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Original article
Computer-aided analysis of transrectal ultrasound images of the prostate
Análisis de imagen asistido por ordenador en ecografía transrectal de próstata
Á. Gómez-Ferrer
Corresponding author
dr.alvaro@gomez-ferrer.net

Corresponding author.
, S. Arlandis
Servicio de Urología, Hospital Universitario La Fe, Valencia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Despite the gradual progress in image quality of the current transrectal ultrasound devices and the incorporation of new technologies&#44; Doppler study&#44; use of ultrasound contrast&#44; and three-dimensional reconstruction&#44; prostate cancer remains difficult to detect by ultrasound&#44; especially in its earliest stages&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Most authors find a high percentage of hypoechoic&#44; very rarely hyperechoic cancers&#44; and they all recognize the high prevalence of isoechoic tumors&#44; undetectable by ultrasound&#44; which can be between 20 and 50&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> In order to minimize this diagnostic difficulty&#44; the most frequent distribution of the disease has been studied to direct the punctures to the areas where it is most present&#44; and different schemes have been proposed in terms of number and location of punctures&#44; which are not to be exposed in this work&#46; On the other hand&#44; we could potentially improve the ability of ultrasound to provide images more suspicious of cancer in order to lead the punctures to them&#46; With this aim&#44; the vascular behavior of tumors has been studied by Doppler technology with all its variants&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> including the use of ultrasound contrast&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> with and without Doppler&#44; and more recently&#44; three-dimensional ultrasound&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> In parallel with the above&#44; it is also reasonable to think that there may be characteristic ultrasound patterns of prostate cancer and hidden from the visual capacity of the human eye&#44; which can be identified by artificial intelligence processes&#46; Under this work hypothesis&#44; we present our study of transrectal ultrasound images of prostate cancer through image analysis techniques aided by computer in the department of Systems at the Polytechnic University of Valencia&#46; Another possible approach of the seemingly hidden information provided by the ultrasound scanner is the study of the signal obtained by the different absorption of the emitted ultrasound wave&#44; which is known as raw data&#44; attenuation signal &#40;backscattered&#41;&#44; or radio frequency &#40;RF&#41;&#46; Later&#44; we will present the most important work done with our same purpose by other groups&#44; both through imaging study itself and through the study of RF signal&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and method</span><p id="par0015" class="elsevierStylePara elsevierViewall">Biopsies of 288 patients with clinical and&#47;or analytical suspicion of prostate cancer were recorded digitally&#58; stages cT1c and CT2&#44; mean PSA 11&#46;6 &#40;median&#58; 9&#46;25&#44; range&#58; 1&#46;2&#8211;66&#41;<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#46; Classical sextant biopsy was performed in most patients&#44; with additional transition zone biopsy in voluminous prostates &#40;&#62;60<span class="elsevierStyleHsp" style=""></span>cc&#41; and second biopsies&#46; The usual ultrasound data&#44; prostate volume and transition zone&#44; presence of suspicious nodules and description of general appearance and echogenicity were registered&#46; In addition&#44; each puncture alone described its echogenicity &#40;hypo&#44; hyper or isoechogenic&#41;&#44; necessarily assigning one category or another&#44; setting the hypoechogenicity as a benchmark for suspected cancer&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In order to perform all the registered explorations&#44; we had a Bruel &#38; Kjaer model 3535 ultrasound scanner&#44; which was coupled with a CD recorder and an external hard drive&#44; at our disposal&#46; We used a 7&#46;5<span class="elsevierStyleHsp" style=""></span>MHz transrectal probe model 8551&#46; All registered biopsies were performed under the same scanning conditions&#44; without changing frequency&#44; speed&#44; level and gain curve&#44; or scale &#40;scale&#58; abscissa from 0 to 5&#46;2<span class="elsevierStyleHsp" style=""></span>c&#59; Power&#58; Low&#59; Gain&#58; 85&#37; Res&#58; 6&#59; Rate&#58; 10<span class="elsevierStyleHsp" style=""></span>f&#47;s&#41;&#46; In all cases&#44; we used the automatic punch biopsy model Microvasive<span class="elsevierStyleSup">&#174;</span> &#40;Boston Scientific&#41; 20<span class="elsevierStyleHsp" style=""></span>mm 18 Gauge&#58; we operated the digital capture of the images using a pedal device and for 10<span class="elsevierStyleHsp" style=""></span>s the procedure was recorded at a speed of 5 frames per second&#46; In the computer lab&#44; three still images previous to the introduction of the needle were isolated from the recording of each puncture&#46; In each of these images&#44; a rectangular area corresponding to the biopsied prostate zone&#44; identified by the introduction of the needle &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; was identified as a region of interest &#40;ROI&#41;&#46; These images were divided into two working groups &#40;sets&#41;&#44; one used for learning &#40;training set&#41; of the system&#44; and the other one to compare the diagnostic ability of the same &#40;test set&#41; with an equal ratio of tumor imaging in each group&#46; There were two types of imaging study&#58; construction of simple mapping vectors of gray levels in each of the pixels in the region of interest &#40;simple gray map&#41; and second-order statistical descriptors called Haralick&#39;s co-occurrence matrices or spatial gray level dependent matrices &#40;SGLDM&#41;&#46; These descriptors are widely used in pattern recognition and in the study of all kinds of images&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Different types of relationship of each pixel with its neighbors&#44; at different angles and distances are described&#58; immediately adjacent &#40;distance<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; and intermediate &#40;distance<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; and so on&#46; Of the 16 originally described&#44; in our imaging&#44; we studied 11 descriptors that analyze different characteristics in the image&#58; uniformity&#44; homogeneity&#44; contrast&#44; variance&#44; cumulative variance&#44; differential variance&#44; entropy&#44; cumulative entropy&#44; differential entropy&#44; correlation&#44; and cumulative average&#46; The 256 gray values of each pixel were reduced to 20 by vector quantization and principal component analysis &#40;PCA&#41; to reduce the computational cost in the study of co-occurrence matrices&#46; In each of these descriptors&#44; 16 matrices were obtained&#44; studying every pixel with its neighbors in one to four distances and in four different directions&#46; Different window sizes were studied&#58; from 8<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8 to 25<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>25 pixels&#46; The simple mapping study was performed in windows of 16<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>16 to 50<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>50 with the 256 original gray levels&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> With the result of these studies and in order to verify the correct identification of images of prostate cancer in the test set&#44; two classification methods were used&#58; the technique of &#8220;k-neighbors&#8221; or &#8220;nearest neighbors&#8221; &#40;nearest neighbor &#91;k-NN&#93;&#41; and the hidden Markov&#39;s models&#44; which are also commonly used techniques in the identification of images&#46; The diagnostic yield of all these experiments was assessed by determining the sensitivity &#40;SE&#41; and specificity &#40;S&#41;&#44; and the construction of ROC curves &#40;Receiver Operator Characteristic&#41;&#46; Finally&#44; we conducted a simulation experiment using the results of our study on 408 recorded images of biopsies already performed&#44; not in real time&#44; on which the software developed by the team of the Polytechnic University of Valencia colored the most suspicious areas of cancer in the optimal ratio of sensitivity&#47;specificity &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The images obtained this way were compared with the level of suspicion in the original image valued on a scale of 0&#8211;10&#44; as interpreted by 4 sonographers&#46; The calculation of the sensitivity and specificity of both interpretations was made with different level of suspicion of prostate cancer thresholds&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 66 cases were diagnosed with prostate cancer&#44; identifying cancer in 205 cylinders&#46; The total of benign cylinders available for the study was 1370&#44; both of patients with and without cancer&#46; Of each individual puncture&#44; three quality still images immediately prior to the introduction of the needle were isolated&#44; so in the end&#44; 4725 images were available for analysis&#59; 4110 were benign and 615 malignant&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The punctures described as hypoechoic or suspicious for cancer were 199 &#40;12&#46;6&#37;&#41; among a total of 1575 cylinders&#46; Of the 199 hypoechoic images&#44; 137 &#40;68&#37;&#41; were benign cylinders&#44; representing 10&#37; of the 1370 benign cylinders&#59; and 62 &#40;32&#37;&#41; were malignant cylinders&#44; being 30&#37; of the 205 malignant cylinders&#46; If we consider only this description of echogenicity as suspicious for malignancy&#44; we obtained 30&#37; sensitivity&#44; 90&#37; specificity&#44; 37&#37; positive predictive value&#44; an 89&#37; negative predictive value&#44; and area under the curve &#40;ROC curve&#41; of 0&#46;601&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The diagnostic capacity of the system by means of co-occurrence matrices study and classification with k-neighbors was 60&#46;1&#37;&#44; and 60&#37; with classification using hidden Markov&#39;s models &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The study of simple gray vectors and classification with k-neighbors obtained an area under the ROC curve of 59&#46;7&#37; and classification by means of hidden Markov&#39;s models of 61&#46;6&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; The diagnostic capacity of each of the 4 sonographers who valued transrectal ultrasound images on an original gray scale is reflected in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1&#8211;4</a>&#44; according to how different thresholds are assessed in the above-mentioned scale of 0&#8211;10 proposed to grade the level of suspicion of prostate cancer&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The calculation of area under the ROC curve in the interpretation of the original image on gray scale was 61&#44; 60&#44; 66 and 60&#37;&#44; respectively&#46; His interpretation of probability of cancer with colored images by our system gave an area under the ROC curve of 63&#44; 67&#44; 64 and 63&#37; in each of the 4 involved&#44; respectively&#44; as we can observe in <a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Classically&#44; the observation of a less echogenic nodule in the peripheral area was defined as suspected prostate cancer&#59; however&#44; that description does not appear in most cases and even watching it&#44; it is not pathognomonic&#46; In our work&#44; we found only 12&#46;6&#37; hypoechoic lesions&#44; housing in the majority &#40;68&#37;&#41; benign tissue&#46; These data confirm the need to try to improve the diagnostic yield of prostate cancer by means of imaging techniques&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">As we will see&#44; such promising initial results of other working groups have not been reflected in a subsequent clinical application of relevant benefit&#44; and the vast majority of groups have not moved their studies to the development of software for image recognition for use in real time&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In light of our results&#44; we have not developed any software either&#46; The computational cost that would be necessary to do so is great because the image would have to be analyzed and suspected areas identified in real time&#46; In addition&#44; our modest results would not justify this development&#44; since we have not achieved a significant improvement regarding conventional ultrasound&#46; We believe that this may be due to several factors&#58; methodological and&#47;or inherent to the disease&#46; It might be that prostate cancer and its histological variants do not share an echotexture that may differ from the normal gland&#46; Another problem we face when approaching this type of study is imperfect monitoring&#44; as it is practically impossible to accurately identify the precise location of the cancer in the resulting image with the current technology&#46; This monitoring can be carried out with the study of the prostatectomy piece and&#47;or that of the punctures&#46; In our case&#44; we performed it through the histological study of the obtained cylinder&#46; However&#44; this may be affected to a greater or lesser extent&#44; and the entire length of the cylinder rarely corresponds to carcinoma&#46; Finally&#44; we believe&#44; and so seems to be observed in other works&#44; that the study of the signal attenuation would provide more reliable and independent information of the ultrasound scanner used&#44; the signal not having been processed to image&#44; and that this line of work is the one that in the future may give better results&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">When we analyzed the experience of other centers&#44; we appreciated that the image recognition system that initially had most impact was the one made by the Nijmegen group in Holland&#44; called Automated Urologic Diagnostic Expert System &#40;AUDEX&#41;&#46; In their early work&#44; they obtained an 80 and 88&#37; sensitivity and specificity&#44; respectively&#44; after studying the image analyzing 5 co-occurrence matrices&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Subsequently&#44; they presented a validation of results with the findings on prostatectomy&#44; obtaining a 78&#37; sensitivity and a 50&#37; specificity&#44; considering the existence of a tumor volume greater than 10&#37; of the gland as a cut-off&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In a more recent publication&#44; the poor relationship of their AUDEX system with the histological confirmation on prostatectomy pieces in a larger number of patients was objectified&#44; finding an 85&#37; sensitivity&#44; an 18&#37; specificity&#44; and a 58&#37; diagnostic accuracy&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The University of Waterloo&#44; in Ontario&#44; Canada&#44; conducted a study with similar methodology to ours and the AUDEX group&#44; studying 4 matrices and simple mapping on gray scale and classifying the images using the k-neighbors technique&#44; with a maximum diagnostic efficacy close to 90&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> However&#44; they do not communicate how the supervision of their images is performed and there are no results of clinical application&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Fair et al&#46;&#44; from the MSKCC&#44; together with the Riverside Research Institute of New York&#44; combine the analysis of the RF signal with clinical parameters such as PSA&#44; and get 80&#37; correct classification of their images&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;19</span></a> At the University of Kiel&#44; an applied technology called C-TRUS &#40;Computer Transrectal Ultrasound&#41; was developed through image analysis&#44; reporting very good results in prostate cancer detection in 132 patients with previous negative biopsies&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a> However&#44; in the literature&#44; we did not find any evidence of this technology being applied in recent years&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The Seoul National University&#44; in Korea&#44; has worked with descriptors of textures similar to those used in our work&#44; but adding clinical parameters such as location&#44; morphology and contour of the prostate cancer&#46; It is hardly surprising that they get 90&#37; sensitivity and 96&#37; specificity&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> since they use the same images for the training and the test&#44; which would invalidate their system for extrapolating results to other patients&#46; Besides&#44; the supervision of a region of interest is not performed by histological verification whatsoever&#46; Despite the success of many of these working groups&#44; none has managed to develop a software that helps real-time decision making for biopsy&#44; and virtually all researchers have abandoned the development of a device for clinical application&#46; The only exception to this is the technology called HistoScanning&#44; created by Braeckman et al&#46; with the Belgian company Advanced Medical Diagnostics&#46; Based on studies of RF signal&#44; they segment the ultrasound information in regions of interest of 0&#46;04<span class="elsevierStyleHsp" style=""></span>ml &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;89&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> and&#44; in a later publication&#44; they demonstrate how their system can show small tumors&#44; around 0&#46;5<span class="elsevierStyleHsp" style=""></span>ml&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> This technology is now commercially available coupled with ultrasound devices Bruel &#38; Kjaer&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In summary&#44; conventional ultrasound has its limitations in the early diagnosis of the disease&#44; and it would be useful to identify apparently hidden cancer image patterns&#46; In our work&#44; we found no significant benefit to justify the development of software for image recognition&#46; Currently&#44; only the HistoScanning software is available for commercial use&#44; although we are unaware of its benefit in daily clinical practice&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Funding</span><p id="par0090" class="elsevierStylePara elsevierViewall">Work funded by grant to the <span class="elsevierStyleGrantSponsor">cabinet Foundation for Health Research &#40;FHR&#41;</span>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "fechaRecibido" => "2010-09-28"
    "fechaAceptado" => "2011-02-13"
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          "clase" => "keyword"
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          "palabras" => array:3 [
            0 => "Prostate cancer"
            1 => "Computer-Aided Diagnosis"
            2 => "Transrectal ultrasound"
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          "clase" => "keyword"
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          "palabras" => array:3 [
            0 => "C&#225;ncer de pr&#243;stata"
            1 => "Diagn&#243;stico"
            2 => "Ecograf&#237;a transrectal"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Prostate cancer is usually diagnosed by transrectal ultrasound &#40;TRUS&#41; biopsy&#46; Nevertheless&#44; suspicious images are frequently not found&#46; Imaging analysis studies aim to identify ultrasound patterns characteristic of apparently hidden conditions&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We digitally recorded 288 TRUS ultrasound guided transrectal biopsies and extracted 3 static images from the puncture-biopsy area&#46; The extraction of the texture characteristics were obtained by &#8220;simple mapping&#8221; on a gray scale and spatial gray level dependence matrices &#40;SGLDM&#41;&#44; also known as Haralick&#39;s co-occurrence matrices&#44; which study the relationship of each pixel and its neighbors&#46; A pattern recognition software system was developed with two different classification methods&#58; nearest neighbor &#40;k-NN&#41; and Markov&#39;s hidden models&#46; Finally&#44; a virtual experiment was carried out in which four urologists compared their diagnostic accuracy for prostate cancer with our system in 408 TRUS images&#44; not in real time&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The diagnostic capacity &#40;ROC curve&#41; with the simple gray map study was 59&#46;7&#37; with nearest-neighbor classification and 61&#46;6&#37; with Markov&#39;s hidden models classification&#46; The co-occurrence matrices showed an area under ROC curve of 60&#46;1&#37; and 60&#46;0&#37; with k-NN and Markov&#39;s hidden models classification&#44; respectively&#46; The virtual experiment was conducted with a simple gray map study and k-NN classification&#46; The images processed by our system showed the following diagnostic accuracy&#58; 63&#46;3&#44; 67&#44; 64&#46;3 and 63&#46;7&#37; compared to 61&#46;7&#44; 60&#46;5&#44; 66&#46;2 and 60&#46;7&#37; with the original image&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Our pattern recognition system for prostate cancer TRUS images has a limited&#44; yet stable&#44; accuracy&#46;</p>"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El m&#233;todo de diagn&#243;stico de elecci&#243;n del c&#225;ncer de pr&#243;stata &#40;CP&#41; es la biopsia transrectal guiada ecogr&#225;ficamente&#46; Sin embargo&#44; es frecuente no objetivar im&#225;genes sospechosas&#46; Los estudios de an&#225;lisis de imagen pretenden identificar patrones ecogr&#225;ficos propios de una patolog&#237;a aparentemente ocultos&#46;</p> <span class="elsevierStyleSectionTitle">Materiales y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Registramos digitalmente 288 biopsias transrectales ecoguiadas&#44; de las que se aislaron im&#225;genes est&#225;ticas de cada punci&#243;n-biopsia para su an&#225;lisis computarizado&#46; Para ello se procedi&#243; a la extracci&#243;n de caracter&#237;sticas de textura mediante &#171;mapeo simple&#187; en escala de gris y &#171;matrices espaciales dependientes del nivel de gris&#187; o &#171;matrices de coaparici&#243;n&#187;&#44; que estudian la relaci&#243;n de cada p&#237;xel con sus vecinos&#46; Se desarroll&#243; un sistema de &#171;reconocimiento de formas&#187; con dos m&#233;todos de clasificaci&#243;n&#58; &#171;t&#233;cnica de k-vecinos&#187; y &#171;modelos ocultos de Markov&#187;&#46; Finalmente realizamos una simulaci&#243;n del sistema con 4 ecografistas&#44; comparando su capacidad diagn&#243;stica en escala de gris con im&#225;genes procesadas con nuestro sistema en 408 punciones grabadas&#44; no en tiempo real&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La capacidad diagn&#243;stica &#40;curva ROC&#41; con mapeo simple fue de 59&#44;7 y 61&#44;6&#37; con clasificaci&#243;n mediante k-vecinos y modelos ocultos de Markov&#44; respectivamente&#46; Las matrices de coaparici&#243;n ofrecieron un &#225;rea bajo la curva ROC de 60&#44;1 y 60&#44;0&#37;&#46; El experimento virtual se llev&#243; a cabo mediante &#171;mapeo simple&#187; y clasificaci&#243;n con &#171;k-vecinos&#187;&#44; otorgando una capacidad diagn&#243;stica en cada ur&#243;logo de 63&#44;3&#44; 67&#44;0&#44; 64&#44;3 y 63&#44;7&#37; frente a 61&#44;7&#44; 60&#44;5&#44; 66&#44;2 y 60&#44;7&#37; conseguidas con la imagen original&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La utilizaci&#243;n de nuestro m&#233;todo de an&#225;lisis de imagen tiene una capacidad limitada&#44; aunque estable&#44; en la detecci&#243;n de &#225;reas prost&#225;ticas cancer&#237;genas&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; G&#243;mez-Ferrer A&#44; Arlandis S&#46; An&#225;lisis de imagen asistido por ordenador en ecograf&#237;a transrectal de pr&#243;stata&#46; Actas Urol Esp&#46; 2011&#59;35&#58;404&#8211;13&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">NF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Sensibility&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Specificity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Classification obtained on gray scale</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">162&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">192&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">167&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">202&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">196&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Classification obtained with the computer system</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  """
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                  """
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      "titulo" => "References"
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ISSN: 21735786
Original language: English
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