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Volume 14
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Diagnostics, Volume 14, Issue 14 (July-2 2024) – 117 articles

Cover Story (view full-size image): One in 10 U.S. babies is premature, meaning that they are born before 37 weeks’ gestation. Clinical preterm birth risk factors capture few premature deliveries and overlook first-time mothers who lack pregnancy histories. AVERT PRETERM evaluated a test-and-treat strategy that uses a biomarker risk predictor, PreTRM®, to measure the ratio of two maternal circulating proteins in weeks 19–20 of pregnancy. Women deemed higher risk by PreTRM were offered interventions comprising aspirin, vaginal progesterone, and frequent nurse calls. Those accepting treatment had significant reductions in neonatal hospital stays and medical complications compared to historical controls. This strategy shows effectiveness for all pregnancies, including those without overt risk, in reducing prematurity and its neonatal complications. View this paper
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11 pages, 269 KiB  
Review
Is It Useful to Repeat Blood Cultures in Endocarditis Patients? A Critical Appraisal
by Wouter Kok
Diagnostics 2024, 14(14), 1578; https://doi.org/10.3390/diagnostics14141578 - 22 Jul 2024
Viewed by 384
Abstract
Background: Previous guidelines for endocarditis have suggested repeating blood cultures until they become negative, with limited evidence. Methods: Literature reviews were conducted (1) on the incidence of persistent bacteremia and association with outcome and (2) on timing of valve culture negativization to examine [...] Read more.
Background: Previous guidelines for endocarditis have suggested repeating blood cultures until they become negative, with limited evidence. Methods: Literature reviews were conducted (1) on the incidence of persistent bacteremia and association with outcome and (2) on timing of valve culture negativization to examine the claim for prolongation of antibiotic therapy starting from negative blood cultures. Results: Persistent bacteremia and fever may be present in the first 3 days of endocarditis, despite treatment, and are more common in Staphylococcus (especially MRSA) and Enterococcus species. Persistent bacteremia (48–72 h), persistent infection (day 7), and new onset septic shock are related and predict in-hospital mortality. It is, however, persistent infection at day 7 and septic shock that primarily determine the infectious course of endocarditis, and not persistent bacteremia. Valve cultures at surgery become negative in most cases (>85–90%) after 14–21 days of antibiotic therapy, with no calculated benefit for prolonging therapy after 21 days. Conclusions: Persistent infection at 7 days after appropriate antibiotic therapy is a better key event for prognosis then positive or negative blood cultures at 48–72 h. Therapy prolongation from the day of negative blood cultures is not reasonable. There is no need to survey blood cultures in endocarditis patients after starting therapy. Full article
(This article belongs to the Special Issue Advances in the Diagnosis of Infectious Diseases and Microorganisms)
10 pages, 2875 KiB  
Brief Report
Liquid Biopsies in Follicular Thyroid Carcinomas—A Brief Report
by Marie-Louise Uhre Hansen, Simone Kloch Bendtsen, Kathrine Kronberg Jakobsen, Ane Yde Schmidt, Christoffer Holst Hahn, Christian von Buchwald and Christian Grønhøj
Diagnostics 2024, 14(14), 1577; https://doi.org/10.3390/diagnostics14141577 - 22 Jul 2024
Viewed by 360
Abstract
Thyroid cancer (TC) represents a significant health burden globally, with follicular thyroid cancer (FTC) posing diagnostic challenges despite advancements. This pilot study aimed to evaluate the utility of a liquid biopsy with cell-free DNA (cfDNA) in patients with FTC. Blood samples were collected [...] Read more.
Thyroid cancer (TC) represents a significant health burden globally, with follicular thyroid cancer (FTC) posing diagnostic challenges despite advancements. This pilot study aimed to evaluate the utility of a liquid biopsy with cell-free DNA (cfDNA) in patients with FTC. Blood samples were collected from 13 patients diagnosed with FTC, DNA extraction was performed, and cfDNA was analyzed using the Illumina’s TruSight Oncology 500 High-Throughput panel. The results revealed low tumor mutational burden and minimal pathogenic variants in cfDNA, indicating challenges such as low DNA yield and poor material quality despite adequate coverage. Our findings indicate that cfDNA as an add-on diagnostic tool in patients with FTC might not be a useful supplement. Full article
(This article belongs to the Special Issue Recent Advances in Thyroid Carcinoma)
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11 pages, 1367 KiB  
Article
Right Ventricular and Right Atrial Strain Are Associated with Kidney Dysfunction in Acute Heart Failure
by Vasileios Anastasiou, Emmanouela Peteinidou, Christos Tountas, Stylianos Daios, Dimitrios V. Moysidis, Emmanouil Fardoulis, Christos Gogos, Marieta Theodorakopoulou, Fotini Iatridi, Pantelis Sarafidis, George Giannakoulas, Theodoros Karamitsos, Victoria Delgado, Antonios Ziakas and Vasileios Kamperidis
Diagnostics 2024, 14(14), 1576; https://doi.org/10.3390/diagnostics14141576 - 21 Jul 2024
Viewed by 418
Abstract
Background: In acute heart failure (HF), low cardiac output and venous congestion are pathophysiological mechanisms that contribute to renal function impairment. This study investigated the association between advanced echocardiographic measures of right ventricular and atrial function and renal impairment in patients with acute [...] Read more.
Background: In acute heart failure (HF), low cardiac output and venous congestion are pathophysiological mechanisms that contribute to renal function impairment. This study investigated the association between advanced echocardiographic measures of right ventricular and atrial function and renal impairment in patients with acute HF. Methods and Results: A total of 377 patients hospitalized for acute HF were prospectively evaluated. Estimated glomerular filtration rate (eGFR) on admission was measured using the 2021 Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Advanced echocardiographic assessment was performed on admission. Patients with eGFR < 45 mL/min/1.73 m2 were more likely to have chronic heart failure, chronic atrial fibrillation, and type 2 diabetes mellitus compared to patients with eGFR ≥ 45 mL/min/1.73 m2. Patients with lower eGFR had lower cardiac output, higher mean E/e’ ratio, larger right ventricular (RV) size, worse RV free wall longitudinal strain, more impaired right atrial (RA) reservoir strain, and more frequent severe tricuspid regurgitation. RV free wall longitudinal strain and RA reservoir strain were the only independent echocardiographic associates of low eGFR, whereas cardiac output was not. Conclusions: Impaired RV and RA longitudinal strain were independently associated with eGFR < 45 mL/min/1.73 m2 in acute HF, while reduced cardiac output was not. This suggests that RV and RA dysfunction underlying venous congestion and increased renal afterload are more important pathophysiological determinants of renal impairment in acute HF than reduced cardiac output. Full article
(This article belongs to the Special Issue Editorial Board Members' Collection Series in “Imaging in Heart Diseases”)
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16 pages, 2828 KiB  
Article
Validation of Contrast-Enhanced Mammography as Breast Imaging Modality Compared to Standard Mammography and Digital Breast Tomosynthesis
by Nina Bartolović, Ana Car Peterko, Manuela Avirović, Doris Šegota Ritoša, Emina Grgurević Dujmić and Petra Valković Zujić
Diagnostics 2024, 14(14), 1575; https://doi.org/10.3390/diagnostics14141575 - 21 Jul 2024
Viewed by 413
Abstract
Contrast-enhanced mammography (CEM) is a relatively new imaging technique that allows morphologic, anatomic and functional imaging of the breast. The aim of our study was to validate contrast-enhanced mammography (CEM) compared to mammography (MMG) and digital breast tomosynthesis (DBT) in daily clinical practice. [...] Read more.
Contrast-enhanced mammography (CEM) is a relatively new imaging technique that allows morphologic, anatomic and functional imaging of the breast. The aim of our study was to validate contrast-enhanced mammography (CEM) compared to mammography (MMG) and digital breast tomosynthesis (DBT) in daily clinical practice. This retrospective study included 316 consecutive patients who underwent MMG, DBT and CEM at the Centre for Prevention and Diagnosis of Chronic Diseases of Primorsko-goranska County. Two breast radiologists independently analyzed the image data, without available anamnestic information and without the possibility of comparison with previous images, to determine the presence of suspicious lesions and their morphological features according to the established criteria of the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The diagnostic value of MMG, DBT and CEM was assessed by ROC analysis. The interobserver agreement was excellent. CEM showed higher diagnostic accuracy in terms of sensitivity and specificity compared to MMG and DBT, the reporting time for CEM was significantly shorter, and CEM findings resulted in a significantly lower proportion of equivocal findings (BI-RADS 0), suggesting fewer additional procedures. In conclusion, CEM achieves high diagnostic accuracy while maintaining simplicity, reproducibility and applicability in complex clinical settings. Full article
(This article belongs to the Special Issue Recent Advances in Breast Imaging)
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13 pages, 3357 KiB  
Article
Comparison of the Efficacy of Percutaneous Microwave Ablation Therapy versus Laparoscopic Partial Nephrectomy for Early-Stage Renal Tumors
by Osman Kula, Yeliz Ateş, Hakkı Mete Çek, Atınç Tozsin, Burak Günay, Burak Akgül, Selçuk Korkmaz, Gökhan Karataş, Serdar Solak, Fethi Emre Ustabaşıoğlu and Ersan Arda
Diagnostics 2024, 14(14), 1574; https://doi.org/10.3390/diagnostics14141574 - 20 Jul 2024
Viewed by 339
Abstract
This study aimed to compare the efficacy of percutaneous microwave ablation therapy (MWAT) and laparoscopic partial nephrectomy (LPN) in early-stage renal cell carcinoma (RCC) classified as T1a; a retrospective analysis was conducted on patients treated between January 2017 and November 2023. Oncological outcomes, [...] Read more.
This study aimed to compare the efficacy of percutaneous microwave ablation therapy (MWAT) and laparoscopic partial nephrectomy (LPN) in early-stage renal cell carcinoma (RCC) classified as T1a; a retrospective analysis was conducted on patients treated between January 2017 and November 2023. Oncological outcomes, radiological recurrence, length of stay (LOS), and costs were evaluated. The study included 110 patients, with no significant differences between the two groups regarding residual tumors, local tumor progression, and disease-free survival rates (p > 0.05). The LPN group showed significantly lower pre/postoperative serum urea and creatinine and higher estimated glomerular filtration rate values, whereas the MWA group experienced significantly lower mean costs, complication rates, LOS in the hospital, and procedure durations (p ≤ 0.05). However, post-procedure residual tumors and local tumor progression rates did not differ significantly between the LPN and MWAT groups (p > 0.05). MWAT is as effective as LPN for T1a RCC lesions. In addition, MWAT has lower costs than LPN and is a cost-effective treatment method. Therefore, MWAT minimizes hospital stay and complications and since the oncological results are similar to LPN, it might be considered as the first choice of treatment in young patients. Full article
(This article belongs to the Special Issue Advances in Diagnostic and Interventional Radiology)
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12 pages, 1982 KiB  
Article
Influencing Factors Regarding the Severity of Peri-Implantitis and Peri-Implant Mucositis
by Csilla Benedek, Bernadette Kerekes-Máthé, Liana Bereșescu, Imola Zsuzsa Buka, Zsuzsanna Bardocz-Veres, Ildikó Geréb, Krisztina Ildikó Mártha and Kinga Mária Jánosi
Diagnostics 2024, 14(14), 1573; https://doi.org/10.3390/diagnostics14141573 - 19 Jul 2024
Viewed by 374
Abstract
The scientific literature is increasingly focused on peri-implant mucositis and peri-implantitis, which are biological outcomes of dental implant treatment. Background/Objectives: The present study aimed to evaluate the two most critical complications of dental implantation, peri-implant mucositis and peri-implantitis, through the prism of different [...] Read more.
The scientific literature is increasingly focused on peri-implant mucositis and peri-implantitis, which are biological outcomes of dental implant treatment. Background/Objectives: The present study aimed to evaluate the two most critical complications of dental implantation, peri-implant mucositis and peri-implantitis, through the prism of different influencing factors. Methods: We followed 40 patients, with a total number of 92 dental implants, divided into three age groups: under 35 years, between 35 and 55 years, and older than 55 years. Patients were also divided into groups according to the time since implant placement: 1–3 years, 4–7 years, and more than 7 years. The patients were examined, and periodontal pocket depth, peri-implant pocket depth, Löe–Silness gingival index, mucosal thickness, and keratinized mucosal width were recorded; bone resorption was measured on radiographs using a 2D image analysis method; and a questionnaire was also conducted. Results: Bone resorption was highest in the 35–55 age group (3.09 ± 0.04 mm) and for implants placed 4–7 years ago (3.39 ± 0.12 mm). Females had a mean bone resorption of 3.4 ± 0.15 mm and males of 2.45 ± 0.07 mm. Statistically, there was a significant difference only in the Löe–Silness index: the 35–55 age group had the highest values (p = 0.04). Conclusions: There were no statistically significant differences between the time since implant placement and the degree of bone resorption, nor between sexes. Peri-implant inflammation may occur at any age, regardless of the lifetime of the implants. Full article
(This article belongs to the Special Issue Advances in Oral Diseases Diagnosis and Management: 2nd Edition)
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11 pages, 1544 KiB  
Article
Topotecan in a Real-World Small-Cell Lung Cancer Cohort: Prognostic Biomarkers Improve Selection of Patients for Second-Line Treatment
by Laura Lambrecht, Paola Arnold, Jürgen Behr, Pontus Mertsch, Amanda Tufman and Diego Kauffmann-Guerrero
Diagnostics 2024, 14(14), 1572; https://doi.org/10.3390/diagnostics14141572 - 19 Jul 2024
Viewed by 408
Abstract
Background: Small-cell lung cancer (SCLC) is a highly aggressive tumor, and overall survival (OS) remains poor despite intensive efforts to develop new treatment strategies. In second line, topotecan is the only approved drug, with a median OS of 5.9 months. However, real-world SCLC [...] Read more.
Background: Small-cell lung cancer (SCLC) is a highly aggressive tumor, and overall survival (OS) remains poor despite intensive efforts to develop new treatment strategies. In second line, topotecan is the only approved drug, with a median OS of 5.9 months. However, real-world SCLC patients are often in worse condition and harbor more comorbidities than study populations. Therefore, the real-world performance of topotecan may differ from that seen in studies. Here, we analyzed outcomes of SCLC patients receiving topotecan and identified predictive and prognostic markers. Patients and Methods: We retrospectively analyzed 44 consecutive SCLC patients receiving topotecan between 2015 and 2022. We analyzed baseline characteristics (age, ECOG-PS, topotecan cycles, and dosage) and pre-treatment blood values (LDH, CRP, sodium) as well as prognostic scores (neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio (TLR), Glasgow Prognostic Score, prognostic nutritional score, systemic inflammation index (SII), and the prognostic index) extracted from electronic patients’ charts to identify predictive and prognostic markers. Results: In our cohort, mPFS and mOS were only 1.9 and 5.6 months, respectively. Gender, ECOG-PS, active brain metastases, NLR, GPS, PNI, and SII significantly influenced PFS and OS in univariate analysis. ECOG-PS (p > 0.001), active brain metastases (p = 0.001), and SII (p = 0.008) were significant independent prognostic variables in a multivariate COX regression model. Selecting patients by these three markers achieved an mPFS of 5.7 months and thus increased the mPFS three-fold. Patients not meeting all criteria had an mPFS of 1.8 months (p = 0.006). Patients identified by prognostic markers had an mOS of 9.1 months (p = 0.002). Conclusions: The efficacy of topotecan in SCLC real-world patients is poor, indicating that many patients were treated without any benefit. Easy-to-obtain markers can predict response and treatment efficacy and should therefore be validated in larger cohorts to identify patients who are more likely to benefit from topotecan. Full article
(This article belongs to the Special Issue Diagnosis, Classification, and Monitoring of Pulmonary Diseases)
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21 pages, 5587 KiB  
Article
Implementing Explainable Machine Learning Models for Practical Prediction of Early Neonatal Hypoglycemia
by Lin-Yu Wang, Lin-Yen Wang, Mei-I Sung, I-Chun Lin, Chung-Feng Liu and Chia-Jung Chen
Diagnostics 2024, 14(14), 1571; https://doi.org/10.3390/diagnostics14141571 - 19 Jul 2024
Viewed by 323
Abstract
Hypoglycemia is a common metabolic disorder that occurs in the neonatal period. Early identification of neonates at risk of developing hypoglycemia can optimize therapeutic strategies in neonatal care. This study aims to develop a machine learning model and implement a predictive application to [...] Read more.
Hypoglycemia is a common metabolic disorder that occurs in the neonatal period. Early identification of neonates at risk of developing hypoglycemia can optimize therapeutic strategies in neonatal care. This study aims to develop a machine learning model and implement a predictive application to assist clinicians in accurately predicting the risk of neonatal hypoglycemia within four hours after birth. Our retrospective study analyzed data from neonates born ≥35 weeks gestational age and admitted to the well-baby nursery between 1 January 2011 and 31 August 2021. We collected electronic medical records of 2687 neonates from a tertiary medical center in Southern Taiwan. Using 12 clinically relevant features, we evaluated nine machine learning approaches to build the predictive models. We selected the models with the highest area under the receiver operating characteristic curve (AUC) for integration into our hospital information system (HIS). The top three AUC values for the early neonatal hypoglycemia prediction models were 0.739 for Stacking, 0.732 for Random Forest and 0.732 for Voting. Random Forest is considered the best model because it has a relatively high AUC and shows no significant overfitting (accuracy of 0.658, sensitivity of 0.682, specificity of 0.649, F1 score of 0.517 and precision of 0.417). The best model was incorporated in the web-based application integrated into the hospital information system. Shapley Additive Explanation (SHAP) values indicated mode of delivery, gestational age, multiparity, respiratory distress, and birth weight < 2500 gm as the top five predictors of neonatal hypoglycemia. The implementation of our machine learning model provides an effective tool that assists clinicians in accurately identifying at-risk neonates for early neonatal hypoglycemia, thereby allowing timely interventions and treatments. Full article
(This article belongs to the Special Issue AI-Driven Diagnostics: Transforming Healthcare from Data to Clinical Decisions)
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8 pages, 455 KiB  
Brief Report
Left Atrial Volume Index Predicts Atrial Fibrillation Recurrence after Catheter Ablation Only in Obese Patients—Brief Report
by Franjo Husam Naji, Jan Alatic, Igor Balevski and David Suran
Diagnostics 2024, 14(14), 1570; https://doi.org/10.3390/diagnostics14141570 - 19 Jul 2024
Viewed by 291
Abstract
Background: It has been shown that obesity and a higher body mass index (BMI) are associated with a higher recurrence rate of atrial fibrillation (AF) after successful catheter ablation (CA). The same has been proven for the left atrial volume index (LAVI). It [...] Read more.
Background: It has been shown that obesity and a higher body mass index (BMI) are associated with a higher recurrence rate of atrial fibrillation (AF) after successful catheter ablation (CA). The same has been proven for the left atrial volume index (LAVI). It has also been shown that there is a correlation between LAVI and BMI. However, whether the LAVI’s prognostic impact on AF recurrence is BMI-independent remains unclear. Methods: We prospectively included 62 patients with paroxysmal AF who were referred to our institution for CA. All patients underwent radiofrequency CA with standard pulmonary veins isolation. Transthoracic 2-D echocardiography was performed one day after CA to obtain standard measures of cardiac function and morphology. Recurrence was defined as documented AF within 6 months of the follow-up period. Patients were also instructed to visit our outpatient clinic earlier in case of symptoms suggesting AF recurrence. Results: We observed AF recurrence in 27% of patients after 6 months. The mean BMI in our cohort was 29.65 ± 5.08 kg/cm2 and the mean LAVI was 38.04 ± 11.38 mL/m2. We further divided patients into two groups according to BMI. Even though the LAVI was similar in both groups, we found it to be a significant predictor of AF recurrence only in obese patients (BMI ≥ 30) and not in the non-obese group (BMI < 30). There was also no significant difference in AF recurrence between both cohorts. The significance of the LAVI as an AF recurrence predictor in the obesity group was also confirmed in a multivariate model. Conclusions: According to our results, the LAVI tends to be a significant predictor of AF recurrence after successful catheter ablation in obese patients, but not in normal-weight or overweight patients. This would suggest different mechanisms of AF in non-obese patients in comparison to obese patients. Further studies are needed in this regard. Full article
(This article belongs to the Section Pathology and Molecular Diagnostics)
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13 pages, 925 KiB  
Article
Impact of Obesity on Target Organ Damage in Patients with Metabolic Syndrome
by Svetlana Kostić, Ivan Tasić, Nikola Stojanović, Jelena Rakočević, Marina Deljanin Ilić, Dragan Đorđević, Viktor Stoičkov and Isidora Tasić
Diagnostics 2024, 14(14), 1569; https://doi.org/10.3390/diagnostics14141569 - 19 Jul 2024
Viewed by 411
Abstract
Background: Metabolic syndrome (MetSy) is characterized by the presence of obesity, hypertension, altered glucose metabolism, and/or increased non-HDL cholesterol. This study aimed at elucidating the association between obesity with subclinical target organ damage and biochemical parameters included in MetSy pathogenesis. Methods: This study [...] Read more.
Background: Metabolic syndrome (MetSy) is characterized by the presence of obesity, hypertension, altered glucose metabolism, and/or increased non-HDL cholesterol. This study aimed at elucidating the association between obesity with subclinical target organ damage and biochemical parameters included in MetSy pathogenesis. Methods: This study included 130 apparently healthy subjects. Plasma levels of oxidized-LDL-cholesterol (ox-LDL-Chol), nitric oxide (NO) metabolites, inducible NO synthase (iNOS), and plasminogen activator inhibitor-1 (PAI-1) were measured. Non-invasive assessment of liver disease included fatty liver index (FLI) and nonalcoholic fatty liver disease (NAFLD) fibrosis score. Carotid artery plaques were assessed by color Doppler imaging. Results: A total of 65 patients with MetSy were included in the MetSy group, while 65 without MetSy entered the control group. Ox-LDL-Chol levels were higher in the MetSy group compared to the control group, regardless of obesity. Levels of NO metabolites were similar in obese and non-obese patients with MetSy, but lower than in the control group. Obese patients with MetSy had higher iNOS values compared to non-obese ones, with similar PAI-1 levels. NAFLD was present in all obese patients with MetSy compared to 70% of non-obese subjects. Hypertension, higher values of waist-to-hip ratio, PAI-1, and remnant cholesterol were associated with NAFLD. Finding of asymptomatic carotid plaques was associated with patients’ age, hypertension, and higher waist-to-hip ratio. Conclusion: MetSy and obesity significantly alter the levels of NO metabolites, iNOS, ox-LDL-Chol, and PAI-1. High prevalence of NAFLD in obese patients with MetSy requires active screening and treatment of potential risk factors. Full article
(This article belongs to the Special Issue Diagnosis, Biomarkers, and Treatment of Metabolic Disorders)
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17 pages, 319 KiB  
Review
Real-World Research on Retinal Diseases Using Health Claims Database: A Narrative Review
by Seong Joon Ahn
Diagnostics 2024, 14(14), 1568; https://doi.org/10.3390/diagnostics14141568 - 19 Jul 2024
Viewed by 390
Abstract
Real-world data (RWD) has emerged as a crucial component in understanding and improving patient outcomes across various medical conditions, including retinal diseases. Health claims databases, generated from healthcare reimbursement claims, offer a comprehensive source of RWD, providing insights into patient outcomes, healthcare utilization, [...] Read more.
Real-world data (RWD) has emerged as a crucial component in understanding and improving patient outcomes across various medical conditions, including retinal diseases. Health claims databases, generated from healthcare reimbursement claims, offer a comprehensive source of RWD, providing insights into patient outcomes, healthcare utilization, and treatment effectiveness. However, the use of these databases for research also presents unique challenges. This narrative review explores the role of real-world research on retinal diseases using health claims databases, highlighting their advantages, limitations, and potential contributions to advancing our understanding and management of the diseases. The review examines the applications of health claims databases in retinal disease research, including epidemiological studies, comparative effectiveness and safety analyses, economic burden assessments, and evaluations of patient outcomes and quality of care. Previous findings demonstrate the value of these databases in generating prevalence and incidence estimates, identifying risk factors and predictors, evaluating treatment effectiveness and safety, and understanding healthcare utilization patterns and costs associated with retinal diseases. Despite their strengths, health claims databases face challenges related to data limitations, biases, privacy concerns, and methodological issues. Accordingly, the review also explores future directions and opportunities, including advancements in data collection and analysis, integration with electronic health records, collaborative research networks and consortia, and the evolving regulatory landscape. These developments are expected to enhance the utility of health claims databases for retinal disease research, resulting in more comprehensive and impactful findings across diverse retinal disorders and robust real-world insights from a large population. Full article
(This article belongs to the Special Issue Eye Disease: Diagnosis, Management, and Prognosis)
25 pages, 21716 KiB  
Article
Explainable AI for Interpretation of Ovarian Tumor Classification Using Enhanced ResNet50
by Srirupa Guha, Ashwini Kodipalli, Steven L. Fernandes and Santosh Dasar
Diagnostics 2024, 14(14), 1567; https://doi.org/10.3390/diagnostics14141567 - 19 Jul 2024
Viewed by 323
Abstract
Deep learning architectures like ResNet and Inception have produced accurate predictions for classifying benign and malignant tumors in the healthcare domain. This enables healthcare institutions to make data-driven decisions and potentially enable early detection of malignancy by employing computer-vision-based deep learning algorithms. These [...] Read more.
Deep learning architectures like ResNet and Inception have produced accurate predictions for classifying benign and malignant tumors in the healthcare domain. This enables healthcare institutions to make data-driven decisions and potentially enable early detection of malignancy by employing computer-vision-based deep learning algorithms. These CNN algorithms, in addition to requiring huge amounts of data, can identify higher- and lower-level features that are significant while classifying tumors into benign or malignant. However, the existing literature is limited in terms of the explainability of the resultant classification, and identifying the exact features that are of importance, which is essential in the decision-making process for healthcare practitioners. Thus, the motivation of this work is to implement a custom classifier on the ovarian tumor dataset, which exhibits high classification performance and subsequently interpret the classification results qualitatively, using various Explainable AI methods, to identify which pixels or regions of interest are given highest importance by the model for classification. The dataset comprises CT scanned images of ovarian tumors taken from to the axial, saggital and coronal planes. State-of-the-art architectures, including a modified ResNet50 derived from the standard pre-trained ResNet50, are implemented in the paper. When compared to the existing state-of-the-art techniques, the proposed modified ResNet50 exhibited a classification accuracy of 97.5 % on the test dataset without increasing the the complexity of the architecture. The results then were carried for interpretation using several explainable AI techniques. The results show that the shape and localized nature of the tumors play important roles for qualitatively determining the ability of the tumor to metastasize and thereafter to be classified as benign or malignant. Full article
(This article belongs to the Section Machine Learning and Artificial Intelligence in Diagnostics)
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15 pages, 1712 KiB  
Article
MV-MFF: Multi-View Multi-Feature Fusion Model for Pneumonia Classification
by Najla Alsulami, Hassan Althobaiti and Tarik Alafif
Diagnostics 2024, 14(14), 1566; https://doi.org/10.3390/diagnostics14141566 - 19 Jul 2024
Viewed by 432
Abstract
Pneumonia ranks among the most prevalent lung diseases and poses a significant concern since it is one of the diseases that may lead to death around the world. Diagnosing pneumonia necessitates a chest X-ray and substantial expertise to ensure accurate assessments. Despite the [...] Read more.
Pneumonia ranks among the most prevalent lung diseases and poses a significant concern since it is one of the diseases that may lead to death around the world. Diagnosing pneumonia necessitates a chest X-ray and substantial expertise to ensure accurate assessments. Despite the critical role of lateral X-rays in providing additional diagnostic information alongside frontal X-rays, they have not been widely used. Obtaining X-rays from multiple perspectives is crucial, significantly improving the precision of disease diagnosis. In this paper, we propose a multi-view multi-feature fusion model (MV-MFF) that integrates latent representations from a variational autoencoder and a β-variational autoencoder. Our model aims to classify pneumonia presence using multi-view X-rays. Experimental results demonstrate that the MV-MFF model achieves an accuracy of 80.4% and an area under the curve of 0.775, outperforming current state-of-the-art methods. These findings underscore the efficacy of our approach in improving pneumonia diagnosis through multi-view X-ray analysis. Full article
(This article belongs to the Section Machine Learning and Artificial Intelligence in Diagnostics)
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12 pages, 223 KiB  
Review
A Review of Current Evidence for the Use of Steroids in the Medical Intensive Care Unit
by Patrick Jenkins, Cory Cross, Tony Abdo, Houssein Youness and Jean Keddissi
Diagnostics 2024, 14(14), 1565; https://doi.org/10.3390/diagnostics14141565 - 19 Jul 2024
Viewed by 717
Abstract
Systemic steroids are frequently used in critically ill patients for their anti-inflammatory properties. Potential benefits of these agents should be balanced against their known side effects. In this paper, we review trials assessing the use of systemic steroids in common conditions requiring admission [...] Read more.
Systemic steroids are frequently used in critically ill patients for their anti-inflammatory properties. Potential benefits of these agents should be balanced against their known side effects. In this paper, we review trials assessing the use of systemic steroids in common conditions requiring admission to the intensive care unit. These include septic shock, the acute respiratory distress syndrome, severe pneumonia, COVID-19, and hypercapnic respiratory failure due to chronic obstructive pulmonary disease. We will mainly focus on well-conducted randomized controlled trials to determine whether steroids should be administered to critically ill patients presenting with these conditions. Full article
(This article belongs to the Special Issue Pulmonary Disease: Diagnosis and Management)
15 pages, 491 KiB  
Systematic Review
Assessment of the Diagnostic Efficacy of Low-Field Magnetic Resonance Imaging: A Systematic Review
by Barbora Mašková, Martin Rožánek, Ondřej Gajdoš, Evgeniia Karnoub, Vojtěch Kamenský and Gleb Donin
Diagnostics 2024, 14(14), 1564; https://doi.org/10.3390/diagnostics14141564 - 19 Jul 2024
Viewed by 343
Abstract
Background: In recent years, there has been an increasing effort to take advantage of the potential use of low magnetic induction devices with less than 1 T, referred to as Low-Field MRI (LF MRI). LF MRI systems were used, especially in the early [...] Read more.
Background: In recent years, there has been an increasing effort to take advantage of the potential use of low magnetic induction devices with less than 1 T, referred to as Low-Field MRI (LF MRI). LF MRI systems were used, especially in the early days of magnetic resonance technology. Over time, magnetic induction values of 1.5 and 3 T have become the standard for clinical devices, mainly because LF MRI systems were suffering from significantly lower quality of the images, e.g., signal–noise ratio. In recent years, due to advances in image processing with artificial intelligence, there has been an increasing effort to take advantage of the potential use of LF MRI with induction of less than 1 T. This overview article focuses on the analysis of the evidence concerning the diagnostic efficacy of modern LF MRI systems and the clinical comparison of LF MRI with 1.5 T systems in imaging the nervous system, musculoskeletal system, and organs of the chest, abdomen, and pelvis. Methodology: A systematic literature review of MEDLINE, PubMed, Scopus, Web of Science, and CENTRAL databases for the period 2018–2023 was performed according to the recommended PRISMA protocol. Data were analysed to identify studies comparing the accuracy, reliability and diagnostic performance of LF MRI technology compared to available 1.5 T MRI. RESULTS: A total of 1275 publications were retrieved from the selected databases. Only two articles meeting all predefined inclusion criteria were selected for detailed assessment. Conclusions: A limited number of robust studies on the accuracy and diagnostic performance of LF MRI compared with 1.5 T MRI was available. The current evidence is not sufficient to draw any definitive insights. More scientific research is needed to make informed conclusions regarding the effectiveness of LF MRI technology. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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13 pages, 920 KiB  
Review
Sample Collection and Processing in Volatile Organic Compound Analysis for Gastrointestinal Cancers
by Weiyang Zheng, Yiyang Min, Ke Pang and Dong Wu
Diagnostics 2024, 14(14), 1563; https://doi.org/10.3390/diagnostics14141563 - 19 Jul 2024
Viewed by 371
Abstract
Volatile organic compounds have drawn significant attention in recent years as a novel tool for non-invasive detection of a wide range of diseases, including gastrointestinal cancers, for which the need for effective, affordable, and non-invasive screening methods is substantial. Sample preparation is a [...] Read more.
Volatile organic compounds have drawn significant attention in recent years as a novel tool for non-invasive detection of a wide range of diseases, including gastrointestinal cancers, for which the need for effective, affordable, and non-invasive screening methods is substantial. Sample preparation is a fundamental step that greatly influences the quality of results and the feasibility of wide-range applications. This review summarizes sampling methods used in studies aiming at testing the diagnostic value of volatile organic compounds in gastrointestinal cancers, discussing in detail some of the recent advancements in automated sampling techniques. Finally, we propose some directions in which sample collection and processing can improve for VOC analysis to be popularized in clinical settings. Full article
(This article belongs to the Section Clinical Laboratory Medicine)
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12 pages, 4678 KiB  
Article
The Role of Line-Field Confocal Optical Coherence Tomography in Detecting Extramammary Paget Disease Recurrences: A Pilot Diagnostic Study
by Gwendoline Diet, Clément Lenoir, Margot Fontaine, Lucas Boussingault, Carmen Orte Cano, Lyna Mtimet, Danielle Liénard, Dilara Sanak, Florine Moulart, Dana Bernardi, Anne-Laure Trepant, Javiera Perez-Anker, Susana Puig, Josep Malvehy, Elisa Cinotti, Linda Tognetti, Pietro Rubegni, Jean-Luc Perrot, Véronique Del Marmol and Mariano Suppa
Diagnostics 2024, 14(14), 1562; https://doi.org/10.3390/diagnostics14141562 - 19 Jul 2024
Viewed by 324
Abstract
Extramammary Paget disease (EMPD) is an uncommon adenocarcinoma of apocrine gland-rich areas, presenting significant diagnostic challenges due to its nonspecific clinical appearance and frequent misidentification as benign, inflammatory skin conditions. Traditional diagnostic methods such as biopsy are invasive and uncomfortable, often required repeatedly [...] Read more.
Extramammary Paget disease (EMPD) is an uncommon adenocarcinoma of apocrine gland-rich areas, presenting significant diagnostic challenges due to its nonspecific clinical appearance and frequent misidentification as benign, inflammatory skin conditions. Traditional diagnostic methods such as biopsy are invasive and uncomfortable, often required repeatedly due to high recurrence rates. Dermoscopy and non-invasive imaging techniques have been used but provide limited diagnostic accuracy due to their constraints in depth penetration and resolution. Recent advancements in imaging technologies, such as line-field confocal optical coherence tomography (LC-OCT), show promise in enhancing diagnostic precision while minimizing invasive procedures. LC-OCT merges high-resolution imaging with deep penetration capabilities, capturing detailed horizontal and vertical skin images akin to histopathology. This study evaluated the diagnostic performance of LC-OCT in detecting EMPD and its recurrence in 17 clinically suspicious anogenital regions, belonging to six patients. Data were collected prospectively at the patient’s bedside by an LC-OCT expert with poor training for EMPD, and, then, reviewed retrospectively by an independent LC-OCT expert with adequate training for EMPD and no concerns about time. The prospective examination yielded 64.7% accuracy (11 true results out of 17 total cases), 71.4% sensitivity (10 true positives out of 14 actual positives), and 33.3% specificity (1 true negative out of 3 actual negatives). The retrospective analysis achieved 94.1% accuracy (16 true results out of 17 total cases), 100% sensitivity (14 true positives out of 14 actual positives), and 66.7% specificity (2 true positives out of 3 actual positives), with the only false positive case being a difficult-to-diagnose concomitant presentation of a lichen sclerosus et atrophicus. Despite the need for specialized training, our results suggest that LC-OCT represents a valuable tool for accurately identifying EMPD and improving its management by reducing unnecessary biopsies. Further studies are needed to standardize its clinical application. Full article
(This article belongs to the Collection Medical Optical Imaging)
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10 pages, 992 KiB  
Article
Establishing a Foundation for the In Vivo Visualization of Intravascular Blood with Photon-Counting Technology in Spectral Imaging in Cranial CT
by Anna Klempka, Philipp Neumayer, Alexander Schröder, Eduardo Ackermann, Svetlana Hetjens, Sven Clausen and Christoph Groden
Diagnostics 2024, 14(14), 1561; https://doi.org/10.3390/diagnostics14141561 - 19 Jul 2024
Viewed by 347
Abstract
Background: Advances in computed tomography (CT) technology, particularly photon-counting CT (PCCT), are reshaping the possibilities for medical imaging. PCCT in spectral imaging enables the high-resolution visualization of tissues with material-specific accuracy. This study aims to establish a foundational approach for the in vivo [...] Read more.
Background: Advances in computed tomography (CT) technology, particularly photon-counting CT (PCCT), are reshaping the possibilities for medical imaging. PCCT in spectral imaging enables the high-resolution visualization of tissues with material-specific accuracy. This study aims to establish a foundational approach for the in vivo visualization of intracranial blood using PCCT, focusing on non-enhanced imaging techniques and spectral imaging capabilities. Methods: We employed photon-counting detector within a spectral CT framework to differentiate between venous and arterial intracranial blood. Our analysis included not only monoenergetic +67 keV reconstructions, but also images from virtual non-contrast and iodine phases, enabling detailed assessments of blood’s characteristics without the use of contrast agents. Results: Our findings demonstrate the ability of PCCT to provide clear and distinct visualizations of intracranial vascular structures. We quantified the signal-to-noise ratio across different imaging phases and found consistent enhancements in image clarity, particularly in the detection and differentiation of arterial and venous blood. Conclusion: PCCT offers a robust platform for the non-invasive and detailed visualization of intravascular intracranial blood. With its superior resolution and specific imaging capabilities, PCCT lays the groundwork for advancing clinical applications and research, notably in the diagnosis and management of intracranial disorders. This technology promises to improve diagnostic accuracy by enabling more precise imaging assessments. Full article
(This article belongs to the Special Issue Recent Advances in Computed Tomography Imaging for Clinical Diagnosis)
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11 pages, 2471 KiB  
Article
Improvement of Breast Cancer Detection Using Dual-Layer Spectral CT
by Felix Christian Hasse, Athanasios Giannakis, Eckhard Wehrse, Wolfram Stiller, Markus Wallwiener, Hans-Ulrich Kauczor, Tim F. Weber, Jörg Heil and Theresa Mokry
Diagnostics 2024, 14(14), 1560; https://doi.org/10.3390/diagnostics14141560 - 19 Jul 2024
Viewed by 407
Abstract
This study aimed to investigate the diagnostic performance of breast mass detection on monoenergetic image data at 40 keV (MonoE40) and on iodine maps (IM) compared with conventional image data (CI). In this prospective single-center case-control study, 50 breast cancer patients were examined [...] Read more.
This study aimed to investigate the diagnostic performance of breast mass detection on monoenergetic image data at 40 keV (MonoE40) and on iodine maps (IM) compared with conventional image data (CI). In this prospective single-center case-control study, 50 breast cancer patients were examined using contrast-enhanced dual-layer spectral CT. For qualitative and quantitative comparison of MonoE40 and IM with CI image data, four blinded, independent readers assessed 300 randomized single slices (two slices for each imaging type per case) with or without cancerous lesions for the presence of a breast mass. Detection sensitivity and specificity were calculated and readers rated their subjective diagnostic certainty. For statistical analysis of sensitivity and specificity, a paired t-test and ANOVA were used (significance level p = 0.05). A total of 50 female patients (median age 51 years, range 28–83 years) participated. IM had the highest overall scores in sensitivity and specificity for breast cancer detection, with 0.97 ± 0.06 and 0.95 ± 0.07, respectively, compared with 0.90 ± 0.04 and 0.92 ± 0.06 in CI. MonoE40 yielded a sensitivity of 0.96 ± 0.02 and specificity of 0.94 ± 0.08. All differences in sensitivity and specificity between MonoE or IM and CI were statistically significant (p < 0.001). The superiority of IM sensitivity and specificity was most pronounced in patients with dense breasts. Spectral CT improved the detection of breast cancer with higher sensitivity and specificity compared to conventional image data in our study. Full article
(This article belongs to the Special Issue Advances in the Diagnosis of Cancer/Tumors)
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16 pages, 4882 KiB  
Article
Dental Age Assessment Based on Developmental Stages and Maturity Index of Third Molars for Medico-Legal Purposes
by Petra Švábová, Michal Soták, Branislav Galis, Patrícia Kroupová, Lucia Bundová, Adriana Vojtušová, Soňa Masnicová and Radoslav Beňuš
Diagnostics 2024, 14(14), 1559; https://doi.org/10.3390/diagnostics14141559 - 18 Jul 2024
Viewed by 337
Abstract
As results may vary depending on the method of examination, this paper analyzes methods of age estimation based on the maturation index of third molars (I3M) and Kohler’s developmental stages in living individuals. A total of 1475 orthopantomograms were analyzed. The [...] Read more.
As results may vary depending on the method of examination, this paper analyzes methods of age estimation based on the maturation index of third molars (I3M) and Kohler’s developmental stages in living individuals. A total of 1475 orthopantomograms were analyzed. The results showed that the development of third molars tended to be more advanced in males than in females. Regression equations that included the value of the developmental stage of the left third molar most accurately predicted chronologic age in males and females. Using the I3M method, there were no statistically significant bilateral differences between the mandibular right and left third molars. Overall, 82.92% of males and only 72.82% of females were correctly classified with the cut-off value (0.08) for the left mandibular third molar index. In addition, 81.97% of individuals were correctly classified as minors and adults using the Kohler method, while only 78.62% of individuals were correctly classified as minors and adults using the I3M method. Based on the misclassification of minors as adults, both methods should be used with caution and overestimation of age should be considered, especially for those close to 18 years of age. Full article
(This article belongs to the Special Issue Oral and Maxillofacial Image Diagnosis 2.0)
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2 pages, 163 KiB  
Editorial
Interesting Images in Obstetrics and Gynecology
by Nicolae Gică
Diagnostics 2024, 14(14), 1558; https://doi.org/10.3390/diagnostics14141558 - 18 Jul 2024
Viewed by 294
Abstract
Dear Readers, [...] Full article
(This article belongs to the Special Issue Interesting Images in Obstetrics and Gynecology)
13 pages, 1480 KiB  
Article
Impacts and Correlations on Corneal Biomechanics, Corneal Optical Density and Intraocular Pressure after Cataract Surgery
by Fang-Yang Lin, Ren-Wen Ho, Hun-Ju Yu, I-Hui Yang, Po-Chiung Fang and Ming-Tse Kuo
Diagnostics 2024, 14(14), 1557; https://doi.org/10.3390/diagnostics14141557 - 18 Jul 2024
Viewed by 309
Abstract
The study aimed to investigate the extended effects and interrelations of corneal biomechanics, corneal optical density (COD), corneal thickness (CT), and intraocular pressure (IOP) following cataract surgery. Sixteen eyes were analyzed prospectively. The Corneal Visualization Scheimpflug Technology (Corvis ST) device assessed corneal biomechanics, [...] Read more.
The study aimed to investigate the extended effects and interrelations of corneal biomechanics, corneal optical density (COD), corneal thickness (CT), and intraocular pressure (IOP) following cataract surgery. Sixteen eyes were analyzed prospectively. The Corneal Visualization Scheimpflug Technology (Corvis ST) device assessed corneal biomechanics, while the Pentacam AxL® (Pentacam) measured COD and CT. Postoperative data were collected around six months after surgery, with a subgroup analysis of data at nine months. The Pearson correlation was used to examine the relationship between surgical-induced changes in corneal biomechanics and COD. At six months, significant postoperative differences were observed in various biomechanical indices, including uncorrected IOP (IOPuct) and biomechanics-corrected IOP (bIOP). However, many indices lost statistical significance by the nine-month mark, suggesting the reversibility of postoperative corneal changes. Postoperative COD increased at the anterior layer of the 2−6 mm annulus and incision site. The changes in COD correlated with certain biomechanical indices, including maximal (Max) deformative amplitude (DA) and stiffness parameter (SP). In conclusion, despite significant immediate postoperative changes, corneal biomechanics, COD, and IOP experienced a gradual recovery process following cataract surgery. Clinicians should maintain vigilance for any unusual changes during the short-term observation period to detect abnormalities early. Full article
(This article belongs to the Special Issue Advances in Diagnostics of the Cornea, Cataract and Refractive Surgery)
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10 pages, 2767 KiB  
Article
Reference Ranges of 2-Dimensional Placental Biometry and 3-Dimensional Placental Volume between 11 and 14 Weeks of Gestation
by Cristina Trilla Solà, Juan Parra Roca and Elisa Llurba Olivé
Diagnostics 2024, 14(14), 1556; https://doi.org/10.3390/diagnostics14141556 - 18 Jul 2024
Viewed by 280
Abstract
Objective: The purpose of this study was to provide gestational age (GA) specific reference ranges for 2-dimensional (2D) placental biometry and 3-dimensional (3D) placental volume between 11 and 14 weeks of gestation. Methods: Placental biometry including 2D and 3D variables was calculated in [...] Read more.
Objective: The purpose of this study was to provide gestational age (GA) specific reference ranges for 2-dimensional (2D) placental biometry and 3-dimensional (3D) placental volume between 11 and 14 weeks of gestation. Methods: Placental biometry including 2D and 3D variables was calculated in 1142 first-trimester singleton pregnancies with non-complicated outcome between September 2016 and February 2020. Ultrasound datasets were obtained at the time of the first-trimester ultrasound, and 2D basal plate (BP), chorionic plate (CP), placental thickness (PT), and 3D placental volume (PV) were measured following a standardized methodology. Reference ranges for each variable were calculated according to GA and crown-rump-length (CRL). Results: A total of 1142 uncomplicated pregnancies were considered for analysis. All placental measurements increased significantly between 11 and 14 weeks, especially for PT (39.64%) and PV (64.4%). Reference ranges were constructed for each 2D and 3D first-trimester placental variable using the best-fit regression model for the predicted mean and SD as a function of GA and CRL. Conclusions: Reference ranges of 2D placental biometry and 3D placental volume between 11 and 14 weeks of gestation were constructed, generating reference values. Placental biometry showed a progressive increase during the first trimester. This highlights the importance of using reference range charts according to GA. Full article
(This article belongs to the Special Issue Diagnosis and Management in Prenatal Medicine—3rd Edition)
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22 pages, 5643 KiB  
Review
Adverse Effects Associated with Dermal Filler Treatments: Part II Vascular Complication
by Gi-Woong Hong, Hyewon Hu, Kathleen Chang, Youngjin Park, Kar Wai Alvin Lee, Lisa Kwin Wah Chan and Kyu-Ho Yi
Diagnostics 2024, 14(14), 1555; https://doi.org/10.3390/diagnostics14141555 - 18 Jul 2024
Cited by 1 | Viewed by 445
Abstract
Vascular complications arising from dermal filler treatments pose significant risks, including ischemia, tissue necrosis, and severe outcomes like blindness and pulmonary embolism. This study investigates the mechanisms of vascular complications, categorizing them into extravascular compression and intravascular emboli. Extravascular compression occurs when injected [...] Read more.
Vascular complications arising from dermal filler treatments pose significant risks, including ischemia, tissue necrosis, and severe outcomes like blindness and pulmonary embolism. This study investigates the mechanisms of vascular complications, categorizing them into extravascular compression and intravascular emboli. Extravascular compression occurs when injected fillers compress adjacent blood vessels, leading to ischemia and potential necrosis, while intravascular emboli result from fillers entering blood vessels, causing blockages. The study emphasizes the importance of anatomical knowledge, careful injection techniques, and early intervention. Management strategies include the use of hyaluronidase to dissolve HA fillers, vasodilators to improve blood circulation, and hyperbaric oxygen therapy. The regions most susceptible to complications align with major arterial pathways, particularly the nasolabial folds and nasal region. The study also highlights the need for meticulous injection techniques, the use of cannulas over needles in high-risk areas, and the aspiration test to detect vessel penetration. Early detection and immediate intervention are crucial to mitigate adverse outcomes. Continuous education and training for practitioners, along with advancements in filler materials and injection methods, are essential for improving the safety of cosmetic procedures. This comprehensive understanding aids in preventing and managing vascular complications, ensuring better patient outcomes. The field of dermal filler treatments is advancing with new techniques and technologies, such as High-Resolution Ultrasound, Infrared Imaging, self-crossing hyaluronic acid filler, biodegradable microspheres, and microinjection. Full article
(This article belongs to the Special Issue Advances in Anatomy—Third Edition)
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1 pages, 120 KiB  
Editorial
Diagnostics Increases Visibility
by Andreas Kjaer
Diagnostics 2024, 14(14), 1554; https://doi.org/10.3390/diagnostics14141554 - 18 Jul 2024
Viewed by 310
Abstract
It is with great pleasure that we announce that our journal has recently received the 2023 CiteScore of 4 [...] Full article
11 pages, 451 KiB  
Article
Kallistatin as a Potential Biomarker in Polycystic Ovary Syndrome: A Prospective Cohort Study
by Aslihan Yurtkal and Mujde Canday
Diagnostics 2024, 14(14), 1553; https://doi.org/10.3390/diagnostics14141553 - 18 Jul 2024
Viewed by 343
Abstract
Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder with significant metabolic implications, including an increased risk of cardiovascular diseases and diabetes. Kallistatin, a serine proteinase inhibitor with anti-inflammatory and antioxidative properties, has been identified as a potential biomarker for PCOS due [...] Read more.
Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder with significant metabolic implications, including an increased risk of cardiovascular diseases and diabetes. Kallistatin, a serine proteinase inhibitor with anti-inflammatory and antioxidative properties, has been identified as a potential biomarker for PCOS due to its role in modulating inflammation and oxidative stress. Methods: This prospective cohort study was conducted at a university hospital’s gynecology clinic. It included 220 women diagnosed with PCOS and 220 healthy controls matched for age and body mass index. Kallistatin levels were quantitatively assessed using enzyme-linked immunosorbent assay (ELISA) techniques. Associations between kallistatin levels and clinical manifestations of PCOS, including hyperandrogenism and metabolic profiles, were examined. Results: Kallistatin levels were significantly lower in patients with PCOS (2.65 ± 1.84 ng/mL) compared to controls (6.12 ± 4.17 ng/mL; p < 0.001). A strong negative correlation existed between kallistatin levels and androgen concentrations (r = −0.782, p = 0.035). No significant associations were found between kallistatin levels and insulin resistance or lipid profiles. Conclusions: The findings indicate that reduced kallistatin levels are closely associated with PCOS and could serve as a promising biomarker for its diagnosis. The specific correlation with hyperandrogenism suggests that kallistatin could be particularly effective for identifying PCOS subtypes characterized by elevated androgen levels. This study supports the potential of kallistatin in improving diagnostic protocols for PCOS, facilitating earlier and more accurate detection, which is crucial for effective management and treatment. Full article
(This article belongs to the Section Pathology and Molecular Diagnostics)
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16 pages, 4986 KiB  
Article
Radiomic Gradient in Peritumoural Tissue of Liver Metastases: A Biomarker for Clinical Practice? Analysing Density, Entropy, and Uniformity Variations with Distance from the Tumour
by Francesco Fiz, Elisa Maria Ragaini, Sara Sirchia, Chiara Masala, Samuele Viganò, Marco Francone, Lara Cavinato, Ettore Lanzarone, Angela Ammirabile and Luca Viganò
Diagnostics 2024, 14(14), 1552; https://doi.org/10.3390/diagnostics14141552 - 18 Jul 2024
Viewed by 328
Abstract
The radiomic analysis of the tissue surrounding colorectal liver metastases (CRLM) enhances the prediction accuracy of pathology data and survival. We explored the variation of the textural features in the peritumoural tissue as the distance from CRLM increases. We considered patients with hypodense [...] Read more.
The radiomic analysis of the tissue surrounding colorectal liver metastases (CRLM) enhances the prediction accuracy of pathology data and survival. We explored the variation of the textural features in the peritumoural tissue as the distance from CRLM increases. We considered patients with hypodense CRLMs >10 mm and high-quality computed tomography (CT). In the portal phase, we segmented (1) the tumour, (2) a series of concentric rims at a progressively increasing distance from CRLM (from one to ten millimetres), and (3) a cylinder of normal parenchyma (Liver-VOI). Sixty-three CRLMs in 51 patients were analysed. Median peritumoural HU values were similar to Liver-VOI, except for the first millimetre around the CRLM. Entropy progressively decreased (from 3.11 of CRLM to 2.54 of Liver-VOI), while uniformity increased (from 0.135 to 0.199, p < 0.001). At 10 mm from CRLM, entropy was similar to the Liver-VOI in 62% of cases and uniformity in 46%. In small CRLMs (≤30 mm) and responders to chemotherapy, normalisation of entropy and uniformity values occurred in a higher proportion of cases and at a shorter distance. The radiomic analysis of the parenchyma surrounding CRLMs unveiled a wide halo of progressively decreasing entropy and increasing uniformity despite a normal radiological aspect. Underlying pathology data should be investigated. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Management of Gastrointestinal and Hepato-Bilio-Pancreatic Disorders)
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9 pages, 618 KiB  
Case Report
Hybrid Positron Emission Tomography and Magnetic Resonance Imaging Guided Microsurgical Management of Glial Tumors: Case Series and Review of the Literature
by Yusuf Sukru Caglar, Murat Buyuktepe, Emre Yagiz Sayaci, Ihsan Dogan, Melih Bozkurt, Elif Peker, Cigdem Soydal, Elgin Ozkan and Nuriye Ozlem Kucuk
Diagnostics 2024, 14(14), 1551; https://doi.org/10.3390/diagnostics14141551 - 18 Jul 2024
Viewed by 397
Abstract
In this case series, we aimed to report our clinical experience with hybrid positron emission tomography (PET) and magnetic resonance imaging (MRI) navigation in the management of recurrent glial brain tumors. Consecutive recurrent neuroglial brain tumor patients who underwent PET/MRI at preoperative or [...] Read more.
In this case series, we aimed to report our clinical experience with hybrid positron emission tomography (PET) and magnetic resonance imaging (MRI) navigation in the management of recurrent glial brain tumors. Consecutive recurrent neuroglial brain tumor patients who underwent PET/MRI at preoperative or intraoperative periods were included, whereas patients with non-glial intracranial tumors including metastasis, lymphoma and meningioma were excluded from the study. A total of eight patients (mean age 50.1 ± 11.0 years) with suspicion of recurrent glioma tumor were evaluated. Gross total tumor resection of the PET/MRI-positive area was achieved in seven patients, whereas one patient was diagnosed with radiation necrosis, and surgery was avoided. All patients survived at 1-year follow-up. Five (71.4%) of the recurrent patients remained free of recurrence for the entire follow-up period. Two patients with glioblastoma had tumor recurrence at the postoperative sixth and eighth months. According to our results, hybrid PET/MRI provides reliable and accurate information to distinguish recurrent glial tumor from radiation necrosis. With the help of this differential diagnosis, hybrid imaging may provide the gross total resection of recurrent tumors without harming eloquent brain areas. Full article
(This article belongs to the Special Issue New Advances in Neurosurgery: Clinical Diagnosis, Treatment and Prognosis)
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3 pages, 877 KiB  
Interesting Images
“Unkinking” the “Kink” Normalizes the Doppler Pattern
by Elaina A. Blickenstaff, Michael O’Shea, Timothy Barry, Reza Arsanjani, John P. Fasolino, Donald J. Hagler, Francois Marcotte and David S. Majdalany
Diagnostics 2024, 14(14), 1550; https://doi.org/10.3390/diagnostics14141550 - 18 Jul 2024
Viewed by 471
Abstract
Coarctation of the aorta (CoA) comprises 5–7% of congenital heart disease and can present as an isolated narrowing in the aortic arch just distal to the left subclavian artery or can be associated with cardiac abnormalities such as a bicuspid aortic valve, aortopathy, [...] Read more.
Coarctation of the aorta (CoA) comprises 5–7% of congenital heart disease and can present as an isolated narrowing in the aortic arch just distal to the left subclavian artery or can be associated with cardiac abnormalities such as a bicuspid aortic valve, aortopathy, or ventricular septal defects. With the advances in the medical field, intervention on CoA can either be via surgical repair or endovascular stenting. Echocardiography is the mainstay in diagnosing CoA, with tomographic imaging such as magnetic resonance imaging (MRI) or computed tomography providing supplementary assessment of the aorta, valves, and collateral vessels. We present a case of a young hypertensive male who was noted to have a continuous cardiac murmur with diagnostic Doppler pattern of CoA on echocardiography that normalized soon after percutaneous stenting. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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10 pages, 14479 KiB  
Case Report
Repetitive Self-Inflicted Craniocerebral Injury in a Patient with Antisocial Personality Disorder
by Andrei Ionut Cucu, Claudia Florida Costea, Sînziana Călina Silișteanu, Laurentiu Andrei Blaj, Ana Cristina Istrate, Raluca Elena Patrascu, Vlad Liviu Hartie, Emilia Patrascanu, Mihaela Dana Turliuc, Serban Turliuc, Anca Sava and Otilia Boişteanu
Diagnostics 2024, 14(14), 1549; https://doi.org/10.3390/diagnostics14141549 - 18 Jul 2024
Viewed by 387
Abstract
Self-inflicted penetrating injuries in patients with mental disorders are a rare phenomenon. The authors report the case of a prisoner who recurrently presented to the emergency department over a period of four years for self-insertion of six metal foreign bodies into the skull. [...] Read more.
Self-inflicted penetrating injuries in patients with mental disorders are a rare phenomenon. The authors report the case of a prisoner who recurrently presented to the emergency department over a period of four years for self-insertion of six metal foreign bodies into the skull. Computed tomography each time revealed the presence of a metal foreign body (screw, nail, metal rod, and wire) passing through the frontal bone into the frontal lobe. In each situation, the foreign body was safely extracted with a favorable outcome. Despite the use of the latest imaging modalities, metal artifacts can limit the assessment of vascular involvement, and special attention must be given to preoperative planning. Surgical extraction of the foreign body can be safely performed when appropriate preoperative planning is carried out to consider all possible complications. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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