Current Issue : October-December Volume : 2023 Issue Number : 4 Articles : 5 Articles
Background A quantitative assessment of pulmonary edema is important because the clinical severity can range from mild impairment to life threatening. A quantitative surrogate measure, although invasive, for pulmonary edema is the extravascular lung water index (EVLWI) extracted from the transpulmonary thermodilution (TPTD). Severity of edema from chest X-rays, to date is based on the subjective classification of radiologists. In this work, we use machine learning to quantitatively predict the severity of pulmonary edema from chest radiography. Methods We retrospectively included 471 X-rays from 431 patients who underwent chest radiography and TPTD measurement within 24 h at our intensive care unit. The EVLWI extracted from the TPTD was used as a quantitative measure for pulmonary edema. We used a deep learning approach and binned the data into two, three, four and five classes increasing the resolution of the EVLWI prediction from the X-rays. Results The accuracy, area under the receiver operating characteristic curve (AUROC) and Mathews correlation coefficient (MCC) in the binary classification models (EVLWI < 15, ≥ 15) were 0.93 (accuracy), 0.98 (AUROC) and 0.86(MCC). In the three multiclass models, the accuracy ranged between 0.90 and 0.95, the AUROC between 0.97 and 0.99 and the MCC between 0.86 and 0.92. Conclusion Deep learning can quantify pulmonary edema as measured by EVLWI with high accuracy....
Background A timely diagnosis is essential for improving breast cancer patients’ survival and designing targeted therapeutic plans. For this purpose, the screening timing, as well as the related waiting lists, are decisive. Nonetheless, even in economically advanced countries, breast cancer radiology centres fail in providing effective screening programs. Actually, a careful hospital governance should encourage waiting lists reduction programs, not only for improving patients care, but also for minimizing costs associated with the treatment of advanced cancers. Thus, in this work, we proposed a model to evaluate several scenarios for an optimal distribution of the resources invested in a Department of Breast Radiodiagnosis. Materials and methods Particularly, we performed a cost-benefit analysis as a technology assessment method to estimate both costs and health effects of the screening program, to maximise both benefits related to the quality of care and resources employed by the Department of Breast Radiodiagnosis of Istituto Tumori “Giovanni Paolo II” of Bari in 2019. Specifically, we determined the Quality-Adjusted Life Year (QALY) for estimating health outcomes, in terms of usefulness of two hypothetical screening strategies with respect to the current one. While the first hypothetical strategy adds one team made up of a doctor, a technician and a nurse, along with an ultrasound and a mammograph, the second one adds two afternoon teams. Results This study showed that the most cost-effective incremental ratio could be achieved by reducing current waiting lists from 32 to 16 months. Finally, our analysis revealed that this strategy would also allow to include more people in the screening programs (60,000 patients in 3 years)....
Eclampsia is a common complication of hypertensive disorders of pregnancy and in the puerperium with the attendant risk to both the mother and baby. Although it is a multi-systemic disorder, its manifestation that affects the brain and resulting in altered sensorium demands brain imaging to define the possible brain lesions and the implications for critical care management and outcome. We evaluated the CT brain lesions in the patients with eclampsia who were admitted in the intensive care unit, University of Port Harcourt, Port Harcourt Nigeria. Objective: To analyse the CT brain images of eclamptic parturients and the outcome following their admission in the intensive care unit. Methods: We undertook this observational study after obtaining ethical exemption from the University of Portharcourt Teaching Hospital ethical review board, and commenced the review between March 2021 to February 2023. We included all parturients that were admitted into the intensive care unit of the University of Portharcourt Teaching Hospital, a nine-bedded open intensive care unit with the clinical diagnosis of eclampsia. Every admitted parturient was required to obtain a brain computed tomography (CT) by local protocol. The brain CT images were retrieved for review from the parturients’ relatives, radiology department and the ICU. Parturients included were aged ≥ 18 years. The radiological reports of these brain images which were also reviewed by a neurosurgeon in case of any need for secondary opinion were subjected to statistical analysis. Result: Thirty-one parturients were admitted with eclampsia with a mean age of 30 years ± 5.29. Sixteen (16) parturients died representing 52%. Only twenty-four (24) CT brain images were retrieved for review (77%). The following brain lesions were identified from the brain CT and they comprised the following: intracerebral haemorrhage, including extensions into the ventricles 7 (29.17%), cerebral oedema 12 (50%), subdural hematoma 1 (4.17%) and normal imaging 4 (16.66%). The subdural haematoma was promptly evacuated with a good outcome. Conclusion: Neuro imaging comprising computed tomography and magnetic resonance imaging of the brain are basic ancillary investigations for patients with eclampsia presenting with neurologic deficits and low GCS. Early presentation and access to brain CT could influence outcome as it was demonstrated in the prompt intervention in the patient with subdural haematoma which was evacuated with a satisfactory outcome....
Background Enchondromas (EC) and atypical cartilaginous tumours (ACT) of the knee joint represent benign/ intermediate chondromatous neoplasms of the bone that are most commonly discovered incidentally. Based on small to intermediate-sized cohorts, the prevalence of cartilaginous tumours of the knee as visible in MRI is estimated at 0.2–2.9%. This study aimed at verifying/challenging these numbers via retrospective examination of a larger, uniform patient cohort. Methods Between 01.01.2007 and 01.03.2020, 44,762 patients had received an MRI of the knee for any indication at a radiologic centre. Of these, 697 patients presented with MRI reports positive for cartilaginous lesions. In a three-step workflow, 46 patients were excluded by a trained co-author, a radiologist and an orthopaedic oncologist, as wrongly being diagnosed for a cartilage tumour. Results Of 44,762 patients, 651 presented with at least one EC/ACT indicating a prevalence of 1.45% for benign/ intermediate cartilaginous tumours of the knee joint (EC: 1.4%; ACTs: 0.05%). As 21 patients showed 2 chondromatous lesions, altogether 672 tumours (650 ECs [96.7%] and 22 ACTs [3.3%]) could be analysed in terms of tumour characteristics: With a mean size of 1.6 ± 1.1 cm, most lesions were located in the distal femur (72.9%), in the metaphysis of the respective bone (58.9%) and centrally in the medullary canal (57.4%). Conclusions This study revealed an overall prevalence of 1.45% for cartilage lesions around the knee joint. Whilst a constant increase in prevalence was found for ECs over 13.2 years, prevalence remained constant for ACTs....
Background: Magnetic Resonance Imaging (MRI) is a valuable diagnostic tool but often requires sedation to complete, especially in children. Dexmedetomidine (DEX) is an a2 agonist, for which there are experimental findings that support its potential neuroprotective effects. Given the potential risks of anesthetic drugs, we ran this study to examine DEX’s effectiveness and cardiopulmonary safety as a sedative drug for children undergoing MRI. Material and Methods: Systematic research was conducted in PubMed, Google Scholar, Scopus and Cochrane databases for randomized controlled trials published between 2010 and 6th/2022 and involving children undergoing MRI who received DEX as sedative medication. The records which met the including criteria, after indexing via the PRISMA chart and assessing for bias, were processed, and a meta-analysis was carried out with the random effects method. Results: Thirteen studies were included. Out of 6204 measurements obtained, in 4626, it was planned for the participants to only receive DEX (measure group) as an anesthetic drug throughout the procedure. The participants’ mean age was 57 months (I2 = 4%, τ2 = 0.5317, p = 0.40). A total of 5.6% (95% CI: 0.6–14.1%, I2 = 98%, p < 0.01) of the patients needed a second dose of DEX. In total, 6% (95% CI: 1–15%, I2 = 93%, τ2 = 0.0454, p < 0.01) required the administration of another drug, besides DEX, to complete the imaging (sedation failure). The effectiveness of the only-DEX method was 99% (95% CI: 97.5–100%, I2 = 81%, τ2 = 0.0107, p < 0.01). The whole rate of adverse events was 15% (95% CI: 9.3–21.5%, I2 = 92%, p < 0.01). Hypotension was reported in 8.7% of the cases (95% CI: 3.1–16.4%, I2 = 84%, p < 0.01), hypertension in 1.1% (95% CI: 0–5.4%, I2 = 89%, p < 0.01), bradycardia in 10% (95% CI: 4–18%, I2 = 95%, p < 0.01) and desaturation in 1.2% (95% CI: 0–4%, I2 = 68%, p < 0.01). There was no statistically significant incidence in respiratory rate decrease (comparing the children who received DEX to their baseline). Five cases of vomiting and one of apnea were recorded. Conclusions: Given that DEX seems to be an effective as well as respiratory and hemodynamically safe drug, it may be a future spotlight in (pediatric) sedation for imaging procedures such as MRI....
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