The challenge of applying digital image processing software on intraoral radiographs for osteoporosis risk assessment

Objectives: The purpose of this study was to evaluate rater agreement and the accuracy of a semi-automated software and its fully automated tool for osteoporosis risk assessment in intraoral radiographs. Methods: A total of 567 intraoral radiographs was selected retrospectively from women aged 75–80 years participating in a large population-based study (SUPERB) based in Gothenburg, Sweden. Five raters assessed participants’ risk of osteoporosis in the intraoral radiographs using a semi-automated software. Assessments were repeated after 4 weeks on 121 radiographs (20%) randomly selected from the original 567. Radiographs were also assessed by the softwares’ fully automated tool for analysis. Results: Overall interrater agreement for the five raters was 0.37 (95% CI 0.32–0.41), and for the five raters with the fully automated tool included as ‘sixth rater’ the overall Kappa was 0.34 (0.30–0.38). Intrarater agreement varied from moderate to substantial according to the Landis and Koch interpretation scale. Diagnostic accuracy was calculated in relation to reference standard for osteoporosis diagnosis which is T-score values for spine, total hip and femoral neck and presented in form of sensitivities, specificities, predictive values, likelihood ratios and odds ratios. All raters' mean sensitivity, including the fully automated tool, was 40,4% (range 14,3%–57,6%). Corresponding values for specificity was 69,5% (range 59,7%–90,4%). The diagnostic odds ratios ranged between 1 and 2.7. Conclusion: The low diagnostic odds ratio and agreement between raters in osteoporosis risk assessment using the software for analysis of the trabecular pattern in intraoral radiographs shows that more work needs to be done to optimise the automation of trabecular pattern analysis in intraoral radiographs.

Correlation between alveolar bone level and mandibular trabecular Pattern In Periodontitis Patients Of Belgaum: A Radiological Survey

Introduction – Bone is a living, dynamic tissue, which undergoes remodelling throughout life, especially in adults. Deterioration of bone microarchitecture involves changes in the thickness and number of trabeculae, separation of trabeculae, and morphometric changes in the trabecula. Some studies suggest that changes in bone metabolism are reflected more so in the trabecular pattern rather than the bone mineral density. To further explore this, a short-study was carried out to investigate radiographically the relationship between the alveolar bone level and different trabecular bone patterns in periodontitis patients. Materials and Methods – A set of panoramic radiographs of 30 subjects was taken from radiology section, which included both males and females. Average alveolar bone level in a quadrant was calculated for each patient. Trabecular bone in the mandibular premolar area was categorised using Taguchi et alcriteria. The two variables were analysed using Spearman’s correlation coefficient and regression analysis models. Result – A significant positive correlation was found between alveolar bone loss and density of trabecular pattern. Conclusion–With increasing grade of trabeculation, a larger alveolar bone loss can be expected. This may prove to be useful in preventing tooth loss as well as in implant planning. KeyWords: alveolar bone, trabecular bone pattern, panoramic radiographs.

RAP1GAP is a novel marker of trabecular pattern and poor sorafenib treatment response in hepatocellular carcinoma

Background The trabecular pattern is one of the most common features of hepatocellular carcinoma (HCC). In this study, we aimed to identify the molecular mechanisms underlying different trabecular patterns in HCC, and their interaction with current therapies. Methods To screen potential biomarkers of different trabecular patterns, we first linked gene expression data to haematoxylin and eosin (H&E) images from The Cancer Genome Atlas (TCGA). The Gene Expression Omnibus (GEO) database was used to explore potential targets of sorafenib treatment. Selected candidate biomarkers were further verified by immunohistochemistry, and their relationship with sorafenib efficacy was evaluated in 107 HCC samples with trabecular patterns. Results Analysis of RNA sequencing data from TCGA showed that the increasing number of cells in the trabecular structure correlated with increase in the expression of related signalling pathways—Ras, Rap1, IL17, TNF, AGE-RAGE, oestrogen, toll-like receptor signalling, and ubiquitin-mediated proteolysis—and genes related to response to oxygen levels and neoangiogenesis. In contrast, the expression of bile acid and carton, tryptophan, butanoate, and lipid metabolism-related pathways was reduced. The GEO database showed that RAP1GAP, TOB1, ACO2, and SCNN1D expression levels were selectively up-regulated in sorafenib non-responders. Based on the combined analysis of the two datasets and our previous studies, two candidate biomarkers, RAP1GAP and HIF1α, were selected. Immunohistochemical staining showed that RAP1GAP and HIF1α were expressed in the tumour tissues. Interestingly, RAP1GAP was also expressed in the tumour sinusoids. Overexpression of RAP1GAP in sinusoids were associated with trabecular patterns. Multivariate analysis also showed that RAP1GAP expression in the sinusoid was an independent predictor of progressive free survival (PFS) and overall survival (OS) in response to sorafenib treatment. Conclusions RAP1GAP is an essential microenvironment marker in the trabecular structure of HCC and exhibits an adverse association with outcome in sorafenib treatment.

Strumal Carcinoid Focus in Mature Cystic Teratoma in a Patient with Breast Cancer and Desire for Fertility Preservation

Ovarian primary carcinoid tumors are very rare, accounting for 0.5-1.7% of all carcinoid tumors and 3% of ovarian teratomas. This type of tumor frequently arises from a mature cystic teratoma. The primary ovarian carcinoid tumors are divided into 4 major types, based on their histological characteristics: insular, trabecular or mucinous pattern. Strumal carcinoid refers to insular or trabecular pattern associated with struma ovarii. The strumal type is the most common histologic form, accounting for 40% of primary ovarian carcinoid tumors. Approximately 5% of carcinoid tumors of the non-mucinous type can be malignant. However, in the case of ovarian strumal carcinoid, the occurrence of metastasis is unusual. This article is based on a case of a 30-year-old nulliparous woman diagnosed with strumal carcinoid, who presented a right ovarian tumor suggestive of teratoma synchronous to a breast cancer. She was referred to our center for fertility preservation.

ASSESSMENT OF ALVEOLAR BONE PATTERN IN OBESE AND NON-OBESE WOMEN, BEFORE AND AFTER BARIATRIC SURGERY: A PROSPECTIVE COHORT STUDY

ABSTRACT Background: Bariatric surgery may have a negative impact on oral bone structure. Aim: To verify the alveolar bone pattern through radiomorphometric indices of panoramic radiography and linear measurements performed in periapical radiographs in eutrophic and morbidly obese patients before and after bariatric surgery. Methods: The sample consisted of 31 women aged 20-35 years old, divided into two groups: obese group (GO-obese grade III) and control group (GC-eutrophic). Twenty eutrophic and 11 obese morbidities were evaluated in the pre and postoperative bariatric surgery (six months). Radiomorphometric and plaque indices were evaluated at T0 (baseline) and T1 (six months) times, in both groups. In the radiographic analysis the trabecular pattern through the Lindh visual ladder and the bone loss were evaluated by calculating the distance from the cement-enamel junction to the bone crest in periapical radiographs. Panoramic radiographs were used to measure the mandibular cortical index (ICM), mentonian index (IM) and panoramic mandibular index (MPI), in addition to the Turesky plate index. Results: There was a significant loss of bone in T1 in patients submitted to bariatric surgery, when compared to eutrophic patients (p<0.05). The trabecular pattern became sparser after surgery with a visual difference. The plate index showed a slight improvement after surgery and the eutrophic maintained similar values over time. Conclusion: The standard alveolar bone presents greater bone loss in obese patients and worsens this standard after bariatric surgery when compared to eutrophic patients. The same happens with the trabecular pattern that becomes sparser after bariatric surgery.

Mandibular Trabecular Bone Analysis Using Local Binary Pattern for Osteoporosis Diagnosis

Background: Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and micro-architectural deterioration of bone tissue, leading to bone fragility and increased fracture risk. Since Panoramic image is a feasible and relatively routine imaging technique in dentistry; it could provide an opportunistic chance for screening osteoporosis. In this regard, numerous panoramic derived indices have been developed and suggested for osteoporosis screening. Jaw trabecular pattern is one of the main bone strength factors and trabecular bone pattern assessment is important factor in bone quality analysis. Texture analysis applied to trabecular bone images offers an ability to exploit the information present on conventional radiographs.Objective: The purpose of this study was to evaluate the relationship between Jaw trabecular pattern in panoramic image and osteoporosis based on image texture analyzing using local binary pattern.Material and Methods: An experiment is evaluated in this paper based on a real hand-captured database of panoramic radiograph images from osteoporosis and non-osteoporosis person in Namazi Hospital , Shiraz, Iran .An approach is proposed for osteoporosis diagnosis consisting of two steps. First, modified version of local binary patterns is used to extract discriminative features from jaw panoramic radiograph images. Then, classification is done using different classifiers.Results: Comparative results show that the proposed approach provides classification accuracy about 99.6%, which is higher than many state-of-the-art methods.Conclusion: High classification accuracy, low computational complexity, multi-resolution and rotation invariant are among advantages of our proposed approach.