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PubMed1989

Multimodality approach to osteonecrosis of the femoral head.

Treatment of osteonecrosis of the femoral head appears to be effective when the disease is identified and treated early. Forty-one patients were evaluated with prospective laboratory assessment, anteroposterior and frog-lateral roentgenograms of both hips, intraosseous pressure measurements (IOP), magnetic resonance imaging (MRI), and 99mTc methylene diphosphonate planar and single-photon emission computerized tomographic (SPECT) bone imaging. Pathologic specimens were obtained in most patients. Preradiographic disease was identified in 26 hips and 11 of these were asymptomatic. Fifteen clinically symptomatic hips had normal plain roentgenograms, but abnormal protocol studies. Evaluation of sensitivity, specificity, and predictive value (positive and negative), respectively, in diagnosing osteonecrosis of the femoral head revealed the following percentages: 83%, 83%, 96%, and 48% for planar bone scanning; 91%, 78%, 94%, and 70% for SPECT; 87%, 83%, 96%, and 55% for MRI; 80%, 60%, 95%, and 25% for IOP; and 88%, 100%, 100%, and 25% for core biopsy. (There were few true negatives, thus specificity values are approximations.) The identification of preradiographic stages is possible, but difficult. MRI appears appealing at present, particularly in identifying disease in asymptomatic hips. However, there is no definitive method for noninvasive diagnosis. Pathologic confirmation in early stages is difficult.

Adolescent↗

PubMed2004

Comparison of dynamic gadolinium-enhanced and ferumoxides-enhanced MRI of the liver on high- and low-field scanners.

PURPOSE: To compare the performance of dynamic gadolinium-enhanced and ferumoxides-enhanced MRI in the detection and characterization of hepatic lesions, on 1.5-T and 0.2-T magnets MATERIALS AND METHODS: In 41 patients (23 men, 18 women), 52 hepatic MR examinations were performed and retrospectively analyzed; 39 and 13 examinations were performed on 1.5-T and 0.2-T magnets, respectively. A total of 33 of 41 patients had known malignancies, and 31 of 33 patients had biopsy of at least one lesion. First, a combination of unenhanced T2-weighted sequences and gradient-echo T1-weighted sequences were performed. Then, dynamic gadolinium-enhanced (0.1 mmol/kg) T1 GRE sequences were obtained, followed by intravenous drip infusion of ferumoxides (10 micromol/kg). The T2-weighted sequences were then repeated. The unenhanced and gadolinium-enhanced images (the Gd set) were reviewed separately from the unenhanced and ferumoxides-enhanced images (the ferumoxides set) by two abdominal imagers. The reviewers were blinded to clinical history and reviewed the individual studies in each set randomly. Each detected lesion was scored on a five-point scale for characterization scores: nonsolid (1 or 2), indeterminate (3), or solid (4 or 5). A consensus review was then performed correlating all available pathology, imaging, clinical findings, and follow-up to act as a gold standard. Receiver-operating-characteristic (ROC) curves were generated and both area-under-the-curve (Az values) and sensitivity values were calculated. Significance of Az and sensitivity differences was assessed using standard Z-test and chi-square. RESULTS: Of 270 lesions detected by consensus, 211 were on 1.5-T and 59 were on 0.2-T scanners. The accuracy (Az values) of lesion detection overall, of both readers, was greater for the ferumoxides set than for the Gd set (reader 1: 0.95 vs. 0.89 (P < 0.05); reader 2: 0.91 vs. 0.78 (P < 0.05)). Az values for both readers were greater on the ferumoxides set for both the 1.5-T scans and the 0.2-T scans. Out of 270 lesions detected, 231 were characterized by consensus review as solid (185) or nonsolid (46). There was a significant improvement in lesion characterization for both readers on the GD set compared with the ferumoxides set on both high and low field scanners (Az reader 1: 0.99 vs. 0.96 (P < 0.05); Az reader 2: 0.99 vs. 0.95 (P < 0.05)), respectively. CONCLUSION: At both 1.5-T and 0.2-T, ferumoxides-enhanced sequences were better for lesion detection, while gadolinium-enhanced sequences were better for lesion characterization, respectively.

Adult↗

PubMed2001

Web-based access to mouse models of human cancers: the Mouse Tumor Biology (MTB) Database.

The Mouse Tumor Biology (MTB) Database serves as a curated, integrated resource for information about tumor genetics and pathology in genetically defined strains of mice (i.e., inbred, transgenic and targeted mutation strains). Sources of information for the database include the published scientific literature and direct data submissions by the scientific community. Researchers access MTB using Web-based query forms and can use the database to answer such questions as 'What tumors have been reported in transgenic mice created on a C57BL/6J background?', 'What tumors in mice are associated with mutations in the Trp53 gene?' and 'What pathology images are available for tumors of the mammary gland regardless of genetic background?'. MTB has been available on the Web since 1998 from the Mouse Genome Informatics web site (http://www.informatics.jax.org). We have recently implemented a number of enhancements to MTB including new query options, redesigned query forms and results pages for pathology and genetic data, and the addition of an electronic data submission and annotation tool for pathology data.

Animals↗

PubMed1995

Malignant granular cell tumour of the sciatic nerve.

A case of malignant granular cell tumour of the sciatic nerve is presented. Computed tomography demonstrated isodensity with muscle and minimal enhancement. Magnetic resonance demonstrated T1 isointensity with muscle with marked enhancement, and isointensity with fat on proton and T2 images. Pathological evidence is presented for its probable Schwann cell histogenesis.

Aged↗

PubMed2004

[Clinical value of PET/CT for the diagnosis and management of lung nodules].

OBJECTIVE: To investigate the clinical value of 18F-fluorodeoxyglucose positron emission tomography (FDG PET)/CT for the diagnosis and management of lung nodules. METHODS: Twenty patients were evaluated: 15 with suspected cancer and 5 confirmed cancer. PET/CT scans were performed by discovery LS-PET/CT system. RESULTS: (1) The diagnostic accuracy of PET/CT was 100% in these 20 patients. Of 15 patients with suspected cancer, 7 were diagnosed as having benign disease and 8 malignant. All the 5 patients with confirmed cancer were all FDG positive. Of 11 single lesions on CT, 3 were positive by PET/CT images, 6 of 8 with positive CT images were diagnosed as having metastasis to the tissue outside the lung and the other 2 were metastatic. (2) After PET/CT scanning, the therapy scheme of 16 out of 20 patients were changed, and continual observation was practiced in 2, 3 were treated by anti-inflammation regimen, 2 by operation, 4 by local radiotherapy, 3 by chemotherapy only, 4 by radiotherapy plus chemotherapy or operation. (3) The radiotherapists made use of PET/CT fusion imaging for positioning in 8 patients who were indicated for radiotherapy. One of them who had received MM50 one course of intensity medulated conformal radiotherapy was re-examined by PET/CT after one and half months, the former parenchymal nodule disappeared and the glucose metabolism returned to normal. Two of them were finally operated after the surgeons have decided an operative approach on estimation of extent of lesion by the PET/CT fusion images. Pathological results showed no cancer cell involvement in the specimen margin or the local lymph nodes. CONCLUSION: (1) PET/CT is better in discriminating malignant from benign lung nodules than CT only. (2) PET/CT scanning facilitates an accurate assessment of response in clinical staging and neoadjuvant therapy scheme of lung cancer. (3) PET/CT fusion imaging provides an accurate biological target for radiotherapy and confirms the operation plan and extent of surgery.

Adult↗

PubMed2026

Survival prediction for clear cell renal cell carcinoma based on deep multimodal synergistic survival network.

Objective.To propose a deep multimodal synergistic survival analysis framework (Deep Multimodal Synergistic Survival Network, DMSSN) to achieve accurate prognostic analysis for clear cell renal cell carcinoma (ccRCC).Methods.This study (DMSSN) utilized matched multimodal data from the Cancer Genome Atlas-KIRC database, including CT imaging data, whole slide images, copy number variation (CNV) features, and clinical data. Deep Canonical Correlation Analysis was employed to map heterogeneous modalities into a shared latent space. Contrastive learning was introduced to enhance semantic consistency across multimodal features, and a gating network was utilized for the adaptive fusion of multimodal information to achieve precise survival risk prediction for patients.Results.Experimental results demonstrated that DMSSN achieved a Concordance Index (C-index) of 0.8153 ± 0.0994, with a Log-rank testp-value of 1.6553×10-11. DMSSN exhibited significant performance advantages over traditional statistical methods like Log-rank-Cox (0.7055 ± 0.0670) and machine learning methods such as Random Survival Forest (RSF) (0.6836 ± 0.1048). Furthermore, in comparison with similar deep learning approaches, DMSSN outperformed late fusion strategies (0.7493 ± 0.1211) and discrete-time survival models such as DeepHit (0.7655 ± 0.1041) and Nnet-surv (0.7694 ± 0.0635). Notably, DMSSN still achieved the best predictive performance when compared to the classic deep survival model DeepSurv (0.7919 ± 0.0978) and advanced state-of-the-art multimodal fusion frameworks like Context-Aware Transformer (0.7735 ± 0.0818) and Multimodal Co-Attention Transformer (0.8102 ± 0.0972). Ablation studies showed that removing any single modality led to a decline in performance, with the largest numerical decrease occurring after removing CT imaging features (C-index decreased to 0.7327), validating the complementarity of multimodal data and the pivotal role of radiomic features in prognostic assessment. Module ablation experiments further confirmed the effectiveness of the core components.Conclusion:By effectively integrating imaging, pathology, genomic, and clinical features, the DMSSN framework demonstrates superior performance and robustness in the survival prediction of ccRCC.

Carcinoma, Renal Cell↗

PubMed1997

Transcontinental consults in surgical pathology via the Internet.

An efficient and inexpensive electronic system to submit surgical pathology cases in consultation via the Internet is presented. A transcontinental pilot study showed a high degree of concordance between the diagnosis provided by the consultant on the basis of the pathology images and that given after examining the corresponding microscopic slides.

Adult↗

PubMed1997

Erdheim-Chester disease of the central nervous system. Report of two cases.

The authors report two cases of Erdheim-Chester disease (ECD), an illness of unknown pathogenesis. Generally, this disease process involves the metaphyseal and diaphyseal portions of the long bones, the lungs, and the retroperitoneum; however, other tissues may be involved including the central nervous system (CNS). To date only two cases of CNS-related ECD have been reported. The present report adds to the literature by documenting two more recent cases of ECD involving the CNS. The clinical presentations of these cases, their radiological findings with special reference to magnetic resonance imaging, pathological determination, and clinical management are briefly reviewed.

Adult↗

PubMed1996

Primary diaphragmatic schwannoma with a typical target appearance: correlation of CT and MR imagings and histologic findings.

A rare case of benign diaphragmatic schwannoma in a 38-year-old female is reported. Precontrast computed tomography (CT) showed an encapsulated well-defined round homogeneous tumor with central calcification, measuring approximately 5 cm in diameter, arising from the left diaphragm. Contrast-enhanced CT and gadolinium-enhanced T1-weighted magnetic resonance (MR) imaging showed focal enhancement in the central portion of the tumor. The tumor showed a typical target appearance of increased peripheral signal intensity and decreased central signal intensity on unenhanced T2-weighted images. Pathological examination of resected specimens of the tumor showed two zonal histological components: a hypercellular portion of spindle cells with nuclear palisading (Antoni A tissue) and a hypocellular portion of cells with cystic degeneration, together with focal calcification and hemangeomatous vascular changes (Antoni B tissue). We consider the radiological characteristics of diaphragmatic schwannoma on CT and MR imagings to represent the geographic difference between the histologic zones of the tumor.

Adult↗

PubMed1985

Comparison as a lymphoscintigraphic agent between 99Tcm dextran and 99Tcm antimony sulphide colloid.

To determine its suitability as a lymph node imaging agent, 99Tcm dextran (99TcmDx) was compared with 99Tcm antimony sulphide colloid (99TcmSb2S3) in rabbits and dogs. In two groups of five rabbits each, absorption from the interstitial injection site, popliteal lymph node sequestration and total body uptake and distribution of both agents were determined. In three dogs, both agents were studied simultaneously, 99TcmDx and 99TcmSb2S3 being injected into the left and right hind feet respectively; therefore, only popliteal lymph node sequestration and image qualities were evaluated. Uptake curves in the rabbits indicated that total body uptake of 99TcmDx is faster and greater than that of 99TcmSb2S3. In spite of rapid lymph node uptake rates, total popliteal lymph node sequestration of 99TcmDx is significantly lower than that observed for 99TcmSb2S3. While lymph node uptake of 99TcmDx in dogs is higher than in rabbits, disparity between the two agents persists and is demonstrable in the image in both species. Reduced lymph node sequestration of 99TcmDx may result from its non-colloidal nature as well as its instability, both of which render this agent unsuitable for imaging pathological features of lymph nodes although its rapid absorption and distribution may be ideal characteristics for the study of lymphatic kinetics.

Animals↗

PubMed1994

Ultrasound, computed tomography and magnetic resonance imaging in myopathies: correlations with electromyography and histopathology.

Imaging of examinations by ultrasound (US), computerized tomography (CT) and low field magnetic resonance imaging (MRI) were compared with EMG and muscle biopsy findings in the same muscles of 33 patients with different neuromuscular diseases. None of the imaging methods revealed specific diagnostic details, but gave valuable information on the extent and distribution of muscle involvement. In myopathies all imaging modalities corresponded well with the EMG and histopathology findings, but in the neuropathies with minimal tissue destruction EMG was, understandably, more sensitive. The imaging characteristics of MR were as good as those of CT, but MRI has the advantage of not requiring ionizing radiation. US is the most economical method and it was found to be, despite its lower resolution, very informative in the hands of an experienced examiner, especially for the detection of fibrosis. The good agreement of histopathology with pathologic imaging and EMG findings implies that the accuracy of muscle biopsy increases, if its site is selected on the basis of imaging and/or EMG examination.

Adipocytes↗

PubMed2004

Gallbladder and biliary tract carcinoma: A comprehensive update, Part 1.

Gallbladder carcinoma and carcinoma of the bile ducts are relatively rare cancers in the United States. These cancers are often diagnosed in an advanced stage due to their nonspecific symptomatology and until recently have been associated with a dismal prognosis. Recent advances in imaging and surgical techniques along with emerging options in palliative chemotherapy have improved the outlook in these cancers. While complete surgical resection remains the only hope of cure in both these cancers, palliative biliary decompression and chemotherapy result in substantial improvement in quality of life. Part 1 of this review provides a relevant and comprehensive update of molecular pathology, imaging modalities, and surgical care. In part 2, which will appear next month, we will review palliative care and systemic therapy in gallbladder and biliary tract carcinomas, as well as the use of liver transplantation in the treatment of cholangiocarcinomas. These strategies are of relevance to internists as well as oncologists caring for these patients.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1990

[Three-dimensional imaging in plastic surgery. Application to the carpal bones and skull].

Since 1987, the authors have developed three-dimensional (3D) imaging of the carpus. This new application of imaging allows spatial visualization of the complex shapes of the carpal skeleton from all angles and from all illuminations. The development of this technique should lead to a better understanding of the intimate physiology of the carpus, allowing the construction of a model of the wrist enabling precise planning of operative procedures. It also helps to elucidate complex pathological images which are sometimes difficult to interpret on computed tomography scans. In parallel, the same process has been developed for the skull. It is particularly useful in cranio-facial surgery, especially in congenital deformities. Progress in this technique should allow surgical simulation on a video screen in the very near future.

Carpal Bones↗

PubMed2002

[A case of adenomyosis showing multiple large cysts on MR imaging].

Adenomyosis is a condition characterized by benign invasion of the endometrium into the myometrium associated with reactive hypertrophy of the surrounding musculature. The ectopic endometrium in adenomyosis is of the basalis type, and menstrual bleeding is less common than in endometriosis. We report a rare case of adenomyosis that had multiple, large, adenomyotic cysts. These cysts were located in the outer layer of adenomyosis on MR imaging. Pathologic features consisted of blood-filled cysts of 1 cm to 5 cm in maximum diameter of the functioning endometrial type.

Adult↗

PubMed1989

[Magnetic resonance tomography of the locomotor system with rapid image sequences].

Rapid imaging of the musculoskeletal system with gradient-echosequences exhibits important advantages. Scanning time is reduced to 1/50 up to 1/100. Depending on TR, TE and flip-angle T1 or T2*-weighted image contrast can be achieved with comparable information to spin-echo images. Gradient-echo techniques combined with 3D-data acquisition is especially advantageous. Within a few minutes imaging of the whole interesting volume with thin contiguous slices is possible as well as secondary reconstruction of any plane. Applications of 2D- and 3D-gradient-echo-sequences for imaging pathological conditions of the spine, pelvis, upper and lower extremities, with special regard of the knee joint, will be demonstrated.

Bone Diseases↗

PubMed2004

Bilateral epididymal sarcoidosis presenting without radiographic evidence of intrathoracic lesion: Review of sarcoidosis involving the male reproductive tract.

Sarcoidosis is a multisystem disorder that rarely involves the genitourinary tract. To date, only 59 cases of histologically proven sarcoidosis involving the male reproductive tract have been reported in the literature. We present here a case of bilateral epididymal sarcoidosis without radiographic evidence of intrathoracic lesion. A 46-year-old man presented with a one-week history of painless bilateral scrotal swellings. Physical examination detected multiple elastic firm nodules on both sides of the scrotum which showed no tenderness. The nodules seemed to involve the entire bilateral epididymides. Some irregularly shaped hypoechoic masses in the bilateral epididymides were identified on gray scale ultrasonography. On magnetic resonance images, the bilateral epididymides were seen to be enlarged, heterogeneous and nodular without any signs of testicular involvement. The lesion showed a slightly high signal intensity on the T2-weighted image. Pathological evaluation following bilateral epididymectomy found non-caseating epithelioid cell granulomas with giant cells in epididymal tissue, thus confirming a diagnosis of sarcoidosis. Gallium-67 scanning showed additional small hot spots in the anterior chest wall and extremities. Open biopsy of a superficial papular lesion in the dermis of the right upper arm was performed and pathological findings indicated sarcoid granulomas. This report also includes a review of the literature pertaining to sarcoidosis of the male reproductive tract.

Epididymis↗

PubMed1996

Glaucoma with inflammatory precipitates on the trabecular meshwork: a report of Grant's syndrome with ultrasound biomicroscopy of precipitates.

BACKGROUND: The syndrome of inflammatory precipitates on the trabecular meshwork is a rare form of inflammatory glaucoma that was described by Chandler and Grant in 1968 and subsequently given the eponym Grant's syndrome. METHODS: We present two cases of elevated intraocular pressure associated with inflammatory precipitates on the trabecular meshwork in otherwise relatively quiet eyes, consistent with Grant's syndrome. We review the epidemiology, clinical features, and mechanism of this syndrome. In addition, we demonstrate the use of ultrasound biomicroscopy for imaging angle inflammatory precipitates. RESULTS: Our patients demonstrate the cardinal features of Grant's syndrome, including acute onset, significant elevation of tension, trabecular meshwork precipitates in an otherwise quiet eye, limited response to typical pressure lowering agents, excellent response to topical steroids, evidence of recurrence with bilaterality, and systemic association with sarcoidosis. Ultrasound biomicroscopy proves to be a useful adjunct for pathologic imaging. CONCLUSIONS: The syndrome of glaucoma with inflammatory precipitates on the trabecular meshwork is a rare entity that should be considered as a possible diagnosis of elevated intraocular pressures in otherwise apparently quiet eyes.

Female↗

PubMed1990

[Three-dimensional imaging of the carpus].

Since 1987, the authors have developed three-dimensional (3D) imaging of the carpus. This reconstruction based on 30 CT scans of the carpus is a new approach to imaging and allows spatial visualisation of the complex shapes of the carpal skeleton from all angles. The development of this technique should lead to a better understanding of the intimate physiology of the carpus and should allow the development of a real simulator of the wrist for precise planning of surgical procedures (osteotomy, intracarpal arthrodeses, etc.). It also helps to elucidate complex pathological images which are not always easy to interpret on CT scans.

Carpal Bones↗