Comparison of conservative treatment versus transcatheter arterial embolisation for the treatment of spontaneously ruptured hepatocellular carcinoma

Purpose: To elucidate the prognostic factors in the spontaneous rupture of hepatocellular carcinoma (HCC) and to determine whether transcatheter arterial embolisation (TAE) is associated with better prognosis compared to conservative treatment. Material and methods: A retrospective multicentre study was conducted involving 71 patients with spontaneous rupture of HCC. A conservative treatment group (Cons T group) included 20 patients, while a transcatheter arterial embolisation group (TAE group) included 51 patients. Results: The median survival time (MST) in the Cons T group was only 16 days and the survival rate was 39% at one month, whereas the MST in the TAE group was 28 days and the one month survival rate was 63%. However, there is no statistically significant difference in the overall survival between Cons T and TAE groups (p = 0.213). Multivariable analysis identified only the presence of distant metastasis as an independent prognostic factor (p = 0.023). A subanalysis including patients without distant metastasis showed that the presence of portal vein tumour thrombosis was a significant prognostic factor (p = 0.015). Conclusions: Distant metastasis appears to be a prognostic factor in spontaneous rupture of HCC. In cases without distant metastasis, portal vein tumour thrombosis could influence the prognosis. Our data failed to prove any benefit of TAE as the primary management

Accelerated Splenic Enlargement after Splenic Trauma: Influence of Splenic Arterial Embolization

Splenic injury is common in blunt trauma. As post-injury splenic volume changes are unclear, the aim of this study was to elucidate such changes. This retrospective study included 18 patients (14 males, median age 24.5 years) with a splenic injury treated between January 2009 and December 2016. All underwent computed tomography (CT) during admission to our hospital and at the last follow-up visit. The splenic volumes on the first and last enhanced delayed-phase CT scans were compared. The fluid response, transfusion, injury severity score, trauma grade, and extent of splenic artery embolization (SAE) were obtained from medical records. The volume change was assessed with a Mann-Whitney U-test. The volume change in patients treated conservatively was also evaluated to study the natural course after injury. On the first and last scans, the median splenic volume was 105.8 (interquartile range [IQR] 65.4–139.7) and 123.6 (IQR 102.0–225.0) cm3, respectively. The volume increased by 67 (-0.4 ± 120.0) %. SAE was the only factor significantly related to the volume change (p < 0.05). The median follow-up period was 13 (IQR 6–20) days. In conservatively treated patients, the splenic volume change was correlated with the interval between the first and last CT studies. Our findings suggest that the volume of the injured spleen increases in the natural course after trauma. SAE resulted in a decrease in the splenic volume

Experimental renal and hepatic artery embolization with a new embolic agent, atelocollagen, in a porcine model

PURPOSEWe aimed to investigate the potentiality of atelocollagen, a new embolic agent which is collagen type I in a porcine experimental model. MATERIALS AND METHODSThree pigs underwent transcatheter embolization of lower interlobular arteries of the renal artery (n=6) and one branch of the hepatic artery (n=3) with collagen type I. Angiography was performed prearterial, during, and postarterial embolization. After the procedure, samples from the embolized organs were evaluated by histological analysis. RESULTSSix lower interlobular renal arteries and three hepatic arteries were successfully embolized by administration of 0.8±0.3 mL and 2.9±1.2 mL, respectively, of the collagen type I. Histological findings of the embolized kidney specimens showed that the collagenous materials filled the arterial lumen, whose size ranged from 2.02 to 839.82 μm and reached the level of afferent arteries of glomerular tufts. Although the area of occluded arteries of the liver was smaller than the kidney, histological findings of the liver specimens showed that the collagenous materials filled small arterial lumens from 2.81 to 187.86 μm in diameter. CONCLUSIONAtelocollagen, a collagen type I, has the potential to be used to embolize the distal vessels of both renal and hepatic arteries

Content-based CT image retrieval system using deep learning: Preliminary assessment of its accuracy for classifying lesion patterns and retrieving similar cases among patients with diffuse lung diseases

Practical image retrieval systems must fully use image databases. We investigated the accuracy of our content-based computer tomography (CT) image retrieval system (CB-CTIRS) for classifying lesion patterns and retrieving similar cases in patients with diffuse lung diseases. The study included 503 individuals, with 328 having diffuse lung disease and 175 having normal chest CT scans. Among the former, we randomly selected ten scans that revealed one of five specific patterns [consolidation, ground-glass opacity (GGO), emphysema, honeycombing, or micronodules: two cases each]. Two radiologists separated the squares into six categories (five abnormal patterns and one normal pattern) to create a reference standard. Subsequently, each square was entered into the CB-CTIRS, and the F-score used to classify squares was determined. Next, we selected 15 cases (three per pattern) among the 503 cases, which served as the query cases. Three other radiologists graded the similarity between the retrieved and query cases using a 5-point grading system, where grade 5 = similar in both the opacity pattern and distribution and 1 = different therein. The F-score was 0.71 for consolidation, 0.63 for GGO, 0.74 for emphysema, 0.61 for honeycombing, 0.15 for micronodules, and 0.67 for normal lung. All three radiologists assigned grade 4 or 5 to 67.7% of retrieved cases with consolidation, emphysema, or honeycombing, and grade 2 or 3 to 67.7% of the retrieved cases with GGO or micronodules. The retrieval accuracy of CB-CTIRS is satisfactory for consolidation, emphysema, and honeycombing but not for GGO or micronodules

Deep Learning Predicts Rapid Over-softening and Shelf Life in Persimmon Fruits

In contrast to the progress in the research on physiological disorders relating to shelf life in fruit crops, it has been difficult to non-destructively predict their occurrence. Recent high-tech instruments have gradually enabled non-destructive predictions for various disorders in some crops, while there are still issues in terms of efficiency and costs. Here, we propose application of a deep neural network (or simply deep learning) to simple RGB images to predict a severe fruit disorder in persimmon, rapid over-softening. With 1,080 RGB images of ‘Soshu’ persimmon fruits, three convolutional neural networks (CNN) were examined to predict rapid over-softened fruits with a binary classification and the date to fruit softening. All of the examined CNN models worked successfully for binary classification of the rapid over-softened fruits and the controls with > 80% accuracy using multiple criteria. Furthermore, the prediction values (or confidence) in the binary classification were correlated to the date to fruit softening. Although the features for classification by deep learning have been thought to be in a black box by conventional standards, recent feature visualization methods (or “explainable” deep learning) has allowed identification of the relevant regions in the original images. We applied Grad-CAM, Guided backpropagation, and layer-wise relevance propagation (LRP), to find early symptoms for CNNs classification of rapid over-softened fruits. The focus on the relevant regions tended to be on color unevenness on the surface of the fruit, especially in the peripheral regions. These results suggest that deep learning frameworks could potentially provide new insights into early physiological symptoms of which researchers are unaware

Predicting Blood Flow from the Superior Mesenteric Artery to the Celiac Arterial Region on CT Angiography in Patients with Median Arcuate Ligament Syndrome

Purpose: This study aimed to assess whether computed tomography (CT) findings can be used to predict blood flow from the superior mesenteric artery (SMA) to the celiac artery (CA) region in patients with median arcuate ligament syndrome (MALS). Materials and methods: Two radiologists who reviewed 1,290 conventional SMA angiograms and CT scans identified 36 patients with MALS. MALS was classified by their blood flow angiography findings as type A (CA region not or barely visualized) and type B (CA region clearly visualized). The association between patient age, sex, post-stenotic dilatation ratio of the celiac axis, maximum diameter of the pancreaticoduodenal arcade (PDA), and MALS classification based on SMA angiography was assessed. Results: Of 36 MALS patients, 17 had MALS type A and 19 had MALS type B. The mean of the maximum diameter of the PDA in MALS type A was 1.6 ± 0.9 mm (SD) and 4.3 ± 1.3 mm in MALS type B. The poststenotic dilatation ratio of the celiac axis was 2.4 ± 1.2 in MALS type A and 2.2 ± 1.4 in MALS type B. Only maximum diameter of the PDA was a predictor of MALS type B (odds ratio, 15.7; 95% confidence interval, 2.3–108.1). Conclusion: The maximum diameter of the PDA on CT angiography can be used to predict the blood flow from the SMA to the CA region in patients with MALS

Relationship of flow-volume curve pattern on pulmonary function test with clinical and radiological features in idiopathic pulmonary fibrosis.

Background:The flow-volume (FV) curve pattern in the pulmonary function test (PFT) for obstructive lung diseases is widely recognized. However, there are few reports on FV curve pattern in idiopathic pulmonary fibrosis (IPF). In this study, we investigated the relationship between FV curve pattern and clinical or radiological features in IPF.Methods:The FV curves on PFTs and chest high-resolution computed tomography (HRCT) images of 130 patients with IPF were retrospectively evaluated. The FV curves were divided into four groups based on the presence or absence of the convex and concave patterns: convex/concave, non-convex/concave, convex/non-concave, and non-convex/non-concave. Using a computer-aided system, CT honeycombing area (%HA) and subtracted low attenuation area (%sLAA) were quantitatively measured. To assess the distribution of CT findings, the lung area was divided into upper, lower, central, and peripheral areas. The relationships of FV curve patterns with patient characteristics, spirometry results, and quantitative CT findings were evaluated.Results:The patients with convex pattern was identified in 93 (71.5%) and concave pattern in 72 (55.4%). Among the four groups, patients with the convex/non-concave pattern had significantly lower forced vital capacity (FVC) and higher %HA of the upper/peripheral lung area (p = 0.018, and p = 0.005, respectively). The convex/non-concave pattern was a significant predictor of mortality for IPF (hazard ratio, 2.19; p = 0.032).Conclusions:Patients with convex/non-concave pattern in FV curve have lower FVC and poorer prognosis with distinct distribution of fibrosis. Hence, FV curve pattern might be a useful predictor of mortality in IPF