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Diagnostics, Volume 13, Issue 1 (January-1 2023) – 168 articles

Cover Story (view full-size image): Chest X-ray (CXR) is among the most frequently used medical imaging modalities by Radiologists and Physicians. It has a preeminent value in the detection of multiple life-threatening diseases. Most thoracic diseases have similar patterns, which makes diagnosis prone to human error. Deep learning (DL) provides techniques to make this task more efficient. This work reviews recent advances in DL for CXR disease detection. We present the developed algorithms, the preprocessing techniques and the available datasets. We discuss the challenges present in the published literature and highlight the importance of interpretability and explainability to better understand the models’ detections. Finally, we outline a direction for researchers to help develop more effective models for the early detection of chest diseases. View this paper 
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12 pages, 2016 KiB  
Article
Determining HER2 Status by Artificial Intelligence: An Investigation of Primary, Metastatic, and HER2 Low Breast Tumors
by Christiane Palm, Catherine E. Connolly, Regina Masser, Barbara Padberg Sgier, Eva Karamitopoulou, Quentin Simon, Beata Bode and Marianne Tinguely
Diagnostics 2023, 13(1), 168; https://doi.org/10.3390/diagnostics13010168 - 3 Jan 2023
Cited by 15 | Viewed by 4266
Abstract
The expression of human epidermal growth factor receptor 2 (HER2) protein or gene transcripts is critical for therapeutic decision making in breast cancer. We examined the performance of a digitalized and artificial intelligence (AI)-assisted workflow for HER2 status determination in accordance with the [...] Read more.
The expression of human epidermal growth factor receptor 2 (HER2) protein or gene transcripts is critical for therapeutic decision making in breast cancer. We examined the performance of a digitalized and artificial intelligence (AI)-assisted workflow for HER2 status determination in accordance with the American Society of Clinical Oncology (ASCO)/College of Pathologists (CAP) guidelines. Our preliminary cohort consisted of 495 primary breast carcinomas, and our study cohort included 67 primary breast carcinomas and 30 metastatic deposits, which were evaluated for HER2 status by immunohistochemistry (IHC) and in situ hybridization (ISH). Three practicing breast pathologists independently assessed and scored slides, building the ground truth. Following a washout period, pathologists were provided with the results of the AI digital image analysis (DIA) and asked to reassess the slides. Both rounds of assessment from the pathologists were compared to the AI results and ground truth for each slide. We observed an overall HER2 positivity rate of 15% in our study cohort. Moderate agreement (Cohen’s κ 0.59) was observed between the ground truth and AI on IHC, with most discrepancies occurring between 0 and 1+ scores. Inter-observer agreement amongst pathologists was substantial (Fleiss´ κ 0.77) and pathologists’ agreement with AI scores was 80.6%. Substantial agreement of the AI with the ground truth (Cohen´s κ 0.80) was detected on ISH-stained slides, and the accuracy of AI was similar for the primary and metastatic tumors. We demonstrated the feasibility of a combined HER2 IHC and ISH AI workflow, with a Cohen’s κ of 0.94 when assessed in accordance with the ASCO/CAP recommendations. Full article
(This article belongs to the Special Issue Artificial Intelligence in Pathological Image Analysis)
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30 pages, 4124 KiB  
Article
CAD-ALZ: A Blockwise Fine-Tuning Strategy on Convolutional Model and Random Forest Classifier for Recognition of Multistage Alzheimer’s Disease
by Qaisar Abbas, Ayyaz Hussain and Abdul Rauf Baig
Diagnostics 2023, 13(1), 167; https://doi.org/10.3390/diagnostics13010167 - 3 Jan 2023
Cited by 4 | Viewed by 3295
Abstract
Mental deterioration or Alzheimer’s (ALZ) disease is progressive and causes both physical and mental dependency. There is a need for a computer-aided diagnosis (CAD) system that can help doctors make an immediate decision. (1) Background: Currently, CAD systems are developed based on hand-crafted [...] Read more.
Mental deterioration or Alzheimer’s (ALZ) disease is progressive and causes both physical and mental dependency. There is a need for a computer-aided diagnosis (CAD) system that can help doctors make an immediate decision. (1) Background: Currently, CAD systems are developed based on hand-crafted features, machine learning (ML), and deep learning (DL) techniques. Those CAD systems frequently require domain-expert knowledge and massive datasets to extract deep features or model training, which causes problems with class imbalance and overfitting. Additionally, there are still manual approaches used by radiologists due to the lack of dataset availability and to train the model with cost-effective computation. Existing works rely on performance improvement by neglecting the problems of the limited dataset, high computational complexity, and unavailability of lightweight and efficient feature descriptors. (2) Methods: To address these issues, a new approach, CAD-ALZ, is developed by extracting deep features through a ConvMixer layer with a blockwise fine-tuning strategy on a very small original dataset. At first, we apply the data augmentation method to images to increase the size of datasets. In this study, a blockwise fine-tuning strategy is employed on the ConvMixer model to detect robust features. Afterwards, a random forest (RF) is used to classify ALZ disease stages. (3) Results: The proposed CAD-ALZ model obtained significant results by using six evaluation metrics such as the F1-score, Kappa, accuracy, precision, sensitivity, and specificity. The CAD-ALZ model performed with a sensitivity of 99.69% and an F1-score of 99.61%. (4) Conclusions: The suggested CAD-ALZ approach is a potential technique for clinical use and computational efficiency compared to state-of-the-art approaches. The CAD-ALZ model code is freely available on GitHub for the scientific community. Full article
(This article belongs to the Special Issue AI/ML-Based Medical Image Processing and Analysis)
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11 pages, 1497 KiB  
Article
Prognostic Role of Vascular Endothelial Growth Factor and Correlation with Oxidative Stress Markers in Locally Advanced and Metastatic Ovarian Cancer Patients
by Oana Gabriela Trifanescu, Laurentia Nicoleta Gales, Bogdan Cosmin Tanase, Serban Andrei Marinescu, Raluca Alexandra Trifanescu, Iuliana Maria Gruia, Mihai Andrei Paun, Laura Rebegea, Radu Mitrica, Luiza Serbanescu and Rodica Maricela Anghel
Diagnostics 2023, 13(1), 166; https://doi.org/10.3390/diagnostics13010166 - 3 Jan 2023
Cited by 3 | Viewed by 1796
Abstract
Background: Vascular endothelial growth factor (VEGF) plays an important role in tumor progression in ovarian cancer, but the complex mechanism and interaction with oxidative stress are not fully understood. Methods: A prospective study included 52 patients with ovarian adenocarcinoma stage IIIA-IV. Serum VEGF [...] Read more.
Background: Vascular endothelial growth factor (VEGF) plays an important role in tumor progression in ovarian cancer, but the complex mechanism and interaction with oxidative stress are not fully understood. Methods: A prospective study included 52 patients with ovarian adenocarcinoma stage IIIA-IV. Serum VEGF and reactive oxygen species (ROS) such as malondialdehyde and ceruloplasmin were measured. Results: VEGF levels were elevated (mean 1014.7 ± 165 pg/mL), especially in patients with macroscopic residual disease (1058 vs. 810 pg/mL, p = 0.0001). Median progression-free survival (PFS) and overall survival (OS) were 6 and 40 months in patients with a very high VEGF (over 1200 pg/mL), 11 and 48 months in patients with VEGF between 1000–1200 pg/mL, 18 and 84 months in patients with VEGF between 800–1000 pg/mL, and not reached in patients with normal VEGF. Increased VEGF values were associated with a 2.6-fold increased risk of disease progression (HR = 2.60, 95% CI 1.69–3.99), and a 1.4-fold increased risk of death (HR = 1.4, 95% CI 1.15–1.91, p = 0.002). Receiver operator characteristic (ROC) curves were used to validate VEGF as a prognostic factor and the area under the curve (AUC) was 0.814, p = 0.036 for PFS and 0.729, p = 0.043, for OS. There was a positive correlation between VEGF and malondialdehyde, Pearson coefficient of 0.35, p = 0.0001. Conclusions: VEGF and malondialdehyde are important prognostic markers in ovarian cancer, especially in macroscopic residual disease, and there is a positive correlation between angiogenesis and oxidative stress. Full article
(This article belongs to the Section Pathology and Molecular Diagnostics)
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13 pages, 2413 KiB  
Article
Oncologic Outcome after Pulmonary Metastasectomy as Part of Multidisciplinary Treatment in a Tertiary Oncological Center
by Natalia Motas, Mihnea Dan Davidescu, Bogdan Cosmin Tanase, Ovidiu Rus, Alin Ionut Burlacu, Vlad Alexe, Veronica Manolache, Madalina Cristiana Mizea, Nicolae Gheorghiu, Oana Gabriela Trifanescu, Laurentia Nicoleta Gales, Teodor Horvat and Rodica Maricela Anghel
Diagnostics 2023, 13(1), 165; https://doi.org/10.3390/diagnostics13010165 - 3 Jan 2023
Cited by 2 | Viewed by 1848
Abstract
(1) Background: Pulmonary metastases are encountered in approximately one-third of patients with malignancies, especially from colorectal, lung, breast, and renal cancers, and sarcomas. Pulmonary metastasectomy is the ablative approach of choice, when possible, as part of the multidisciplinary effort to integrate and personalize [...] Read more.
(1) Background: Pulmonary metastases are encountered in approximately one-third of patients with malignancies, especially from colorectal, lung, breast, and renal cancers, and sarcomas. Pulmonary metastasectomy is the ablative approach of choice, when possible, as part of the multidisciplinary effort to integrate and personalize the oncological treatment. (2) Methods: The study includes 58 consecutive cases of pulmonary metastasectomies, retrospectively analyzed, performed in 12 consecutive months, in which the pathology reports confirmed lung metastases. (3) Results: Most frequent pathological types of metastases were: 14 of colorectal cancer, 10 breast, 8 lung, and 8 sarcomas. At the time of primary cancer diagnosis, 14 patients (24.14%) were in the metastatic stage. The surgical approach was minimally invasive through uniportal VATS (Video-Assisted Thoracic Surgery) in 3/4 of cases (43 patients, 74%). Almost 20% of resections were typical (lobectomy, segmentectomy). Lymphadenectomy was associated in almost 1/2 of patients and lymph node metastases were found in 11.11% of cases. The mortality rate (intraoperative and 90 days postoperative) is zero. The OS after pulmonary metastasectomy is 87% at 18 months, and the estimated OS for cancer is 90% at 5 years. The worst outcome presents the patients with sarcomas and the best outcome—colorectal and lung cancer. The patients with 1 or 2 resected metastases presented 96% survival at 24 months. (4) Conclusions: After pulmonary metastasectomy, survival is favored by the small number of metastases resected (1 or 2), and by the dimension of metastases under 20.5 mm. The non-anatomic (wedge) type of lung resection may present a lower risk of death compared to lobectomy. No statistical significance on survival has the presence of lymphadenectomy, the laterality right/left lung, the upper/lower lobes. In the future, longer follow-up and prospective randomized trials are needed for drawing definitive conclusions. Full article
(This article belongs to the Section Pathology and Molecular Diagnostics)
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11 pages, 236 KiB  
Review
Right Ventricle and Radiotherapy: More Questions than Answers
by Marijana Tadic, Johannes Kersten, Dominik Buckert, Wolfgang Rottbauer and Cesare Cuspidi
Diagnostics 2023, 13(1), 164; https://doi.org/10.3390/diagnostics13010164 - 3 Jan 2023
Cited by 1 | Viewed by 1363
Abstract
The injury of the left ventricle (LV) during anticancer therapy has long been recognized, and guidelines recommend a specific set of parameters for determination of LV impairment. The influence of anticancer therapy on the right ventricle (RV) has been insufficiently investigated, and there [...] Read more.
The injury of the left ventricle (LV) during anticancer therapy has long been recognized, and guidelines recommend a specific set of parameters for determination of LV impairment. The influence of anticancer therapy on the right ventricle (RV) has been insufficiently investigated, and there are only a few studies that have considered the effect of radiotherapy on RV remodeling. On the other hand, large number of patients with different types of cancers located in the chest are treated with radiotherapy, and the negative clinical effects of this treatment such as accelerated coronary artery disease, valve degeneration and heart failure have been documented. The anatomical position of the RV, which is in the front of the chest, is responsible for its large exposure during radiation treatment, particularly in patients with left-sided breast and lung cancers and mediastinal cancers (hematological malignancies, esophagus cancers, thymomas, etc.). For the same reason, but also due to its anatomical complexity, the RV remains under-investigated during echocardiographic examination, which remains the cornerstone of cardiac imaging in everyday practice. In the last decade many new echocardiographic imaging techniques that enable better evaluation of RV structure, function and mechanics appeared, and they have been used in detection of early and late signs of RV injuries in oncological patients. These investigations are related to some important restrictions that include limited numbers of patients, used parameters and imaging techniques. Many questions about the potential impact of these changes and possible predictions of adverse events remain to be evaluated in future large longitudinal studies. The current body of evidence indicates an important role of radiotherapy in RV remodeling, and therefore, the aim of this review is to summarize currently available data regarding RV changes in patients with various oncological conditions and help clinicians in the assessment of possible cardiac damage. Full article
(This article belongs to the Special Issue Diagnosis of Valvular Heart Disease and Myocardial Function)
29 pages, 6524 KiB  
Review
Molecular Genetics of Thrombotic Myeloproliferative Neoplasms: Implications in Precision Oncology
by Yuh Cai Chia, Mat Jusoh Siti Asmaa, Marini Ramli, Peng Yeong Woon, Muhammad Farid Johan, Rosline Hassan and Md Asiful Islam
Diagnostics 2023, 13(1), 163; https://doi.org/10.3390/diagnostics13010163 - 3 Jan 2023
Cited by 4 | Viewed by 2618
Abstract
Classical BCR-ABL-negative myeloproliferative neoplasms (MPN) include polycythaemia vera, essential thrombocythaemia, and primary myelofibrosis. Unlike monogenic disorders, a more complicated series of genetic mutations are believed to be responsible for MPN with various degrees of thromboembolic and bleeding complications. Thrombosis is one of [...] Read more.
Classical BCR-ABL-negative myeloproliferative neoplasms (MPN) include polycythaemia vera, essential thrombocythaemia, and primary myelofibrosis. Unlike monogenic disorders, a more complicated series of genetic mutations are believed to be responsible for MPN with various degrees of thromboembolic and bleeding complications. Thrombosis is one of the early manifestations in patients with MPN. To date, the driver genes responsible for MPN include JAK2, CALR, MPL, TET2, ASXL1, and MTHFR. Affords have been done to elucidate these mutations and the incidence of thromboembolic events. Several lines of evidence indicate that mutations in JAK2, MPL, TET2 and ASXL1 gene and polymorphisms in several clotting factors (GPIa, GPIIa, and GPIIIa) are associated with the occurrence and prevalence of thrombosis in MPN patients. Some polymorphisms within XRCC1, FBG, F2, F5, F7, F12, MMP9, HPA5, MTHFR, SDF-1, FAS, FASL, TERT, ACE, and TLR4 genes may also play a role in MPN manifestation. This review aims to provide an insightful overview on the genetic perspective of thrombotic complications in patients with MPN. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Management of Tumors/Cancers)
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24 pages, 3368 KiB  
Article
A Holistic Approach to Identify and Classify COVID-19 from Chest Radiographs, ECG, and CT-Scan Images Using ShuffleNet Convolutional Neural Network
by Naeem Ullah, Javed Ali Khan, Shaker El-Sappagh, Nora El-Rashidy and Mohammad Sohail Khan
Diagnostics 2023, 13(1), 162; https://doi.org/10.3390/diagnostics13010162 - 3 Jan 2023
Cited by 26 | Viewed by 3054
Abstract
Early and precise COVID-19 identification and analysis are pivotal in reducing the spread of COVID-19. Medical imaging techniques, such as chest X-ray or chest radiographs, computed tomography (CT) scan, and electrocardiogram (ECG) trace images are the most widely known for early discovery and [...] Read more.
Early and precise COVID-19 identification and analysis are pivotal in reducing the spread of COVID-19. Medical imaging techniques, such as chest X-ray or chest radiographs, computed tomography (CT) scan, and electrocardiogram (ECG) trace images are the most widely known for early discovery and analysis of the coronavirus disease (COVID-19). Deep learning (DL) frameworks for identifying COVID-19 positive patients in the literature are limited to one data format, either ECG or chest radiograph images. Moreover, using several data types to recover abnormal patterns caused by COVID-19 could potentially provide more information and restrict the spread of the virus. This study presents an effective COVID-19 detection and classification approach using the Shufflenet CNN by employing three types of images, i.e., chest radiograph, CT-scan, and ECG-trace images. For this purpose, we performed extensive classification experiments with the proposed approach using each type of image. With the chest radiograph dataset, we performed three classification experiments at different levels of granularity, i.e., binary, three-class, and four-class classifications. In addition, we performed a binary classification experiment with the proposed approach by classifying CT-scan images into COVID-positive and normal. Finally, utilizing the ECG-trace images, we conducted three experiments at different levels of granularity, i.e., binary, three-class, and five-class classifications. We evaluated the proposed approach with the baseline COVID-19 Radiography Database, SARS-CoV-2 CT-scan, and ECG images dataset of cardiac and COVID-19 patients. The average accuracy of 99.98% for COVID-19 detection in the three-class classification scheme using chest radiographs, optimal accuracy of 100% for COVID-19 detection using CT scans, and average accuracy of 99.37% for five-class classification scheme using ECG trace images have proved the efficacy of our proposed method over the contemporary methods. The optimal accuracy of 100% for COVID-19 detection using CT scans and the accuracy gain of 1.54% (in the case of five-class classification using ECG trace images) from the previous approach, which utilized ECG images for the first time, has a major contribution to improving the COVID-19 prediction rate in early stages. Experimental findings demonstrate that the proposed framework outperforms contemporary models. For example, the proposed approach outperforms state-of-the-art DL approaches, such as Squeezenet, Alexnet, and Darknet19, by achieving the accuracy of 99.98 (proposed method), 98.29, 98.50, and 99.67, respectively. Full article
(This article belongs to the Section Machine Learning and Artificial Intelligence in Diagnostics)
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26 pages, 4780 KiB  
Systematic Review
Deep Learning Based Methods for Breast Cancer Diagnosis: A Systematic Review and Future Direction
by Maged Nasser and Umi Kalsom Yusof
Diagnostics 2023, 13(1), 161; https://doi.org/10.3390/diagnostics13010161 - 3 Jan 2023
Cited by 38 | Viewed by 11066
Abstract
Breast cancer is one of the precarious conditions that affect women, and a substantive cure has not yet been discovered for it. With the advent of Artificial intelligence (AI), recently, deep learning techniques have been used effectively in breast cancer detection, facilitating early [...] Read more.
Breast cancer is one of the precarious conditions that affect women, and a substantive cure has not yet been discovered for it. With the advent of Artificial intelligence (AI), recently, deep learning techniques have been used effectively in breast cancer detection, facilitating early diagnosis and therefore increasing the chances of patients’ survival. Compared to classical machine learning techniques, deep learning requires less human intervention for similar feature extraction. This study presents a systematic literature review on the deep learning-based methods for breast cancer detection that can guide practitioners and researchers in understanding the challenges and new trends in the field. Particularly, different deep learning-based methods for breast cancer detection are investigated, focusing on the genomics and histopathological imaging data. The study specifically adopts the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), which offer a detailed analysis and synthesis of the published articles. Several studies were searched and gathered, and after the eligibility screening and quality evaluation, 98 articles were identified. The results of the review indicated that the Convolutional Neural Network (CNN) is the most accurate and extensively used model for breast cancer detection, and the accuracy metrics are the most popular method used for performance evaluation. Moreover, datasets utilized for breast cancer detection and the evaluation metrics are also studied. Finally, the challenges and future research direction in breast cancer detection based on deep learning models are also investigated to help researchers and practitioners acquire in-depth knowledge of and insight into the area. Full article
(This article belongs to the Special Issue Breast Cancer Theranostics)
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13 pages, 3117 KiB  
Article
A Deep Learning System for Automated Quality Evaluation of Optic Disc Photographs in Neuro-Ophthalmic Disorders
by Ebenezer Chan, Zhiqun Tang, Raymond P. Najjar, Arun Narayanaswamy, Kanchalika Sathianvichitr, Nancy J. Newman, Valérie Biousse, Dan Milea and for the BONSAI Group
Diagnostics 2023, 13(1), 160; https://doi.org/10.3390/diagnostics13010160 - 3 Jan 2023
Cited by 3 | Viewed by 2146
Abstract
The quality of ocular fundus photographs can affect the accuracy of the morphologic assessment of the optic nerve head (ONH), either by humans or by deep learning systems (DLS). In order to automatically identify ONH photographs of optimal quality, we have developed, trained, [...] Read more.
The quality of ocular fundus photographs can affect the accuracy of the morphologic assessment of the optic nerve head (ONH), either by humans or by deep learning systems (DLS). In order to automatically identify ONH photographs of optimal quality, we have developed, trained, and tested a DLS, using an international, multicentre, multi-ethnic dataset of 5015 ocular fundus photographs from 31 centres in 20 countries participating to the Brain and Optic Nerve Study with Artificial Intelligence (BONSAI). The reference standard in image quality was established by three experts who independently classified photographs as of “good”, “borderline”, or “poor” quality. The DLS was trained on 4208 fundus photographs and tested on an independent external dataset of 807 photographs, using a multi-class model, evaluated with a one-vs-rest classification strategy. In the external-testing dataset, the DLS could identify with excellent performance “good” quality photographs (AUC = 0.93 (95% CI, 0.91–0.95), accuracy = 91.4% (95% CI, 90.0–92.9%), sensitivity = 93.8% (95% CI, 92.5–95.2%), specificity = 75.9% (95% CI, 69.7–82.1%) and “poor” quality photographs (AUC = 1.00 (95% CI, 0.99–1.00), accuracy = 99.1% (95% CI, 98.6–99.6%), sensitivity = 81.5% (95% CI, 70.6–93.8%), specificity = 99.7% (95% CI, 99.6–100.0%). “Borderline” quality images were also accurately classified (AUC = 0.90 (95% CI, 0.88–0.93), accuracy = 90.6% (95% CI, 89.1–92.2%), sensitivity = 65.4% (95% CI, 56.6–72.9%), specificity = 93.4% (95% CI, 92.1–94.8%). The overall accuracy to distinguish among the three classes was 90.6% (95% CI, 89.1–92.1%), suggesting that this DLS could select optimal quality fundus photographs in patients with neuro-ophthalmic and neurological disorders affecting the ONH. Full article
(This article belongs to the Special Issue Deep Learning Applications in Ophthalmology)
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36 pages, 11742 KiB  
Review
A Review of Recent Advances in Deep Learning Models for Chest Disease Detection Using Radiography
by Adnane Ait Nasser and Moulay A. Akhloufi
Diagnostics 2023, 13(1), 159; https://doi.org/10.3390/diagnostics13010159 - 3 Jan 2023
Cited by 21 | Viewed by 8620
Abstract
Chest X-ray radiography (CXR) is among the most frequently used medical imaging modalities. It has a preeminent value in the detection of multiple life-threatening diseases. Radiologists can visually inspect CXR images for the presence of diseases. Most thoracic diseases have very similar patterns, [...] Read more.
Chest X-ray radiography (CXR) is among the most frequently used medical imaging modalities. It has a preeminent value in the detection of multiple life-threatening diseases. Radiologists can visually inspect CXR images for the presence of diseases. Most thoracic diseases have very similar patterns, which makes diagnosis prone to human error and leads to misdiagnosis. Computer-aided detection (CAD) of lung diseases in CXR images is among the popular topics in medical imaging research. Machine learning (ML) and deep learning (DL) provided techniques to make this task more efficient and faster. Numerous experiments in the diagnosis of various diseases proved the potential of these techniques. In comparison to previous reviews our study describes in detail several publicly available CXR datasets for different diseases. It presents an overview of recent deep learning models using CXR images to detect chest diseases such as VGG, ResNet, DenseNet, Inception, EfficientNet, RetinaNet, and ensemble learning methods that combine multiple models. It summarizes the techniques used for CXR image preprocessing (enhancement, segmentation, bone suppression, and data-augmentation) to improve image quality and address data imbalance issues, as well as the use of DL models to speed-up the diagnosis process. This review also discusses the challenges present in the published literature and highlights the importance of interpretability and explainability to better understand the DL models’ detections. In addition, it outlines a direction for researchers to help develop more effective models for early and automatic detection of chest diseases. Full article
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16 pages, 3494 KiB  
Review
PSMA Receptor-Based PET-CT: The Basics and Current Status in Clinical and Research Applications
by Aadil Adnan and Sandip Basu
Diagnostics 2023, 13(1), 158; https://doi.org/10.3390/diagnostics13010158 - 3 Jan 2023
Cited by 5 | Viewed by 4047
Abstract
Prostate-specific membrane antigen (PSMA) is a 100 kD, 750 amino acid (AA) long type II transmembrane glycoprotein that has a short N-terminal intracellular domain with 19 AA, 24 AA transmembrane proteins and a large C-terminal extracellular domain with 707 AA. PSMA has been [...] Read more.
Prostate-specific membrane antigen (PSMA) is a 100 kD, 750 amino acid (AA) long type II transmembrane glycoprotein that has a short N-terminal intracellular domain with 19 AA, 24 AA transmembrane proteins and a large C-terminal extracellular domain with 707 AA. PSMA has been mapped to chromosome 11p 11-12 in the region of the folate hydrolase gene (FOLH1) and has no known natural ligand. The protein possesses enzymatic activity—glutamate carboxypeptidase II (GCP-II)—and is thought to have role in folate uptake (FOLH1 gene). ‘PSMA’ expression, although significantly up-regulated in prostate carcinoma (more in high-risk and aggressive variants), is not exclusive for it and is noted in various other benign and malignant conditions, especially in the neovasculature. Currently, PSMA PET-CT is approved for high-risk and biochemically recurrent prostate carcinoma (PCa), and in patient selection for PSMA based theranostics. This review aims to highlight the clinical evolution of the PSMA molecule and PSMA PET-CT as a diagnostic modality, various indications of PSMA PET-CT, the appropriateness criteria for its use, pitfalls and artefacts, and other uses of PSMA PET apart from prostate carcinoma. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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11 pages, 1083 KiB  
Article
Performance of Deauville Criteria in [18F]FDG-PET/CT Diagnostics of Giant Cell Arteritis
by Jeffrey Siefert, Jonas Kaufmann, Felix Thiele, Thula Walter-Rittel, Julian Rogasch, Robert Biesen, Gerd R. Burmester, Holger Amthauer, Udo Schneider and Christian Furth
Diagnostics 2023, 13(1), 157; https://doi.org/10.3390/diagnostics13010157 - 3 Jan 2023
Viewed by 1529
Abstract
In this retrospective study, PET/CT data from 59 patients with suspected giant cell arteritis (GCA) were reviewed using the Deauville criteria to determine an optimal cut-off between PET positivity and negativity. Seventeen standardised vascular regions were analysed per patient by three investigators blinded [...] Read more.
In this retrospective study, PET/CT data from 59 patients with suspected giant cell arteritis (GCA) were reviewed using the Deauville criteria to determine an optimal cut-off between PET positivity and negativity. Seventeen standardised vascular regions were analysed per patient by three investigators blinded to clinical information. Statistical analysis included ROC curves with areas under the curve (AUC), Cohen’s and Fleiss’ kappa (κ) to calculate sensitivity, specificity, accuracy, and agreement. According to final clinician’s diagnosis and the revised 2017 ACR criteria GCA was confirmed in 29 of 59 (49.2 %) patients. With a diagnostic cut-off ≥ 4 (highest tracer uptake of a vessel wall exceeds liver uptake) for PET positivity, all investigators achieved high accuracy (range, 89.8–93.2%) and AUC (range, 0.94–0.97). Sensitivity and specificity ranged from 89.7–96.6% and 83.3–96.7%, respectively. Agreement between the three investigators suggested ‘almost perfect agreement’ (Fleiss’ κ = 0.84) A Deauville score of ≥4 as threshold for PET positivity yielded excellent results with high accuracy and almost perfect inter-rater agreement, suggesting a standardized, reproducible, and reliable score in diagnosing GCA. However, the small sample size and reference standard could lead to biases. Therefore, verification in a multicentre study with a larger patient cohort and prospective setting is needed. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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13 pages, 2308 KiB  
Article
Deciphering the Autoantibody Response to the OJ Antigenic Complex
by Marvin J. Fritzler, Chelsea Bentow, Minoru Satoh, Neil McHugh, Anna Ghirardello and Michael Mahler
Diagnostics 2023, 13(1), 156; https://doi.org/10.3390/diagnostics13010156 - 3 Jan 2023
Cited by 3 | Viewed by 2413
Abstract
(1) Background: Myositis specific antibodies (MSA) are important diagnostic biomarkers. Among the rarest and most challenging MSA are anti-OJ antibodies which are associated with anti-synthetase syndrome (ASS). In contrast to the other tRNA synthetases that are targets of ASS autoantibodies (e.g Jo-1, PL-7, [...] Read more.
(1) Background: Myositis specific antibodies (MSA) are important diagnostic biomarkers. Among the rarest and most challenging MSA are anti-OJ antibodies which are associated with anti-synthetase syndrome (ASS). In contrast to the other tRNA synthetases that are targets of ASS autoantibodies (e.g Jo-1, PL-7, PL-12, EJ, KS, Zo), OJ represents a macromolecular complex with several ribonucleoprotein subunits. Therefore, the choice of the antigen in autoantibody assays can be challenging. (2) Methods: We collected two independent cohorts with anti-OJ antibodies, one based on a commercial line immunoassay (LIA) (n = 39), the second based on protein immunoprecipitation (IP) (n = 15). Samples were tested using a particle-based multi-analyte technology (PMAT) system that allows for the simultaneous detection of antibodies to various autoantigens. For the detection of anti-OJ antibodies, two different antigens were deployed (KARS, IARS) on PMAT. The reactivity to the two antigens KARS and IARS was analyzed individually and combined in a score (sum of the median fluorescence intensities). (3) Results: In the cohort selection based on LIA, 3/39 (7.7%) samples were positive for anti-KARS and 7/39 (17.9%) for anti-IARS and 14/39 (35.9%) when the two antigens were combined. In contrast, in samples selected by IP the sensitivity of anti-KARS was higher: 6/15 (40.0%) samples were positive for anti-KARS, 4/15 (26.7%) for anti-IARS and 12/15 (80.0%) for the combination of the two antigens. 18/39 (46.2%) of the LIA samples generated a cytoplasmic IIF pattern (compatible with anti-synthetase antibodies), but there was no association with the antibody levels, neither with LIA nor with PMAT. (4) Conclusions: The combination of IARS and KARS might represent a promising approach for the detection of anti-OJ antibodies on a fully automated platform. Full article
(This article belongs to the Special Issue Precision Medicine in Autoimmunity)
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15 pages, 1970 KiB  
Article
A Comparative Study on Visual Detection of Mycobacterium tuberculosis by Closed Tube Loop-Mediated Isothermal Amplification: Shedding Light on the Use of Eriochrome Black T
by Alireza Neshani, Hosna Zare, Hamid Sadeghian, Hadi Safdari, Bamdad Riahi-Zanjani and Ehsan Aryan
Diagnostics 2023, 13(1), 155; https://doi.org/10.3390/diagnostics13010155 - 2 Jan 2023
Cited by 7 | Viewed by 3084
Abstract
Loop-mediated isothermal amplification is a promising candidate for the rapid detection of Mycobacterium tuberculosis. However, the high potential for carry-over contamination is the main obstacle to its routine use. Here, a closed tube LAMP was intended for the visual detection of Mtb [...] Read more.
Loop-mediated isothermal amplification is a promising candidate for the rapid detection of Mycobacterium tuberculosis. However, the high potential for carry-over contamination is the main obstacle to its routine use. Here, a closed tube LAMP was intended for the visual detection of Mtb to compare turbidimetric and two more favorable colorimetric methods using calcein and hydroxy naphthol blue (HNB). Additionally, a less studied dye (i.e., eriochrome black T (EBT)) was optimized in detail in the reaction for the first time. Mtb purified DNA and 30 clinical specimens were used to respectively determine the analytical and diagnostic sensitivities of each method. The turbidimetric method resulted in the best analytical sensitivity (100 fg DNA/reaction), diagnostic sensitivity and specificity (100%), and time-to-positivity of the test (15 min). However, this method is highly prone to subjective error in reading the results. Moreover, HNB-, calcein-, and EBT-LAMP could respectively detect 100 fg, 1 pg, and 1 pg DNA/reaction (the analytical sensitivities) in 30, 15, and 30 min, while the diagnostic sensitivity and specificity were respectively 93.3% and 100% for them all. Interestingly, EBT-LAMP showed the lowest potential for subjective error in reading the results. This report helps judiciously choose the most appropriate visual method, taking a step forward toward the field applicability of LAMP for the detection of Mtb, particularly in resource-limited settings. Full article
(This article belongs to the Special Issue Laboratory Diagnosis in Microbial Diseases)
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7 pages, 1641 KiB  
Interesting Images
Popcorn Appearance of Severely Calcified Uterine Leiomyoma: Image-Pathological Correlation
by Charuwan Tantipalakorn, Surapan Khunamornpong, Sirinart Sirilert and Theera Tongsong
Diagnostics 2023, 13(1), 154; https://doi.org/10.3390/diagnostics13010154 - 2 Jan 2023
Cited by 2 | Viewed by 4963
Abstract
Calcified subserous leiomyoma is a rare benign tumor commonly seen in the postmenopausal age group. Cases with severely calcified degeneration all over the mass are extremely rare. It causes diagnostic confusion with the solid calcified adnexal mass and the large bladder calculi in [...] Read more.
Calcified subserous leiomyoma is a rare benign tumor commonly seen in the postmenopausal age group. Cases with severely calcified degeneration all over the mass are extremely rare. It causes diagnostic confusion with the solid calcified adnexal mass and the large bladder calculi in the pelvis. We hereby present a case of heavily calcified subserous uterine leiomyoma in a 66-year-old postmenopausal woman. An X-ray of the abdomen and pelvis and CT scan showed a pelvic mass with scattered popcorn appearance in the pelvis, representing severely calcified discrete spots all over the mass. Sonographically, different from typical uterine leiomyomas which exhibit recurrent refractory shadowing patterns, our case showed heavy homogeneous acoustic shadow obscuring all structures beneath the mass surface, resulting in a suboptimal ultrasound examination. Accordingly, CT scans, which are usually not a primary tool for the diagnosis of uterine leiomyomas, are helpful to characterize the mass and identify their organ of origin. The case presented here was treated with a hysterectomy with bilateral oophorectomy and was post-operatively confirmed for severely calcified subserous leiomyomas. Full article
(This article belongs to the Special Issue Interesting Images in Obstetrics and Gynecology)
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13 pages, 1198 KiB  
Article
Prognostic Value of Bladder Involvement in the Outcome of Upper Tract Urothelial Carcinoma
by Sara Meireles, Nuno Dias, Diana Martins, Carolina Dias, Marina Gonçalves, João Silva, Carlos Martins Silva, Paulo Dinis Oliveira, Paula Soares and José Manuel Lopes
Diagnostics 2023, 13(1), 153; https://doi.org/10.3390/diagnostics13010153 - 2 Jan 2023
Cited by 2 | Viewed by 1840
Abstract
Accurately predicting the clinical prognosis of upper tract urothelial carcinoma (UTUC) seems crucial. We evaluated the effect of the involvement of urothelial bladder carcinoma (UBC) as a potential prognostic factor for overall survival (OS) and progression-free survival (PFS). The cohort included 115 patients [...] Read more.
Accurately predicting the clinical prognosis of upper tract urothelial carcinoma (UTUC) seems crucial. We evaluated the effect of the involvement of urothelial bladder carcinoma (UBC) as a potential prognostic factor for overall survival (OS) and progression-free survival (PFS). The cohort included 115 patients with UTUC, subgrouped between January 2009 and December 2019 as follows: (1) only UTUC and (2) UTUC with synchronous or metachronous UBC (UTUC + UBC). Univariate and multivariate analyses were performed to identify independent prognostic factors for OS and PFS. Synchronous or metachronous UBC diagnosis in UTUC patients was an independent predictor of worse PFS (HR 3.326 CI 95% 1.474–7.503, p = 0.004), but it was not identified as a prognostic factor for OS (p > 0.05). Lymphovascular invasion (LVI) was associated with decreased PFS (HR 2.687 CI 95%1.172–6.163, p = 0.020) and OS (HR 4.980 CI 95%1.763–14.064, p = 0.002). This study indicates that concomitant or later UBC could predict a poor PFS, but it is not associated with a significantly worse OS in UTUC patients. The prognostic impact of LVI underlines its inclusion in the tumor staging system of UTUC. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Management of Tumors/Cancers)
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12 pages, 1752 KiB  
Article
Follow-Up Infarct Volume Prediction by CTP-Based Hypoperfusion Index, and the Discrepancy between Small Follow-Up Infarct Volume and Poor Functional Outcome—A Multicenter Study
by Pengyu Zhou, Ran Li, Siyun Liu, Jincheng Wang, Lixiang Huang, Bin Song, Xiaoqiang Tang, Boyu Chen, Haiting Yang, Chengcheng Zhu, Ajay Malhotra and Yuting Wang
Diagnostics 2023, 13(1), 152; https://doi.org/10.3390/diagnostics13010152 - 2 Jan 2023
Cited by 1 | Viewed by 2083
Abstract
(1) Background: Follow-up infarct volume (FIV) may have implications for prognostication in acute ischemic stroke patients. Factors predicting the discrepancy between FIV and 90-day outcomes are poorly understood. We aimed to develop a comprehensive predictive model of FIV and explore factors associated with [...] Read more.
(1) Background: Follow-up infarct volume (FIV) may have implications for prognostication in acute ischemic stroke patients. Factors predicting the discrepancy between FIV and 90-day outcomes are poorly understood. We aimed to develop a comprehensive predictive model of FIV and explore factors associated with the discrepancy. (2) Methods: Patients with acute anterior circulation large vessel occlusion were included. Baseline clinical and CT features were extracted and analyzed, including the CTP-based hypoperfusion index (HI) and the NCCT-based e-ASPECT, measured by automated software. FIV was assessed on follow-up NCCT at 3–7 days. Multiple linear regression was used to construct the predictive model. Subgroup analysis was performed to explore factors associated with poor outcomes (90-mRS scores 3–6) in small FIV (<70 mL). (3) Results: There were 170 patients included. Baseline e-ASPECT, infarct core volume, hypoperfusion volume, HI, baseline international normalized ratio, and successful recanalization were associated with FIV and included in constructing the predictive model. Baseline NIHSS, baseline hypertension, stroke history, and current tobacco use were associated with poor outcomes in small FIV. (4) Conclusions: A comprehensive predictive model (including HI) of FIV was constructed. We also emphasized the importance of hypertension and smoking status at baseline for the functional outcomes in patients with a small FIV. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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15 pages, 3980 KiB  
Article
Computational Design and Experimental Evaluation of MERS-CoV siRNAs in Selected Cell Lines
by Sayed S. Sohrab, Sherif A. El-Kafrawy, Zeenat Mirza, Ahmed M. Hassan, Fatima Alsaqaf and Esam I. Azhar
Diagnostics 2023, 13(1), 151; https://doi.org/10.3390/diagnostics13010151 - 2 Jan 2023
Cited by 1 | Viewed by 1311
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) is caused by a well-known coronavirus first identified in a hospitalized patient in the Kingdom of Saudi Arabia. MERS-CoV is a serious pathogen affecting both human and camel health globally, with camels being known carriers of viruses [...] Read more.
Middle East respiratory syndrome coronavirus (MERS-CoV) is caused by a well-known coronavirus first identified in a hospitalized patient in the Kingdom of Saudi Arabia. MERS-CoV is a serious pathogen affecting both human and camel health globally, with camels being known carriers of viruses that spread to humans. In this work, MERS-CoV genomic sequences were retrieved and analyzed by multiple sequence alignment to design and predict siRNAs with online software. The siRNAs were designed from the orf1ab region of the virus genome because of its high sequence conservation and vital role in virus replication. The designed siRNAs were used for experimental evaluation in selected cell lines: Vero cells, HEK-293-T, and Huh-7. Virus inhibition was assessed according to the cycle threshold value during a quantitative real-time polymerase chain reaction. Out of 462 potential siRNAs, we filtered out 21 based on specific selection criteria without off-target effect. The selected siRNAs did not show any cellular toxicity in the tested cell lines at various concentrations. Based on our results, it was obvious that the combined use of siRNAs exhibited a reduction in MERS-CoV replication in the Vero, HEK-293-T, and Huh-7 cell lines, with the highest efficacy displayed in the Vero cells. Full article
(This article belongs to the Section Machine Learning and Artificial Intelligence in Diagnostics)
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15 pages, 1012 KiB  
Review
Haemostasis and Inflammatory Parameters as Potential Diagnostic Biomarkers for VTE in Trauma-Immobilized Patients
by Noor Nabila Ramli, Salfarina Iberahim, Noor Haslina Mohd Noor, Zefarina Zulkafli, Tengku Muzaffar Tengku Md Shihabuddin, Mohd Hadizie Din, Muhamad Aizat Mohamed Saat and Ahmad Hadif Zaidin Samsudin
Diagnostics 2023, 13(1), 150; https://doi.org/10.3390/diagnostics13010150 - 2 Jan 2023
Cited by 2 | Viewed by 1825
Abstract
Venous thromboembolism (VTE), which encompasses deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major public health concern due to its high incidences of morbidity and mortality. Patients who have experienced trauma with prolonged immobilization are at an increased risk of developing [...] Read more.
Venous thromboembolism (VTE), which encompasses deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major public health concern due to its high incidences of morbidity and mortality. Patients who have experienced trauma with prolonged immobilization are at an increased risk of developing VTE. Plasma D-dimer levels have been known to be elevated in trauma patients, and they were closely correlated with the number of fractures. In other words, plasma D-dimer levels cannot be used as the only indicator of VTE in trauma cases. Given the limitations, further study is needed to explore other potential biomarkers for diagnosing VTE. To date, various established and novel VTE biomarkers have been studied in terms of their potential for predicting VTE, diagnostic performance, and improving clinical therapy for VTE. Therefore, this review aims to provide information regarding classic and essential haemostasis (including prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer, fibrinogen, thrombin generation, protein C, protein S, antithrombin, tissue factor pathway inhibitor, and platelet count) and inflammatory biomarkers (C-reactive protein, erythrocyte sedimentation rate, and soluble P-selectin) as potential diagnostic biomarkers that can predict the risk of VTE development among trauma patients with prolonged immobilization. Thus, further advancement in risk stratification using these biomarkers would allow for a better diagnosis of patients with VTE, especially in areas with limited resources. Full article
(This article belongs to the Special Issue Haematology: Diagnosis and Management)
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2 pages, 160 KiB  
Editorial
Radiomics in Oncology III
by Marta Zerunian, Andrea Laghi and Damiano Caruso
Diagnostics 2023, 13(1), 149; https://doi.org/10.3390/diagnostics13010149 - 1 Jan 2023
Viewed by 1217
Abstract
In recent years, radiomics has been among the most impactful topics in the research field of quantitative imaging [...] Full article
(This article belongs to the Special Issue Radiomics in Oncology 3rd Edition)
15 pages, 3168 KiB  
Article
An AI-Powered Clinical Decision Support System to Predict Flares in Rheumatoid Arthritis: A Pilot Study
by Hannah Labinsky, Dubravka Ukalovic, Fabian Hartmann, Vanessa Runft, André Wichmann, Jan Jakubcik, Kira Gambel, Katharina Otani, Harriet Morf, Jule Taubmann, Filippo Fagni, Arnd Kleyer, David Simon, Georg Schett, Matthias Reichert and Johannes Knitza
Diagnostics 2023, 13(1), 148; https://doi.org/10.3390/diagnostics13010148 - 1 Jan 2023
Cited by 7 | Viewed by 3124
Abstract
Treat-to-target (T2T) is a main therapeutic strategy in rheumatology; however, patients and rheumatologists currently have little support in making the best treatment decision. Clinical decision support systems (CDSSs) could offer this support. The aim of this study was to investigate the accuracy, effectiveness, [...] Read more.
Treat-to-target (T2T) is a main therapeutic strategy in rheumatology; however, patients and rheumatologists currently have little support in making the best treatment decision. Clinical decision support systems (CDSSs) could offer this support. The aim of this study was to investigate the accuracy, effectiveness, usability, and acceptance of such a CDSS—Rheuma Care Manager (RCM)—including an artificial intelligence (AI)-powered flare risk prediction tool to support the management of rheumatoid arthritis (RA). Longitudinal clinical routine data of RA patients were used to develop and test the RCM. Based on ten real-world patient vignettes, five physicians were asked to assess patients’ flare risk, provide a treatment decision, and assess their decision confidence without and with access to the RCM for predicting flare risk. RCM usability and acceptance were assessed using the system usability scale (SUS) and net promoter score (NPS). The flare prediction tool reached a sensitivity of 72%, a specificity of 76%, and an AUROC of 0.80. Perceived flare risk and treatment decisions varied largely between physicians. Having access to the flare risk prediction feature numerically increased decision confidence (3.5/5 to 3.7/5), reduced deviations between physicians and the prediction tool (20% to 12% for half dosage flare prediction), and resulted in more treatment reductions (42% to 50% vs. 20%). RCM usability (SUS) was rated as good (82/100) and was well accepted (mean NPS score 7/10). CDSS usage could support physicians by decreasing assessment deviations and increasing treatment decision confidence. Full article
(This article belongs to the Special Issue Imaging and Artificial Intelligence in Rheumatology)
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12 pages, 1996 KiB  
Article
Morphological and Compositional Features of Chronic Internal Carotid Artery Occlusion in MR Vessel Wall Imaging Predict Successful Endovascular Recanalization
by Jin Zhang, Shenghao Ding, Bing Zhao, Beibei Sun, Qinhua Guo, Yaohua Pan, Xiao Li, Lingling Wang, Jianjian Zhang, Jiaqi Tian, Yan Zhou, Jianrong Xu, Chun Yuan, Jieqing Wan, Xihai Zhao and Huilin Zhao
Diagnostics 2023, 13(1), 147; https://doi.org/10.3390/diagnostics13010147 - 1 Jan 2023
Cited by 2 | Viewed by 1985
Abstract
Background: We sought to determine if the morphological and compositional features of chronic internal carotid artery occlusion (CICAO), as assessed by MR vessel wall imaging (MR-VWI), initially predict successful endovascular recanalization. Methods: Consecutive patients with CICAO scheduled for endovascular recanalization were recruited. MR-VWI [...] Read more.
Background: We sought to determine if the morphological and compositional features of chronic internal carotid artery occlusion (CICAO), as assessed by MR vessel wall imaging (MR-VWI), initially predict successful endovascular recanalization. Methods: Consecutive patients with CICAO scheduled for endovascular recanalization were recruited. MR-VWI was performed within 1 week prior to surgery for evaluating the following features: proximal stump morphology, extent of occlusion, occlusion with collapse, arterial tortuosity, the presence of hyperintense signals (HIS) and calcification in the occluded C1 segment. Multivariate logistic regression was used to identify features associated with technical success and construct a prediction model. Results: Eighty-three patients were recruited, of which fifty-seven (68.7%) were recanalized successfully. The morphological and compositional characteristics of CICAO were associated with successful recanalization, including occlusions limited to C1 and extensive HIS, as well as the absence of extensive calcification, absence of high tortuosity, and absence of artery collapse. The MR CICAO score that comprised the five predictors showed a high predictive ability (area under the curve: 0.888, p < 0.001). Conclusion: the MR-VWI characteristics of CICAO predicted the technical success of endovascular recanalization and may be leveraged for identifying patients with a high probability of successful recanalization. Full article
(This article belongs to the Special Issue Advances in the Imaging of Stroke and Neurodegenerative Disorders)
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10 pages, 1254 KiB  
Article
Subtypes of the Completely Reversed Flow Waveform in Vertebral Artery Can Help to Differentiate Subclavian Artery Occlusion from Severe Stenosis
by Shun-Ping Chen, Zhen Zhong and Dong-Pei Tu
Diagnostics 2023, 13(1), 146; https://doi.org/10.3390/diagnostics13010146 - 1 Jan 2023
Viewed by 1882
Abstract
Objectives: To investigate the value of subtypes of completely reversed flow (CRF) waveform in vertebral artery (VA) on Doppler ultrasound in differentiation occlusion from severe stenosis of the ipsilateral proximal subclavian artery (SA). Methods: A total of 357 patients with CRF in the [...] Read more.
Objectives: To investigate the value of subtypes of completely reversed flow (CRF) waveform in vertebral artery (VA) on Doppler ultrasound in differentiation occlusion from severe stenosis of the ipsilateral proximal subclavian artery (SA). Methods: A total of 357 patients with CRF in the VA on Doppler US were reviewed retrospectively. Among them, 49 patients (mean age, 68.2 ± 7.8 years) confirmed by digital subtraction angiography (DSA) were included. According to the status of diastolic flow, the CRF was divided into continuous CRF (CCRF, n = 27) and intermittent CRF (ICRF, n = 22). The correlation of subtypes of CRF waveform and VA parameters with the severity of SA stenosis was evaluated. The severity of SA stenosis was determined by DSA. Results: Of those 49 patients, SA occlusion was observed in 33 patients (67%, occlusion group) and severe stenosis in 16 patients (33%, stenosis group). The subtypes of CRF waveforms showed a significant between-group difference (p = 0.005). CCRF exhibited an accuracy of 85.2% (23/27) in diagnosing SA occlusion. The diameter of the target VA with ICRF showed a significant between-group difference (p = 0.041). The target VA diameter ≥ 3.8 mm in ICRF achieved an accuracy of 81.8% (18/22), and its combination with CCRF achieved an accuracy of 83.7% (41/49) in the differentiation of SA occlusion from severe stenosis. Conclusions: Subtypes of CRF in VA can help to differentiate SA occlusion from severe stenosis. CCRF has higher accuracy in diagnosing SA occlusion. The CCRF waveform plus VA diameter in ICRF is more accurate for differentiating SA occlusion from severe stenosis. Full article
(This article belongs to the Collection Vascular Diseases Diagnostics)
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21 pages, 9161 KiB  
Article
Electronic Alert Signal for Early Detection of Tissue Injuries in Patients: An Innovative Pressure Sensor Mattress
by Jinpitcha Mamom, Bunyong Rungroungdouyboon, Hanvedes Daovisan and Chawakorn Sri-Ngernyuang
Diagnostics 2023, 13(1), 145; https://doi.org/10.3390/diagnostics13010145 - 1 Jan 2023
Cited by 2 | Viewed by 1956
Abstract
Monitoring the early stage of developing tissue injuries requires intact skin for surface detection of cell damage. However, electronic alert signal for early detection is limited due to the lack of accurate pressure sensors for lightly pigmented skin injuries in patients. We developed [...] Read more.
Monitoring the early stage of developing tissue injuries requires intact skin for surface detection of cell damage. However, electronic alert signal for early detection is limited due to the lack of accurate pressure sensors for lightly pigmented skin injuries in patients. We developed an innovative pressure sensor mattress that produces an electronic alert signal for the early detection of tissue injuries. The electronic alert signal is developed using a web and mobile application for pressure sensor mattress reporting. The mattress is based on body distributions with reference points, temperature, and a humidity sensor to detect lightly pigmented skin injuries. Early detection of the pressure sensor is linked to an electronic alert signal at 32 mm Hg, a temperature of 37 °C, a relative humidity of 33.5%, a response time of 10 s, a loading time of 30 g, a density area of 1 mA, and a resistance of 7.05 MPa (54 N) at 0.87 m3/min. The development of the innovative pressure sensor mattress using an electronic alert signal is in line with its enhanced pressure detection, temperature, and humidity sensors. Full article
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13 pages, 969 KiB  
Review
Immunological Aspects of Von Hippel-Lindau Disease: A Focus on Neuro-Oncology and Myasthenia Gravis
by Davide Norata, Marta Peri, Giuseppe Roberto Giammalva, Antonino Lupica, Federica Paolini, Lorena Incorvaia, Giuseppe Badalamenti, Valerio Gristina, Antonio Galvano, Antonio Russo, Domenico Gerardo Iacopino, Mauro Silvestrini, Viviana Bazan, Filippo Brighina and Vincenzo Di Stefano
Diagnostics 2023, 13(1), 144; https://doi.org/10.3390/diagnostics13010144 - 1 Jan 2023
Cited by 6 | Viewed by 2037
Abstract
Von Hippel-Lindau (VHL) disease is an autosomal dominant condition that predisposes affected individuals to a variety of malignant and benign neoplasms. The pathogenetic turning point of this illness is the accumulation of hypoxia-inducible factor (HIF)-1α, a transcription factor of several genes involved in [...] Read more.
Von Hippel-Lindau (VHL) disease is an autosomal dominant condition that predisposes affected individuals to a variety of malignant and benign neoplasms. The pathogenetic turning point of this illness is the accumulation of hypoxia-inducible factor (HIF)-1α, a transcription factor of several genes involved in oncogenesis, angiogenesis, tissue regeneration, metabolic regulation, hematopoiesis, and inflammatory responses. From an oncological perspective, increased awareness of the molecular pathways underlying this disease is bringing us closer to the development of specific and targeted therapies. Meanwhile, on the surgical side, improved understanding can help to better identify the patients to be treated and the surgical timing. Overall, pathogenesis research is crucial for developing patient-tailored therapies. One of the actual key topics of interest is the link between the VHL/HIF axis and inflammation. The present study aims to outline the fundamental mechanisms that link VHL disease and immune disorders, as well as to explore the details of the overlap between VHL disease and myasthenia gravis (MG) pathogenetic pathways. As a result, MG becomes a paradigm for autoimmune disorders that might be related with VHL disease. Full article
(This article belongs to the Special Issue Advances in Pediatric Neuro-Oncology 2.0)
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8 pages, 1010 KiB  
Article
Comparison of Safety of RADial comPRESSion Devices: A Multi-Center Trial of Patent Hemostasis following Percutaneous Coronary Intervention from Conventional Radial Access (RAD-PRESS Trial)
by Balazs T. Nemeth, Istvan Hizoh, Fanni Nowotta, Zoltan Ruzsa, Tibor Szuk, Peter Kulyassa, Gabor A. Fulop, Fanni E. Szablics, David Becker, Bela Merkely and Istvan F. Edes
Diagnostics 2023, 13(1), 143; https://doi.org/10.3390/diagnostics13010143 - 1 Jan 2023
Cited by 1 | Viewed by 2786
Abstract
Although radial access is the current gold standard for the implementation of percutaneous coronary interventions (PCI), post-procedural radial compression devices are seldom compared with each other in terms of safety or efficacy. Our group aimed to compare a cost effective and potentially green [...] Read more.
Although radial access is the current gold standard for the implementation of percutaneous coronary interventions (PCI), post-procedural radial compression devices are seldom compared with each other in terms of safety or efficacy. Our group aimed to compare a cost effective and potentially green method to dedicated radial compression devices, with respect to access site complications combined in a device oriented complex endpoint (DOCE), freedom from which served as our primary endpoint. Patients undergoing PCI were randomized to receive either the cost effective or a dedicated device, either of which were removed using patent hemostasis. Twenty-four hours after the procedure, radial artery ultrasonography was performed to evaluate the access site. The primary endpoint was assessed using a non-inferiority framework with a non-inferiority margin of five percentage points, which was considered as the least clinically meaningful difference. The cost-effective technique and the dedicated devices were associated with a comparably low rate of complications (freedom from DOCE: 83.3% vs. 70.8%, absolute risk difference: 12.5%, one-sided 95% confidence interval (CI): 1.11%). Composition of the DOCE (i.e., no complication, hematoma, pseudoaneurysm, and radial artery occlusion) and compression time were also assessed in superiority tests as secondary endpoints. Both the cost-effective technique and the dedicated devices were associated with comparably low rates of complications: p = 0.1289. All radial compression devices performed similarly when considering the time to complete removal of the respective device (120.0 (inter-quartile range: 100.0–142.5) for the vial vs. 120.0 (inter-quartile range: 110.0–180) for the dedicated device arm, with a median difference of [95% CI]: 7.0 [−23.11 to 2.00] min, p = 0.2816). In conclusion, our cost-effective method was found to be non-inferior to the dedicated devices with respect to safety, therefore it is a safe alternative to dedicated radial compression devices, as well as seeming to be similarly effective. Full article
(This article belongs to the Special Issue New Techniques in Interventional Cardiology)
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12 pages, 1552 KiB  
Article
Increased Epicardial Adipose Tissue (EAT), Left Coronary Artery Plaque Morphology, and Valvular Atherosclerosis as Risks Factors for Sudden Cardiac Death from a Forensic Perspective
by Timur Hogea, Bogdan Andrei Suciu, Adrian Dumitru Ivănescu, Cosmin Carașca, Laura Chinezu, Emil Marian Arbănași, Eliza Russu, Réka Kaller, Eliza Mihaela Arbănași, Adrian Vasile Mureșan and Corina Carmen Radu
Diagnostics 2023, 13(1), 142; https://doi.org/10.3390/diagnostics13010142 - 1 Jan 2023
Cited by 11 | Viewed by 2260
Abstract
Background: In sudden cardiac deaths (SCD), visceral adipose tissue has begun to manifest interest as a standalone cardiovascular risk factor. Studies have shown that epicardial adipose tissue can be seen as a viable marker of coronary atherosclerosis. This study aimed to evaluate, from [...] Read more.
Background: In sudden cardiac deaths (SCD), visceral adipose tissue has begun to manifest interest as a standalone cardiovascular risk factor. Studies have shown that epicardial adipose tissue can be seen as a viable marker of coronary atherosclerosis. This study aimed to evaluate, from a forensic perspective, the correlation between body mass index (BMI), heart weight, coronary and valvular atherosclerosis, left ventricular morphology, and the thickness of the epicardial adipose tissue (EAT) in sudden cardiac deaths, establishing an increased thickness of EAT as a novel risk factor. Methods: This is a retrospective case–control descriptive study that included 80 deaths that were autopsied, 40 sudden cardiac deaths, and 40 control cases who hanged themselves and had unknown pathologies prior to their death. In all the autopsies performed, the thickness of the epicardial adipose tissue was measured in two regions of the left coronary artery, and the left ventricular morphology, macro/microscopically quantified coronary and valvular atherosclerosis, and weight of the heart were evaluated. Results: This study revealed a higher age in the SCD group (58.82 ± 9.67 vs. 53.4 ± 13.00; p = 0.03), as well as a higher incidence in females (p = 0.03). In terms of heart and coronary artery characteristics, there were higher values of BMI (p = 0.0009), heart weight (p < 0.0001), EAT of the left circumflex artery (LCx) (p < 0.0001), and EAT of the left anterior descending artery (LAD) (p < 0.0001). In the multivariate analysis, a high baseline value of BMI (OR: 4.05; p = 0.004), heart weight (OR: 5.47; p < 0.001), EAT LCx (OR: 23.72; p < 0.001), and EAT LAD (OR: 21.07; p < 0.001) were strong independent predictors of SCD. Moreover, age over 55 years (OR: 2.53; p = 0.045), type Vb plaque (OR: 17.19; p < 0.001), mild valvular atherosclerosis (OR: 4.88; p = 0.002), and moderate left ventricle dilatation (OR: 16.71; p = 0.008) all act as predictors of SCD. Conclusions: The data of this research revealed that higher baseline values of BMI, heart weight, EAT LCx, and EAT LAD highly predict SCD. Furthermore, age above 55 years, type Vb plaque, mild valvular atherosclerosis, and left ventricle dilatation were all risk factors for SCD. Full article
(This article belongs to the Special Issue Autopsy for Medical Diagnostics 2.0)
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11 pages, 283 KiB  
Review
Pulmonary Embolism and Respiratory Deterioration in Chronic Cardiopulmonary Disease: A Narrative Review
by Delphine Douillet, Tahar Chouihed, Laurent Bertoletti and Pierre-Marie Roy
Diagnostics 2023, 13(1), 141; https://doi.org/10.3390/diagnostics13010141 - 1 Jan 2023
Cited by 1 | Viewed by 1926
Abstract
Patients with chronic cardiopulmonary pathologies have an increased risk of developing venous thromboembolic events. The worsening of dyspnoea is a frequent occurrence and often leads patients to consult the emergency department. Pulmonary embolism can then be an exacerbation factor, a differential diagnosis or [...] Read more.
Patients with chronic cardiopulmonary pathologies have an increased risk of developing venous thromboembolic events. The worsening of dyspnoea is a frequent occurrence and often leads patients to consult the emergency department. Pulmonary embolism can then be an exacerbation factor, a differential diagnosis or even a secondary diagnosis. The prevalence of pulmonary embolism in these patients is unknown, especially in cases of chronic heart failure. The challenge lies in needing to carry out a systematic or targeted diagnostic strategy for pulmonary embolism. The occurrence of a pulmonary embolism in patients with chronic cardiopulmonary disease clearly worsens their prognosis. In this narrative review, we study pulmonary embolism and chronic obstructive pulmonary disease, after which we turn to pulmonary embolism and chronic heart failure. Full article
(This article belongs to the Section Pathology and Molecular Diagnostics)
19 pages, 4011 KiB  
Article
Cervicovaginal-Microbiome Analysis by 16S Sequencing and Real-Time PCR in Patients from Novosibirsk (Russia) with Cervical Lesions and Several Years after Cancer Treatment
by Mikhail K. Ivanov, Evgeny V. Brenner, Anastasia A. Hodkevich, Victoria V. Dzyubenko, Sergey E. Krasilnikov, Alphiya S. Mansurova, Irina E. Vakhturova, Eduard F. Agletdinov, Anastasia O. Shumeikina, Alyona L. Chernyshova and Sergei E. Titov
Diagnostics 2023, 13(1), 140; https://doi.org/10.3390/diagnostics13010140 - 1 Jan 2023
Cited by 4 | Viewed by 1897
Abstract
Disturbed cervicovaginal-microbiome (CVM) structure promotes human papillomavirus (HPV) persistence and reflects risks of cervical lesions and cancer onset and recurrence. Therefore, microbiomic biomarkers may be useful for cervical disease screening and patient management. Here, by 16S rRNA gene sequencing and commercial PCR-based diagnostic [...] Read more.
Disturbed cervicovaginal-microbiome (CVM) structure promotes human papillomavirus (HPV) persistence and reflects risks of cervical lesions and cancer onset and recurrence. Therefore, microbiomic biomarkers may be useful for cervical disease screening and patient management. Here, by 16S rRNA gene sequencing and commercial PCR-based diagnostic kits, we profiled CVM in cytological preparations from 140 HPV-tested women (from Novosibirsk, Russia) with normal cytological findings, cervical lesions, or cancer and from 101 women who had recently received different cancer therapies. An increase in lesion severity was accompanied by higher HPV prevalence and elevated CVM biodiversity. Post-treatment CVM was found to be enriched with well-known microbial biomarkers of dysbiosis, just as in cervical disease. Nonetheless, concentrations of some skin-borne and environmental species (which gradually increased with increasing lesion severity)—especially Cutibacterium spp., Achromobacter spp., and Ralstonia pickettii—was low in post-treatment patients and depended on treatment types. Frequency of Lactobacillus iners dominance was high in all groups and depended on treatment types in post-treatment patients. Microbiome analysis via PCR-based kits revealed statistically significant differences among all groups of patients. Thus, microbiome profiling may help to find diagnostic and prognostic markers for management of cervical lesions; quantitative PCR-based kits may be suitable for these purposes. Full article
(This article belongs to the Special Issue Cancer Diagnostic Probe)
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15 pages, 10120 KiB  
Review
Ischiofemoral Impingement Syndrome: Clinical and Imaging/Guidance Issues with Special Focus on Ultrasonography
by Wei-Ting Wu, Ke-Vin Chang, Kamal Mezian, Ondřej Naňka, Vincenzo Ricci, Hsiang-Chi Chang, Bow Wang, Chen-Yu Hung and Levent Özçakar
Diagnostics 2023, 13(1), 139; https://doi.org/10.3390/diagnostics13010139 - 31 Dec 2022
Cited by 6 | Viewed by 5474
Abstract
Ischiofemoral impingement syndrome is a neglected cause of posterior hip pain which is derived from narrowing of the space between the lateral aspect of the ischium and the medial aspect of the lesser trochanter. Its diagnosis is challenging and requires the combination of [...] Read more.
Ischiofemoral impingement syndrome is a neglected cause of posterior hip pain which is derived from narrowing of the space between the lateral aspect of the ischium and the medial aspect of the lesser trochanter. Its diagnosis is challenging and requires the combination of physical tests and imaging studies. In the present narrative review, we found that femoral anteversion predisposes patients to the narrowing of the ischiofemoral space and subsequent quadratus femoris muscle injury. Magnetic resonance imaging serves as the gold-standard diagnostic tool, which facilities the quantification of the ischiofemoral distance and the recognition of edema/fat infiltration/tearing of the quadratus femoris muscle. Ultrasound is useful for scrutinizing the integrity of deep gluteal muscles, and its capability to measure the ischiofemoral space is comparable to that of magnetic resonance. Various injection regimens can be applied to treat ischiofemoral impingement syndrome under ultrasound guidance and they appear to be safe and effective. Finally, more randomized controlled trials are needed to build solid bases of evidence on ultrasound-guided interventions in the management of ischiofemoral impingement syndrome. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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