Optimization of Clinical Imaging: From Diagnosis to Prognosis

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: 31 July 2025 | Viewed by 5642

Special Issue Editors


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Guest Editor
Department of Neuroradiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Interests: clinical imaging; interventional; neuro; economics

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Guest Editor
Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Interests: clinical imaging; cardiovascular; emergency medicine/intensive care; oncology; workflow; efficiancy; economics

Special Issue Information

Dear Colleagues,

Clinical imaging aims at providing the best possible patient care and is playing an increasingly important role in various areas, including disease prevention, diagnosis, prognosis assessment, and therapeutic decision-making. Accordingly, there is an increasing demand for all imaging modalities.

In contrast to other clinical areas, oncologic imaging is typically quite extensive and thus accounts for a significant portion of the radiological workload. Furthermore, it is necessary to access examinations from different sources over longer time intervals, and this further increases the complexity of interpretation and reporting.

On the other hand, there is a shortage of resources and a need for optimal allocation from an economic and also an ecological point of view.

The aim of this Special Issue is to present recent developments and novel approaches to improve clinical imaging covering insights from recent technical developments to imaging management and seamless integration in patient care.

Dr. Johannes Kahn
Dr. Georg Böning
Guest Editors

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Keywords

  • clinical imaging
  • medical image analysis
  • imaging management
  • computed tomography (CT)
  • magnetic resonance imaging (MRI)

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Published Papers (7 papers)

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10 pages, 1358 KiB  
Article
Bone Mineral Density and First Line Imaging with [18F]fluorocholine PET/CT in Normocalcemic and Hypercalcemic Primary Hyperparathyroidism: Results from a Single Center
by Dagmar Schaffler-Schaden, Gregor Schweighofer-Zwink, Lukas Hehenwarter, Antje van der Zee-Neuen, Maria Flamm, Mohsen Beheshti and Christian Pirich
Diagnostics 2024, 14(22), 2466; https://doi.org/10.3390/diagnostics14222466 - 5 Nov 2024
Viewed by 394
Abstract
Objectives: Primary hyperparathyroidism (PHPT) is associated with normal or elevated calcium levels and affects bone mineral density. The proportion of cases predisposed to metabolic bone disease is unknown in patients with PHPT. The aim of this study was to assess bone mineral [...] Read more.
Objectives: Primary hyperparathyroidism (PHPT) is associated with normal or elevated calcium levels and affects bone mineral density. The proportion of cases predisposed to metabolic bone disease is unknown in patients with PHPT. The aim of this study was to assess bone mineral density and bone quality in patients with normo- or hypercalcemic primary hyperparathyroidism undergoing baseline parathyroid gland assessment with [18F]fluorocholine PET/CT imaging. Methods: A total of 140 consecutive patients were enrolled in this observational study. All patients with normo- or hypercalcemic primary hyperparathyroidism underwent dual-energy X-ray absorptiometry (DXA) for assessment of bone mineral density (BMD) and trabecular bone score (TBS). [18F]fluorocholine PET/CT was performed in all patients for the detection and localization of parathyroid adenoma. Hyper- and normocalcemic patients were compared with regard to the proportion of osteoporosis and osteopenia, T-Score, TBS, serum calcium, phosphorus and parathyroid hormone levels, the maximum standardized uptake value (SUVmax) in PET/CT imaging, and laboratory results. Results: The majority of patients was female (88.57%) and had a pathologic bone mineral density (52.86%). Overall, 33 patients had osteoporosis and 41 osteopenia. The mean lumbar T-Score was −1.48 (SD 1.37) and the T-Score of the femoral neck was −1.21 (SD 0.92). Mean TBS was also decreased (−2.13). No difference was found between normo- or hypercalcemic patients regarding bone metabolism and imaging parameters. Conclusions: More than half of patients with normo- or hypercalcemic PHPT showed abnormal BMD. First-line [18F]fluorocholine PET/CT identified parathyroid adenoma in a high proportion of patients, even in patients with normocalcemic PHPT. The early evaluation of metabolic bone disease seems desirable in clinical management of females with PHPT. Full article
(This article belongs to the Special Issue Optimization of Clinical Imaging: From Diagnosis to Prognosis)
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14 pages, 1878 KiB  
Article
A Machine Learning-Based Clustering Using Radiomics of F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for the Prediction of Prognosis in Patients with Intrahepatic Cholangiocarcinoma
by Rosie Kwon, Hannah Kim, Keun Soo Ahn, Bong-Il Song, Jinny Lee, Hae Won Kim, Kyoung Sook Won, Hye Won Lee, Tae-Seok Kim, Yonghoon Kim and Koo Jeong Kang
Diagnostics 2024, 14(19), 2245; https://doi.org/10.3390/diagnostics14192245 - 8 Oct 2024
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Abstract
Background: Intrahepatic cholangiocarcinoma (IHCC) is highly aggressive primary hepatic malignancy with an increasing incidence. Objective: This study aimed to develop machine learning-based radiomic clustering using F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for predicting recurrence-free survival (RFS) and overall survival (OS) in [...] Read more.
Background: Intrahepatic cholangiocarcinoma (IHCC) is highly aggressive primary hepatic malignancy with an increasing incidence. Objective: This study aimed to develop machine learning-based radiomic clustering using F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for predicting recurrence-free survival (RFS) and overall survival (OS) in IHCC. Methods: We retrospectively reviewed pretreatment F-18 FDG PET/CT scans of 60 IHCC patients who underwent surgery without neoadjuvant treatment between January 2008 and July 2020. Radiomic features such as first order, shape, and gray level were extracted from the scans of 52 patients and analyzed using unsupervised hierarchical clustering. Results: Of the 60 patients, 36 experienced recurrence and 31 died during follow-up. Eight patients with a negative FDG uptake were classified as Group 0. The unsupervised hierarchical clustering analysis divided the total cohort into three clusters (Group 1: n = 27; Group 2: n = 23; Group 3: n = 2). The Kaplan–Meier curves showed significant differences in RFS and OS among the clusters (p < 0.0001). Multivariate analyses showed that the PET radiomics grouping was an independent prognostic factor for RFS (hazard ratio (HR) = 3.03, p = 0.001) and OS (HR = 2.39, p = 0.030). Oxidative phosphorylation was significantly activated in Group 1, and the KRAS, P53, and WNT β-catenin pathways were enriched in Group 2. Conclusions: This study demonstrated that machine learning-based PET radiomics clustering can preoperatively predict prognosis and provide valuable information complementing the genomic profiling of IHCC. Full article
(This article belongs to the Special Issue Optimization of Clinical Imaging: From Diagnosis to Prognosis)
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14 pages, 1695 KiB  
Article
Early Detection of Lymph Node Metastasis Using Primary Head and Neck Cancer Computed Tomography and Fluorescence Lifetime Imaging
by Nimu Yuan, Mohamed A. Hassan, Katjana Ehrlich, Brent W. Weyers, Garrick Biddle, Vladimir Ivanovic, Osama A. A. Raslan, Dorina Gui, Marianne Abouyared, Arnaud F. Bewley, Andrew C. Birkeland, D. Gregory Farwell, Laura Marcu and Jinyi Qi
Diagnostics 2024, 14(18), 2097; https://doi.org/10.3390/diagnostics14182097 - 23 Sep 2024
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Abstract
Objectives: Early detection and accurate diagnosis of lymph node metastasis (LNM) in head and neck cancer (HNC) are crucial for enhancing patient prognosis and survival rates. Current imaging methods have limitations, necessitating new evaluation of new diagnostic techniques. This study investigates the [...] Read more.
Objectives: Early detection and accurate diagnosis of lymph node metastasis (LNM) in head and neck cancer (HNC) are crucial for enhancing patient prognosis and survival rates. Current imaging methods have limitations, necessitating new evaluation of new diagnostic techniques. This study investigates the potential of combining pre-operative CT and intra-operative fluorescence lifetime imaging (FLIm) to enhance LNM prediction in HNC using primary tumor signatures. Methods: CT and FLIm data were collected from 46 HNC patients. A total of 42 FLIm features and 924 CT radiomic features were extracted from the primary tumor site and fused. A support vector machine (SVM) model with a radial basis function kernel was trained to predict LNM. Hyperparameter tuning was conducted using 10-fold nested cross-validation. Prediction performance was evaluated using balanced accuracy (bACC) and the area under the ROC curve (AUC). Results: The model, leveraging combined CT and FLIm features, demonstrated improved testing accuracy (bACC: 0.71, AUC: 0.79) over the CT-only (bACC: 0.58, AUC: 0.67) and FLIm-only (bACC: 0.61, AUC: 0.72) models. Feature selection identified that a subset of 10 FLIm and 10 CT features provided optimal predictive capability. Feature contribution analysis identified high-pass and low-pass wavelet-filtered CT images as well as Laguerre coefficients from FLIm as key predictors. Conclusions: Combining CT and FLIm of the primary tumor improves the prediction of HNC LNM compared to either modality alone. Significance: This study underscores the potential of combining pre-operative radiomics with intra-operative FLIm for more accurate LNM prediction in HNC, offering promise to enhance patient outcomes. Full article
(This article belongs to the Special Issue Optimization of Clinical Imaging: From Diagnosis to Prognosis)
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12 pages, 2607 KiB  
Article
Associations of Longitudinal Multiparametric MRI Findings and Clinical Outcomes in Intra-Articular Injections for Knee Osteoarthritis
by Woo Young Kang, Suk-Joo Hong, Ji-Hoon Bae, Zepa Yang, In Seong Kim and Ok Hee Woo
Diagnostics 2024, 14(18), 2025; https://doi.org/10.3390/diagnostics14182025 - 13 Sep 2024
Viewed by 569
Abstract
Background: Osteoarthritis (OA) is a complex disease marked by the degradation of articular cartilage. Objective: This study aimed to explore the relationship between cartilage volume/thickness and clinical outcomes in knee OA patients treated with intra-articular injections over one year. Methods: Twenty-four patients with [...] Read more.
Background: Osteoarthritis (OA) is a complex disease marked by the degradation of articular cartilage. Objective: This study aimed to explore the relationship between cartilage volume/thickness and clinical outcomes in knee OA patients treated with intra-articular injections over one year. Methods: Twenty-four patients with mild-to-moderate OA were retrospectively analyzed using knee MRI. OA features were assessed semiquantitatively with the Whole-Organ Magnetic Resonance Imaging Score (WORMS), while cartilage thickness and volume in the medial femoral condyle (MFC) and medial tibial plateau (MTP) were measured. T1ρ and T2 values for MFC cartilage were also recorded. Clinical outcomes were evaluated using the Korean Western Ontario and McMaster Universities (K-WOMAC) and Knee Injury Osteoarthritis Outcomes (KOOS) scores. Spearman’s rank test assessed the associations between imaging changes and clinical outcomes. Results: The baseline MTP and MFC cartilage thickness and MTP cartilage volume showed significant correlations with clinical outcomes. Additionally, less progressive cartilage loss in the medial femorotibial joint (MFTJ) and overall joint was linked to a better clinical response over 12 months. Conclusions: In conclusion, thicker baseline MFTJ cartilage and minimal cartilage loss were associated with favorable clinical outcomes in knee OA patients receiving intra-articular injections. Full article
(This article belongs to the Special Issue Optimization of Clinical Imaging: From Diagnosis to Prognosis)
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11 pages, 3875 KiB  
Article
[68Ga]Ga-DOTAGA-Glu(FAPi)2 Shows Enhanced Tumor Uptake and Theranostic Potential in Preclinical PET Imaging
by Julie van Krimpen Mortensen, Simona Mattiussi, Lars Hvass, Emilie Graae Lund, Vladimir Shalgunov, Frank Roesch, Umberto Maria Battisti, Matthias Manfred Herth and Andreas Kjaer
Diagnostics 2024, 14(18), 2024; https://doi.org/10.3390/diagnostics14182024 - 13 Sep 2024
Viewed by 977
Abstract
The use of fibroblast activation protein inhibitors (FAPis) for positron emission tomography (PET) imaging in cancer has garnered significant interest in recent years, yielding promising results in preclinical and clinical settings. FAP is predominantly expressed in pathological conditions such as fibrosis and cancer, [...] Read more.
The use of fibroblast activation protein inhibitors (FAPis) for positron emission tomography (PET) imaging in cancer has garnered significant interest in recent years, yielding promising results in preclinical and clinical settings. FAP is predominantly expressed in pathological conditions such as fibrosis and cancer, making it a compelling target. An optimized approach involves using FAPi homodimers as PET tracers, which enhance tumor uptake and retention, making them more effective candidates for therapy. Here, a UAMC-1110 inhibitor-based homodimer, DOTAGA-Glu(FAPi)2, was synthesized and radiolabeled with gallium-68, and its efficacy was evaluated in vivo for PET imaging in an endogenously FAP-expressing xenografted mouse model, U87MG. Notably, 45 min post-injection, the mean uptake of [68Ga]Ga-DOTAGA-Glu(FAPi)2 was 4.7 ± 0.5% ID/g in the tumor with low off-target accumulation. The ex vivo analysis of the FAP expression in the tumors confirmed the in vivo results. These findings highlight and confirm the tracer’s potential for diagnostic imaging of cancer and as a theranostic companion. Full article
(This article belongs to the Special Issue Optimization of Clinical Imaging: From Diagnosis to Prognosis)
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15 pages, 11150 KiB  
Article
Design Optimisation of a Flat-Panel, Limited-Angle TOF-PET Scanner: A Simulation Study
by Matic Orehar, Rok Dolenec, Georges El Fakhri, Samo Korpar, Peter Križan, Gašper Razdevšek, Thibault Marin, Dejan Žontar and Rok Pestotnik
Diagnostics 2024, 14(17), 1976; https://doi.org/10.3390/diagnostics14171976 - 6 Sep 2024
Viewed by 651
Abstract
In time-of-flight positron emission tomography (TOF-PET), a coincidence time resolution (CTR) below 100 ps reduces the angular coverage requirements and, thus, the geometric constraints of the scanner design. Among other possibilities, this opens the possibility of using flat-panel PET detectors. Such a design [...] Read more.
In time-of-flight positron emission tomography (TOF-PET), a coincidence time resolution (CTR) below 100 ps reduces the angular coverage requirements and, thus, the geometric constraints of the scanner design. Among other possibilities, this opens the possibility of using flat-panel PET detectors. Such a design would be more cost-accessible and compact and allow for a higher degree of modularity than a conventional ring scanner. However, achieving adequate CTR is a considerable challenge and requires improvements at every level of detection. Based on recent results in the ongoing development of optimised TOF-PET photodetectors and electronics, we expect that within a few years, a CTR of about 75 ps will be be achievable at the system level. In this work, flat-panel scanners with four panels and various design parameters were simulated, assessed and compared to a reference scanner based on the Siemens Biograph Vision using NEMA NU 2-2018 metrics. Point sources were also simulated, and a method for evaluating spatial resolution that is more appropriate for flat-panel geometry is presented. We also studied the effects of crystal readout strategies, comparing single-crystal and module readout levels. The results demonstrate that with a CTR below 100 ps, a flat-panel scanner can achieve image quality comparable to that of a reference clinical scanner, with considerable savings in scintillator material. Full article
(This article belongs to the Special Issue Optimization of Clinical Imaging: From Diagnosis to Prognosis)
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11 pages, 2623 KiB  
Case Report
Pancreatic Metastases of Esophageal Squamous Cell Carcinoma: A Case Report and Review of the Literature
by Tivadar Bara, Jr., Alexandra Georgiana Scurtu, Tivadar Bara, Zsolt Zoltan Fulop, Renata Moriczi, Patricia Simu, Paul Borz and Simona Gurzu
Diagnostics 2024, 14(19), 2164; https://doi.org/10.3390/diagnostics14192164 - 28 Sep 2024
Viewed by 749
Abstract
Esophageal carcinoma is an aggressive cancer with a poor therapeutic response and a significant risk of recurrence after radical resection. It usually metastasizes to the lung, bones, or liver. Unusual spread can be found in other organs, but only nine cases of pancreatic [...] Read more.
Esophageal carcinoma is an aggressive cancer with a poor therapeutic response and a significant risk of recurrence after radical resection. It usually metastasizes to the lung, bones, or liver. Unusual spread can be found in other organs, but only nine cases of pancreatic metastases have been reported in the Medline database. In the present paper, a literature review of nine cases with esophageal squamous cell carcinoma and pancreatic metastasis was carried out. In addition to these cases, we present our case, the tenth case in the literature. It involved a patient who underwent surgery for esophageal squamous cell carcinoma and developed metachronous pancreatic metastasis 67 months after esophagectomy. Histopathological examination confirmed a squamous cell carcinoma metastasis. Conclusions: Pancreatic metastasis of esophageal squamous cell carcinoma is extremely rare. Pancreatic metastasis may develop several years after the treatment of the primary lesion. The diagnosis of metastasis is difficult, requiring histopathological and immunohistochemical examination. Full article
(This article belongs to the Special Issue Optimization of Clinical Imaging: From Diagnosis to Prognosis)
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