Polarization Color Imaging System for On-Line Quantitative Evaluation of Facial Skin Lesions

BACKGROUND A number of studies have been performed for accurate evaluation of chromophores in skin lesions. Qualitative methods are subjective and cause user-dependent error in evaluation. Quantitative methods have limitations for widely distributed skin lesions due to poor spatial resolution, potential skin blanching, and difficulty in relocating identical sites for subsequent measurements and analysis.
OBJECTIVE The objective was to develop a new imaging modality that provides both qualitative and quantitative methods to evaluate widely distributed skin lesions.
METHODS We have developed a prototype polarization color imaging system named "DermaVision," which provides quantitative on-line image analysis of polarization color images. Herein, we describe the hardware and software of DermaVision in terms of its performance and usefulness for dermatologic applications.
RESULTS Polarization color images were successfully acquired from patients with vascular or pigmented skin lesions. The erythema and melanin index images were successfully computed and quantitatively confirmed the degree of erythema and pigmentation in the skin lesions.
CONCLUSION We believe that DermaVision can be a useful auxiliary tool in dermatology because it simultaneously provides both qualitative and quantitative images of skin lesions.     

Vibrography: first experimental results in swine brains.

OBJECT: The aim of this study was to determine whether vibrography, an ultrasound-based real-time strain imaging method for registering the elastic properties of tissue, is superior to conventional ultrasound imaging techniques for detecting low-contrast space-occupying lesions in brain tissue and for delineating the boundaries between such lesions and the surrounding tissue. METHODS: As our experimental model we used swine brains taken from freshly slaughtered pigs. After injecting agarose into these brains at different depths, we compared both the conventional ultrasonographic images and the elastographic images of the region of interest with the corresponding anatomical brain sections. RESULTS: In 83.6 % of the experiments, it was possible to detect the polymerized agarose in the brain tissue with vibrographic techniques. In 17 experiments agarose lesions which were not detectable by ultrasound were visualized via vibrography. Furthermore, statistical analysis revealed that elastography is a more precise tool than conventional ultrasound for determining lesion size. CONCLUSION: These findings indicate that vibrography is a promising real-time imaging method with numerous potential applications in the field of neurosurgery. Visualization of the elastic properties provides the neurosurgeon with additional data on the lesion and the boundary between the lesion and the surrounding tissue.     

Iatrogenic issues in breast pathology

Modern breast imaging techniques include digital mammography, 3‐dimensional tomography, high‐resolution ultrasound, and magnetic resonance imaging. Each of these has enabled the diagnosis of ever smaller, largely non‐palpable lesions, not all of which require surgery. As these techniques evolved, so too did methods of accurately targeting and sampling the lesions, necessitating methods to mark the areas should surgical localization be needed. These methods have introduced heretofore unseen histologic changes to both breast tissue and lymph nodes, especially sentinel lymph nodes. These changes are the topic of this review.     

MR imaging of head trauma: visibility of contusions and other intraparenchymal injuries in early and late stage

The aim of this study was to investigate the visibility of traumatic brain lesions on conventional magnetic resonance images (MRI) in early and late phase. Thirty-six patients were studied 1 week and 1 year after a traumatic brain injury. A similar MRI technique was used in both studies; T₂-weighted fast or turbo spin echo images, fluid attenuated inversion recovery (FLAIR) images and T₁-weighted images were used for analysis. The number and extent of contusions and semi-quantitative score of other traumatic intraparenchymal lesions were compared in the early and late phase. Contusions were seen in 18 patients both in acute and 1 year MRI; the number and extent of visible contusions was significantly decreased at 1 year. Other traumatic intraparenchymal lesions were detected in 12 patients in early MRI and in 10 patients in late MRI. The number of visible lesions and the semi-quantitative scores were significantly lower at 1 year. There is a significant decrease in the visibility of both cortical contusions and other intraparenchymal injuries in late MRI studies compared with studies in acute stage using conventional imaging techniques. Thus, early phase MRI is essential for the detection of brain injury at least using conventional imaging techniques.     

四种精液检测方法的比较和临床评价

目的 对以色列计数板(IC)、Makler计数板(MC)、精子质量分析仪(SQA)和血细胞计数板(CC)应用于精液常规分析的结果进行比较，并作出评估。方法 用4四种方法对来自有正常生育力的健康男性的64份精液标本进行分析。结果 在计数精子密度方面，IC、MC和SQA的结果有较好的一致性，3者之间无统计学上显著性差异；而CC与IC和SQA之间存在统计学上显著性差异，其P值分别为0．002和0．005。在计数精子活率方面，CC与MC和SQA之间也有统计学上显著性差异，其P值分别为0和0．02。我们使用了IC和MC检测前向运动精子百分率，结果显示两者之间无统计学上显著性差异，两者之间有较好的一致性。结论 在精液常规分析中，IC、MC和SQA这3种方法的结果虽具有较好的一致性，但不如CC准确，在临床应用时，应注明使用何种方法进行测定；也可将IC、MC和SQA等方法与CC进行比较，计算出校正系数予以调整。     

Spinous process marking: a reliable method for preoperative surface localization of intradural lesions of the high thoracic spine

Surgical exposure of intradural lesions in the thoracic spine requires intraoperative landmarks to identify the vertebral level. If spinal neuronavigation is not available, the surgeon must rely on alternative localizing methods. Intraoperative fluoroscopy is traditionally used to count the vertebrae throughout the whole spine. In the high thoracic spine, counting the vertebrae is often hampered by the scapular shadows. In these cases, a preoperative marking procedure seems preferable. Magnetic resonance imaging (MRI) based techniques have been increasingly reported, but they share an intrinsic risk of error due to the skin shift occurring at the time of surgery. We describe here a simple technique for unequivocal identification of the vertebral target. In six patients undergoing surgery for intradural lesions of the high thoracic spine, the spinous process of the vertebra corresponding to the lesion was preoperatively identified on an anteroposterior radiograph view and marked infiltrating its tip with a blue dye. At surgery, the vertebral target was identified easily and immediately. No errors occurred. No complications related to the technique were observed. Preoperative marking of the vertebral spinous process with a coloured dye is a simple and unequivocal guide to expose intradural lesions in the high thoracic spine.     

Surgical management for supratentorial astrocytic tumors.

To compare the surgical treatment of supratentorial astrocytic tumors, various methods were performed by the same surgeon. Removal of the tumor was performed using stereotactic open surgery, the fluorescein surgical microscope, and a frameless stereotactic system, and these methods were compared. The method using the stereotactic technique was useful because there was no disturbance by the shifting of the brain during the operation. However, its limitation was that only points can be marked. The fluorescein surgical microscope was very useful in the cases where neuroradiological images were enhanced by the contrast medium, but deep lesions could not be identified from the brain surface. This method could not be used, either, in the case of images that were not enhanced. By the method using the frameless stereotactic system, identification of tumors including deep lesions was possible from every direction, but the problems were the mobility of the registered skin and the shifting of the brain during the operation. On the basis of these results, the combined method of the fluorescein surgical microscope and the frameless stereotactic system appeared to be useful when neuroradiological images of lesions were enhanced because these methods were complementary towards each other, and the frameless stereotactic system supplemented by the stereotactic open surgery technique (such as leaving a marker in deep lesions just before the start of microsurgery) seemed useful when images could not be enhanced.     

Computer processing of CT images: advances and prospects

Computerized tomography (CT) images are created by computer and as such are inherently amenable to computer image processing techniques. Advances have been made in the areas of alternative visualization (coronal views, etc.), image enhancement, feature extraction, and computer analysis of the extracted information. Further advances await imaginative application of these techniques and time; others will depend upon necessary advances in image processing methods.     

Endoscopic Suturing and Knot Tying: Theory Into Practice

OBJECTIVE: To advance modern surgical techniques of endoscopic knot tying, encompassing a new appreciation of knot-tying theory and the application of second-generation, purpose-designed instruments. SUMMARY BACKGROUND DATA: During open surgery, surgeons automatically create the surgical half-hitch by using either instrument or hand/finger knot-tying methods (figure 4). Each of these methods, which are mirror images of each other, forms the same result, the half-hitch. Two opposing half-hitches are needed to form a square knot. There are many ways for new-generation instruments to create a secure square knot during endoscopic surgery. An overview of the current endoscopic knot-tying methods is presented. METHODS: The author presents a theoretical analysis of square knot-tying techniques as applied during instrument and hand/finger movements. The application of a mirror-image concept was considered in the analysis of these two contrasting methods. RESULTS: There are 12 ways to create a square knot, some of which have previously not been described or needed in open surgery. Some of these methods have particular application in endoscopic surgery. CONCLUSIONS: A new understanding of knot-tying theory has been developed, with innovative methods being defined for tissue approximation during endoscopic surgery. These ergonomic, efficient, and contrasting methods of knot tying are described using second-generation endoscopic instruments. The new techniques have direct and broad application in many fields of minimally invasive surgery.     

Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology.

OBJECTIVE: To compare intraoral periapical radiography with 3D images for the diagnosis of periapical pathology. STUDY DESIGN: Maxillary molars and premolars and mandibular molars with endodontic problems and examined with periapical radiographs and a 3D technique (3D Accuitomo) were retrospectively selected and evaluated by 3 oral radiologists. Numbers of roots and root canals, presence and location of periapical lesions, and their relation to neighboring structures were studied. RESULTS: Among 46 teeth, both techniques demonstrated lesions in 32 teeth, and an additional 10 teeth were found in the Accuitomo images. As regards individual roots, 53 lesions were found in both techniques, and 33 more roots were found to have lesions in Accuitomo images. Artefacts were sometimes a problem in Accuitomo images. In 32 of the 46 cases, all observers agreed that additional clinically relevant information was obtained with Accuitomo images. CONCLUSIONS: A high-resolution 3D technique can be of value for diagnosis of periapical problems.     

Brain surface reformatted images for fast and easy localization of perirolandic lesions

OBJECT: The goal of this study was to evaluate a novel form of brain surface representation that allows simple, reliable mapping of the surface neuroanatomy for the preoperative evaluation of the spatial relationship between a focal lesion and the precentral gyrus. METHODS: High-resolution three-dimensional (3D) magnetic resonance (MR) imaging data sets were postprocessed using a curved multiplanar reformatting technique to create brain surface reformatted (BSR) images. These BSR images were reconstructed in less than 5 minutes and demonstrated the entire central sulcus with adjacent surface structures in one view. Two experienced neuroradiologists determined the localization of lesions near the central sulcus in 27 patients on standard MR images in three orthogonal planes and on BSR images. In addition, these observers judged whether the lesions were easy or difficult to localize on standard MR and BSR images, and whether diagnoses based on these methods were certain or doubtful. Anatomical localization based on BSR images was compared with that based on functional MR (fMR) images or intraoperative mapping of motor function. The BSR images yielded a perfect concordance with the fMR images and intraoperative mapping (Cohen kappa 1.0) and optimal diagnostic accuracy in localizing perirolandic lesions (both sensitivity and specificity were 100%). Localization was judged to be easy for 48 of 54 diagnoses based on BSR images compared with 26 of 54 based on standard MR images. Diagnoses were assessed as certain for 52 cases based on BSR images and 34 cases based on standard MR images. CONCLUSIONS: Brain surface reformatted imaging improves the diagnostic accuracy of standard anatomical MR imaging for localizing superficial brain lesions in relation to the precentral gyrus. The complementary use of this technique with standard two-dimensional imaging is supported by the fast and simple postprocessing technique and may provide useful information for preoperative surgical planning.     

Editorial Commentary: Do We Need to Treat All Lesions Operatively in Elbow Terrible Triad?

Arthroscopic reduction and fixation techniques in elbow surgery are evolving, and more and more literature is describing good outcomes of new arthroscopic fixation methods for coronoid fractures, lateral collateral ligament tears, radial head fractures, or capsular avulsions. The possible next step could be to use all these different techniques in cases in which all the described lesions can be seen. However, the question is if this approach is too aggressive. Although it is technically feasible to perform, this approach may not be necessary.     

Utility of fractional anisotropy imaging analyzed by statistical parametric mapping for detecting minute brain lesions in chronic-stage patients who had mild or moderate traumatic brain injury

Diffusion tensor imaging (DTI) has recently evolved as valuable technique to investigate diffuse axonal injury (DAI). This study examined whether fractional anisotropy (FA) images analyzed by statistical parametric mapping (FA-SPM images) are superior to T(2)*-weighted gradient recalled echo (T2*GRE) images or fluid-attenuated inversion recovery (FLAIR) images for detecting minute lesions in traumatic brain injury (TBI) patients. DTI was performed in 25 patients with cognitive impairments in the chronic stage after mild or moderate TBI. The FA maps obtained from the DTI were individually compared with those from age-matched healthy control subjects using voxel-based analysis and FA-SPM images (p < 0.001). Abnormal low-intensity areas on T2*GRE images (T2* lesions) were found in 10 patients (40.0%), abnormal high-intensity areas on FLAIR images in 4 patients (16.0%), and areas with significantly decreased FA on FA-SPM image in 16 patients (64.0%). Nine of 10 patients with T2* lesions had FA-SPM lesions. FA-SPM lesions topographically included most T2* lesions in the white matter and the deep brain structures, but did not include T2* lesions in the cortex/near-cortex or lesions containing substantial hemosiderin regardless of location. All 4 patients with abnormal areas on FLAIR images had FA-SPM lesions. FA-SPM imaging is useful for detecting minute lesions because of DAI in the white matter and the deep brain structures, which may not be visualized on T2*GRE or FLAIR images, and may allow the detection of minute brain lesions in patients with post-traumatic cognitive impairment.     

Digital breast imaging: tomosynthesis and digital subtraction mammography

Advances in the computer technology and the introduction of new digital imaging detectors offer the potential for digital image acquisition and several new mammography techniques, such as tomosynthesis and digital subtraction mammography. Tomosynthesis is a method of obtaining tomographic images of a breast. In tomosynthesis, any number of tomographic planes may be reconstructed from a set of images obtained as the X-ray source is moved in an arc above the breast. By shifting and adding the information obtained at different source positions, any plane of the breast can be brought into a sharp focus, while structures outside this selected plane are blurred. This may lead to improved lesion detection, especially in dense breast tissue. Thus, tomosynthesis may play a role in improving breast cancer screening and lesion characterization. Digital subtraction mammography is a method of breast angiography. It is performed by obtaining a digital radiographic image before, and one or more digital radiographic images after the injection of a contrast agent such as iodine. The pre- and post-contrast images are subtracted, resulting in an image of the vascular structures in the breast. Because breast cancer lesions have increased vascularity, digital subtraction mammography may play an important role in improving lesion detection, characterizing lesions, monitoring response to therapy, and determining lesion extent.Thus, both of these new digital techniques have the potential to address the major limitation of conventional mammography, namely the difficulty in detecting cancer in radiographically dense breasts.     

Benign Diseases of the Bladder

Benign diseases of the bladder often present diagnostic challenges to practicing pathologists due to their diverse nature and ability to mimic a variety of epithelial or mesenchymal neoplasms. Categories of benign bladder disease include infectious cystitis, noninfectious cystitis, reactive proliferative processes, and benign processes that secondarily involve the bladder. An understanding of the key clinical and morphologic features of these lesions and the useful ancillary techniques specific for these entities is critical to the correct diagnosis of these lesions. This article reviews the key features of these benign bladder diseases and highlights methods to distinguish these lesions from other benign and malignant processes involving the bladder.     

The Heterozygous <Emphasis Type="Italic">Lemd3</Emphasis><Superscript><Emphasis Type="Italic">+/GT</Emphasis></Superscript> Mouse Is Not a Murine Model for Osteopoikilosis in Humans

Osteopoikilosis and the Buschke-Ollendorff syndrome are skeletal dysplasias with hyperostotic lesions in the long bones. These disorders are caused by heterozygous loss-of-function mutations in the LEMD3 gene. LEMD3 codes for a protein of the inner nuclear membrane that, through interaction with R-SMADs, antagonizes the BMP and TGFβ1 pathway. It is suggested that the hyperostotic lesions in these disorders are caused by enhanced BMP and TGFβ1 signaling. The exact mechanism by which mutations in the LEMD3 gene lead to these bone lesions has not yet been unraveled precisely. To further assess this, an Lemd3 gene–trapped mouse was created in a gene-trapping program by Baygenomics. To investigate whether the heterozygous gene-trapped mouse is a good model for osteopoikilosis in humans, we studied these mice radiologically with high-resolution micro-computed tomography (microCT) and histologically. X-ray images were evaluated by a trained radiologist, but no typical osteopoikilosis lesions could be recognized. On all microCT reconstructed images a 3D cortical and trabecular quantitative analysis was performed, investigating different histomorphometric parameters ranging from percent bone volume, bone surface/volume ratio over trabecular thickness, separation, number, and pattern factor to structure model index and fractal dimension. No significant differences were found after a t-test statistical analysis. Also, histological analysis did not reveal lesions typical for osteopoikilosis. We conclude that the heterozygous Lemd3 gene–trapped mouse is not a good model to study osteopoikilosis and the Buschke-Ollendorff syndrome.     

Soft agarose colony formation assay for human renal cell carcinoma: comparison of optical colony counting versus tritiated thymidine incorporation

Use of the Hamburger-Salmon soft agar assay method for in vitro chemotherapy sensitivity testing of samples of renal cell carcinoma has been somewhat limited by a relatively low proliferation/evaluability rate for this tumor type (approximately 50%). The tritiated thymidine ([ 3H]-TdR) incorporation assay method of Tanigawa et al. (Cancer Res., 42: 2159, 1982) was compared to a standard optical colony counting assay technique. Fifty-seven different primary and five metastatic fresh samples of human renal cell carcinoma were studied. Evaluability rate by the [3H]-TdR assay was 90% (greater than or equal to 300 cpm control). In comparison, evaluability rate by optical colony counting was 43% for this group of tumors. [3H]-TdR incorporation increased with increasing tumor grade and increasing stage. Spindle cell tumors showed significantly higher cpm than other cell types. Twenty-three primary tumors were evaluable by both [3H]-TdR and colony counting methods. The correlation coefficient ("r") for regression lines for drug sensitivity data points (optical counting vs. [3H]-TdR) of these individual experiments ranged from 0.50 to 0.99 with a mean r +/- S.D. of 0.76 +/- 0.15. For all 260 paired drug response observations of 23 tumors exposed to different drugs, the correlation was very good with r = 0.71. Since the [3H]-TdR assay has an evaluability rate of approximately 90% for renal cell carcinoma, gives drug sensitivity information which correlates well with the colony counting endpoint and yields chemotherapy sensitivity information four days after sample accession, the [3H]-TdR assay may be a more useful method for study of human renal cell carcinoma in vitro chemotherapy sensitivity testing than standard colony counting techniques.     

Dynamic nature of cavernous malformations: a prospective magnetic resonance imaging study with volumetric analysis

OBJECT: Although cavernous malformations (CMs) are not detected in angiographic studies, they have a characteristic appearance on magnetic resonance (MR) images. A number of reports published in the last decade have focused on the behavior of these lesions within the clinical environment. However, little has been published about the evolution of CMs over time, as observed in imaging studies. To understand imaging-documented changes in CMs over time, we analyzed MR images of 114 cavernous malformations in 68 patients who were followed prospectively. METHODS: For each CM the location, volume, and MR imaging signal characteristics were recorded. Volume data were available for 107 lesions from initial images. The mean volume of these 107 CMs was 2779 mm3. The lesions ranged in size from 0.5 to 46,533 mm3 (46.5 cm3). Volume data from a second set of images were available for 76 CMs (mean interval from first imaging session 26 months), and from a third set of images for 24 lesions (mean interval from second imaging session 18 months). Over the first follow-up interval, the mean volume change was -991 mm3 (a decrease of approximately 1 cm3) and over the second interval the mean volume change was -642 mm3. Although these mean volume changes appear modest, volume changes in single lesions during follow-up intervals were more dramatic, with decreases as large as 45,629 mm3 (45.6 cm3) and increases as large as 6,074 mm3 (6 cm3). Serial examinations of the MR imaging signal characteristics of these CMs demonstrate a trend for maturation of blood products from a subacute, to a mixed, and finally to a chronic appearance. Three lesions appeared de novo during the follow-up period. CONCLUSIONS: On the basis of their analysis, the authors conclude that CMs exhibit a range of dynamic behaviors including enlargement, regression, and de novo formation, as well as progression through a series of characteristic MR imaging appearances.     

The diagnosis and management of renal inflammatory processes in children

Renal inflammatory processes in children often present a diagnostic and therapeutic dilemma. Since the advent of improved diagnostic imaging techniques these lesions can be appreciated and defined better. An analysis of 12 children with renal inflammatory lesions treated at our institution clearly outlines the pathological spectrum of these lesions and provides a format for their diagnosis and management.     

Comparison between virtual and conventional colonoscopy in the screening of colorectal polyps

Aim of this study was to compare virtual and conventional colonoscopy for the detection of colon-rectal polyps. The authors studied 20 patients with these two methods and it was found that virtual colonoscopy is dependent on the size of lesions regarding sensitivity and specificity, is expensive and the learning process with reading images is very long.