Veenu Singla

Automatic Detection of Pectoral Muscle Using Average Gradient and Shape Based Feature

In medio-lateral oblique view of mammogram, pectoral muscle may sometimes affect the detection of breast cancer due to their similar characteristics with abnormal tissues. As a result pectoral muscle should be handled separately while detecting the breast cancer. In this paper, a novel approach for the detection of pectoral muscle using average gradient- and shape-based feature is proposed. The process first approximates the pectoral muscle boundary as a straight line using average gradient-, position-, and shape-based features of the pectoral muscle. Straight line is then tuned to a smooth curve which represents the pectoral margin more accurately. Finally, an enclosed region is generated which represents the pectoral muscle as a segmentation mask. The main advantage of the method is its’ simplicity as well as accuracy. The method is applied on 200 mammographic images consisting 80 randomly selected scanned film images from Mammographic Image Analysis Society (mini-MIAS) database, 80 direct radiography (DR) images, and 40 computed radiography (CR) images from local database. The performance is evaluated based upon the false positive (FP), false negative (FN) pixel percentage, and mean distance closest point (MDCP). Taking all the images into consideration, the average FP and FN pixel percentages are 4.22%, 3.93%, 18.81%, and 6.71%, 6.28%, 5.12% for mini-MIAS, DR, and CR images, respectively. Obtained MDCP values for the same set of database are 3.34, 3.33, and 10.41 respectively. The method is also compared with two well-known pectoral muscle detection techniques and in most of the cases, it outperforms the other two approaches.

Prevalence and related risk factors of osteoporosis in peri- and postmenopausal Indian women

Aim: We undertook this study involving 200 peri- and postmenopausal women to determine the prevalence of osteoporosis, and in turn increase the awareness, education, prevention, and treatment of osteoporosis. Setting and Design: Postgraduate Institute of Medical Education and Research, UT Chandigarh, India, and a clinical study. Materials and Methods: A detailed medical, obstetrical, menstrual, and drug history was recorded in a proforma designated for the study. Height and weight was measured, weight-bearing exercise was assessed, and sunlight exposure per day for each woman was recorded. Food intake was estimated by using the 24-hour dietary recall method, and calcium and vitamin D consumption pattern was assessed. Bone mineral density (BMD) at postero-anterior lumbar spine and dual femurs was assessed by densitometer. Women were classified according to the WHO criteria. Statistical Analysis Used: Students t-test, multiple logistic regression analysis. Results: The prevalence of low BMD was found in more than half of this population (53%). The mean age in group I (normal BMD) was found to be 50.56 ± 5.74 years as compared to 52.50 ± 5.94 in group II with low BMD (P=0.02). The two groups were similar with respect to parity, education, socioeconomic status, family history of osteoporosis, hormone replacement therapy, and thyroid disorders. 46.8% of the women in group I and 33% of the women in group II had low physical activity and there was no statistically significant difference in sunlight exposure between the groups. Parity or the number of children and type of menopause was not seen to have much association with low BMD in our study. Lack of exercise and low calcium diet were significantly associated with low BMD. Multiple logistic regression analysis showed that age, exercise, menopause, and low calcium diet acted as significant predictors of low bone density. Conclusion: The findings from the study suggest the need for large community-based studies so that high-risk population can be picked up and early interventions and other life style changes can be instituted if there is delay in implementing national or international health strategies to tackle this increasing global health problem. Strategies to identify and manage low BMD in the primary care setting need to be established and implemented.

Detection of masses in mammograms using region growing controlled by multilevel thresholding

Mammographic masses are important signs of breast cancer. However, due to its irregular and obscured margin, variability in size, and occlusion within dense breast tissue, a mass is often difficult to detect. In this paper, a multilevel thresholding approach controlled by gradient and intensity is proposed, where an image is considered as a 3D topographic map with intensity as the third dimension. A multilevel high-to-low intensity thresholding approach is used for the detection of the focal region of a mass. After each step of thresholding, a region growing technique is applied on each focal region to detect potential sites of masses using gradient and intensity information. The performance of the proposed method is tested on 107 scanned-film images consisting of 52 images with masses and 55 normal images from the mini-MIAS database, and 158 digital radiography (DR) images containing 78 images with masses and 80 normal images from a local database. A sensitivity of 95% with 5.2 false positives (FPs)/image is obtained with the mini-MIAS images and a sensitivity of 98.8% with 2.1 FPs/image is obtained with the DR images.

Maroteaux–Lamy Syndrome (Mucopolysaccharidosis VI) Presenting as Familial Myelopathy

ABSTRACT A 24-year-old male presented with features of progressively worsening spastic quadriparesis of 5 years’ duration with similar milder features in the younger brother. His neuroradiological investigations revealed diffuse thickening of posterior longitudinal ligament, ligamentum flavum, and duramater in the cervical spine causing severe canal stenosis with secondary ischemic cord changes. As both brothers had dysmorphic facial features, further work-up suggested the diagnosis of a rare familial form of myelopathy due to mucopolysacchari- dosis VI.

Cruveilhier Baumgarten syndrome with giant paraumbilical vein

A 25-year-old woman came to the hospital with the feeling of a lump in the left hypochondrium for one year. On examination, she was found to have massive splenomegaly, mild pallor, icterus and dilated veins in the infraumbilical region over which a venous hum was present. Laboratory examination confirmed her anti-HCV reactivity. The aspartate transaminase, alanine transaminase levels were 57.97 and 34.99 IU/l respectively. She had serum alkaline phosphatase of 104 kAU; total protein was 6.59 gm/dl and albumin was 3.5 gm/dl. There was no history of hemetemesis, somnolence or mental confusion. Gray scale and Doppler ultrasound abdomen revealed coarsened liver echotexture with nodular outline suggestive of chronic liver parenchymal disease. The main portal vein and its right as well as left branches were dilated with hepatopetal flow in all segmental portal veins [Figure 1a]. There was gross splenomegaly and multiple collaterals were observed at the splenic hilum and anterior abdominal wall [Figure 1b]. The paraumbilical vein was patent and had hepatofugal flow, and was communicating with the anterior abdominal wall collaterals. No ascites was present. Multidetector computed tomography was performed on a 16-slice scanner (Sensation 16, Siemens Medical Solutions) after injecting 100 ml of non-ionic contrast at a rate of 4 ml/sec; using tube current of 200 mAs, tube voltage of 120 kVp and pitch of 1.5; with image acquisition in both arterial and venous phases. The axial images were post-processed on a workstation and supplemented by multi-planar reformations, volume rendering, and maximum intensity projections. The computed tomography (CT) confirmed Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, PGIMER, Chandigarh 160 012, India

HIV infection presenting as cerebral venous sinus thrombosis

Risk of cerebrovascular disease is increased in patients with HIV infection; however, cerebral venous sinus thrombosis is not commonly reported in this condition. We report a case of young man with intracranial hemorrhage whose radiologic investigations revealed thrombosis of the left transverse and sigmoid sinuses extending into the left internal jugular vein. On further investigations, he was found to be positive for HIV-1, and his procoagulant workup showed protein S deficiency. He was started on anticoagulant therapy, after which he showed gradual recovery. This case highlights a rarely encountered presentation of HIV infection as cerebral venous sinus thrombosis.

Prenatal diagnosis of thoracopagus fetus: a case report with brief review of literature.

Conjoined twins are uncommon and refer to monozygotic, monoamniotic and monochorionic twins with varying degree and sites of fusion between the twins. In this report, we illustrate a case of thoracopagus twins highlighting the prenatal sonographic and magnetic resonance imaging appearance. Emphasis is laid on the role of appropriate imaging strategy in prognostic assessment and postnatal surgical treatment planning of these cases.

Chronic Rupture of Abdominal Aortic Aneurysm with Vertebral Erosion: An Uncommon but Important Cause of Back Pain

Chronic contained rupture of the aorta is a rare condition that may present with varied patient symptomatology. We present a case of contained rupture of an abdominal aortic aneurysm causing vertebral erosion in an elderly male patient who had chronic backache and presented to the emergency services with a recently developed throbbing epigastric mass. Early use of computed tomography enabled prompt diagnosis and the condition was managed by endovascular stenting. The clinical and imaging findings of this potentially fatal condition are described, awareness of which is important to the physicians, orthopedicians, surgeons, and radiologists.

Paget's disease of breast masquerading as chronic benign eczema.

1. Bassi F, Gatti G, Mauri E, Ballardini B, De Pas T, Luini A. Breast metastases from cutaneous malignant melanoma. Breast 2004;13:533-5. 2. Komorowski AL, Wysocki WM, Mitus J. Metastasis to the breasta Clinical Challenge in Outpatient. Acta chir Belg 2005;105:59-61. 3. Amichetti M, Perani B, Boi S. Metastasis to the breast from extramammary malignancies. Oncology 1990;47:257-60. 4. da Silva BB, da Silva RG Jr, Lopes Costa PV, Pires CG, da Silva Pinheiro G. Melanoma metastasis to the breast masquerading as fibroadenoma. Gynecol Obstet Invest 2006;62:97-9. 5. Majeski J. Bilateral breast masses as initial presentation of widely metastatic melanoma. J Surg Oncol 1999;72:175-7. 6. Ravdel L, Robinson WA, Lewis K, Gonzalez R. Metastatic melanoma in the breast: A report of 27 cases. J Surg Oncol 2006;94:101-4.

Acro-osteolysis and mononeuritis multiplex as a presenting symptom of systemic angiitis of Wegener's type

Wegeners granulomatosis is a multisystem disorder involving small- and medium-sized vessels, leading to granuloma formation and involvement of upper and lower respiratory tract with or without glomerulonephritis. However, limited forms of angiitis and granulomatosis of the Wegeners type with oligosymptomatic and atypical site involvement are known to occur. We present here a rare case of limited form of angiitis and granulomatosis of Wegeners type who presented sequentially with spontaneous resorption of digits with acro-osteolysis and mononeuritis multiplex over a period of 10 months. His vasculitic workup revealed high proteinase 3 antibodies (c-ANCA) titers and an almost asymptomatic lung involvement, detected on high-resolution computed tomography of chest. The patient was aggressively treated with immunosuppressive therapy, following which he showed good improvement.