Breast cancer is a malignancy caused by the abnormal proliferation of breast epithelial cells, predominantly affecting female patients, and it is commonly diagnosed using histopathological images. Currently, deep learning techniques have made significant breakthroughs in medical image processing, outperforming traditional detection methods in breast cancer pathology classification tasks. This paper first reviewed the advances in applying deep learning to breast pathology images, focusing on three key areas: multi-scale feature extraction, cellular feature analysis, and classification. Next, it summarized the advantages of multimodal data fusion methods for breast pathology images. Finally, the study discussed the challenges and future prospects of deep learning in breast cancer pathology image diagnosis, providing important guidance for advancing the use of deep learning in breast diagnosis.
Magnetic resonance imaging (MRI) plays a crucial role in the diagnosis of ischemic stroke. Accurate segmentation of the infarct is of great significance for selecting intervention treatment methods and evaluating the prognosis of patients. To address the issue of poor segmentation accuracy of existing methods for multiscale stroke lesions, a novel encoder-decoder architecture network based on depthwise separable convolution is proposed. Firstly, this network replaces the convolutional layer modules of the U-Net with redesigned depthwise separable convolution modules. Secondly, an modified Atrous spatial pyramid pooling (MASPP) is introduced to enlarge the receptive field and enhance the extraction of multiscale features. Thirdly, an attention gate (AG) structure is incorporated at the skip connections of the network to further enhance the segmentation accuracy of multiscale targets. Finally, Experimental evaluations are conducted using the ischemic stroke lesion segmentation 2022 challenge (ISLES2022) dataset. The proposed algorithm in this paper achieves Dice similarity coefficient (DSC), Hausdorff distance (HD), sensitivity (SEN), and precision (PRE) scores of 0.816 5, 3.668 1, 0.889 2, and 0.894 6, respectively, outperforming other mainstream segmentation algorithms. The experimental results demonstrate that the method in this paper effectively improves the segmentation of infarct lesions, and is expected to provide a reliable support for clinical diagnosis and treatment.
Objective To evaluate the clinical features of acute macular neuroretinopathy (AMN) associated with COVID-19. MethodsA retrospective case series studies. A total of 12 eyes of 8 patients diagnosed of AMN associated with COVID-19 at Peking University People’s Hospital from December 5, 2022 to January 5, 2023 were included. Of the 8 patients, 2 were male (4 eyes) and 6 were female (8 eyes), with an average age of (29.38±8.60) years. All patients underwent best-corrected visual acuity (BCVA), spectral-domain optical coherence tomography (OCT), and infra-red fundus photography (IR). After definite diagnosis, the patients were given symptomatic treatment such as local vasodilation, anti-inflammatory and systemic circulation improvement and nutritional nerve. Follow-up time was 21-30 days weeks. Clinical manifestations, OCT and IR image characteristics, and treatment outcomes were retrospectively analyzed. ResultsThe time from diagnosis of COVID-19 to the onset of ocular symptoms was (3.00±0.93) days. Among 12 eyes, 6 had complaints of paracentral scotoma, with 2 of them accompanied by visual acuity loss; and 6 had complaints of dark shadows in the vision, with 2 of them accompanied by visual acuity loss. At the initial examination, 2 eyes had a BCVA of less than 0.05, 2 eyes had a BCVA between 0.4 and 0.6, and 8 eyes had a BCVA between 0.8 and 1.0. At the last follow-up, visual symptoms improved in 7 eyes and remained unchanged in 5 eyes. Fundus color photography showed reddish-brown lesions in the macular area. Spectral-domain OCT revealed localized thickening and strong reflection of the outer plexiform layer (OPL) in the macular area, patchy strong reflections in the outer nuclear layer (ONL), and varying degrees of local discontinuity in the adjacent external limiting membrane, ellipsoid zone/interdigitation zone (EZ/IZ), with reduced local reflection in the adjacent retinal pigment epithelium layer in 2 eyes. The strong reflection area of the ONL on corresponding structural OCT was observed more clearly as a lesion range with strong reflection on en-face OCT. The incomplete structure of the EZ/IZ band was observed more clearly as a lesion range with weak reflection on en-face OCT. IR showed several clear-bordered and weakly reflecting lesions at the center of the macula, with the tip pointing to the fovea. ConclusionsAMN associated with COVID-19 tends to occur in young females. The OCT findings of AMN are characterized by strong reflections in the OPL and ONL, and lesion ranges can be observed more clearly at different levels using en-face OCT. The lesions on IR appear as weak reflections.
ObjectiveTo observe the multimodal imaging characteristics of tamoxifen retinopathy. MethodsA retrospective case study. From January 2019 to December 2021, 4 patients (8 eyes) with tamoxifen retinopathy diagnosed in Tangshan Eye Hospital were included in the study. All patients were female, with sick binoculus. The age was 59.5±4.6 years. After breast cancer resection, tamoxifen 20 mg/d was taken orally consecutively, including 1, 1, and 2 cases who took tamoxifen orally for 5, 7, and ≥10 years. All eyes were examined by fundus color photography, optical coherence tomography (OCT), OCT angiography (OCTA), fundus fluorescein angiography (FFA), and fundus autofluorescence (AF). The multi-mode image features of the fundus of the affected eyes were observed. ResultsThe yellow white dot crystal like material deposition in the macular area was observed in all eyes. In fundus AF examination, macular area showed patchy strong AF. FFA examination showed telangiectasia and fluorescein leakage in macular area at late stage. OCT showed that punctate strong reflexes could be seen between the neuroepithelial layers in the macular region with the formation of a space between the neuroepithelial layers, the interruption of the elliptical zone (EZ), and the formation of a hole in the outer lamella including 4, 5 and 3 eyes; The thickness of ganglion cells in macular region decreased in 7 eyes. OCTA showed that the blood flow density of the superficial retinal capillary plexus around the arch ring was decreased, and the retinal venules were dilated in 2 eyes; Deep capillary plexus (DCP) showed telangiectasia. ConclusionDeposition of yellowish white dot like crystals can be seen in the macular region of tamoxifen retinopathy; dotted strong reflex between neuroepithelial layers, cavity formation, thinning of ganglion cell layer, EZ middle fissure and outer lamellar fissure; DCP capillaries and venules around the arch were dilated; telangiectasia in macular region; flaky strong AF in macular region.
ObjectiveTo observe the multimodal imaging characteristics of multiple evanescent white dot syndrom (MEWDS).MethodsThis was a retrospective series case study. Eighteen patients (18 eyes) diagnosed with MEWDS in Eye Center of The Second People’s Hospital of Foshan from September 2015 to April 2017 were enrolled in this study. There were 12 females and 6 males, with the mean age of 35.9 years. The disease course ranged from 3 to 90 days, with the mean of 14 days. All the patients underwent BCVA, slit-lamp microscope with +90D preset lens, fundus photography, spectral domain OCT (SD-OCT) and FAF examinations. FFA was simultaneously performed in 6 eyes, FFA and ICGA were simultaneously performed in 12 eyes. Ten patients received the treatment of glucocorticoids and vasodilator substance, and other 8 patients without any treatment. The follow-up duration was 4.5 months. The multimodal imaging characteristics were reviewed and analyzed.ResultsFundus color photography showed a variable number of small dots and large spots lesions (14 eyes), and/or fovea granularity (7 eyes) and disk swelling (5 eyes). A variable number of little dots and larger spots lesions showed respectively in FFA, FAF and ICGA were needle-like dots distributed in a wreathlike pattern and a large plaque occasionally confluent of early highly fluorescent, highly autofluorescence and hypofluoresence. Combined hypofluorescent spots with overlying dots were observed in 10 eyes of the late stages of the ICGA. Black lesions in the gray background show in ICGA were the most obvious and the most extensive, gray-white lesions in the gray-black show in FAF were the second, light gray-black lesions in the gray show in FFA were the least. Gray-white lesions in an orange background show in fundus photography were not obvious and transient. SD-OCT showed disruption of the ellipsoid zone and/or accumulations of hyperreflective material from the ellipsoid layer toward the outer plexiform layer and vitreous cells. During the period of following-up, some patients were prescribed low-dose glucocorticoid and some not, almost all the patients except one patient experienced recovery in BCVA and the lesions in fundus imaging.ConclusionsThe lesions in MEWDS eyes in modern multimodal imaging modalities among fundus photography (fovea granularity), FFA (needle-like dots distributed in a wreathlike pattern and a large plaque occasionally confluent of early highly fluorescent), ICGA (flake hypofluorescent) and SD-OCT (disruption of the ellipsoid zone) showed good consistency. Almost eyes were recovery.
The update of the cognition of fundus diseases is inseparable from the rapid development of fundus multimodal imaging. Especially in recent years, the application of wide and ultra-wide fundus photography, ultra-wide fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence and optical coherence tomography angiography contribute to observe the peripheral retinopathy more directly. The application of adaptive optics and fluorescence lifetime imaging ophthalmoscopy contribute to have a further understanding of fundus diseases at the cellular and metabolic level. Multimodal imageing reflect the pathological characteristics of the diseases from different angles and levels. At the same time, the digitization and intelligence of fundus images are also developing rapidly. However, there are some problems that the ophthalmologists needs to consider further, such as the correctly understanding the use of multimodal imaging, the application of artificial intelligence, and how to sum up from the images.
Female pelvic floor dysfunction (PFD) is a common disease affecting women's quality of life, especially in older women. The establishment and application of multimodal evaluation system is the key to the accurate diagnosis and effective treatment of PFD. The purpose of this expert consensus is to provide a comprehensive, multi-layered assessment framework that includes clinical examinations, imaging examinations, biomechanical tests, and questionnaires to comprehensively assess pelvic floor function in women. By integrating different assessment methods, we aim to improve the early identification and diagnostic accuracy of PFD, so that personalized treatment can be developed to improve patient outcomes. The consensus also discusses the advantages and disadvantages of various assessment techniques and suggests directions for future research and clinical applications.
ObjectiveTo observe multimodal imaging characteristics in eyes with focal choroidal excavation (FCE) and preliminarily analyze the risk factors in FCE with complications correlated with RPE.MethodsA retrospective case series. Thirty-one patients (31 eyes) with monocular FCE, first identified by spectral-domain (SD)-OCT in the Eye Center of The Second People’s Hospital of Foshan from December 2014 to December 2018, were involved in this study. There were 14 males and 17 females, with the mean age of 45.84±13.57 years. All patients underwent BCVA, optometry, and SD-OCT examinations. FFA and ICGA were simultaneously performed in 3 FCE patients with RPE complications. The subfoveal choroidal thickness (SFCT) and excavation width were measured with enhanced depth imaging OCT (EDI-OCT). The eyes with FCE were divided into two groups (FCE alone group 17 eyes vs. FCE complication group 14 eyes), based on whether complicated by RPE dysfunction. Among 14 eyes of FCE complication group, 7 (22.6%) with choroidal neovascularization, 4 (12.9%) with central serous chorioretinopathy, 1 (3.2%) with polypoidal choroidal vasculopathy, and 2 (6.5%) with RPE detachment. No significant difference was found in the mean age (t=0.87), gender composition (χ2=0.06), ocular laterality (χ2=2.58), and spherical equivalent (t=?0.81) between two groups, respectively (P＞0.05), except that the BCVA was significantly different (t=?2.11, P＜0.05). The SFCT and excavation width of eyes in both groups and the ICGA imaging characteristics of eyes in FCE complication group were analyzed. Risk factors of FCE with RPE complications were analyzed by logistic regression analysis.ResultsThirty-three excavations were identified in 31 eyes with FCE. The mean SFCT was 167.00±85.18 μm in FCE alone group vs. 228.36±67.95 μm in FCE complication group, while the excavation width was 645.00±231.93 μm vs. 901.00±420.55 μm and they were both significantly different (P＜0.05). Logistic regression analysis showed the SFCT (OR=1.016, P=0.026) and excavation width (OR=1.004, P=0.034) were risk factors for RPE complications of FCE. EDI-OCT showed the RPE at the excavation was impaired or vulnerable in all eyes of the FCE alone group, especially at the boundary area of excavation. The RPE damages were located at the boundary area of excavation in 10 eyes (71.4%) of FCE complication group. Constant choroidal hypofluorescence and filling defect were observed under the excavation in 3 eyes with ICGA imaging.ConclusionsSFCT and excavation width may be risk factors for RPE complications of FCE. Impairment of RPE at boundary area of excavation and focal choroidal ischemia or aberrant circulation under the excavation may correlate with the development of FCE complications.
In recent years, the incidence of thyroid diseases has increased significantly and ultrasound examination is the first choice for the diagnosis of thyroid diseases. At the same time, the level of medical image analysis based on deep learning has been rapidly improved. Ultrasonic image analysis has made a series of milestone breakthroughs, and deep learning algorithms have shown strong performance in the field of medical image segmentation and classification. This article first elaborates on the application of deep learning algorithms in thyroid ultrasound image segmentation, feature extraction, and classification differentiation. Secondly, it summarizes the algorithms for deep learning processing multimodal ultrasound images. Finally, it points out the problems in thyroid ultrasound image diagnosis at the current stage and looks forward to future development directions. This study can promote the application of deep learning in clinical ultrasound image diagnosis of thyroid, and provide reference for doctors to diagnose thyroid disease.
Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a peripheral retinal disease characterized by subretinal hemorrhage and/or subretinal pigment epithelial hemorrhage or exudation. It is often misdiagnosed as age-related macular degeneration, polypoidal chorioretinopathy or choroidal melanoma. With the development of multimodal imaging, PEHCR has different features under different examinations, such as B-scan ultrasound, fluorescein fundus angiography, optical coherence tomography and so on, which contributes to differention from other diseases. Clinical treatments for the disease include intravitreal injection of retinal photocoagulation therapy, anti-vascular endothelial growth factor, pars plana vitrectomyand so on, but there is still no universal consensus. In order to gain a deeper understanding of the clinical features, treatment options and prognosis of PEHCR, minimize missed diagnoses and misdiagnoses, and improve treatment efficiency, further research is required.
