Increasing CAD system efficacy for lung texture analysis using a convolutional network

International audienceThe infiltrative lung diseases are a class of irreversible, non-neoplastic lung pathologies requiring regular follow-up with CT imaging. Quantifying the evolution of the patient status imposes the development of automated classification tools for lung texture. For the large majority of CAD systems, such classification relies on a two-dimensional analysis of axial CT images. In a previously developed CAD system, we proposed a fully-3D approach exploiting a multi-scale morphological analysis which showed good performance in detecting diseased areas, but with a major drawback consisting of sometimes overestimating the pathological areas and mixing different type of lung patterns. This paper proposes a combination of the existing CAD system with the classification outcome provided by a convolutional network, specifically tuned-up, in order to increase the specificity of the classification and the confidence to diagnosis. The advantage of using a deep learning approach is a better regularization of the classification output (because of a deeper insight into a given pathological class over a large series of samples) where the previous system is extra-sensitive due to the multi-scale response on patient-specific, localized patterns. In a preliminary evaluation, the combined approach was tested on a 10 patient database of various lung pathologies, showing a sharp increase of true detections

US-guided percutaneous treatment and physical therapy in rotator cuff calcific tendinopathy of the shoulder: outcome at 3 and 12 months

Objectives To monitor the results of ultrasound (US)-guided percutaneous treatment of calcific tendinopathy of the shoulder at 12 months (T12) after treatment (T0). To verify the possible relations between some pre- and post-procedural variables with the clinical outcome at T12. Methods Forty-seven patients (26 female and 21 male) were enrolled in the study. Patients' approval and written informed consent were obtained. Symptoms were assessed by Constant Shoulder Score (CSS) at T0 and T12. Thirty of these also underwent a CSS control at 3 months (T3). The treatment efficacy was statistically tested for relation with location and type of calcification, characteristics of the tendon and subdeltoid bursa, impingement, and rehabilitation treatments. Results There was a significant increase in the average CSS value between T0 and T12 (40.7 vs. 75.3). The variables analysed did not show a statistically significant effect on the outcome at T12. A link was noticed only between patients' increasing age and score improvement, particularly among female subjects. Conclusion US-guided treatment of calcific tendonitis is a viable therapeutic option. No pre- or intra-procedural parameters emerged which might help in predicting the outcome, apart from patients' needs in everyday life

Grading lung neuroendocrine tumors: Controversies in search of a solution

Background. Pathological grading of tumors is a way to measure biological aggressiveness. In lung neuroendocrine tumors (NET), grading is tautologically included into the current 2015 WHO histologic classification. Little is known, however, about alternative grading systems in lung NET. Methods. Through an extensive search of the English literature on lung NET (updated to April 2016), the following key questions were addressed: a) current concepts of grading; b) clinicians’ requests for grading; c) functional parameters for grading; d) Ki-67 labeling index (LI) for grading; e) towards an effective pathology grading system. Results. There is some room for inconsistency in the histologic classification of lung NET, likely due to the varying attribution of defining criteria. Innovative diffusion-weighted imaging upon magnetic resonance or molecular analysis could help separate indolent from aggressive lung NET, thus integrating a grading approach other than histology. Troubles in the clinical handling of metastatic or individual tumors when relying on morphology alone support the development of a lungspecific grading system for the more accurate prediction of prognosis and planning therapy in individual patients. To integrate the 2015 WHO classification using innovative grading based on Ki-67 LI, mitotic count and necrosis, a new proposal is emerging where three categories of lung NET are identified, namely Lu-NET G1, Lu-NET G2 and Lu-NET G3, which would allow tumors with similar behavior and therapy to be better handled according to their own biological potential. Conclusion. A new formulation of lung NET grading could have clinical relevance for the individual handling of patients. Key words

Update Of Disease Activity Assessment In Rheumatoid Arthritis: Comparison Between Clinical, Ultrasound And Mri Scores And Introduction Of Volumetric Inflammation Measure Concept

Background: Therapeutic decisions in rheumatoid arthritis (RA) are driven by the estimated grade of disease activity. It is clinically evaluated by composite scores such as DAS28, SDAI and CDAI (1). Ultrasound (US) and MRI imaging of the joints provide further characterization of disease activity. US assessments search for the presence of synovitis, joint effusion and Power Doppler (PD) scored semi-quantitatively from 0-3 on joints of DAS28 or proposed reduced score systems (2). MRI joint imaging is evaluated through RAMRIS (RA MRI Scoring) grading separately with a semi-quantitative score (0-3) synovitis after contrast enhancement (CE-MRI), extension of bone marrow edema and erosions on 7 joints of each hand. In 2010 SAMIS (Simplified RA MRI Score) was proposed for reducing examination time by analyzing the most tender or dominant hand only (3). Despite all efforts for objectively quantifying disease activity, all evaluations depend on the subjective feeling of patient or examiner and on the interpretation of imaging data. Objectives: Comparison of clinical, US and MRI scores and volumetric measure of synovial inflammation by dedicated MRI software. Methods: Methods: Clinical data (CRP, ESR, DAS28, CDAI, SDAI and HAQ) were collected from 32 RA patients. Rheumatologists assessed further the number of joints positive for presence of synovitis, effusion and PD (DAS28 and 12-joint US score). Three radiologists independently performed RAMRIS and SAMIS validation on CE-MRI. Moreover, an software was developed in house to estimate total volume of contrast perfusion in joint spaces of both hands. Correlations were analyzed by Spearmen test. Results: SAMIS and RAMRIS correlated significantly for synovitis, edema and erosions (p<0,0001). Interoperator agreement was nearly perfect (Kendall coefficient=0,99). SAMIS and RAMRIS synovitis correlated significantly with DAS28, SDAI, CDAI, HAQ, PCR and ESR (p<0,05), whereas US scores did neither correlate with MRI nor clinical scores. The measure of \u201cinflammation volume\u201d estimated with the software was assumed to be a proxy of synovitis, but did not correlate with clinical, US and MRI scores. Conclusions: MRI remains the gold standard for estimating disease activity in RA, since it correlates with clinical scores more than US-derived scores. Software evaluation of total contrast perfusion or \u201csynovitis volume\u201d is an objective measurement that might provide an independent variable, but its role has yet to be fully tested

MR and CEUS monitoring of patients with severe rheumatoid arthritis treated with biological agents: a preliminary study

PURPOSE: This study was done to propose a study protocol for patients with rheumatoid arthritis (RA) treated with biological agents, by evaluating the contribution of contrast-enhanced magnetic resonance (CE-MR) imaging, a software programme that calculates the volume of synovitis on CE-MR images, and contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS: Sixteen patients with RA receiving treatment with biologics were analysed. The patients underwent clinical examination, CE-MR imaging and CEUS on the same day. Images were postprocessed with the software and evaluated independently by three physicians in terms of RAMRIS (Rheumatoid Arthritis Magnetic Resonance Imaging Score), SAMIS (Simplified Rheumatoid Arthritis Magnetic Resonance Imaging Score) and CEUS grade. The techniques were correlated statistically. RESULTS: The RAMRIS and SAMIS scores were found to correlate statistically. CE-MR imaging correlated with the clinical data (p < 0.05), whereas CEUS did not. The data provided by the software did not correlate statistically with the other techniques. The most painful joint was consistently found to be the joint with most synovitis. CONCLUSIONS: CE-MR imaging may be used prior to treatment and for long-term follow-up. CEUS might be useful in the short-term follow-up, as it seems to provide an indication of the presence or absence of disease, though not of its severity. The software is a very useful tool that can supplement, but not replace, the other techniques