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PubMed2002

Transvaginal and transabdominal extended field-of-view (EFOV) and power doppler EFOV sonography in gynecology: advantages and applications.

OBJECTIVE: To evaluate the possible advantages, applications, and usefulness of real-time transabdominal and transvaginal extended field-of-view sonography combined with power Doppler sonography in gynecology. METHODS: A series of 63 gynecologic patients, referred for preoperative sonographic examination and for whom the examiner thought that extended field-of-view sonography might be helpful in imaging pathologic findings, were selected. Patients were examined with conventional vaginal and abdominal B-mode sonography, extended field-of-view sonography, and power Doppler extended field-of-view sonography. A sonographic system with 3.5- to 7-MHz transducers was used to study and document pathologic findings. RESULTS: Extended field-of-view sonography provided a superior overview of pathologic findings and topography by creating a single image showing the relationship to reference structures. The combination of power Doppler extended field-of-view sonography provided additional information on the perfusion pattern in huge masses. In comparison with conventional sonographic images, the extended field-of-view sonographic images were easier to interpret by the referring or nonexamining physician. A list of proposed gynecologic applications for the use of extended field-of-view sonography was compiled. CONCLUSIONS: The extended field-of-view and power Doppler extended field-of-view sonographic technique provides documentation of surroundings, topographic orientation, and perfusion patterns in large pelvic masses and findings that exceed the limitations of the conventional sonographic sector. The clinical applications and advantages of extended field-of-view and power Doppler extended field-of-view imaging in gynecologic sonography are illustrated.

Abdomen↗

PubMed1997

Localization of parathyroid glands using technetium-99m-tetrofosmin imaging.

UNLABELLED: Preoperative localization of hyperactive parathyroid glands is useful to minimize operative time and reduce patient morbidity. This investigation compared the sensitivity of radionuclide imaging with 99mTc tetrofosmin with that of ultrasonography and magnetic resonance (MR) imaging in patients with hyperparathyroidism. METHODS: Twenty-six patients with primary (n = 7) or secondary (n = 19) hyperparathyroidism were imaged with 99mTc tetrofosmin, ultrasound and MR imaging of the neck and thorax to localize the lesions. The presence of hyperparathyroidism was identified by an intact parathyroid hormone in vitro assay. The parathyroid/normal thyroid tissue activity ratio was calculated for all patients with evidence of an abnormality on tetrofosmin images. Pathological findings were compared with the results of imaging in 18 of the 26 patients who underwent parathyroidectomy. RESULTS: Technetium-99m tetrofosmin scans demonstrated focal uptake in 46 glands of 26 patients. The uptake was categorized as slight in 78.3% (36/46) and intense (parathyroid/normal thyroid tissue activity ratio, > 1.4) in 21.7% (10/46). Ultrasonography and MR imaging identified 44 and 47 glands, respectively, in these patients. Eleven of the 18 patients who underwent parathyroidectomy within 1 mo after tetrofosmin imaging had hyperplastic glands, while 7 had parathyroid adenomas. Tetrofosmin imaging successfully localized 7 of 7 (100%) adenomas and 27 of 37 (73.0%) hyperplastic glands. The sensitivities of each technique for localizing abnormal parathyroid glands were 77.3% (34/44) for tetrofosmin imaging: 68.2% (20/44) for ultrasonography: and 68.2% (30/44) for MR imaging. Technetium-99m tetrofosmin uptake ratio in the 18 patients with surgical exploration was not proportional to several oxyphil cells. CONCLUSION: Technetium-99m tetrofosmin parathyroid imaging may be useful for localizing abnormal glands in patients with primary and secondary hyperparathyroidism. The sensitivity of 99mTc tetrofosmin parathyroid imaging was high as compared to ultrasonography or MR imaging. The prolonged retention of tetrofosmin may not depend on the number of mitochondria-rich oxyphil cells.

Adenoma↗

PubMed1998

Delivering labeled teaching images over the Web.

The Web provides educators with the best opportunity to date for distributing teaching images across the educational enterprise and within the clinical environment. Experience in the pre-Web era showed that labels and information linked to parts of the image are crucial to student learning. Standard Web technology does not enable the delivery of labeled images. We have developed an environment called OverLayer that succeeds in the authoring and delivering of such images in a variety of formats. OverLayer has a number of functional specifications, based on the literature and on our experience, among them, the following: Users should be able to find components by name or by image; to receive feedback about their choice to test themselves. The image should be of arbitrary size; should be reusable; should be linked to further information; should be stand-alone files. The labels should not obscure the image; should be linked to further information. Images should be stand-alone files that can be transferred among faculty members. Implemented in Java, OverLayer (http:/(/)omie.med.jhmi.edu/overlayer) has at its heart a set of object classes that have been reused in a number of applets for different teaching purposes and a file format for creating OverLayer images. We have created a 350-image histology library and a 500-image pathology library, and are working on a 400-image GI endoscopy library. We hope that the OverLayer suite of classes and implementations will help to further the gains made by previous image-based hyperlinked technologies.

Anatomy↗

PubMed2000

[Digital image analysis in pathology--exemplified in prostatic cancer].

Digital image analysis is increasingly used in medicine. This paper reviews image analysis methods currently used in pathology. To exemplify established and future use of these methods, we present our own research and available literature on prostate cancer. DNA ploidy examinations mean measuring nuclear DNA content. A review of available literature shows that DNA ploidy is a very good prognostic marker in early and localized prostate cancer. Nevertheless, request for such examinations is sparse, in contrast to what is the case for gynecological cancers. In addition to assessing nuclear DNA content, we have today the means of quantitatively assessing the chromatin organisation. Such nucleotyping and texture analysis of chromatin has been shown to give significant diagnostic and prognostic information both in localized and advanced prostate cancer. DNA ploidy and nucleotyping are methods that analyze features of single cells. New methods for describing tissue architecture in an objective and reproducible way have been developed in our department. Preliminary results demonstrate the ability of these methods to discriminate between groups of prostate cancer patients with good or poor diagnosis. Digital techniques in combination with new methods from molecular biology have a potential for reducing workload, with parallel assessment of a large number of markers on large populations. The combination of traditional, molecular and digital pathology already offers the possibility of improved diagnostic and prognostic activity. However, there is the challenge of actually employing these methods. DNA ploidy for localized prostate cancer is only one example of a reliable prognostic marker that is not used to its full potential.

Chromatin↗

PubMed2004

Digital image acquisition using a consumer-type digital camera in the anatomic pathology setting.

Imaging is central to anatomic pathology. The captured images are used for documentation, archiving, teaching, and publication. The advent of low-cost, consumer-type, high-end digital cameras has provided a convenient, easy-to-use alternative for routine image acquisition. The various applications for digital image acquisition in anatomic pathology include, among others, digitizing conventional photographs, digital gross photography and digital macrophotography, digitizing radiographic images, and digital photomicrography. This article reviews digital image acquisition in the anatomic pathology setting using a consumer-type digital camera. The camera type chosen as an example for the discussion was selected for its popularity and wide use among pathologists and for its potential to function as a sole image input device in all applications combined. Techniques and accessories to further increase the functionality of the camera and help overcome some of the commonly encountered problems in some applications are described.

Diagnostic Imaging↗

PubMed1997

Digital imaging as a teaching tool for pathologists.

Digital Imaging is a technology which should be of considerable interest to pathologists as the use of gross and microscopic pathology images plays an important part in their role as medical educators. Digital imaging may have important advantages over conventional film photography which can be exploited by the pathologist to create all-digital presentations. In this article, the basic components of digital imaging are described, along with an affordable and practical approach which should allow most pathologists to begin to explore this medium.

Computers↗

PubMed2005

Diffusion weighted imaging of bone marrow pathologies.

Diffusion weighted imaging of non-CNS tissue has attracted much attention during the last years. Its capability of probing the microstructure of a biologic tissue at a sub-millimeter range is used to evaluate its diffusion capacity, which is tissue specific and can be used for tissue characterization. Processes involving bone marrow where the primary target for DWI during the last years. Most experience has been gained for differentiating benign from pathologic vertebral compression fractures, which can be reliably done when quantitative diffusion measurements are available. However, preliminary results exist indicating that this non-invasive technique may be a potential tool for therapy monitoring, which will revise the management of cancer patients. Moreover, this will be the first non-invasive and quantifiable tool for evaluating the effectiveness of modern tumor treatment. In this article, we will give an overview on the current status of DWI in the evaluation of bone marrow alterations; on currently available DWI techniques and a short out-look on future aspects of DWI in bone marrow pathologies.

Bone Marrow Diseases↗

PubMed1995

Cost effective Internet access and video conferencing for a community cancer network.

Utilizing the ubiquitous personal computer as a platform, and Integrated Services Digital Network (ISDN) communications, cost effective medical information access and consultation can be provided for physicians at geographically remote sites. Two modes of access are provided: information retrieval via the Internet, and medical consultation video conferencing. Internet access provides general medical information such as current treatment options, literature citations, and active clinical trials. During video consultations, radiographic and pathology images, and medical text reports (e.g., history and physical, pathology, radiology, clinical laboratory reports), may be viewed and simultaneously annotated by either video conference participant. Both information access modes have been employed by physicians at community hospitals which are members of the Jefferson Cancer Network, and oncologists at Thomas Jefferson University Hospital. This project has demonstrated the potential cost effectiveness and benefits of this technology.

Computer Communication Networks↗

PubMed1990

Regenerating nodules in hepatic cirrhosis: MR findings with pathologic correlation.

To establish clearly the pathologic basis for small low-intensity nodules seen on MR images of the cirrhotic liver, we obtained MR images in 26 patients with cirrhosis in whom partial hepatectomy for hepatoma (15 patients), laparoscopy for cirrhosis (10 patients), or autopsy (one patient) was subsequently performed. Small low-intensity nodules were seen on gradient-echo images with short TEs (10-13 msec) in 13 of the 26 patients. In 12 of these 13 patients, small low-intensity nodules appeared larger and clearer as the TE was prolonged (14-25 msec). On T2-weighted spin-echo images, small low-intensity nodules were seen in 12 of the 13 patients, but not seen as well as on gradient-echo images. Pathologic correlation in these 13 patients revealed that the nodules on the MR images corresponded to iron deposits in regenerating nodules. Small low-intensity nodules were observed only on T2-weighted spin-echo images in two of the remaining 13 patients, in whom microscopic examination of the liver revealed marked inflammatory cell infiltration in the fibrous septa and no iron deposition. We conclude that small low-intensity nodules observed on MR images are caused by iron deposits in regenerating nodules, and that gradient-echo images with short and prolonged TEs are useful to confirm the presence of iron deposits in regenerating nodules.

Adult↗

PubMed2004

The renal sinus: pathologic spectrum and multimodality imaging approach.

Various pathologic conditions can occur in the renal sinus, primarily originating in the constituents of the renal sinus, and the renal sinus can be secondarily involved by surrounding renal parenchymal and adjacent retroperitoneal lesions. Lipomatosis and cysts are common renal sinus lesions with little clinical significance, but differentiation from other pathologic conditions is important. Renal vascular lesions such as renal artery aneurysm or arteriovenous fistula can mimic other parapelvic or peripelvic lesions at excretory urography, but their vascular nature is evident at color Doppler ultrasonography, contrast material-enhanced computed tomography (CT), and magnetic resonance (MR) imaging. Although most tumors originating in the renal pelvis are transitional cell carcinoma or squamous cell carcinoma, renal parenchymal tumors such as renal cell carcinoma or benign multilocular cystic nephroma have a tendency to grow into the renal sinus. Rare tumors of mesenchymal origin can develop in the renal sinus, but their imaging findings are nonspecific. The observation of renal sinus fat is important for detecting a small tumor located in that area and determining the exact tumor stage. Multiplanar CT or MR images can allow exact evaluation of the extent of complex renal sinus disease.

Adolescent↗

PubMed1997

Inflammatory central nervous system demyelination: correlation of magnetic resonance imaging findings with lesion pathology.

Magnetic resonance imaging (MRI) is widely used to evaluate and monitor disease activity in inflammatory demyelinating central nervous system (CNS) diseases such as multiple sclerosis. The present study aimed at correlating MRI findings with histological parameters in 6 cases of biopsy-proven inflammatory demyelination of the CNS. The earliest stages of demyelinating activity manifested as almost isointense lesions with a massive gadolinium-DTPA (Gd-DTPA) enhancement in T1-weighted scans. In T2-weighted scans, early active lesions formed a border of decreased intensity compared with the lesion center and the perifocal edema. The morphological correlate of this pattern in our patients was activated macrophages in the zone of myelin destruction at the plaque border. Late active lesions were hypointense in T1 and hyperintense in T2 scans. Inactive demyelinated and remyelinating lesions were hyperintense in T2 scans and enhanced inhomogenously after Gd-DTPA application. T1 scans revealed major differences in the degree of hypointensity that correlated with the extent of axonal damage, extracellular edema, and the degree of demyelination or remyelination.

Adult↗

PubMed2002

Potential pitfalls in cranial sonography.

BACKGROUND: We present several anatomic variants of the brain and artifacts related to scanning techniques which could be misinterpreted as lesions on neonatal cranial sonography. MATERIALS AND METHODS: The findings were derived from US studies performed on 176 premature infants and 26 full-term newborns, using the anterior, posterior and mastoid fontanelles as acoustic windows. RESULTS: The pseudolesions are divided into three groups: ventricular system (asymmetric lateral ventricle size and coarctation of the lateral ventricles); choroid plexus ("split" choroid, "truncated" choroid and choroid cyst); and brain parenchyma (peritrigonal blush, thalamic pseudolesion, pseudo-absence of the inferior vermis, occipital pseudomass and calcar avis simulating intraventricular clot). We provide images of these pseudolesions and clues to their differentiation from true brain pathology. Images of several brain disorders are included for comparison. Knowledge of these potential pitfalls is essential for proper interpretation of US brain studies and will help to avoid the use of other more invasive diagnostic tests. CONCLUSIONS: Misleading images seen on US examination of the neonatal brain that could be misinterpreted as pathology are presented, with clues to their differentiation from true lesions.

Brain↗

PubMed1994

Preliminary results from attenuation-slope mapping of plaque using intravascular ultrasound.

Excised femoral and iliac artery segments have been examined with 20 MHz intravascular ultrasound followed by histological assessment. During the ultrasound examinations, radio-frequency (RF) data were recorded digitally, and used for calculating local values of attenuation slope throughout the tissue, using a frequency-domain technique. The RF data were also reconstructed as conventional ultrasound images, and the attenuation-slope information presented as a threshold colour overlay. Areas identified as degenerative plaque in the histological assessments were usually found to correspond to areas of high attenuation slope, and were clearly identified from the pattern of colours on the combined image. Some examples are presented, illustrating the appearance of various pathologies imaged by this technique.

Algorithms↗

PubMed2003

Applications of image analysis to anatomic pathology: realities and promises.

Image Analysis in Pathology is viewed as an ancillary method meant to provide objective support in the resolution of difficult problems. Its Achilles heel is the process of nuclear segmentation (delimitation of the nuclear membrane) which is extremely difficult in pathology materials. Although interactive segmentation procedures are available no reliable fully automatic method has been described. The only application of image analysis that has truly succeeded in Pathology is DNA ploidy measurement. A very desirable application is the quantitation of immunohistochemical markers, which is technically challenging, has been resolved only in certain cases and is unlikely to have a general solution. Nuclear quantitation has repeatedly proven to be helpful in reaching differential diagnoses, in particular when based on size distributions of nuclear profiles rather than its average, but is hampered by the segmentation problem discussed above. Texture analysis of chromatin is an exciting, mathematically complex application likely to succeed, for which many approaches have been described. Finally a diagnosis (classification) can be obtained based on algorithms applied to multiple descriptors of tumor cells (for instance nuclear sizes, chromatin texture, shape, etc). The best classificatory approaches are neural networks (a form of artificial intelligencee), multivariate analysis, and logistic regression (statistical).

Algorithms↗

PubMed2004

Proteomics in diagnostic pathology: profiling and imaging proteins directly in tissue sections.

Direct tissue profiling and imaging mass spectrometry (MS) provide a molecular assessment of numerous expressed proteins within a tissue sample. MALDI MS (matrix-assisted laser desorption ionization) analysis of thin tissue sections results in the visualization of 500 to 1000 individual protein signals in the molecular weight range from 2000 to over 200,000. These signals directly correlate with protein distribution within a specific region of the tissue sample. The systematic investigation of the section allows the construction of ion density maps, or specific molecular images, for virtually every signal detected in the analysis. Ultimately, hundreds of images, each at a specific molecular weight, may be obtained. To date, profiling and imaging MS has been applied to multiple diseased tissues, including human non-small cell lung tumors, gliomas, and breast tumors. Interrogation of the resulting complex MS data sets using modern biocomputational tools has resulted in identification of both disease-state and patient-prognosis specific protein patterns. These studies suggest that such proteomic information will become more and more important in assessing disease progression, prognosis, and drug efficacy. Molecular histology has been known for some time and its value clear in the field of pathology. Imaging mass spectrometry brings a new dimension of molecular data, one focusing on the disease phenotype. The present article reviews the state of the art of the technology and its complementarity with traditional histopathological analyses.

Animals↗

PubMed1999

Primary sclerosing cholangitis: MR imaging findings with pathologic correlation.

OBJECTIVE: The purpose of this study was to evaluate MR imaging findings of primary sclerosing cholangitis, to compare them with histopathologic findings, and to determine if these findings help differentiate primary sclerosing cholangitis from other disorders that result in end-stage liver disease. MATERIALS AND METHODS: MR imaging was performed in 40 patients (27 men, 13 women; age range, 13-72 years; mean, 47 years) with primary sclerosing cholangitis over a 9-year period. In 16 patients who underwent orthotopic hepatic transplantation and in seven patients who underwent needle biopsy, correlation was made between MR imaging and pathologic findings. RESULTS: Focal signal changes in the liver parenchyma were seen on T2-weighted images as peripheral wedge-shaped zones of increased signal intensity in 29 patients (72%), as a reticular pattern in 15 patients (38%), and as periportal edema in 16 patients (40%). Lobar atrophy involved the right lobe in three patients (8%) and the left lobe in 11 patients (28%); hypertrophy of the caudate lobe was seen in nine patients (23%). Features of portal hypertension were seen in 14 patients (35%). Histologic assessment showed zones of segmental atrophy and scarring on the periphery of the liver. CONCLUSION: Peripheral wedge-shaped areas of high T2 signal intensity and dilatation of bile ducts are characteristic MR features of primary sclerosing cholangitis. Pathologic correlation suggests that these features may be related to underlying perfusion changes and bile duct inflammation in patients with primary sclerosing cholangitis.

Adolescent↗

PubMed1992

Intradural schwannomas of the spine: MR findings with emphasis on contrast-enhancement characteristics.

Intradural extramedullary schwannomas are nerve sheath neoplasms that consist of focal proliferations of Schwann cells involving a spinal nerve. We reviewed the MR findings in seven patients with pathologically proved intradural schwannomas. The contrast-enhancement characteristics on MR images were determined and compared with the histologic features of the tumor. Six lesions were variably hyperintense on T2-weighted images and one was uniformly hypointense compared with the signal intensity of the spinal cord. Signal on T1-weighted images ranged from hypointense to isointense. All seven tumors showed heterogeneous enhancement; in five, the enhancement involved only the periphery of the lesion. The pattern of enhancement did not correlate with the signal characteristics noted on unenhanced T1- and T2-weighted images. Pathologically, hyaline thickening of vessel walls and cyst formation were prevalent in the peripherally enhancing lesions. However, enhancement did not correlate with the relative proportion of Antoni type A and type B tissue. Recognition of the MR characteristics of intradural extramedullary schwannomas may be helpful in the differential diagnosis of spinal tumors. In particular, peripheral contrast enhancement of an intradural extramedullary tumor on MR images should suggest the diagnosis of schwannoma.

Adult↗

PubMed2000

Subcutaneous and musculoskeletal sparganosis: imaging characteristics and pathologic correlation.

OBJECTIVE: To document the imaging characteristics of subcutaneous and musculoskeletal sparganosis. DESIGN AND PATIENTS: Ten patients with musculoskeletal sparganosis were examined, with a variety of imaging modalities including MRI (n=6), ultrasonography (n=8), plain radiography (n=7) and CT (n=1). Pathologic correlation was carried out in all cases. RESULTS: Nine lesions involved soft tissues, of which seven were in the thigh, two in the trunk and one involved a vertebral body. The majority of the lesions in soft tissue were confined to the subcutaneous layer but two extended deep into underlying muscles. Sonography revealed low-echoic serpiginous tubular tracts (8/8), and an intraluminal echogenic structure (4/8). MRI revealed multiple serpiginous tubular tracts and peripheral rim enhancement. Two patients showed perilesional soft tissue edema. Pathologically, the lesion consisted of a larva surrounded by three layers of inflammation: an inner epithelioid granulomatous cell layer, middle chronic inflammatory cell layers, and an outer fibrous layer. CONCLUSION: The study suggests that if serpiginous tubular tracts are seen at imaging studies, musculoskeletal sparganosis should be included in the differential diagnosis.

Adult↗