ALBERT

Description: Background: Penile paraffinoma is a well-known delayed complication of paraffin oil injection into the penis for penile girth augmentation but its MRI features have not been previously described.Case presentationA 35-year-old Ukraine man presented with erectile dysfunction, voiding difficulty and an irregular, hard and painful penile mass that had progressively grown over the last year. He reported having received, seven years before, several penile injections of paraffin oil for penile girth augmentation. On physical examination, the mass was tender, poorly delimited, and involved the whole penile shaft and the cranial part of the scrotum. Preoperative MRI, performed to determine the extent of tissue to be removed and the possibilities of penile reconstruction, showed a newly-formed homogeneous tissue, compressing but not infiltrating Buck's fascia, iso-hypointense relative to muscle on T1-weighted sequences, and with a low signal intensity at T2-weighted sequences. On T1-weighted fat suppressed sequences, it did not enhance with contrast administration. MRI data were confirmed by surgical findings, as the newly-formed scar tissue did not infiltrate Buck's fascia. Pathology confirmed the diagnosis of penile paraffinoma. Conclusion: MRI seems to provide an adequate imaging of the histological events occurring after injection of paraffin oil in the subcutaneous tissues. Penile paraffinoma remains a clinical diagnosis, but MRI features may be helpful in planning an adequate surgical strategy and, in selected cases, establishing the differential diagnosis with other penile diseases, including cancer.

Description: Contributing reviewersThe Editors of BMC Medical Imaging would like to thank all our reviewers who have contributed to the journal in Volume 13 (2013)

Description: Background: Temperature measurement is a vital part of daily neonatal care. Accurate measurements are important for detecting deviations from normal values for both optimal incubator and radiant warmer functioning. The purpose of monitoring the temperature is to maintain the infant in a thermoneutral environmental zone. This physiological zone is defined as the narrow range of environmental temperatures in which the infant maintains a normal body temperature without increasing his or her metabolic rate and thus oxygen consumption. Although the temperature measurement gold standard is the skin electrode, infrared thermography (IRT) should be considered as an effortless and reliable tool for measuring and mapping human skin temperature distribution and assist in assessing thermoregulatory reflexes. Methods: Body surface temperature was recorded under several clinical conditions using an infrared thermography imaging technique. Temperature distributions were recorded as real-time video, which was analyzed to evaluate mean skin temperatures. Emissivity variations were considered for optimal neonatal IRT correction for which the compensation vector was overlaid on the tracking algorithm to improve the temperature reading. Finally, a tracking algorithm was designed for active follow-up of the defined region of interest over a neonate's geometry. Results: The outcomes obtained from the thermal virtual sensor demonstrate its ability to accurately track different geometric profiles and shapes over the external anatomy of a neonate. Only a small percentage of the motion detection attempts failed to fit tracking scenarios due to the lack of a properly matching matrix for the ROI profile over neonate's body surface. Conclusions: This paper presents the design and implementation of a virtual temperature sensing application that can assist neonatologists in interpreting a neonate's skin temperature patterns. Regarding the surface temperature, the influence of different environmental conditions inside the incubator has been confirming.

Description: Background: Ultrasound is considered a reliable, widely available, non-invasive and inexpensive imaging technique for assessing soft tissue involvement in Lateral epicondylalgia. Despite the number of diagnostic studies for Lateral Epicondylalgia, there is no consensus in the current literature on the best abnormal ultrasound findings that confirm lateral epicondylalgia. Methods: Eligible studies identified by searching electronic databases, scanning reference lists of articles and chapters on ultrasound in reference books, and consultation of experts in sonography. Three reviewers (VCDIII, KP, KW) independently searched the databases using the agreed search strategy, and independently conducted all stages of article selection. Two reviewers (VCDIII, KP) then screened titles and abstracts to remove obvious irrelevance. Potentially relevant full text publications which met the inclusion criteria were reviewed by the primary investigator (VCDIII) and another reviewer (CGS). Results: Among the 15 included diagnostic studies in this review, seven were Level II diagnostic accuracy studies for chronic lateral epicondylalgia based on the National Health and Medical Research Council Hierarchy of Evidence. Based from the pooled sensitivity of abnormal ultrasound findings with homogenous results (p 〉 0.05), the hypoechogenicity of the common extensor origin has the best combination of diagnostic sensitivity and specificity. It is moderately sensitive [Sensitivity: 0.64 (0.56-0.72)] and highly specific [Specificity: 0.82 (0.72-0.90)] in determining elbows with lateral epicondylalgia. Additionally, bone changes on the lateral epicondyle [Sensitivity: 0.56 (0.50-0.62)] were moderately sensitive to chronic LE. Conversely, neovascularity [Specificity: 1.00 (0.97-1.00)], calcifications [Specificity: 0.97 (0.94-0.99)] and cortical irregularities [Specificity: 0.96 (0.88-0.99)] have strong specificity for chronic lateral epicondylalgia. There is insufficient evidence supporting the use of Power Doppler Ultrasonogrophy, Real-time Sonoelastography and sonographic probe-induced tenderness in diagnosing LE. Conclusions: The use of Gray-scale Ultrasonography is recommended in objectively diagnosing lateral epicondylalgia. The presence of hypoechogenicity and bone changes indicates presence of a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia. In addition to diagnosis, detection of these abnormal ultrasound findings allows localization of pathologies to tendon or bone that would assist in designing an appropriate treatment suited to patient's condition.

Description: Background: Delineation of the target volume is a time-consuming task in radiotherapy treatment planning, yetessential for a successful treatment of cancers such as prostate cancer. To facilitate the delineationprocedure, the paper proposes an intuitive approach for 3D modeling of the prostate by slice-wisebest fitting ellipses.The proposed estimate is initialized by the definition of a few control points in a new patient. Themethod is not restricted to particular image modalities but assumes a smooth shape with elliptic crosssections of the object. A training data set of 23 patients was used to calculate a prior shape model.The mean shape model was evaluated based on the manual contour of 10 test patients. The patientrecords of training and test data are based on axial T1-weighted 3D fast-field echo (FFE) sequences.The manual contours were considered as the reference model. Volume overlap (Vo), accuracy (Ac)(both ratio, range 0-1, optimal value 1) and Hausdorff distance (HD) (mm, optimal value 0) werecalculated as evaluation parameters. Results: The median and median absolute deviation (MAD) between manual delineation and deformed Mean Best Fitting Ellipses (MBFE) was Vo (0.9 +/- 0.02), Ac (0.81 +/- 0.03) and HD (4.05 +/- 1.3)mm and between manual delineation and Best Fitting Ellipses (BFE) was Vo (0.96 +/- 0.01), Ac (0.92 +/- 0.01 and HD (1.6 +/- 0.27)mm. Additional results show a moderate improvement of the MBFE results afterMonte Carlo Markov Chain (MCMC) method. Conclusions: The results emphasize the potential of the proposed method of modeling the prostate by best fittingellipses. It shows the robustness and reproducibility of the model. A small sample test on 8 patientssuggest possible time saving using the model.KeywordsDelineation, Ellipse model, Empirical Bayes, Prostate, Radiotherapy treatment planning, Statistical shape analysis

Description: Background: Functional magnetic resonance imaging (fMRI) analysis is commonly done with cross-correlation analysis (CCA) and the General Linear Model (GLM). Both CCA and GLM techniques, however, typically perform calculations on a per-voxel basis and do not consider relationships neighboring voxels may have. Clustered voxel analyses have then been developed to improve fMRI signal detections by taking advantages of relationships of neighboring voxels. Mean-shift clustering (MSC) is another technique which takes into account properties of neighboring voxels and can be considered for enhancing fMRI activation detection. Methods: This study examines the adoption of MSC to fMRI analysis. MSC was applied to a Statistical Parameter Image generated with the CCA technique on both simulated and real fMRI data. The MSC technique was then compared with CCA and CCA plus cluster analysis. A range of kernel sizes were used to examine how the technique behaves. Results: Receiver Operating Characteristic curves shows an improvement over CCA and Cluster analysis. False positive rates are lower with the proposed technique. MSC allows the use of a low intensity threshold and also does not require the use of a cluster size threshold, which improves detection of weak activations and highly focused activations. Conclusion: The proposed technique shows improved activation detection for both simulated and real Blood Oxygen Level Dependent fMRI data. More detailed studies are required to further develop the proposed technique.

Description: Background: Objective physical assessment of patients with lumbar spondylosis involves plain film radiographs (PFR) viewing and interpretation by the radiologists. Physiotherapists also routinely assess PFR within the scope of their practice. However, studies appraising the level of agreement of physiotherapists' PFR interpretation with radiologists are not common in Ghana.MethodForty-one (41) physiotherapists took part in the cross-sectional survey. An assessment guide was developed from findings of the interpretation of three PFR of patients with lumbar spondylosis by a radiologist. The three PFR were selected from a pool of different radiographs based on clarity, common visible pathological features, coverage body segments and short post production period. Physiotherapists were required to view the same PFR after which they were assessed with the assessment guide according to the number of features identified correctly or incorrectly. The score range on the assessment form was 0-24, interpreted as follow: 0-8 points (low), 9-16 points (moderate) and 17-24 points (high) levels of agreement. Data were analyzed using one sample t-test and fisher's exact test at alpha = 0.05. Results: The mean score of interpretation for the physiotherapists was 12.7 +/- 2.6 points compared to the radiologist's interpretation of 24 points (assessment guide). The physiotherapists' levels were found to be significantly associated with their academic qualification (p = 0.006) and sex (p = 0.001), of the physiotherapists. However, their levels of agreement were not significantly associated with their age group (p = 0.098), work settings (p = 0.171), experience (p = 0.666), preferred PFR view (p = 0.088) and continuing education (p = 0.069). Conclusions: The physiotherapists' skills fall short of expectation for interpreting PFR of patients with lumbar spondylosis. The levels of agreement with radiologist's interpretation have no link with year of clinial practice, age, work settings and continuing education. Thus, routine PFR viewing techniques should be made a priority in physiotherapists' continuing professional education.

Description: Background: Two-dimensional projection radiographs have been traditionally considered the modality of choice for cephalometric analysis. To overcome the shortcomings of two-dimensional images, three-dimensional computed tomography (CT) has been used to evaluate craniofacial structures. However, manual landmark detection depends on medical expertise, and the process is time-consuming. The present study was designed to produce software capable of automated localization of craniofacial landmarks on cone beam (CB) CT images based on image registration and to evaluate its accuracy. Methods: The software was designed using MATLAB programming language. The technique was a combination of feature-based (principal axes registration) and voxel similarity-based methods for image registration. A total of 8 CBCT images were selected as our reference images for creating a head atlas. Then, 20 CBCT images were randomly selected as the test images for evaluating the method. Three experts twice located 14 landmarks in all 28 CBCT images during two examinations set 6 weeks apart. The differences in the distances of coordinates of each landmark on each image between manual and automated detection methods were calculated and reported as mean errors. Results: The combined intraclass correlation coefficient for intraobserver reliability was 0.89 and for interobserver reliability 0.87 (95% confidence interval, 0.82 to 0.93). The mean errors of all 14 landmarks were

Description: Background: The objective was to evaluate the use of fruit juice with an interactive inversion recovery (IR) MR pulse sequence to visualise the gastrointestinal tract. Methods: We investigated the relaxation properties of 12 different natural fruit juices in vitro, to identify which could be used as oral contrast. We then describe our initial experience using an interactive MR pulse sequence to allow optimal visualisation after administering pineapple juice orally, and suppressing pre-existing bowel fluid contents, with variable TI in three adult and one child volunteers. Results: Pineapple juice (PJ) had both the shortest T1 (243 ms) and shortest T2 (48 ms) of the fruit juices tested. Optimal signal differentiation between pre-existing bowel contents and oral PJ administration was obtained with TIs of between 900 and 1100 ms. Conclusion: The use of an inversion recovery preparation allowed long T1 pre-existing bowel contents to be suppressed whilst the short T1 of fruit juice acts as a positive contrast medium. Pineapple juice could be used as oral contrast agent for neonatal gastrointestinal magnetic resonance imaging.

Description: Background: Adverse reactions to iodinated and gadolinium contrast media are an important clinical issue. Although some guidelines have proposed oral steroid premedication protocols to prevent adverse reactions, some patients may have reactions to contrast media in spite of premedication (breakthrough reaction; BTR).The purpose of this study was to assess the frequency, type and severity of BTR when following an oral steroid premedication protocol. Methods: All iodinated and gadolinium contrast-enhanced radiologic examinations between August 2011 and February 2013 for which the premedication protocol was applied in our institution were assessed for BTRs. Results: The protocol was applied to a total of 252 examinations (153 patients, ages 15-87 years; 63 males, 90 females). Of these, 152 were for prior acute adverse reactions to contrast media, 85 were for a history of bronchial asthma, and 15 were for other reasons. There were 198 contrast enhanced CTs and 54 contrast enhanced MRIs. There were nine BTR (4.5 %) for iodinated contrast media, and only one BTR (1.9 %) for gadolinium contrast media: eight were mild and one was moderate. No patient who had a mild index reaction (IR) had a severe BTR. Conclusion: Incidence of BTRs when following the premedication protocol was low. This study by no means proves the efficacy of premedication, but provides some support for following a premedication protocol to improve safety of contrast-enhanced examinations when prior adverse reactions are mild, or when there is a history of asthma.