Diagnostics

17 pages, 1455 KiB

Open AccessReview

Echocardiography in Cardiac Arrest: Incremental Diagnostic and Prognostic Role during Resuscitation Care

by Alfredo Mauriello, Gemma Marrazzo, Gerardo Elia Del Vecchio, Antonia Ascrizzi, Anna Selvaggia Roma, Adriana Correra, Francesco Sabatella, Renato Gioia, Alfonso Desiderio, Vincenzo Russo and Antonello D’Andrea

Diagnostics 2024, 14(18), 2107; https://doi.org/10.3390/diagnostics14182107 - 23 Sep 2024

Viewed by 564

Abstract

Background: Cardiac arrest (CA) is a life-critical condition. Patients who survive after CA go into a defined post-cardiac arrest syndrome (PCAS). In this clinical context, the role of the echocardiogram in recent years has become increasingly important to assess the causes of arrest, [...] Read more.

Background: Cardiac arrest (CA) is a life-critical condition. Patients who survive after CA go into a defined post-cardiac arrest syndrome (PCAS). In this clinical context, the role of the echocardiogram in recent years has become increasingly important to assess the causes of arrest, the prognosis, and any direct and indirect complications dependent on cardiopulmonary resuscitation (CPR) maneu-vers. Methods: We have conduct a narrative revision of literature. Results: The aim of our review is to evaluate the increasingly important role of the transthoracic and transesophageal echocardiogram in the CA phase and especially post-arrest, analyzing the data already present in the literature. Conclusion: Transthoracic and transesophageal echocardiogram in the CA phase take on important diagnostic and prognostic role. Full article

(This article belongs to the Special Issue Recent Advances in Echocardiography)

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7 pages, 935 KiB

Open AccessBrief Report

Radiofrequency Echographic Multi Spectrometry (REMS) Technology for Bone Health Status Evaluation in Kidney Transplant Recipients

by Angelo Fassio, Giovanni Adami, Stefano Andreola, Pietro Manuel Ferraro, Paola Pisani, Fiorella Anna Lombardi, Ombretta Viapiana, Maurizio Rossini, Chiara Caletti, Giovanni Gambaro, Matteo Gatti and Davide Gatti

Diagnostics 2024, 14(18), 2106; https://doi.org/10.3390/diagnostics14182106 - 23 Sep 2024

Viewed by 355

Abstract

Background: A significant loss in bone density and strength occurs during the post-renal-transplant period with higher susceptibility to fracture. The study aims to compare the performance of the Radiofrequency Echographic Multi Spectrometry (REMS) in the bone mineral density assessment with the conventional [...] Read more.

Background: A significant loss in bone density and strength occurs during the post-renal-transplant period with higher susceptibility to fracture. The study aims to compare the performance of the Radiofrequency Echographic Multi Spectrometry (REMS) in the bone mineral density assessment with the conventional dual-energy X-ray absorptiometry (DXA) in a cohort of kidney transplant recipients (KTR). Methods: A cohort of 40 patients underwent both DXA and REMS examinations on the lumbar spine and/or proximal femur. The paired t-test was used to compare DXA and REMS measurements; the chi-square test was used to compare the prevalence of osteoporosis/osteopenia. The agreement between the two techniques was assessed through Spearman’s correlation. Results: As expected, most KTR patients were osteopenic or osteoporotic with both REMS and DXA (86.5% and 81% for the femur; 88% and 65% for the lumbar spine p < 0.05). A modest correlation (r = 0.4, p < 0.01) was observed at the lumbar spine between the T-score measured by REMS and DXA. A strong correlation was defined between REMS and DXA in the femoral region (r = 0.7, p < 0.0001). Conclusions: The study demonstrates the exchangeability of the two techniques on the proximal femur in KTR and a higher diagnostic accuracy of REMS at the spine level than DXA. Full article

(This article belongs to the Section Biomedical Optics)

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19 pages, 301 KiB

Open AccessReview

Imaging in Renal Cell Carcinoma Detection

by Dixon Woon, Shane Qin, Abdullah Al-Khanaty, Marlon Perera and Nathan Lawrentschuk

Diagnostics 2024, 14(18), 2105; https://doi.org/10.3390/diagnostics14182105 - 23 Sep 2024

Viewed by 428

Abstract

Introduction: Imaging in renal cell carcinoma (RCC) is a constantly evolving landscape. The incidence of RCC has been rising over the years with the improvement in image quality and sensitivity in imaging modalities resulting in “incidentalomas” being detected. We aim to explore the [...] Read more.

Introduction: Imaging in renal cell carcinoma (RCC) is a constantly evolving landscape. The incidence of RCC has been rising over the years with the improvement in image quality and sensitivity in imaging modalities resulting in “incidentalomas” being detected. We aim to explore the latest advances in imaging for RCC. Methods: A literature search was conducted using Medline and Google Scholar, up to May 2024. For each subsection of the manuscript, a separate search was performed using a combination of the following key terms “renal cell carcinoma”, “renal mass”, “ultrasound”, “computed tomography”, “magnetic resonance imaging”, “18F-Fluorodeoxyglucose PET/CT”, “prostate-specific membrane antigen PET/CT”, “technetium-99m sestamibi SPECT/CT”, “carbonic anhydrase IX”, “girentuximab”, and “radiomics”. Studies that were not in English were excluded. The reference lists of selected manuscripts were checked manually for eligible articles. Results: The main imaging modalities for RCC currently are ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). Contrast-enhanced US (CEUS) has emerged as an alternative to CT or MRI for the characterisation of renal masses. Furthermore, there has been significant research in molecular imaging in recent years, including FDG PET, PSMA PET/CT, ^99mTc-Sestamibi, and anti-carbonic anhydrase IX monoclonal antibodies/peptides. Radiomics and the use of AI in radiology is a growing area of interest. Conclusions: There will be significant change in the field of imaging in RCC as molecular imaging becomes increasingly popular, which reflects a shift in management to a more conservative approach, especially for small renal masses (SRMs). There is the hope that the improvement in imaging will result in less unnecessary invasive surgeries or biopsies being performed for benign or indolent renal lesions. Full article

(This article belongs to the Special Issue Kidney Disease: Biomarkers, Diagnosis, and Prognosis: 3rd Edition)

14 pages, 6342 KiB

Open AccessReview

[18F]FDG PET/CT Integration in Evaluating Immunotherapy for Lung Cancer: A Clinician’s Practical Approach

by Juliette Brezun, Nicolas Aide, Evelyne Peroux, Jean-Laurent Lamboley, Fabrice Gutman, David Lussato and Carole Helissey

Diagnostics 2024, 14(18), 2104; https://doi.org/10.3390/diagnostics14182104 - 23 Sep 2024

Viewed by 550

Abstract

The advent of immune checkpoint inhibitors (ICIs) has revolutionized the treatment paradigm of lung cancer, resulting in notable enhancements in patient survival. Nevertheless, evaluating treatment response in patients undergoing immunotherapy poses distinct challenges due to unconventional response patterns like pseudoprogressive disease (PPD), dissociated [...] Read more.

The advent of immune checkpoint inhibitors (ICIs) has revolutionized the treatment paradigm of lung cancer, resulting in notable enhancements in patient survival. Nevertheless, evaluating treatment response in patients undergoing immunotherapy poses distinct challenges due to unconventional response patterns like pseudoprogressive disease (PPD), dissociated response (DR), and hyperprogressive disease (HPD). Conventional response criteria such as the RECIST 1.1 may not adequately address these complexities. To tackle this issue, novel response criteria such as the iRECIST and imRECIST have been proposed, enabling a more comprehensive assessment of treatment response by incorporating additional scans and considering the best overall response even after radiologic progressive disease evaluation. Additionally, [18F]FDG PET/CT imaging has emerged as a valuable modality for evaluating treatment response, with various metabolic response criteria such as the PERCIMT, imPERCIST, and iPERCIST developed to overcome the limitations of traditional criteria, particularly in detecting pseudoprogression. A multidisciplinary approach involving oncologists, radiologists, and nuclear medicine specialists is crucial for effectively navigating these complexities and enhancing patient outcomes in the era of immunotherapy for lung cancer. In this review, we delineate the key components of these guidelines, summarizing essential aspects for radiologists and nuclear medicine physicians. Furthermore, we provide insights into how imaging can guide the management of individual lung cancer patients in real-world multidisciplinary settings. Full article

(This article belongs to the Section Medical Imaging and Theranostics)

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Tumor response according RECIST 1.1. SLD: sum of the longest diameters. CR: complete response. PR: partial response. SD: stable disease. PD: progressive disease. Full article ">Figure 2
iRECIST. Full article ">Figure 3
PET/CT imaging of patient with metastatic non-small cell lung cancer: evaluating pseudoprogression during treatment. Whole-body maximum intensity projection views are presented in panels (a,c,e). Corresponding fused transaxial PET/CT slices at the level of the thoracic disease and the left adrenal metastasis are shown in panels (b,d,f). (a,b) Baseline PET/CT images of a 58-year-old male patient with metastatic non-small cell lung cancer, showing a left upper lobe tumor (head arrow), bulky nodal disease (red arrow), and oligometastatic disease with a soft tissue lesion adjacent to the right hip and left adrenal metastasis (red dotted arrow). (c,d) Two months after initiation of chemotherapy plus immunotherapy, partial metabolic response is observed, with increased tracer uptake in the left adrenal metastasis (red dotted arrow). According to conventional criteria (PERCIST or EORTC), this would classify the patient as having progressive disease. However, using imPERCIST, the patient is classified as a partial metabolic responder. As the patient did not experience deterioration in performance status, treatment was continued. Evaluation two months later (e,f) revealed a complete metabolic response of distant metastases and nodal disease, along with an almost complete metabolic response of the primary tumor (head arrow). Full article ">Figure 4
The usefulness of PET/CT imaging of patient with metastatic non-small cell lung cancer: patient experiencing good response to treatment followed by progression. A 54-year-old male patient diagnosed with metastatic adenocarcinoma of the left upper lobe treated with chemotherapy (paclitaxel and carboplatin) and immunotherapy (pembrolizumab). 18F-FDG PET/CT (a–d) maximum-intensity views depicting at baseline (a) high uptake with a rim-like pattern in the primary tumor (red dotted arrow), along with bulky nodal disease involving the mediastinum and the left hilum (red arrows), as well as two bone metastases in the axial and appendicular skeleton. 18F-FDG PET/CT after 3 cycles of treatment (b) shows a partial metabolic response of the primary lesion (red dotted arrow) and the nodal disease with only one residual nodal uptake remaining at the level of station 2R (red arrow). Additionally, complete metabolic response is noted in both bone lesions. Subsequent 18F-FDG PET/CT after 5 months of treatment (c) shows only residual uptake in the primary tumor (red dotted arrow). Maintenance immunotherapy was initiated, and a follow-up PET examination at 10 months reveals an increase in both the size and metabolic activity of the primary tumor (red dotted arrow), with adjacent rib involvement (d). Corresponding fused PET/CT transverse slices at the level of the primary tumor (red dotted arrow) are depicted in panels (e–h). Full article ">Figure 5
A checklist for the PET reader. Full article ">Figure 6
Algorithm for care pathway for patients with lung cancer receiving immunotherapy. Full article ">

13 pages, 2410 KiB

Open AccessArticle

Age Estimation through Hounsfield Unit Analysis of Pelvic Bone in the Romanian Population

by Emanuela Stan, Alexandra Enache, Camelia-Oana Muresan, Veronica Ciocan, Stefania Ungureanu, Alexandru Catalin Motofelea, Adrian Voicu and Dan Costachescu

Diagnostics 2024, 14(18), 2103; https://doi.org/10.3390/diagnostics14182103 - 23 Sep 2024

Viewed by 285

Abstract

Background: Bone density is affected by age- and sex-related changes in the os coxae, often known as the pelvic bone. Recent developments in computed tomography (CT) imaging have created new opportunities for quantitative analysis, notably regarding Hounsfield Units (HU). Objectives: The [...] Read more.

Background: Bone density is affected by age- and sex-related changes in the os coxae, often known as the pelvic bone. Recent developments in computed tomography (CT) imaging have created new opportunities for quantitative analysis, notably regarding Hounsfield Units (HU). Objectives: The study aims to investigate the possibility of using HU obtained from os coxae CT scans to estimate age in the Romanian population. Methods: A statistical analysis was conducted on a sample of 80 pelvic CT scans in order to find any significant correlation between age, sex, and variation in density among the different pelvic bone locations of interest. According to the research, pelvic radiodensity measurements varied significantly between male and female participants, with men having greater levels. This technique may be valuable for determining an individual’s sex precisely, as evidenced by the substantial association found between HU levels and changes in bone density associated with sex. Results: The analysis of variance underscores that HU values exhibit a significant negative relationship with radiodensity, with a general trend of decreasing HU with increasing age. The equation derived from the ordinary least squares OLS regression analysis can be used to estimate the age of individuals in the Romanian population based on their HU values at specific pelvic sites. Conclusions: In conclusion, the application of HU analysis in CT imaging of the coxae represents a non-invasive and potentially reliable method for age and sex estimation, and a promising avenue in the field of human identification. Full article

(This article belongs to the Special Issue Advances in Forensic Medical Diagnosis)

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14 pages, 2919 KiB

Open AccessArticle

Insights into the Neutrophil-to-Lymphocyte Ratio and the Platelet-to-Lymphocyte Ratio as Predictors for the Length of Stay and Readmission in Chronic Heart Failure Patients

by Liviu Cristescu, Ioan Tilea, Dragos-Gabriel Iancu, Florin Stoica, Diana-Andreea Moldovan, Vincenzo Capriglione and Andreea Varga

Diagnostics 2024, 14(18), 2102; https://doi.org/10.3390/diagnostics14182102 - 23 Sep 2024

Viewed by 451

Abstract

Background/Objectives: Chronic heart failure (CHF) is characterized by complex pathophysiology, leading to increased hospitalizations and mortality. Inflammatory biomarkers such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) provide valuable diagnostic insights. Methods: This study evaluates the prognostic relationship between NLR, PLR, and, [...] Read more.

Background/Objectives: Chronic heart failure (CHF) is characterized by complex pathophysiology, leading to increased hospitalizations and mortality. Inflammatory biomarkers such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) provide valuable diagnostic insights. Methods: This study evaluates the prognostic relationship between NLR, PLR, and, in a specific subcohort, N-terminal pro B-type natriuretic peptide (NT-proBNP), alongside length of stay (LOS) and 90-day readmission rates in CHF patients, irrespective of heart failure phenotype. A retrospective analysis of 427 CHF admissions (males = 57.84%) was conducted. Results: The mean age of the entire population was 68.48 ± 11.53 years. The average LOS was 8.33 ± 5.26 days, with a readmission rate of 73 visits (17.09%) for 56 patients. The NLR (3.79 ± 3.32) showed a low but positive correlation with the LOS (r = 0.222, p < 0.001). Conversely, the PLR (144.84 ± 83.08) did not demonstrate a significant association with the LOS. The NLR presented a low negative correlation for days until the next admission (r = −0.023, p = 0.048). In a prespecified subanalysis of 323 admissions, the NT-proBNP exhibited a low positive Pearson correlation with the NLR (r = 0.241, p < 0.001) and PLR (r = 0.151, p = 0.006). Conclusions: The impact of the NLR across heart failure phenotypes may suggest the role of systemic inflammation in understanding and managing CHF. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Heart Disease, 2nd Edition)

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Flow diagram of study cohort selection. CHF, chronic heart failure; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; n, number; NT-proBNP, N-terminal pro B-type natriuretic peptide; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio. Full article ">Figure 2
Distribution of NLR (left panel) and PLR (right panel) across NYHA functional classes. HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; NLR, neutrophil-to-lymphocyte ratio; NYHA, New York Heart Association; PLR, platelet-to-lymphocyte ratio. The horizontal line inside the floating bars refers to the median of the specified HF phenotype. Full article ">Figure 3
Readmission events within 90 days related to the HF phenotype. HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction. Full article ">Figure 4
Receiver operating characteristic (ROC) curves for NLR (left panel) and PLR (right panel) in predicting early readmission. NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio. Full article ">Figure 5
The NLR subgroup readmissions within 90 days after the first discharge. NLR, neutrophil-to-lymphocyte ratio. Full article ">Figure 6
The PLR subgroups readmissions within 90 days. PLR, platelet-to-lymphocyte ratio. Full article ">

13 pages, 1911 KiB

Open AccessArticle

The Value of C-Reactive Protein and Peritoneal Cytokines as Early Predictors of Anastomotic Leak after Colorectal Surgery

by Dubravka Mužina, Mario Kopljar, Zdenko Bilić, Blaženka Ladika Davidović, Goran Glavčić, Suzana Janković and Monika Mačkić

Diagnostics 2024, 14(18), 2101; https://doi.org/10.3390/diagnostics14182101 - 23 Sep 2024

Viewed by 343

Abstract

Objectives: The aim of this study was to evaluate the accuracy of serum C-reactive protein (CRP) and intraperitoneal CRP, interleukin-6, and tumor necrosis factor-alpha in early diagnostics of anastomotic leakage in the first 4 postoperative days after colorectal surgery. Methods: Between January 2023 [...] Read more.

Objectives: The aim of this study was to evaluate the accuracy of serum C-reactive protein (CRP) and intraperitoneal CRP, interleukin-6, and tumor necrosis factor-alpha in early diagnostics of anastomotic leakage in the first 4 postoperative days after colorectal surgery. Methods: Between January 2023 and June 2023, one hundred patients with colorectal carcinoma were operated on with primary anastomosis. Ten patients had anastomotic leak (10%). Results: Based on serum CRP, a patient with a leak will be detected with a 78% probability on postoperative day 3 with values above 169.0 mg/L and on postoperative day 4 with values equal to 159.0 mg/L and above. Intraperitoneal CRP values greater than 56 mg/L on the fourth postoperative day indicate a 78% probability of a diagnosis of leakage. An anastomotic leak will be detected with a 70.0% probability based on an IL-6 value on the first day, at a cut-off value of 42,150. The accuracy of TNF-alpha in predicting anastomotic leak in the first two days is 70% at values higher than 78.00 on the first and 58.50 on the second postoperative day. Conclusion: In this study serum CRP proved to be the most accurate in predicting anastomotic dehiscence after colorectal surgery. Full article

(This article belongs to the Section Clinical Laboratory Medicine)

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Mean serum CRP values over 4 days of follow-up, with respect to anastomotic leak. Full article ">Figure 2
Diagnostic accuracy of serum CRP in detecting anastomotic leak, shown through ROC curves. Full article ">Figure 3
Mean values of intraperitoneal CRP at 4 days of follow-up, with respect to anastomotic leak. Full article ">Figure 4
Diagnostic accuracy of intraperitoneal CRP in the detection of anastomotic leak, shown through ROC curves. Full article ">Figure 5
Mean values of interleukin-6 through 4 days of follow-up, with respect to anastomotic leak. Full article ">Figure 6
Diagnostic accuracy of IL-6 in anastomotic leak detection, shown through ROC curves. Full article ">Figure 7
Mean TNF-alpha values over 4 days of follow-up, with respect to dehiscence. Full article ">Figure 8
Diagnostic accuracy of TNF-alpha in anastomotic leak detection, shown through ROC curves. Full article ">

17 pages, 955 KiB

Open AccessReview

Software as a Medical Device (SaMD) in Digestive Healthcare: Regulatory Challenges and Ethical Implications

by Miguel Mascarenhas, Miguel Martins, Tiago Ribeiro, João Afonso, Pedro Cardoso, Francisco Mendes, Hélder Cardoso, Rute Almeida, João Ferreira, João Fonseca and Guilherme Macedo

Diagnostics 2024, 14(18), 2100; https://doi.org/10.3390/diagnostics14182100 - 23 Sep 2024

Viewed by 571

Abstract

The growing integration of software in healthcare, particularly the rise of standalone software as a medical device (SaMD), is transforming digestive medicine, a field heavily reliant on medical imaging for both diagnosis and therapeutic interventions. This narrative review aims to explore the impact [...] Read more.

The growing integration of software in healthcare, particularly the rise of standalone software as a medical device (SaMD), is transforming digestive medicine, a field heavily reliant on medical imaging for both diagnosis and therapeutic interventions. This narrative review aims to explore the impact of SaMD on digestive healthcare, focusing on the evolution of these tools and their regulatory and ethical challenges. Our analysis highlights the exponential growth of SaMD in digestive healthcare, driven by the need for precise diagnostic tools and personalized treatment strategies. This rapid advancement, however, necessitates the parallel development of a robust regulatory framework to ensure SaMDs are transparent and deliver universal clinical benefits without the introduction of bias or harm. In addition, the discussion highlights the importance of adherence to the FAIR principles for data management—findability, accessibility, interoperability, and reusability. However, enhanced accessibility and interoperability require rigorous protocols to ensure compliance with data protection guidelines and adequate data security, both of which are crucial for effective integration of SaMDs into clinical workflows. In conclusion, while SaMDs hold significant promise for improving patients’ outcomes in digestive medicine, their successful integration into clinical workflow depends on rigorous data protection protocols and clinical validation. Future directions include the need for adequate clinical and real-world studies to demonstrate that these devices are safe and well-suited to healthcare settings. Full article

(This article belongs to the Special Issue AI-Driven Diagnostics: Transforming Healthcare from Data to Clinical Decisions)

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21 pages, 7299 KiB

Open AccessArticle

RDAG U-Net: An Advanced AI Model for Efficient and Accurate CT Scan Analysis of SARS-CoV-2 Pneumonia Lesions

by Chih-Hui Lee, Cheng-Tang Pan, Ming-Chan Lee, Chih-Hsuan Wang, Chun-Yung Chang and Yow-Ling Shiue

Diagnostics 2024, 14(18), 2099; https://doi.org/10.3390/diagnostics14182099 - 23 Sep 2024

Viewed by 328

Abstract

Background/Objective: This study aims to utilize advanced artificial intelligence (AI) image recog-nition technologies to establish a robust system for identifying features in lung computed tomog-raphy (CT) scans, thereby detecting respiratory infections such as SARS-CoV-2 pneumonia. Spe-cifically, the research focuses on developing a new [...] Read more.

Background/Objective: This study aims to utilize advanced artificial intelligence (AI) image recog-nition technologies to establish a robust system for identifying features in lung computed tomog-raphy (CT) scans, thereby detecting respiratory infections such as SARS-CoV-2 pneumonia. Spe-cifically, the research focuses on developing a new model called Residual-Dense-Attention Gates U-Net (RDAG U-Net) to improve accuracy and efficiency in identification. Methods: This study employed Attention U-Net, Attention Res U-Net, and the newly developed RDAG U-Net model. RDAG U-Net extends the U-Net architecture by incorporating ResBlock and DenseBlock modules in the encoder to retain training parameters and reduce computation time. The training dataset in-cludes 3,520 CT scans from an open database, augmented to 10,560 samples through data en-hancement techniques. The research also focused on optimizing convolutional architectures, image preprocessing, interpolation methods, data management, and extensive fine-tuning of training parameters and neural network modules. Result: The RDAG U-Net model achieved an outstanding accuracy of 93.29% in identifying pulmonary lesions, with a 45% reduction in computation time compared to other models. The study demonstrated that RDAG U-Net performed stably during training and exhibited good generalization capability by evaluating loss values, model-predicted lesion annotations, and validation-epoch curves. Furthermore, using ITK-Snap to convert 2D pre-dictions into 3D lung and lesion segmentation models, the results delineated lesion contours, en-hancing interpretability. Conclusion: The RDAG U-Net model showed significant improvements in accuracy and efficiency in the analysis of CT images for SARS-CoV-2 pneumonia, achieving a 93.29% recognition accuracy and reducing computation time by 45% compared to other models. These results indicate the potential of the RDAG U-Net model in clinical applications, as it can accelerate the detection of pulmonary lesions and effectively enhance diagnostic accuracy. Additionally, the 2D and 3D visualization results allow physicians to understand lesions' morphology and distribution better, strengthening decision support capabilities and providing valuable medical diagnosis and treatment planning tools. Full article

(This article belongs to the Special Issue Advances in Imaging Diagnosis and Management of Cardiovascular and Pulmonary Diseases)

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15 pages, 9765 KiB

Open AccessCase Report

Cleft Sign in MRI May Represent the Disruption of Cartilage Structure within Pubic Symphysis and Pubic Plate: A Cadaver Case Report

by Haruki Nishimura, Xueqin Gao, Sadao Niga, Naomasa Fukase, Yoichi Murata, Patrick M. Quinn, Masayoshi Saito, Hajime Utsunomiya, Soshi Uchida, Johnny Huard and Marc J. Philippon

Diagnostics 2024, 14(18), 2098; https://doi.org/10.3390/diagnostics14182098 - 23 Sep 2024

Viewed by 338

Abstract

Background/Objectives: Long-standing groin pain is a severe issue for athletes, often associated with the cleft sign on magnetic resonance imaging (MRI) scans, yet its underlying causes are poorly understood. The purpose of this study is to histologically examine the pubic plate structure in [...] Read more.

Background/Objectives: Long-standing groin pain is a severe issue for athletes, often associated with the cleft sign on magnetic resonance imaging (MRI) scans, yet its underlying causes are poorly understood. The purpose of this study is to histologically examine the pubic plate structure in cadavers with and without the cleft sign on MRI, shedding light on the pathology behind the cleft sign. Methods: Three fresh human pelvic cadavers underwent 3.0T MRI to detect the cleft sign before histological dissection of pubic plates. Pubic plate tissues were fixed in formalin, decalcified, and processed. Of the two cleft sign-negative specimens, one was cut into sagittal sections, and the other was cut into coronal sections for histology. For the cleft sign positive specimen, a sagittal section was cut. Moreover, 5 µm thick sections were cut at different axial levels for each orientation. Sections were subjected to Safranin O, Alcian blue, and Herovici’s staining or hematoxylin and eosin staining. Results: MRI confirmed that one specimen had a cleft sign in the inferior region on both sides of the pubis and that two specimens had no cleft sign. Both sagittal and coronal sections showed the presence of a cartilage structure continuing from the pubic symphysis to 3 mm laterally within the pubic plate. In the specimen with a positive cleft sign, cartilage damage within the pubic symphysis and pubic plate was identified as revealed by Safranin O staining, Herovici’s staining, and H&E staining. Conclusions: This study elucidated the existence of a cartilage component extending from the pubic symphysis to the pubic plate. The cleft sign in MRI correlated with a disruption in the cartilage component in histology within this specific area. Full article

(This article belongs to the Section Medical Imaging and Theranostics)

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14 pages, 1695 KiB

Open AccessArticle

Early Detection of Lymph Node Metastasis Using Primary Head and Neck Cancer Computed Tomography and Fluorescence Lifetime Imaging

by Nimu Yuan, Mohamed A. Hassan, Katjana Ehrlich, Brent W. Weyers, Garrick Biddle, Vladimir Ivanovic, Osama A. A. Raslan, Dorina Gui, Marianne Abouyared, Arnaud F. Bewley, Andrew C. Birkeland, D. Gregory Farwell, Laura Marcu and Jinyi Qi

Diagnostics 2024, 14(18), 2097; https://doi.org/10.3390/diagnostics14182097 - 23 Sep 2024

Viewed by 481

Abstract

Objectives: Early detection and accurate diagnosis of lymph node metastasis (LNM) in head and neck cancer (HNC) are crucial for enhancing patient prognosis and survival rates. Current imaging methods have limitations, necessitating new evaluation of new diagnostic techniques. This study investigates the [...] Read more.

Objectives: Early detection and accurate diagnosis of lymph node metastasis (LNM) in head and neck cancer (HNC) are crucial for enhancing patient prognosis and survival rates. Current imaging methods have limitations, necessitating new evaluation of new diagnostic techniques. This study investigates the potential of combining pre-operative CT and intra-operative fluorescence lifetime imaging (FLIm) to enhance LNM prediction in HNC using primary tumor signatures. Methods: CT and FLIm data were collected from 46 HNC patients. A total of 42 FLIm features and 924 CT radiomic features were extracted from the primary tumor site and fused. A support vector machine (SVM) model with a radial basis function kernel was trained to predict LNM. Hyperparameter tuning was conducted using 10-fold nested cross-validation. Prediction performance was evaluated using balanced accuracy (bACC) and the area under the ROC curve (AUC). Results: The model, leveraging combined CT and FLIm features, demonstrated improved testing accuracy (bACC: 0.71, AUC: 0.79) over the CT-only (bACC: 0.58, AUC: 0.67) and FLIm-only (bACC: 0.61, AUC: 0.72) models. Feature selection identified that a subset of 10 FLIm and 10 CT features provided optimal predictive capability. Feature contribution analysis identified high-pass and low-pass wavelet-filtered CT images as well as Laguerre coefficients from FLIm as key predictors. Conclusions: Combining CT and FLIm of the primary tumor improves the prediction of HNC LNM compared to either modality alone. Significance: This study underscores the potential of combining pre-operative radiomics with intra-operative FLIm for more accurate LNM prediction in HNC, offering promise to enhance patient outcomes. Full article

(This article belongs to the Special Issue Optimization of Clinical Imaging: From Diagnosis to Prognosis)

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The overall workflow of predicting LNM using CT and FLIm. The original data used for predicting LNM are the CT and FLIm data. The primary tumor masks of HNC were manually delineated on CT images by an experienced radiologist. Primary tumors in CT images were used to extract radiomic features; FLIm features were extracted from three spectral channels for each point measurement. Two sets of features were generated separately and then fused together. The fused and selected features were further used for the ML model training, validation, and testing. Abbreviations: ML—machine learning, LNM—lymph node metastasis, ROC—receiver operating characteristic, AUC—area under curve. Full article ">Figure 2
AUC comparisons using CT features only, FLIm features only and a combination of FLIm and CT features. (a) Comparison of ROC curves using fused features (purple curve), CT features alone (blue curve), and FLIm features alone (orange curve); (b) AUC performance versus relative distance from the location of the FLIm measurement to the tumor border based solely on fused features (purple curve) and FLIm features alone (orange curve), with yellow histograms illustrating the distribution in the relative distance of FLIm measurements. The relative distance is the ratio of the distance from the point to the tumor border (in centimeters) over the maximum distance within the tumor. Full article ">Figure 3
Comparative ROC curves for varying numbers of features. (a) FLIm-only classifiers: “FLIm-n” indicates that a total number of n FLIm features were selected. (b) CT + FLIm classifiers: “CT-n + FLIm-m” indicates that n CT features and m FLIm features were selected. Full article ">Figure 4
AUC performance and subject distribution for small (<2.0 cm) and large (≥2.0 cm) tumor dimensions spanning two tumor anatomical sites (oropharynx and oral cavity). (a) AUC for CT-only classification; (b) AUC for FLIm-only classification; (c) AUC for combined CT + FLIm classification; and (d) the distribution of subjects by LNM status across varying tumor dimensions and sites. The X-axis divides tumors based on anatomical location (oropharynx vs. oral cavity) and size (<2.0 cm vs. ≥2.0 cm). Full article ">

26 pages, 5902 KiB

Open AccessReview

Computed Tomography Evaluation of Coronary Atherosclerosis: The Road Travelled, and What Lies Ahead

by Chadi Ayoub, Isabel G. Scalia, Nandan S. Anavekar, Reza Arsanjani, Clinton E. Jokerst, Benjamin J. W. Chow and Leonard Kritharides

Diagnostics 2024, 14(18), 2096; https://doi.org/10.3390/diagnostics14182096 - 23 Sep 2024

Viewed by 594

Abstract

Coronary CT angiography (CCTA) is now endorsed by all major cardiology guidelines for the investigation of chest pain and assessment for coronary artery disease (CAD) in appropriately selected patients. CAD is a leading cause of morbidity and mortality. There is extensive literature to [...] Read more.

Coronary CT angiography (CCTA) is now endorsed by all major cardiology guidelines for the investigation of chest pain and assessment for coronary artery disease (CAD) in appropriately selected patients. CAD is a leading cause of morbidity and mortality. There is extensive literature to support CCTA diagnostic and prognostic value both for stable and acute symptoms. It enables rapid and cost-effective rule-out of CAD, and permits quantification and characterization of coronary plaque and associated significance. In this comprehensive review, we detail the road traveled as CCTA evolved to include quantitative assessment of plaque stenosis and extent, characterization of plaque characteristics including high-risk features, functional assessment including fractional flow reserve-CT (FFR-CT), and CT perfusion techniques. The state of current guideline recommendations and clinical applications are reviewed, as well as future directions in the rapidly advancing field of CT technology, including photon counting and applications of artificial intelligence (AI). Full article

(This article belongs to the Special Issue Latest Advances and Prospects in Cardiovascular Imaging)

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High-risk plaque features on coronary CT angiography (CAD RADS = 3 + HRP). HRP = High-risk plaque. (A) Positive remodeling seen in proximal left anterior descending artery (red bracket), with moderate (50–60%) underlying stenosis (2.5 mm luminal diameter shown with the yellow line). Outer caliber of artery is >1.5 times the inner lumen; 7.0 mm total vessel diameter is shown with the red line, and the green lines with 4.6 mm measurements demonstrate the luminal diameter pre- and post-stenosis. (B) Low-attenuation lipid core (<30 Hounsfield units, light blue arrow) with speckled calcium. Full article ">Figure 2
A 75-year-old outpatient with stable angina, with CT demonstrating moderate CAD without ischemia. (A,B) Coronary CT angiography demonstrated moderate coronary artery disease, stenosis 50% with mixed disease in the proximal and mid-left anterior descending artery, red arrows (CAD-RADS = 3). (C) FFR-CT negative for obstructive disease. Patient subsequently underwent stress echocardiography which was negative for inducible ischemia. He was commenced on aggressive risk factor modification. Full article ">Figure 3
A 59-year-old male reviewed in the outpatient clinic with stable angina and multiple cardiovascular risk factors, found to have moderate CAD with ischemia. (A,B) Linear and curved multiplanar reconstructions on CCTA respectively demonstrate moderate stenosis in right coronary artery (RCA), red arrows, reported as 50–70% (CAD-RADS = 3). (C) FFR-CT positive for ischemia and suggesting obstructive coronary artery disease in right coronary artery. Patient was referred for invasive coronary angiography. Full article ">Figure 4
Nonobstructive coronary artery disease. A 67-year-old male with a history of hyperlipidemia presented with subacute atypical chest pain. CCTA excluded obstructive coronary artery disease. Curved multiplanar reconstruction demonstrates mild stenosis in the proximal left anterior descending artery (25–50% stenosis, red arrow) with myocardial bridging in the mid segment (yellow arrow). Patient was accordingly commenced on statin therapy. Full article ">Figure 5
Obstructive coronary artery disease. A 79-year-old male presented to Emergency Room with two-week history of chest pain. (A,B) CCTA demonstrated severe stenosis with mixed plaque in left anterior descending artery (CAD-RADS = 4) on axial imaging, red arrow, and 3D reconstruction, light blue arrow, respectively. (C) FFR-CT positive for ischemia with a value of 0.67. (D) Invasive coronary angiography confirmed severe obstructive disease, yellow arrow; patient proceeded to percutaneous coronary intervention. Full article ">Figure 6
Suggested algorithm for the approach to acute chest pain in the Emergency Room. * If no contraindication. # Can consider triple rule-out if PE or aortic dissection is suspected. Abbreviations: ACS = acute coronary syndrome, CCTA = cardiac computed tomography angiography, ECG = electrocardiogram, PE = pulmonary embolism. Full article ">

14 pages, 265 KiB

Open AccessReview

Perioperative Care for Bariatric Surgery

by Reno Rudiman and Ricarhdo Valentino Hanafi

Diagnostics 2024, 14(18), 2095; https://doi.org/10.3390/diagnostics14182095 - 23 Sep 2024

Viewed by 339

Abstract

This review will start with a brief pathophysiology of obesity and the requirement for bariatric surgery, and it continues with a preoperative assessment, which includes a surgical mortality risk assessment, respiratory and cardiovascular assessments, and a psychological assessment. In-hospital postoperative care will be [...] Read more.

This review will start with a brief pathophysiology of obesity and the requirement for bariatric surgery, and it continues with a preoperative assessment, which includes a surgical mortality risk assessment, respiratory and cardiovascular assessments, and a psychological assessment. In-hospital postoperative care will be discussed, including which patients need a surgical intensive care unit and the monitoring tools required. The need for postoperative medications, postoperative complications, strategies for management, and a follow-up plan are also reviewed. This manuscript is written in a narrative review form with a chance of bias as a possible limitation. Full article

(This article belongs to the Special Issue Diagnosis and Management of Obesity, Eating and Weight-Related Disorders)

16 pages, 1488 KiB

Open AccessReview

The Role of Oxidative Stress as a Mechanism in the Pathogenesis of Acute Heart Failure in Acute Kidney Injury

by Danijela Tasić and Zorica Dimitrijević

Diagnostics 2024, 14(18), 2094; https://doi.org/10.3390/diagnostics14182094 - 23 Sep 2024

Viewed by 1144

Abstract

Despite a large amount of research on synchronous and mutually induced kidney and heart damage, the basis of the disease is still not fully clarified. Healthy mitochondria are essential for normal kidney and heart function. Mitochondrial dysfunction occurs when the clearance or process [...] Read more.

Despite a large amount of research on synchronous and mutually induced kidney and heart damage, the basis of the disease is still not fully clarified. Healthy mitochondria are essential for normal kidney and heart function. Mitochondrial dysfunction occurs when the clearance or process of generation and fragmentation of mitochondria is disturbed. The kidney is the second organ after the heart in terms of the number of mitochondria. Kidney tubules are rich in mitochondria due to the high energy requirements for absorption of large amounts of ultrafiltrate and dissolved substances. The place of action of oxidative stress is the influence on the balance in the production and breakdown of the mitochondrial reactive oxygen species. A more precise determination of the place and role of key factors that play a role in the onset of the disease is necessary for understanding the nature of the onset of the disease and the creation of therapy in the future. This underscores the urgent need for further research. The narrative review integrates results found in previously performed studies that have evaluated oxidative stress participation in cardiorenal syndrome type 3. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Urological Diseases)

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ROS-induced pathways in the kidney and heart relationship (created with <a href="http://BioRender.com" target="_blank">BioRender.com</a> on 7 July 2024). ROS are a normal outcome of mitochondrial respiration and energy production. They are highly reactive molecules with toxic potential. Production ROS affects many signaling pathways simultaneously. Nonradicals: H2O2—hydrogen peroxide; NADPH—Nicotinamide adenine dinucleotide phosphate; SOD-superoxide dismutase; H2O—water; MPO—myeloperoxidase; Cl−—Chlorine; HOCL-Hypochlorous acid; O2—oxygen reduction reaction; e−—electron; Radicals: O2−—superoxide anion; OH−—Hydroxide anion. Full article ">Figure 2
Oxidative stress and AKI (created with <a href="http://BioRender.com" target="_blank">BioRender.com</a> on 7 July 2024). The effect of oxidative stress on kidney tubule cells is shown in the figure. Changes in the structure and function of kidney mitochondria during AKI cause a disturbance in the energy metabolism in the kidney cells. The mutual interaction between different structures of the kidney and oxidative stress is based on the number of mitochondria, the way of production of reactive oxygen species, and the regulation of the response to oxidative stress. Downward black arrows: induction; black T: inhibition; yellow thunderbolt: oxidative damage. ROS—reactive oxygen species; TBARS—thiobarbituric acid; MDA—malonyl dialdechyde; AOPP—products of oxidative modification protein; R-SX—thiol sulfhydryl group; LMW—low molecular weight; NO—nitrogen oxide; NADPH—Nicotinamide adenine dinucleotide phosphate; HIF—hypoxia-inducible factors; NpF2—nuclear factor erythroid 2-related factor 2; NOX—Nicotinamide adenine dinucleotide phosphate oxidase; H2O2—hydrogen peroxide; O2−—superoxide anion. Full article ">Figure 3
Mithochondrial ROS in cardiorenal syndrome type 3. Mechanisms of reactive oxygen species generation in mitochondria, kidney, and heart cells during AKI are shown in the figure. Mitochondria are the main source of reactive oxygen species and are directly responsible for the intensification of oxidative stress in AKI as well as for triggering mechanisms that are responsible for remodeling and progression of heart damage. Upward black arrows: increase; downward black arrows: decrease; black Rightwards Arrow Over Leftwards Arrow: equilibrium arrow. MFN1: Mitofusin 1; MFN2: Mitofusin 2; OPA1: Optic atrophy 1; DRP: Dyamin-related protein 1; FIS1: Mitochondrial fission 1 protein; mtDNA: Mitochondrial double-stranded deoxyribonucleic acid. Full article ">

15 pages, 4632 KiB

Open AccessArticle

An Innovative Hybrid Model for Automatic Detection of White Blood Cells in Clinical Laboratories

by Aziz Aksoy

Diagnostics 2024, 14(18), 2093; https://doi.org/10.3390/diagnostics14182093 - 22 Sep 2024

Viewed by 543

Abstract

Background: Microscopic examination of peripheral blood is a standard practice in clinical medicine. Although manual examination is considered the gold standard, it presents several disadvantages, such as interobserver variability, being quite time-consuming, and requiring well-trained professionals. New automatic digital algorithms have been developed [...] Read more.

Background: Microscopic examination of peripheral blood is a standard practice in clinical medicine. Although manual examination is considered the gold standard, it presents several disadvantages, such as interobserver variability, being quite time-consuming, and requiring well-trained professionals. New automatic digital algorithms have been developed to eliminate the disadvantages of manual examination and improve the workload of clinical laboratories. Objectives: Regular analysis of peripheral blood cells and careful interpretation of their results are critical for protecting individual health and early diagnosis of diseases. Because many diseases can occur due to this, this study aims to detect white blood cells automatically. Methods: A hybrid model has been developed for this purpose. In the developed model, feature extraction has been performed with MobileNetV2 and EfficientNetb0 architectures. In the next step, the neighborhood component analysis (NCA) method eliminated unnecessary features in the feature maps so that the model could work faster. Then, different features of the same image were combined, and the extracted features were combined to increase the model’s performance. Results: The optimized feature map was classified into different classifiers in the last step. The proposed model obtained a competitive accuracy value of 95.6%. Conclusions: The results obtained in the proposed model show that the proposed model can be used in the detection of white blood cells. Full article

(This article belongs to the Special Issue Artificial Intelligence and Deep Learning in Clinical Classification and Prediction)

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10 pages, 1804 KiB

Open AccessArticle

The Development of a Yolov8-Based Model for the Measurement of Critical Shoulder Angle (CSA), Lateral Acromion Angle (LAA), and Acromion Index (AI) from Shoulder X-ray Images

by Turab Selçuk

Diagnostics 2024, 14(18), 2092; https://doi.org/10.3390/diagnostics14182092 - 22 Sep 2024

Viewed by 296

Abstract

Background: The accurate and effective evaluation of parameters such as critical shoulder angle, lateral acromion angle, and acromion index from shoulder X-ray images is crucial for identifying pathological changes and assessing disease risk in the shoulder joint. Methods: In this study, a YOLOv8-based [...] Read more.

Background: The accurate and effective evaluation of parameters such as critical shoulder angle, lateral acromion angle, and acromion index from shoulder X-ray images is crucial for identifying pathological changes and assessing disease risk in the shoulder joint. Methods: In this study, a YOLOv8-based model was developed to automatically measure these three parameters together, contributing to the existing literature. Initially, YOLOv8 was used to segment the acromion, glenoid, and humerus regions, after which the CSA, LAA angles, and AI between these regions were calculated. The MURA dataset was employed in this study. Results: Segmentation performance was evaluated with the Dice and Jaccard similarity indices, both exceeding 0.9. Statistical analyses of the measurement performance, including Pearson correlation coefficient, RMSE, and ICC values demonstrated that the proposed model exhibits high consistency and similarity with manual measurements. Conclusions: The results indicate that automatic measurement methods align with manual measurements with high accuracy and offer an effective alternative for clinical applications. This study provides valuable insights for the early diagnosis and management of shoulder diseases and makes a significant contribution to existing measurement methods. Full article

(This article belongs to the Special Issue Recent Advances in Bone and Joint Imaging—2nd Edition)

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27 pages, 5119 KiB

Open AccessArticle

Comparative Performance of Autoencoders and Traditional Machine Learning Algorithms in Clinical Data Analysis for Predicting Post-Staged GKRS Tumor Dynamics

by Simona Ruxandra Volovăț, Tudor Ovidiu Popa, Dragoș Rusu, Lăcrămioara Ochiuz, Decebal Vasincu, Maricel Agop, Călin Gheorghe Buzea and Cristian Constantin Volovăț

Diagnostics 2024, 14(18), 2091; https://doi.org/10.3390/diagnostics14182091 - 21 Sep 2024

Viewed by 394

Abstract

Introduction: Accurate prediction of tumor dynamics following Gamma Knife radiosurgery (GKRS) is critical for optimizing treatment strategies for patients with brain metastases (BMs). Traditional machine learning (ML) algorithms have been widely used for this purpose; however, recent advancements in deep learning, such as [...] Read more.

Introduction: Accurate prediction of tumor dynamics following Gamma Knife radiosurgery (GKRS) is critical for optimizing treatment strategies for patients with brain metastases (BMs). Traditional machine learning (ML) algorithms have been widely used for this purpose; however, recent advancements in deep learning, such as autoencoders, offer the potential to enhance predictive accuracy. This study aims to evaluate the efficacy of autoencoders compared to traditional ML models in predicting tumor progression or regression after GKRS. Objectives: The primary objective of this study is to assess whether integrating autoencoder-derived features into traditional ML models can improve their performance in predicting tumor dynamics three months post-GKRS in patients with brain metastases. Methods: This retrospective analysis utilized clinical data from 77 patients treated at the “Prof. Dr. Nicolae Oblu” Emergency Clinic Hospital-Iasi. Twelve variables, including socio-demographic, clinical, treatment, and radiosurgery-related factors, were considered. Tumor progression or regression within three months post-GKRS was the primary outcome, with 71 cases of regression and 6 cases of progression. Traditional ML models, such as Logistic Regression, Support Vector Machine (SVM), K-Nearest Neighbors (KNN), Extra Trees, Random Forest, and XGBoost, were trained and evaluated. The study further explored the impact of incorporating features derived from autoencoders, particularly focusing on the effect of compression in the bottleneck layer on model performance. Results: Traditional ML models achieved accuracy rates ranging from 0.91 (KNN) to 1.00 (Extra Trees). Integrating autoencoder-derived features generally enhanced model performance. Logistic Regression saw an accuracy increase from 0.91 to 0.94, and SVM improved from 0.85 to 0.96. XGBoost maintained consistent performance with an accuracy of 0.94 and an AUC of 0.98, regardless of the feature set used. These results demonstrate that hybrid models combining deep learning and traditional ML techniques can improve predictive accuracy. Conclusion: The study highlights the potential of hybrid models incorporating autoencoder-derived features to enhance the predictive accuracy and robustness of traditional ML models in forecasting tumor dynamics post-GKRS. These advancements could significantly contribute to personalized medicine, enabling more precise and individualized treatment planning based on refined predictive insights, ultimately improving patient outcomes. Full article

(This article belongs to the Special Issue Integrative Approaches in Head and Neck Cancer Imaging)

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17 pages, 3821 KiB

Open AccessArticle

Application of the 5th WHO Guidelines for the Diagnosis of Lung Carcinoma in Small Lung Biopsies in a Tertiary Care Center: Is Insecurity of Pathologists for the Accurate Diagnosis Justified?

by Manuela Beckert, Christian Meyer, Thomas Papadopoulos and Georgia Levidou

Diagnostics 2024, 14(18), 2090; https://doi.org/10.3390/diagnostics14182090 - 21 Sep 2024

Viewed by 393

Abstract

Background/Objectives: The diagnosis of lung carcinoma (LC) is currently performed in small biopsies and according to the WHO classification by using limited stains to spare tissue for molecular testing. This procedure, however, often causes diagnostic uncertainty among pathologists. Methods: In this retrospective analysis, [...] Read more.

Background/Objectives: The diagnosis of lung carcinoma (LC) is currently performed in small biopsies and according to the WHO classification by using limited stains to spare tissue for molecular testing. This procedure, however, often causes diagnostic uncertainty among pathologists. Methods: In this retrospective analysis, we compared the diagnosis made by these guidelines in 288 lung biopsies with that using more stains, as retrieved from our archive. We also compared the results of p63 and p40 immunoexpression and investigated the diagnostic role of p53/Rb1. Results: In our investigation, we reached a definite diagnosis with a mean number of one stain compared with six stains in the original diagnostic procedure, with a 97.3% concordance rate. Only in the case of metastases, a clear advantage is proven in the use of more stains, especially in the absence of clinical information. We also found a comparable utility of p40 and p63 for the diagnosis of squamous cell carcinoma, despite the higher p63 expression in other histological types. Moreover, normal p53/Rb1 expression could be utilized for the exclusion of small-cell LC. Conclusions: Our study confirms the diagnostic certainty achieved by the suggestions of the WHO classification and justifies the potential insecurity in the absence of adequate communication with the treating clinician. Full article

(This article belongs to the Special Issue Histopathology in Cancer Diagnosis and Prognosis)

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19 pages, 3177 KiB

Open AccessReview

Review of In Situ Hybridization (ISH) Stain Images Using Computational Techniques

by Zaka Ur Rehman, Mohammad Faizal Ahmad Fauzi, Wan Siti Halimatul Munirah Wan Ahmad, Fazly Salleh Abas, Phaik Leng Cheah, Seow Fan Chiew and Lai-Meng Looi

Diagnostics 2024, 14(18), 2089; https://doi.org/10.3390/diagnostics14182089 - 21 Sep 2024

Viewed by 488

Abstract

Recent advancements in medical imaging have greatly enhanced the application of computational techniques in digital pathology, particularly for the classification of breast cancer using in situ hybridization (ISH) imaging. HER2 amplification, a key prognostic marker in 20–25% of breast cancers, can be assessed [...] Read more.

Recent advancements in medical imaging have greatly enhanced the application of computational techniques in digital pathology, particularly for the classification of breast cancer using in situ hybridization (ISH) imaging. HER2 amplification, a key prognostic marker in 20–25% of breast cancers, can be assessed through alterations in gene copy number or protein expression. However, challenges persist due to the heterogeneity of nuclear regions and complexities in cancer biomarker detection. This review examines semi-automated and fully automated computational methods for analyzing ISH images with a focus on HER2 gene amplification. Literature from 1997 to 2023 is analyzed, emphasizing silver-enhanced in situ hybridization (SISH) and its integration with image processing and machine learning techniques. Both conventional machine learning approaches and recent advances in deep learning are compared. The review reveals that automated ISH analysis in combination with bright-field microscopy provides a cost-effective and scalable solution for routine pathology. The integration of deep learning techniques shows promise in improving accuracy over conventional methods, although there are limitations related to data variability and computational demands. Automated ISH analysis can reduce manual labor and increase diagnostic accuracy. Future research should focus on refining these computational methods, particularly in handling the complex nature of HER2 status evaluation, and integrate best practices to further enhance clinical adoption of these techniques. Full article

(This article belongs to the Special Issue Advances in Machine Learning for Computer-Aided Diagnosis in Biomedical Imaging—2nd Edition)

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Differenttypes of cytogenic images resulting from ISH: (a) FISH at 20× magnification, (b) CISH at 20× magnification, and (c) SISH at 40× magnification. Full article ">Figure 2
Breakdown of computational methods commonly used for histopathology image analysis. Full article ">Figure 3
A machine vision-based approach used in digital pathology image analysis. The red squares in subfigure (A) indicate selected regions for machine vision analysis. The whole slide image (WSI) is at a magnification level of 40×. Full article ">Figure 4
Examples of how digital photographs have been altered using grayscale-based contrast enhancement and thresholding for different cytogenetic types of ISH: (a) scale variation in CISH at 20× magnification, (b) scale variation in FISH at 20× magnification, and (c) scale variation in SISH at 40× magnification. Full article ">Figure 5
Automated image processing-based system demonstration at 40× magnification: (a) original SISH images, (b) preprocessed for ground truth generation, (c) nuclei-labeled ground truth images, (d) marked labeled nuclei on the original image, and (e) marked labeled nuclei and HER2 signals. More precise signal detection refines nuclei segmentation. Full article ">

3 pages, 4122 KiB

Open AccessInteresting Images

Atraumatic Hepatic Laceration with Hemoperitoneum

by Gaetano Maria Russo, Evangelia Zoi, Imma D’Iglio and Maria Luisa Mangoni di Santo Stefano

Diagnostics 2024, 14(18), 2088; https://doi.org/10.3390/diagnostics14182088 - 21 Sep 2024

Viewed by 308

Abstract

Introduction: A rare case of atraumatic liver laceration associated with hemoperitoneum is presented in a patient with amyloidosis who came to the hospital for abdominal pain. Case Presentation: The imaging findings reveal significant hepatomegaly with finely heterogeneous hepatic density and subcapsular hypo-dense streaks [...] Read more.

Introduction: A rare case of atraumatic liver laceration associated with hemoperitoneum is presented in a patient with amyloidosis who came to the hospital for abdominal pain. Case Presentation: The imaging findings reveal significant hepatomegaly with finely heterogeneous hepatic density and subcapsular hypo-dense streaks in segments VI and VII, likely representing lesions. Post-contrast enhancement shows a punctiform contrast medium extravasation within the subhepatic fluid collection, visible from the arterial phase and intensifying in subsequent study phases. Discussion: These imaging findings suggest an atraumatic hepatic laceration, a diagnosis confirmed by the presence of hemoperitoneum distributed bilaterally under the diaphragm, in the paracolic gutters, along the mesentery root, and predominantly in the peri-hepatic region. Conclusion: The detailed imaging analysis provided critical insights into the diagnosis and management of this rare clinical presentation. Full article

(This article belongs to the Special Issue Diagnosis and Management of Liver Diseases—2nd Edition)

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Axial phases without and with contrast CT images demonstrating hepatomegaly with a liver length of approximately 25 cm. The liver parenchyma displays a finely and diffusely heterogeneous density. Full article ">Figure 2
Coronal CT images in different phases showing subdiaphragmatic fluid collection bilaterally, within the paracolic gutters, and prominently around the liver. The fluid collection is suggestive of hemoperitoneum. Full article ">Figure 3
Axial CT images in venous phase focused on liver segments VI and VII, revealing hypodense subcapsular streaks (maximum extension of approximately 1.5 cm). These findings are consistent with hepatic lesions, likely indicative of a laceration [<a href="#B1-diagnostics-14-02088" class="html-bibr">1</a>,<a href="#B2-diagnostics-14-02088" class="html-bibr">2</a>]. Full article ">Figure 4
Axial CT images in different phases, highlighting extravasation of contrast medium within the subhepatic fluid collection. The extravasation becomes more prominent in the last phases, confirming the presence of active bleeding. The purple arrow demonstrates blood extravasation in the collection during the venous and delayed phases of the study, not visible in the baseline and arterial phases. Full article ">Figure 5
Axial CT images in different phases, highlighting extravasation of contrast medium within the subhepatic fluid collection. In the venous and delayed contrast-enhanced phases, a difference in the density of the perihepatic fluid collection is observed, indicating ongoing active bleeding. The lower border of the liver shows a blurred contour, especially evident along its inferior surface [<a href="#B3-diagnostics-14-02088" class="html-bibr">3</a>]. Full article ">

12 pages, 2165 KiB

Open AccessArticle

The Effectiveness of Ultrasound-Guided Infiltrations Combined with Early Rehabilitation in the Management of Low Back Pain: A Retrospective Observational Study

by Danilo Donati, Fabio Vita, Vincenza Amoruso, Flavio Origlio, Roberto Tedeschi, Francesco Castagnini, Salvatore Massimo Stella, Marco Miceli, Cesare Faldini and Stefano Galletti

Diagnostics 2024, 14(18), 2087; https://doi.org/10.3390/diagnostics14182087 - 20 Sep 2024

Viewed by 349

Abstract

Background and Aims: Low back pain is a prevalent condition affecting 60–85% of individuals during their lifetime. Despite various proposed mechanisms, the etiology of low back pain remains unclear. This study aims to evaluate the effectiveness of combining ultrasound-guided infiltrations with early rehabilitation [...] Read more.

Background and Aims: Low back pain is a prevalent condition affecting 60–85% of individuals during their lifetime. Despite various proposed mechanisms, the etiology of low back pain remains unclear. This study aims to evaluate the effectiveness of combining ultrasound-guided infiltrations with early rehabilitation in reducing pain and improving functional limitations in patients with chronic nonspecific low back pain. Methods: A retrospective observational study was conducted, reviewing data from January to April 2024 involving 40 patients with chronic nonspecific low back pain. Each patient received two cycles of ultrasound-guided lidocaine and corticosteroid infiltrations at the level of the posterior lower iliac spine, followed by 10 rehabilitation sessions. Patients were assessed at baseline (T0), after the first treatment cycle (T1), and after the second cycle (T2) using the Oswestry Disability Index, Quebec Back Pain Disability Scale, Roland Disability Questionnaire, and Numeric Rating Scale. Results: Significant improvements were observed across all assessment scales. The ODI scores decreased from 33.5 at baseline to 3.5 after treatment (p < 0.001). Similar reductions were noted in the QBPDS (from 61.5 to 10.3), RDQ (from 18 to 3.4), and NRS (from 7.4 to 1.3). The combination of ultrasound-guided infiltrations and early rehabilitation resulted in a significant reduction in pain and disability, with the most notable improvements occurring after the second treatment cycle. Conclusions: The integration of ultrasound-guided infiltrations with early rehabilitation is highly effective in managing chronic nonspecific low back pain, significantly reducing both pain and functional limitations. Full article

(This article belongs to the Special Issue Current Perspectives and Advances in Ultrasound Imaging)

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Ultrasound-guided injection. The image shows an ultrasound-guided injection procedure with the needle precisely positioned near the spine. This technique is used to deliver medication directly to the affected area, reducing pain and improving functionality in patients with chronic low back pain. Full article ">Figure 2
Postural rehabilitation exercises. A series of postural rehabilitation exercises aimed at strengthening the abdomen, aligning the spine, and improving posture. These exercises are an integral part of the rehabilitation protocol for patients with chronic low back pain, helping to reduce pain and enhance mobility. Full article ">Figure 3
Oswestry Disability Index (ODI) scores during different treatment periods and comparison between variables. Full article ">Figure 4
Quebec Back Pain Disability Scale (QBPDS) scores during different treatment periods and comparison between variables. Full article ">Figure 5
Roland Disability Questionnaire (RDQ) results during various observation periods and for the analyzed variables. Full article ">Figure 6
Numeric Rating Scale (NRS) trends for pain levels following treatments. Full article ">

16 pages, 3258 KiB

Open AccessReview

Endoscopic Ultrasound and Intraductal Ultrasound in the Diagnosis of Biliary Tract Diseases: A Narrative Review

by Akiya Nakahata, Yasunobu Yamashita and Masayuki Kitano

Diagnostics 2024, 14(18), 2086; https://doi.org/10.3390/diagnostics14182086 - 20 Sep 2024

Viewed by 464

Abstract

Endoscopic ultrasound (EUS) and intraductal ultrasound (IDUS) play very important roles in the field of biliary tract disease. Because of their excellent spatial resolution, the detection of small lesions and T- or N-staging of tumors have become possible. Additionally, contrast-enhanced EUS and the [...] Read more.

Endoscopic ultrasound (EUS) and intraductal ultrasound (IDUS) play very important roles in the field of biliary tract disease. Because of their excellent spatial resolution, the detection of small lesions and T- or N-staging of tumors have become possible. Additionally, contrast-enhanced EUS and the new imaging technique of detective flow imaging are reported to be useful for differential diagnosis. Furthermore, EUS-guided tissue acquisition is used not only for pathological diagnosis but also to collect tissue samples for cancer genome profiling. This review provides an overview of diagnosis utilizing the features and techniques of EUS and IDUS. Full article

(This article belongs to the Special Issue Ultrasound Technologies in Clinical Medicine: Recent Advances in Gastroenterology)

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Images and schema of the two types of endoscopic ultrasound (EUS). (a) Convex-type EUS (GF-UCT260, Olympus, Tokyo, Japan); (b) radial-type EUS (GF-UE290, Olympus, Japan); (c) scheme of convex-type EUS; (d) scheme of radial type EUS; (e) ultrasound view of convex-type EUS; and (f) ultrasound view of radial-type EUS. Full article ">Figure 2
These are images of intraductal ultrasound probes: (a,b) the ultrasound probe is attached at the point indicated by the red arrow (UM-DG20-31R, Olympus, Japan). Full article ">Figure 3
Detection of small choledocholithiasis by intraductal ultrasound (IDUS) and endoscopic ultrasound (EUS): (a) IDUS image of choledocholithiasis (arrowhead, 5 mm); (b) EUS image of choledocholithiasis (arrowhead, 5 mm). Full article ">Figure 4
Images of the normal structure of the biliary duct wall and gallbladder wall: (a,b) images of the biliary duct wall on intraductal ultrasound and the gallbladder wall on endoscopic ultrasound; (c,d) red arrows show the inner hypoechoic layer corresponding to the mucosa, the muscularis propria, and part of the subserosa. Yellow arrows show the outer hyperechoic layer corresponding to part of the subserosa and the serosa. Full article ">Figure 5
Endoscopic ultrasound image of adenomyomatosis: thickened wall and cystic anechoic spots are visible. The cystic spots show Rokitansky–Aschoff sinuses. Full article ">Figure 6
Pancreaticobiliary maljunction: an endoscopic ultrasound image showing the pancreatic duct and the bile duct converging outside the duodenal wall. Full article ">

16 pages, 21964 KiB

Open AccessReview

Osteosarcoma Metastasis to the Thorax: A Pictorial Review of Chest Computed Tomography Findings

by Khalid Abdulaziz Alduraibi, Jawaher Ali Towhari, Hatim Abdullah Alebdi, Bader Zaid Alfadhel, Ghazi S. Alotaibi, Subha Ghosh and Mnahi Bin Saeedan

Diagnostics 2024, 14(18), 2085; https://doi.org/10.3390/diagnostics14182085 - 20 Sep 2024

Viewed by 457

Abstract

Background: Osteosarcoma, a primary bone malignancy in children and adolescents, frequently metastasizes to the lungs, contributing significantly to morbidity and mortality. Lung Metastases: At diagnosis, 15–20% of patients present with detectable lung metastases. Chest computed tomography (CT) is vital for the early detection [...] Read more.

Background: Osteosarcoma, a primary bone malignancy in children and adolescents, frequently metastasizes to the lungs, contributing significantly to morbidity and mortality. Lung Metastases: At diagnosis, 15–20% of patients present with detectable lung metastases. Chest computed tomography (CT) is vital for the early detection and monitoring of these metastases. Lung involvement typically presents as multiple nodules of varying sizes and can include atypical features such as cavitation, cystic lesions, ground-glass halos, intravascular tumor thrombi, and endobronchial disease. Additional Findings: Pleural metastasis often occurs alongside pulmonary disease, and complications like spontaneous pneumothorax may arise. Additional findings may include thoracic lymphadenopathy, cardiac tumor thrombus, and chest wall deposits. Conclusion: Familiarity with these imaging patterns is essential for radiologists to ensure timely diagnosis and effective management. This review highlights the critical role of chest CT in detecting and characterizing osteosarcoma metastasis. Full article

(This article belongs to the Special Issue Recent Developments and Future Trends in Thoracic Imaging)

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9 pages, 1647 KiB

Open AccessCase Report

“Lazarus Response” When Feto-Maternal Microchimerism Kicks in: Spontaneous Remission in Refractory Primary Mediastinal B Cell Lymphoma Following Twin Pregnancy

by Radu Andrei Tomai, Sabina Iluta, Adrian Bogdan Tigu, Madalina Nistor, Anamaria Bancos, Diana Cenariu, Ciprian Jitaru, Sergiu Patcas, Delia Dima, David Kegyes, Sanda Buruiana, Mihnea Zdrenghea, Alina Daniela Tanase, Ciprian Tomuleasa and Romeo Micu

Diagnostics 2024, 14(18), 2084; https://doi.org/10.3390/diagnostics14182084 - 20 Sep 2024

Viewed by 344

Abstract

Background: Spontaneous remission of cancer is a rare and poorly understood phenomenon characterized by complete or partial remission of a malignancy in the absence of or with inadequate treatment. The underlying mechanism for such occurrences is poorly understood, however, immune mechanisms seem [...] Read more.

Background: Spontaneous remission of cancer is a rare and poorly understood phenomenon characterized by complete or partial remission of a malignancy in the absence of or with inadequate treatment. The underlying mechanism for such occurrences is poorly understood, however, immune mechanisms seem to play an important role in such cases. In recent years increasingly more data have become available in favor of the clinical benefit of low levels of chimerism in hematologic malignancies. One such instance of naturally occurring low-level chimerism is feto-maternal microchimerism which has been shown to influence cancer progression and, in some instances, to be a protective factor against malignancy. Case report: We report a case of a young female patient with aggressive primary mediastinal large B cell lymphoma refractory to two lines of chemo-immunotherapy achieving sustained complete metabolic remission of tumor while pregnant with twins. Results: A focus on feto-maternal microchimerism during and after pregnancy revealed transient levels of feto-maternal microchimerism in the peripheral blood of the patient as measured by quantifying the Y-chromosome-linked SRY gene. Conclusions: Microchimerism presents significant potential for enhancing our comprehension of disease mechanisms, uncovering novel therapeutic targets, and refining diagnostic and treatment approaches, especially concerning cancer. Full article

(This article belongs to the Special Issue Imaging of Fetal and Maternal Diseases in Pregnancy: 3rd Edition)

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12 pages, 4392 KiB

Open AccessArticle

Optical Coherence Tomography as a Diagnosis-Assisted Tool for Guiding the Treatment of Melasma: A Case Series Study

by Chin-Yi Yang, Ja-Hon Lin and Chien-Ming Chen

Diagnostics 2024, 14(18), 2083; https://doi.org/10.3390/diagnostics14182083 - 20 Sep 2024

Viewed by 385

Abstract

Background/Objectives: Multiple underlying pathomechanisms may lead to melasma, but there has been no report on the use of optical coherence tomography (OCT) to reveal specific pathomechanisms in individual patients and provide individualized treatments accordingly. Using real-time OCT images, we studied the pathomechanisms of [...] Read more.

Background/Objectives: Multiple underlying pathomechanisms may lead to melasma, but there has been no report on the use of optical coherence tomography (OCT) to reveal specific pathomechanisms in individual patients and provide individualized treatments accordingly. Using real-time OCT images, we studied the pathomechanisms of melasma in 12 female patients and the effects of individualized treatments. Methods: Patients were divided into good and bad improved groups according to the improvement in hyperpigmentation at month 4. Results: In the bad improved group, all melanin or confetti melanin had significantly decreased at month 2 or month 4 while granular melanin ratio at month or month 4 significantly increased, the most parameters of dendritic-sharped cells (DCs) before and after treatment were not significantly different, the collagen area or collagen density at month 4 significantly decreased. In the good improved group, there was slightly low all melanin/confetti melanin at month 4 and high granular melanin at month 4 in comparison to the bad improved group. Moreover, most of the parameters in the DCs at month 4 significantly increased while most parameters in collagen at month 4 significantly decreased. Conclusions: OCT is useful in revealing the involved pathomechanisms of melasma in individualized patients. Positive treatment results can be achieved through individualized therapy regimen targeting the pathomechanisms. Full article

(This article belongs to the Special Issue Dermatology: Diagnosis and Management)

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OCT analysis of facial melasma. Cross-section images of each lesion of interest, B-scan or C-scan, were generated and analyzed. In the C-scan images, (A) all melanin (brightness level > 153 gray scale and diameter > 0.5 µm, gray color), confetti melanin (area > 8.42 µm2 and diameter > 3.3 µm, yellow color), or granular melanin (diameter 0.5–3.2 µm and area = 8.42 µm2, red color) 15 µm above the dermal–epidermal junction of lesional skin and (B) all DCs in the dermal–epidermal junction of lesional skin were measured. In the B-scan images, (C) collagen 100 µm under the dermal–epidermal junction of lesional skin was also measured. Full article ">Figure 2
Melasma area and severity index (MASI) scores before and four months after the final treatment. Values were plotted as individuals and median was shown by the horizontal line. * p < 0.05. Full article ">Figure 3
Photographs of facial melasma with good treatment efficacy before and after treatment. A 50-year-old female patient showing melasma in the bilateral cheek. Full article ">Figure 4
Photographs of facial melasma with bad treatment efficacy before and after treatment. A 43-year-old female patient showing melasma in the bilateral cheek. Full article ">Figure 5
The level of melanin before and after treatment. Mean melanin size, confetti melanin density, mean confetti melanin size, confetti melanin ratio (CM or CG), and granular melanin ratio at baseline, month 2, or month 4 was compared in patients with good or bad treatment efficacy. * p < 0.05. Full article ">Figure 6
The level of DCs before and after treatment. DC area, DC density, maximal DC size, median DC width, median DC length, minimal DC length, or maximal DC length at baseline, month 2 or month 4 compared in patients with good or bad treatment efficacy. * p < 0.05, *** p < 0.001. Full article ">Figure 7
The level of collagen before and after treatment. Collagen area, collagen density, maximal collagen size, median collagen width, median collagen length, minimal collagen length, or maximal collagen length at baseline, month 2, and month 4 was compared in patients with good or bad treatment efficacy. * p < 0.05, ** p < 0.01, *** p < 0.001. Full article ">

10 pages, 1155 KiB

Open AccessArticle

A Rapid Increase in Serum Lactate Levels after Cardiovascular Surgery Is Associated with Postoperative Serious Adverse Events: A Single Center Retrospective Study

by Kenichiro Kikuchi, Satoshi Kazuma and Yoshiki Masuda

Diagnostics 2024, 14(18), 2082; https://doi.org/10.3390/diagnostics14182082 - 20 Sep 2024

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Abstract

Background/Objectives: Hyperlactatemia is a common predictive factor for poor post-cardiovascular surgery outcomes. However, it is not well understood whether the rapid postoperative lactate level elevation in a short period of time is associated with patient outcomes. Herein, we investigated the relationship between the [...] Read more.

Background/Objectives: Hyperlactatemia is a common predictive factor for poor post-cardiovascular surgery outcomes. However, it is not well understood whether the rapid postoperative lactate level elevation in a short period of time is associated with patient outcomes. Herein, we investigated the relationship between the degree of change in serum lactate levels and postoperative serious adverse events (PSAEs), including mortality, within 24 h of cardiovascular surgery. Methods: In this retrospective study, we evaluated the relationship between a rapid serum lactate level increase and PSAEs after open-heart and major vascular surgery. We divided the patients into those with and without PSAEs. Univariate and multivariate analyses were performed to evaluate the association between PSAEs and rapid lactate level increases. Results: We enrolled 445 patients; 16% (n = 71) had PSAEs. The peak lactate levels during the first 24 h of intensive care unit (ICU) stay were higher in patients with PSAEs than in those without. The maximum change in lactate levels between two consecutive lactate measurements during the first 24 h after ICU admission was higher in patients with PSAEs than in those without. A multivariate logistic regression analysis revealed that changes in lactate levels of 2 mmol/L or more between two consecutive lactate measurements were associated with PSAEs. ICU peak lactate levels of 3 mmol/L or more were not associated with PSAEs. Conclusions: Rapid serum lactate level increases of 2 mmol/L or more during the first 24 h of ICU admission post-cardiovascular surgery are associated with PSAEs. Full article

(This article belongs to the Section Clinical Laboratory Medicine)

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Flow diagram of study patients’ enrollment. Among 531 patients undergoing cardiovascular surgery, 445 were included for analysis in this study. Among them, 71 had PSAEs, and 374 did not. One or more of the following were considered PSAEs: in-hospital death, need for revision, need for circulatory assist devices, need for reintubation, need for dialysis, and intensive care unit re-entry. Abbreviation: PSAEs, postoperative serious adverse events. Full article ">Figure 2
The incidence of PSAEs among subgroups based on the maximum Lac levels during the first 24 h after intensive care unit admission. The percentage of PSAEs in the Lac < 2 mmol/L, 2 ≦ Lac < 3 mmol/L, and Lac ≥ 3 mmol/L groups were 3%, 13%, and 20%, respectively. The percentage of PSAEs in the Lac ≥ 3 mmol/L group was significantly higher than that in the Lac < 2 mmol/L group. *: p < 0.001 vs Lac < 2 mmol/L group. Abbreviations: PSAE, postoperative serious adverse event; Lac, lactate. Full article ">Figure 3
The incidence of PSAEs among subgroups based on the ΔLac in the first 24 h after intensive care unit admission. The percentages of PSAE in the ΔLac < 1 mmol/L, 1 mmol/L ≦ ΔLac < 2 mmol/L, and ΔLac ≥ 2 mmol/L groups were 13%, 12%, and 29%, respectively. The percentage of PSAE in the ΔLac ≥ 2 mmol/L group was higher than that in the ΔLac < 1 mmol/L and 1 mmol/L ≦ ΔLac < 2 mmol/L groups. *: p < 0.05 vs ΔLac < 1 mmol/L and 1 mmol/L ≦ ΔLac < 2 mmol/L groups. Abbreviations: PSAE, postoperative serious adverse event; Lac, lactate. Full article ">Figure 4
The peak Lac levels during the first 24 h after intensive care unit admission. The peak Lac levels during the first 24 h after ICU admission were lower in the group without PSAEs than in the group with PSAEs (3.1 (2.3–4.4) vs. 4.0 (2.9–6.1); p < 0.0001). The dots indicate individual patients, and the horizontal lines indicate the median with interquartile range. Abbreviations: PSAE, postoperative serious adverse event; Lac, lactate. Full article ">Figure 5
ΔLac during the first 24 h after intensive care unit admission. The ΔLac in patients with PSAEs was significantly higher than in patients without PSAEs (1.0 (0.5–1.6) vs. 0.8 (0.3–1.3); p = 0.02). The dots indicate individual patients, and the horizontal lines indicate the median with interquartile range. Abbreviations: PSAE, postoperative serious adverse event; Lac, lactate. Full article ">

15 pages, 1957 KiB

Open AccessArticle

Distal Transradial Access Optimization: A Prospective Trial of Ultrasound-Guided Radial Artery Characterization for the Anatomical Snuffbox

by Łukasz Koziński, Zbigniew Orzałkiewicz, Paweł Zagożdżon and Alicja Dąbrowska-Kugacka

Diagnostics 2024, 14(18), 2081; https://doi.org/10.3390/diagnostics14182081 - 20 Sep 2024

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Abstract

Background/Objectives: The distal transradial approach (dTRA) is increasingly used in interventional cardiology. Doppler Ultrasound (DUS) effectively assesses radial artery (RA) characteristics. This study aims to identify specific RA DUS characteristics in patients undergoing coronary procedures via dTRA. Methods: Participants from the ANTARES [...] Read more.

Background/Objectives: The distal transradial approach (dTRA) is increasingly used in interventional cardiology. Doppler Ultrasound (DUS) effectively assesses radial artery (RA) characteristics. This study aims to identify specific RA DUS characteristics in patients undergoing coronary procedures via dTRA. Methods: Participants from the ANTARES trial who completed the intervention per-protocol and retained RA patency were included. DUS was performed at baseline, 1 day, and 60 days post-procedure. Results: Among 400 participants, 348 had either dTRA (n = 169) or conventional transradial access (cTRA) (n = 179). Distal RA lumen diameter was 12% smaller than that of the proximal RA (p < 0.001). Men had a 14% larger distal RA diameter than women (2.33 ± 0.31 mm vs. 2.04 ± 0.27 mm, p < 0.0001), similar to the proximal RA relationship. Peak flow velocities were similar between the sexes. Univariate linear regression showed that height, weight, body mass index, and body surface area (BSA) predicted arterial size, with BSA remaining significant in multivariate analysis (beta coefficient 0.62; confidence interval 0.49–0.75; p < 0.0001). Distal RA diameter correlated positively with palpable pulse at the snuffbox and wrist. The dTRA resulted in an immediate 14% and 11% increase in distal and proximal RA diameter, respectively (both p < 0.05). Sixty days after dTRA, the distal RA remained slightly dilated (p < 0.05), while the proximal RA returned to baseline. Conclusions: Distal RA diameter is significantly associated with sex, measuring smaller than the forearm segment. A strong palpable pulse correlates with larger distal RA size. The dTRA induces RA lumen expansion. A thorough understanding of distal RA anatomy is essential for optimizing patient selection and refining techniques for transradial procedures. Full article

(This article belongs to the Special Issue New Trends and Advances in Cardiac Imaging)

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Graphical abstract

Graphical abstract
Full article ">Figure 1
Ultrasound measurement of lumen diameters and blood flow velocities in the distal radial artery (A,C) and forearm radial artery (B,D). Arrows indicate the luminal diameter of the artery, measured as the distance between the intimal layers of the intima-media complex. Full article ">Figure 2
Study flow chart. CKD = chronic kidney disease; MI = myocardial infarction; RAO = radial artery occlusion; TRA = transradial approach. Full article ">Figure 3
Gender-related cumulative frequencies of lumen diameters in the distal radial artery (A) and forearm radial artery (B). Full article ">Figure 4
Correlation between radial artery size, blood peak velocity flow, and strength of palpable pulse at the snuffbox and forearm. Correlation between distal radial artery size and palpable pulse strength at the snuffbox (A), forearm radial artery size and palpable pulse strength at the wrist (B), distal radial artery size and palpable pulse strength at the wrist (C), distal radial artery size and blood peak velocity flow at the snuffbox (D). r = correlation coefficient. Full article ">Figure 5
Differences in radial artery lumen size changes at the snuffbox (A) and forearm (B) at baseline, 1 day, and 60 days after distal and conventional transradial approaches. TRA = transradial approach; mm = millimeter. Full article ">Figure 6
Differences in radial artery peak flow velocity dynamics at the snuffbox (A) and forearm (B) at baseline, 1 day, and 60 days after distal and conventional transradial approaches. TRA = transradial approach; m/s = meter per second. Full article ">

18 pages, 7920 KiB

Open AccessArticle

Optimal Training Positive Sample Size Determination for Deep Learning with a Validation on CBCT Image Caries Recognition

by Yanlin Wang, Gang Li, Xinyue Zhang, Yue Wang, Zhenhao Zhang, Jupeng Li, Junqi Ma and Linghang Wang

Diagnostics 2024, 14(18), 2080; https://doi.org/10.3390/diagnostics14182080 - 20 Sep 2024

Viewed by 421

Abstract

Objectives: During deep learning model training, it is essential to consider the balance among the effects of sample size, actual resources, and time constraints. Single-arm objective performance criteria (OPC) was proposed to determine the optimal positive sample size for training deep learning [...] Read more.

Objectives: During deep learning model training, it is essential to consider the balance among the effects of sample size, actual resources, and time constraints. Single-arm objective performance criteria (OPC) was proposed to determine the optimal positive sample size for training deep learning models in caries recognition. Methods: An expected sensitivity (P_T) of 0.6 and a clinically acceptable sensitivity (P₀) of 0.5 were applied to the single-arm OPC calculation formula, yielding an optimal training set comprising 263 carious teeth. U-Net, YOLOv5n, and CariesDetectNet were trained and validated using clinically self-collected cone-beam computed tomography (CBCT) images that included varying quantities of carious teeth. To assess performance, an additional dataset was utilized to evaluate the accuracy of caries detection by both the models and two dental radiologists. Results: When the number of carious teeth reached approximately 250, the models reached the optimal performance levels. U-Net demonstrated superior performance, achieving accuracy, sensitivity, specificity, F1-Score, and Dice similarity coefficients of 0.9929, 0.9307, 0.9989, 0.9590, and 0.9435, respectively. The three models exhibited greater accuracy in caries recognition compared to dental radiologists. Conclusions: This study demonstrated that the positive sample size of CBCT images containing caries was predictable and could be calculated using single-arm OPC. Full article

(This article belongs to the Special Issue Applications of Dentomaxillofacial Diagnostic Imaging in Different Specialties)

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10 pages, 633 KiB

Open AccessArticle

Influence of Right Atrial Pressure on the Prognosis of Patients with Rheumatic Mitral Stenosis Undergoing Percutaneous Mitral Balloon Valvuloplasty

by Daniella Cian Nazzetta, Larissa Christine Gomes de Sousa, Vitor Emer Egypto Rosa, Fernanda Castiglioni Tessari, Carlos M. Campos, Maria Antonieta Albanez Medeiros Lopes, Carlos Viana Poyares Jardim, Luís Gustavo Mapa, Layara Fernanda Vicente Pereira Lipari, Mariana Pezzute Lopes, João Ricardo Cordeiro Fernandes, Antonio de Santis, Lucas José Neves Tachotti Pires, Roney Orismar Sampaio and Flávio Tarasoutchi

Diagnostics 2024, 14(18), 2079; https://doi.org/10.3390/diagnostics14182079 - 19 Sep 2024

Viewed by 444

Abstract

Background: Pulmonary hypertension (PH) often complicates mitral stenosis (MS). The prognostic impact of pulmonary vascular resistance (PVR) in MS patients remains unclear. Previous study has demonstrated the prognostic impact of right atrial pressure (RAP) in patients with primary PH. We aim to determine [...] Read more.

Background: Pulmonary hypertension (PH) often complicates mitral stenosis (MS). The prognostic impact of pulmonary vascular resistance (PVR) in MS patients remains unclear. Previous study has demonstrated the prognostic impact of right atrial pressure (RAP) in patients with primary PH. We aim to determine the prognostic impact of PVR and RAP in patients with rheumatic MS undergoing percutaneous mitral balloon valvuloplasty (PMBV). Methods: A total of 58 patients with symptomatic severe rheumatic MS who underwent PMBV between 2016 and 2020 were included. Patients were divided into two groups: PVR ≤ 2WU (N = 26) and PVR > 2WU (N = 32). The composite endpoint included death, reintervention or persistent NYHA functional class III-IV during follow-up. Results: The median age was 50 (42–60) years, with 82.8% being female. Median pulmonary artery systolic pressure (PASP) was 42 (35–50.5) mmHg. Patients with PVR ≤ 2WU had lower PASP on both echocardiogram and catheterization. The PMBV success rate was 75.9%. Multivariate analysis, adjusted for PVR, showed RAP as the only independent predictor of the composite endpoint (HR:1.507, 95% CI:1.015–2.237, p = 0.042). The optimal RAP cutoff was 9.5 mmHg (HR:3.481, 95% CI:1.041–11.641; p = 0.043). Conclusions: RAP was an independent predictor of adverse outcomes in patients with rheumatic MS undergoing PMBV, while PVR did not show prognostic significance. These findings suggest that the prognostic value of PVR may be lower than expected. Full article

(This article belongs to the Special Issue Rheumatic Diseases: Diagnosis and Management)

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11 pages, 1516 KiB

Open AccessArticle

Glucose and Lipid Metabolism Disorders in Adults with Spinal Muscular Atrophy Type 3

by Marija Miletić, Zorica Stević, Svetlana Vujović, Jelena Rakočević, Ana Tomić, Milina Tančić Gajić, Miloš Stojanović, Aleksa Palibrk and Miloš Žarković

Diagnostics 2024, 14(18), 2078; https://doi.org/10.3390/diagnostics14182078 - 19 Sep 2024

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Abstract

Background: Spinal muscular atrophy type 3 (juvenile SMA, Kugelberg–Welander disease) is a genetic disease caused by changes in the survival motor neuron 1 (SMN) gene. However, there is increasing evidence of metabolic abnormalities in SMA patients, such as altered fatty acid metabolism, impaired [...] Read more.

Background: Spinal muscular atrophy type 3 (juvenile SMA, Kugelberg–Welander disease) is a genetic disease caused by changes in the survival motor neuron 1 (SMN) gene. However, there is increasing evidence of metabolic abnormalities in SMA patients, such as altered fatty acid metabolism, impaired glucose tolerance, and defects in the functioning of muscle mitochondria. Given that data in the literature are scarce regarding this subject, the purpose of this study was to estimate the prevalence of glucose and lipid metabolism disorders in adult patients with SMA type 3. Methods: We conducted a cross-sectional study of 23 adult patients with SMA type 3 who underwent a comprehensive evaluation, including a physical examination, biochemical analysis, and an oral glucose tolerance test during 2020–2023. Results: At least one lipid abnormality was observed in 60.8% of patients. All four lipid parameters were atypical in 4.3% of patients, three lipid parameters were abnormal in 21.7% of patients, and two lipid parameters were altered in 8.7% patients. A total of 91.3% of SMA3 patients met the HOMA-IR criteria for insulin resistance, with 30.43% having impaired glucose tolerance. None of the patients met the criteria for a diagnosis of overt DM2. Conclusions: The prevalence of dyslipidemia and altered glucose metabolism in our study sets apart the adult population with SMA3 from the general population, confirming a significant interplay between muscle, liver, and adipose tissue. Ensuring metabolic care for aging patients with SMA 3 is crucial, as they are vulnerable to metabolic derangements and cardiovascular risks. Full article

(This article belongs to the Special Issue Diagnosis, Biomarkers, and Treatment of Metabolic Disorders)

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Diagnostics, Volume 14, Issue 18 (September-2 2024) – 110 articles

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