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Diagnostics
Volume 14
Issue 21
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Diagnostics, Volume 14, Issue 21 (November-1 2024) – 119 articles

Cover Story (view full-size image): This study explores how recanalization success of endovascular treatment (EVT), measured on the mTICI scale, affects outcomes in patients with basilar artery occlusion (BAO) and emphasizes differences in treatment efficacy for the underlying stroke etiology. While successful EVT improves clinical outcomes significantly, patients with underlying basilar stenosis (BS) have lower rates of successful recanalization and worse outcomes even with successful recanalization than those with embolic occlusions. The analysis highlights BS as an independent predictor of poor outcomes. This study emphasizes that successful EVT remains crucial but is less effective in BS, indicating the importance of tailored interventional approaches for BAO with underlying stenosis. View this paper
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11 pages, 840 KiB  
Article
Ultrashort Cell-Free DNA Fragments and Vimentin-Positive Circulating Tumor Cells for Predicting Early Recurrence in Patients with Biliary Tract Cancer
by Sung Hee Park, Hye Ji Lee, Tae In Kim, Jonghyun Lee, Sung Yong Han, Hyung Il Seo and Dong Uk Kim
Diagnostics 2024, 14(21), 2462; https://doi.org/10.3390/diagnostics14212462 - 4 Nov 2024
Viewed by 578
Abstract
Background/Objectives: Biliary tract cancer (BTC) is a rare but aggressive malignancy that requires surgical treatment. However, postoperative recurrence rates are high, and reliable predictors of recurrence are limited. This study aimed to investigate the effectiveness of cell-free DNA (cfDNA) and circulating tumor cells [...] Read more.
Background/Objectives: Biliary tract cancer (BTC) is a rare but aggressive malignancy that requires surgical treatment. However, postoperative recurrence rates are high, and reliable predictors of recurrence are limited. This study aimed to investigate the effectiveness of cell-free DNA (cfDNA) and circulating tumor cells (CTCs) in predicting early recurrence after curative surgery and complete adjuvant therapy in patients with BTC. Methods: Twenty-four patients who underwent R0 and R1 resections and completed adjuvant therapy for BTC between September 2019 and March 2022 were followed up until March 2024. Patients were categorized into early recurrence (ER) and non-ER groups, using one year as the cutoff for recurrence. Results: The combination score derived from ultrashort fragments of cfDNA, vimentin-positive CTCs, and carbohydrate antigen (CA) 19-9 levels showed a statistically significant difference between the ER and non-ER groups (p-value < 0.001). The receiver operating characteristic curve from the combination score and CA 19-9 levels yielded areas under the curve of 0.891 and 0.750, respectively. Conclusions: Although further research is required, these findings suggest that cfDNA and CTCs may increase the accuracy of predicting postoperative recurrence in patients with BTC. Full article
(This article belongs to the Special Issue Recent Advancements of Molecular Biomarkers in Cancer)
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11 pages, 710 KiB  
Article
Monitoring and Management of Cytomegalovirus Reactivations After Allogeneic Hematopoietic Stem Cell Transplantation in Children: Experience from a Single Pediatric Center
by Giulia Ferrando, Francesca Bagnasco, Stefano Giardino, Filomena Pierri, Sara Pestarino, Eddi Di Marco, Maria Santaniello, Elio Castagnola and Maura Faraci
Diagnostics 2024, 14(21), 2461; https://doi.org/10.3390/diagnostics14212461 - 3 Nov 2024
Viewed by 707
Abstract
Background: CMV reactivation represents a frequent complication after HSCT. The aim of this study was to describe the incidence of CMV reactivation in a pediatric HSCT cohort and analyze the potential impact of recipient/donor-related or transplant-related factors on this complication. Furthermore, we analyzed [...] Read more.
Background: CMV reactivation represents a frequent complication after HSCT. The aim of this study was to describe the incidence of CMV reactivation in a pediatric HSCT cohort and analyze the potential impact of recipient/donor-related or transplant-related factors on this complication. Furthermore, we analyzed the management of CMV reactivation in order to purpose criteria for pre-emptive therapy. Methods: Allogeneic HSCTs, performed at IRCCS Istituto Gaslini between 2012 and 2022, were included in this analysis. CMV–DNAemia was regularly monitored. Risk stratification was based on donor/recipient serological status and additional potential risk factors were considered: haploidentical transplant; any HSCT subsequent to the first; acute and chronic GvHD; steroids; and other immunosuppressive therapies. We described also the approach for pre-emptive therapy during the period 2012–2019. Results: A total of 214 allogeneic HSCTs were performed in 189 patients. In total, 100 (46.7%) HSCTs were complicated by at least one reactivation. CMV reactivation was significantly associated with high serological risk and steroid treatment. Pre-emptive therapy was administered in 59/69 (85.5%) HSCTs during 2012–2019. In the presence of predefined risk conditions, therapy was started at a median viremia of 2050 copies/mL. No difference was observed in OS between patients with CMV reactivation versus patients who did not present this complication. Conclusions: These results suggest the potential effectiveness of the approach used in providing pre-emptive therapy based on viral load monitoring and individualized risk factors. Full article
(This article belongs to the Special Issue Diagnosis, Prophylaxis and Treatments of Cytomegalovirus Infection and Reactivation)
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8 pages, 229 KiB  
Article
Evaluating Diagnostic Concordance in Primary Open-Angle Glaucoma Among Academic Glaucoma Subspecialists
by Chenmin Wang, De-Fu Chen, Xiao Shang, Xiaoyan Wang, Xizhong Chu, Chengju Hu, Qiangjie Huang, Gangwei Cheng, Jianjun Li, Ruiyi Ren and Yuanbo Liang
Diagnostics 2024, 14(21), 2460; https://doi.org/10.3390/diagnostics14212460 - 3 Nov 2024
Viewed by 731
Abstract
Objective: The study aimed to evaluate the interobserver agreement among glaucoma subspecialists in diagnosing glaucoma and to explore the causes of diagnostic discrepancies. Methods: Three experienced glaucoma subspecialists independently assessed frequency domain optical coherence tomography, fundus color photographs, and static perimetry results from [...] Read more.
Objective: The study aimed to evaluate the interobserver agreement among glaucoma subspecialists in diagnosing glaucoma and to explore the causes of diagnostic discrepancies. Methods: Three experienced glaucoma subspecialists independently assessed frequency domain optical coherence tomography, fundus color photographs, and static perimetry results from 464 eyes of 275 participants, adhering to unified glaucoma diagnostic criteria. All data were collected from the Wenzhou Glaucoma Progression Study between August 2014 and June 2021. Results: The overall interobserver agreement among the three experts was poor, with a Fleiss’ kappa value of 0.149. The kappa values interobserver agreement between pairs of experts ranged from 0.133 to 0.282. In 50 cases, or approximately 10.8%, the three experts reached completely different diagnoses. Agreement was more likely in cases involving larger average cup-to-disc ratios, greater vertical cup-to-disc ratios, more severe visual field defects, and thicker retinal nerve fiber layer measurements, particularly in the temporal and inferior quadrants. High myopia also negatively impacted interobserver agreement. Conclusions: Despite using unified diagnostic criteria for glaucoma, significant differences in interobserver consistency persist among glaucoma subspecialists. To improve interobserver agreement, it is recommended to provide additional training on standardized diagnostic criteria. Furthermore, for cases with inconsistent diagnoses, long-term follow-up is essential to confirm the diagnosis of glaucoma. Full article
(This article belongs to the Special Issue Advances in the Diagnosis of Eye Diseases)
24 pages, 1337 KiB  
Systematic Review
Molecular Imaging Biomarkers for Early Cancer Detection: A Systematic Review of Emerging Technologies and Clinical Applications
by Maajid Mohi Ud Din Malik, Mansour M. Alqahtani, Ibrahim Hadadi, Ibrahem Kanbayti, Zeyad Alawaji and Bader A. Aloufi
Diagnostics 2024, 14(21), 2459; https://doi.org/10.3390/diagnostics14212459 - 3 Nov 2024
Viewed by 984
Abstract
Background: Early cancer detection is crucial for improving patient outcomes. Molecular imaging biomarkers offer the potential for non-invasive, early-stage cancer diagnosis. Objectives: To evaluate the effectiveness and accuracy of molecular imaging biomarkers for early cancer detection across various imaging modalities and cancer types. [...] Read more.
Background: Early cancer detection is crucial for improving patient outcomes. Molecular imaging biomarkers offer the potential for non-invasive, early-stage cancer diagnosis. Objectives: To evaluate the effectiveness and accuracy of molecular imaging biomarkers for early cancer detection across various imaging modalities and cancer types. Methods: A comprehensive search of PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus was performed, covering the period from January 2010 to December 2023. Eligibility criteria included original research articles published in English on molecular imaging biomarkers for early cancer detection in humans. The risk of bias for included studies was evaluated using the QUADAS-2 tool. The findings were synthesized through narrative synthesis, with quantitative analysis conducted where applicable. Results: In total, 50 studies were included. Positron emission tomography (PET)-based biomarkers showed the highest sensitivity (mean: 89.5%, range: 82–96%) and specificity (mean: 91.2%, range: 85–100%). Novel tracers such as [68Ga]-PSMA for prostate cancer and [18F]-FES for breast cancer demonstrated promising outcomes. Optical imaging techniques showed high specificity in intraoperative settings. Conclusions: Molecular imaging biomarkers show significant potential for improving early cancer detection. Integration into clinical practice could lead to earlier interventions and improved outcomes. Further research is needed to address standardization and cost-effectiveness. Full article
(This article belongs to the Special Issue Advances in the Diagnosis of Cancer/Tumors)
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14 pages, 3713 KiB  
Technical Note
AI-Assisted Detection and Localization of Spinal Metastatic Lesions
by Edgars Edelmers, Artūrs Ņikuļins, Klinta Luīze Sprūdža, Patrīcija Stapulone, Niks Saimons Pūce, Elizabete Skrebele, Everita Elīna Siņicina, Viktorija Cīrule, Ance Kazuša and Katrina Boločko
Diagnostics 2024, 14(21), 2458; https://doi.org/10.3390/diagnostics14212458 - 3 Nov 2024
Viewed by 707
Abstract
Objectives: The integration of machine learning and radiomics in medical imaging has significantly advanced diagnostic and prognostic capabilities in healthcare. This study focuses on developing and validating an artificial intelligence (AI) model using U-Net architectures for the accurate detection and segmentation of spinal [...] Read more.
Objectives: The integration of machine learning and radiomics in medical imaging has significantly advanced diagnostic and prognostic capabilities in healthcare. This study focuses on developing and validating an artificial intelligence (AI) model using U-Net architectures for the accurate detection and segmentation of spinal metastases from computed tomography (CT) images, addressing both osteolytic and osteoblastic lesions. Methods: Our methodology employs multiple variations of the U-Net architecture and utilizes two distinct datasets: one consisting of 115 polytrauma patients for vertebra segmentation and another comprising 38 patients with documented spinal metastases for lesion detection. Results: The model demonstrated strong performance in vertebra segmentation, achieving Dice Similarity Coefficient (DSC) values between 0.87 and 0.96. For metastasis segmentation, the model achieved a DSC of 0.71 and an F-beta score of 0.68 for lytic lesions but struggled with sclerotic lesions, obtaining a DSC of 0.61 and an F-beta score of 0.57, reflecting challenges in detecting dense, subtle bone alterations. Despite these limitations, the model successfully identified isolated metastatic lesions beyond the spine, such as in the sternum, indicating potential for broader skeletal metastasis detection. Conclusions: The study concludes that AI-based models can augment radiologists’ capabilities by providing reliable second-opinion tools, though further refinements and diverse training data are needed for optimal performance, particularly for sclerotic lesion segmentation. The annotated CT dataset produced and shared in this research serves as a valuable resource for future advancements. Full article
(This article belongs to the Special Issue AI-Driven Diagnostics: Transforming Healthcare from Data to Clinical Decisions)
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14 pages, 2245 KiB  
Article
Clinical Feasibility of 5.0 T MRI/MRCP in Characterizing Pancreatic Cystic Lesions: Comparison with 3.0 T and MDCT
by Huijia Zhao, Qiang Xu, Ruichen Gao, Bohui Yin, Gan Sun, Ke Xue, Yuxin Yang, Enhui Li, Liang Zhu, Feng Feng and Wenming Wu
Diagnostics 2024, 14(21), 2457; https://doi.org/10.3390/diagnostics14212457 - 2 Nov 2024
Viewed by 486
Abstract
Objectives: To assess the feasibility of 5.0 T magnetic resonance imaging (MRI) in characterizing pancreatic cystic lesions (PCLs), compared with 3.0 T MRI and multidetector computed tomography (MDCT). Methods: Thirty-five patients with PCLs underwent 5.0 T MR alongside 3.0 T MR or MDCT. [...] Read more.
Objectives: To assess the feasibility of 5.0 T magnetic resonance imaging (MRI) in characterizing pancreatic cystic lesions (PCLs), compared with 3.0 T MRI and multidetector computed tomography (MDCT). Methods: Thirty-five patients with PCLs underwent 5.0 T MR alongside 3.0 T MR or MDCT. Two observers measured subjective and objective image quality scores. The consistency of two observers between 5.0 T and 3.0 T was calculated by intraclass correlation coefficients. The characteristics of PCLs and their specific diagnosis, as well as benignity/malignancy, were evaluated across MDCT, 3.0 T, and 5.0 T MRI. Results: The 5.0 T MR demonstrated significantly higher subjective image quality and SNR on T1WI compared to that in 3.0 T MR (p < 0.05). The 5.0 T MRI identified more cyst lesions than the 3.0 T MRI (40 and 32) and MDCT (82 and 56). The sensitivity, specificity, and accuracy for differentiating benign from malignant lesions with 5.0 T MRI (75%, 100%, and 91.4%, respectively) surpassed those of 3.0 T MRI and MDCT. The accuracy of the specific diagnosis of PCLs at 5.0 T MRI (80%) was superior to 3.0 T MRI and MDCT. Conclusions: 5.0 T MRI exhibits certain superiority in delineating details of PCLs and in clinical diagnostic accuracy, outperforming MDCT and 3.0 T MRI while maintaining sufficient image quality. Full article
(This article belongs to the Special Issue Diagnosis of Pancreatic Diseases)
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17 pages, 1715 KiB  
Article
Using Key Predictors in an SVM Model for Differentiating Spinal Fractures and Herniated Intervertebral Discs in Preoperative Anesthesia Evaluation
by Shih-Ying Yang, Shih-Yen Hsu, Yi-Kai Su, Nan-Han Lu, Kuo-Ying Liu, Tai-Been Chen, Kon-Ning Chiu, Yung-Hui Huang and Li-Ren Yeh
Diagnostics 2024, 14(21), 2456; https://doi.org/10.3390/diagnostics14212456 - 2 Nov 2024
Viewed by 524
Abstract
Background/Objectives: Spinal conditions, such as fractures and herniated intervertebral discs (HIVDs), are often challenging to diagnose due to overlapping clinical symptoms and the difficulty in assessing their functional impact. Accurate differentiation between these conditions is crucial for effective treatment, particularly in the context [...] Read more.
Background/Objectives: Spinal conditions, such as fractures and herniated intervertebral discs (HIVDs), are often challenging to diagnose due to overlapping clinical symptoms and the difficulty in assessing their functional impact. Accurate differentiation between these conditions is crucial for effective treatment, particularly in the context of preoperative anesthesia evaluation, where understanding the underlying condition can influence anesthesia planning and pain management. Methods and Materials: This study presents a Support Vector Machine (SVM) model designed to distinguish between spinal fractures and HIVDs using key clinical predictors, including age, gender, preoperative Visual Analog Scale (VAS) pain scores, and the number of spinal fractures. A retrospective analysis was conducted on a dataset of 199 patients diagnosed with these conditions. The SVM model, using a radial basis function (RBF) kernel, classified the conditions based on the selected predictors. Model performance was evaluated using precision, recall, accuracy, and the Kappa index, with Leave-One-Out (LOO) cross-validation applied to ensure robust results. Results: The SVM model achieved a precision of 92.1% for fracture cases and 91.2% for HIVDs, with recall rates of 98.1% for fractures and 70.5% for HIVDs. The overall accuracy was 92%, and the Kappa index was 0.76, indicating substantial agreement. The analysis revealed that age and VAS pain scores were the most critical predictors for accurately diagnosing these conditions. Conclusions: These results highlight the potential of the SVM model with an RBF kernel to reliably differentiate between spinal fractures and HIVDs using routine clinical data. Future work could enhance model performance by incorporating additional clinical parameters relevant to preoperative anesthesia evaluation. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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10 pages, 821 KiB  
Article
Influence of Newborns’ Characteristics on Postpartum Depression: The Impact of Birth Season and Male Sex in a Romanian Cohort Study
by Silvia Onuc, Gheorghe Mihail Banariu, Sergiu Ioachim Chirila, Cristian Delcea, Costin Niculescu, Mihaela Rus, Diana Badiu and Vlad Tica
Diagnostics 2024, 14(21), 2455; https://doi.org/10.3390/diagnostics14212455 - 1 Nov 2024
Viewed by 576
Abstract
Background: Although risk factors associated with maternal postpartum depression (PPD) have been recognized, it is still unknown how some newborn characteristics could influence the appearance of PPD. Aim: Our research aimed to unravel the impact of a newborn’s features on women with PPD. [...] Read more.
Background: Although risk factors associated with maternal postpartum depression (PPD) have been recognized, it is still unknown how some newborn characteristics could influence the appearance of PPD. Aim: Our research aimed to unravel the impact of a newborn’s features on women with PPD. Methods: The study was conducted in the Obstetrics and Gynecology Department at our University Emergency County Hospital, between August 2019 and April 2021. We included 904 women from the second day of the postpartum period, divided into two groups: women with PPD (n = 236) and control (i.e., women without PPD, n = 668), by using the Edinburg Postpartum Depression Scale. Characteristic information on the newborns (i.e., the months in which they were born, premature delivery, birth weight, or sex) was evaluated. Results: Our results suggest that the winter season (i.e., December and January months, p = 0.01) births and male newborns (p = 0.02) were strongly related with the appearance of depressive symptoms during the postpartum period. Conclusions: Therefore, our study sustains that women who give birth to male newborns in the winter season are more prone to developing PPD. This should be analyzed by all public health care systems in order to prevent such a condition earlier in certain groups of women. Full article
(This article belongs to the Section Pathology and Molecular Diagnostics)
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9 pages, 5410 KiB  
Case Report
Massive Fetomaternal Hemorrhage Caused by an Intraplacental Choriocarcinoma: Case Report and Review of the Literature
by Felice Sorrentino, Teresa Silvestris, Francesca Greco, Lorenzo Vasciaveo, Guglielmo Stabile, Veronica Falcone, Andrea Etrusco, Antonio D’Amato, Antonio Simone Laganà and Luigi Nappi
Diagnostics 2024, 14(21), 2454; https://doi.org/10.3390/diagnostics14212454 - 1 Nov 2024
Viewed by 599
Abstract
Intraplacental choriocarcinoma (IC) is a gestational trophoblastic neoplasia located within the placenta. Due to its silent presentation, more than half of the cases are diagnosed incidentally. An association with fetomaternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction has been found. The aim of [...] Read more.
Intraplacental choriocarcinoma (IC) is a gestational trophoblastic neoplasia located within the placenta. Due to its silent presentation, more than half of the cases are diagnosed incidentally. An association with fetomaternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction has been found. The aim of this review is to describe the clinical management of this rare condition stemming from a case report of an incidental diagnosis following an emergency cesarean section, and taking into account the available literature. Emergency interventions and examination of the placenta, even for the smallest IC lesion can ensure timely treatment and improve maternal and fetal outcomes. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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15 pages, 713 KiB  
Review
Myeloid-Derived Suppressor Cells (MDSCs) and Obesity-Induced Inflammation in Type 2 Diabetes
by Larisa Ghemiș, Ancuța Goriuc, Bogdan Minea, Gina Eosefina Botnariu, Maria-Alexandra Mârțu, Melissa Ențuc, Daniel Cioloca and Liliana Georgeta Foia
Diagnostics 2024, 14(21), 2453; https://doi.org/10.3390/diagnostics14212453 - 1 Nov 2024
Viewed by 653
Abstract
Type 2 diabetes mellitus is a complex metabolic disorder characterized by insulin resistance and, subsequently, decreased insulin secretion. This condition is closely linked to obesity, a major risk factor that boosts the development of chronic systemic inflammation, which, in turn, is recognized for [...] Read more.
Type 2 diabetes mellitus is a complex metabolic disorder characterized by insulin resistance and, subsequently, decreased insulin secretion. This condition is closely linked to obesity, a major risk factor that boosts the development of chronic systemic inflammation, which, in turn, is recognized for its crucial role in the onset of insulin resistance. Under conditions of obesity, adipose tissue, particularly visceral fat, becomes an active endocrine organ that releases a wide range of pro-inflammatory mediators, including cytokines, chemokines, and adipokines. These mediators, along with cluster of differentiation (CD) markers, contribute to the maintenance of systemic low-grade inflammation, promote cellular signaling and facilitate the infiltration of inflammatory cells into tissues. Emerging studies have indicated the accumulation of a new cell population in the adipose tissue in these conditions, known as myeloid-derived suppressor cells (MDSCs). These cells possess the ability to suppress the immune system, impacting obesity-related chronic inflammation. Given the limited literature addressing the role of MDSCs in the context of type 2 diabetes, this article aims to explore the complex interaction between inflammation, obesity, and MDSC activity. Identifying and understanding the role of these immature cells is essential not only for improving the management of type 2 diabetes but also for the potential development of targeted therapeutic strategies aimed at both glycemic control and the reduction in associated inflammation. Full article
(This article belongs to the Section Pathology and Molecular Diagnostics)
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11 pages, 1341 KiB  
Article
Can Radiologists Replace Digital 2D Mammography with Synthetic 2D Mammography in Breast Cancer Screening and Diagnosis, or Are Both Still Needed?
by Areej Saud Aloufi, Mona Alomrani, Rafat Mohtasib, Bayan Altassan, Afaf Bin Rakhis and Mehreen Anees Malik
Diagnostics 2024, 14(21), 2452; https://doi.org/10.3390/diagnostics14212452 - 1 Nov 2024
Viewed by 582
Abstract
Background/Objectives: Digital mammography (DM) has long been the standard for breast cancer screening, while digital breast tomosynthesis (DBT) offers an advanced 3D imaging modality capable of generating 2D Synthetic Mammography (SM) images. Despite SM’s potential to reduce radiation exposure, many clinics favor [...] Read more.
Background/Objectives: Digital mammography (DM) has long been the standard for breast cancer screening, while digital breast tomosynthesis (DBT) offers an advanced 3D imaging modality capable of generating 2D Synthetic Mammography (SM) images. Despite SM’s potential to reduce radiation exposure, many clinics favor DM, with DBT and SM, due to its perceived diagnostic reliability. This study investigates whether radiologists can replace DM with SM in breast cancer screening and diagnosis or if both modalities are necessary. Methods: We retrospectively analyzed DM and SM images from 375 women aged 40–65 who underwent DM with DBT at King Khaled University Hospital from 2020–2022. Three radiologists evaluated the images using ACR BI-RADS, assessing diagnostic accuracy via the area under the receiver operating characteristic (ROC) curve (AUC). The agreement in cancer conspicuity, breast density, size, and calcifications were measured using weighted kappa (κ). Results: Among 57 confirmed cancer cases and 290 cancer-free cases, DM demonstrated higher sensitivity (82.5% vs. 78.9%) and diagnostic accuracy (AUC 0.800 vs. 0.783, p < 0.05) compared to SM. However, SM detected more suspicious calcifications in cancer cases (75.6% vs. 51.2%, p < 0.05). Agreement was fair for conspicuity (κ = 0.288) and calcifications (κ = 0.409), moderate for density (κ = 0.591), and poor for size (κ = 0.254). Conclusions: while SM demonstrates enhanced effectiveness in detecting microcalcifications, DM still proves superior in overall diagnostic accuracy and image clarity. Therefore, although SM offers certain advantages, it remains slightly inferior to DM and cannot yet replace DM in breast cancer screening. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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16 pages, 2343 KiB  
Article
Automated Diagnosis of Knee Osteoarthritis Using ResNet101 on a DEEP:PHI: Leveraging a No-Code AI Platform for Efficient and Accurate Medical Image Analysis
by Kyu-Hong Lee, Ro-Woon Lee, Jae-Sung Yun, Myung-Sub Kim and Hyun-Seok Choi
Diagnostics 2024, 14(21), 2451; https://doi.org/10.3390/diagnostics14212451 - 1 Nov 2024
Viewed by 631
Abstract
Background: Knee osteoarthritis (OA) is a prevalent degenerative joint disease significantly impacting global health. Early and accurate diagnosis is crucial for effective management, but traditional methods often rely on subjective assessments. This study evaluates the efficacy of a deep learning model implemented through [...] Read more.
Background: Knee osteoarthritis (OA) is a prevalent degenerative joint disease significantly impacting global health. Early and accurate diagnosis is crucial for effective management, but traditional methods often rely on subjective assessments. This study evaluates the efficacy of a deep learning model implemented through a no-code AI platform for diagnosing and grading knee OA from plain radiographs. Methods: We utilized the Osteoarthritis Initiative (OAI) dataset, comprising knee X-ray data from 1526 patients. The data were split into training (47.0%), validation (26.5%), and test (26.5%) sets. We employed a ResNet101 model on the DEEP:PHI no-code AI platform for image analysis. The model was trained to classify knee OA into five grades (0–4) based on the Kellgren–Lawrence scale. Results: Our AI model demonstrated high accuracy in distinguishing between different OA grades, with particular strength in early-stage detection. The model achieved optimal performance at 20 epochs, suggesting efficient learning dynamics. Grad-CAM visualizations were used to enhance the interpretability of the model’s decision-making process. Conclusions: This study demonstrates the potential of AI, implemented through a no-code platform, to accurately diagnose and grade knee OA from radiographs. The use of a no-code AI platform such as DEEP:PHI represents a step towards democratizing AI in healthcare, enabling the rapid development and deployment of sophisticated medical AI applications without extensive coding expertise. This approach could significantly enhance the early detection and management of knee OA, potentially improving patient outcomes and streamlining clinical workflows. Full article
(This article belongs to the Topic New Advances in Musculoskeletal Disorders)
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14 pages, 656 KiB  
Article
Circulating Autoantibodies in Adults with Hashimoto’s Thyroiditis: New Insights from a Single-Center, Cross-Sectional Study
by Omar Tripolino, Maria Mirabelli, Roberta Misiti, Antonio Torchia, Denise Casella, Francesco Dragone, Eusebio Chiefari, Marta Greco, Antonio Brunetti and Daniela P. Foti
Diagnostics 2024, 14(21), 2450; https://doi.org/10.3390/diagnostics14212450 - 31 Oct 2024
Viewed by 635
Abstract
Background: Hashimoto’s thyroiditis (HT) is a common autoimmune thyroid disorder characterized by elevated anti-thyroid peroxidase (A-TPO) antibodies. HT frequently coexists with other autoimmune conditions, which are marked by organ-specific and non-organ-specific autoantibodies, reflecting a deregulated immune response. However, the burden and clinical significance [...] Read more.
Background: Hashimoto’s thyroiditis (HT) is a common autoimmune thyroid disorder characterized by elevated anti-thyroid peroxidase (A-TPO) antibodies. HT frequently coexists with other autoimmune conditions, which are marked by organ-specific and non-organ-specific autoantibodies, reflecting a deregulated immune response. However, the burden and clinical significance of these circulating autoantibodies in adult patients with HT remains unclear. Methods: A cross-sectional study was conducted at the University Hospital “R. Dulbecco” in Catanzaro, Italy, from November 2023 to May 2024, involving 200 euthyroid adults. The study population comprised 100 A-TPO-positive HT patients and 100 A-TPO-negative controls, matched for age and sex. Laboratory assessments included thyroid function tests and detection of autoantibodies [e.g., antinuclear antibodies (ANA), anti-parietal cell antibodies (APCA), and anti-neutrophil cytoplasmic antibodies (ANCA)]. Cytokine profiles were also measured using sensitive chemiluminescent multi-array technology. Results: HT patients were predominantly female (77.0%) with a median age of 56 years. Compared to controls, HT patients had higher median thyroid stimulating hormone (TSH) levels (2.215 vs. 1.705 μIU/mL, p = 0.025). Circulating autoantibodies were more prevalent in the HT group, with higher rates of APCA positivity (16.3% vs. 4.1%, p = 0.008) and atypical ANCA positivity (27.3% vs. 10.2%, p = 0.003). This suggests an increased risk for autoimmune gastritis and systemic inflammation. Additionally, HT patients with positive atypical ANCA showed elevated inflammatory cytokines, particularly interleukin-1 alpha (IL-1α), in female patients (p = 0.035). Conclusions: HT is significantly associated with a higher prevalence of circulating autoantibodies, such as APCA and atypical ANCA, which may indicate a heightened risk for autoimmune gastritis and broader autoimmune involvement. Detecting these autoantibodies in HT patients could serve as markers for more severe autoimmune dysfunction. These findings emphasize the need for proactive screening, especially in older patients and those with elevated A-TPO levels. Further research is essential to better understand the clinical implications and develop targeted management strategies for these patients. Full article
(This article belongs to the Section Pathology and Molecular Diagnostics)
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5 pages, 3896 KiB  
Interesting Images
Abdominal B-Cell Lymphoma Mimicking Ovarian Cancer
by Dennis Jung, Lina Judit Schiestl, Simin Schadmand-Fischer, Arno Schad, Annette Hasenburg and Roxana Schwab
Diagnostics 2024, 14(21), 2449; https://doi.org/10.3390/diagnostics14212449 - 31 Oct 2024
Viewed by 433
Abstract
A 54-year-old patient presented in our clinic with pressure in the upper abdomen, dyspnea and abdominal distension. The clinical examination showed pleural effusion, ascites and an enlarged axillary lymph node on the right side. In gynecological sonography ascites, an ovarian cyst and peritoneal [...] Read more.
A 54-year-old patient presented in our clinic with pressure in the upper abdomen, dyspnea and abdominal distension. The clinical examination showed pleural effusion, ascites and an enlarged axillary lymph node on the right side. In gynecological sonography ascites, an ovarian cyst and peritoneal carcinosis in the pouch of Douglas were detected, which were potentially indicative of ovarian cancer. A staging laparoscopy was performed to confirm the diagnosis of ovarian cancer and to evaluate operability. Intraoperatively white milky ascites, white-yellow marbling of the liver and white stipple bedding on the diaphragm and liver were detected. The ovaries and the fallopian tubes were tumorously enlarged. Biopsies were taken from the right fimbrial funnel, the liver around the falciform ligament and the diaphragm. Histology of all abdominal biopsies and the axillary lymph node revealed high lymphatic infiltration matching a stage III B-cell-lymphoma. The patient was transferred to the hemato-oncological department for further therapy. Six cycles of cytostatic therapy with R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine sulfate, prednisone) were initiated. The patient is doing well and in stable disease 6 months after completion of cytotoxic therapy. This case report presents a rare case of manifestation of an extra nodal B-cell-lymphoma with abdominal presentation that mimicked ovarian cancer. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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17 pages, 1263 KiB  
Review
Integrative Cross-Talk in Asthma: Unraveling the Complex Interactions Between Eosinophils, Immune, and Structural Cells in the Airway Microenvironment
by Andrius Januskevicius, Egle Vasyle, Airidas Rimkunas and Kestutis Malakauskas
Diagnostics 2024, 14(21), 2448; https://doi.org/10.3390/diagnostics14212448 - 31 Oct 2024
Viewed by 552
Abstract
Asthma is a chronic inflammatory process that leads to airway narrowing, causing breath loss followed by spasms, wheezing, and shortness of breath. Within the asthmatic lungs, interaction among various immune cells and structural cells plays a significant role in orchestrating an inflammatory response [...] Read more.
Asthma is a chronic inflammatory process that leads to airway narrowing, causing breath loss followed by spasms, wheezing, and shortness of breath. Within the asthmatic lungs, interaction among various immune cells and structural cells plays a significant role in orchestrating an inflammatory response in which eosinophils hold central importance. In these settings, allergens or other environmental exposures commonly drive the immune response to recruit eosinophils to the airways. The appearance of eosinophils in the airways indicates a dynamic interplay of various cell types within lung tissue and does not represent a passive effect of inflammation. The cellular cross-talk causes the persistence of eosinophilic inflammation, and if left untreated, it results in long-term damage to the airway structure and function. Further exacerbation of the condition occurs because of this. We discuss how this complex interplay of eosinophils, immune, and structural cells within the airway microenvironment leads to the distinct pathophysiological features in asthma, the variability in disease severity, and the response to biological treatments. Full article
(This article belongs to the Special Issue Diagnosis and Management of Immunological, Allergic and Inflammatory Disorders)
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16 pages, 2545 KiB  
Article
Assessing Pain Levels Using Bioelectrical Impedance in Low Back Pain Patients: Clinical Performance Evaluation
by Seungwan Jang, Jong Gab Ho, A-Ram Jo, Seung Mo Yoo, Hoonyoung Lee, Hyunyoung Lee, Young Kim and Se Dong Min
Diagnostics 2024, 14(21), 2447; https://doi.org/10.3390/diagnostics14212447 - 31 Oct 2024
Viewed by 564
Abstract
Background/Objectives: Musculoskeletal pain is one of the leading causes of years lived with disability worldwide and has a negative impact on daily life and quality of life. Methods: The purpose of this study was to analyze the electrical characteristics of back pain by [...] Read more.
Background/Objectives: Musculoskeletal pain is one of the leading causes of years lived with disability worldwide and has a negative impact on daily life and quality of life. Methods: The purpose of this study was to analyze the electrical characteristics of back pain by measuring and calculating bioelectrical impedance variables (R, Z, PA) in 85 subjects (45 in the Healthy group and 40 in the LBP group). Additionally, impedance measurements were conducted on 20 subjects (10 in the Young group and 10 in the Older group) to assess the impact of aging. Results: Bioelectrical impedance parameter values were higher in cases of back pain, and correlation analysis showed that there was a statistically significant difference between the Healthy and LBP groups (p < 0.05). A positive correlation was found between impedance parameters and pain related indices (ODI, RMDQ, VAS) (mean R, Z, PA: 0.68, 0.54, 0.75), with BMI positively correlating only with PA (0.493). Diagnostic accuracy for detecting back pain exceeded 95% (R, Z, PA: 0.984, 0.984, 0.963). Conclusions: Results indicated that aging did not significantly affect impedance values. The bioelectrical impedance measurement device used in this study, with its simultaneous diagnostic and therapeutic capabilities, proved useful for real-time pain diagnosis and treatment monitoring, highlighting its potential clinical utility. Full article
(This article belongs to the Section Clinical Diagnosis and Prognosis)
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13 pages, 3464 KiB  
Article
CD34 and Ki-67 Immunoexpression in Periapical Granulomas: Implications for Angiogenesis and Cellular Proliferation
by Ciprian Roi, Mircea Riviș, Alexandra Roi, Marius Raica, Raluca Amalia Ceaușu, Alexandru Cătălin Motofelea and Pușa Nela Gaje
Diagnostics 2024, 14(21), 2446; https://doi.org/10.3390/diagnostics14212446 - 31 Oct 2024
Viewed by 503
Abstract
Background/Objectives: The main mechanism of the formation of granulation tissue is the progression of an infection from the tooth to the periapical bone. At this level, the immune system tries to localize and annihilate the microorganism’s injury. Ki-67 is a protein directly associated [...] Read more.
Background/Objectives: The main mechanism of the formation of granulation tissue is the progression of an infection from the tooth to the periapical bone. At this level, the immune system tries to localize and annihilate the microorganism’s injury. Ki-67 is a protein directly associated with the cell proliferation rate, while CD34 is a biomarker involved in angiogenesis, and studies suggest that they both have a positive correlation with the intensity of the local inflammatory infiltrate. This study will determine the immunoexpression of CD34 and Ki-67 in periapical granulomas and assess their impact on the growth and development of this tissue, as well as consider their roles in the proliferative process and aggressiveness of evolution. Methods: In the present study, 35 periapical granulomas obtained after a tooth extraction were included. The specimens were analyzed via histopathology and immunohistochemistry. Results: A positive reaction for the Ki-67 antibody was observed in 32 (86.5%) of the 35 periapical granuloma cases included in our study. We identified the overexpression of Ki-67 and CD34 and further calculated the Ki-67 index to evaluate and correlate the proliferation potential and angiogenesis with regard to the presence of an inflammatory infiltrate. Conclusions: These findings suggest that the persistence of an inflammatory environment directly influences Ki-67 and CD34 expression, sustaining the proliferative capacity of cells and abnormal angiogenesis. This study is the first to evaluate the presence of the CD34+ and Ki-67+ proliferating vessels in periapical granulomas. Full article
(This article belongs to the Special Issue Advances in the Diagnosis of Oral and Maxillofacial Disease)
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16 pages, 856 KiB  
Review
Preparticipation Cardiovascular Screening of Athletes: Current Controversies and Challenges for the Future
by Hélder Dores, Paulo Dinis, José Miguel Viegas and António Freitas
Diagnostics 2024, 14(21), 2445; https://doi.org/10.3390/diagnostics14212445 - 31 Oct 2024
Viewed by 729
Abstract
Sports cardiology is an evolving field in cardiology, with several topics remaining controversial. Beyond the several well-known benefits of regular exercise practice, the occurrence of adverse clinical events during sports in apparently healthy individuals, especially sudden cardiac death, and the described long-term adverse [...] Read more.
Sports cardiology is an evolving field in cardiology, with several topics remaining controversial. Beyond the several well-known benefits of regular exercise practice, the occurrence of adverse clinical events during sports in apparently healthy individuals, especially sudden cardiac death, and the described long-term adverse cardiac adaptations associated to high volume of exercise, remain challenging. The early identification of athletes with increased risk is critical, but the most appropriate preparticipation screening protocols are also debatable and a more personalized evaluation, considering individual and sports-related characteristics, will potentially optimize this evaluation. As the risk of major clinical events during sports is not zero, independently of previous evaluation, ensuring the capacity for cardiopulmonary resuscitation, especially with availability of automated external defibrillators, in sports arenas, is crucial for its prevention and to improve outcomes. As in other areas of medicine, application of new digital technologies, including artificial intelligence, is promising and could improve in near future several aspects of sports cardiology. This paper aims to review the methodology of athletes’ preparticipation screening, emphasizing current controversies and future challenges, in order to improve early diagnosis of conditions associated with sudden cardiac death. Full article
(This article belongs to the Special Issue Diagnosis and Management in Sports Cardiology)
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37 pages, 14727 KiB  
Article
Enhancing the Understanding of Abdominal Trauma During the COVID-19 Pandemic Through Co-Occurrence Analysis and Machine Learning
by Dumitru Radulescu, Dan Marian Calafeteanu, Patricia-Mihaela Radulescu, Gheorghe-Jean Boldea, Razvan Mercut, Eleonora Daniela Ciupeanu-Calugaru, Eugen-Florin Georgescu, Ana Maria Boldea, Ion Georgescu, Elena-Irina Caluianu, Georgiana-Andreea Marinescu and Emil-Tiberius Trasca
Diagnostics 2024, 14(21), 2444; https://doi.org/10.3390/diagnostics14212444 - 31 Oct 2024
Viewed by 437
Abstract
Background: This study examines the impact of the COVID-19 pandemic on abdominal trauma management by comparing pre-pandemic (17 February 2018–26 February 2020) and pandemic periods (27 February 2020–7 March 2022). Methods: Analyzing data from 118 patients at the Emergency County Clinical Hospital of [...] Read more.
Background: This study examines the impact of the COVID-19 pandemic on abdominal trauma management by comparing pre-pandemic (17 February 2018–26 February 2020) and pandemic periods (27 February 2020–7 March 2022). Methods: Analyzing data from 118 patients at the Emergency County Clinical Hospital of Craiova, we identified significant shifts in clinical practices affecting patient outcomes. Results: During the pandemic, a moderate increase in surgical interventions for specific abdominal traumas indicated the effective adaptation of the medical system. Prioritizing critical cases and deferring non-urgent procedures optimized limited resources. Demographic and clinical factors—including age, sex, body mass index (BMI), and red cell distribution width (RDW)—significantly influenced the hospitalization duration and recovery outcomes. Gender disparities in mortality lessened during the pandemic, possibly due to standardized interventions and the physiological effects of SARS-CoV-2. The link between occupation and obesity highlighted how work environments impact trauma severity, especially as lifestyle changes affect BMI. While age remained a major predictor of mortality, its influence slightly decreased, potentially due to improved protocols for elderly patients. RDW emerged as an important prognostic marker for disease severity and mortality risk. Conclusions: Employing advanced co-occurrence analysis enhanced with machine learning, we uncovered complex relationships between clinical and demographic variables often overlooked by traditional methods. This innovative approach provided deeper insights into the collective impact of various factors on patient outcomes. Our findings demonstrate the healthcare system’s rapid adaptations during the pandemic and offer critical insights for optimizing medical strategies and developing personalized interventions in global crises. Full article
(This article belongs to the Special Issue Advances in Artificial Intelligence in Healthcare)
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16 pages, 2351 KiB  
Review
COVID-19 and Its Potential Impact on Children Born to Mothers Infected During Pregnancy: A Comprehensive Review
by Cristiana Stolojanu, Gabriela Doros, Melania Lavinia Bratu, Iulia Ciobanu, Krisztina Munteanu, Emil Radu Iacob, Laura Andreea Ghenciu, Emil Robert Stoicescu and Mirabela Dima
Diagnostics 2024, 14(21), 2443; https://doi.org/10.3390/diagnostics14212443 - 31 Oct 2024
Viewed by 551
Abstract
Pregnancy is a vulnerable period of time during which pregnant people are prone to infections like COVID-19, which can increase risks for both the mother and fetus. These infections may lead to complications such as preterm birth, developmental delays, and congenital abnormalities. While [...] Read more.
Pregnancy is a vulnerable period of time during which pregnant people are prone to infections like COVID-19, which can increase risks for both the mother and fetus. These infections may lead to complications such as preterm birth, developmental delays, and congenital abnormalities. While COVID-19 poses additional risks like placental dysfunction and neonatal infections, studies on long-term effects remain limited. Ongoing research and monitoring are essential to understand and mitigate potential cognitive and developmental challenges in children born to mothers infected with COVID-19. This review aims to guide clinicians in managing these risks throughout childhood. Maternal COVID-19 infection during pregnancy can have significant implications for fetal development, even if the newborn is not infected at birth. The release of inflammatory cytokines may cross the placental barrier, potentially disrupting fetal brain development and increasing the risk of long-term cognitive and behavioral issues, such as ADHD or autism. Placental dysfunction, caused by inflammation or thrombosis, can lead to intrauterine growth restriction (IUGR), preterm birth, or hypoxia, affecting both neurological and respiratory health in newborns. Furthermore, a compromised fetal immune system can increase susceptibility to autoimmune conditions and infections. The early diagnosis and management of infections during pregnancy are crucial in mitigating risks to both the mother and fetus. Swift intervention can prevent complications like preterm birth and long-term developmental challenges, ensuring better health outcomes for both the mother and child. Long-term monitoring of children born to mothers infected with COVID-19 is necessary to understand the full extent of the virus’s impact. This review evaluates the long-term systemic effects of maternal COVID-19 infection during pregnancy on fetuses, newborns, and children, focusing beyond vertical transmission. It highlights the broader impacts on fetal development, offering insights to help clinicians manage potential issues that may arise later in life. Full article
(This article belongs to the Special Issue Diagnosis and Management in Prenatal Medicine, 3rd Edition)
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29 pages, 8863 KiB  
Systematic Review
Exploring the Applications of Artificial Intelligence in Dental Image Detection: A Systematic Review
by Shuaa S. Alharbi and Haifa F. Alhasson
Diagnostics 2024, 14(21), 2442; https://doi.org/10.3390/diagnostics14212442 - 31 Oct 2024
Viewed by 790
Abstract
Background: Dental care has been transformed by neural networks, introducing advanced methods for improving patient outcomes. By leveraging technological innovation, dental informatics aims to enhance treatment and diagnostic processes. Early diagnosis of dental problems is crucial, as it can substantially reduce dental disease [...] Read more.
Background: Dental care has been transformed by neural networks, introducing advanced methods for improving patient outcomes. By leveraging technological innovation, dental informatics aims to enhance treatment and diagnostic processes. Early diagnosis of dental problems is crucial, as it can substantially reduce dental disease incidence by ensuring timely and appropriate treatment. The use of artificial intelligence (AI) within dental informatics is a pivotal tool that has applications across all dental specialties. This systematic literature review aims to comprehensively summarize existing research on AI implementation in dentistry. It explores various techniques used for detecting oral features such as teeth, fillings, caries, prostheses, crowns, implants, and endodontic treatments. AI plays a vital role in the diagnosis of dental diseases by enabling precise and quick identification of issues that may be difficult to detect through traditional methods. Its ability to analyze large volumes of data enhances diagnostic accuracy and efficiency, leading to better patient outcomes. Methods: An extensive search was conducted across a number of databases, including Science Direct, PubMed (MEDLINE), arXiv.org, MDPI, Nature, Web of Science, Google Scholar, Scopus, and Wiley Online Library. Results: The studies included in this review employed a wide range of neural networks, showcasing their versatility in detecting the dental categories mentioned above. Additionally, the use of diverse datasets underscores the adaptability of these AI models to different clinical scenarios. This study highlights the compatibility, robustness, and heterogeneity among the reviewed studies. This indicates that AI technologies can be effectively integrated into current dental practices. The review also discusses potential challenges and future directions for AI in dentistry. It emphasizes the need for further research to optimize these technologies for broader clinical applications. Conclusions: By providing a detailed overview of AI’s role in dentistry, this review aims to inform practitioners and researchers about the current capabilities and future potential of AI-driven dental care, ultimately contributing to improved patient outcomes and more efficient dental practices. Full article
(This article belongs to the Special Issue Advances in the Diagnosis of Oral and Maxillofacial Disease)
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13 pages, 2349 KiB  
Article
Fluoroscopy-Guided Percutaneous Transthoracic Needle Lung Biopsy with the Aid of Planning Cone-Beam CT: Diagnostic Accuracy and Complications
by Sang Hyun Cho, Hyun Jung Yoon, Young Lee, Injoong Kim, Je Ryung Gil and Yeo Jin Kim
Diagnostics 2024, 14(21), 2441; https://doi.org/10.3390/diagnostics14212441 - 31 Oct 2024
Viewed by 466
Abstract
Background: Fluoroscopy-guided PTNB for fluoroscopy-identifiable lung lesions has been suggested as a useful method for the pathological diagnosis of lung lesions; however, it is lacking in accuracy and safety compared to CT-guided PTNB. Thus, we aimed to investigate the diagnostic accuracy and complications [...] Read more.
Background: Fluoroscopy-guided PTNB for fluoroscopy-identifiable lung lesions has been suggested as a useful method for the pathological diagnosis of lung lesions; however, it is lacking in accuracy and safety compared to CT-guided PTNB. Thus, we aimed to investigate the diagnostic accuracy and complications of fluoroscopy-guided percutaneous transthoracic needle biopsy (PTNB) with the aid of pre-procedural planning cone-beam computed tomography (CBCT) in order to take advantage of their respective strengths. Methods: A total of 255 fluoroscopy-guided PTNBs with the aid of planning CBCT were performed. Pre-procedural planning CBCT was conducted to calculate the shortest length from the skin puncture site to the margin of the target lesion for the needle trajectory. No intra-procedural CBCT was performed. The diagnostic performance of fluoroscopy-guided PTNB with the aid of planning CBCT was calculated. The prognostic factors for diagnostic failures and complications were evaluated using logistic regression analysis. Results: The accuracy, sensitivity, specificity, PPV, and NPV were 97.3%, 88.0%, 90.9%, 100%, and 62.5%, respectively. There were 29 diagnostic failures (11.8%), and the multivariable analysis showed that a longer lesion depth on CBCT and a shorter specimen length were each associated with diagnostic failure (p = 0.010 and 0.012, respectively). Complications occurred in 34 PTNBs (13.3%). The multivariable analysis showed that an increased total number of biopsies per lesion, a longer length of lung aeration via needle insertion, a smaller lesion size on CT imaging (≤20 mm), and the presence of an air bronchogram were associated with the occurrence of complications (p = 0.027, <0.001, 0.003, and 0.020, respectively). Conclusions: Excellent diagnostic accuracy was obtained by fluoroscopy-guided PTNB with the aid of planning CBCT. Compared to that of CT- or CBCT-guided PTNB, the procedure-related complication rate was acceptably low, but the radiation dose to patients could be potentially reduced. Full article
(This article belongs to the Special Issue Diagnosis of Cardio-Thoracic Diseases)
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11 pages, 486 KiB  
Article
Are Extracorporeal Shock Waves Just a Therapeutic Tool?
by Bernardo Gialanella, Laura Comini, Gian Pietro Bonometti, Fabio Vanoglio, Andrea Bettinsoli, Raffaele Santoro, Adriana Olivares and Alberto Luisa
Diagnostics 2024, 14(21), 2440; https://doi.org/10.3390/diagnostics14212440 - 31 Oct 2024
Viewed by 467
Abstract
Background: Focused extracorporeal shock wave therapy (ESWT) has been successfully used to treat musculoskeletal conditions, but ESWT stimulates nociceptors, causing pain deep in the tissue during treatment. The occurrence of pain during ESWT is a side effect, but it can help identify painful [...] Read more.
Background: Focused extracorporeal shock wave therapy (ESWT) has been successfully used to treat musculoskeletal conditions, but ESWT stimulates nociceptors, causing pain deep in the tissue during treatment. The occurrence of pain during ESWT is a side effect, but it can help identify painful sites and assess minimum (MiTI) and maximum (MaTI) pain thresholds to ESWT pressure stimuli. This topic has received limited attention in literature. Methods: This observational study describes a specific approach to using ESWT to study pain in 71 patients. The approach proposes moving the ESWT transducer head of the device over the entire joint surface, progressively increasing the energy level until the patient experiences pain. Results: In the study, MiTI and MaTI were 0.218 ± 0.090 and 0.416 ± 0.165 mJ/mm2 in the affected joint and 0.282 ± 0.128 and 0.501 ± 0.174 mJ/mm2 in the contralateral homologous healthy joint, being significantly lower in the affected joint (MiTI: p < 0.001 and MaTI: p = 0.003, respectively). ESWT induced pain in 94.37% of the sites with the highest subjective pain and in a greater number of sites (204) than digital pressure (123) (p < 0.001). All sites with digital pressure pain also had ESWT pain. Conclusions: These results suggest that the ESWT device may be useful in investigating pain in musculoskeletal conditions and tailoring therapy. Full article
(This article belongs to the Special Issue Diagnosis and Management of Musculoskeletal Diseases)
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14 pages, 831 KiB  
Article
Sentinel Lymph Node Biopsy in Breast Cancer Using Different Types of Tracers According to Molecular Subtypes and Breast Density—A Randomized Clinical Study
by Ionut Flaviu Faur, Amadeus Dobrescu, Ioana Adelina Clim, Paul Pasca, Catalin Prodan-Barbulescu, Cristi Tarta, Carmen Neamtu, Alexandru Isaic, Dan Brebu, Vlad Braicu, Catalin Vladut Ionut Feier, Ciprian Duta and Bogdan Totolici
Diagnostics 2024, 14(21), 2439; https://doi.org/10.3390/diagnostics14212439 - 31 Oct 2024
Viewed by 1082
Abstract
Background: Sentinel lymph node biopsy (SLNB) has become a method more and more frequently used in loco-regional breast cancer in the initial stages. Starting from the first report on the technical feasibility of the sentinel node method in breast cancer, published by Krag [...] Read more.
Background: Sentinel lymph node biopsy (SLNB) has become a method more and more frequently used in loco-regional breast cancer in the initial stages. Starting from the first report on the technical feasibility of the sentinel node method in breast cancer, published by Krag (1993) and Giuliano (1994), the method underwent numerous improvements and was also largely used worldwide. Methods: This article is a prospective study that took place at the “SJUPBT Surgery Clinic Timisoara” over a period of 1 year between July 2023 and July 2024, during which 137 underwent sentinel lymph node biopsy (SLNB) based on the current guidelines. For the identification of sentinel lymph nodes, we used various methods, including single traces and also a dual tracer and triple tracer. Results: Breast density represents a predictive biomarker for the identification rate of a sentinel node, being directly correlated with BMI (above 30 kg/m2) and with an age of above 50 years. The classification of the patients according to breast density represents an important criterion given that an adipose breast density (Tabar-Gram I-II) represents a lower IR of SLN compared with a density of the fibro-nodular type (Tabar-Gram III-V). We did not obtain any statistically significant data for the linear correlations between IR and the molecular profile, whether referring to the luminal subtypes (Luminal A and Luminal B) or to the non-luminal ones (HER2+ and TNBC), with p > 0.05, 0.201 [0.88, 0.167]; z = 1.82. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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11 pages, 1376 KiB  
Article
Role of Apparent Diffusion Coefficient Value and Apparent Diffusion Coefficient Ratio as Prognostic Factors for Prostate Cancer Aggressiveness
by Arvids Buss, Maija Radzina, Mara Liepa, Edgars Birkenfelds, Laura Saule, Karlis Miculis, Madara Mikelsone and Egils Vjaters
Diagnostics 2024, 14(21), 2438; https://doi.org/10.3390/diagnostics14212438 - 31 Oct 2024
Viewed by 561
Abstract
Background: Prostate cancer is one of the most prevalent cancers in the male population. To determine the aggressiveness of suspected lesions precisely, predictive models are increasingly being developed using quantitative MRI measurements, and particularly the ADC value. This study aimed to determine whether [...] Read more.
Background: Prostate cancer is one of the most prevalent cancers in the male population. To determine the aggressiveness of suspected lesions precisely, predictive models are increasingly being developed using quantitative MRI measurements, and particularly the ADC value. This study aimed to determine whether ADC values could be used to establish the aggressiveness of prostate cancer. Methods: A retrospective single-center study included 398 patients with prostate cancer who underwent a multiparametric MRI prior to radical prostatectomy. DWI ADC values were measured (µm2/s) using b values of 50 and 1000. The dominant lesion best visualized on MRI was analyzed. The ADC values of the index lesion and reference tissue were compared to tumor aggressivity according to the Gleason grade groups based on radical prostatectomy results. Statistical analysis was performed using the Mann–Whitney U test, Kruskal–Wallis H test, Spearman’s rank correlation, and ROC curves. Results: A very strong negative correlation (rs = −0.846, p < 0.001) between ADC and GS was found. ROC analysis revealed an AUC of 0.958 and an ADC threshold value of 758 µm2/s in clinically significant prostate cancer diagnoses using the absolute ADC value, with no advantage of using the ADC ratio over the absolute ADC value being identified. Conclusion: DWI ADC values and the calculated ADC ratio have a significant inverse correlation with GS. The findings indicate a strong capability in determining prostate cancer aggressiveness, as well as the possibility of assisting with assigning PI-RADS categories using ADC as quantitative metrics. Full article
(This article belongs to the Special Issue Diagnostic Imaging of Prostate Cancer)
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19 pages, 934 KiB  
Article
Assessment of Metabolic Syndrome in Patients with Chronic Obstructive Pulmonary Disease: A 6-Month Follow-Up Study
by Elena-Andreea Moaleș, Lucia Corina Dima-Cozma, Doina-Clementina Cojocaru, Ioana Mădălina Zota, Cristina Mihaela Ghiciuc, Cristina Andreea Adam, Mitică Ciorpac, Ivona Maria Tudorancea, Florin Dumitru Petrariu, Maria-Magdalena Leon, Romică Sebastian Cozma and Florin Mitu
Diagnostics 2024, 14(21), 2437; https://doi.org/10.3390/diagnostics14212437 - 31 Oct 2024
Viewed by 603
Abstract
Background/Objectives: The association between chronic obstructive pulmonary disease (COPD) and metabolic syndrome (MetS) is a common one, with long-term therapeutic and prognostic impact. In view of the high pulmonary and cardiovascular morbidity and mortality, self-management contributes to decreasing the risk of an acute [...] Read more.
Background/Objectives: The association between chronic obstructive pulmonary disease (COPD) and metabolic syndrome (MetS) is a common one, with long-term therapeutic and prognostic impact. In view of the high pulmonary and cardiovascular morbidity and mortality, self-management contributes to decreasing the risk of an acute cardiac event or pulmonary decompensation. Methods: We conducted a prospective cohort study on 100 patients admitted to Iasi Clinical Rehabilitation Hospital who were divided into two groups according to the presence (67 patients) or absence (33 patients) of MetS. All patients benefited from multidisciplinary counseling sessions on their active role in improving modifiable cardiovascular risk factors and thus increasing quality of life. The aim of this study was to examine the impact of metabolic syndrome on lung function and the role of self-management in a 6-month follow-up period. The demographic, anthropometric, cardiovascular risk factors, and respiratory function were analyzed at baseline and at 6 months. Results: The presence of MetS was associated with higher fasting blood glucose (p = 0.004) and triglycerides (p = 0.003) but not with higher levels of interleukins or TNF-alpha. At the 6-month follow-up, abdominal circumference, forced expiratory volume in one second (FEV1), dyspnea severity, and blood pressure values improved in male patients with COPD. Systolic and diastolic blood pressure decreased in the COPD group as a whole, but especially in male patients with and without associated MetS. BMI was positively correlated with FEV1 (r = 0.389, p = 0.001) and the FEV1/forced vital capacity (FVC) ratio (r = 0.508, p < 0.001) in all COPD patients and in the MetS subgroup. In the COPD group as a whole. the six-minute walk test (6MWT) results (m) were positively correlated with FEV1 and FVC. The correlation remained significant for FVC in COPD patients with and without MetS. An increase in BMI by one unit led to an increase in TG values by 3.358 mg/dL, and the presence of metabolic syndrome led to an increase in TG values by 17.433 mg/dL. Conclusions: In our study, MetS is a common comorbidity in patients with COPD and is associated with higher BMI, fasting glucose, and triglycerides but not with the inflammatory parameters. A mixed pulmonary–cardiovascular rehabilitation intervention leads to improvement in various parameters in both female and male COPD patients. Full article
(This article belongs to the Special Issue Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD))
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9 pages, 489 KiB  
Case Report
Impact of General Anesthesia on Ciliary Functional Analysis by Digital High-Speed Videomicroscopy in Suspected Primary Ciliary Dyskinesia
by Lionel Benchimol, Noemie Bricmont, Romane Bonhiver, Grégory Hans, Céline Kempeneers, Philippe Lefebvre and Anne-Lise Poirrier
Diagnostics 2024, 14(21), 2436; https://doi.org/10.3390/diagnostics14212436 - 31 Oct 2024
Viewed by 484
Abstract
Digital high-speed videomicroscopy (DHSV) is a crucial tool for evaluating ciliary function in children suspected of primary ciliary dyskinesia (PCD). However, until now, samples are taken without anesthesia due to uncertainty about its effect on ciliary function and DHSV interpretation. This study aimed [...] Read more.
Digital high-speed videomicroscopy (DHSV) is a crucial tool for evaluating ciliary function in children suspected of primary ciliary dyskinesia (PCD). However, until now, samples are taken without anesthesia due to uncertainty about its effect on ciliary function and DHSV interpretation. This study aimed to investigate the impact of general anesthesia on ciliary functional analysis by DHSV in a series of three patients listed for ENT surgeries, which could improve diagnostic procedures for pediatric patients. Patient 1 (7-year-old girl) underwent adenotonsillectomy and tympanostomy placement tube, while patients 2 (17-month-old boy) and 3 (15-month-old girl) underwent adenoidectomy and tympanostomy placement tube. All patients underwent nasal brushing before general anesthesia (control sample). Experimental samples were taken in the contralateral nostril at the time of equilibration of the anesthetic agents (sevoflurane, propofol, sufentanil). Ciliary beat frequency and pattern were measured using digital high-speed videomicroscopy. Our findings highlighted the variability of respiratory ciliary function under general anesthesia among individuals. Our results emphasize the need for caution when interpreting ciliary function data obtained during general anesthesia. Further research with larger cohorts is warranted for validation. Full article
(This article belongs to the Section Biomedical Optics)
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15 pages, 1497 KiB  
Review
Quantification of Replacement Fibrosis in Aortic Stenosis: A Narrative Review on the Utility of Cardiovascular Magnetic Resonance Imaging
by Megan R. Rajah, Anton F. Doubell and Philip G. Herbst
Diagnostics 2024, 14(21), 2435; https://doi.org/10.3390/diagnostics14212435 - 31 Oct 2024
Viewed by 568
Abstract
Aortic stenosis (AS) is associated with the development of replacement myocardial fibrosis/scar. Given the dose-dependent relationship between scar and clinical outcomes after aortic valve replacement (AVR) surgery, scar quantity may serve as an important risk-stratification tool to aid decision-making on the optimal timing [...] Read more.
Aortic stenosis (AS) is associated with the development of replacement myocardial fibrosis/scar. Given the dose-dependent relationship between scar and clinical outcomes after aortic valve replacement (AVR) surgery, scar quantity may serve as an important risk-stratification tool to aid decision-making on the optimal timing of AVR. Scar is non-invasively assessed and quantified by cardiovascular magnetic resonance (CMR) imaging. Several quantification techniques exist, and consensus on the optimal technique is lacking. These techniques range from a visual manual method to fully automated ones. This review describes the different scar quantification techniques used and highlights their strengths and shortfalls within the context of AS. The two most commonly used techniques in AS include the semi-automated signal threshold versus reference mean (STRM) and full-width half-maximum (FWHM) techniques. The accuracy and reproducibility of these techniques may be hindered in AS by the coexistence of diffuse interstitial fibrosis and the presence of relatively small, non-bright scars. The validation of these techniques against histology, which is the current gold standard for scar quantification in AS, is limited. Based on the best current evidence, the STRM method using a threshold of three standard deviations above the mean signal intensity of remote myocardium is recommended. The high reproducibility of the FWHM technique in non-AS cohorts has been shown and merits further evaluation within the context of AS. Future directions include the use of quantitative T1 mapping for the detection and quantification of scar, as well as the development of serum biomarkers that reflect the fibrotic status of the myocardium in AS. Full article
(This article belongs to the Special Issue Recent Advances in Cardiac Imaging: 2024)
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10 pages, 3744 KiB  
Article
mFFE CT-like MRI Sequences for the Assessment of Vertebral Fractures
by David Ferreira Branco, Hicham Bouredoucen, Marion Hamard, Karel Gorican, Pierre-Alexandre Poletti, Bénédicte Marie Anne Delattre and Sana Boudabbous
Diagnostics 2024, 14(21), 2434; https://doi.org/10.3390/diagnostics14212434 - 30 Oct 2024
Viewed by 551
Abstract
Objectives: The aim of this study was to evaluate the diagnostic performance, image quality, and inter- and intra-observer agreement of the 3D T1 multi-echo fast field echo (mFFE) sequence in cervico-thoraco-lumbar vertebral fractures compared with conventional computed tomography (CT) as the gold standard. [...] Read more.
Objectives: The aim of this study was to evaluate the diagnostic performance, image quality, and inter- and intra-observer agreement of the 3D T1 multi-echo fast field echo (mFFE) sequence in cervico-thoraco-lumbar vertebral fractures compared with conventional computed tomography (CT) as the gold standard. Methods: We conducted a prospective single-centre study including 29 patients who underwent spinal magnetic resonance imaging (MRI) at the surgeon’s request, in addition to CT for vertebral fracture assessment and classification. A 3D T1 mFFE sequence was added to the standard MRI protocol. Consecutively, two readers analyzed the 3D mFFE sequence alone, the 3D mFFE sequence with the entire MRI protocol, including the STIR and T1 sequences, and, finally, the CT images in random order and 1 month apart. A standardized assessment was performed to determine the presence or absence of a fracture, its location, its classification according to the Genant and AO classifications for traumatic and osteoporotic fractures, respectively, the loss of height of the anterior and posterior walls of the vertebral body, and the presence of concomitant disco-ligamentous lesions. Contingency tables, intraclass correlation coefficients, and Cohen’s kappa tests were used for statistical analysis. Results: A total of 25 fractures were recorded (48% cervical, 20% thoracic, and 32% lumbar), of which 52% were classified A, according to the AO classification system. The quality of the 3D mFFE image was good or excellent in 72% of cases. Inter-observer agreement was near perfect (0.81–1) for vertebral body height and for AO and Genant classifications for all modalities. Intra-observer agreement was strong-to-near perfect between CT and the 3D mFFE sequence. Regarding the diagnostic performance of the 3D mFFE sequence, the sensitivity was 0.9200 and 0.9600, the specificity was 0.9843 and 0.9895, and the accuracy was 0.9861 and 0.9769 for Readers 1 and 2, respectively. In addition, up to 40% of intervertebral disc lesions and 33% of ligamentous lesions were detected by the 3D mFFE sequence compared to CT, allowing four AO type A fractures to be reclassified as type B. Conclusions: The 3D mFFE sequence allows accurate diagnosis of vertebral fractures, with superiority over CT in detecting disco-ligamentous lesions and a more precise classification of fractures, which can prompt clinicians to adapt their management despite an image quality that still requires improvement in some cases. Key points: Vertebral fractures and disco-ligamentous lesions can be assessed using CT-like MRI sequences, with 3D T1 mFFE being superior to CT for the detection of disco-ligamentous lesions. CT-like images using the 3D T1 mFFE sequence improve the diagnostic accuracy of bone structures in MRI. Full article
(This article belongs to the Special Issue Advanced Musculoskeletal Imaging in Clinical Diagnostics)
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Article
Validity of the Strengths and Difficulties Questionnaire for Screening and Diagnosis in Western Australian Adolescents
by Carolyn Maxwell, Elaine Chapman and Stephen Houghton
Diagnostics 2024, 14(21), 2433; https://doi.org/10.3390/diagnostics14212433 - 30 Oct 2024
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Abstract
Background/Objectives: The Strengths and Difficulties Questionnaire (SDQ) is a widely used 25-item screening and diagnostic tool for behavioral and emotional problems in young people. Despite its popularity, evaluations of the SDQ’s factor structure in adolescent populations have produced disparate results, and its relationships [...] Read more.
Background/Objectives: The Strengths and Difficulties Questionnaire (SDQ) is a widely used 25-item screening and diagnostic tool for behavioral and emotional problems in young people. Despite its popularity, evaluations of the SDQ’s factor structure in adolescent populations have produced disparate results, and its relationships with theoretically related variables are rarely evaluated. In the present study, these two elements of validity were evaluated based on a large sample of Western Australian adolescents. Methods: Participants were 1489 adolescents, n = 623 males with a mean age of 13.79 years (SD = 1.61) and n = 866 females, with a mean age of 14.29 years (SD = 1.51). Participants completed the SDQ alongside measures of loneliness, sense of belonging, depression, bullying, and diagnostic status to evaluate its internal structure and correlations with theoretically related variables. Results: Confirmatory factor analyses supported the internal structure of the SDQ both for males and for females. Relationships between the SDQ subscale scores and those from theoretically related variables were also aligned with the instrument’s underpinning framework. Conclusions: Despite the somewhat disparate results of previous studies, overall, this study supported the validity of the SDQ for use in the Western Australian context. Full article
(This article belongs to the Special Issue Advances in Mental Health Diagnosis and Screening)
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