Zanon E

Hyperdynamic circulation in patients with cirrhosis: direct measurement of nitric oxide levels in hepatic and portal veins

BACKGROUND/AIMS Peripheral vasodilation represents the main vascular dysfunction associated with the hyperdynamic circulation of liver cirrhosis. This study was intended to measure directly regional and systemic levels of nitric oxide, a potent vasorelaxing mediator, in order to assess its role in the development of hemodynamic changes of cirrhosis. METHODS We compared nitric oxide levels in the splanchinic and systemic circulation of 25 patients with cirrhosis undergoing transjugular intrahepatic portosystemic stent shunt and in the hepatic vein and peripheral blood of 10 patients without cirrhosis submitted to venous catheterization. Nitric oxide levels were measured through electron paramagnetic resonance spectroscopy as nitrosylhemoglobin complexes. RESULTS Significantly higher nitric oxide levels were calculated in patients with cirrhosis with respect to controls, both in the peripheral and hepatic veins. In patients with cirrhosis, nitric oxide levels in the portal vein (3.44 +/- 2.17, expressed in arbitrary units) were higher than in the systemic circulation (1.89 +/- 1.15), but lower than in the hepatic vein (4.75 +/- 2.53; p < 0.001 by variance analysis). CONCLUSIONS These data suggest that nitric oxide synthetic pathway activity as well as nitric oxide release are enhanced at the level of splanchnic vasculature and, more important, in the hepatic tissue, confirming evidence of the predominant role of nitric oxide in the pathogenesis of hemodynamic changes in patients with cirrhosis with portal hypertension.

A completely automated CAD system for mass detection in a large mammographic database

Mass localization plays a crucial role in computer-aided detection (CAD) systems for the classification of suspicious regions in mammograms. In this article we present a completely automated classification system for the detection of masses in digitized mammographic images. The tool system we discuss consists in three processing levels: (a) Image segmentation for the localization of regions of interest (ROIs). This step relies on an iterative dynamical threshold algorithm able to select iso-intensity closed contours around gray level maxima of the mammogram. (b) ROI characterization by means of textural features computed from the gray tone spatial dependence matrix (GTSDM), containing second-order spatial statistics information on the pixel gray level intensity. As the images under study were recorded in different centers and with different machine settings, eight GTSDM features were selected so as to be invariant under monotonic transformation. In this way, the images do not need to be normalized, as the adopted features depend on the texture only, rather than on the gray tone levels, too. (c) ROI classification by means of a neural network, with supervision provided by the radiologists diagnosis. The CAD system was evaluated on a large database of 3369 mammographic images [2307 negative, 1062 pathological (or positive), containing at least one confirmed mass, as diagnosed by an expert radiologist]. To assess the performance of the system, receiver operating characteristic (ROC) and free-response ROC analysis were employed. The area under the ROC curve was found to be Az = 0.783 +/- 0.008 for the ROI-based classification. When evaluating the accuracy of the CAD against the radiologist-drawn boundaries, 4.23 false positives per image are found at 80% of mass sensitivity.

The MAGIC-5 Project: medical applications on a GRID infrastructure connection

The MAGIC-5 Project aims at developing computer aided detection (CAD) software for medical applications on distributed databases by means of a GRID infrastructure connection. The use of automatic systems for analyzing medical images is of paramount importance in the screening programs, due to the huge amount of data to check. Examples are: mammographies for breast cancer detection, computed-tomography (CT) images for lung cancer analysis, and the positron emission tomography (PET) imaging for the early diagnosis of the Alzheimer disease. The need for acquiring and analyzing data stored in different locations requires a GRID approach of distributed computing system and associated data management. The GRID technologies allow remote image analysis and interactive online diagnosis, with a relevant reduction of the delays actually associated to the screening programs. From this point of view, the MAGIC-5 Collaboration can be seen as a group of distributed users sharing their resources for implementing different virtual organizations (VO), each one aiming at developing screening programs, tele-training, tele-diagnosis and epidemiologic studies for a particular pathology.

MAGIC-5: an Italian mammographic database of digitised images for research

The implementation of a database of digitised mammograms is discussed. The digitised images were collected beginning in 1999 by a community of physicists in collaboration with radiologists in several Italian hospitals as a first step in developing and implementing a computer-aided detection (CAD) system. All 3,369 mammograms were collected from 967 patients and classified according to lesion type and morphology, breast tissue and pathology type. A dedicated graphical user interface was developed to visualise and process mammograms to support the medical diagnosis directly on a high-resolution screen. The database has been the starting point for developing other medical imaging applications, such as a breast CAD, currently being upgraded and optimised for use in a distributed environment with grid services, in the framework of the Instituto Nazionale di Fisicia Nucleare (INFN)-funded Medical Applications on a Grid Infrastructure Connection (MAGIC)-5 project.RiassuntoIn qesto lavoro viene discussa l’implementazione di un database immagini mammografiche digitalizzate. Le immagini sono state raccolte dal 1999 da un gruppo di fisici in collaborazione con radiology di alcuni ospedali italiani, come primo passo dello sviluppo e implementazione di un sistema di Computer Aided Detection (CAD). I 3369 mammogrammi appartengono a 967 pazienti e sono classificati secondo I tipi e la morfologia delle lesioni, il tessuto mammario e i tipi di patologie. Una interfaccia grafica opportunamente progettata è stata sviluppata per la visualizzazione e l’elaborazione delle mammografie digitalizzate al fine di runpoter supportare direttamente una diagnosi medica su monitor ad alta risoluzione. Il database ha rappresentato il punto di partenza per lo sviluppo di altre applicazioni di imaging medicale come il CAD mammografico costantemente ottimizzato e aggiornato con l’uso di un ambiente distribuito che dispone di servizi GRID, nel framework del progetto MAGIC-5, finanziato dell’INFN.

Comparison between different monitors to be used in the reading of digital mammographic images

Digital acquisition of mammographic images is becoming more diffuse in hospitals, as well as off line digitalization of analogical images to allow use of CAD, filing and statistical tools. Radiologists performance in reading digital images are strictly related to the quality of the images displayed on the monitor. We are investigating how different display devices, influence digital images reading. To reach the goal we are using phantoms for quality controls in mammography. Three different monitors are considered. The first one is the high resolution CRT display used as diagnostic monitor for the GE digital mammograph. The others are a high quality monitor for personal computer and the monitor of a high quality notebook. The phantoms used are the CDMAM 3.2 (a contrast-detail phantom) and the RMI 156 (which contains test objects that represent malignancies and small breast structures). Their images were acquired by the digital mammograph and were then analyzed by two expert radiologists by observing them on the different display devices, adopting the same procedure. The results about the reading of the phantoms and the interpretation of the images with different monitors are presented here.

Selective salpingography and tubaric catheterization in the diagnosis and treatment of fallopian tube obstruction

Fallopian tube catheterization with selective salpingography is a new technique for the diagnosis of tubal factors of sterility and also for the treatment of proximal tubal obstruction (PTO). In this study, 156 women, 20–42 years of age, with a mean duration of infertility of 5.7 years, who presented at conventional hysterosalpingography (HSG) a unilateral or bilateral PTO, were studied. Catheterization and selective salpingography was successful in 93% of the cases. Failures (6.1%) were ascribed to obliterative organic diseases, where it was impossible to overcome the stenosis with the catheter or the guidewire. Fourteen spontaneous pregnancies were obtained (7 full term deliveries, 4 miscarriages, 3 tubal pregnancies) and 11 patients became pregnant after gamete intra-fallopian transfer (GIFT). At follow-up, after 12 monts, four out of ten patients had patent tubes, while six presented a new unilateral or bilateral PTO. No major complications occurred; nevertheless, it is acknowledged that ectopic pregnancy is a possible outcome, due to the mechanical re-establishment of patency in a non-functioning tube.