Fine needle aspiration of the thyroid: can an image processing system improve differentiation?

OBJECTIVE: To differentiate thyroid nodules by means of fine needle aspiration with subsequent computer-aided diagnosis. STUDY DESIGN: Fine needle aspiration biopsies obtained from 137 patients for whom histopathologic diagnosis was available were investigated: 16 hyperplastic nodules (12%), 39 adenomas (28%), 25 follicular thyroid carcinomas (18%), 19 follicular variants of papillary thyroid carcinoma (14%) and 38 papillary thyroid carcinomas (28%). From each stained specimen 100 cell scenes were scanned and analyzed, constituting a total of 62,325 cell images. RESULTS: All the entities described could be well discriminated from each other by automated image analysis methods. Both the diagnosis of tumor type and the differentiation between benign and malignant could be achieved with a sensitivity of .98. CONCLUSION: With only 7-10 calculated cell features (texture line analysis) and classification with decision trees, a tool for high-quality cell image diagnosis is available. Subtypes of cells characterized by the calculated features could be found in all the specimens and could be assigned to the malignancies with high statistical significance. The method increases the relevance of image processing as an additional diagnostic tool for cytologic examination of thyroid nodules.     

Simultaneous occurrence of medullary and papillary carcinoma of the thyroid gland identified by fine needle aspiration. A case report

BACKGROUND: Fine needle aspiration (FNA) diagnosis of simultaneous medullary and papillary thyroid carcinoma in independent thyroid lobes is exceedingly rare. CASE: A 36-year-old female presented with a one-month history of dysphagia. Thyroid ultrasound revealed a multinodular goiter. She was clinically and biochemically euthyroid. FNA of the right thyroid nodule was consistent with medullary carcinoma, and FNA of the left thyroid lobe was consistent with papillary carcinoma. Immunohistochemistry revealed strong calcitonin and CEA positivity in the right lobe and lack of staining in the left lobe. Conversely, staining for thyroglobulin was negative on the right lobe and positive on the left lobe. CONCLUSION: The patient developed tumors in separate lobes of the thyroid. Immunoreactivity of calcitonin, CEA and thyroglobulin made a sharp distinction between the two tumors. Therefore, we conclude that these tumors were not linked by either embryology or genetics.     

C cells in normal thyroid aspirates.

OBJECTIVE: To quantify C cells in normal thyroid aspirates. STUDY DESIGN: Smears of 18 glands from patients with no thyroid disease, 8 women and 10 men aged on average 52.8 years, were analyzed. Five samples were aspirated from the upper, middle and lower thirds of each lateral lobe and from the isthmus. Smears were stained with anticalcitonin monoclonal antibody. RESULTS: C cells were detected in all specimens, ranging in number from 3 to 19 per gland, with 53.4% of the cells in the right lobe, 42.8% in the left lobe and 3.7% in the isthmus. The aspirates from the right lobe had 0-13 cells in the upper third, 0-9 in the middle third and 0-3 in the lower third. In the left lobe aspirates there were 0-7 cells in the upper third, 0-6 in the middle third and 0-2 in the lower third. One to two C cells were observed in the isthmus in only four cases. CONCLUSION: It is possible to determine the presence of C cells in normal thyroids and confirm studies conducted on histologic material; the cells were more frequently detected in the middle and upper third and mainly on the right side. They were rare in the isthmus. The search for C cells in thyroid aspirates is of great importance because it permits one to confirm rapidly, precisely and minimally invasively cases suspected of C cell hyperplasia, a preneoplastic condition that precedes the development of medullary carcinoma. In addition, the method shows numerical changes in these cells in such conditions as Hashimoto's thyroiditis and colloid goiter, in which the present results could serve as a control.     

Neural network-based segmentation and classification system for automated grading of histologic sections of bladder carcinoma

OBJECTIVE: To develop an image analysis system for automated nuclear segmentation and classification of histologic bladder sections employing quantitative nuclear features. STUDY DESIGN: Ninety-two cases were classified into three classes by experienced pathologists according to the WHO grading system: 18 cases as grade 1, 45 as grade 2, and 29 as grade 3. Nuclear segmentation was performed by means of an artificial neural network (ANN)-based pixel classification algorithm, and each case was represented by 36 nuclei features. Automated grading of bladder tumor histologic sections was performed by an ANN classifier implemented in a two-stage hierarchic tree. RESULTS: On average, 95% of the nuclei were correctly detected. At the first stage of the hierarchic tree, classifier performance in discriminating between cases of grade 1 and 2 and cases of grade 3 was 89%. At the second stage, 79% of grade 1 cases were correctly distinguished from grade 2 cases. CONCLUSION: The proposed image analysis system provides the means to reduce subjectivity in grading bladder tumors and may contribute to more accurate diagnosis and prognosis since it relies on nuclear features, the value of which has been confirmed.     

Anterior pituitary cell antibodies detected in Hashimoto's thyroiditis and Graves' disease

An immunofluorescence study using unfixed cryostat sections of rat pituitary glands was carried out on sera from 34 patients with Hashimoto's thyroiditis, 28 patients with Graves' disease, 10 patients with thyroid adenoma and 50 healthy subjects. After absorption of sera with rat liver tissues, 19 of 34 patients retained reactivity to anterior pituitary cell antibodies (PCA, 55.8%). On the other hand, immunofluorescence in anterior pituitary cells was faint and detected in only 2 of 28 patients with Graves' disease (7.1%) after absorption of their sera with rat liver aceton powder. A similar result was also obtained when PCA were compared in the sera of Hashimoto's thyroiditis and Graves' disease with high titers of thyroid microsomal autoantibodies. PCA were detected neither in the sera of patients with thyroid adenoma nor in the healthy subjects. The present study suggests that PCA were considerably more prevalent in Hashimoto's thyroiditis than in Graves' disease.     

A singular case of Graves' disease in congenital thyroid hemiagenesis

We report the observation of an unusual case of Graves' disease associated with thyroid hemiagenesis. A 41-year-old woman who presented with symptoms and clinical signs of hyperthyroidism was discovered to have thyroid hemiagenesia of the left lobe. Thyroid ultrasound scan showed enlargement of the right lobe with a single nodule, and absence of the left lobe; isotope scan showed homogeneous uptake in the single lobe and nodule. Ophthalmopathy, which was absent at presentation, developed after two years; after a further 2 years the patient developed decompensated hypothyroidism requiring thyroxine replacement. This is the first case of Graves' disease in thyroid hemiagenesis evolved to hypothyroidism, and a rare case of thyroid ophthalmopathy accompanying this condition.     

Morphometric analysis of the degree of aggregation of follicular cells in the diagnosis of malignant thyroid tumors

OBJECTIVE: To develop a system of decision criteria based on a set of features of the degree of thyrocyte aggregation with assessment of their weighting coefficient in the diagnosis of malignant and benign thyroid pathology. STUDY DESIGN: Autopsy, operative and aspiration biopsy material were the object of the study. Light microscopic morphometry was performed with semiautomated computer analysis of images. RESULTS: Of all the sets of features of the degree of thyrocyte aggregation, 10 were chosen that provided the least overlap between the groups of malignant and benign pathology. Boundary values of these features to discriminate between malignant and benign pathology were assembled into a set of diagnostic decision criteria for thyroid carcinoma diagnosis. Based on results from trials, an equation for the calculation of a weighting coefficient for each feature was derived. A diagnostic index was determined by the sum of values of weighting coefficients of the features within the range of values listed in the set of diagnostic decision criteria. CONCLUSION: A set of diagnostic decision criteria was developed for thyroid carcinoma diagnosis that is based on morphometric features reflecting the regularities of changes in the structure of thyrocyte aggregates with malignant and benign pathology. Weighting coefficients of features were assessed, making it possible to perform a probabilistic carcinoma diagnosis.     

Temporal lobe volume in disorders with psychotic features

Since early neuropathological findings, temporal lobe has been related to the pathophysiology of some disorders with psychotic features. The aim of this study was to compare temporal lobe volumes and asymmetry differences in patients with schizophrenia, schizoaffective and bipolar disorders, disorders that cover the whole psychotic spectrum. Temporal lobe volumes were estimated using high resolution magnetic resonance imaging in 60 subjects, 15 subjects in each patient and one healthy volunteer (control) group. There are no statistically significant differences in temporal lobe volumes among patient and control groups. Comparison of left and right temporal lobes shows that left temporal lobes are smaller than right temporal lobes, however this difference reaches statistical significance only in groups of patients with schizoaffective and bipolar disorders. Overall temporal lobe volume may be less informative in respect to neuropathology of disorders with psychotic features than volumes of specific temporal lobe structures, in particular medial temporal lobe structures.     

基于不同决策树的面向对象林区遥感影像分类比较

面向地理对象影像分析技术(GEOBIA)是影像分辨率越来越高的背景下的产物.如何提高高分辨率影像分类精度和分类效率是影像处理的重要议题之一.本研究对QuickBird影像多尺度分割后的对象进行分类,分析了C5.0、C4.5、CART决策树算法在林区面向对象分类中的效率,并与kNN算法的分类精度进行比较.利用eCognition软件对遥感影像进行多尺度分割,分析得到最佳尺度为90和40.在90尺度下分离出植被和非植被后,在40尺度下提取不同类别植被的光谱、纹理、形状等共21个特征,并利用C5.0、C4.5、CART决策树算法分别对其进行知识挖掘,自动建立分类规则.最后利用建立的分类规则分别对植被区域进行分类,并比较分析其精度.结果表明: 基于决策树的分类精度均高于传统的kNN法.其中,C5.0方法的精度最高,其总体分类精度为90.0%,Kappa系数0.87.决策树算法能有效提高林区树种分类精度,且C5.0决策树的Boosting算法对该分类效果具有最明显的提升.     

Correlation of Findings from Iodine 123 Scan and Ultrasonography in the Recommendation for Thyroid Fine-Needle Aspiration Biopsy

ObjectiveTo assess the impact of correlating findings from iodine I 123 (¹²³I) radionuclide scans and thyroid ultrasonography on the decision to perform fine-needle aspiration (FNA) biopsy of thyroid nodules.MethodsIodine 123 scans and sonographic images of adult patients who had both examinations performed within 6 months of each other at our institution were retrospectively reviewed. The presence of 1 or more nodules satisfying imaging-specific criteria for recommending FNA biopsy was recorded. Iodine 123 scan and sonographic images were then directly compared to determine how frequently the FNA recommendation would be affected by discordant findings.ResultsThe study included 97 adult patients, with a total of 291 thyroid lobes (right thyroid lobe, left thyroid lobe, and isthmus). Recommendations for FNA biopsy were concordant in 231 of 291 lobes (79.4%), with both modalities recommending FNA biopsy in 55 lobes and not recommending FNA biopsy in 176 lobes. A discordant recommendation occurred in 60 of 291 lobes (20.6%). Using only ultrasonography findings, a recommendation for FNA biopsy was not indicated for 11 of the 291 lobes (3.8%) with functioning nodules. Using only ¹²³I findings, a recommendation for FNA biopsy was not indicated for 23 of the 291 lobes (7.9%); 13 had nodules, but none that fulfilled sonographic criteria, and 10 had no identifiable nodule on ultrasonography. Iodine 123 scan did not identify 26 lobes with nodules (8.9%) for which FNA biopsy was recommended based on ultrasonography findings.ConclusionRecommendations for FNA biopsy should not be based on the presence of hypofunctioning regions on ¹²³I scan without sonographic confirmation. (Endocr Pract. 2011;17:699-706)     

Accumulation of cytochrome P450 induced by proteasome inhibition during cardiac ischemia

Although differences in size of the right and left thyroid lobes are well defined, differences in morphology, follicles structure, cAMP production, thyrotropin receptor, and protein involved in cell signalling have not previously been reported. This study provides morpho-functional data of right and left thyroid lobes by biochemical, immunohistochemistry, immunoblotting and immunofluorescence analysis. We demonstrate that, in comparison with the left lobe, the right lobe has a higher activation index, is more sensitive to thyrotropin treatment, is rich in thyrotropin receptor and caveolin 1 involved in thyroid hormone synthesis as well as in epithelial thyroid cell homeostasis, is characterised by a high content of molecules involved in cell signalling such as stat3, raf1, sphingomyelinase and sphingomyelin-synthase whose activity ratio is necessary for epithelial cell activity and finally has more areas calcitonin-dependent. The relation between structure/function of right lobe and its susceptibility to the higher risk of pathological modifications with respect the left lobe is discussed.     

Improvement of image classification using wavelet coefficients with structured-based neural network

Image classification is a challenging problem in organizing a large image database. However, an effective method for such an objective is still under investigation. A method based on wavelet analysis to extract features for image classification is presented in this paper. After an image is decomposed by wavelet, the statistics of its features can be obtained by the distribution of histograms of wavelet coefficients, which are respectively projected onto two orthogonal axes, i.e., x and y directions. Therefore, the nodes of tree representation of images can be represented by the distribution. The high level features are described in low dimensional space including 16 attributes so that the computational complexity is significantly decreased. 2,800 images derived from seven categories are used in experiments. Half of the images were used for training neural network and the other images used for testing. The features extracted by wavelet analysis and the conventional features are used in the experiments to prove the efficacy of the proposed method. The classification rate on the training data set with wavelet analysis is up to 91%, and the classification rate on the testing data set reaches 89%. Experimental results show that our proposed approach for image classification is more effective.     

Graves' hyperthyroidism following primary hypothyroidism due to Hashimoto's thyroiditis in a case of thyroid hemiagenesis: case report

Thyroid hemiagenesis (TH) is a rare inborn anomaly, resulting from failure of one thyroid lobe development. It is usually detected incidentally during investigation of concomitant thyroid disorders. The reported patient first presented hypothyroidism at the age of 49, when Hashimoto's thyroiditis (HT) and left thyroid lobe agenesis was diagnosed. L-thyroxine (LT4) replacement therapy restored hormonal balance. Two years later, the patient developed features of Graves' hyperthyroidism. The antithyroid pharmacotherapy by thiamazole was used. However, due to severe side-effects it was discontinued, and radioiodine treatment was applied. Four months after 131I administration, symptoms of hypothyroidism appeared, so thyroid hormone substitution was reintroduced. The patient, whose observation period has now reached 5 years, under LT4 replacement therapy, remains both clinically and biochemically euthyroid. The described case displays a very rare coincidence of hypothyroidism due to HT converted into Graves' hyperthyroidism, accompanying TH. Each of these three entities, may influence the thyroid function in a different way, hence, systematic follow-up and individual therapeutic management is required.     

Object-based classification of land cover and tree species by integrating airborne LiDAR and high spatial resolution imagery data

We evaluated the effectiveness of integrating discrete return light detection and ranging (LiDAR) data with high spatial resolution near-infrared digital imagery for object-based classification of land cover types and dominant tree species. In particular we adopted LiDAR ratio features based on pulse attributes that have not been used in past studies. Object-based classifications were performed first on land cover types, and subsequently on dominant tree species within the area classified as trees. In each classification stage, two different data combinations were examined: LiDAR data integrated with digital imagery or digital imagery only. We created basic image objects and calculated a number of spectral, textural, and LiDAR-based features for each image object. Decision tree analysis was performed and important features were investigated in each classification. In the land cover classification, the overall accuracy was improved to 0.975 when using the object-based method and integrating LiDAR data. The mean height value derived from the LiDAR data was effective in separating “trees” and “lawn” objects having different height. As for the tree species classification, the overall accuracy was also improved by object-based classification with LiDAR data although it remained up to 0.484 because spectral and textural signatures were similar among tree species. We revealed that the LiDAR ratio features associated with laser penetration proportion were important in the object-based classification as they can distinguish tree species having different canopy density. We concluded that integrating LiDAR data was effective in the object-based classifications of land cover and dominant tree species.     

一种非酒精性脂肪性肝病的超声影像人工智能辅助诊断系统开发

摘要 目的：结合人工智能方法设计针对肝脏超声影像的辅助诊断系统，辅助医生对大样本肝脏超声影像数据的标准化和高效化诊断，实现基于肝脏超声图像的非酒精性脂肪性肝病的精准诊断。方法：通过开发肝脏超声影像的识别与分类、脂肪肝分级分析和肝脏脂肪含量定量分析三个模块，建立一套非酒精性脂肪性肝病的超声影像人工智能辅助诊断系统，该系统能够自动区分输入到系统中不同采样视野的超声影像类型，并对肝脏超声图像进行数字化分析，给出待测超声图像是否呈现脂肪肝以及其肝脏脂肪含量的百分比值。结果：本研究中的超声图像识别分类模块可高通量区分出肝肾比图像和衰减率图像的两类超声影像，其分类的准确率达100%。脂肪肝分级分析模块在测试集数据的准确率达到84%，展现出可胜任辅助医生诊断的能力。基于人工肝脏脂肪含量定量方法开发的肝脏脂肪含量定量分析模块的准确率达到67.74%。结论：本研究已开发出一套基于肝脏超声影像的智能辅助诊断系统，可以辅助医生快速、简单、无创地筛选出潜在患有脂肪肝的患者，虽然现阶段实现肝脏脂肪定量分析仍有难度，但已展现出较大的临床应用潜力。     

Brain activity in hunger and satiety: an exploratory visually stimulated FMRI study

Objective: To explore neuroanatomical sites of eating behavior, we have developed a simple functional magnetic resonance imaging (fMRI) paradigm to image hunger vs. satiety using visual stimulation. Methods and Procedures: Twelve healthy, lean, nonsmoking male subjects participated in this study. Pairs of food‐neutral and food‐related pictures were presented in a block design, after a 14‐h fast and 1 h after ad libitum ingestion of a mixed meal. Statistically, a general linear model for serially autocorrelated observations with a P level <0.001 was used. Results: During the hunger condition, significantly enhanced brain activity was found in the left striate and extrastriate cortex, the inferior parietal lobe, and the orbitofrontal cortices. Stimulation with food images was associated with increased activity in both insulae, the left striate and extrastriate cortex, and the anterior midprefrontal cortex. Nonfood images were associated with enhanced activity in the right parietal lobe and the left and right middle temporal gyrus. A significant interaction in activation pattern between the states of hunger and satiety and stimulation with food and nonfood images was found for the left anterior cingulate cortex, the superior occipital sulcus, and in the vicinity of the right amygdala. Discussion: These preliminary data from a homogenous healthy male cohort suggest that central nervous system (CNS) activation is not only altered with hunger and satiety but that food and nonfood images have also specific effects on regional brain activity if exposure takes place in different states of satiety. Wider use of our or a similar approach would help to establish a uniform paradigm to map hunger and satiety to be used for further experiments.     

Tissue counter analysis of histologic sections of melanoma: influence of mask size and shape, feature selection, statistical methods and tissue preparation.

BACKGROUND: Tissue counter analysis is an image analysis tool designed for the detection of structures in complex images at the macroscopic or microscopic scale. As a basic principle, small square or circular measuring masks are randomly placed across the image and image analysis parameters are obtained for each mask. Based on learning sets, statistical classification procedures are generated which facilitate an automated classification of new data sets. OBJECTIVE: To evaluate the influence of the size and shape of the measuring masks as well as the importance of feature selection, statistical procedures and technical preparation of slides on the performance of tissue counter analysis in microscopic images. As main quality measure of the final classification procedure, the percentage of elements that were correctly classified was used. STUDY DESIGN: HE-stained slides of 25 primary cutaneous melanomas were evaluated by tissue counter analysis for the recognition of melanoma elements (section area occupied by tumour cells) in contrast to other tissue elements and background elements. Circular and square measuring masks, various subsets of image analysis features and classification and regression trees compared with linear discriminant analysis as statistical alternatives were used. The percentage of elements that were correctly classified by the various classification procedures was assessed. In order to evaluate the applicability to slides obtained from different laboratories, the best procedure was automatically applied in a test set of another 50 cases of primary melanoma derived from the same laboratory as the learning set and two test sets of 20 cases each derived from two different laboratories, and the measurements of melanoma area in these cases were compared with conventional assessment of vertical tumour thickness. RESULTS: Square measuring masks were slightly superior to circular masks, and larger masks (64 or 128 pixels in diameter) were superior to smaller masks (8 to 32 pixels in diameter). As far as the subsets of image analysis features were concerned, colour features were superior to densitometric and Haralick texture features. Statistical moments of the grey level distribution were of least significance. CART (classification and regression tree) analysis turned out to be superior to linear discriminant analysis. In the best setting, 95% of melanoma tissue elements were correctly recognized. Automated measurement of melanoma area in the independent test sets yielded a correlation of r=0.846 with vertical tumour thickness (p<0.001), similar to the relationship reported for manual measurements. The test sets obtained from different laboratories yielded comparable results. CONCLUSIONS: Large, square measuring masks, colour features and CART analysis provide a useful setting for the automated measurement of melanoma tissue in tissue counter analysis, which can also be used for slides derived from different laboratories.     

实验猕猴肺部CT影像断层初步观察

目的应用CT技术对成年实验猕猴胸部肺窗进行断层扫描观察,探讨CT技术对猕猴肺部疾病的临床诊断意义,建立正常猴肺部CT断层扫描图谱,为CT技术在猕猴解剖学的研究、疾病的临床诊断及科学实验方面的应用,提供影像学的基础资料。方法经过触诊、叩诊、听诊、体温、呼吸率、心率、呼吸运动、血液常规等检查,选择健康猴10只,雌雄各半,年龄分别为5～10岁,进行肺部CT断层扫描检测。试验猴全身麻醉后,置于CT诊断床上,取头前尾后仰卧位进行肺部扫描,获取肺窗扫描图像。对具有解剖意义的扫描图像的每个层面的主要结构（肺叶、气管、动脉血管、静脉血管等）进行标注。结果 （1）获得具有解剖意义的肺窗扫描图像13张。（2）在断层扫描的图像中,肺、气管、较大血管等组织器官界面清晰。肺为左右两侧,左肺分为上叶、中叶、下叶,右肺分为上叶、中叶、下叶、奇叶四部分。不同的断层面分别可见肺部左主支气管、右主支气管、支气管、血管等组织。（3）肺部较小或细小的血管、神经组织界面不清晰。结论 （1）应用CT获得的正常猕猴胸部肺窗断层扫描图像表明,正常健康猴双肺纹理清晰,走行自然,肺野透光度良好,双肺无异常实质病变影像。（2）获得了健康猕猴肺部的CT影像学资料,为猕猴肺部疾病的诊断,提供了一种安全、方便又准确的新依据,建立了成年健康猕猴肺部CT断层解剖研究的背景资料。     

Thyroid cryotherapy in an experimental rat model-topography of temperature during therapy and functional results

The aim of this study was to investigate post cryotherapy thyroid function status of normal rat thyroid tissue and to determine the topography of temperature of cryotreated tissues and of tissues adjacent to them. Nitrous oxide cryotherapy was performed in 40 male Wistar rats. They were divided into four groups of 10. In group I, the right thyroid lobe was subjected to cryotherapy and the left lobe was not frozen. In group II, both thyroid lobes were cryotreated. In group III, the right lobe was frozen and the left lobe was excised. In group IV, the thyroid was subjected to neither cryotherapy nor surgery. During cryotherapy, the temperature in various places of the thyroid and in the surrounding tissues was measured. Serum thyrotropin concentrations were determined before an experiment and 4 weeks after in all rats. The results of temperature measurements proved that it is possible to limit cryotherapy to certain areas of thyroid tissue and to spare the neighboring tissues, because they are not subjected to temperatures that are damaging. The effectiveness of cryotherapy was confirmed by functional effect. Cryotherapy changed function of thyroid tissue. There was a statistically significant difference between mean baseline and follow-up concentrations in rats of groups II and III. In both groups hypothyroidism occurred post cryotherapy.     

Pulmonary immunoreactive calcitonin in the African green monkey (Cercopithecus aethiops): Anatomic distribution

The hormone calcitonin, which occurs predominantly within the C cells of the mammalian thyroid gland, is also found within the pulmonary endocrine cells of the epithelium of the tracheobronchial tree. A study was made of the distribution of immunoreactive calcitonin (iCT) in the African green monkey. Using two different region-specific antisera, the total respiratory iCT comprised 2.5% and 5.8% of the total thyroid iCT. The mean concentration of iCT in the right lung exceeded that in the left, and the mean concentration of the right middle or right upper lobe exceeded that of all other lobes. Embryologically, the ultimobranchial bodies contribute their iCT-producing C cell primordia to the thyroid gland near the level of the primitive laryngotracheal cleft and shortly after the early arborization of the bronchial tree. In monkeys and most other mammals, the right main stem bronchus is larger and develops earlier than the left. The data suggest an early migration of cells from the ultimobranchial bodies to the bronchi, eventually giving rise to the iCT-containing pulmonary endocrine cells.