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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5528_Библиотеки_им_академика_М_И_Перельмана.pdf
120 S. Sherwani
et al.
have been tested to support immediate automated diagnosis from microscopic images.
For CLE, content-based image retrieval protocols based on an
algorithm for automatic feature extraction in CLE images have been tested
preliminarily.
104
Similarly, a retrospective analysis of a series of 1035
artifact-free CLE images used fractal analysis of glandular structures for
CAD. Of the seven geometric parameters that were tested, contrast, homogeneity, and feature number were significantly different between normal
and cancer samples and were found useful to complement conventional
diagnosis of microscopic images.
105
With ongoing improvement of computer performance, novel devel-
opments have become available for on-site use: for endocytoscopy, a CAD
106
system was trained on 5543 images from 238 lesions.
Validation showed
188 of 200 images to be assessable with CAD. Accuracy was 94.1% for
the diagnosis of invasive cancer. The same group published a trial on CAD
in one white light and one endocytoscopic image of small colorectal polyps
107
from 123 patients.
CAD accurately identified neoplasia in 89%. Such
on-site imaging protocols may become even more interesting in the near
future when resect-and-discard strategies might be incorporated into clinical practice.
108
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Pancreaticobiliary System Chapter
7
Somashekar G. Krishna∗and
Anjuli K. Luthra
Introduction
†
Confocal Laser Endomicroscopy (CLE) is a real-time laser-assisted microscopic imaging of tissue where the system provides tissue sequences with a
high resolution facilitating in vivo histopathology. The CLE probes that are
utilized for imaging the pancreaticobiliary epithelium are shown in Table 1.
Intravenous fluorescein is the most commonly used contrast agent for CLE
imaging. Fluorescein is a contrast agent used to visualize the blood vessels
and surrounding tissue microstructures. By providing in vivo microscopicresolution images, it has the potential to complement or replace the role
of biopsies in specimen acquisition. The CholangioFlex probe (Cellvizio,
Mauna Kea Technologies, Paris, France) is utilized for imaging the biliary
epithelium and the device is introduced through a standard sphincterotome
∗
Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University
Wexner Medical Center, Columbus, OH, USA.
†
Division of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA.
129