is assessed. A total of 37 patients fulfilled the inclusion criteria were enrolled. Azithromycin, 500 mg orally once daily first 3 days of 10 days' cycle for 9 cycle & topical Adapalene (0.5%) at night. Patients evaluated at 4 weeks' interval by using Michaelsson acne severity index. The overall assessment was made by percent reduction of acne lesions and severity score. At the end of 12 weeks' treatment 99.8% of comedones, 98.7% papular lesion, 94.3% pustular lesion and 88.8% infiltrated lesion were cleared. Only 2.9% cystic lesion responded to the regimens. Percent reduction of Michaelsson acne severity index was 87%, which was statistically highly significant. Overall assessment revealed acne lesion cleared in 22% cases, excellent improvement observed in 65% and 13% showed good response. Adverse effect was minimal. So, azithromycin pulse therapy and topical adapalene is indeed effective and safe in the treatment of acne vulgaris.Medicine Today 2016 Vol.28(2): 52-56
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Barber, P. A., D. G. Darby, P. M. Desmond, Q. Yang, R. P. Gerraty, D. Jolley, G. A. Donnan, B. M. Tress, and S. M. Davis. "Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI." Neurology 51, no. 2 (August 1998): 418–26. http://dx.doi.org/10.1212/wnl.51.2.418.
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Objectives: We examined the utility of echoplanar magnetic resonance perfusion imaging and diffusion-weighted imaging (DWI) in predicting stroke evolution and outcome in 18 patients with acute hemispheric infarction.Methods: Patients were studied within 24 hours (mean, 12.2 hours), subacutely(mean, 4.7 days), and at outcome (mean, 84 days). Comparisons were made between infarction volumes as measured on perfusion imaging (PI) and isotropic DWI maps, clinical assessment scales (Canadian Neurological Scale, Barthel Index, and Rankin Scale), and final infarct volume (T2-weighted MRI).Results: Acute PI lesion volumes correlated with acute neurologic state, clinical outcome, and final infarct volume. Acute DWI lesions correlated less robustly with acute neurologic state, but correlated well with clinical outcome and final infarct volume. Three of six possible patterns of abnormalities were seen: PI lesion larger than DWI lesion (65%), PI lesion smaller than DWI lesion (12%), and DWI lesion but no PI lesion (23%). A pattern of a PI lesion larger than the DWI lesion predicted DWI expansion into surrounding hypoperfused tissue (p < 0.05). In the other two patterns, DWI lesions did not enlarge, suggesting that no significant increase in ischemic lesion size occurs in the absence of a larger perfusion deficit.Conclusions: Combined early PI and DWI can define different acute infarct patterns, which may allow the selection of rational therapeutic strategies based on the presence or absence of potentially salvageable ischemic tissue.
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Liu, Shih Sing, William L. White, Peter C. Johnson, and Charles Gauntt. "Hemophilic pseudotumor of the spinal canal." Journal of Neurosurgery 69, no. 4 (October 1988): 624–27. http://dx.doi.org/10.3171/jns.1988.69.4.0624.
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✓ Hemophilic pseudotumor is an uncommon complication among hemophiliacs. Most of these lesions are located in the long bones and the pelvis. The authors describe a case of hemophilic pseudotumor in a patient who presented with symptoms of L-5 radiculopathy and evidence of a destructive lesion on computerized tomography scans. Histologically, the lesion consisted of an organizing hematoma with reactive fibrosis. The diagnosis requires a high index of suspicion. Surgery is recommended for symptomatic patients.
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HAHN, P., and E. HEINDL. "Does an Ulnar Nerve Lesion Influence the Motion of the Index Finger?" Journal of Hand Surgery 21, no. 2 (April 1996): 252–54. http://dx.doi.org/10.1016/s0266-7681(96)80108-2.
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Clawing of the ring and little fingers and “rolling” during prehension grip are well-known clinical phenomena of ulnar nerve lesions. In contrast to this the index and middle fingers seem to move normally. We compared the movement of right index fingers in healthy people with the right index fingers of people with an ulnar nerve lesion. The movement was measured using a three-dimensional real time motion analysis system based on ultrasound. The angles of the joints were plotted in a rectangular coordinate system. Statistical analysis of the numerical data showed no difference between the two groups. We trained a neural-network (Learning Vector Quantization) with the data of both groups. The network was able to distinguish between people with and without lesions of the ulnar nerve. We conclude that prehension grip of the index finger is also influenced by paralysis of the ulnar nerve.
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Vitagliano, Gonzalo, Luis Rico, Hernando R. Pita, Miguel E. Nazar, Carlos Ameri, and Leandro Blas. "Tumour Volume of the Index Lesion in Prostate Cancer: Correlation between Results of Multiparametric Magnetic Resonance Imaging and the Histophatology." Urology and Andrology – Open Journal 4, no. 3 (December 31, 2020): 51–55. http://dx.doi.org/10.17140/uaoj-4-134.
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Introduction Prostate cancer is generally multifocal, presenting a lesion with a dominant focus (index lesion) that is characterized by being the lesion with the greatest volume and the biological capacity of invasion to adjacent tissues and distant metastases. With the advent of focal therapy and organ preservation in prostate cancer, it is essential to know the real tumour volume and thus, avoid the persistence of disease after treatments with curative intent. The aim of this study is to correlate the results of the dominant tumour volume obtained from the multiparametric magnetic resonance imaging (MRI) of the prostate and the histopathology. Material and Methods A retrospective study was performed which included all radical prostatectomies (RP) with previous MRI. A comparative analysis was performed between the tumour volume obtained from the MRI and the histopathology. Results A total of 46 patients were included in the study. The sensibility of the MRI in diagnosing the index lesion was 82.6%, highlighting that all tumours with a Gleason score ≥ 4+3 were diagnosed. The mean tumour volume in the MRI was 14.3 mm and in the histological result was 18.82 mm (p<0.05). The estimation tumour volume concordance was greatest in higher risk (International Society of Urological Pathology (ISUP)). Conclusion The MRI underestimates the real tumour volume of the prostate cancer index lesion when compared to the histological result of the surgical piece, being significantly lower in high-risk lesions.
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Autio, Karen A., Josef J. Fox, Coursen Walker Schneider, Heiko Schöder, John Humm, Dana E. Rathkopf, Susan F. Slovin, et al. "Evaluating 18F-16B-fluoro-5α-dihydrotestosterone (FDHT) and FDG-PET as a measure of disease progression in metastatic castration resistant prostate cancer (mCRPC)." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 5090. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.5090.
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5090 Background: Prostate Cancer Working Group 2 defines radiographic progression as new lesions on bone scan. Molecular imaging has potential as a biomarker that reflects both alterations in disease burden and tumor biology. FDG and FDHT PET capture glycolytic activity and androgen receptor (AR) expression and tracer binding, respectively. We examined these tracers in mCRPC patients (pts) at progression (POD) to determine patterns of relapse. Methods: mCRPC pts simultaneously enrolled in imaging and therapeutic clinical trials had FDG and/or FDHT PET scans performed at baseline (BL) and within 4 weeks of treatment (rx) discontinuation for protocol-defined POD. BL characteristics, rx, SUVmax, SUVmaxavg (average of 5 index lesions), and presence of new lesion(s) at POD were collected. ΔSUV was calculated relative to BL. Results: 44 mCRPC pts (86 BL PET scans, 84 scans at POD) receiving novel anti-androgens (eg, enzalutamide) (n=18), abiraterone (abi) (n=10), chemotherapy-based rx (n=5), prednisone (n=4), or other targeted rx (n=7) were included. Of those with PET POD, 75% (24/32) had > 1 new lesion on FDG-PET and 96% (25/26) had > 1 new lesion on FDHT. New lesions on FDHT were seen in 33% (6/18) of pts on novel anti-androgens as compared with 100% (10/10) on abi. Presence of a new FDG avid lesion was similar for both anti-androgens and abi (56% vs 60%). Conclusions: POD on FDG/FDHT is more frequently detected by a new lesion rather than ΔSUV in existing index lesions. This is possibly an underestimate of change as the BL scan and not the post-rx nadir scan were used as a comparator. AR and glycolytic activity at POD may be dependent on individual and treatment factors. Notably, a third of pts on anti-androgens had a new FDHT avid lesion at POD. Full lesional analysis of metastases may enhance our understanding of tumor biology at POD. Clinical trial information: NCT00588185. [Table: see text]
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Ambra, Luiz Felipe, Betina B. Hinckel, Elizabeth A. Arendt, Jack Farr, and Andreas H. Gomoll. "Anatomic Risk Factors for Focal Cartilage Lesions in the Patella and Trochlea: A Case-Control Study." American Journal of Sports Medicine 47, no. 10 (July 9, 2019): 2444–53. http://dx.doi.org/10.1177/0363546519859320.
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Background:Focal cartilage lesions in the patellofemoral (PF) joint are common. Several studies correlated PF risk factors with PF instability, anterior knee pain, and PF arthritis; however, there is a lack of evidence correlating those factors to PF focal cartilage lesions.Purpose:To evaluate the influence of the anatomic PF risk factors in patients with isolated focal PF cartilage lesions.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Patients with isolated PF focal cartilage lesions were included in the cartilage lesion group, and patients with other pathologies and normal PF cartilage were included in the control group. Multiple PF risk factors were accessed on magnetic resonance imaging scans: patellar morphology (patellar width, patellar thickness, and patellar angle), trochlear morphology (trochlear sulcus angle, lateral condyle index, and trochlear sulcus depth), patellar height (Insall-Salvati ratio and Caton-Deschamps index), axial patellar positioning (patellar tilt, angle of Fulkerson), and quadriceps vector (tibial tuberosity–trochlear groove distance).Results:A total of 135 patients were included in the cartilage lesion group and 100 in the control group. As compared with the control group, the cartilage lesion group had a higher sulcus angle ( P = .0007), lower trochlear sulcus depth ( P < .0001), lower angle of Fulkerson ( P < .0001), lower patellar width ( P = .0003), and higher Insall-Salvati ratio ( P < .0001). From the patients in the cartilage lesion group, 36% had trochlear dysplasia; 27.6%, patella alta; and 24.7%, abnormal patellar tilt. These parameters were more frequent in the cartilage lesion group ( P < .0001). Trochlear lesions were more frequent in men, presented at an older age, and had fewer associated anatomic risk factors. Patellar lesions, conversely, were more frequent in women, presented at younger age, and were more closely associated with anatomic risk factors.Conclusion:PF anatomic abnormalities are significantly more common in patients with full-thickness PF cartilage lesions. Trochlear dysplasia, patella alta, and excessive lateral patellar tilt are the most common correlated factors, especially in patellar lesions.
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McClincy, Michael P., Drake G. Lebrun, Frances A. Tepolt, Young-Jo Kim, Yi-Meng Yen, and Mininder S. Kocher. "Clinical and Radiographic Predictors of Acetabular Cartilage Lesions in Adolescents Undergoing Hip Arthroscopy." American Journal of Sports Medicine 46, no. 13 (October 16, 2018): 3082–89. http://dx.doi.org/10.1177/0363546518801848.
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Background: Acetabular cartilage lesions are a known cause of poor outcomes after hip arthroscopy and are seen regularly among adolescents. However, studies identifying preoperative factors predictive of acetabular cartilage lesions have been limited to adult populations. Purpose: To assess clinical and radiographic predictors of acetabular cartilage lesions in a large cohort of adolescents undergoing hip arthroscopy. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: Patients undergoing hip arthroscopy for idiopathic femoroacetabular impingement or acetabular labral tears at a children’s hospital were reviewed. Demographic predictors were analyzed by use of univariate logistic regression with generalized estimating equations. A matched case-control analysis was subsequently performed to identify radiographic predictors of acetabular cartilage lesions through use of univariate and multivariable conditional logistic regression. Results: Four hundred two patients (446 hips) undergoing hip arthroscopy between 2010 and 2015 were analyzed. Median age was 16.7 years (range, 13.6-19.0) and 72% of patients were female. Ninety-five hips (21%) were found to have an acetabular cartilage lesion at the time of arthroscopic surgery. Age (odds ratio [OR], 1.7; 95% CI, 1.4-2.1), male sex (OR, 2.5; 95% CI, 1.7-5.0), and body mass index (OR, 1.07; 95% CI, 1.01-1.14) were found to be predictive of intraoperative acetabular cartilage lesions. In the matched case-control analysis, femoral alpha angle as calculated on a Dunn lateral radiograph was independently predictive of an intraoperative acetabular cartilage lesion (OR, 1.8; 95% CI, 1.2-2.6). Additionally, the presence of a crossover sign was independently associated with a decreased odds of an acetabular cartilage lesion (OR, 0.3; 95% CI, 0.1-0.7). On multivariate analysis, alpha angle (Dunn lateral) (OR, 2.0; 95% CI, 1.3-3.1) and crossover sign (OR, 0.2; 95% CI, 0.1-0.7) remained independently associated with the presence of an acetabular cartilage lesion. The presence of an acetabular labral tear was not predictive of an associated cartilage lesion (OR, 1.17; 95% CI, 0.39-3.47; P = .78). Conclusion: In an adolescent population undergoing hip arthroscopy, older age, male sex, and higher body mass index were predictive of acetabular cartilage lesions. From an imaging standpoint, increased alpha angle increased the likelihood of an acetabular cartilage lesion whereas the presence of a crossover sign decreased this likelihood. Predicting the presence of an acetabular cartilage lesion is important when considering a hip arthroscopy procedure to facilitate preoperative planning and to more accurately set patient expectations.
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Urbano, Nicoletta, Manuel Scimeca, Carmela Di Russo, Alessandro Mauriello, Elena Bonanno, and Orazio Schillaci. "[99mTc]Sestamibi SPECT Can Predict Proliferation Index, Angiogenesis, and Vascular Invasion in Parathyroid Patients: A Retrospective Study." Journal of Clinical Medicine 9, no. 7 (July 13, 2020): 2213. http://dx.doi.org/10.3390/jcm9072213.
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The aim of this study was to evaluate the possible association among sestamibi uptake and the main histopathological characteristics of parathyroid lesions related to aggressiveness such as the proliferation index (Ki67 expression and mitosis), angiogenesis (number of vessels), and vascular invasion in hyperparathyroidism patients. To this end, 26 patients affected by primary hyperparathyroidism subjected to both scintigraphy with [99mTc]Sestamibi and surgery/bioptic procedure were retrospectively enrolled. Hyperfunctioning of the parathyroid was detected in 19 patients. Our data showed a significant positive association among the sestamibi uptake and the proliferation index histologically evaluated both in terms of the number of Ki67 positive cells and mitosis. According to these data, lesions with a higher valuer of L/N (lesion to nonlesion ratio) frequently showed several vessels in tumor areas and histological evidence of vascular invasion. It is noteworthy that among patients with negative scintigraphy, 2 patients showed a neoplastic lesion after surgery (histological analysis). However, it is important to highlight that these lesions displayed very low proliferation indexes, which was evaluated in terms of number of both mitosis and Ki67-positive cells, some/rare vessels in the main lesion, and no evidence of vascular invasion. In conclusion, data obtained on patients with positive or negative scintigraphy support the hypothesis that sestamibi can be a tracer that is capable of predicting some biological characteristics of parathyroid tumors such as angiogenesis, proliferation indexes, and the invasion of surrounding tissues or vessels.
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Dave, Rajiv V., Emma Barrett, Jenna Morgan, Mihir Chandarana, Suzanne Elgammal, Nicola Barnes, Amtul Sami, et al. "Wire- and magnetic-seed-guided localization of impalpable breast lesions: iBRA-NET localisation study." British Journal of Surgery 109, no. 3 (January 28, 2022): 274–82. http://dx.doi.org/10.1093/bjs/znab443.
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Abstract Background Wire localization is historically the most common method for guiding excision of non-palpable breast lesions, but there are limitations to the technique. Newer technologies such as magnetic seeds may allow some of these challenges to be overcome. The aim was to compare safety and effectiveness of wire and magnetic seed localization techniques. Methods Women undergoing standard wire or magnetic seed localization for non-palpable lesions between August 2018 and August 2020 were recruited prospectively to this IDEAL stage 2a/2b platform cohort study. The primary outcome was effectiveness defined as accurate localization and removal of the index lesion. Secondary endpoints included safety, specimen weight and reoperation rate for positive margins. Results Data were accrued from 2300 patients in 35 units; 2116 having unifocal, unilateral breast lesion localization. Identification of the index lesion in magnetic-seed-guided (946 patients) and wire-guided excisions (1170 patients) was 99.8 versus 99.1 per cent (P = 0.048). There was no difference in overall complication rate. For a subset of patients having a single lumpectomy only for lesions less than 50 mm (1746 patients), there was no difference in median closest margin (2 mm versus 2 mm, P = 0.342), re-excision rate (12 versus 13 per cent, P = 0.574) and specimen weight in relation to lesion size (0.15 g/mm2versus 0.138 g/mm2, P = 0.453). Conclusion Magnetic seed localization demonstrated similar safety and effectiveness to those of wire localization. This study has established a robust platform for the comparative evaluation of new localization devices.
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Allahabadi, Sachin, Sameer Allahabadi, Ruthvik Allala, Kartik Garg, Nirav K. Pandya, and Brian C. Lau. "Osteochondral Lesions of the Distal Tibial Plafond: A Systematic Review of Lesion Locations and Treatment Outcomes." Orthopaedic Journal of Sports Medicine 9, no. 4 (April 1, 2021): 232596712199712. http://dx.doi.org/10.1177/2325967121997120.
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Background: Osteochondral lesions of the tibial plafond (OLTPs) remain less common than osteochondral lesions of the talus (OLTs), but recognition of the condition has increased. Purpose: To systematically evaluate the literature on lesion locations and treatment outcomes of OLTPs, whether in isolation or in combination with OLTs. Study Design: Systematic review; Level of evidence, 4. Methods: A search was performed using the PubMed, Embase, and CINAHL databases for studies on lesion locations or with imaging or treatment outcomes of OLTPs. Case reports and reports based on expert opinion were excluded. Lesion locations as well as outcome measure results were aggregated. The Methodological Index for Non-randomized Studies score was used to assess methodological quality when applicable. Results: Included in this review were 10 articles, all published in 2000 or later. Most studies were evidence level 4, and the mean Methodological Index for Non-randomized Studies score was 8.6 (range, 8-10). Overall, 174 confirmed OLTP cases were identified, and the mean patient age was 38.8 years. Of the 157 lesions with confirmed locations, the most common was central-medial (32/157; 20.4%). Of 6 studies on treatment outcomes, all but 1 evaluated bone marrow stimulation techniques. Microfracture of small lesions (<150 mm2) was the most common treatment utilized. Imaging and functional outcomes appeared favorable after treatment. The data did not support differences in outcomes between isolated OLTPs and OLTPs with coexisting OLTs. Conclusion: Osteochondral lesions of the distal tibia most commonly occurred at the central-medial tibial plafond. Microfracture of small lesions was the most common treatment utilized, and clinical and magnetic resonance imaging results were favorable, although data were heterogeneous. Areas for future research include the following: the effect of patient factors and additional pathologies on outcomes; larger or deeper lesion treatment; more direct comparisons of outcomes between kissing or coexisting lesions and isolated lesions; and head-to-head comparison of treatments, such as microfracture, bone marrow–derived cell transplantation, and osteochondral autografts/allografts.
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Sechi, Elia, Karl N. Krecke, Steven A. Messina, Marina Buciuc, Sean J. Pittock, John J. Chen, Brian G. Weinshenker, et al. "Comparison of MRI Lesion Evolution in Different Central Nervous System Demyelinating Disorders." Neurology 97, no. 11 (July 14, 2021): e1097-e1109. http://dx.doi.org/10.1212/wnl.0000000000012467.
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Background and ObjectiveThere are few studies comparing lesion evolution across different CNS demyelinating diseases, yet knowledge of this may be important for diagnosis and understanding differences in disease pathogenesis. We sought to compare MRI T2 lesion evolution in myelin oligodendrocyte glycoprotein immunoglobulin G (IgG)–associated disorder (MOGAD), aquaporin 4 IgG–positive neuromyelitis optica spectrum disorder (AQP4-IgG-NMOSD), and multiple sclerosis (MS).MethodsIn this descriptive study, we retrospectively identified Mayo Clinic patients with MOGAD, AQP4-IgG-NMOSD, or MS and (1) brain or myelitis attack; (2) available attack MRI within 6 weeks; and (3) follow-up MRI beyond 6 months without interval relapses in that region. Two neurologists identified the symptomatic or largest T2 lesion for each patient (index lesion). MRIs were then independently reviewed by 2 neuroradiologists blinded to diagnosis to determine resolution of T2 lesions by consensus. The index T2 lesion area was manually outlined acutely and at follow-up to assess variation in size.ResultsWe included 156 patients (MOGAD, 38; AQP4-IgG-NMOSD, 51; MS, 67) with 172 attacks (brain, 81; myelitis, 91). The age (median [range]) differed between MOGAD (25 [2–74]), AQP4-IgG-NMOSD (53 [10–78]), and MS (37 [16–61]) (p < 0.01) and female sex predominated in the AQP4-IgG-NMOSD (41/51 [80%]) and MS (51/67 [76%]) groups but not among those with MOGAD (17/38 [45%]). Complete resolution of the index T2 lesion was more frequent in MOGAD (brain, 13/18 [72%]; spine, 22/28 [79%]) than AQP4-IgG-NMOSD (brain, 3/21 [14%]; spine, 0/34 [0%]) and MS (brain, 7/42 [17%]; spine, 0/29 [0%]) (p < 0.001). Resolution of all T2 lesions occurred most often in MOGAD (brain, 7/18 [39%]; spine, 22/28 [79%]) than AQP4-IgG-NMOSD (brain, 2/21 [10%]; spine, 0/34 [0%]) and MS (brain, 2/42 [5%]; spine, 0/29 [0%]) (p < 0.01). There was a larger median (range) reduction in T2 lesion area in mm2 on follow-up axial brain MRI with MOGAD (213 [55–873]) than AQP4-IgG-NMOSD (104 [0.7–597]) (p = 0.02) and MS (36 [0–506]) (p < 0.001) and the reductions in size on sagittal spine MRI follow-up in MOGAD (262 [0–888]) and AQP4-IgG-NMOSD (309 [0–1885]) were similar (p = 0.4) and greater than in MS (23 [0–152]) (p < 0.001).DiscussionThe MRI T2 lesions in MOGAD resolve completely more often than in AQP4-IgG-NMOSD and MS. This has implications for diagnosis, monitoring disease activity, and clinical trial design, while also providing insight into pathogenesis of CNS demyelinating diseases.
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Rogers, Davis L., Walter Klyce, Tymoteusz J. Kajstura, and R. Jay Lee. "Association of Body Mass Index With Severity and Lesion Location in Adolescents With Osteochondritis Dissecans of the Knee." Orthopaedic Journal of Sports Medicine 9, no. 9 (September 1, 2021): 232596712110453. http://dx.doi.org/10.1177/23259671211045382.
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Background: The association between body mass index (BMI) and severity of osteochondritis dissecans (OCD) of the knee at presentation is poorly understood. Hypothesis: We hypothesized that adolescents in higher BMI percentiles for age and sex would have OCD lesions that were more severe at their initial presentation and located more posteriorly on the condyle as compared with adolescents in lower BMI percentiles. Study Design: Cohort study; Level of evidence, 3. Methods: This study included patients aged 10 to 18 years who were treated for knee OCD at a tertiary care hospital from 2006 to 2017. Patients with noncondylar OCD or missing BMI data within 3 months of presentation were excluded. Patients were stratified per the Centers for Disease Control and Prevention guidelines as underweight, normal weight, overweight, or obese, and the groups were compared according to age, side of lesion, 4 markers of lesion severity (cystic changes, loose fragments, subchondral fluid, and subchondral edema), and surgical treatment. Lesion angle was measured in reference to a line parallel to the femoral axis drawn through the center of a best-fit circle covering the distal condyle. Data were analyzed using chi-square tests, relative risk, Student t tests, analysis of variance, and linear regression of cumulative running percentages. Bonferroni correction was performed when applicable. Results: A total of 77 patients met our inclusion criteria (mean age, 14.2 years; range, 10.1-18.8): 2 were underweight, 50 had normal BMI, 13 were overweight, and 12 were obese. We found correlations between BMI percentile and surgical treatment ( R 2 = .732), subchondral fluid ( R 2 = .716), subchondral edema ( R 2 = .63), loose fragments ( R 2 = .835), and the presence of at least 1 marker of lesion severity ( R 2 = .857) ( P < .0001 for all). No correlation was observed for cystic changes ( R 2 = .026). There were significant associations between BMI ≥80th percentile and subchondral edema (risk ratio, 2.5; 95% CI, 1.3-4.8), medial condylar lesions (risk ratio, 1.3; 95% CI, 1.01-1.7), and lesions more anterior on the condyle ( P < .05). Conclusion: Higher BMI in adolescents was strongly correlated with multiple markers of severity of knee OCD at initial presentation as well as with more anterior lesions.
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Rehman, Mohibur, Mushtaq Ali, Marwa Obayya, Junaid Asghar, Lal Hussain, Mohamed K. Nour, Noha Negm, and Anwer Mustafa Hilal. "Machine learning based skin lesion segmentation method with novel borders and hair removal techniques." PLOS ONE 17, no. 11 (November 10, 2022): e0275781. http://dx.doi.org/10.1371/journal.pone.0275781.
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The effective segmentation of lesion(s) from dermoscopic skin images assists the Computer-Aided Diagnosis (CAD) systems in improving the diagnosing rate of skin cancer. The results of the existing skin lesion segmentation techniques are not up to the mark for dermoscopic images with artifacts like varying size corner borders with color similar to lesion(s) and/or hairs having low contrast with surrounding background. To improve the results of the existing skin lesion segmentation techniques for such kinds of dermoscopic images, an effective skin lesion segmentation method is proposed in this research work. The proposed method searches for the presence of corner borders in the given dermoscopc image and removes them if found otherwise it starts searching for the presence of hairs on it and eliminate them if present. Next, it enhances the resultant image using state-of-the-art image enhancement method and segments lesion from it using machine learning technique namely, GrabCut method. The proposed method was tested on PH2 and ISIC 2018 datasets containing 200 images each and its accuracy was measured with two evaluation metrics, i.e., Jaccard index, and Dice index. The evaluation results show that our proposed skin lesion segmentation method obtained Jaccard Index of 0.77, 0.80 and Dice index of 0.87, 0.82 values on PH2, and ISIC2018 datasets, respectively, which are better than state-of-the-art skin lesion segmentation techniques.
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Vagholkar, Ketan. "Morel-Lavallée Lesion: Uncommon Injury often Missed." Journal of Orthopaedic Case Reports 12, no. 10 (2022): 57–60. http://dx.doi.org/10.13107/jocr.2022.v12.i10.3366.
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Introduction: Morel-Lavalleé lesion is an uncommon closed degloving injury usually affecting the lower extremity. Although these lesions have been documented in literature, yet there is no standard treatment algorithm for the same. A case of Morel-Lavallée lesion following blunt injury to the thigh is therefore presented to highlight the diagnostic and therapeutic challenges in managing such lesions. The aim of presenting the case is to create awareness of clinical presentation, diagnosis, and management of Morel-Lavallée lesions, especially in the setting of polytrauma patients. Case Report: A case of Morel-Lavallée lesion in a 32-year-old male with history of a blunt injury to the right thigh caused by a partial run over accident is presented. A magnetic resonance imaging (MRI) was done to confirm the diagnosis. A limited open approach for evacuating the fluid in the lesion was performed followed by irrigation of the cavity with a combination of 3% hypertonic saline and hydrogen peroxide in order to induce fibrosis to obliterate the dead space. This was followed by continuous negative suction accompanied with a pressure bandage. Conclusion: A high index of suspicion is necessary especially in cases of severe blunt injuries to the extremities. MRI is essential for early diagnosis of Morel-Lavallée lesions. A limited open approach is a safe and effective option for treatment. The use of 3% hypertonic saline along with hydrogen peroxide irrigation of the cavity to induce sclerosis is a novel method for treating the condition. Keywords: Morel-Lavallée lesion, diagnosis, management.
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Gold, Samuel, Jonathan Bloom, Graham R. Hale, Kareem Rayn, Sherif Mehralivand, Brad J. Wood, Baris Turkbey, and Peter A. Pinto. "Ability of multiparametric magnetic resonance imaging (MRI) to predict prostate tumor heterogeneity on targeted biopsy." Journal of Clinical Oncology 36, no. 6_suppl (February 20, 2018): 113. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.113.
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113 Background: Prostate cancer (PCa) can show heterogeneous histology within lesions. MRI-targeted biopsy (Tbx) of the prostate improves PCa detection, but sampling within lesions has yet to be standardized. Furthermore, Tbx results are often heterogeneous as evidenced by differing histologic grades of Tbx cores within the same lesion. This introduces potential variability in biopsy results, on which clinical decisions are made. Here we aim to characterize lesion heterogeneity and identify predictive multiparametric MRI (mpMRI) features. Methods: A cohort of men who underwent mpMRI and Tbx between 2014-2017 were selected for analysis from a prospectively maintained database. To characterize lesion heterogeneity, only men with ≥2 positive Tbx cores were included. Histologic grades were scored according to International Society of Urological Pathology (ISUP) grades. Lesion heterogeneity, reported as a heterogeneity index (HI), was calculated as the difference of the average ISUP grades of Tbx cores per lesion from the maximum sampled ISUP grade of that lesion. Statistical analyses identified associations between imaging features and lesion heterogeneity. Results: 157 lesions in 114 patients met inclusion criteria. Maximum ISUP grade ranged from 1 to 5, with a median ISUP grade of 2. Higher ISUP grades were associated with greater lesion heterogeneity, HI for ISUP grade ≥3 = 0.58±0.11 vs <3 = 0.29±0.08, p = 0.0001. In addition, increasing lesion size on mpMRI was associated with greater lesion heterogeneity, HI for ≥2cm = 0.52±0.14 vs <2cm = 0.32±0.08, p = 0.0096. Finally, higher mpMRI suspicion scores were associated with increased heterogeneity vs lower suspicion scores, p = 0.048. Conclusions: mpMRI aids in characterizing PCa lesion heterogeneity to predict variability of histologic grades on Tbx. This information can assist Tbx planning to potentially reduce risks of upgrading on final pathology. Future research will examine how lesion heterogeneity can impact risk stratification and clinical decision-making for patients and practitioners. This research was supported by the Intramural Research Program of the National Cancer Institute, NIH and NIH Medical Research Scholars Program.
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Yılmaz, Ebru, Ayhan Yılmaz, Sebahat Nacar Dogan, Merve Cin, and Rabia Karasu. "Comparison of ADC Value and Prognostic Factors in Invasive Ductal Carcinoma." Journal of Medical Research 5, no. 5 (October 25, 2019): 175–79. http://dx.doi.org/10.31254/jmr.2019.5503.
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Objective: Aim of this study is to investigate whether there is a correlation by comparison of apparent diffusion coefficient (ADC) in invasive ductal carcinoma patients whom magnetic resonance imaging (MRI) was performed before surgery with prognostic factors such as tumour grade, estrogen/progesterone receptors (ER/PR), HER2/neu (c-erbB-2 protooncogene), level of Ki-67. Methods: We retrospectively reviewed breast MRI in our radiology department between 2015 and 2017. The patients in whom diagnosed as not otherwise specified invasive ductal carcinoma (NOSIDC) after tru-cut biopsy and had preoperatively performed MRI were included in this study. Results: The retrospective review yielded 27 patients and evaluated ADC value in 30 lesions. Mean ADC value of lesions was 0,911x10-3mm2 /s (0,456-1,30x10-3mm2 /s) and mean ADC value of normal breast parenchyma was 1,613x10-3mm2 /s (1,116-2,453x10- 3mm2 /s). Statistically significant difference was not found between grade 1 (1 lesion), grade 2 (19 lesions), grade 3 (10 lesions), ER positive (25 lesions), ER negative (4 lesions), PR positive (1 lesion), PR negative (8 lesions), HER2 negative (21 lesions), HER2 positive (8 lesions) cases (grade; p=0.074, ER; p=0.57, PR; p=0.66, HER2; p=0.58). Mean ADC value was 0,855x10-3mm2 /s (0.660-1.30 x10-3mm²/s) in lesions of high Ki-67 proliferative index (20 lesions) and was 1,040x10- 3mm2 /s (0.985-1.70 x10-3mm²/s) in lesions of low Ki-67 proliferative index (5 lesions). Statistically significant difference between these two groups was found (p=0.007). Conclusion: In our evaluated prognostic factors, correlation with ADC value was found only in Ki-67 proliferative index and statistically significant difference was not found in the others.
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Vermiglio, Andrew J. "On Diagnostic Accuracy in Audiology: Central Site of Lesion and Central Auditory Processing Disorder Studies." Journal of the American Academy of Audiology 27, no. 02 (February 2016): 141–56. http://dx.doi.org/10.3766/jaaa.15079.
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Background: In the field of audiology a test protocol (index test) is used to determine the presence or absence of a target condition. The value of an index test rests in its diagnostic accuracy. Results from an index test must be verified through the use of a reference standard. The clinician and researcher should determine the quality and applicability of diagnostic accuracy studies. The Standards for Reporting of Diagnostic Accuracy (STARD) statement was published in response to the low quality of research conducted across many fields of study. It provides guidelines for the development and interpretation of diagnostic accuracy studies. Purpose: The primary purpose of this article is to assess the degree to which the main principles of diagnostic accuracy studies are used for the detection of central auditory nervous system lesions and a central auditory processing disorder (CAPD). The secondary purpose is to compare the design of these studies to select key guidelines from the STARD statement. The third purpose of this article is to present an argument against the reassignment of diagnostic accuracy values of a particular index test for one target condition (e.g., a central site of lesion) to a different target condition (e.g., a CAPD). Results: A review of diagnostic accuracy literature on the detection of a central site of lesion reveals the use of a reference standard for the independent verification of the index test results. However, diagnostic accuracy studies involving index tests for the detection of a CAPD show that independent verification of index test results is nonexistent or at best questionable. Conclusion: For a particular index test, while the diagnostic accuracy for detection of a central site of lesion may have been determined appropriately, it is inappropriate to reassign these diagnostic accuracy values to a different diagnostic target such as a CAPD.
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Rasool, M. N., and P. K. Ramdial. "Osseous Localization of Rosai-Dorfman Disease." Journal of Hand Surgery 21, no. 3 (June 1996): 349–50. http://dx.doi.org/10.1016/s0266-7681(05)80200-1.
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Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) is a disease of bone marrow stem cell origin which primarily affects lymph nodes. Solitary bone lesions are rare and can cause diagnostic difficulties. A primary lesion in the right index finger of a 10-month-old child is reported.
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Calio, Brian P., Sandeep Deshmukh, Donald Mitchell, Christopher G. Roth, Anne E. Calvaresi, Kim Hookim, Peter McCue, Edouard J. Trabulsi, and Costas D. Lallas. "Spatial distribution of biopsy cores and the detection of intra-lesion pathologic heterogeneity." Therapeutic Advances in Urology 11 (January 2019): 175628721984248. http://dx.doi.org/10.1177/1756287219842485.
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Objectives: The objective of this study was to determine if spatial distribution of multiparametric magnetic resonance imaging–transrectal ultrasound (mpMRI-TRUS) fusion biopsy cores to the index lesion reveals trends in the detection of intra-lesion Gleason heterogeneity and a more optimal prostate biopsy strategy. Methods: Index lesion was the lesion with longest diameter on T2-weighted (T2W)-MRI. In cohort 1, fusion biopsy cores biopsies were taken in areas in the center of the target as well as 1 cm laterally on each side. For cohort 2, targeted biopsies were taken from the center of the lesion only. Heterogeneity was defined as difference in maximum Gleason score obtained from fusion cores in the center of the index lesion versus cores obtained from the periphery (cohort 1), or any difference in maximum Gleason score obtained from fusion cores targeted to the index lesion (cohort 2) compared with systematic 12 cores TRUS biopsy. Results: Ninety-nine consecutive patients (35 and 64 in cohorts 1 and 2, respectively) with median age (SD) and prostate-specific antigen (PSA) of 66.9 (±5.9) and 9.7 (±8.2) respectively, were included. Age, PSA, Prostate Imaging Reporting and Data System (PI-RADS) score, and preoperative MRI lesion size were not significantly different between cohorts. Gleason heterogeneity was observed at a significantly higher rate in cohort 1 versus cohort 2 (58% versus 24%; p = 0.041). In cohort 1, cores obtained from the center of the lesion had higher Gleason score than cores obtained from the periphery of the targeted lesion in 57% of cases. Conclusions: We demonstrate that there is observable tumor heterogeneity in biopsy specimens, and that increased number of cores, as well as cores focused on the center and periphery of the largest lesion in the prostate, provide more comprehensive diagnostic information about the patient’s clinical risk category than taking nonspecific cores targeted within the tumor.
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Pih, Gyu Young, and Ji Hoon Yoon. "Multifocal early gastric neoplasms of three or more lesions versus single lesion without recurrence: A comparative study." Journal of Clinical Oncology 41, no. 4_suppl (February 1, 2023): 329. http://dx.doi.org/10.1200/jco.2023.41.4_suppl.329.
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329 Background: As indication for endoscopic resection for gastric neoplasms have been expanded, patients receiving multiple times of endoscopic resection for metachronous or synchronous lesions have been increasing. We aimed to compare clinicopathologic characteristics of patient with gastric neoplasm in a single location and multifocal lesions of three or more. Methods: From January 2006 to December 2021, 255 patients underwent endoscopic resection for three or more of multifocal lesions at tertiary medical institution were reviewed retrospectively and 8667 patient showed no recurrence after endoscopic resection for single lesion. The clinicopathologic characteristics of index gastric lesions were compared. Results: The male ratio was higher in multifocal lesions group than single lesion group (83.9% vs. 68.4%, P < 0.001). Diabetes mellitus was significantly more in multifocal lesions group than single lesion group (20.4% vs. 18.4%, P = 0.046), however hypertension, cardiovascular disease, kidney disease, and hepatitis showed no significant difference between the two groups. Smoking rate was significantly higher in the multifocal lesions group (current smoker 31.0% vs. 25.4%, and ex-smoker 24.7% vs. 24.8%, P = 0.028). In rapid urease test for Helicobacter pylori infection, the multifocal group showed significantly higher positives (54.9% vs. 40.8%, P < 0.001). Tumor depth, lymphovascular invasion, and perineural invasion showed no significant differences. Conclusions: Patients with multifocal early gastric neoplasms showed higher male ratio, higher rate of diabetes mellitus, and smoking rate compared with single lesion group. In addition, Helicobacter pylori infection was also significantly higher in patients with multifocal gastric neoplasm.
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Kang, Kyusik, Seung-Hoon Lee, Beom Kim, Jae-Sung Lim, and Byung-Woo Yoon. "Correlations between left ventricular mass index and cerebrovascular lesion." Open Medicine 6, no. 3 (June 1, 2011): 320–30. http://dx.doi.org/10.2478/s11536-011-0019-z.
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AbstractLeft ventricular (LV) mass and LV geometry are well-established measures of hypertension chronicity and severity, have a prognostic value on cardiovascular morbidity and mortality, and are related to asymptomatic cerebral small-artery disease (SAD) and largeartery disease (LAD). The aim of the present study was to clarify the different effects of LV mass and LV geometry on underlying SAD compared with its effects on underlying LAD in ischemic stroke patients. Four hundred three ischemic stroke patients underwent echocardiography to determine LV mass index and relative wall thickness. Brain magnetic resonance imaging, angiography, and carotid magnetic resonance angiography were preformed to detect LAD (≥50% stenosis) and SAD (leukoaraiosis, microbleeds, and old lacunar infarction) in the brain. Multivariate analyses showed that the LV mass index was highly associated with underlying SAD but not with underlying LAD. Among the various subtypes of SAD, only cerebral microbleeds were closely related to the LV mass index. Concentric LV hypertrophy was not related to the presence of either SAD or LAD. Subgroup analyses revealed that, among the various subtypes of SAD, only cerebral microbleeds were associated with concentric LV hypertrophy. In conclusion, cerebral microbleeds may imply more advanced target organ damage than underlying LAD and ischemic subtypes of SAD.
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Ahmed, Hashim Uddin. "The Index Lesion and the Origin of Prostate Cancer." New England Journal of Medicine 361, no. 17 (October 22, 2009): 1704–6. http://dx.doi.org/10.1056/nejmcibr0905562.
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Valerio, Massimo, Chukwuemeka Anele, Alex Freeman, Charles Jameson, Paras B. Singh, Yipeng Hu, Mark Emberton, and Hashim U. Ahmed. "Identifying the Index Lesion with Template Prostate Mapping Biopsies." Journal of Urology 193, no. 4 (April 2015): 1185–90. http://dx.doi.org/10.1016/j.juro.2014.11.015.
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Tourinho-Barbosa, Rafael R., Jean de la Rosette, and Rafael Sanchez-Salas. "Prostate cancer multifocality, the index lesion, and the microenvironment." Current Opinion in Urology 28, no. 6 (November 2018): 499–505. http://dx.doi.org/10.1097/mou.0000000000000537.
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Lasa, Juan S., Liliana Spallone, Saul S. Berman, Silvina M. Gandara, Elsa C. Chaar, Felix A. Trelles, Natalia Leibovich, et al. "Sa1405 Flat Lesion Detection As a Colonoscopy Quality Index." Gastrointestinal Endoscopy 79, no. 5 (May 2014): AB199—AB200. http://dx.doi.org/10.1016/j.gie.2014.05.024.
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Fika, Z., P. D. Karkos, K. Badran, and R. E. Williams. "Primary cutaneous aggressive epidermotropic CD8 positive cytotoxic T-cell lymphoma of the ear." Journal of Laryngology & Otology 121, no. 5 (December 14, 2006): 503–5. http://dx.doi.org/10.1017/s0022215106005457.
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We report a case of an epidermotropic CD8+ cutaneous T-cell lymphoma which initially presented as an ulcerated lesion of the pinna. Although T-cell lymphomas may present as cutaneous lesions, the ear is rarely involved. This uncommon presentation and the need for multiple biopsies means that the diagnosis of these lesions may be delayed or missed. A high index of suspicion is required when evaluating cutaneous lesions in the head and neck area.
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Maruyama, Kimiko, Takaharu Ikeda, Katsunori Tanaka, and Fukumi Furukawa. "Evaluation of Arteriosclerosis Using the Brachial-Ankle Pulse Wave Velocity in Patients with Visceral Lesion-Free Systemic Lupus Erythematosus Characterized by Skin Lesions." Open Dermatology Journal 9, no. 1 (December 18, 2015): 30–33. http://dx.doi.org/10.2174/1874372201509010030.
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Recently, the cardio-/cerebrovascular lesion-related mortality rate has been high in patients with systemic lupus erythematosus (SLE). In these patients, the risk of cardio-/cerebrovascular lesions is also higher than in the general population. Cardio-/cerebrovascular lesions may occur during long-term follow-up. In this study, we evaluated arteriosclerosis using the brachial-ankle pulse wave velocity (baPWV) in visceral lesion-free SLE patients with skin lesions. In these patients, baPWV was higher than in healthy adults even at a young age. This suggests that baPWV is a possible tool to evaluate the patient’s vascular function, which was difficult to evaluate using a conventional sera arteriosclerosis index. Even when conditions are characterized by skin lesions, it may be important to consider the influence on the cardio-/cerebrovascular systems, as indicated for patients with systemic symptoms.
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Chechlacz, Magdalena, Pia Rotshtein, Peter C. Hansen, Jane M. Riddoch, Shoumitro Deb, and Glyn W. Humphreys. "The Neural Underpinings of Simultanagnosia: Disconnecting the Visuospatial Attention Network." Journal of Cognitive Neuroscience 24, no. 3 (March 2012): 718–35. http://dx.doi.org/10.1162/jocn_a_00159.
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Because of our limited processing capacity, different elements of the visual scene compete for the allocation of processing resources. One of the most striking deficits in visual selection is simultanagnosia, a rare neuropsychological condition characterized by impaired spatial awareness of more than one object at time. To decompose the neuroanatomical substrates of the syndrome and to gain insights into the structural and functional organization of visuospatial attention, we performed a systematic evaluation of lesion patterns in a group of simultanagnosic patients compared with patients with either (i) unilateral visuospatial deficits (neglect and/or extinction) or (ii) bilateral posterior lesions without visuospatial deficits, using overlap/subtraction analyses, estimation of lesion volume, and a lesion laterality index. We next used voxel-based morphometry to assess the link between different visuospatial deficits and gray matter and white matter (WM) damage. Lesion overlap/subtraction analyses, lesion laterality index, and voxel-based morphometry measures converged to indicate that bilateral parieto-occipital WM disconnections are both distinctive and necessary to create symptoms associated with simultanagnosia. We also found that bilateral gray matter damage within the middle frontal area (BA 46), cuneus, calacarine, and parieto-occipital fissure as well as right hemisphere parietal lesions within intraparietal and postcentral gyri were associated with simultanagnosia. Further analysis of the WM based on tractography revealed associations with bilateral damage to major pathways within the visuospatial attention network, including the superior longitudinal fasciculus, the inferior fronto-occipital fasciculus, and the inferior longitudinal fasciculus. We conclude that damage to the parieto-occipital regions and the intraparietal sulcus, together, with bilateral WM disconnections within the visuosptial attention network, contribute to poor visual processing of multiple objects and the loss of processing speed characteristic of simultanagnosia.
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Ünver, Halil Murat, and Enes Ayan. "Skin Lesion Segmentation in Dermoscopic Images with Combination of YOLO and GrabCut Algorithm." Diagnostics 9, no. 3 (July 10, 2019): 72. http://dx.doi.org/10.3390/diagnostics9030072.
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Skin lesion segmentation has a critical role in the early and accurate diagnosis of skin cancer by computerized systems. However, automatic segmentation of skin lesions in dermoscopic images is a challenging task owing to difficulties including artifacts (hairs, gel bubbles, ruler markers), indistinct boundaries, low contrast and varying sizes and shapes of the lesion images. This paper proposes a novel and effective pipeline for skin lesion segmentation in dermoscopic images combining a deep convolutional neural network named as You Only Look Once (YOLO) and the GrabCut algorithm. This method performs lesion segmentation using a dermoscopic image in four steps: 1. Removal of hairs on the lesion, 2. Detection of the lesion location, 3. Segmentation of the lesion area from the background, 4. Post-processing with morphological operators. The method was evaluated on two publicly well-known datasets, that is the PH2 and the ISBI 2017 (Skin Lesion Analysis Towards Melanoma Detection Challenge Dataset). The proposed pipeline model has achieved a 90% sensitivity rate on the ISBI 2017 dataset, outperforming other deep learning-based methods. The method also obtained close results according to the results obtained from other methods in the literature in terms of metrics of accuracy, specificity, Dice coefficient, and Jaccard index.
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Fumadó, Lluís, Lluís Cecchini, Nuria Juanpere, Anna Ubré, Jose Antonio Lorente, and Antonio Alcaraz. "Twelve Core Template Prostate Biopsy is an Unreliable Tool to Select Patients Eligible for Focal Therapy." Urologia Internationalis 95, no. 2 (2015): 197–202. http://dx.doi.org/10.1159/000381559.
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Introduction: To determine whether unilateral prostate cancer diagnosed at 12-core prostate biopsy harbours relevant prostate cancer foci in contralateral lobe in cases eligible for hemiablative focal therapy. Material and Methods: We analysed 112 radical prostatectomies of unilateral Gleason 6/7 prostate cancer based on prostate biopsy information. The presence of significant prostate cancer foci and/or the index lesion in the contralateral lobe is described. A subanalysis is performed in cases of Gleason score 6 and in cases of very-low-risk prostate cancer. Results: Contralateral prostate cancer was present in 69.6% of cases, fulfilling significant prostate cancer criteria in 33% and being the index lesion in 32%. No significant differences were found when analysing the Gleason 6 group (73% contralateral prostate cancer, 34% significant prostate cancer and 35% index lesion) or the very-low-risk prostate cancer group (80% contralateral prostate cancer, 29% significant prostate cancer and 45% index lesion). Conclusions: The assumption of unilateral prostate cancer based on 12-core template prostate biopsy information is unreliable. In about one third of the cases, there will be focus of significant prostate cancer or the index lesion in the contralateral lobe. This information should be taken into account when hemiablative focal therapies are considered.
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Scivoletto, Giorgio, Elena Cosentino, Alessia Mammone, and Marco Molinari. "Inflammatory Myelopathies and Traumatic Spinal Cord Lesions: Comparison of Functional and Neurological Outcomes." Physical Therapy 88, no. 4 (April 1, 2008): 471–84. http://dx.doi.org/10.2522/ptj.20070049.
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Background and Purpose Outcomes knowledge is essential to answer patients' questions regarding function, to plan the use of resources, and to evaluate treatments to enhance recovery. The purpose of this study was to compare the outcomes of patients with traumatic spinal cord injury (SCI) with those of patients with inflammatory spinal cord lesions (ISCLs). Subjects and Methods The authors evaluated 181 subjects with traumatic SCI and 67 subjects with ISCLs. Using a matching cohorts procedure, 38 subjects were selected from each group. The measures used were the American Spinal Injury Association (ASIA) Impairment Scale (motor function), the Barthel Index (BI), the Rivermead Mobility Index (RMI), and the Walking Index for Spinal Cord Injury (WISCI). Results The subjects in the ISCL group were older than those in the SCI group, with a longer interval from onset of lesion to rehabilitation admission and more incomplete lesions. In the matching cohorts, at admission, the traumatic SCI group had RMI and WISCI scores comparable to those of the ISCL group, but the traumatic SCI group had lower scores on the BI (greater dependence on assistance for activities of daily living). At discharge, the 2 groups had comparable functional outcomes. The neurological status of the 2 groups was comparable at admission and discharge. Discussion and Conclusion The results indicate that, at admission, patients with SCI have a greater physical dependence for assistance with activities of daily living than patients with ISCLs who have comparable neurological status. Such a difference depends on factors not related to the spinal cord lesion, such as the presence of associated lesions, the need to wear an orthotic device, or the sequelae of surgery. The outcomes of patients with SCI are determined more by factors such as lesion level and severity and age than by etiology. This finding could have implications for health care planning and rehabilitation research.
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Parveen, Ishrat, Koukab Javed, Breeha Elahi, Faran Nasrullah, Rashid Mahmood, and Muhammad Omer Aamir. "Evaluation of breast lesions with Doppler ultrasound: Diagnostic accuracy of resistive index as a predictor of malignancy." Professional Medical Journal 27, no. 04 (April 10, 2020): 825–30. http://dx.doi.org/10.29309/tpmj/2020.27.04.3947.
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Objectives: To evaluate breast lesions with doppler ultrasound and calculated the diagnostic accuracy of resistive index as a predictor of malignancy, taking histopathology as gold standard. Study Design: Cross-sectional study. Setting: Radiology Department, CMH Multan. Period: December 2015 to May 2016. Material & Methods: 150 female patients, having age between 20 – 60 years, with palpable breast lumps were admitted in the study. Doppler ultrasound of the lesion was performed with emphasis on the vascularity and resistive index was formulated. Categorization as malignant or otherwise was declared as established by doppler ultrasound. Patients then underwent biopsy followed by histopathology. Correlation of doppler ultrasound and histopathological findings was done with calculation of diagnostic accuracy of doppler ultrasound, keeping histopathology as gold standard. Results: The mean of age was 40.23 ± 5.75 years. In 81 breast doppler ultrasound positive patients, 73 (True Positive) showed malignant lesions in breast while 08 (False Positive) did not have malignancy on biopsy. Among 69 Breast Doppler Ultrasound negative patients, 06 (False Negative) demonstrated malignancy on biopsy whereas 63 (True Negative) did not have any malignant lesion. Overall specificity was 88.77%, sensitivity 92.40%, negative predictive value 91.30%, positive predictive value 90.12% and diagnostic accuracy of Doppler Ultrasound came out 90.67%. Conclusion: Angiogenesis in malignant lesions lead to formation of structurally abnormal and tortuous vessels with increased resistive index. Doppler ultrasound is a safe and effective modality which shows acceptable diagnostic accuracy for noninvasive characterization of malignant breast lesions. Therefore, it can be employed as an alternative to histopathology in patients who present with breast lesions.
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Jha, Anamika. "Ultrasonographic Elasticity Contrast Index of Palpable Breast Lumps." Journal of Nepal Medical Association 56, no. 212 (August 31, 2018): 787–90. http://dx.doi.org/10.31729/jnma.3536.
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Introduction: Elastrography used in addition to grey scale sonography increases its specificity. Elasticity contrast index (ECI) is based on strain elastrography and being a quantitative parameter, maybe more easy to obtain and reproducible while researches has been done in ECI in thyroid lesions, this is the first study, to the best of our knowledge to evaluate in breast lesions. This study was done to evaluate the diagnostic accuracy of Elasticity Contrast Index (ECI) in differentiating benign from malignant lesions of breast and to determine its cutoff value.
Methods: This is a descriptive cross-sectional study done at tertiary health care centre, which involved retrospective evaluation of data collected from September 2016 to March 2017. Conventional sonography was done followed by elastography on commercially available ultrasound machine. ECI was calculated in thyroid protocol available in the unit. Histopathological diagnosis was obtained for all the lesions and taken as gold standard.
Results: A total of 89 breast lumps were evaluated, of which was 61 (69.3%) were benign and 27 (30.7%) malignant on histopathology. Independent t test revealed the average ECI value of benign lesions was 2.48 and malignant 5.1. Receiver operating curve showed ECI value of 3.25 as the cutoff, above which the lesions were malignant.
Conclusions: ECI is a quantitative elastography technique which can be easily used as an adjunct during breast sonography and can increase its specificity for diagnosing a lesion as malignant. This could reduce the number of false positive biopsies.
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McKnight, Tracy R., Mary H. von dem Bussche, Daniel B. Vigneron, Ying Lu, Mitchel S. Berger, Michael W. McDermott, William P. Dillon, Edward E. Graves, Andrea Pirzkall, and Sarah J. Nelson. "Histopathological validation of a three-dimensional magnetic resonance spectroscopy index as a predictor of tumor presence." Journal of Neurosurgery 97, no. 4 (October 2002): 794–802. http://dx.doi.org/10.3171/jns.2002.97.4.0794.
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Object. Data obtained preoperatively from three-dimensional (3D)/proton magnetic resonance (MR) spectroscopy were compared with the results of histopathological assays of tissue biopsies obtained during surgery to verify the sensitivity and specificity of a choline-containing compound—N-acetylaspartate index (CNI) used to distinguish tumor from nontumorous tissue within T2 hyperintense and contrast-enhancing lesions of patients with untreated gliomas. The information gleaned from the biopsy correlation study was used to test the hypothesis that there is metabolically active tumor in nonenhancing regions of the T2-hyperintense lesion that can be detected using MR spectroscopy. Methods. Patients suspected of harboring a glioma underwent 3D MR spectroscopy during their preoperative MR imaging examination. Surgical navigation techniques were used to record the location of tissue biopsies collected during open resection of the tumor. A receiver operating curve analysis of the CNI and histological characteristics of specimens at each biopsy location was performed to determine the optimal threshold of the CNI required to separate tumor from nontumorous tissue. Histograms of the CNIs within enhancing and nonenhancing regions of lesions appearing on MR images were generated to determine the spatial distribution of CNIs consistent with tumor. Conclusions. Biopsy samples containing tumor were distinguished from those containing a mixture of normal, edematous, gliotic, and necrotic tissue with 90% sensitivity and 86% specificity by using a CNI threshold of 2.5. The CNIs of nontumorous specimens were significantly different from those of biopsy specimens containing Grade II (p < 0.03), Grade III (p < 0.005), and Grade IV (p < 0.01) tumors. On average, one third to one half of the T2-hyperintense lesion outside the contrast-enhancing lesion contained CNI greater than 2.5.