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Article
8.THE VALUE OF MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF PERI-ANAL FISTULA

Authors: Ammar M. Jawad --- Mohammed A. kadhim محمد عبد كاظم --- Zainab K. Al-Jobouri --- Mohssin A.A. Hussain
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2018 Volume: 16 Issue: 2 Pages: 166-176
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: Perianal fistula accounts for 0.01% of general population and is frequently managed inadequately resulting in a significant morbidity. Magnetic resonance imaging (MRI) plays an essential role in the preoperative assessment of the disease, therefore improving post-operative surgical outcome.Objective: To study the role of MRI in the evaluation of perianal fistula and to show the value of using contrast enhanced MR study in the determination of the precise tract pathway, extensions and other associated pathologies.Methods: A cross sectional analytic study was conducted on a total of 32 patients with perianal fistulas in the MRI Department of Al-Imamein Al-Kadhimein Medical City, Baghdad, Iraq during the period from November 2015 to December 2016. Patients underwent MRI examination using axial and coronal T2 weighted images with and without fat suppression and T1 fat suppressed sequences before and after contrast administration. The type of fistula, location of the internal opening, associated abscesses and/or sinus tracts and horseshoe extension were evaluated using different MR sequences. Results: The most common type of fistula encountered was the inter-sphincteric type, which was seen in 21 patients (66%), of those patients 16 fistulas (50%) were grade I and 5 fistulas (16%) were grade II. Trans-sphincteric fistulas were seen in 9 patients (28%), 2 of them (6%) were grade III and 7 fistulas (22%) were grade IV. Two patients (6%) had extra-sphincteric type. T2 weighted TSE, T2 TSE with fat suppression and T1 weighted fat suppressed post contrast sequences all show significant correlation with surgical results (with p-value less than 0.05) and the highest significance was obtained by the post contrast sequence (p-value of 0.00001). The highest accuracy in the diagnosis of fistula in ano was with the use of T1 enhanced fat suppressed sequence (98.8%) followed by 87% for the T2 fat suppression sequence and only 57% for the T2 weighted TSE sequence.Conclusion: MRI is an essential, noninvasive tool in the preoperative assessment of perianal fistulous tracks, with the axial and coronal post contrast fat suppression T1 providing the highest accuracy and clinical significance with surgical data and therefore giving a highly promising decrement in the incidence of post-operative complications.Keywords: MRI, perianal fistulaCitation: Jawad AM, kadhim MA, Al-Jobouri ZK, Hussain MAA. The value of magnetic resonance imaging in the evaluation of peri-anal fistula. Iraqi JMS. 2018; 16(2): 166-176. doi: 10.22578/IJMS.16.2.8

Keywords

MRI --- perianal fistula


Article
Analytical Study of Medical Image Combination Techniques

Authors: Heba Kh. Abbas --- Anwar H. Mahdy --- Ali A. Al Zuky --- Sally F. Ahmad
Journal: Iraqi Journal of Science المجلة العراقية للعلوم ISSN: 00672904/23121637 Year: 2018 Volume: 59 Issue: 3B Pages: 1538-1547
Publisher: Baghdad University جامعة بغداد

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Abstract

Image combination is a technique that fuses two or more medical images taken with different conditions or imaging devices into a single image contain complete information. In this study relied on mathematical, statistical and spatial techniques, to fuse MRI images that captured horizontal and vertical times (T1, T2), and applied a method of supervised classification based on the minimum distance before and after combination process, then examine the quality of the resulting image based on the statistical standards resulting from the analysis of edge analysis, showing the results to identify the best techniques adopted in combination process, determine the exact details in each class and between classes.

Keywords

combination --- MRI --- contrast


Article
Case report Leigh Syndrome: Report of a Rare Case with Late Onset Presentation

Author: Qays A. Hassan*
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2018 Volume: 14 Issue: 1 Pages: 87-89
Publisher: Baghdad University جامعة بغداد

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Abstract

Leigh's syndrome, or sub acute necrotizing encephalomyelopathy, is a rare inherited neurometabolic disease of infancy and early childhood with variable course and prognosis. Rarely, it occurs in juveniles and adults. The diagnosis is difficult and still remains to challenge the clinicians on the basis of history; hence the role of imaging is very essential. It is the neuroimaging, chiefly the Magnetic Resonance Imaging showing characteristic symmetrical necrotic lesions in the basal ganglia and/or brain stem that leads to the diagnosis. Late-onset varieties are rare and only few cases were reported all over the world. Here, I report a case of late onset (juvenile) Leigh syndrome presenting with an acute polyneuropathy. Neuroimaging confirmed it to be a case of Leigh syndrome.

Keywords

Leigh syndrome --- MRI --- Children --- Case report.


Article
MRI Assessment of Liver and Cardiac Iron Concentrations in Some Patients with Beta Thalassemia Major

Author: Mohammed Abd kadhim *, Zainab Kassim Al-Jobouri**, Ammar Mosa Jawad***, Mohssin Abd Ali Hussain****
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 1 Pages: 82-90
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSCTRACT:BACKGROUND: Iron overload is a major concern in blood transfusion dependent beta-thalassemic patient and it is a major cause of cardiac dysfunction. Magnetic resonance imaging T2* has a vital role in liver and cardiac iron deposition and assessment of its severityOBJECTIVE:To highlight the role of MRI T2* in assessment of liver and cardiac iron deposition and assessment of other methods of liver and cardiac iron concentration estimation.PATIENTS AND METHODS: This cross sectional prospective study had been conducted at the MRI unit of Al-Imamain AL-Khadimain medical city, Baghdad/ Iraq, from December 2015 to December 2016. One hundred, blood transfusion dependent beta-thalassemia major patients had been examined by MRI using T2* images to assess its value which had been changed to liver iron concentration and cardiac iron concentration by using a MEDIS software program. RESULTS:One hundred patients (56 male and 44 female) of transfusion dependent beta-thalassemia major had been evaluated for their liver and cardiac T2*, 17 of them shows a mild LIC (liver iron concentration) and normal MIC (myocardial iron concentration), 49 patients show mild increase in both LIC and MIC, 9 show moderate LIC and mild MIC, 16 show moderate both LIC and MIC, 2 show severe LIC with mild MIC, only one shows severe LIC with moderate MIC and 6 of them show severe both LIC and MIC. There is a positive significant correlation between liver T2* and cardiac T2* (P values of 0.017), between liver T2* and LIC (P value of > 0.001), between liver T2* and MIC (P value of 0.031) and that between cardiac T2* and MIC (P value is >0.001). There is non- significant correlation between the age and frequency of blood transfusion with LIC and MIC (P value <0.05). There is also a significant negative correlation between S.ferritin and liver T2*and cardiac T2* (correlation coefficient of -0.251 and -0.397 respectively), with a (P value of 0.014 and 0.00015 respectively). There is non significant correlation between S. ferritin and the severity of LIC and MIC (P value of 0.129 and 0.792). CONCLUSION: Magnetic resonance imaging has a vital role as a non-invasive and reliable method in the assessment of liver and cardiac iron deposition in patients with blood transfusion dependent beta-thalassemia major. There is no correlation between S.ferritin level and the severity of LIC and MIC. Patients using Exjade show a lower LIC and MIC than those using Desferal. No correlation between age and frequency of blood transfusion with LIC and MIC in patients on regular chelation. *.


Article
Cervical Spinal Cord Lesions in Multiple Sclerosis: Comparison among Different Magnetic Resonance Imaging (MRI) Sequences

Author: Raad H. Abed Tawfeq Al-Kayat *, Husham Jubran Mousa**, Neam Bayan Abdulrahman
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 3 Pages: 271-277
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease of the brain and spinal cord. The cervical spinal cord is commonly affected in multiple sclerosis ,as many as 90% of MS patients which is often associated with an increase in clinical disability. Though rarely seen in other diseases, asymptomatic lesions of the spinal cord can be present in MS and may help lead to the correct diagnosis. Since the integration of MR imaging into the International Panel (McDonald) criteria in 2001,there is increasing international effort to standardize MR imaging protocols.OBJECTIVE:To evaluate MRI imaging protocols for detection of cervical spinal cord multiple sclerosis lesions using 1.5 T MRI scanner.PATIENTS AND METHODS: A cross sectional analytical study was conducted at Al-Yarmouk Teaching hospital in Baghdad city. Thirty-one known as MS Patients were examined. from October 2016 till December 2017 by Phillips Achieva Nova Dual 1.5T using a SENSE Neurovascular coil .All patients. underwent sagitta1 T2-turbo spin echo(T2-TSE), Sagittal proton density-turbo spin echo(PD-TSE), sagittal short tau inversion recovery-turbo-spin echo(STIR-TSE )and axial T2-fast field echo(T2-FFE).Comparison was done between the sequences in the means of detectability, conspicuity and number of lesions.RESULTS: Total patients were (31),22 were females and 9 were males .The female to male ratio was (2.4:1). The patient ages ranges between 20-61 years with a mean of age of about 38 years.Mean Lesion to Cord Contrast Ratio (mean LCCR) of STIR and T2WI MR imaging was lower than PD imaging [p value < 0.01].Despite of STIR and T2WI had comparable LCCR (mean= 0.39), STIR imaging had expressively better Lesion Contrast to Noise Ratio (LCNR) [P value < 0.01]. PD had better LCNR (mean=48.8) as compared to T2 and STIR [p value<0.001].PD-TSE sequence detected a large number of spinal cord lesions as compared to T2-TSE and STIR-TSE sequences [110 vs. 76 , 76; respectively . P value < 0.001]. CONCLUSION: PD-TSE improves overall lesion detection ,delineation, conspicuity and edge definition, however it cannot give precise cord morphological data, but it prove to be the sequence of choice in cervical MS plaque detection as it has the higher lesion contrast ,and it is beneficial in overcoming artifacts seen in both STIR and T2-TSE. STIR-TSE have good signal to noise ratio, although have higher CSF flow artifacts..


Article
Comparison of proton density MRI and T2-Weighted Fast Spin Echo for the Detection of Cervical Spinal Cord Multiple Sclerosis Lesions
مقارنة التصوير بالرنين المغناطيسي من خلال تسلسل كثافة البروتون وتسلسل FSE-T2 في الكشف عن أضرار التصلب المتعدد التي تصيب الحبل الشوكي العنقي

Authors: Mohammed M. Alkahlissi د. محمد محمد جواد الخالصي --- Hayder K. Al-Jaberi د. حيدر كريم الجابوري --- Iman E.Ahmed د. إيمان عماد أحمد
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2018 Volume: 60 Issue: 4 Pages: 195-201
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The prevalence of spinal cord lesions is high in multiple sclerosis particularly in the cervical cord, and their detection can assist in both the diagnosis and follow-up of the patients. For spinal multiple sclerosis, MRI is considered the first line investigation. Objective: To evaluate the value of sagittal 1.5 Tesla proton density-fast spin echo (PD-FSE) MRI in the detecting and increasing conspicuity of multiple sclerosis lesions in cervical cord in comparison with sagittal T2 fast spin-echo (T2-FSE) MRI. Patients and Methods: A cross sectional study carried out from 3rd of January 2017 to 1st of January 2018 in the MRI department of Al-Imamein Al-Kadhimein Medical City, and included 60 selected patients with a known diagnosis of multiple sclerosis. All patients were examined with 1.5 T sagittal PD-FSE, T2-FSE and axial gradient recalled-echo (GRE) MRI.Results: Sixty patients with cervical multiple sclerosis were enrolled in the study, 146 (100%) lesions were detected by PD-FSE imaging, while T2 detected 105 (71.9%), 41 more lesions (28%) were detected by PD-FSE imaging, (P-value <0.001). All extra lesions were confirmed on axial imaging. In 13 patients (21.6%) one lesion or more had been detected on sagittal PD-FSE imaging while on sagittal T2-FSE imaging, no lesion were detected. On PD-FSE imaging, 17 long lesions were detected in 16 patients (26.7%) while 7 long lesions in 7 patients (11.7%) were detected by T2-FSE imaging. So, in 9 patients (16.7%) 10 lesions were detected as long in PD-FSE while short lesion in T2– FSE, the detection of long lesions by PD-FSE was significantly higher than in T2– FSE (100% vs 71.9% with p- value of 0.002). The mean lesion contrast to cord ratio was significantly higher in PD-FSE as compared to T2-FSE (PD-FSE, 79±2.0, against T2-FSE, 61± 2.6; P-value <0.001). Conclusion: Sagittal proton density was more efficient and more accurate in the detection of cervical cord lesions than sagittal T2-FSE sequence, when used in conjunction with sagittal T2-FSE; it can raise the diagnostic assurance via improving the visualization of the lesions.

خلفية الدراسة: آفات الحبل الشوكي منتشرة بشكل كبير في مرض التصلب العصبي المتعدد على وجه التحديد في الحبل العنقي، ويمكن أن يساعد اكتشافها في التشخيص ومتابعة المريض.هدف الدراسة: الغرض من هذه الدراسة هو تقدير دور التصوير بالرنين المغناطيسي باستخدام تسلسل كثافة البروتون بالمقطع السهمي 1.5 تسلا لزيادة كشف ووضوح آفات الحبل الشوكي لمرضى التصلب المتعدد بالمقارنة مع تسلسل FSE-T2 بالمقطع السهمي.الطريقة: أجريت هذه الدراسة على مدى سنة واحدة من يناير 2017 إلى يناير 2018 في قسم التصوير بالرنين المغناطيسي في مدينة الإمامين الكاظمين (ع) الطبية، وشملت 60 مريضا مشخصين بمرض التصلب العصبي المتعدد. تم التصوير بالرنين المغناطيسي لجميع المرضى باستخدام تسلسل كثافة البروتون بالمقطع السهمي 1.5 تسلا، وتسلسل FSE-T2 بالمقطع السهمي واستخدام تسلسل GRE بالمقطع المحوري كمرجع لتصوير الحبل الشوكي العنقي.النَتائِج: تم شمل ستين مريضا مصاب بآفات الحبل الشوكي، عدد الآفات التي تم الكشف عنها من قبل تسلسل كثافة البروتون كان 146 (100٪(، بينما في T2 كان 105 (71.9٪)، تم الكشف عن 41 آفة أخرى (28٪) من قبل التصوير بواسطة تسلسل كثافة البروتون،(P value <0.001) . تم تأكيد جميع الآفات الإضافية على التصوير المحوري. في 13 مريضا (21.6٪) تم الكشف عن واحد أو أكثر من الآفة على التصوير بتسلسل كثافة البروتون السهمي في حين لم يتم الكشف عن اي آفة على التصوير السهمي بتسلسل FSE- T2. تم الكشف عن 17 آفة طويلة في 16 مريضا (26.7٪) على التصوير تسلسل كثافة البروتون و7 آفات طويلة في 7 مرضى (11.7٪) على التصوير تسلسل FSE- T2. في 9 مرضى (16.7٪) تم الكشف عن 10 آفات طويلة في تسلسل كثافة البروتون كانت عل شكل آفة قصيرة في T2 -FSE، الكشف عن الآفات الطويلة من قبل تسلسل كثافة البروتون كان أعلى بكثير مما كانت عليه في T2 -FSE (p value 0.002)، بينما كان معدل نسبة تباين الآفة إلى الحبل الشوكي أعلى بكثير في تسلسل كثافة البروتون بالمقارنة مع تسلسل FSE- T2 تسلسل كثافة البروتون، (2.0 ± 79)، مقابل تسلسل FSE- T2((61±2.6؛ (P <0.001).الاستنتاج: التصوير بالمقطع السهمي باستخدام تسلسل كثافة البروتون كان أكثر كفاءة وأكثر دقة في تقدير آفات الحبل الشوكي مقارنة مع تسلسل FSE- T2 بالمقطع السهمي، عندما تستخدم بالاشتراك مع تسلسل FSE- T2 يمكن أن يزيد من الثقة التشخيصية من خلال الرؤية الأفضل لهذه الآفات.


Article
Prevalence of Intracerebral Hemorrhage and Its Risk Factors among Stroke Cases Admitted to Sulaimani General Teaching Hospital

Author: Mohammed Tahir Kurmanji
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2018 Volume: 11 Issue: 2 Pages: 3993-4001
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Although hypertension remains the most common cause of non-traumatic Intracerebral hemorrhage (ICH), several other conditions and lifestyle factors have been associated with ICH such as age, gender, race differences, cigarette smoking, alcohol, drug abuse, anticoagulant treatment, dyslipidemia, and others .Aim: Our aims are to estimate a prevalence and incidence of ICH among stroke cases within Sulaimani’s people, in addition to investigate the main risk factors of patients with ICH among stroke cases admitted to General teaching hospital in Sulaimani city.Patients and method: In this study, 108 patients with either ischemic stroke or non-traumatic ICH were enrolled; these patients were recorded in Sulaimani General Teaching Hospital with a special form of demographic data. All patients were thoroughly examined and investigated with brain CT scan for all and brain MRI for some of them.Discussion: Out of 108 stroke patient admitted, 33 patients (30.6%) had ICH, while 75 patients (69.4%) had ischemic stroke, 19 cases (out of 33) (57.58%) of ICH patients were females, while 14 (42.42%) of them were males. Among the modifiable risk factors of ICH, hypertension remains the most common risk which was present in 25 patients out of 33 (75.8%), but dyslipidemia and diabetes mellitus were other less common risk factors which might have predisposed to the occurrence of ICH.In conclusions: Spontaneous intracerebral hemorrhage, which is a common cause of mortality and morbidity, is relatively a common form of stroke in our locality which is more predominant in females. Hypertension is the main risk factor for spontaneous ICH


Article
MRI Finding of Cartilaginous Endplates Herniation of Lumbar Spine in Patient with Low Back Pain

Author: Mohammed Abd Kadhim* , Mansour Eidan Dawood Al – Zubaidi**, Firas Mahmood Yaqub
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 4 Pages: 328-334
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Magnetic resonance imaging (MRI) provides a noninvasive assessment of the lumbar spine. Little isthought about the MRI characteristics of cartilaginous endplate (CEP) and CEP herniation on theground that their normal thickness is only 0.6mm, making it hard to perceive at routine MRIexaminationsOBJECTIVE :To study the reliable magnetic resonance imaging findings suggested cartilage endplate herniation inlumbar spine.PATIENTS AND METHODS:This prospective study was conducted on 46 patients with low back pain in the MRI unit of Al-Imamein Alkadhmein Medical City, Baghdad, Iraq between September, 2016 and August 2017.Inclusion criteria: adult patients with lumbar disc herniation proved by MRI with surgical prove ofcartilage end plates herniation. Exclusion criteria include: patients with previous back surgery,history of spinal tumor and the general contraindications to MRI. Sagittal and axial T1-weightedspino-echo image and sagittal and axial T2 weighted spine echo images were obtained. Statisticalanalysis using SPSS version 23, the level of significance (p value) was set as ≤ 0.05.RESULT:Forty six patients with low back pain were included in this study, the mean age of 44±9 years, 26patients were females and 20 patients were males.The CEP herniation was detected by MRI among52.2% of patients with back pain. There was a highly significant association between CEP andincreased age of the patients, back pain radiated to both limbs, L4-5 defect site, modic changes andlumbar posterior marginal nodes (p value 0.01, 0.004, 0.02, 0.03 and <0.001 respectively). Nosignificant differences between patients with CEP herniation and those without CEP herniationregarding posterior osteophytes, dorsal vertebral cornal defect, heterogeneous signal intensity andposterior corner and mid endplate irregularities. There was a highly significant association betweenlumbar posterior marginal nodes and CEP herniation (p<0.001).CONCLUSION:CEP herniation is more prevalent among advanced age and at lower lumbar level. The most commonMRI signs related to CEP herniation were modic changes in mid endplate and lumbar posteriormarginal nodes..


Article
Brain Tumors Classification by Using Gray Level Co-occurrence Matrix, Genetic Algorithm and Probabilistic Neural Network
تصنيف أورام الدماغ باستخدام GLCM، ألخوارزمية ألوراثية و الشبكة ألعصبية ألاحتمالية

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Background:Brain tumors classification by MRI (Magnetic Resonance Imaging) is important in medical diagnosis because it provides information associated with anatomical structures as well as potential abnormal tissues necessary for treatment planning and patient's case follow-up. There are a number of techniques for medical image classification. In this paper brain tumors detection and classification system are developed into seven tumors types. The image processing techniques such as preprocessing by using a mean filter and feature extraction have been implemented for the detection of a brain tumor in the MRI images. In this paper, extraction of texture features using GLCM (Gray Level Co-occurrence Matrix). We used Probabilistic Neural Network Algorithm (PNNA) for image classification technique based on Genetic Algorithm (GA) and K-Nearest Neighbor (K-NN) classifier for feature selection is proposed in this paper. Objective: MRI brain tumors detection and classification system by using GA and PNN which able to diagnose different types of tumors in human brain.Patients and Methods: Medical image techniques are used to imaging the internal structures of the human body for medical diagnosis. Image processing is an effective field of research in the medical field. MRI dataset, obtained from the Atlas Website of Harvard University.Results: Brain Tumors are classified by using the genetic algorithm where the total number of features (20 features) has been reduced to 10 features as the strongest features in the classification. Conclusion: MRI brain image is one of the best methods in brain tumor detection and classification, by observing only MRI images the specialists are unable to keep up with diagnosing. Hence, the computer-based diagnosis is necessary for the correct brain tumor classification.

خلفية الدراسة: تصنيف أورام الدماغ للرنين المغناطيسي (التصوير بالرنين المغناطيسي) أمر مهم في التشخيص الطبي لأنه يوفر المعلومات المرتبطة بالهياكل التشريحية وكذلك الأنسجة الطبيعية المحتملة اللازمة لتخطيط العلاج و متابعه حاله المريض. يوجد عدد من التقنيات لتصنيف الصور الطبية. في هذا البحث يتم تطوير نظام الكشف عن أورام الدماغ وتصنيفها إلى سبعه أنواع من الأورام. وقد تم تنفيذ تقنيات معالجه الصور مثل Preprocessing باستخدام Mean Filter و Feature Extraction للكشف عن أورام في الدماغ في صور الرنين المغناطيسي. في هذا البحث، يتم استخراج Texture Features باستخدام GLCM. لقد استخدمنا خوارزميه الشبكة العصبية الاحتمالية (PNN) لتقنية تصنيف الصور علي أساس الخوارزمية الوراثية (GA) و المصنف أقرب جار (k-NN) لاختيار الميزة المقترحة في هذا البحث.اهداف الدراسة: هدفت هذه الدراسة الى التعرف على نظام كشف وتصنيف صور الرنين المغناطيسي أورام الدماغ باستخدام GA و PNN مع أمكانية تشخيص انواع مختلفة من الاورام في دماغ الانسان.المرضى والطرائق: : تقنيات الصورة الطبية تستخدم لتصوير الهياكل الداخلية للجسم البشري للتشخيص الطبي. معالجة الصور هو مجال فعال للبحث في المجال الطبي. بيانات صور الرنين المغناطيسي تم الحصول عليها من الموقع الالكتروني أطلس لجامعة هارفارد.النتائج: صنفت الاورام باستعمال الخوارزمية الوراثية حيث تم تقليل عدد الميزات الكلي ( 20 ميزة) الى 10 ميزات كأقوى الميزات في التصنيف.

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