Diagnostics

4 pages, 431 KiB

Open AccessComment

Myositis “Diaphragm Cramp” as a Potential Cause of Respiratory Arrests in Infants. Comment on Salfi, N.C.M. et al. Fatal Deterioration of a Respiratory Syncytial Virus Infection in an Infant with Abnormal Muscularization of Intra-Acinar Pulmonary Arteries: Autopsy and Histological Findings. Diagnostics 2024, 14, 601

by Dov Jordan Gebien

Diagnostics 2024, 14(10), 1061; https://doi.org/10.3390/diagnostics14101061 - 20 May 2024

Cited by 1 | Viewed by 1443

Abstract

This Letter to the Editor provides additional information regarding the tragic case of a 6-month-old in Italy with respiratory syncytial virus who deteriorated and died unexpectedly from rapid respiratory insufficiency [...] Full article

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

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10 pages, 264 KiB

Open AccessReview

Interpreting Prostate MRI Reports in the Era of Increasing Prostate MRI Utilization: A Urologist’s Perspective

by Kevin Miszewski, Katarzyna Skrobisz, Laura Miszewska and Marcin Matuszewski

Diagnostics 2024, 14(10), 1060; https://doi.org/10.3390/diagnostics14101060 - 20 May 2024

Viewed by 1051

Abstract

Multi-parametric prostate MRI (mpMRI) is crucial for diagnosing, staging, and assessing treatment response in individuals with prostate cancer. Radiologists, through an accurate and standardized interpretation of mpMRI, stratify patients who may benefit from more invasive treatment or exclude patients who may be harmed [...] Read more.

Multi-parametric prostate MRI (mpMRI) is crucial for diagnosing, staging, and assessing treatment response in individuals with prostate cancer. Radiologists, through an accurate and standardized interpretation of mpMRI, stratify patients who may benefit from more invasive treatment or exclude patients who may be harmed by overtreatment. The integration of prostate MRI into the diagnostic pathway is anticipated to generate a substantial surge in the demand for high-quality mpMRI, estimated at approximately two million additional prostate MRI scans annually in Europe. In this review we examine the immediate impact on healthcare, particularly focusing on the workload and evolving roles of radiologists and urologists tasked with the interpretation of these reports and consequential decisions regarding prostate biopsies. We investigate important questions that influence how prostate MRI reports are handled. The discussion aims to provide insights into the collaboration needed for effective reporting. Full article

(This article belongs to the Special Issue Recent Advancements in MRI and PET/CT Technologies in the Field of Urologic Oncology)

12 pages, 5440 KiB

Open AccessArticle

Does Timing of Radiation Therapy Impact Wound Healing in Patients Undergoing Metastatic Spine Surgery?

by Ranbir Ahluwalia, Hani Chanbour, Tyler Zeoli, Amir M. Abtahi, Byron F. Stephens and Scott L. Zuckerman

Diagnostics 2024, 14(10), 1059; https://doi.org/10.3390/diagnostics14101059 - 20 May 2024

Viewed by 1285

Abstract

Introduction: The impact of radiation on wound healing after metastatic spine surgery remains an active area of research. In patients undergoing metastatic spine surgery, we sought to (1) assess the relationship between preoperative and/or postoperative radiation on wound complications, and (2) evaluate the [...] Read more.

Introduction: The impact of radiation on wound healing after metastatic spine surgery remains an active area of research. In patients undergoing metastatic spine surgery, we sought to (1) assess the relationship between preoperative and/or postoperative radiation on wound complications, and (2) evaluate the relationship between the timing of postoperative radiation and wound complications. Methods: A single-center, retrospective, cohort study of patients undergoing metastatic spine surgery was conducted from 2010 to 2021. The primary exposure variable was the use/timing of radiation. Radiation included both external beam radiotherapy (EBRT) and stereotactic body radiotherapy (SBRT). Patients were trichotomized into the following groups: (1) preoperative radiation only, (2) postoperative radiation only, and (3) no radiation. The primary outcome variable was wound complications, which was defined as dehiscence requiring reoperation, infection requiring antibiotics, or infection requiring surgical debridement. Multivariable logistic/linear regression controlled for age, tumor size, primary organ of origin, and the presence of other organ metastases. Results: A total of 207 patients underwent surgery for extradural spinal metastasis. Participants were divided into three groups: preoperative RT only (N = 29), postoperative RT only (N = 91), and no RT (N = 178). Patients who received postoperative RT only and no RT were significantly older than patients who received preoperative RT only (p = 0.009) and were less likely to be white (p < 0.001). No other significant differences were found in basic demographics, tumor characteristics, or intraoperative variables. Wound-related complications occurred in two (6.9%) patients with preoperative RT only, four patients (4.4%) in postoperative RT only, and 11 (6.2%) patients with no RT, with no significant difference among the three groups (p = 0.802). No significant difference was found in wound-related complications, reoperation, and time to wound complications between patients with preoperative RT only and no RT, and between postoperative RT only and no RT (p > 0.05). Among the postoperative-RT-only group, no difference in wound complications was seen between those receiving SBRT (5.6%) and EBRT (4.1%) (p > 0.999). However, patients who received preoperative RT only had a longer time to wound complications in comparison to those who received postoperative RT only (43.5 ± 6.3 vs. 19.7 ± 3.8, p = 0.004). Regarding timing of postoperative RT, the mean (SD) time to RT was 28.7 ± 10.0 days, with a median of 28.7 (21–38) days. No significant difference was found in time to postoperative RT between patients with and without wound complications (32.9 ± 12.3 vs. 29.0 ± 9.7 days, p = 0.391). Conclusion: In patients undergoing metastatic spine surgery, a history of previous RT or postoperative RT did not significantly affect wound complications. However, those with previous RT prior to surgery had a longer time to wound complications than patients undergoing postoperative RT only. Moreover, timing of RT had no impact on wound complications, indicating that earlier radiation may be safely employed to optimize tumor control without fear of compromising wound healing. Full article

(This article belongs to the Special Issue Spinal Tumors: Advances in Diagnosis and Treatment)

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Histogram showing the distribution of time to first postop RT. Full article ">Figure 2
Histogram showing the distribution of time to first SBRT or EBRT. Full article ">Figure 3
Scatter plot of time to wound complication and time to first postoperative RT. Full article ">Figure 4
(A–D) A 78-year-old female with a history of stage IV metastatic breast cancer presented with urinary retention and lower extremity numbness within a 4-day duration, who was found to have metastatic tumor causing spinal cord compression with pathologic fracture at T8–T9 on T2-weighted MRI (A,B). She underwent separation surgery with T6–T11 posterior spinal instrumentation and fusion; T8, T9, and T10 laminectomy; right-sided T9 transpedicular decompression; and inferior facetectomies from T6 to T11, as seen on postoperative posteroanterior (C) and lateral (D) X-rays. Intraoperative ultrasound and neuromonitoring were used. The patient received postoperative EBRT after 1 month, and had wound infection 10 days after radiation, which required surgical debridement. Full article ">Figure 5
(A–D) A 26-year-old female presented with severe mechanical neck pain for several months and was found to have a C5 lytic lesion affecting 70% of the vertebral body as seen on preoperative sagittal T2-weighted MRI (A) and CT scan (B). The patient also had a left C6 radiculopathy, along with numbness and paresthesia, but with no reported weakness. She underwent separation surgery with a C5 corpectomy and C4–C6 anterior fusion with fibular allograft, as well as a posterior C4–C6 instrumented fusion, as seen on postoperative posteroanterior (C) and lateral (D) X-rays. The patient received SBRT for 2 weeks postoperatively and did not encounter any postoperative wound complications. Full article ">

11 pages, 2611 KiB

Open AccessArticle

Does Elective Admission vs. Emergency Department Presentation Affect Surgical Outcomes in Metastatic Spine Surgery?

by Tyler Zeoli, Hani Chanbour, Ranbir Ahluwalia, Amir M. Abtahi, Byron F. Stephens and Scott L. Zuckerman

Diagnostics 2024, 14(10), 1058; https://doi.org/10.3390/diagnostics14101058 - 20 May 2024

Viewed by 1048

Abstract

Introduction: Approximately 20% of patients with metastatic spine disease develop symptomatic spinal cord compression, and these patients can present urgently to the emergency department (ED) or, in a more organized fashion, to a clinic. In a cohort of patients undergoing metastatic spine surgery, [...] Read more.

Introduction: Approximately 20% of patients with metastatic spine disease develop symptomatic spinal cord compression, and these patients can present urgently to the emergency department (ED) or, in a more organized fashion, to a clinic. In a cohort of patients undergoing metastatic spine surgery, we sought to (1) determine the rate of ED presentation, (2) identify preoperative and perioperative risk factors associated with ED presentation, and (3) evaluate whether ED vs. clinic presentation impacts long-term outcomes. Methods: A single-institution, multi-surgeon, retrospective cohort study was undertaken of patients undergoing metastatic spinal tumor surgery between 02/2010 and 01/2021. The primary exposure variable was presentation setting, dichotomized to the ED vs. clinic. The primary outcomes were postoperative functional status, measured with the Karnofsky Performance Scale (KPS) and McCormick Scale (MMS), local recurrence (LR), and overall survival (OS). Secondary outcomes included complications and readmissions. Results: A total of 311 patients underwent metastatic spine surgery (51.7% ED vs. 48.3% clinic). Those presenting to the ED had higher rates of smoking (21.7% vs. 16.0%, p = 0.02), were more likely to have 2+ comorbidities (47.2% vs. 32.7%, p = 0.011), and were more likely to have public insurance (43.5% vs. 32.0%, p = 0.043). Preoperative KPS was lower in ED patients (p < 0.001), while the Bilsky score was higher (p = 0.049). ED patients had higher rates of oligometastatic disease (p = 0.049), higher total decompressed levels (p = 0.041), and higher rates of costotransversectomy (p = 0.031) compared to clinic patients. Length of stay was significantly longer for ED patients (7.7 ± 6.1 vs. 6.1 ± 5.8 days, p = 0.020), and they were less likely to be discharged home (52.2% vs. 69.3%, p = 0.025). ED presentation was significantly associated with shorter overall survival (HR =1.53 95% CI = 1.13–2.08, p = 0.006). Conclusions: Of patients undergoing metastatic spine disease, approximately half presented through the ED vs. clinic. ED patients had higher rates of smoking, public insurance, and higher Bilsky score. ED patients also underwent more extensive surgery, had longer LOS, were less likely discharged home, and most importantly, had a shorter overall survival. These results suggest that initial presentation for patients undergoing surgery for metastatic spine disease significantly impacts outcomes, and signs/symptoms of metastatic spine disease should be recognized as soon as possible to prevent ED presentation. Full article

(This article belongs to the Special Issue Spinal Tumors: Advances in Diagnosis and Treatment)

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A 53-year-old female presented to the clinic with a several-week history of back pain and difficulty ambulating due to poor balance. On preoperative T2-weighted MRI (A,B), the patient was found to have T6 Bilsky grade 3 epidural spinal cord compression due to metastatic breast cancer. The patient underwent separation surgery with T3-T9 posterolateral fusion, T5-T7 laminectomies, T5-T6 and T6-T7 osteotomies, inferior facetectomies at T3-T9, costotransversectomy on the left side at T6 with removal of 4 cm of the left T6 rib, and bilateral transpedicular decompression at T6 with T4-T7 anterior fusion with a static cage filled with allograft and demineralized bone matrix, as seen on postero-anterior (C) and lateral X-ray (D). Full article ">Figure 2
A 61-year-old female patient presented to the emergency department with bilateral leg weakness and right shoulder pain and was found to have Bilsky 3 compression at T4 as seen on preoperative T2-weighted MRI (A,B). The patient underwent separation surgery with thoracic laminectomy, partial of T3, total of T4, with transpedicular corpectomy bilaterally of the T4 vertebral body with greater than 50% removal of the T4 vertebral body and decompression of the spinal cord as seen on her postero-anterior and lateral X-rays (C,D). Despite initial improvement, the patient died a year later from progression of her renal cell carcinoma. Full article ">Figure 3
KM plot of local recurrence. Full article ">Figure 4
KM plot of overall survival. Full article ">

25 pages, 1302 KiB

Open AccessReview

Taxonomy of Acute Stroke: Imaging, Processing, and Treatment

by Wieslaw L. Nowinski

Diagnostics 2024, 14(10), 1057; https://doi.org/10.3390/diagnostics14101057 - 19 May 2024

Viewed by 2077

Abstract

Stroke management employs a variety of diagnostic imaging modalities, image processing and analysis methods, and treatment procedures. This work categorizes methods for stroke imaging, image processing and analysis, and treatment, and provides their taxonomies illustrated by a state-of-the-art review. Imaging plays a critical [...] Read more.

Stroke management employs a variety of diagnostic imaging modalities, image processing and analysis methods, and treatment procedures. This work categorizes methods for stroke imaging, image processing and analysis, and treatment, and provides their taxonomies illustrated by a state-of-the-art review. Imaging plays a critical role in stroke management, and the most frequently employed modalities are computed tomography (CT) and magnetic resonance (MR). CT includes unenhanced non-contrast CT as the first-line diagnosis, CT angiography, and CT perfusion. MR is the most complete method to examine stroke patients. MR angiography is useful to evaluate the severity of artery stenosis, vascular occlusion, and collateral flow. Diffusion-weighted imaging is the gold standard for evaluating ischemia. MR perfusion-weighted imaging assesses the penumbra. The stroke image processing methods are divided into non-atlas/template-based and atlas/template-based. The non-atlas/template-based methods are subdivided into intensity and contrast transformations, local segmentation-related, anatomy-guided, global density-guided, and artificial intelligence/deep learning-based. The atlas/template-based methods are subdivided into intensity templates and atlases with three atlas types: anatomy atlases, vascular atlases, and lesion-derived atlases. The treatment procedures for arterial and venous strokes include intravenous and intraarterial thrombolysis and mechanical thrombectomy. This work captures the state-of-the-art in stroke management summarized in the form of comprehensive and straightforward taxonomy diagrams. All three introduced taxonomies in diagnostic imaging, image processing and analysis, and treatment are widely illustrated and compared against other state-of-the-art classifications. Full article

(This article belongs to the Special Issue Brain Imaging in Acute Stroke)

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19 pages, 1652 KiB

Open AccessReview

Novel Insights into Postoperative Surveillance in Resected Pancreatic Cystic Neoplasms—A Review

by Daniel Vasile Balaban, Laura-Ioana Coman, Marina Balaban, Raluca Simona Costache and Mariana Jinga

Diagnostics 2024, 14(10), 1056; https://doi.org/10.3390/diagnostics14101056 - 19 May 2024

Viewed by 1040

Abstract

Pancreatic cystic lesions (PCL) are frequently encountered in clinical practice and some are referred to surgery due to their neoplastic risk or malignant transformation. The management of PCL involves complex decision-making, with postoperative surveillance being a key component for long-term outcomes, due to [...] Read more.

Pancreatic cystic lesions (PCL) are frequently encountered in clinical practice and some are referred to surgery due to their neoplastic risk or malignant transformation. The management of PCL involves complex decision-making, with postoperative surveillance being a key component for long-term outcomes, due to the potential for recurrence and postoperative morbidity. Unfortunately, the follow-up of resected patients is far from being optimal and there is a lack of consensus on recommendations with regard to timing and methods of surveillance. Here, we summarize the current knowledge on the postoperative surveillance of neoplastic pancreatic cysts, focusing on the mechanisms and risk factors for recurrence, the recurrence rates according to the initial indication for surgery, the final result of the surgical specimen and neoplastic risk in the remaining pancreas, as well as the postsurgical morbidity comprising pancreatic exocrine insufficiency, metabolic dysfunction and diabetes after resection, according to the type of surgery performed. We analyze postsurgical recurrence rates and morbidity profiles, as influenced by different surgical techniques, to better delineate at-risk patients, and highlight the need for tailored surveillance strategies adapted to preoperative and operative factors with an impact on outcomes. Full article

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

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13 pages, 496 KiB

Open AccessSystematic Review

Robotic Stereotactic Body Radiation Therapy for Oligometastatic Liver Metastases: A Systematic Review of the Literature and Evidence Quality Assessment

by Ilektra Kyrochristou, Ilias Giannakodimos, Maria Tolia, Ioannis Georgakopoulos, Nikolaos Pararas, Francesk Mulita, Nikolaos Machairas and Dimitrios Schizas

Diagnostics 2024, 14(10), 1055; https://doi.org/10.3390/diagnostics14101055 - 19 May 2024

Viewed by 886

Abstract

Introduction: The role of stereotactic body radiation therapy (SBRT) as a locally effective therapeutic approach for liver oligometastases from tumors of various origin is well established. We investigated the role of robotic SBRT (rSBRT) treatment on oligometastatic patients with liver lesions. Material and [...] Read more.

Introduction: The role of stereotactic body radiation therapy (SBRT) as a locally effective therapeutic approach for liver oligometastases from tumors of various origin is well established. We investigated the role of robotic SBRT (rSBRT) treatment on oligometastatic patients with liver lesions. Material and Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The PubMed and Scopus databases were accessed by two independent investigators concerning robotic rSBRT for liver metastases, up to 3 October 2023. Results: In total, 15 studies, including 646 patients with 847 lesions that underwent rSBRT, were included in our systematic review. Complete response (CR) after rSBRT was achieved in 40.5% (95% CI, 36.66–44.46%), partial response (PR) in 19.01% (95% CI, 16.07–22.33%), whereas stable disease (SD) was recorded in 14.38% (95% CI, 11.8–17.41%) and progressive disease (PD) in 13.22% (95% CI, 10.74–16.17%) of patients. Progression-free survival (PFS) rates at 12 and 24 months were estimated at 61.49% (95% CI, 57.01–65.78%) and 32.55% (95% CI, 28.47–36.92%), respectively, while the overall survival (OS) rates at 12 and 24 months were estimated at 58.59% (95% CI, 53.67–63.33%) and 44.19% (95% CI, 39.38–49.12%), respectively. Grade 1 toxicity was reported in 13.81% (95% CI, 11.01–17.18%), Grade 2 toxicity in 5.57% (95% CI, 3.82–8.01%), and Grade 3 toxicity in 2.27% (955 CI, 1.22–4.07%) of included patients. Conclusions: rSBRT represents a promising method achieving local control with minimal toxicity in a significant proportion of patients. Further studies are needed to evaluate the role of rSBRT in the management of metastatic liver lesions. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Hepatobiliary Pancreatic Disorders)

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13 pages, 276 KiB

Open AccessArticle

Enhancing Surgical Safety: Microbiological Air Control in Operating Theatres at University Medical Centre Maribor

by Lidija Gradisnik, Gorazd Bunc, Janez Ravnik and Tomaz Velnar

Diagnostics 2024, 14(10), 1054; https://doi.org/10.3390/diagnostics14101054 - 19 May 2024

Cited by 1 | Viewed by 1627

Abstract

Background: the aim of the study was to assess microbiological air quality in operating theatres by determining the level of microbiological contamination of the air and critical surfaces using the passive air sampling method and compliance of the operating theatre staff with infection [...] Read more.

Background: the aim of the study was to assess microbiological air quality in operating theatres by determining the level of microbiological contamination of the air and critical surfaces using the passive air sampling method and compliance of the operating theatre staff with infection control measures. Materials and methods: The prospective study was conducted in the surgical block of the University Medical Centre Maribor. For two months continuously, ten operating theatres were assessed for microbial contamination of air and surfaces during quiet and active times of the day. A passive air sampling method with Petri dishes on an agar specially adapted for this purpose (plate count agar) was used. In addition, ten surgical procedures were observed to assess staff compliance with recommended practises. Results: Air samples met microbiological standards in all operating theatres. In both sampling sessions of the day (quiet and active periods), microbial contamination of the air was always within the limit of 10 CFU/m³. The average number of bacterial colonies was zero to two during quiet phases and one to four during active phases. Approximately 60% of the isolates from the operating theatres belonged mainly to the genus Staphylococcus: S. epidermidis (36% of the isolates), S. hominis (17.5%) and S. haemolyticus (5.5%). The rest were identified as Streptococcus anginosus (23%) and Bacillus sp. (18%). Pathogenic bacteria and moulds were not present. In regard to staff compliance with good surgical practise, the former varied by behaviour and function, with non-compliance in pre-operative skin preparation and operating theatre congestion being notable. The cleanliness of the environment was satisfactory. Conclusions: Microbiological air control is extremely important for the safety and success of both surgical and postoperative practises. In spite of good results obtained in the study, further improvements in surgical staff compliance with good surgical practise are essential to reduce surgical site infections. Full article

(This article belongs to the Special Issue Microbiology Laboratory: Sample Collection and Diagnosis Advances)

14 pages, 1067 KiB

Open AccessSystematic Review

Objective Methods to Assess Aorto-Iliac Calcifications: A Systematic Review

by Anna Fornasari, Salomé Kuntz, Chiara Martini, Paolo Perini, Elisa Cabrini, Antonio Freyrie, Anne Lejay and Nabil Chakfé

Diagnostics 2024, 14(10), 1053; https://doi.org/10.3390/diagnostics14101053 - 19 May 2024

Cited by 2 | Viewed by 1572

Abstract

Vascular calcifications in aorto-iliac arteries are emerging as crucial risk factors for cardiovascular diseases (CVDs) with profound clinical implications. This systematic review, following PRISMA guidelines, investigated methodologies for measuring these calcifications and explored their correlation with CVDs and clinical outcomes. Out of 698 [...] Read more.

Vascular calcifications in aorto-iliac arteries are emerging as crucial risk factors for cardiovascular diseases (CVDs) with profound clinical implications. This systematic review, following PRISMA guidelines, investigated methodologies for measuring these calcifications and explored their correlation with CVDs and clinical outcomes. Out of 698 publications, 11 studies met the inclusion criteria. In total, 7 studies utilized manual methods, while 4 studies utilized automated technologies, including artificial intelligence and deep learning for image analyses. Age, systolic blood pressure, serum calcium, and lipoprotein(a) levels were found to be independent risk factors for aortic calcification. Mortality from CVDs was correlated with abdominal aorta calcification. Patients requiring reintervention after endovascular recanalization exhibited a significantly higher volume of calcification in their iliac arteries. Conclusions: This review reveals a diverse landscape of measurement methods for aorto-iliac calcifications; however, they lack a standardized reproducibility assessment. Automatic methods employing artificial intelligence appear to offer broader applicability and are less time-consuming. Assessment of calcium scoring could be routinely employed during preoperative workups for risk stratification and detailed surgical planning. Additionally, its correlation with clinical outcomes could be useful in predicting the risk of reinterventions and amputations. Full article

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

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12 pages, 1669 KiB

Open AccessArticle

Early-Onset Colorectal Cancer—A Retrospective Study from a Tertiary Referral Hospital in Romania

by Elena Savu, Valeriu Șurlin, Liviu Vasile, Ileana Octavia Petrescu, Cristina Elena Singer, Nicolae-Daniel Pirici and Stelian Stefanita Mogoanta

Diagnostics 2024, 14(10), 1052; https://doi.org/10.3390/diagnostics14101052 - 19 May 2024

Viewed by 1109

Abstract

Early-onset colorectal cancer emerges as a distinctive clinical and biological entity and is generally defined as the onset of colon or rectal neoplasia before the age of 50. Several reports describe an increasing incidence worldwide of colorectal cancers occurring in individuals younger than [...] Read more.

Early-onset colorectal cancer emerges as a distinctive clinical and biological entity and is generally defined as the onset of colon or rectal neoplasia before the age of 50. Several reports describe an increasing incidence worldwide of colorectal cancers occurring in individuals younger than 50 years, along with particular histologic and molecular features. Although heredity may be an explanation in some cases with young-onset colorectal cancer, other driving factors remain partially unknown. The present study explores demographic, clinical, and pathological features within a group of patients diagnosed with colorectal cancer before the age of 50. It is a retrospective survey based on data collected between 2017 and 2023 within three surgical departments from a tertiary Romanian hospital. The clinical and pathological features we identified (later-stage disease, distal colon tumor localization, mucinous histology) are mainly superimposed with the existing data in the literature regarding this pathology. In order to lower the burden that colorectal neoplasia diagnosed in the young implies, a change of paradigm should be made in terms of establishing effective and targeted screening programs but also in the direction of enhancing complex clinical, pathological, and molecular diagnosis. Full article

(This article belongs to the Special Issue Contemporary Challenges and Innovations in Oncological Diagnosis and Treatment: The Romanian Landscape)

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12 pages, 8735 KiB

Open AccessEditor’s ChoiceArticle

The Value of Contrast-Enhanced Ultrasound (CEUS) in the Evaluation of Central Lung Cancer with Obstructive Atelectasis

by Ehsan Safai Zadeh, Katharina Paulina Huber, Christian Görg, Helmut Prosch and Hajo Findeisen

Diagnostics 2024, 14(10), 1051; https://doi.org/10.3390/diagnostics14101051 - 18 May 2024

Cited by 2 | Viewed by 1250

Abstract

Purpose: To assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) alongside contrast-enhanced computed tomography (CECT) in evaluating central lung cancer (CLC). Materials and Methods: From 2006 to 2022, 54 patients with CLC and obstructive atelectasis (OAT) underwent standardized examinations using CEUS [...] Read more.

Purpose: To assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) alongside contrast-enhanced computed tomography (CECT) in evaluating central lung cancer (CLC). Materials and Methods: From 2006 to 2022, 54 patients with CLC and obstructive atelectasis (OAT) underwent standardized examinations using CEUS in addition to CECT. The ability to differentiate CLC from atelectatic tissue in CECT and CEUS was categorized as distinguishable or indistinguishable. In CEUS, in distinguishable cases, the order of enhancement (time to enhancement) (OE; categorized as either an early pulmonary arterial [PA] pattern or a delayed bronchial arterial [BA] pattern of enhancement), the extent of enhancement (EE; marked or reduced), the homogeneity of enhancement (HE; homogeneous or inhomogeneous), and the decrease in enhancement (DE; rapid washout [<120 s] or late washout [≥120 s]) were evaluated. Results: The additional use of CEUS improved the diagnostic capability of CECT from 75.9% to 92.6% in differentiating a CLC from atelectatic tissue. The majority of CLC cases exhibited a BA pattern of enhancement (89.6%), an isoechoic reduced enhancement (91.7%), and a homogeneous enhancement (91.7%). Rapid DE was observed in 79.2% of cases. Conclusions: In cases of suspected CLC with obstructive atelectasis, the application of CEUS can be helpful in differentiating tumor from atelectatic tissue and in evaluating CLC. Full article

(This article belongs to the Special Issue Current Challenges and Perspectives of Ultrasound)

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A 75-year-old patient with total opacity reduction in the left lung on chest X-ray (A) and suspected bronchogenic carcinoma. On computed tomography scans (B–E), a central tumor formation (arrows) with obstructive atelectasis is visible. On B-mode lung ultrasound (F), a central tumor (arrows) is distinguishable from the downstream atelectasis. On contrast-enhanced ultrasound, the atelectatic tissue shows inhomogeneous early pulmonary arterial enhancement (arrows) after 5 s, before the chest wall (G). The tumor tissue exhibits homogeneous delayed bronchial arterial enhancement (arrows) after 9 s, simultaneously with the chest wall (red circle), which is a sign of systemic vascularization (H). The tumor displays isoenhancement (arrows) compared with the atelectasis after 1 min (I), with rapid washout (arrows) after 2 min (J). Full article ">Figure 2
A 66-year-old male patient with left-sided thoracic pain and non-resolving pneumonia after 2 weeks of antibiotic therapy. Computed tomography scans (A) reveal a central tumor formation (arrows) with obstructive atelectasis. Due to significant secretion retention and respiratory instability, bronchoscopic histology collection could not be performed. In B-mode lung ultrasound (B), a central tumor is not distinguishable from the downstream atelectasis. In contrast-enhanced ultrasound (C), a central tumor can be differentiated from the atelectasis. The visualization of the tumor in contrast-enhanced ultrasound enabled a complication-free histologic confirmation of the central tumor formation through the subsequent atelectasis (D). The histology confirmed the diagnosis of squamous cell carcinoma of the left upper lobe. Full article ">Figure 3
A 57-year-old patient with a bronchoscopically confirmed small cell bronchogenic carcinoma of the left lower lobe and contralateral rib and chest wall metastases (arrow) (A). On computed tomography scans (B–E), an obstructive atelectasis with pleural effusion is visible, but a tumor formation cannot be differentiated. On B-mode lung ultrasound (F), a central tumor is distinguishable from the downstream atelectasis (arrows). On contrast-enhanced ultrasound, the atelectatic tissue shows homogeneous early pulmonary arterial enhancement (arrows) after 5 s, before the aorta (*) (G). The tumor tissue exhibits homogeneous delayed bronchial arterial enhancement (arrows) after 9 s, simultaneously with the aorta (*), which is a sign of systemic vascularization (H). The tumor displays isoenhancement (arrows) compared with the atelectasis after 18 s (I), with rapid washout (arrows) after 2 min (J). Full article ">Figure 4
A 75-year-old patient with a bronchoscopically confirmed squamous cell carcinoma of the left upper lobe. On computed tomography scans (A–D), a central tumor formation (arrows) with obstructive atelectasis is visible. On B-mode lung ultrasound (E), a central tumor is not distinguishable from the atelectatic tissue. On contrast-enhanced ultrasound, the atelectatic tissue shows homogeneous delayed bronchial arterial enhancement simultaneously with the chest wall (arrow) after the enhancement of the pulmonary artery (*), which is a sign of systemic vascularization (F). After 1.5 min, a tumor formation is still not distinguishable (G). The atelectasis shows rapid washout after 2 min (H). Full article ">

16 pages, 2600 KiB

Open AccessArticle

Assessment of Calcaneal Spongy Bone Magnetic Resonance Characteristics in Women: A Comparison between Measures Obtained at 0.3 T, 1.5 T, and 3.0 T

by Silvia Capuani, Alessandra Maiuro, Emiliano Giampà, Marco Montuori, Viviana Varrucciu, Gisela E. Hagberg, Vincenzo Vinicola and Sergio Colonna

Diagnostics 2024, 14(10), 1050; https://doi.org/10.3390/diagnostics14101050 - 18 May 2024

Viewed by 1038

Abstract

Background: There is a growing interest in bone tissue MRI and an even greater interest in using low-cost MR scanners. However, the characteristics of bone MRI remain to be fully defined, especially at low field strength. This study aimed to characterize the signal-to-noise [...] Read more.

Background: There is a growing interest in bone tissue MRI and an even greater interest in using low-cost MR scanners. However, the characteristics of bone MRI remain to be fully defined, especially at low field strength. This study aimed to characterize the signal-to-noise ratio (SNR), T₂, and T₂* in spongy bone at 0.3 T, 1.5 T, and 3.0 T. Furthermore, relaxation times were characterized as a function of bone-marrow lipid/water ratio content and trabecular bone density. Methods: Thirty-two women in total underwent an MR-imaging investigation of the calcaneus at 0.3 T, 1.5 T, and 3.0 T. MR-spectroscopy was performed at 3.0 T to assess the fat/water ratio. SNR, T₂, and T₂* were quantified in distinct calcaneal regions (ST, TC, and CC). ANOVA and Pearson correlation statistics were used. Results: SNR increase depends on the magnetic field strength, acquisition sequence, and calcaneal location. T₂* was different at 3.0 T and 1.5 T in ST, TC, and CC. Relaxation times decrease as much as the magnetic field strength increases. The significant linear correlation between relaxation times and fat/water found in healthy young is lost in osteoporotic subjects. Conclusion: The results have implications for the possible use of relaxation vs. lipid/water marrow content for bone quality assessment and the development of quantitative MRI diagnostics at low field strength. Full article

(This article belongs to the Special Issue Machine-Extractable Knowledge from the Shape of Anatomical Structures 2024)

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(a) T2*–T1-weighted image obtained at 3.0 T. (b) Selection of ROIs that correspond to the three calcaneus areas of interest: ST, subtalar region, TC, tuber calcanei region, CC, cavum calcanei region. Image resolution was 0.35 × 0.35 × 5 mm3. Full article ">Figure 2
T2*-weighted images obtained at 0.3 T, 1.5 T, and 3.0 T in young women. Specifically, images (a–c) were obtained using a low-cost 0.3 T scanner dedicated to the extremities using TE = 10 ms, 14 ms, and 16 ms, respectively. Images (d–f) and (g–i) are obtained at 1.5 T whole-body scanner and 3.0 T head dedicated scanner using TE = 5, 10, and 20 ms. Images obtained at 1.5 T and 3.0 T are of the same volunteer. Image resolution is 0.55 × 0.55 × 7 mm3 for those obtained at 0.3 T and 1.5 × 1.5 × 5 mm3 for those obtained at 1.5 T and 3.0 T. The different image contrasts are due to the magnetic susceptibility differences between tissues that increase in parallel to the magnetic field strength increase. Full article ">Figure 3
An example of a bone marrow NMR spectrum obtained in calcaneus at 3 T using SVS PRESS (TE/TR = 22/5000 ms) together with the images for the voxel localization in calcaneus. The LC-Model [<a href="#B44-diagnostics-14-01050" class="html-bibr">44</a>] fit to spectrum data (in black) is reported in red. The extract resonance quantifications and their standard deviation (SD) are displayed in the insert. Full article ">Figure 4
Thirteen young volunteers’ transverse relaxation times in subtalar (a,d), tuber calcanei (b,e), and cavum calcanei regions (c,f) versus fat-to-water concentration ratio. Their linear correlations (R2 coefficients) and their functional linear dependency y(x) are also shown. Full article ">Figure 5
Comparison between the T2* dependence on lipid/water in the healthy young and osteoporotic group obtained in the whole calcaneus at 3.0 T. The significant linear correlation in the healthy group is lost when osteoporotic subjects are investigated. Full article ">

15 pages, 4524 KiB

Open AccessArticle

A Multichannel CT and Radiomics-Guided CNN-ViT (RadCT-CNNViT) Ensemble Network for Diagnosis of Pulmonary Sarcoidosis

by Jianwei Qiu, Jhimli Mitra, Soumya Ghose, Camille Dumas, Jun Yang, Brion Sarachan and Marc A. Judson

Diagnostics 2024, 14(10), 1049; https://doi.org/10.3390/diagnostics14101049 - 18 May 2024

Cited by 1 | Viewed by 1619

Abstract

Pulmonary sarcoidosis is a multisystem granulomatous interstitial lung disease (ILD) with a variable presentation and prognosis. The early accurate detection of pulmonary sarcoidosis may prevent progression to pulmonary fibrosis, a serious and potentially life-threatening form of the disease. However, the lack of a [...] Read more.

Pulmonary sarcoidosis is a multisystem granulomatous interstitial lung disease (ILD) with a variable presentation and prognosis. The early accurate detection of pulmonary sarcoidosis may prevent progression to pulmonary fibrosis, a serious and potentially life-threatening form of the disease. However, the lack of a gold-standard diagnostic test and specific radiographic findings poses challenges in diagnosing pulmonary sarcoidosis. Chest computed tomography (CT) imaging is commonly used but requires expert, chest-trained radiologists to differentiate pulmonary sarcoidosis from lung malignancies, infections, and other ILDs. In this work, we develop a multichannel, CT and radiomics-guided ensemble network (RadCT-CNNViT) with visual explainability for pulmonary sarcoidosis vs. lung cancer (LCa) classification using chest CT images. We leverage CT and hand-crafted radiomics features as input channels, and a 3D convolutional neural network (CNN) and vision transformer (ViT) ensemble network for feature extraction and fusion before a classification head. The 3D CNN sub-network captures the localized spatial information of lesions, while the ViT sub-network captures long-range, global dependencies between features. Through multichannel input and feature fusion, our model achieves the highest performance with accuracy, sensitivity, specificity, precision, F1-score, and combined AUC of 0.93 ± 0.04, 0.94 ± 0.04, 0.93 ± 0.08, 0.95 ± 0.05, 0.94 ± 0.04, and 0.97, respectively, in a five-fold cross-validation study with pulmonary sarcoidosis (n = 126) and LCa (n = 93) cases. A detailed ablation study showing the impact of CNN + ViT compared to CNN or ViT alone, and CT + radiomics input, compared to CT or radiomics alone, is also presented in this work. Overall, the AI model developed in this work offers promising potential for triaging the pulmonary sarcoidosis patients for timely diagnosis and treatment from chest CT. Full article

(This article belongs to the Special Issue Artificial Intelligence in Clinical Decision Support)

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12 pages, 3585 KiB

Open AccessArticle

The Role of T2 Mapping in Cardiac Amyloidosis

by Giulia Grazzini, Silvia Pradella, Rossella Bani, Chiara Fornaciari, Francesco Cappelli, Federico Perfetto, Diletta Cozzi, Simona Giovannelli, Giacomo Sica and Vittorio Miele

Diagnostics 2024, 14(10), 1048; https://doi.org/10.3390/diagnostics14101048 - 18 May 2024

Cited by 1 | Viewed by 1151

Abstract

Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy divided into two types: light-chain (LA) and transthyretin (ATTR) CA. Cardiac magnetic resonance (CMR) has emerged as an important diagnostic tool in CA. While late gadolinium enhancement (LGE), T1 mapping and extracellular volume (ECV) have a [...] Read more.

Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy divided into two types: light-chain (LA) and transthyretin (ATTR) CA. Cardiac magnetic resonance (CMR) has emerged as an important diagnostic tool in CA. While late gadolinium enhancement (LGE), T1 mapping and extracellular volume (ECV) have a consolidate role in the assessment of CA, T2 mapping has been less often evaluated. We aimed to test the value of T2 mapping in the evaluation of CA. This study recruited 70 patients with CA (51 ATTR, 19 AL). All the subjects underwent 1.5 T CMR with T1 and T2 mapping and cine and LGE imaging. Their QALE scores were evaluated. The myocardial T2 values were significantly (p < 0.001) increased in both types of CA compared to the controls. In the AL-CA group, increased T2 values were associated with a higher QALE score. The myocardial native T1 values and ECV were significantly (p < 0.001) higher in the CA patients than in the healthy subjects. Left ventricular (LV) mass, QALE score and ECV were higher in ATTR amyloidosis compared with AL amyloidosis, while the LV ejection fraction was lower (p < 0.001). These results support the concept of the presence of myocardial edema in CA. Therefore, a CMR evaluation including not only myocardial T1 imaging but also myocardial T2 imaging allows for more comprehensive tissue characterization in CA. Full article

(This article belongs to the Special Issue Cardiothoracic Imaging: Recent Techniques and Applications in Diagnostics, Second Edition)

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Native T1 and ECV calculation from MOLLI sequences. Endocardial and epicardial contours and blood pool ROIs were drawn on pre-contrast and post-contrast maps in order to quantify native T1 (a) and ECV values (b), respectively. Full article ">Figure 2
Native T2 calculation from T2p-GRE or GraSE sequences. Endocardial and epicardial contours were drawn on short-axis pre-contrast maps (a). On four-chamber images (b), four different ROIs per slice were drawn in order to quantify native T2 values at the basal and mid septa and at the basal and mid lateral walls. Full article ">Figure 3
Myocardial native T2 values are significantly (p < 0.001) higher in CA patients than in healthy subjects, as shown by the boxplots of T2 values in healthy subjects, patients with AL amyloidosis and patients with ATTR amyloidosis. Full article ">Figure 4
Myocardial native T1 values are significantly (p < 0.001) higher in CA patients than in healthy subjects, as shown by the boxplots of T1 values in healthy subjects, patients with AL amyloidosis and patients with ATTR amyloidosis. Full article ">Figure 5
ECV is significantly (p < 0.001) higher in CA patients than in healthy subjects, as shown by the boxplots of ECV values in healthy subjects, patients with AL amyloidosis and patients with ATTR amyloidosis. Full article ">Figure 6
Graph shows QALE score values in AL-CA patients with normal native T2 values and with increased native T2 values. QALE score is significantly (p = 0.002) higher in CA patients with increased native T2 values. Full article ">

11 pages, 1376 KiB

Open AccessArticle

Identifying Autism Gaze Patterns in Five-Second Data Records

by Pedro Lencastre, Maryam Lotfigolian and Pedro G. Lind

Diagnostics 2024, 14(10), 1047; https://doi.org/10.3390/diagnostics14101047 - 18 May 2024

Cited by 1 | Viewed by 1354

Abstract

One of the most challenging problems when diagnosing autism spectrum disorder (ASD) is the need for long sets of data. Collecting data during such long periods is challenging, particularly when dealing with children. This challenge motivates the investigation of possible classifiers of ASD [...] Read more.

One of the most challenging problems when diagnosing autism spectrum disorder (ASD) is the need for long sets of data. Collecting data during such long periods is challenging, particularly when dealing with children. This challenge motivates the investigation of possible classifiers of ASD that do not need such long data sets. In this paper, we use eye-tracking data sets covering only 5 s and introduce one metric able to distinguish between ASD and typically developed (TD) gaze patterns based on such short time-series and compare it with two benchmarks, one using the traditional eye-tracking metrics and one state-of-the-art AI classifier. Although the data can only track possible disorders in visual attention and our approach is not a substitute to medical diagnosis, we find that our newly introduced metric can achieve an accuracy of

93 %

in classifying eye gaze trajectories from children with ASD surpassing both benchmarks while needing fewer data. The classification accuracy of our method, using a 5 s data series, performs better than the standard metrics in eye-tracking and is at the level of the best AI benchmarks, even when these are trained with longer time series. We also discuss the advantages and limitations of our method in comparison with the state of the art: besides needing a low amount of data, this method is a simple, understandable, and straightforward criterion to apply, which often contrasts with “black box” AI methods. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Neuropsychiatric Disorders)

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12 pages, 1907 KiB

Open AccessArticle

Generation and Validation of Normative, Age-Specific Reference Curves for Bone Strain Index in Women

by Luca Rinaudo, Sofia Cuttone, Carmelo Messina, Veronica Magni, Davide Capra, Luca Maria Sconfienza, Francesco Sardanelli and Fabio Massimo Ulivieri

Diagnostics 2024, 14(10), 1046; https://doi.org/10.3390/diagnostics14101046 - 18 May 2024

Viewed by 889

Abstract

Bone Strain Index (BSI), based on dual-energy X-ray absorptiometry (DXA), is a densitometric index of bone strength of the femur and lumbar spine. Higher BSI values indicate a higher strain applied to bone, predisposing to higher fracture risk. This retrospective, multicentric study on [...] Read more.

Bone Strain Index (BSI), based on dual-energy X-ray absorptiometry (DXA), is a densitometric index of bone strength of the femur and lumbar spine. Higher BSI values indicate a higher strain applied to bone, predisposing to higher fracture risk. This retrospective, multicentric study on Italian women reports the BSI normative age-specific reference curves. A cohort of Caucasian Italian women aged 20 to 90 years was selected from three different clinical centres. Bone mineral density (BMD) and BSI measurements were obtained for the lumbar spine vertebrae (L1–L4) and for the femur (neck, trochanter and intertrochanter) using Hologic densitometers scans. The data were compared with BMD normative values provided by the densitometer manufacturer. Then, the age-specific BSI curve for the femur and lumbar spine was generated. No significant difference was found between the BMD of the subjects in this study and BMD reference data provided by Hologic (p = 0.68 for femur and p = 0.90 for lumbar spine). Spine BSI values (L1–L4) increase by 84% between 20 and 90 years of age. The mean BSI of the total femur increases about 38% in the same age range. The BSI age-specific reference curve could help clinicians improve osteoporosis patient management, allowing an appropriate patient classification according to the bone resistance to the applied loads and fragility fracture risk assessment. Full article

(This article belongs to the Special Issue Diagnosis and Management of Osteoporosis)

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Graphic summary of the methodology: (1) “all-comers approach” was taken to enrol patients in the study; (2) only subjects with −1 < Z-score < 1 and 18.5 kg/m2 <BMI < 30 kg/m2 were selected; (3) the population was divided into 7 age groups; (4) for each age group, an outlier detection process was used; (5) all age groups were merged into one group; (6) the outlier detection process was used again. At the end of the process, 6905 hip scans and 2761 spine scans were selected. The BMD and BSI curves were constructed on these. Full article ">Figure 2
Examples of lumbar and femur BSI analysis: The BSI calculation uses Finite Element Method (FEM). The FEM analysis generates a 2D model of the bone segment starting from the bone segmentation, carried out by the DXA software (v5.6). A patient-specific load is applied to each 2D model, divided into triangular elements (mesh). Based on the density distribution, the bone strain is calculated at each geometric element of the mesh. BSI represents the average equivalent strain inside the bone, with the assumption that a higher strain level (high BSI) indicates a more significant risk condition [<a href="#B3-diagnostics-14-01046" class="html-bibr">3</a>,<a href="#B14-diagnostics-14-01046" class="html-bibr">14</a>]. Full article ">Figure 3
BSI age-related changes for lumbar spine (L1–L4). The mean BSI value for the specific age is represented by the black. Red dashed lines represent the two standard deviation lines. The graph highlights three different areas depending on the slope: before 35 years, between 35 and 75 years, and after 75 years. BSI value increases by 2% between 20 and 35 years (slope equal to 0.0026/year), by 78% between 35 and 75 years (slope equal to 0.0193/year), and by 2% after 75 years (slope equal to 0.0021/year). Full article ">Figure 4
BSI age-related changes in the femur. (a) Reference curve for Femoral Neck and (b) for Total Femur. The black line represents the mean BSI value for age. The red dashed lines represent the two SD lines. The curve shows a little slope change before 55 years and after 55 years. Full article ">

20 pages, 729 KiB

Open AccessReview

A Comprehensive Review on Circulating cfRNA in Plasma: Implications for Disease Diagnosis and Beyond

by Pengqiang Zhong, Lu Bai, Mengzhi Hong, Juan Ouyang, Ruizhi Wang, Xiaoli Zhang and Peisong Chen

Diagnostics 2024, 14(10), 1045; https://doi.org/10.3390/diagnostics14101045 - 17 May 2024

Cited by 1 | Viewed by 1688

Abstract

Circulating cfRNA in plasma has emerged as a fascinating area of research with potential applications in disease diagnosis, monitoring, and personalized medicine. Circulating RNA sequencing technology allows for the non-invasive collection of important information about the expression of target genes, eliminating the need [...] Read more.

Circulating cfRNA in plasma has emerged as a fascinating area of research with potential applications in disease diagnosis, monitoring, and personalized medicine. Circulating RNA sequencing technology allows for the non-invasive collection of important information about the expression of target genes, eliminating the need for biopsies. This comprehensive review aims to provide a detailed overview of the current knowledge and advancements in the study of plasma cfRNA, focusing on its diverse landscape and biological functions, detection methods, its diagnostic and prognostic potential in various diseases, challenges, and future perspectives. Full article

(This article belongs to the Topic Advances in Genetics and Precision Medicine in Human Diseases)

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17 pages, 4095 KiB

Open AccessArticle

Epithelial Cell Adhesion Molecule (EpCAM) Expression in Human Tumors: A Comparison with Pan-Cytokeratin and TROP2 in 14,832 Tumors

by Anne Menz, Nora Lony, Maximilian Lennartz, Sebastian Dwertmann Rico, Ria Schlichter, Simon Kind, Viktor Reiswich, Florian Viehweger, David Dum, Andreas M. Luebke, Martina Kluth, Natalia Gorbokon, Claudia Hube-Magg, Christian Bernreuther, Ronald Simon, Till S. Clauditz, Guido Sauter, Andrea Hinsch, Frank Jacobsen, Andreas H. Marx, Stefan Steurer, Sarah Minner, Eike Burandt, Till Krech, Patrick Lebok and Sören Weidemann Show full author list Hide full author list

Diagnostics 2024, 14(10), 1044; https://doi.org/10.3390/diagnostics14101044 - 17 May 2024

Cited by 2 | Viewed by 1394

Abstract

EpCAM is expressed in many epithelial tumors and is used for the distinction of malignant mesotheliomas from adenocarcinomas and as a surrogate pan-epithelial marker. A tissue microarray containing 14,832 samples from 120 different tumor categories was analyzed by immunohistochemistry. EpCAM staining was compared [...] Read more.

EpCAM is expressed in many epithelial tumors and is used for the distinction of malignant mesotheliomas from adenocarcinomas and as a surrogate pan-epithelial marker. A tissue microarray containing 14,832 samples from 120 different tumor categories was analyzed by immunohistochemistry. EpCAM staining was compared with TROP2 and CKpan. EpCAM staining was detectable in 99 tumor categories. Among 78 epithelial tumor types, the EpCAM positivity rate was ≥90% in 60 categories—including adenocarcinomas, neuroendocrine neoplasms, and germ cell tumors. EpCAM staining was the lowest in hepatocellular carcinomas, adrenocortical tumors, renal cell neoplasms, and in poorly differentiated carcinomas. A comparison of EpCAM and CKpan staining identified a high concordance but EpCAM was higher in testicular seminomas and neuroendocrine neoplasms and CKpan in hepatocellular carcinomas, mesotheliomas, and poorly differentiated non-neuroendocrine tumors. A comparison of EpCAM and TROP2 revealed a higher rate of TROP2 positivity in squamous cell carcinomas and lower rates in many gastrointestinal adenocarcinomas, testicular germ cell tumors, neuroendocrine neoplasms, and renal cell tumors. These data confirm EpCAM as a surrogate epithelial marker for adenocarcinomas and its diagnostic utility for the distinction of malignant mesotheliomas. In comparison to CKpan and TROP2 antibodies, EpCAM staining is particularly common in seminomas and in neuroendocrine neoplasms. Full article

(This article belongs to the Section Pathology and Molecular Diagnostics)

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EpCAM immunostaining of normal tissues. In the kidney, EpCAM staining was strong in distal tubuli, moderate in the visceral layer of the Bowman capsule, and weak to moderate and predominantly basolateral in proximal tubuli (A). A strong predominantly membranous EpCAM staining occurred in epithelial cells of the colorectum (B) and the gallbladder (C), as well as in the small bile ducts of the liver (D). In the stomach, EpCAM staining was the most intense in neck cells as well as in scattered small (neuroendocrine) cells within corpus and antrum glands (E). EpCAM staining was moderate to strong in prostatic epithelial cells (F) and weak to moderate in the basal cell layers of the urothelium (G). EpCAM staining was absent in the squamous epithelial cells of the skin (H). All images at 200× magnification. Insets show details at 400× magnification. Full article ">Figure 2
EpCAM immunostaining in cancer. The panels show a strong predominantly membranous EpCAM staining in an adenocarcinoma of the colon (A), in an endometrioid carcinoma of ovary (B), in a Gleason 5 + 5 = 10 adenocarcinoma of the prostate (C), in a seminoma of the testis (D), a cholangiocellular carcinoma of the liver (E), a small cell neuroendocrine carcinoma of the lung (F), in a Warthin tumor of the salivary gland (G), and in an adenocarcinoma of the lung (H). Occasional weak to moderate membranous staining was found in individual cases of diffuse large cell B-cell lymphoma (I), follicular B-cell lymphoma (J), angio-immunoblastic T-cell lymphoma (K), and in a rare example of a pleural malignant (epithelioid) mesothelioma with weak to moderate EpCAM staining of a subset of tumor cells (L). EpCAM staining was lacking in most malignant (epithelioid) mesotheliomas of the pleura (M) and in hepatocellular carcinomas in the liver (N). All images are at 200× magnification except (L,M)) which are at 400× magnification. Full article ">Figure 3
Ranking order of EpCAM immunostaining in cancers. Both the percentage of positive cases (blue dots) and the percentage of strongly positive cases (orange dots) are shown. Full article ">Figure 4
Comparison with EpCAM in previous literature. An “X“ indicates the fraction of EpCAM-positive cancers in the present study, dots indicate the reported frequencies from the literature for comparison: red dots mark studies with ≤10 analyzed tumors, yellow dots mark studies with 11 to 25 analyzed tumors, and green dots mark studies with >25 analyzed tumors. Full article ">

21 pages, 5095 KiB

Open AccessReview

PET/CT Imaging of Infectious Diseases: Overview of Novel Radiopharmaceuticals

by Ferdinando F. Calabria, Giuliana Guadagnino, Andrea Cimini and Mario Leporace

Diagnostics 2024, 14(10), 1043; https://doi.org/10.3390/diagnostics14101043 - 17 May 2024

Cited by 1 | Viewed by 1557

Abstract

Infectious diseases represent one of the most common causes of hospital admission worldwide. The diagnostic work-up requires a complex clinical approach, including laboratory data, CT and MRI, other imaging tools, and microbiologic cultures. PET/CT with ¹⁸F-FDG can support the clinical diagnosis, allowing [...] Read more.

Infectious diseases represent one of the most common causes of hospital admission worldwide. The diagnostic work-up requires a complex clinical approach, including laboratory data, CT and MRI, other imaging tools, and microbiologic cultures. PET/CT with ¹⁸F-FDG can support the clinical diagnosis, allowing visualization of increased glucose metabolism in activated macrophages and monocytes; this tracer presents limits in differentiating between aseptic inflammation and infection. Novel PET radiopharmaceuticals have been developed to overcome these limits; ¹¹C/¹⁸F-labeled bacterial agents, several ⁶⁸Ga-labeled molecules, and white blood cells labeled with ¹⁸F-FDG are emerging PET tracers under study, showing interesting preliminary results. The best choice among these tracers can be unclear. This overview aims to discuss the most common diagnostic applications of ¹⁸F-FDG PET/CT in infectious diseases and, as a counterpoint, to describe and debate the advantages and peculiarities of the latest PET radiopharmaceuticals in the field of infectious diseases, which will probably improve the diagnosis and prognostic stratification of patients with active infectious diseases. Full article

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

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Internalization and phosphorylation of 18F-FDG from the bloodstream in cells. Full article ">Figure 2
11C radiolabeled PET radiopharmaceuticals and their respective cellular targets in Gram-positive bacteria. DHFR: dihydrofolate reductase; DHF: dihydrofolate; THF: tetrahydrofolate; 11C-PABA: 11C-para-Aminobenzoic acid; D-11C-Met: D-methyl-11C-methionine; 11C-TMP: 11C-trimethoprim. Full article ">Figure 3
After intravenous administration, transferrin-bounded 68Ga-citrate circulates in the bloodstream and is transported by the arteries to the site of inflammation by mechanisms of blood flow and increased vascular permeability. The ferric ion-like properties of 68Ga-citrate allow its binding to lactoferrin, released by the apoptotic processes of leukocytes. Full article ">Figure 4
68Ga-FAPI reaches the infectious site by the bloodstream and interacts with FAP in fibroblasts of the infectious microenvironment. Full article ">Figure 5
The uptake of radiolabeled somatostatin analogues in infection is due to the overexpression of cell surface somatostatin receptors in activated macrophages. Full article ">Figure 6
Simplified preparation of 18F-FDG-radiolabeled white blood cells. Venous blood is collected in a heparinized syringe; after plasma separation and centrifugation, 18F-FDG is added to the white blood cell pellet suspension. After incubation, the radiolabeled white blood cell sediment is reconstituted with the patient’s cell-free plasma and intravenously reinjected (18F-FDG: 18F-fluorodeoxyglucose;—WBC: white blood cell). Full article ">Figure 7
Mechanism of uptake of 18F-FDG-labeled white blood cells in infectious foci. Full article ">

16 pages, 574 KiB

Open AccessArticle

The Role of QRS Complex and ST-Segment in Major Adverse Cardiovascular Events Prediction in Patients with ST Elevated Myocardial Infarction: A 6-Year Follow-Up Study

by Srđan Maletin, Milovan Petrović, Anastazija Stojšić-Milosavljević, Tatjana Miljković, Aleksandra Milovančev, Ivan Petrović, Isidora Milosavljević, Ana Balenović and Milenko Čanković

Diagnostics 2024, 14(10), 1042; https://doi.org/10.3390/diagnostics14101042 - 17 May 2024

Viewed by 988

Abstract

Background: as a relatively high number of ST-segment elevation myocardial infarction (STEMI) patients develop major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI), our aim was to determine the significance, and possible predictive value of QRS complex width and ST-segment elevation. Methods: [...] Read more.

Background: as a relatively high number of ST-segment elevation myocardial infarction (STEMI) patients develop major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI), our aim was to determine the significance, and possible predictive value of QRS complex width and ST-segment elevation. Methods: our patient sample included 200 PCI-treated STEMI patients, which were divided into two groups based on the following duration of symptoms: (I) less than 6 h, and (II) 6 to 12 h. For every patient, an ECG was performed at six different time points, patients were followed for up to six years for the occurrence of MACE. Results: the mean age was 60.6 ± 11.39 years, and 142 (71%) were male. The 6–12 h group had significantly wider QRS complex, higher ST-segment elevation, lower prevalence of ST-segment resolution as well as MACE prevalence (p < 0.05). ECG parameters, QRS width, and magnitude of ST-segment elevation were proved to be independent significant predictors of MACE in all measured time points (p < 0.05). Even after controlling for biomarkers of myocardial injury, these ECG parameters remained statistically significant predictors of MACE (p < 0.05). Conclusion: our study highlights that wider QRS complex and a more pronounced ST-segment elevation are associated with longer total ischemic time and higher risk of long-term MACE. Full article

(This article belongs to the Topic Cardiovascular Disease in 2023: Coronary Syndrome, Heart Failure and Structural Heart Disease)

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14 pages, 1239 KiB

Open AccessArticle

Comparative Evaluation of Chest Ultrasonography and Computed Tomography as Predictors of Malignant Pleural Effusion: A Prospective Study

by Samah M. Shehata, Yassir Edrees Almalki, Mohammad Abd Alkhalik Basha, Rasha Mohamed Hendy, Eman M. Mahmoud, Marwa Elsayed Abd Elhamed, Sharifa Khalid Alduraibi, Mervat Aboualkheir, Ziyad A. Almushayti, Alaa K. Alduraibi, Ahmed M. Abdelkhalik Basha and Maha E. Alsadik

Diagnostics 2024, 14(10), 1041; https://doi.org/10.3390/diagnostics14101041 - 17 May 2024

Viewed by 1482

Abstract

Malignant pleural effusion (MPE) is a manifestation of advanced cancer that requires a prompt and accurate diagnosis. Ultrasonography (US) and computed tomography (CT) are valuable imaging techniques for evaluating pleural effusions; however, their relative predictive ability for a malignant origin remains debatable. This [...] Read more.

Malignant pleural effusion (MPE) is a manifestation of advanced cancer that requires a prompt and accurate diagnosis. Ultrasonography (US) and computed tomography (CT) are valuable imaging techniques for evaluating pleural effusions; however, their relative predictive ability for a malignant origin remains debatable. This prospective study aimed to compare chest US with CT findings as predictors of malignancy in patients with undiagnosed exudative pleural effusion. Fifty-four adults with undiagnosed exudative pleural effusions underwent comprehensive clinical evaluation including chest US, CT, and histopathologic biopsy. Blinded radiologists evaluated the US and CT images for features suggestive of malignancy, based on predefined criteria. Diagnostic performance measures were calculated using histopathology as a reference standard. Of the 54 patients, 33 (61.1%) had MPEs confirmed on biopsy. No significant differences between US and CT were found in detecting parietal pleural abnormalities, lung lesions, chest wall invasion, or liver metastasis. US outperformed CT in identifying diaphragmatic pleural thickening ≥10 mm (33.3% vs. 6.1%, p < 0.001) and nodularity (45.5% vs. 3%, p < 0.001), whereas CT was superior for mediastinal thickening (48.5% vs. 15.2%, p = 0.002). For diagnosing MPE, diaphragmatic nodularity detected by US had 45.5% sensitivity and 100% specificity, whereas CT mediastinal thickening had 48.5% sensitivity and 90.5% specificity. Both US and CT demonstrate reasonable diagnostic performance for detecting MPE, with particular imaging findings favoring a malignant origin. US may be advantageous for evaluating diaphragmatic pleural involvement, whereas CT is more sensitive to mediastinal abnormalities. Full article

(This article belongs to the Special Issue Imaging and Chest Diseases)

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14 pages, 3624 KiB

Open AccessArticle

Semi-Supervised Facial Acne Segmentation Using Bidirectional Copy–Paste

by Semin Kim, Huisu Yoon and Jongha Lee

Diagnostics 2024, 14(10), 1040; https://doi.org/10.3390/diagnostics14101040 - 17 May 2024

Viewed by 909

Abstract

Facial acne is a prevalent dermatological condition regularly observed in the general population. However, it is important to detect acne early as the condition can worsen if not treated. For this purpose, deep-learning-based methods have been proposed to automate detection, but acquiring acne [...] Read more.

Facial acne is a prevalent dermatological condition regularly observed in the general population. However, it is important to detect acne early as the condition can worsen if not treated. For this purpose, deep-learning-based methods have been proposed to automate detection, but acquiring acne training data is not easy. Therefore, this study proposes a novel deep learning model for facial acne segmentation utilizing a semi-supervised learning method known as bidirectional copy–paste, which synthesizes images by interchanging foreground and background parts between labeled and unlabeled images during the training phase. To overcome the lower performance observed in the labeled image training part compared to the previous methods, a new framework was devised to directly compute the training loss based on labeled images. The effectiveness of the proposed method was evaluated against previous semi-supervised learning methods using images cropped from facial images at acne sites. The proposed method achieved a Dice score of 0.5205 in experiments utilizing only 3% of labels, marking an improvement of 0.0151 to 0.0473 in Dice score over previous methods. The proposed semi-supervised learning approach for facial acne segmentation demonstrated an improvement in performance, offering a novel direction for future acne analysis. Full article

(This article belongs to the Special Issue Advances in Medical Image Processing, Segmentation and Classification)

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Various acne samples. The shape and skin color of acne are considerably diverse. Full article ">Figure 2
Overall structure of the proposed method. Synthetic images are generated using the bidirectional copy–paste method. The labeled image and synthetic image are each inferred for prediction values through the student network. Then, synthetic GT is generated using ground truth (GT) and pseudo GT. The training loss is calculated by sending a supervisory signal to the student network through each GT. Once the student network is trained, an EMA update is applied to the teacher network. Full article ">Figure 3
An example of creating <math display="inline"><semantics> <msup> <mrow> <mi mathvariant="bold">X</mi> </mrow> <mrow> <mi>i</mi> <mi>n</mi> </mrow> </msup> </semantics></math> by applying BCP to an unlabeled image <math display="inline"><semantics> <msubsup> <mi mathvariant="bold">X</mi> <mi>q</mi> <mi>u</mi> </msubsup> </semantics></math> and a labeled image <math display="inline"><semantics> <msubsup> <mi mathvariant="bold">X</mi> <mi>j</mi> <mi>l</mi> </msubsup> </semantics></math>. In mask M, 1 represents the white area, and 0 represents the black area. 1 represents a matrix of the same size as M, with all elements being 1. ⊙ is element-wise multiplication, and ⊕ is element-wise addition. Full article ">Figure 4
Examples of acne segmentation results from the compared semi-supervised methods. (a) represents the input images, (b) is the ground truth. (c) is the result of SS-Net, (d) is the result of BCP, and (e) is the result of the proposed method. Full article ">Figure 5
Comparison of training and validation loss and Dice score for our method and the BCP method. (a) shows the training and validation losses for each method, and (b) shows the Dice scores. Full article ">Figure 6
Example of creating semantic segmentation ground truth using ACNE04’s bounding boxes. (a) is the original image, and (b) shows the blue boxes indicating acne with bounding boxes. By drawing ellipses inside the bounding boxes, pseudo ground truth for acne is generated as shown in (c). Full article ">Figure 7
Comparison of synthetic images. The two images on the left are synthetic images generated from our database, and those on the right are from ACNE04. Our database reflects a variety of skin tones and lighting, resulting in a significant color difference between the duplicated inner images and the background images. In contrast, the ACNE04 images are synthesized in relatively similar colors. Full article ">

14 pages, 1064 KiB

Open AccessArticle

SARS-CoV-2 Seroepidemiology and Antibody Levels in Children during BA.5 Predominance Period

by Filippos Filippatos, Elizabeth-Barbara Tatsi, Maria-Myrto Dourdouna, Emmanouil Zoumakis, Alexandra Margeli, Vasiliki Syriopoulou and Athanasios Michos

Diagnostics 2024, 14(10), 1039; https://doi.org/10.3390/diagnostics14101039 - 17 May 2024

Viewed by 859

Abstract

This is a SARS-CoV-2 seroepidemiological study in a pediatric population (0–16 years) during the BA.5 Omicron predominance period in the Athens metropolitan area. Serum samples were tested for SARS-CoV-2 nucleocapsid antibodies (Abs-N), representing natural infection during three periods of BA.5 predominance: 1 May [...] Read more.

This is a SARS-CoV-2 seroepidemiological study in a pediatric population (0–16 years) during the BA.5 Omicron predominance period in the Athens metropolitan area. Serum samples were tested for SARS-CoV-2 nucleocapsid antibodies (Abs-N), representing natural infection during three periods of BA.5 predominance: 1 May 2022–31 August 2022 (period A), 1 September 2022–31 December 2022 (period B), and July 2023 (period C). Εpidemiological data were also collected. Additionally, in period C, Abs-N-seronegative samples were tested for SARS-CoV-2 spike antibodies (Abs-S). A total of 878 children were tested (males: 52.6%), with a median age (IQR) of 96 (36–156) months; the number of cases of seropositivity during the three periods were as follows: A: 292/417 (70%), B: 288/356 (80.9%), and C: 89/105 (84.8%), with p < 0.001. SARS-CoV-2 seropositivity increased from period A to C for children 0–1 year (p = 0.044), >1–4 years (p = 0.028), and >6–12 years (p = 0.003). Children > 6–12 years had the highest seropositivity rates in all periods (A: 77.3%, B: 91.4%, and C: 95.8%). A significant correlation of monthly median Abs-N titers with monthly seropositivity rates was detected (r_s: 0.812, p = 0.008). During period C, 12/105 (11.4%) Abs-S-seropositive and Abs-N-seronegative samples were detected and total seropositivity was estimated at 96.2% (101/105). The findings of this study indicate a high SARS-CoV-2 exposure rate of children during the BA.5 predominance period and suggest that in future seroepidemiological studies, both antibodies should be tested in Abs-N-seronegative populations. Full article

(This article belongs to the Special Issue Editorial Board Members' Collection Series: Molecular Diagnostics of Infectious Diseases)

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6 pages, 2006 KiB

Open AccessInteresting Images

Malposition of Central Venous Catheter into Coronary Sinus throughout the Persistent Left Superior Vena Cava and Other Complications Related to Catheterization

by Barbara Syska, Anna S. Veer, Patrycja S. Matusik, Jarosław D. Jarczewski, Katarzyna Krzanowska and Tadeusz J. Popiela

Diagnostics 2024, 14(10), 1038; https://doi.org/10.3390/diagnostics14101038 - 17 May 2024

Cited by 1 | Viewed by 1001

Abstract

This case concentrates on the persistent left superior vena cava (PLSVC), a rare vascular anomaly which contributes to central venous catheter (CVC) misplacement. A 72-year-old woman with renal insufficiency presented to the hospital with recurrent bleeding from her permanent CVC device placed in [...] Read more.

This case concentrates on the persistent left superior vena cava (PLSVC), a rare vascular anomaly which contributes to central venous catheter (CVC) misplacement. A 72-year-old woman with renal insufficiency presented to the hospital with recurrent bleeding from her permanent CVC device placed in the right common jugular vein. An initial attempt to replace the device was unsuccessful, necessitating the placement of a secondary catheter in the left jugular vein. Shortly after the procedure, the patient developed swelling of the face and neck. Further diagnostic imaging, including a chest radiograph and computed tomography (CT), revealed CVC misplacement in the PLSVC and coronary sinus, thrombosis of the common jugular vein, and a posterior mediastinal hematoma. Conservative therapy of the mediastinal hematoma was implemented and proved effective in this case. A temporary CVC was inserted into the left femoral vein. Two months later, the catheter underwent further dysfunction and a decision was made to place a long-term permanent CVC via the right femoral vein. The patient is currently awaiting an arteriovenous fistula for dialysis use. This case emphasizes the importance of radiological techniques for CVC procedural placement, as well as the detection of congenital abnormalities. Providers regularly placing CVCs should have an in-depth knowledge of the possible complications and potential anatomical variations, especially as seen in high-risk patients. Full article

(This article belongs to the Section Pathology and Molecular Diagnostics)

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11 pages, 253 KiB

Open AccessArticle

Evaluating the Performance of FlukeCatcher at Detecting Urogenital Schistosomiasis

by Louis Fok, Berhanu Erko, David Brett-Major, Abebe Animut, M. Jana Broadhurst, Daisy Dai, John Linville, Bruno Levecke, Yohannes Negash and Abraham Degarege

Diagnostics 2024, 14(10), 1037; https://doi.org/10.3390/diagnostics14101037 - 17 May 2024

Cited by 1 | Viewed by 858

Abstract

Urine filtration microscopy (UFM) lacks sensitivity in detecting low-intensity Schistosoma haematobium infections. In pursuit of a superior alternative, this study evaluated the performance of FlukeCatcher microscopy (FCM) at detecting S. haematobium eggs in human urine samples. Urine samples were collected from 572 school-age [...] Read more.

Urine filtration microscopy (UFM) lacks sensitivity in detecting low-intensity Schistosoma haematobium infections. In pursuit of a superior alternative, this study evaluated the performance of FlukeCatcher microscopy (FCM) at detecting S. haematobium eggs in human urine samples. Urine samples were collected from 572 school-age children in Afar, Ethiopia in July 2023 and examined using UFM and FCM approaches. Using the combined UFM and FCM results as a reference, the sensitivity, negative predictive value, and agreement levels for the two testing methods in detecting S. haematobium eggs in urine samples were calculated. The sensitivity and negative predictive value of detecting S. haematobium eggs in urine samples for FCM was 84% and 97%, respectively, compared to 65% and 93% for UFM. The FCM test results had an agreement of 61% with the UFM results, compared to 90% with the combined results of FCM and UFM. However, the average egg count estimates were lower when using FCM (6.6 eggs per 10 mL) compared to UFM (14.7 eggs per 10 mL) (p < 0.0001). Incorporating FCM into specimen processing could improve the diagnosis of S. haematobium infection but may underperform in characterizing the intensity of infection. Full article

(This article belongs to the Special Issue Urinary Tract Infections: Diagnosis and Management)

16 pages, 3398 KiB

Open AccessArticle

Predicting Response to Exclusive Combined Radio-Chemotherapy in Naso-Oropharyngeal Cancer: The Role of Texture Analysis

by Eleonora Bicci, Leonardo Calamandrei, Antonio Di Finizio, Michele Pietragalla, Sebastiano Paolucci, Simone Busoni, Francesco Mungai, Cosimo Nardi, Luigi Bonasera and Vittorio Miele

Diagnostics 2024, 14(10), 1036; https://doi.org/10.3390/diagnostics14101036 - 17 May 2024

Viewed by 921

Abstract

The aim of this work is to identify MRI texture features able to predict the response to radio-chemotherapy (RT-CHT) in patients with naso-oropharyngeal carcinoma (NPC-OPC) before treatment in order to help clinical decision making. Textural features were derived from ADC maps and post-gadolinium [...] Read more.

The aim of this work is to identify MRI texture features able to predict the response to radio-chemotherapy (RT-CHT) in patients with naso-oropharyngeal carcinoma (NPC-OPC) before treatment in order to help clinical decision making. Textural features were derived from ADC maps and post-gadolinium T1-images on a single MRI machine for 37 patients with NPC-OPC. Patients were divided into two groups (responders/non-responders) according to results from MRI scans and 18F-FDG-PET/CT performed at follow-up 3–4 and 12 months after therapy and biopsy. Pre-RT-CHT lesions were segmented, and radiomic features were extracted. A non-parametric Mann–Whitney test was performed. A p-value < 0.05 was considered significant. Receiver operating characteristic curves and area-under-the-curve values were generated; a 95% confidence interval (CI) was reported. A radiomic model was constructed using the LASSO algorithm. After feature selection on MRI T1 post-contrast sequences, six features were statistically significant: gldm_DependenceEntropy and DependenceNonUniformity, glrlm_RunEntropy and RunLengthNonUniformity, and glszm_SizeZoneNonUniformity and ZoneEntropy, with significant cut-off values between responder and non-responder group. With the LASSO algorithm, the radiomic model showed an AUC of 0.89 and 95% CI: 0.78–0.99. In ADC, five features were selected with an AUC of 0.84 and 95% CI: 0.68–1. Texture analysis on post-gadolinium T1-images and ADC maps could potentially predict response to therapy in patients with NPC-OPC who will undergo exclusive treatment with RT-CHT, being, therefore, a useful tool in therapeutical–clinical decision making. Full article

(This article belongs to the Special Issue Advances in Diagnostic Imaging of Head and Neck Tumors: 2nd Edition)

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21 pages, 3702 KiB

Open AccessReview

MRI Application and Challenges of Hyperpolarized Carbon-13 Pyruvate in Translational and Clinical Cardiovascular Studies: A Literature Review

by Francesca Frijia, Alessandra Flori, Giulio Giovannetti, Andrea Barison, Luca Menichetti, Maria Filomena Santarelli and Vincenzo Positano

Diagnostics 2024, 14(10), 1035; https://doi.org/10.3390/diagnostics14101035 - 17 May 2024

Viewed by 1185

Abstract

Cardiovascular disease shows, or may even be caused by, changes in metabolism. Hyperpolarized magnetic resonance spectroscopy and imaging is a technique that could assess the role of different aspects of metabolism in heart disease, allowing real-time metabolic flux assessment in vivo. In this [...] Read more.

Cardiovascular disease shows, or may even be caused by, changes in metabolism. Hyperpolarized magnetic resonance spectroscopy and imaging is a technique that could assess the role of different aspects of metabolism in heart disease, allowing real-time metabolic flux assessment in vivo. In this review, we introduce the main hyperpolarization techniques. Then, we summarize the use of dedicated radiofrequency ¹³C coils, and report a state of the art of ¹³C data acquisition. Finally, this review provides an overview of the pre-clinical and clinical studies on cardiac metabolism in the healthy and diseased heart. We furthermore show what advances have been made to translate this technique into the clinic in the near future and what technical challenges still remain, such as exploring other metabolic substrates. Full article

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

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Panel (a) schematic representation of the hyperpolarized state; panel (b) hyperpolarization via d-DNP and schematic pipeline of the typical experiment with hyperpolarized contrast agents. Full article ">Figure 2
In the heart, 13C-pyruvate may undergo transamination to 13C-alanine, reduction to 13C-lactate or oxidation to 13C-CO2 and acetyl-CoA (Ac-CoA). 13C-CO2 is rapidly converted to 13C-bicarbonate by carbonic anhydrase. Acetyl-CoA is metabolized in the tricarboxylic acid (TCA) cycle. *Please note that the study of Acetyl-CoA and TCA metabolites requires labeling of pyruvate in C2 position ([2-13C]pyruvate). ALT, alanine transaminase; CA, carbonic anhydrase; LDH, lactate dehydrogenase; PDH, pyruvate dehydrogenase. Full article ">Figure 3
The different phases in the RF coil development. Full article ">Figure 4
Hyperpolarized 13C-pyruvate and bicarbonate maps evaluated with the hybrid coil: (a) pyruvate signal, (b) bicarbonate signal. Reprinted by permission from Giovannetti et al., App Magn Reson 2013 [<a href="#B91-diagnostics-14-01035" class="html-bibr">91</a>]. Full article ">Figure 5
Schematization of the FIDCSI, EPSI, and IDEAL SPIRAL acquisition sequences and corresponding k-space sampling strategies. Full article ">Figure 6
Hyperpolarized 13C-pyruvate (a), bicarbonate (b), and lactate maps (c) acquired by a 3D-IDEAL spiral CSI sequence. Reprinted by permission from Flori et al., App Magn Reson 2012 [<a href="#B98-diagnostics-14-01035" class="html-bibr">98</a>]. Full article ">Figure 7
(A): Metabolic maps of 13C-pyruvate, 13C-lactate, 13C-bicarbonate, and 13C-alanine map. Metabolite data are shown overlaid with an anatomical cine image and as raw metabolite images. (B): Temporal dynamics for 13C-pyruvate and dynamics for 13C-pyruvate and its downstream metabolites from arrival of pyruvate in the lumen of the right ventricle (RV) and left ventricle (LV) to downstream appearance of 13C-lactate, 13C-bicarbonate, and 13C-alanine. Reprinted with permission from Joergensen et al., J Cardiovasc Magn Reson, 2022 [<a href="#B76-diagnostics-14-01035" class="html-bibr">76</a>]. Full article ">

24 pages, 1606 KiB

Open AccessReview

Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath

by Steffi Kar Kei Yuen, Olivier Traxer, Marcelo Langer Wroclawski, Nariman Gadzhiev, Chu Ann Chai, Ee Jean Lim, Carlo Giulioni, Virgilio De Stefano, Carlotta Nedbal, Martina Maggi, Kemal Sarica, Daniele Castellani, Bhaskar Somani and Vineet Gauhar

Diagnostics 2024, 14(10), 1034; https://doi.org/10.3390/diagnostics14101034 - 16 May 2024

Cited by 3 | Viewed by 1892

Abstract

The ureteral access sheath (UAS) has been a boon and a bane in flexible ureteroscopy (FURS), with its merits and demerits well established. Its design and dimensions were instrumental in reshaping the way flexible scopes were used and were key adjuncts to establishing [...] Read more.

The ureteral access sheath (UAS) has been a boon and a bane in flexible ureteroscopy (FURS), with its merits and demerits well established. Its design and dimensions were instrumental in reshaping the way flexible scopes were used and were key adjuncts to establishing retrograde intrarenal surgery (RIRS) as a standard of care in the endourological management of renal stones. With the ever-changing landscape of RIRS over the decades shaped by technological advancements in lasers and flexible scopes, the UAS has also continuously evolved. The utility of suction in endourology has recently changed the way RIRS is performed and is a game changer for FURS outcomes. With strong clinical and experimental evidence to support its use, the UAS has undergone a transformative change in the recent past, with its ability to monitor intrarenal pressure and provide a superior vacuum-cleaner effect that improves the trifecta of RIRS, namely an improved single-stage stone-free rate (SFR), minimise complications, and reduce reinterventions. Our comprehensive review outlines the key clinical and experimental evidence and traces the developments that were key to modifying the traditional UAS into a flexible and navigable suction ureteric access sheath (FANS) and highlights how the design and modifications, in turn, influence the ability to push the boundaries of RIRS. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Urological Diseases)

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14 pages, 2023 KiB

Open AccessArticle

Development of an Antigen Capture Lateral Flow Immunoassay for the Detection of Burkholderia pseudomallei

by Teerapat Nualnoi, Paweena Wongwitwichot, Siriluk Kaewmanee, Pornchanan Chanchay, Nattapong Wongpanti, Tossapol Ueangsuwan, Rattikarn Siangsanor, Wannittaya Chotirouangnapa, Tanatchaporn Saechin, Suwanna Thungtin, Jidapa Szekely, Chaiyawan Wattanachant and Vannarat Saechan

Diagnostics 2024, 14(10), 1033; https://doi.org/10.3390/diagnostics14101033 - 16 May 2024

Viewed by 1355

Abstract

Early diagnosis is essential for the successful management of Burkholderia pseudomallei infection, but it cannot be achieved by the current gold standard culture technique. Therefore, this study aimed to develop a lateral flow immunoassay (LFIA) targeting B. pseudomallei capsular polysaccharide. The development was [...] Read more.

Early diagnosis is essential for the successful management of Burkholderia pseudomallei infection, but it cannot be achieved by the current gold standard culture technique. Therefore, this study aimed to develop a lateral flow immunoassay (LFIA) targeting B. pseudomallei capsular polysaccharide. The development was performed by varying nitrocellulose membrane reaction pads and chase buffers. The prototype LFIA is composed of Unisart CN95 and chase buffer containing tris-base, casein, and Surfactant 10G. The assay showed no cross-reactivity with E. coli, S. aureus, P. aeruginosa, and P. acne. The limit of detections (LODs) of the prototype LFIA was 10⁷ and 10⁶ CFU/mL B. pseudomallei in hemoculture medium and artificial urine, respectively. These LODs suggest that this prototype can detect melioidosis from positive hemoculture bottles but not straight from urine. Additionally, these LODs are still inferior compared to Active Melioidosis Detect (AMD^TM). Overall, this prototype holds the potential to be used clinically with hemoculture bottles. However, further improvements should be considered, especially for use with urine samples. Full article

(This article belongs to the Section Point-of-Care Diagnostics and Devices)

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Characterization of the mAb Bp2.1 using Western blotting (a) and indirect ELISA (b). Western blot analysis (a) was carried out with proteinase K-treated B. pseudomallei lysate (Bp-PS) separated on 10% SDS-PAGE gel, blotted on the nitrocellulose membrane, and probed with Bp2.1 mAb. The result shows the interaction between Bp2.1 and a high molecular antigen with the size corresponding to CPS. An indirect ELISA (b) with the heat-killed B. pseudomallei immobilized on the plates, and Bp2.1 as a primary antibody shows the interaction with anti-mouse IgG3 HRP. The result indicates that Bp2.1 is an IgG3 subclass. Full article ">Figure 2
Membranes and chase buffers screening for the LFIA development. The optimal conditions for the LFIAs were searched for by varying nitrocellulose membrane types and chase buffer formulas (no. 1-15, <a href="#diagnostics-14-01033-t001" class="html-table">Table 1</a>). PBS was used as a sample for the screening. The intensity of control and test lines was visually inspected and recorded as “+++”, “++”, “+”, and “−” for high, moderate, low, and no band intensity, respectively. “±” marks the conditions that require > 20 min for the test lines to disappear. The optimal conditions, which are the conditions that produced the visible control line with the invisible test line, were asterisked (*). Full article ">Figure 3
LFIAs testing with a hemoculture medium. The selected conditions from the previous screening were tested with fresh hemoculture medium, and the test results were inspected visually at 20 minutes. The intensity of control and test lines was recorded as “++”, “+”, and “−” for moderate, low, and no band intensity, respectively. “±” marks the conditions that require > 20 min for the test lines to disappear. The testing identifies two conditions that did not produce false positive results (Unisart CN95 with buffer no. 8 and Unisart CN95 with buffer no. 10, <a href="#diagnostics-14-01033-t001" class="html-table">Table 1</a>). Full article ">Figure 4
Determinations of the LODs of the prototype LFIA using heat-killed B. pseudomallei. The LODs of the prototype LFIA were determined using fresh hemoculture medium (a) and artificial urine (b) spiked with various concentrations of the heat-killed bacterium. The Active Melioidosis DetectTM RDTs were also included for comparison. The lowest bacterial concentrations giving a positive result (indicated by a red label) marked the LOD values. The results illustrate that the LODs for the heat-killed B. pseudomallei in fresh hemoculture medium and artificial urine were 107 CFU/mL and 106 CFU/mL, respectively. (Pos = positive, Neg = negative). Full article ">Figure 5
Cross-reactivity assessment. The potential cross-reactivity of the LFIA was assessed using killed S. aureus and P. acne (Gram-positive representatives) and E. coli and P. aeruginosa (Gram-negative representatives) spiked in the hemoculture medium (a), and the artificial urine (b). The prototype LFIA did not exhibit any cross-reactivity with these bacteria under the investigated matrices. (Pos = positive, Neg = negative). Full article ">

13 pages, 4339 KiB

Open AccessArticle

Evaluating the Margins of Breast Cancer Tumors by Using Digital Breast Tomosynthesis with Deep Learning: A Preliminary Assessment

by Wei-Chung Shia, Yu-Hsun Kuo, Fang-Rong Hsu, Joseph Lin, Wen-Pei Wu, Hwa-Koon Wu, Wei-Cheng Yeh and Dar-Ren Chen

Diagnostics 2024, 14(10), 1032; https://doi.org/10.3390/diagnostics14101032 - 16 May 2024

Cited by 1 | Viewed by 1143

Abstract

Background: The assessment information of tumor margins is extremely important for the success of the breast cancer surgery and whether the patient undergoes a second operation. However, conducting surgical margin assessments is a time-consuming task that requires pathology-related skills and equipment, and often [...] Read more.

Background: The assessment information of tumor margins is extremely important for the success of the breast cancer surgery and whether the patient undergoes a second operation. However, conducting surgical margin assessments is a time-consuming task that requires pathology-related skills and equipment, and often cannot be provided in a timely manner. To address this challenge, digital breast tomosynthesis technology was utilized to generate detailed cross-sectional images of the breast tissue and integrate deep learning algorithms for image segmentation, achieving an assessment of tumor margins during surgery. Methods: this study utilized post-operative tissue samples from 46 patients who underwent breast-conserving treatment, and generated image sets using digital breast tomosynthesis for the training and evaluation of deep learning models. Results: Deep learning algorithms effectively identifying the tumor area. They achieved a Mean Intersection over Union (MIoU) of 0.91, global accuracy of 99%, weighted IoU of 44%, precision of 98%, recall of 83%, F1 score of 89%, and dice coefficient of 93% on the training dataset; for the testing dataset, MIoU was at 83%, global accuracy at 97%, weighted IoU at 38%, precision at 87%, recall rate at 69%, F1 score at 76%, dice coefficient at 86%. Conclusions: The initial evaluation suggests that the deep learning-based image segmentation method is highly accurate in measuring breast tumor margins. This helps provide information related to tumor margins during surgery, and by using different datasets, this research method can also be applied to the surgical margin assessment of various types of tumors. Full article

(This article belongs to the Special Issue Advances in Breast Radiology)

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