Topology-Aware Loss for Aorta and Great Vessel Segmentation in Computed Tomography Images

Segmentation networks are not explicitly imposed to learn global invariants of an image, such as the shape of an object and the geometry between multiple objects, when they are trained with a standard loss function. On the other hand, incorporating such invariants into network training may help improve performance for various segmentation tasks when they are the intrinsic characteristics of the objects to be segmented. One example is segmentation of aorta and great vessels in computed tomography (CT) images where vessels are found in a particular geometry in the body due to the human anatomy and they mostly seem as round objects on a 2D CT image. This paper addresses this issue by introducing a new topology-aware loss function that penalizes topology dissimilarities between the ground truth and prediction through persistent homology. Different from the previously suggested segmentation network designs, which apply the threshold filtration on a likelihood function of the prediction map and the Betti numbers of the ground truth, this paper proposes to apply the Vietoris-Rips filtration to obtain persistence diagrams of both ground truth and prediction maps and calculate the dissimilarity with the Wasserstein distance between the corresponding persistence diagrams. The use of this filtration has advantage of modeling shape and geometry at the same time, which may not happen when the threshold filtration is applied. Our experiments on 4327 CT images of 24 subjects reveal that the proposed topology-aware loss function leads to better results than its counterparts, indicating the effectiveness of this use

Comparison of Fixed and Ramping Voltage Extracorporeal Shockwave Lithotripsy with Acute Kidney Injury Biomarkers: Prospective Randomized Clinical Study

Objective: To compare extracorporeal shock wave lithotripsy (ESWL) induced renal injury in patients undergoing different ESWL treatment protocols by measuring urinary tissue metalloproteinase-2 inhibitor (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) excretion. Materials and Methods: This prospective, randomized study was conducted between April 2016 and June 2016 in group 1 patients undergoing fixed voltage ESWL and group 2 patients undergoing ramping voltage ESWL. Urinary TIMP-2 and IGFBP7 levels were analyzed before ESWL and 2 hours after ESWL, and urinary beta- 2-microglobulin (β2-MG) and albumin were analyzed before ESWL and 1 week after ESWL to assess renal injury. The primary outcome was to compare the effect of ESWL on early renal injury with biochemical markers in the different treatment protocols, and the secondary outcome was to compare the two treatment protocols in terms of stone free rate and complications. Results: There was no statistically significant difference between groups in terms of demographic and stone characteristics. There were statistically significant differences in serum creatinine and e-GFR at baseline and one week after treatment (p0.05). Conclusion: In this prospective randomized study, we observed a significant increase in TIMP-2, IGFBP7 and combination levels after ESWL treatment in both groups, suggesting that these two biomarkers could be used to identify acute kidney injury due to ESWL. However, the comprehensive evaluation of clinical parameters and urinary markers did not differ in the rates of renal injury, success, and complications after ESWL in both protocols

Report of Two Cases with Simultaneously Detected Tubular Carcinoma and Phyllodes Tumor of the Breast

Tubular carcinoma (TC) is a subtype of invasive breast carcinoma with better prognosis, and phyllodes tumors (PT) are rare fibroepithelial lesions. Accurate preoperative pathological diagnosis allows for correct surgical planning and avoidance of reoperation for these breast neoplasms. A database was created by analyzing the archives of Department of General Surgery of the Istanbul Faculty of Medicine between September 2006 and November 2017, and a total of 105 PTs and 55 TCs were collected. Two cases with concurrence of TC and PT were identified and examined in detail. The first patient was a 33-year-old woman with a 20x12 mm(2) TC and a 65x32 mm(2) malignant PT in the left breast. The second patient was a 28-year-old woman with two masses in the right breast. The first mass was 38x16 mm(2) on the upper outer quadrant, and the second mass was 10x8 mm(2) in size in the lower inner quadrant, accompanied by a 16x10 mm(2) TC and a 33x26 mm(2) borderline PT. Both cases were treated by mastectomies due to patient's decisions or insufficient margin control. This study extrapolated that if two tumors are detected simultaneously, margin control can become more difficult, and breast-conserving surgery should be thoroughly reviewed

The role of histopathologic testing on apocrine carcinoma of the breast

Background: Apocrine carcinoma is a rare primary breast tumor characterized by the apocrine morphology. The purpose of this article is to report a review of cases with apocrine carcinoma and draw physicians' attention to the benefits of immunphenotypic techniques in cases with suspected apocrine morphology in diagnosing this uncommon breast tumor

Frequency of sternal variations in living individuals

To evaluate the variations of the sternum and provide the prevalence of sternal foramen and its anatomical relationships

Granulomatous lobular mastitis in pregnancy: a case report

Granulomatous lobular mastitis (GLM) is a rare, but benign inflamatuary process with unknown underlying etiology. It is typically seen in young women. Painful breast masses, draining sinuses, scarring, and breast atrophy are the main clinical manifestations. This disease is a challenge for clinicians to diagnose and manage. 30 years old and 14 weeks pregnant woman admitted to our clinic with the progressing complaints of a big breast mass, scarring and infectious liquid stream, despite a long term antibiotic treatments. GLM is thought to result from obstruction and rupture of breast lobules. She suffered different side effects from several prescribed treatments and endured a inconclusive recovery. The authors aimed avoid to missdiagnose, such as having bacterial or fungal infections, especially tuberculosis, and perform unneccesary treatment. Idiopathic granulomatous mastitis is a rare unusual condition of unknown etiology. Pathological confirmation is required for its diagnosis and optimal management is still unclear, espically in a pregnant woman

Sex differences in the radial grooves in the first extensor compartment

De Quervain tenosynovitis affects the first extensor compartment of the wrist and occurs more frequently in females. This high prevalence could not be explained by soft tissue. As the osseous anatomy has been mostly neglected, we aimed to compare the distal radius between the sexes

Virtual Assessment of Sex: Linear and Angular Traits of the Mandibular Ramus Using Three-Dimensional Computed Tomography

Morphometric analysis of the mandibular ramus (MR) provides highly accurate data to discriminate sex. The objective of this study was to demonstrate the utility and accuracy of MR morphometric analysis for sex identification in a Turkish population.Four hundred fifteen Turkish patients (18-60 y; 201 male and 214 female) who had previously had multidetector computed tomography scans of the cranium were included in the study. Multidetector computed tomography images were obtained using three-dimensional reconstructions and a volume-rendering technique, and 8 linear and 3 angular values were measured. Univariate, bivariate, and multivariate discriminant analyses were performed, and the accuracy rates for determining sex were calculated.Mandibular ramus values produced high accuracy rates of 51% to 95.6%. Upper ramus vertical height had the highest rate at 95.6%, and bivariate analysis showed 89.7% to 98.6% accuracy rates with the highest ratios of mandibular flexure upper border and maximum ramus breadth. Stepwise discrimination analysis gave a 99% accuracy rate for all MR variables.Our study showed that the MR, in particular morphometric measures of the upper part of the ramus, can provide valuable data to determine sex in a Turkish population. The method combines both anthropological and radiologic studies

Radiologic approach to bloody nipple discharge

Objective: We aimed to evaluate the radiological approach in patients with pathologic nipple discharge in the light of the results of our patients with a complaint of bloody nipple discharge

The role of MRI with diffusion-weighted imaging in restaging rectal cancers after neoadjuvant chemoradiotherapy

Background: It is challenging to restage rectal cancer at MRI, in patients who have had neoadjuvant chemoradiotherapy. Objective: To investigate the accuracy of MRI with diffusion-weighted imaging (DWI) in the restaging of rectal cancer. Materials and methods: Pre- and post-neoadjuvant chemoradiotherapy MRI examinations of 35 patients diagnosed with locally advanced rectal cancer were evaluated and subsequently compared with post-operative pathology results. Results: The accuracy of MRI with DWI to determine the T-stage status was calculated as 54.28%. Kappa statistics revealed poor concordance with pathology results, with a κ value of 0.212 ± 0.114 (p = 0.028). The apparent diffusion coefficient (ADC) values measured after the neoadjuvant chemotherapy revealed a significant increase when compared with pre-treatment ADC values (p < 0.000001). MRI accuracy rate for lymph node involvement was calculated as 57.14% with a κ value of 0.001 (p = 0.989). MRI had 80% sensitivity and 100% specificity in determining mesorectal fascia involvement, with a calculated positive predictive value of 100% and a calculated negative predictive value of 96%. The accuracy of MRI in overall staging according to the TNM staging system was 28%. Conclusion: The accuracy of MRI in restaging rectal cancer is not yet sufficient and is not on par with the accuracy of MRI in the primary staging of the disease. This is attributed to post-treatment changes. Adding DWI to the protocol is promising, but more expanded data are required