10 research outputs found
Case series of breast fillers and how things may go wrong: radiology point of view
INTRODUCTION: Breast augmentation is a procedure opted by women to overcome sagging
breast due to breastfeeding or aging as well as small breast size. Recent years have shown the
emergence of a variety of injectable materials on market as breast fillers. These injectable
breast fillers have swiftly gained popularity among women, considering the minimal
invasiveness of the procedure, nullifying the need for terrifying surgery. Little do they know
that the procedure may pose detrimental complications, while visualization of breast
parenchyma infiltrated by these fillers is also deemed substandard; posing diagnostic
challenges. We present a case series of three patients with prior history of hyaluronic acid and
collagen breast injections.
REPORT: The first patient is a 37-year-old lady who presented to casualty with worsening
shortness of breath, non-productive cough, central chest pain; associated with fever and chills
for 2-weeks duration. The second patient is a 34-year-old lady who complained of cough, fever
and haemoptysis; associated with shortness of breath for 1-week duration. CT in these cases
revealed non thrombotic wedge-shaped peripheral air-space densities.
The third patient is a 37‐year‐old female with right breast pain, swelling and redness for 2-
weeks duration. Previous collagen breast injection performed 1 year ago had impeded
sonographic visualization of the breast parenchyma. MRI breasts showed multiple non-
enhancing round and oval shaped lesions exhibiting fat intensity.
CONCLUSION: Radiologists should be familiar with the potential risks and hazards as well
as limitations of imaging posed by breast fillers such that MRI is required as problem-solving
tool
Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan
INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar
ligament on MRI between male and female. The specific objectives are to assess the prevalence
of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and
signal homogeneity and to find differences in alar ligament signal intensity between male and
female. This study also aims to determine the association between the heights of respondents
with alar ligament signal intensity and dimensions.
MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner
Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar
ligament is depicted in 3 planes and the visualization and variability of the ligament courses,
shapes and signal intensity characteristics were determined. The alar ligament dimensions were
also measured.
RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial
planes. The orientations were laterally ascending in most of the subjects (60%), predominantly
oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar
ligament signal intensity between male and female respondents. No significant association was
found between the heights of the respondents with alar ligament signal intensity and dimensions.
CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal
plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as
depicted in our data shows that caution needs to be exercised when evaluating alar ligament,
especially during circumstances of injury
[<sup>18</sup>F]fluorination of biorelevant arylboronic acid pinacol ester scaffolds synthesized by convergence techniques
Aim: The development of small molecules through convergent multicomponent reactions (MCR) has been boosted during the last decade due to the ability to synthesize, virtually without any side-products, numerous small drug-like molecules with several degrees of structural diversity.(1) The association of positron emission tomography (PET) labeling techniques in line with the “one-pot” development of biologically active compounds has the potential to become relevant not only for the evaluation and characterization of those MCR products through molecular imaging, but also to increase the library of radiotracers available. Therefore, since the [18F]fluorination of arylboronic acid pinacol ester derivatives tolerates electron-poor and electro-rich arenes and various functional groups,(2) the main goal of this research work was to achieve the 18F-radiolabeling of several different molecules synthesized through MCR. Materials and Methods: [18F]Fluorination of boronic acid pinacol esters was first extensively optimized using a benzaldehyde derivative in relation to the ideal amount of Cu(II) catalyst and precursor to be used, as well as the reaction solvent. Radiochemical conversion (RCC) yields were assessed by TLC-SG. The optimized radiolabeling conditions were subsequently applied to several structurally different MCR scaffolds comprising biologically relevant pharmacophores (e.g. β-lactam, morpholine, tetrazole, oxazole) that were synthesized to specifically contain a boronic acid pinacol ester group. Results: Radiolabeling with fluorine-18 was achieved with volumes (800 μl) and activities (≤ 2 GBq) compatible with most radiochemistry techniques and modules. In summary, an increase in the quantities of precursor or Cu(II) catalyst lead to higher conversion yields. An optimal amount of precursor (0.06 mmol) and Cu(OTf)2(py)4 (0.04 mmol) was defined for further reactions, with DMA being a preferential solvent over DMF. RCC yields from 15% to 76%, depending on the scaffold, were reproducibly achieved. Interestingly, it was noticed that the structure of the scaffolds, beyond the arylboronic acid, exerts some influence in the final RCC, with electron-withdrawing groups in the para position apparently enhancing the radiolabeling yield. Conclusion: The developed method with high RCC and reproducibility has the potential to be applied in line with MCR and also has a possibility to be incorporated in a later stage of this convergent “one-pot” synthesis strategy. Further studies are currently ongoing to apply this radiolabeling concept to fluorine-containing approved drugs whose boronic acid pinacol ester precursors can be synthesized through MCR (e.g. atorvastatin)
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Development of computer-based algorithms for unsupervised assessment of radiotherapy contouring
INTRODUCTION: Despite the advances in radiotherapy treatment delivery, target volume
delineation remains one of the greatest sources of error in the radiotherapy delivery process,
which can lead to poor tumour control probability and impact clinical outcome. Contouring
assessments are performed to ensure high quality of target volume definition in clinical trials
but this can be subjective and labour-intensive.
This project addresses the hypothesis that computational segmentation techniques, with a given
prior, can be used to develop an image-based tumour delineation process for contour
assessments. This thesis focuses on the exploration of the segmentation techniques to develop
an automated method for generating reference delineations in the setting of advanced lung
cancer. The novelty of this project is in the use of the initial clinician outline as a prior for
image segmentation.
METHODS: Automated segmentation processes were developed for stage II and III non-small
cell lung cancer using the IDEAL-CRT clinical trial dataset. Marker-controlled watershed
segmentation, two active contour approaches (edge- and region-based) and graph-cut applied
on superpixels were explored. k-nearest neighbour (k-NN) classification of tumour from
normal tissues based on texture features was also investigated.
RESULTS: 63 cases were used for development and training. Segmentation and classification
performance were evaluated on an independent test set of 16 cases. Edge-based active contour
segmentation achieved highest Dice similarity coefficient of 0.80 ± 0.06, followed by graphcut
at 0.76 ± 0.06, watershed at 0.72 ± 0.08 and region-based active contour at 0.71 ± 0.07,
with mean computational times of 192 ± 102 sec, 834 ± 438 sec, 21 ± 5 sec and 45 ± 18 sec
per case respectively. Errors in accuracy of irregularly shaped lesions and segmentation
leakages at the mediastinum were observed.
In the distinction of tumour and non-tumour regions, misclassification errors of 14.5% and
15.5% were achieved using 16- and 8-pixel regions of interest (ROIs) respectively. Higher
misclassification errors of 24.7% and 26.9% for 16- and 8-pixel ROIs were obtained in the
analysis of the tumour boundary.
CONCLUSIONS: Conventional image-based segmentation techniques with the application of
priors are useful in automatic segmentation of tumours, although further developments are
required to improve their performance. Texture classification can be useful in distinguishing
tumour from non-tumour tissue, but the segmentation task at the tumour boundary is more
difficult. Future work with deep-learning segmentation approaches need to be explored.Funded by National Radiotherapy Trials Quality Assurance (RTTQA) grou