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Fulltext Impact of Image Enhancement on the Radiomics Stability of Diffusion-Weighted MRI Images of Cervical Cancer

Ramli Z, Farizan A, Tamchek N, Haron Z, Abdul Karim MK

Cureus, 2024 Jan;16(1):e52132.
PMID: 38347995 DOI: 10.7759/cureus.52132

The diffusion-weighted imaging (DWI) technique is known for its capability to differentiate the diffusion of water molecules between cancerous and non-cancerous cervix tissues, which enhances the accuracy of detection. Despite the potential of DWI-MRI, its accuracy is limited by technical factors influencing in vivo data acquisition, thus impacting the quantification of radiomics features. This study aimed to measure the radiomics stability of manual and semi-automated segmentation on contrast limited adaptive histogram equalization (CLAHE)-enhanced DWI-MRI cervical images. Eighty diffusion-weighted MRI images were obtained from patients diagnosed with cervical cancer, and an active contour model was used to analyze the data. Radiomics analysis was conducted to extract the first statistical order, shape, and textural features with intraclass correlation coefficient (ICC) measurement. The results of the CLAHE segmentation approach showed a marked improvement when compared to the manual and semi-automated segmentation methods, with an ICC value of 0.990 ± 0.005 (p<0.05), compared to 0.864 ± 0.033 (p<0.05) and 0.554 ± 0.185 (p>0.05), respectively. The CLAHE segmentation displayed a higher level of robustness than the manual groups in terms of the features present in both categories. Thus, CLAHE segmentation is owing to its potential to generate radiomics features that are more durable and consistent.
Modulation of lipid metabolism in glycyrrhizic acid-treated rats fed on a high-calorie diet and exposed to short or long-term stress

Yaw HP, Ton SH, Chin HF, Karim MK, Fernando HA, Kadir KA

Int J Physiol Pathophysiol Pharmacol, 2015;7(1):61-75.
PMID: 26069530

Stress and high-calorie diets increase the risk of developing metabolic syndrome. Glycyrrhizic acid (GA) has been shown to improve dyslipidaemia in rats fed on a high-calorie diet. This study aimed to examine the effects of GA on lipid metabolism in rats exposed to short- or long-term stress and on a high-calorie diet. The parameters examined included serum lipid profiles, serum free fatty acids and fatty acid profiles in tissues, and expression of peroxisome proliferator-activated receptors (PPAR), lipoprotein lipase (LPL), elongases and desaturases. Within the 14- or 28-day exposure groups, neither stress nor GA affected the lipid profile and serum free fatty acids. Stress did not affect PPAR-α expression in both the 14- and 28-day exposure groups. However, GA-treated rats from the former group had increased PPAR-α expression only in the kidney while all other tissues from the latter group were unaffected. Stress increased PPAR-γ expression in the heart of the 28-day exposure group but its expression was unaffected in all tissues of the 14-day exposure group. GA elevated PPAR-γ expression in the kidney and the skeletal muscles. Neither stress nor GA affected LPL expressions in all tissues from the 14-day exposure group but its expressions were elevated in the QF of the stressed rats and heart of the GA-treated rats of the 28-day exposure group. As for the elongases and desaturases in the liver, stress down-regulated ELOVL5 in the long-term exposure group while up-regulated ELOVL6 in the short-term exposure group while hepatic desaturases were unaffected by stress. Neither elongase nor desaturase expressions in the liver were affected by GA. This research is the first report of GA on lipid metabolism under stress and high-calorie diet conditions and the results gives evidence for the role of GA in ameliorating MetS via site-specific regulation of lipid metabolism gene expressions and modification of fatty acids.
Fulltext Association of Radiation Doses and Cancer Risks from CT Pulmonary Angiography Examinations in Relation to Body Diameter

Harun HH, Abdul Karim MK, Abbas Z, Abdul Rahman MA, Sabarudin A, Ng KH

Diagnostics (Basel), 2020 Sep 09;10(9).
PMID: 32917029 DOI: 10.3390/diagnostics10090681

In this study, we aimed to estimate the probability of cancer risk induced by CT pulmonary angiography (CTPA) examinations concerning effective body diameter. One hundred patients who underwent CTPA examinations were recruited as subjects from a single institution in Kuala Lumpur. Subjects were categorized based on their effective diameter size, where 19-25, 25-28, and >28 cm categorized as Groups 1, 2, and 3, respectively. The mean value of the body diameter of the subjects was 26.82 ± 3.12 cm, with no significant differences found between male and female subjects. The risk of cancer in breast, lung, and liver organs was 0.009%, 0.007%, and 0.005% respectively. The volume-weighted CT dose index (CTDIvol) was underestimated, whereas the size-specific dose estimates (SSDEs) provided a more accurate description of the radiation dose and the risk of cancer. CTPA examinations are considered safe but it is essential to implement a protocol optimized following the As Low as Reasonably Achievable (ALARA) principle.
Fulltext Establishment of CTPA Local Diagnostic Reference Levels with Noise Magnitude as a Quality Indicator in a Tertiary Care Hospital

Harun HH, Abdul Karim MK, Abd Rahman MA, Abdul Razak HR, Che Isa IN, Harun F

Diagnostics (Basel), 2020 Sep 09;10(9).
PMID: 32916913 DOI: 10.3390/diagnostics10090680

This study aimed to establish the local diagnostic reference levels (LDRLs) of computed tomography pulmonary angiography (CTPA) examinations based on body size with regard to noise magnitude as a quality indicator. The records of 127 patients (55 males and 72 females) who had undergone CTPAs using a 128-slice CT scanner were retrieved. The dose information, scanning acquisition parameters, and patient demographics were recorded in standardized forms. The body size of patients was categorized into three groups based on their anteroposterior body length: P1 (14-19 cm), P2 (19-24 cm), and P3 (24-31 cm), and the radiation dose exposure was statistically compared. The image noise was determined quantitatively by measuring the standard deviation of the region of interest (ROI) at five different arteries-the ascending and descending aorta, pulmonary trunk, and the left and right main pulmonary arteries. We observed that the LDRL values were significantly different between body sizes (p < 0.05), and the median values of the CT dose index volume (CTDIvol) for P1, P2, and P3 were 6.13, 8.3, and 21.40 mGy, respectively. It was noted that the noise reference values were 23.78, 24.26, and 23.97 HU for P1, P2, and P3, respectively, which were not significantly different from each other (p > 0.05). The CTDIvol of 9 mGy and dose length product (DLP) of 329 mGy∙cm in this study were lower than those reported by other studies conducted elsewhere. This study successfully established the LDRLs of a local healthcare institution with the inclusion of the noise magnitude, which is comparable with other established references.
Fulltext Stability and Reproducibility of Radiomic Features Based Various Segmentation Technique on MR Images of Hepatocellular Carcinoma (HCC)

Haniff NSM, Abdul Karim MK, Osman NH, Saripan MI, Che Isa IN, Ibahim MJ

Diagnostics (Basel), 2021 Aug 30;11(9).
PMID: 34573915 DOI: 10.3390/diagnostics11091573

Hepatocellular carcinoma (HCC) is considered as a complex liver disease and ranked as the eighth-highest mortality rate with a prevalence of 2.4% in Malaysia. Magnetic resonance imaging (MRI) has been acknowledged for its advantages, a gold technique for diagnosing HCC, and yet the false-negative diagnosis from the examinations is inevitable. In this study, 30 MR images from patients diagnosed with HCC is used to evaluate the robustness of semi-automatic segmentation using the flood fill algorithm for quantitative features extraction. The relevant features were extracted from the segmented MR images of HCC. Four types of features extraction were used for this study, which are tumour intensity, shape feature, textural feature and wavelet feature. A total of 662 radiomic features were extracted from manual and semi-automatic segmentation and compared using intra-class relation coefficient (ICC). Radiomic features extracted using semi-automatic segmentation utilized flood filling algorithm from 3D-slicer had significantly higher reproducibility (average ICC = 0.952 ± 0.009, p < 0.05) compared with features extracted from manual segmentation (average ICC = 0.897 ± 0.011, p > 0.05). Moreover, features extracted from semi-automatic segmentation were more robust compared to manual segmentation. This study shows that semi-automatic segmentation from 3D-Slicer is a better alternative to the manual segmentation, as they can produce more robust and reproducible radiomic features.
Impact of age and breast thickness on mean glandular dose of standard digital mammography and digital breast tomosynthesis

Norsuddin NM, Mei Sin JG, Ravintaran R, Arasaratnam S, Abdul Karim MK

Appl Radiat Isot, 2023 Feb;192:110525.
PMID: 36436228 DOI: 10.1016/j.apradiso.2022.110525

This study compares the mean glandular dose (MGD) across 2D, 3D projection and Contrast-Enhanced Digital Mammography (CEDM) mammographic techniques. The important metadata were extracted from the digital mammography console. 650 subjects were clustered based on projections, age and CBT. The MGD of 2D, 3D, and CEDM was positively correlated with CBT but inversely correlated with the age factor. This study indicate MGD of CEDM was 16% and 22% lower compared to 2D and 3D techniques, respectively.
Bibliometric Review of Optimization and Image Processing of Positron Emission Tomography (PET) Imaging System between 1981-2022

Murat H, Awang Kechik MM, Chew MT, Kamal I, Abdul Karim MK

Curr Med Imaging, 2024 Apr 09.
PMID: 38616750 DOI: 10.2174/0115734056282004240403042345

BACKGROUND: PET scan stands as a valuable diagnostic tool in nuclear medicine, enabling the observation of metabolic and physiological changes at a molecular level. However, PET scans have a number of drawbacks, such as poor spatial resolution, noisy images, scattered radiation, artifacts, and radiation exposure. These challenges demonstrate the need for optimization in image processing techniques.
OBJECTIVES: Our objective is to identify the evolving trends and impacts of publication in this field, as well as the most productive and influential countries, institutions, authors, themes, and articles.
METHODS: A bibliometric study was conducted using a comprehensive query string such as "positron emission tomography" AND "image processing" AND optimization to retrieve 1,783 publications from 1981 to 2022 found in the Scopus database related to this field of study.
RESULTS: The findings revealed that the most influential country, institution, and authors are from the USA, and the most prevalent theme is TOF PET image reconstruction.
CONCLUSION: The increasing trend in publication in the field of optimization of image processing in PET scans would address the challenges in PET scan by reducing radiation exposure, faster scanning speed, as well as enhancing lesion identification.
Effect of miscentering and low-dose protocols on contrast resolution in computed tomography head examination

Shaffiq Said Rahmat SM, Abdul Karim MK, Che Isa IN, Abd Rahman MA, Noor NM, Hoong NK

Comput Biol Med, 2020 08;123:103840.
PMID: 32658782 DOI: 10.1016/j.compbiomed.2020.103840

BACKGROUND: Unoptimized protocols, including a miscentered position, might affect the outcome of diagnostic in CT examinations. In this study, we investigate the effects of miscentering position during CT head examination on the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR).
METHOD: We simulate the CT head examination using a water phantom with a standard protocol (120 kVp/180 mAs) and a low dose protocol (100 kVp/142 mAs). The table height was adjusted to simulate miscentering by 5 cm from the isocenter, where the height was miscentered superiorly (MCS) at 109, 114, 119, and 124 cm, and miscentered inferiorly (MCI) at 99, 94, 89, and 84 cm. Seven circular regions of interest were used, with one drawn at the center, four at the peripheral area of the phantom, and two at the background area of the image.
RESULTS: For the standard protocol, the mean CNR decreased uniformly as table height increased and significantly differed (p
CT Reconstruction Algorithm and Low Contrast Detectability of Phantom Study: A Systematic Review and Meta-Analysis

Adibah Yusof NA, Abdul Karim MK, Asikin NM, Paiman S, Awang Kechik MM, Abdul Rahman MA, et al.

Curr Med Imaging, 2023;19(10):1105-1113.
PMID: 35975862 DOI: 10.2174/1573405618666220816160544

BACKGROUND: For almost three decades, computed tomography (CT) has been extensively used in medical diagnosis, which led researchers to conduct linking of CT dose exposure with image quality.
METHODS: In this study, a systematic review and a meta-analysis study were conducted on CT phantom for resolution study especially based on the low contrast detectability (LCD). Furthermore, the association between the CT parameter such as tube voltage and the type of reconstruction algorithm, the amount of phantom scanning affecting the image quality and the exposure dose were also investigated in this study. We utilize PubMed, ScienceDirect, Google Scholar and Scopus databases to search related published articles from the year 2011 until 2020. The notable keywords comprise "computed tomography", "CT phantom", and "low contrast detectability". Of 52 articles, 20 articles are within the inclusion criteria in this systematic review.
RESULTS: The dichotomous outcomes were chosen to represent the results in terms of risk ratio as per meta-analysis study. Notably, the noise in iterative reconstruction (IR) reduced by 24%, 33% and 36% with the use of smooth, medium and sharp filters, respectively. Furthermore, adaptive iterative dose reduction (AIDR 3D) improved image quality and the visibility of smaller less dense objects compared to filtered back-projection. Most of the researchers used 120 kVp tube voltage to scan phantom for quality assurance study.
CONCLUSION: Hence, optimizing primary factors such as tube potential reduces the dose exposure significantly, and the optimized IR technique could substantially reduce the radiation dose while maintaining the image quality.
Fulltext Mechanical and Imaging Properties of a Clinical-Grade Kidney Phantom Based on Polydimethylsiloxane and Elastomer

Kamal I, Razak HRA, Abdul Karim MK, Mashohor S, Liew JYC, Low YJ, et al.

Polymers (Basel), 2022 Jan 28;14(3).
PMID: 35160523 DOI: 10.3390/polym14030535

Medical imaging phantoms are considered critical in mimicking the properties of human tissue for calibration, training, surgical planning, and simulation purposes. Hence, the stability and accuracy of the imaging phantom play a significant role in diagnostic imaging. This study aimed to evaluate the influence of hydrogen silicone (HS) and water (H2O) on the compression strength, radiation attenuation properties, and computed tomography (CT) number of the blended Polydimethylsiloxane (PDMS) samples, and to verify the best material to simulate kidney tissue. Four samples with different compositions were studied, including samples S1, S2, S3, and S4, which consisted of PDMS 100%, HS/PDMS 20:80, H2O/PDMS 20:80, and HS/H2O/PDMS 20:40:40, respectively. The stability of the samples was assessed using compression testing, and the attenuation properties of sample S2 were evaluated. The effective atomic number of S2 showed a similar pattern to the human kidney tissue at 1.50 × 10-1 to 1 MeV. With the use of a 120 kVp X-ray beam, the CT number quantified for S2, as well measured 40 HU, and had the highest contrast-to-noise ratio (CNR) value. Therefore, the S2 sample formulation exhibited the potential to mimic the human kidney, as it has a similar dynamic and is higher in terms of stability as a medical phantom.