Chest Radiograph (CXR) Manifestations of the Novel Coronavirus Disease 2019 (Covid-19) - A Mini-Review

Background Coronavirus disease 2019 (COVID-19) is highly contagious and has claimed more than one million lives, besides causing hardship and disruptions. The Fleischner Society has recommended chest X-ray (CXR) in detecting cases with high risk for disease progression, for triaging suspected patients with moderate-to-severe illness, and to eliminate false negatives in areas with high pre-test probability or limited resources. Although CXR is less sensitive than real-time reverse transcription polymerase chain reaction (RT-PCR) in detecting mild COVID-19, it is nevertheless useful because of equipment portability, low cost and practicality in serial assessments of disease progression among hospitalized patients. Objective This study aims to review the typical and relatively atypical CXR manifestations of COVID-19 pneumonia in a tertiary care hospital. Methods The CXRs of 136 COVID-19 patients confirmed through real-time RT-PCR from March to May 2020 were reviewed. Literature search was performed using PubMed. Results A total of 54 patients had abnormal CXR whilst the others were normal. Typical CXR findings included pulmonary consolidation or ground-glass opacities in a multifocal, bilateral peripheral or lower zone distribution, whereas atypical CXR features comprised cavitation and pleural effusion. Conclusion Typical findings of COVID-19 infection in chest computed tomography studies can also be seen in CXR. The presence of atypical features is associated with worse disease outcome. Recognition of these features on CXR will improve accuracy and speed of diagnosing COVID-19 patients

MRI of Breast Lymphoma: A Report of Two Cases with Emphasis on Diffusion Weighted Imaging and Apparent Diffusion Coefficient Value

Breast lymphoma is a rare neoplasm that accounts for approximately 0.04-0.5% of breast malignancies. Most breast lymphomas are B-cell type non-Hodgkin lymphomas. The imaging features of breast lymphoma on mammography and ultrasound are nonspecific. There have been several reports on magnetic resonance imaging characteristics of breast lymphoma but only few have described features on diffusion weighted imaging. Herein, we describe the magnetic resonance imaging findings, with emphasis on diffusion weighted imaging and the apparent diffusion coefficient sequences, of two cases of breast lymphoma and compare them with the magnetic resonance imaging features reported in the literature

Myofibroblastoma of the breast

Introduction: Myofibroblastoma is a rare benign mesenchymal tumour arising from the stromal elements of the breast tissue. Histopathological variants such as classic, cellular, collagenous / fibrous, lipomatous, infiltrative, myxoid and epithelioid have been identified. Most myofibroblastomas are immunoreactive for CD34, actin, CD10 and desmin, usually express oestrogen receptor (ER), progesterone receptor (PR) and variably express androgen receptor (AR). Case report: We report a case of myofibroblastoma in an octogenarian male presenting with painless solitary breast lump. Mammography (digital tomosynthesis) and ultrasound showed a well-circumscribed hyperdense mass and hypoechoic, solid, oval mass with peripheral vascularity respectively. Patient underwent wide local excision. Discussion: Diverse characteristics of myofibroblastoma on imaging necessitates histopathological analysis for an accurate diagnosis. Myofibroblastoma are often confused with fibroadenomas due to the benign imaging characteristics and with malignant neoplasia due to their wide morphological spectrum. Surgical excision is considered curative

Diagnostic Efficacy of Synthesized 2D Digital Breast Tomosynthesis in Multi-ethnic Malaysian Population

Synthesized 2D images can be reconstructed from tomosynthesis images in breast imaging. This study aims to investigate the diagnostic efficacy of synthesized 2D images (C-View) in comparison to full field digital mammography (FFDM) when used with digital breast tomosynthesis (DBT) in multi-ethnic Malaysian population. FFDM and C-View images (n = 380) were independently evaluated by three readers through Breast Imaging Reporting and Data System (BI-RADS) categorisation, breast density and lesion characterisation. Statistical analysis was done comparing sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of C-View + DBT with FFDM + DBT as standard of reference. Very good interreader agreement in BI-RADS category and density assessment between C-View + DBT and FFDM + DBT, with high sensitivity, specificity, PPV and NPV of C-View + DBT when compared with FFDM + DBT. There was comparable PPV between C-View + DBT and FFDM + DBT, with histopathology as gold standard. High level of interreader agreement in BI-RADS category and density assessment for FFDM + DBT and C-View + DBT. There was good agreement between FFDM + DBT and C-View + DBT in mass characterization, and almost perfect agreement in calcification and asymmetric density. 52.2% lower radiation dose incurred when using C-View + DBT. Hence, synthesized 2D images are comparable to FFDM with reduction in radiation dose within the limits of Malaysian multi-ethnic population. © 2019, The Author(s)

Magnetic resonance imaging features of invasive breast cancer association with the tumour stromal ratio.

ObjectiveTo assess the association between breast cancer tumour stroma and magnetic resonance imaging (MRI) features.Materials and methodsA total of 84 patients with treatment-naïve invasive breast cancer were enrolled into this retrospective study. The tumour stroma ratio (TSR) was estimated from the amount of tumour stroma in the pathology specimen of the breast tumour. The MRI images of the patients were analysed based on Breast Imaging Reporting and Data Systems (ACR-BIRADS) for qualitative features which include T2- weighted, diffusion-weighted images (DWI) and dynamic contrast-enhanced (DCE) for kinetic features. The mean signal intensity (SI) of Short Tau Inversion Recovery (STIR), with the ratio of STIR of the lesion and pectoralis muscle (L/M ratio) and apparent diffusion coefficient (ADC) value, were measured for the quantitative features. Correlation tests were performed to assess the relationship between TSR and MRI features.ResultsThere was a significant correlation between the margin of mass, enhancement pattern, and STIR signal intensity of breast cancer and TSR. There were 54.76% (n = 46) in the low stromal group and 45.24% (n = 38) in the high stromal group. A significant association were seen between the margin of the mass and TSR (p = 0.034) between the L/M ratio (p ConclusionBreast cancer with high stroma had spiculated margins, lower STIR signal intensity, and a heterogeneous pattern of enhancement. Hence, in this preliminary study, certain MRI features showed a potential to predict TSR

Use of Nonlinear Features for Automated Characterization of Suspicious Ovarian Tumors Using Ultrasound Images in Fuzzy Forest Framework

Ovarian cancer is one of the prime causes of mortality in women. Diagnosis of ovarian cancer using ultrasonography is tedious as ovarian tumors exhibit minute clinical and structural differences between the suspicious and non-suspicious classes. Early prediction of ovarian cancer will reduce its growth rate and may save many lives. Computer-aided diagnosis (CAD) is a noninvasive method for finding ovarian cancer in its early stage which can avoid patient anxiety and unnecessary biopsy. This study investigates the efficacy of a novel CAD tool to characterize suspicious ovarian cancer using Radon-transformed nonlinear features. The obtained dimension of the extracted features is reduced using Relief-F feature selection method. In this study, we have employed the fuzzy forest-based ensemble classifier in contrast to the known crisp rule-based classifiers. The proposed method is evaluated using 469 (non-suspicious: 238, suspicious: 231) subjects and achieved a maximum 80.60 ± 0.5% accuracy, 81.40% sensitivity, 76.30% specificity with fuzzy forest, an ensemble fuzzy classifier using thirty-nine features. The proposed method is robust and reproducible as it uses maximum number subjects (469) as compared to state-of-the-art techniques. Hence, it can be used as an assisting tool by gynecologists during their routine screening