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Diagnostics, Volume 13, Issue 5 (March-1 2023) – 190 articles

Cover Story (view full-size image): Genomic analyses of pancreas tissue revealed that it may take years for pancreatic cancer to develop. Using contrast-enhanced CT scans, imaging features of the normal pancreas that may portend the development of cancer were identified from 22 patients with historical scans 4–14 years before diagnosis. In this IRB-exempt, retrospective, single institution study, radiomic analysis on seven regions of interest around the pancreas revealed that fat fraction in the pancreas tail (p = 0.029) and skewness of pancreas tissue (p = 0.038) were the most important imaging signatures for subsequent cancer development, confirming the utility of radiomics-based imaging to screen patients for pancreatic cancer. Such techniques could help detect pancreas cancer at an early stage, thereby improving survival. View this paper
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13 pages, 1791 KiB  
Article
The Prevalence and Risk Factors of Chronic Heart Failure in the Mongolian Population
by Pagmadulam Sukhbaatar, Batzorig Bayartsogt, Ganchimeg Ulziisaikhan, Bolortuul Byambatsogt, Chingerel Khorloo, Burmaa Badrakh, Sumiya Tserendavaa, Naranchimeg Sodovsuren, Mungunchimeg Dagva, Mungun-Ulzii Khurelbaatar, Sodchimeg Tsedensodnom, Bat-Erdene Nyamsuren, Rinchyenkhand Myagmardorj and Tsolmon Unurjargal
Diagnostics 2023, 13(5), 999; https://doi.org/10.3390/diagnostics13050999 - 6 Mar 2023
Viewed by 2064
Abstract
Background: The prevalence of heart failure in the Mongolian population is unknown. Thus, in this study, we aimed to define the prevalence of heart failure in the Mongolian population and to identify significant risk factors for heart failure among Mongolian adults. Methods: This [...] Read more.
Background: The prevalence of heart failure in the Mongolian population is unknown. Thus, in this study, we aimed to define the prevalence of heart failure in the Mongolian population and to identify significant risk factors for heart failure among Mongolian adults. Methods: This population-based study included individuals 20 years and older from seven provinces as well as six districts of the capital city of Mongolia. The prevalence of heart failure was based on the European Society of Cardiology diagnostic criteria. Results: In total, 3480 participants were enrolled, of which 1345 (38.6%) participants were males, and the median age was 41.0 years (IQR 30–54 years). The overall prevalence of heart failure was 4.94%. Patients with heart failure had significantly higher body mass index, heart rate, oxygen saturation, respiratory rate, and systolic/diastolic blood pressure than patients without heart failure. In the logistic regression analysis, hypertension (OR 4.855, 95% CI 3.127–7.538), previous myocardial infarction (OR 5.117, 95% CI 3.040–9.350), and valvular heart disease (OR 3.872, 95% CI 2.112–7.099) were significantly correlated with heart failure. Conclusions: This is the first report on the prevalence of heart failure in the Mongolian population. Among the cardiovascular diseases, hypertension, old myocardial infarction, and valvular heart disease were identified as the three foremost risk factors in the development of heart failure. Full article
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17 pages, 1000 KiB  
Article
Association of Vitamin D Deficiency and Insufficiency with Pathology in Hospitalized Patients
by Sandica Bucurica, Ioana Prodan, Mihaela Pavalean, Corina Taubner, Ana Bucurica, Calin Socol, Roxana Calin, Florentina Ionita-Radu and Mariana Jinga
Diagnostics 2023, 13(5), 998; https://doi.org/10.3390/diagnostics13050998 - 6 Mar 2023
Cited by 10 | Viewed by 2655
Abstract
Vitamin D deficiency is one of the most common medical conditions, with approximately one billion people having low vitamin D levels. Vitamin D is associated with a pleiotropic effect (immunomodulatory, anti-inflammatory and antiviral), which can be essential for a better immune response. The [...] Read more.
Vitamin D deficiency is one of the most common medical conditions, with approximately one billion people having low vitamin D levels. Vitamin D is associated with a pleiotropic effect (immunomodulatory, anti-inflammatory and antiviral), which can be essential for a better immune response. The aim of this research was to evaluate the prevalence of vitamin D deficiency/insufficiency in hospitalized patients focusing on demographic parameters as well as assessing the possibility of its associations with different comorbidities. Of 11,182 Romanian patients evaluated in the study over 2 years, 28.83% had vitamin D deficiency, 32.11% insufficiency and 39.05% had optimal vitamin D levels. The vitamin D deficiency was associated with cardiovascular disorders, malignancies, dysmetabolic disorders and SARS-CoV2 infection, older age and the male sex. Vitamin D deficiency was prevalent and showed pathology association, while insufficiency of vitamin D (20–30 ng/mL) had lower statistical relevance and represents a grey zone in vitamin D status. Guidelines and recommendations are necessary for homogeneity of the monitoring and management of inadequately vitamin D status in the risk categories. Full article
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15 pages, 7054 KiB  
Article
Association of Body Mass Index (BMI) with Lip Morphology Characteristics: A Cross-Sectional Study Based on Chinese Population
by Yiyin Chen, Hongmei Yang, Zhijin Zheng, Xiaoqi Zhang, Xinyu Yan, Hu Long and Wenli Lai
Diagnostics 2023, 13(5), 997; https://doi.org/10.3390/diagnostics13050997 - 6 Mar 2023
Cited by 1 | Viewed by 2167
Abstract
Background: Lip morphology is essential in diagnosis and treatment of orthodontics and orthognathic surgery to ensure facial aesthetics. Body mass index (BMI) has proved to have influence on facial soft tissue thickness, but its relationship with lip morphology is unclear. This study aimed [...] Read more.
Background: Lip morphology is essential in diagnosis and treatment of orthodontics and orthognathic surgery to ensure facial aesthetics. Body mass index (BMI) has proved to have influence on facial soft tissue thickness, but its relationship with lip morphology is unclear. This study aimed to evaluate the association between BMI and lip morphology characteristics (LMCs) and thus provide information for personalized treatment. Methods: A cross-sectional study consisted of 1185 patients from 1 January 2010 to 31 December 2020 was conducted. Confounders of demography, dental features, skeletal parameters and LMCs were adjusted by multivariable linear regression to identify the association between BMI and LMCs. Group differences were evaluated with two-samples t-test and one-way ANOVA test. Mediation analysis was used for indirect effects assessment. Results: After adjusting for confounders, BMI is independently associated with upper lip length (0.039, [0.002–0.075]), soft pogonion thickness (0.120, [0.073–0.168]), inferior sulcus depth (0.040, [0.018–0.063]), lower lip length (0.208, [0.139–0.276]), and curve fitting revealed non-linearity to BMI in obese patients. Mediation analysis found BMI was associated with superior sulcus depth and basic upper lip thickness through upper lip length. Conclusions: BMI is positively associated with LMCs, except for nasolabial angle as negatively, while obese patients reverse or weaken these associations. Full article
(This article belongs to the Special Issue New Insights into Diagnosis of Orthodontics)
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10 pages, 792 KiB  
Article
Super-Resolution of Dental Panoramic Radiographs Using Deep Learning: A Pilot Study
by Hossein Mohammad-Rahimi, Shankeeth Vinayahalingam, Erfan Mahmoudinia, Parisa Soltani, Stefaan J. Bergé, Joachim Krois and Falk Schwendicke
Diagnostics 2023, 13(5), 996; https://doi.org/10.3390/diagnostics13050996 - 6 Mar 2023
Cited by 6 | Viewed by 2315
Abstract
Using super-resolution (SR) algorithms, an image with a low resolution can be converted into a high-quality image. Our objective was to compare deep learning-based SR models to a conventional approach for improving the resolution of dental panoramic radiographs. A total of 888 dental [...] Read more.
Using super-resolution (SR) algorithms, an image with a low resolution can be converted into a high-quality image. Our objective was to compare deep learning-based SR models to a conventional approach for improving the resolution of dental panoramic radiographs. A total of 888 dental panoramic radiographs were obtained. Our study involved five state-of-the-art deep learning-based SR approaches, including SR convolutional neural networks (SRCNN), SR generative adversarial network (SRGAN), U-Net, Swin for image restoration (SwinIr), and local texture estimator (LTE). Their results were compared with one another and with conventional bicubic interpolation. The performance of each model was evaluated using the metrics of mean squared error (MSE), peak signal-to-noise ratio (PNSR), structural similarity index (SSIM), and mean opinion score by four experts (MOS). Among all the models evaluated, the LTE model presented the highest performance, with MSE, SSIM, PSNR, and MOS results of 7.42 ± 0.44, 39.74 ± 0.17, 0.919 ± 0.003, and 3.59 ± 0.54, respectively. Additionally, compared with low-resolution images, the output of all the used approaches showed significant improvements in MOS evaluation. A significant enhancement in the quality of panoramic radiographs can be achieved by SR. The LTE model outperformed the other models. Full article
(This article belongs to the Special Issue Advances in Oral and Maxillofacial Diagnostic Imaging)
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11 pages, 3982 KiB  
Article
Ultrasonic Diagnosis of Intestinal Obstruction in Neonates-Original Article
by Binbin Guo, Lin Pang, Chang Liu, Xiaoya Chen, Qiang Qiao and Cong Zhang
Diagnostics 2023, 13(5), 995; https://doi.org/10.3390/diagnostics13050995 - 6 Mar 2023
Cited by 2 | Viewed by 2448
Abstract
Background: Intestinal obstruction in neonates is a common problem that requires prompt diagnosis and treatment, and ultrasound could be a potential tool for it. The purpose of this study was to investigate the accuracy of ultrasonography in diagnosing and identifying the cause of [...] Read more.
Background: Intestinal obstruction in neonates is a common problem that requires prompt diagnosis and treatment, and ultrasound could be a potential tool for it. The purpose of this study was to investigate the accuracy of ultrasonography in diagnosing and identifying the cause of intestinal obstruction in neonates, the corresponding ultrasonic manifestations, as well as to utilize the diagnostic method. Methods: We conducted a retrospective study of all neonatal intestinal obstruction in our institute between 2009 and 2022. The accuracy of ultrasonography in the diagnosis of intestinal obstruction and the identification of its etiology was compared with the results of operation as the gold standard. Results: The accuracy of the ultrasonic diagnosis of intestinal obstruction was 91%, and the accuracy of the ultrasonic etiological diagnosis of intestinal obstruction was 84%. The main ultrasound findings for the neonatal intestinal obstruction were dilation and high tension of the proximal bowel and collapse of the distal intestinal. Other major manifestations were the presence of corresponding diseases causing intestinal obstruction at the junction of the dilated and collapsed bowel. Conclusions: Ultrasound has the advantages of being a flexible multi-section dynamic evaluation and a valuable tool to diagnose and identify the cause of intestinal obstruction in neonates. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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12 pages, 1900 KiB  
Article
Differentiation of Spontaneous Bacterial Peritonitis from Secondary Peritonitis in Patients with Liver Cirrhosis: Retrospective Multicentre Study
by Silvia Würstle, Alexander Hapfelmeier, Siranush Karapetyan, Fabian Studen, Andriana Isaakidou, Tillman Schneider, Roland M. Schmid, Stefan von Delius, Felix Gundling, Rainer Burgkart, Andreas Obermeier, Ulrich Mayr, Marc Ringelhan, Sebastian Rasch, Tobias Lahmer, Fabian Geisler, Paul E. Turner, Benjamin K. Chan, Christoph D. Spinner and Jochen Schneider
Diagnostics 2023, 13(5), 994; https://doi.org/10.3390/diagnostics13050994 - 6 Mar 2023
Cited by 1 | Viewed by 5299
Abstract
Ascitic fluid infection is a serious complication of liver cirrhosis. The distinction between the more common spontaneous bacterial peritonitis (SBP) and the less common secondary peritonitis in patients with liver cirrhosis is crucial due to the varying treatment approaches. This retrospective multicentre study [...] Read more.
Ascitic fluid infection is a serious complication of liver cirrhosis. The distinction between the more common spontaneous bacterial peritonitis (SBP) and the less common secondary peritonitis in patients with liver cirrhosis is crucial due to the varying treatment approaches. This retrospective multicentre study was conducted in three German hospitals and analysed 532 SBP episodes and 37 secondary peritonitis episodes. Overall, >30 clinical, microbiological, and laboratory parameters were evaluated to identify key differentiation criteria. Microbiological characteristics in ascites followed by severity of illness and clinicopathological parameters in ascites were the most important predictors identified by a random forest model to distinguish between SBP and secondary peritonitis. To establish a point-score model, a least absolute shrinkage and selection operator (LASSO) regression model selected the ten most promising discriminatory features. By aiming at a sensitivity of 95% either to rule out or rule in SBP episodes, two cut-off scores were defined, dividing patients with infected ascites into a low-risk (score ≥ 45) and high-risk group (score < 25) for secondary peritonitis. Overall, the discrimination of secondary peritonitis from SBP remains challenging. Our univariable analyses, random forest model, and LASSO point score may help clinicians with the crucial differentiation between SBP and secondary peritonitis. Full article
(This article belongs to the Special Issue Diagnosis and Management of Liver Disease: An Update in 2023)
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23 pages, 928 KiB  
Review
Clinical Characteristics and Current Status of Treatment for Recurrent Bladder Cancer after Surgeries on Upper Tract Urothelial Carcinoma
by Xinfeng Hu, Yufan Xue and Guodong Zhu
Diagnostics 2023, 13(5), 1004; https://doi.org/10.3390/diagnostics13051004 - 6 Mar 2023
Cited by 3 | Viewed by 3599
Abstract
Upper tract urothelial carcinoma (UTUC) is a relatively rare, but highly malignant, disease with an estimated annual incidence of 2 cases per 100,000 people. The main surgical treatment modalities for UTUC are radical nephroureterectomy (RNU) with bladder cuff resection. After surgery, intravesical recurrence [...] Read more.
Upper tract urothelial carcinoma (UTUC) is a relatively rare, but highly malignant, disease with an estimated annual incidence of 2 cases per 100,000 people. The main surgical treatment modalities for UTUC are radical nephroureterectomy (RNU) with bladder cuff resection. After surgery, intravesical recurrence (IVR) can occur in up to 47% of patients, and 75% of them present with non-muscle invasive bladder cancer (NMIBC). However, there are few studies focused on the diagnosis and treatment of postoperatively recurrent bladder cancer for patients with previous UTUC history (UTUC-BC), and many of the influencing factors are still controversial. In this article, we performed a narrative review of the recent literature, mainly summarizing the factors influencing postoperative IVR in patients with UTUC and discussing the subsequent prevention, monitoring, and treatment tools for it. Full article
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12 pages, 12645 KiB  
Article
Comparison of Ultra-Magnifying Endocytoscopic and Hematoxylin-Eosin-Stained Images of Lung Specimens
by Misato Kobayashi, Noriaki Kurimoto, Ryosuke Tanino, Yohei Shiratsuki, Takae Okuno, Mika Nakao, Takamasa Hotta, Yukari Tsubata, Makoto Nagasaki, Takashi Nishisaka and Takeshi Isobe
Diagnostics 2023, 13(5), 1003; https://doi.org/10.3390/diagnostics13051003 - 6 Mar 2023
Viewed by 1478
Abstract
Endocytoscopy enables real-time observation of lesions at ultra-magnification. In the gastrointestinal and respiratory fields, endocytoscopic images are similar to hematoxylin-eosin-stained images. This study aimed to compare the nuclear features of pulmonary lesions in endocytoscopic and hematoxylin-eosin-stained images. We performed an endocytoscopy to observe [...] Read more.
Endocytoscopy enables real-time observation of lesions at ultra-magnification. In the gastrointestinal and respiratory fields, endocytoscopic images are similar to hematoxylin-eosin-stained images. This study aimed to compare the nuclear features of pulmonary lesions in endocytoscopic and hematoxylin-eosin-stained images. We performed an endocytoscopy to observe resected specimens of normal lung tissue and lesions. Nuclear features were extracted using ImageJ. We analyzed five nuclear features: nuclear number per area, mean nucleus area, median circularity, coefficient of variation of roundness, and median Voronoi area. We conducted dimensionality reduction analyses for these features, followed by assessments of the inter-observer agreement among two pathologists and two pulmonologists to evaluate endocytoscopic videos. We analyzed the nuclear features of hematoxylin-eosin-stained and endocytoscopic images from 40 and 33 cases, respectively. Endocytoscopic and hematoxylin-eosin-stained images displayed a similar tendency for each feature, despite there being no correlation. Conversely, the dimensionality reduction analyses demonstrated similar distributions of normal lung and malignant clusters in both images, thus differentiating between the clusters. The diagnostic accuracy of the pathologists was 58.3% and 52.8% (κ-value 0.38, fair), and that of the pulmonologists was 50% and 47.2% (κ-value 0.33, fair). The five nuclear features of pulmonary lesions were similar in the endocytoscopic and hematoxylin-eosin-stained images. Full article
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14 pages, 9320 KiB  
Article
High-Frequency Ultrasound in Diagnosis and Treatment of Non-Melanoma Skin Cancer in the Head and Neck Region
by Tiberiu Tamas, Cristian Dinu, Lavinia Manuela Lenghel, Emil Boțan, Adela Tamas, Sebastian Stoia, Daniel Corneliu Leucuta, Simion Bran, Florin Onisor, Grigore Băciuț, Gabriel Armencea and Mihaela Băciuț
Diagnostics 2023, 13(5), 1002; https://doi.org/10.3390/diagnostics13051002 - 6 Mar 2023
Cited by 5 | Viewed by 2427
Abstract
Non-melanoma skin cancer is one of the most frequently diagnosed cancers in the human body and unfortunately the incidence continues to increase. NMSC is represented by the basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), which are the most prevalent forms, and [...] Read more.
Non-melanoma skin cancer is one of the most frequently diagnosed cancers in the human body and unfortunately the incidence continues to increase. NMSC is represented by the basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), which are the most prevalent forms, and basosquamous cell carcinomas (BSC) together with Merkel cell carcinoma (MCC), which are rare types but with a very aggressive pattern and poor prognosis. The pathological diagnosis is hard to assess without a biopsy, even by the dermoscopy. Moreover, the staging can be problematic because there is no access clinically to the thickness of the tumor and the depth of the invasion. The aim of this study was to evaluate the role of ultrasonography (US), which is a very efficient imaging method, non-irradiating and cheap, in diagnosis and treatment of non-melanoma skin cancer in the head and neck region. Thirty-one patients with highly suspicious malignant lesions of the head and neck skin were evaluated in the Oral and Maxillo-facial Surgery Department and Imaging Department in Cluj Napoca, Romania. All tumors were measured with three transducers: 13 MHz, 20 MHz and 40 MHz. Doppler examination and elastography were also used. The length, width, diameter, thickness, the presence of necrosis, status of regional lymph nodes, the presence of hyperechoic spots, strain ratio and vascularization were all recorded. After that, all patients were treated by surgical resection of the tumor and reconstruction of the defect. Immediately after surgical resection, all tumors were measured again after the same protocol. The resection margins were evaluated by all three types of transducers in order to detect malignant involvement and the results were compared with the histopathological report. We found that the 13 MHz transducers offered a big picture of the tumor but the level of details, in the form of the presence of the hyperechoic spots, is reduced. We recommend this transducer for evaluation of surgical margins or for the large skin tumors. The 20 and 40 MHz transducers are better for viewing the particularities of malignant lesions and for an accurate measurement; however, in the case of large size lesions, assessing all three dimensions of the tumor can be difficult. The intralesional hyperechoic spots are present in case of BCC and they can be used for differential diagnosis of BCC. Full article
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25 pages, 5577 KiB  
Article
Diabetic Retinopathy and Diabetic Macular Edema Detection Using Ensemble Based Convolutional Neural Networks
by Swaminathan Sundaram, Meganathan Selvamani, Sekar Kidambi Raju, Seethalakshmi Ramaswamy, Saiful Islam, Jae-Hyuk Cha, Nouf Abdullah Almujally and Ahmed Elaraby
Diagnostics 2023, 13(5), 1001; https://doi.org/10.3390/diagnostics13051001 - 6 Mar 2023
Cited by 5 | Viewed by 2401
Abstract
Diabetic retinopathy (DR) and diabetic macular edema (DME) are forms of eye illness caused by diabetes that affects the blood vessels in the eyes, with the ground occupied by lesions of varied extent determining the disease burden. This is among the most common [...] Read more.
Diabetic retinopathy (DR) and diabetic macular edema (DME) are forms of eye illness caused by diabetes that affects the blood vessels in the eyes, with the ground occupied by lesions of varied extent determining the disease burden. This is among the most common cause of visual impairment in the working population. Various factors have been discovered to play an important role in a person’s growth of this condition. Among the essential elements at the top of the list are anxiety and long-term diabetes. If not detected early, this illness might result in permanent eyesight loss. The damage can be reduced or avoided if it is recognized ahead of time. Unfortunately, due to the time and arduous nature of the diagnosing process, it is harder to identify the prevalence of this condition. Skilled doctors manually review digital color images to look for damage produced by vascular anomalies, the most common complication of diabetic retinopathy. Even though this procedure is reasonably accurate, it is quite pricey. The delays highlight the necessity for diagnosis to be automated, which will have a considerable positive significant impact on the health sector. The use of AI in diagnosing the disease has yielded promising and dependable findings in recent years, which is the impetus for this publication. This article used ensemble convolutional neural network (ECNN) to diagnose DR and DME automatically, with accurate results of 99 percent. This result was achieved using preprocessing, blood vessel segmentation, feature extraction, and classification. For contrast enhancement, the Harris hawks optimization (HHO) technique is presented. Finally, the experiments were conducted for two kinds of datasets: IDRiR and Messidor for accuracy, precision, recall, F-score, computational time, and error rate. Full article
(This article belongs to the Special Issue Medical Image Processing and Analysis)
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5 pages, 1602 KiB  
Communication
Rise of the BQ.1.1.37 SARS-CoV-2 Sublineage, Italy
by Daniele Focosi, Pietro Giorgio Spezia, Anna-Lisa Capria, Federico Gueli, Scott McConnell, Federica Novazzi and Mauro Pistello
Diagnostics 2023, 13(5), 1000; https://doi.org/10.3390/diagnostics13051000 - 6 Mar 2023
Cited by 1 | Viewed by 2207
Abstract
BQ.1.1 has dominated the Europe and Americas COVID-19 wave across the 2022–2023 winter, and further viral evolution is expected to escape the consolidating immune responses. We report here the emergence of the BQ.1.1.37 variant in Italy, peaking in January 2022 before suffering competition [...] Read more.
BQ.1.1 has dominated the Europe and Americas COVID-19 wave across the 2022–2023 winter, and further viral evolution is expected to escape the consolidating immune responses. We report here the emergence of the BQ.1.1.37 variant in Italy, peaking in January 2022 before suffering competition by XBB.1.*. We attempted to correlate the potential fitness of BQ.1.1.37 with a unique two-amino acid insertion within the Spike protein. Full article
(This article belongs to the Special Issue Monitoring and Detection for SARS-CoV-2 and Its Variants)
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9 pages, 4177 KiB  
Article
Assessment of the Carotid Bodies in Magnetic Resonance—A Head-to-Head Comparison with Computed Tomography
by Lukasz Budynko, Tomasz K. Nowicki, Mariusz F. Kaszubowski, Dominik Swieton and Maciej Piskunowicz
Diagnostics 2023, 13(5), 993; https://doi.org/10.3390/diagnostics13050993 - 5 Mar 2023
Viewed by 1286
Abstract
Objectives: To evaluate carotid body visibility in contrast-enhanced magnetic resonance (MR) studies and to compare the results to contrast-enhanced computed tomography (CT). Methods: Two observers separately evaluated MR and CT examinations of 58 patients. MR scans were acquired with contrast-enhanced isometric T1-weighted water-only [...] Read more.
Objectives: To evaluate carotid body visibility in contrast-enhanced magnetic resonance (MR) studies and to compare the results to contrast-enhanced computed tomography (CT). Methods: Two observers separately evaluated MR and CT examinations of 58 patients. MR scans were acquired with contrast-enhanced isometric T1-weighted water-only Dixon sequence. CT examinations were performed 90 s after contrast agent administration. Carotid bodies’ dimensions were noted and their volumes calculated. To quantify the agreement between both methods, Bland–Altman plots were computed. Receiver operating characteristic (ROC) and its localization-oriented variant (LROC) curves were plotted. Results: Of the 116 expected carotid bodies, 105 were found on CT and 103 on MR at least by a single observer. Significantly more findings were concordant in CT (92.2%) than in MR (83.6%). The mean carotid body volume was smaller in CT (19.4 mm3) than in MR (20.8 mm3). The inter-observer agreement on volumes was moderately good (ICC (2,k) 0.42, p < 0.001), but with significant systematic error. The diagnostic performance of the MR method added up to 88.4% of the ROC’s area under the curve and 78.0% in the LROC algorithm. Conclusions: Carotid bodies can be visualized on contrast-enhanced MR with good accuracy and inter-observer agreement. Carotid bodies assessed on MR had similar morphology as described in anatomical studies. Full article
(This article belongs to the Special Issue Advances in Diagnostic Imaging of Head and Neck Tumors)
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20 pages, 8271 KiB  
Review
More than Just Skin-Deep: A Review of Imaging’s Role in Guiding CAR T-Cell Therapy for Advanced Melanoma
by Conor M. Prendergast, Kathleen M. Capaccione, Egesta Lopci, Jeeban P. Das, Alexander N. Shoushtari, Randy Yeh, Daniel Amin, Laurent Dercle and Dorine De Jong
Diagnostics 2023, 13(5), 992; https://doi.org/10.3390/diagnostics13050992 - 5 Mar 2023
Cited by 3 | Viewed by 3473
Abstract
Advanced melanoma is one of the deadliest cancers, owing to its invasiveness and its propensity to develop resistance to therapy. Surgery remains the first-line treatment for early-stage tumors but is often not an option for advanced-stage melanoma. Chemotherapy carries a poor prognosis, and [...] Read more.
Advanced melanoma is one of the deadliest cancers, owing to its invasiveness and its propensity to develop resistance to therapy. Surgery remains the first-line treatment for early-stage tumors but is often not an option for advanced-stage melanoma. Chemotherapy carries a poor prognosis, and despite advances in targeted therapy, the cancer can develop resistance. CAR T-cell therapy has demonstrated great success against hematological cancers, and clinical trials are deploying it against advanced melanoma. Though melanoma remains a challenging disease to treat, radiology will play an increasing role in monitoring both the CAR T-cells and response to therapy. We review the current imaging techniques for advanced melanoma, as well as novel PET tracers and radiomics, in order to guide CAR T-cell therapy and manage potential adverse events. Full article
(This article belongs to the Special Issue Imaging Diagnosis for Melanoma 2.0)
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8 pages, 1583 KiB  
Case Report
Secondary Breast Malignancy from Renal Cell Carcinoma: Challenges in Diagnosis and Treatment—Case Report
by Marko Spasic, Dusan Zaric, Minja Mitrovic, Sanja Milojevic, Nikola Nedovic, Marija Sekulic, Bojan Stojanovic, Dejan Vulovic, Bojan Milosevic, Filip Milutinovic and Neda Milosavljevic
Diagnostics 2023, 13(5), 991; https://doi.org/10.3390/diagnostics13050991 - 5 Mar 2023
Cited by 2 | Viewed by 3326
Abstract
Renal cell carcinoma represents about 2% of all malignant tumours in adults. Metastases of the primary tumour in the breast make up to about 0.5–2% of the cases. Renal cell carcinoma metastases in the breast are extremely rare and have been sporadically recorded [...] Read more.
Renal cell carcinoma represents about 2% of all malignant tumours in adults. Metastases of the primary tumour in the breast make up to about 0.5–2% of the cases. Renal cell carcinoma metastases in the breast are extremely rare and have been sporadically recorded in the literature. In this paper, we present the case of a patient with breast metastasis of renal cell carcinoma 11 years after primary treatment. Case presentation: An 82-year-old female who had right nephrectomy due to renal cancer in 2010 felt a lump in her right breast in August 2021, whereby a clinical examination revealed a tumour at the junction of the upper quadrants of her right breast, about 2 cm, movable toward the base, vaguely limited, and with a rough surface. The axillae were without palpable lymph nodes. Mammography showed a circular and relatively clearly contoured lesion in the right breast. Ultrasound showed an oval lobulated lesion of 19 × 18 mm at the upper quadrants, with strong vascularisation and without posterior acoustic phenomena. A core needle biopsy was performed, and the histopathological findings and obtained immunophenotype indicated a metastatic clear cell carcinoma of renal origin. A metastasectomy was performed. Histopathologically, the tumour was without desmoplastic stroma, comprising predominantly solid-type alveolar arrangements of large moderately polymorphic cells, bright and abundant cytoplasm, and round vesicular cores with focally prominent nuclei. Immunohistochemically, tumour cells were diffusely positive for CD10, EMA, and vimentin, and negative for CK7, TTF-1, renal cell antigen, and E-cadherin. With a normal postoperative course, the patient was discharged on the third postoperative day. After 17 months, there were no new signs of the underlying disease spreading at regular follow-ups. Conclusion: Metastatic involvement of the breast is relatively rare and should be suspected in patients with a prior history of other cancers. Core needle biopsy and pathohistological analysis are required for the diagnosis of breast tumours. Full article
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14 pages, 3833 KiB  
Review
Advanced Imaging for Robotic Bronchoscopy: A Review
by Nakul Ravikumar, Elliot Ho, Ajay Wagh and Septimiu Murgu
Diagnostics 2023, 13(5), 990; https://doi.org/10.3390/diagnostics13050990 - 5 Mar 2023
Cited by 8 | Viewed by 3945
Abstract
Recent advances in navigational platforms have led bronchoscopists to make major strides in diagnostic interventions for pulmonary parenchymal lesions. Over the last decade, multiple platforms including electromagnetic navigation and robotic bronchoscopy have allowed bronchoscopists to safely navigate farther into the lung parenchyma with [...] Read more.
Recent advances in navigational platforms have led bronchoscopists to make major strides in diagnostic interventions for pulmonary parenchymal lesions. Over the last decade, multiple platforms including electromagnetic navigation and robotic bronchoscopy have allowed bronchoscopists to safely navigate farther into the lung parenchyma with increased stability and accuracy. Limitations persist, even with these newer technologies, in achieving a similar or higher diagnostic yield when compared to the transthoracic computed tomography (CT) guided needle approach. One of the major limitations to this effect is due to CT-to-body divergence. Real-time feedback that better defines the tool–lesion relationship is vital and can be obtained with additional imaging using radial endobronchial ultrasound, C-arm based tomosynthesis, cone-beam CT (fixed or mobile), and O-arm CT. Herein, we describe the role of this adjunct imaging with robotic bronchoscopy for diagnostic purposes, describe potential strategies to counteract the CT-to-body divergence phenomenon, and address the potential role of advanced imaging for lung tumor ablation. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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15 pages, 3696 KiB  
Article
Impact of Breathing Phase, Liver Segment, and Prandial State on Ultrasound Shear Wave Speed, Shear Wave Dispersion, and Attenuation Imaging of the Liver in Healthy Volunteers
by Catherine Paverd, Sivert Kupfer, Iara Nascimento Kirchner, Sherin Nambiar, Alexander Martin, Naiara Korta Martiartu, Thomas Frauenfelder, Marga B. Rominger and Lisa Ruby
Diagnostics 2023, 13(5), 989; https://doi.org/10.3390/diagnostics13050989 - 5 Mar 2023
Cited by 4 | Viewed by 1724
Abstract
Objectives: Measurement location and patient state can impact noninvasive liver assessment and change clinical staging in ultrasound examinations. Research into differences exists for Shear Wave Speed (SWS) and Attenuation Imaging (ATI), but not for Shear Wave Dispersion (SWD). The aim of this study [...] Read more.
Objectives: Measurement location and patient state can impact noninvasive liver assessment and change clinical staging in ultrasound examinations. Research into differences exists for Shear Wave Speed (SWS) and Attenuation Imaging (ATI), but not for Shear Wave Dispersion (SWD). The aim of this study is to assess the effect of breathing phase, liver lobe, and prandial state on SWS, SWD, and ATI ultrasound measurements. Methods: Two experienced examiners performed SWS, SWD, and ATI measurements in 20 healthy volunteers using a Canon Aplio i800 system. Measurements were taken in the recommended condition (right lobe, following expiration, fasting state), as well as (a) following inspiration, (b) in the left lobe, and (c) in a nonfasting state. Results: SWS and SWD measurements were strongly correlated (r = 0.805, p < 0.001). Mean SWS was 1.34 ± 0.13 m/s in the recommended measurement position and did not change significantly under any condition. Mean SWD was 10.81 ± 2.05 m/s/kHz in the standard condition and significantly increased to 12.18 ± 1.41 m/s/kHz in the left lobe. Individual SWD measurements in the left lobe also had the highest average coefficient of variation (19.68%). No significant differences were found for ATI. Conclusion: Breathing and prandial state did not significantly affect SWS, SWD, and ATI values. SWS and SWD measurements were strongly correlated. SWD measurements in the left lobe showed a higher individual measurement variability. Interobserver agreement was moderate to good. Full article
(This article belongs to the Special Issue Advanced Ultrasound Technologies for Diagnosis)
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9 pages, 524 KiB  
Article
Outpatient Hysteroscopic Polypectomy—A Retrospective Study Comparing Rigid and Semirigid Office Hysteroscopes
by Benito Chiofalo, Mauro Calandra, Valentina Bruno, Vincenzo Tarantino, Giovanni Esposito, Enrico Vizza, Giacomo Corrado, Giovanni Scambia and Ursula Catena
Diagnostics 2023, 13(5), 988; https://doi.org/10.3390/diagnostics13050988 - 5 Mar 2023
Cited by 1 | Viewed by 1633
Abstract
Endometrial polyps are one of the most common pathological conditions in gynecology. Hysteroscopy is the gold standard for the diagnosis and treatment of endometrial polyps. The purpose of this multicenter, retrospective study was to compare patients’ pain perception during an operative hysteroscopic endometrial [...] Read more.
Endometrial polyps are one of the most common pathological conditions in gynecology. Hysteroscopy is the gold standard for the diagnosis and treatment of endometrial polyps. The purpose of this multicenter, retrospective study was to compare patients’ pain perception during an operative hysteroscopic endometrial polypectomy in an outpatient setting with two different hysteroscopes (rigid and semirigid) and to identify some clinical and intraoperative characteristics that are related to worsening pain during the procedure. We included women that underwent, at the same time as an diagnostic hysteroscopy, the complete removal of an endometrial polyp (using the see-and-treat strategy) without any kind of analgesia. A total of 166 patients were enrolled, of which 102 patients underwent a polypectomy with a semirigid hysteroscope and 64 patients underwent the procedure with a rigid hysteroscope. No differences were found during the diagnostic step; on the contrary, after the operative procedure, a statistically significant greater degree of pain was reported when the semirigid hysteroscope was used. Cervical stenosis and menopausal status were risk factors for pain both in the diagnostic step and in the operative one. Our results confirm that operative hysteroscopic endometrial polypectomy in an outpatient setting is an effective, safe, and well-tolerated procedure and indicate that it might be better tolerated if a rigid rather than semirigid instrument is used. Full article
(This article belongs to the Special Issue Advances in Hysteroscopy)
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15 pages, 742 KiB  
Review
Mechanisms of Resistance to CDK4/6 Inhibitors and Predictive Biomarkers of Response in HR+/HER2-Metastatic Breast Cancer—A Review of the Literature
by Ioana-Miruna Stanciu, Andreea Ioana Parosanu, Cristina Orlov-Slavu, Ion Cristian Iaciu, Ana Maria Popa, Cristina Mihaela Olaru, Cristina Florina Pirlog, Radu Constantin Vrabie and Cornelia Nitipir
Diagnostics 2023, 13(5), 987; https://doi.org/10.3390/diagnostics13050987 - 5 Mar 2023
Cited by 6 | Viewed by 5221
Abstract
The latest and newest discoveries for advanced and metastatic hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2-) breast cancer are the three cyclin-dependent kinases 4 and 6 inhibitors (CDK4/6i) in association with endocrine therapy (ET). However, even if this treatment [...] Read more.
The latest and newest discoveries for advanced and metastatic hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2-) breast cancer are the three cyclin-dependent kinases 4 and 6 inhibitors (CDK4/6i) in association with endocrine therapy (ET). However, even if this treatment revolutionized the world and continued to be the first-line treatment choice for these patients, it also has its limitations, caused by de novo or acquired drug resistance which leads to inevitable progression after some time. Thus, an understanding of the overview of the targeted therapy which represents the gold therapy for this subtype of cancer is essential. The full potential of CDK4/6i is yet to be known, with many trials ongoing to expand their utility to other breast cancer subtypes, such as early breast cancer, and even to other cancers. Our research establishes the important idea that resistance to combined therapy (CDK4/6i + ET) can be due to resistance to endocrine therapy, to treatment with CDK4/6i, or to both. Individuals’ responses to treatment are based mostly on genetic features and molecular markers, as well as the tumor’s hallmarks; therefore, a future perspective is represented by personalized treatment based on the development of new biomarkers, and strategies to overcome drug resistance to combinations of ET and CDK4/6 inhibitors. The aim of our study was to centralize the mechanisms of resistance, and we believe that our work will have utility for everyone in the medical field who wants to deepen their knowledge about ET + CDK4/6 inhibitors resistance. Full article
(This article belongs to the Special Issue Cancer Diagnosis and Oncological Treatments in Romania)
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10 pages, 729 KiB  
Article
A High-Efficiency Consultation Improves Urological Diagnosis in Patients with Complex LUTS—A Pilot Study
by Alexandru Ciudin, Bernat Padulles, Pasqualino Manasia, Josep Alcoberro, Sanae Ounia, Maria Lopez, Natalia Allue, Joan Maria Ferrer, Jaume Duran and Antonio Aguilar
Diagnostics 2023, 13(5), 986; https://doi.org/10.3390/diagnostics13050986 - 4 Mar 2023
Cited by 1 | Viewed by 1462
Abstract
(1) Background: The diagnosis of moderate-severe lower urinary tract symptoms (LUTS) is not easy due to the complexity of the micturition act. Sequential diagnostic tests can be time consuming due to waiting lists. Thus, we developed a diagnostic model combining all the tests [...] Read more.
(1) Background: The diagnosis of moderate-severe lower urinary tract symptoms (LUTS) is not easy due to the complexity of the micturition act. Sequential diagnostic tests can be time consuming due to waiting lists. Thus, we developed a diagnostic model combining all the tests in a single one-stop consultation. (2) Methods: In a prospective pilot study in patients with complex LUTS, they received all diagnostic tests (ultrasound, uroflowmetry, cystoscopy, pressure-flow study) in a single consultation and by the same doctor. Patients’ results were compared with those from a 2021 paired cohort that underwent the classical sequential diagnostic pathway. (3) Results: Per patient, the high-efficiency consultation saved: 175 days of waiting, 60 min doctor time and 120 nursing assistant time and over 300 euros on average. The intervention also saved 120 patient journeys to the hospital, lowering the total carbon footprint by 145.86 kg CO2. In one-third of the patients, performing all the tests within the same consultation contributed to reaching a more appropriate diagnosis and thus more effective treatment. Patients’ satisfaction was high, with good tolerability. (4) Conclusions: The high-efficiency urology consultation improves waiting times, therapeutic decisions and the degree of patient satisfaction while optimizing the use of resources and generating savings for the health system. Full article
(This article belongs to the Section Pathology and Molecular Diagnostics)
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13 pages, 4474 KiB  
Article
Differentiating Fordyce Spots from Their Common Simulators Using Ultraviolet-Induced Fluorescence Dermatoscopy—Retrospective Study
by Paweł Pietkiewicz, Cristian Navarrete-Dechent, Mohamad Goldust, Katarzyna Korecka, Verce Todorovska and Enzo Errichetti
Diagnostics 2023, 13(5), 985; https://doi.org/10.3390/diagnostics13050985 - 4 Mar 2023
Cited by 11 | Viewed by 47246
Abstract
Fordyce spots (FS) are heterotopic sebaceous glands affecting mostly oral and genital mucosa, commonly misdiagnosed with sexually transmitted infections. In a single-center retrospective study, we aimed to assess the ultraviolet-induced fluorescencedermatoscopy (UVFD) clues of Fordyce spots and their common clinical simulants: molluscum contagiosum, [...] Read more.
Fordyce spots (FS) are heterotopic sebaceous glands affecting mostly oral and genital mucosa, commonly misdiagnosed with sexually transmitted infections. In a single-center retrospective study, we aimed to assess the ultraviolet-induced fluorescencedermatoscopy (UVFD) clues of Fordyce spots and their common clinical simulants: molluscum contagiosum, penile pearly papules, human papillomavirus warts, genital lichen planus, and genital porokeratosis. Analyzed documentation included patients’ medical records (1 September–30 October 2022) and photodocumentation, which included clinical images as well as polarized, non-polarized, and UVFD images. Twelve FS patients were included in the study group and fourteen patients in the control group. A novel and seemingly specific UVFD pattern of FS was described: regularly distributed bright dots over yellowish-greenish clods. Even though, in the majority of instances, the diagnosis of FS does not require more than naked eye examination, UVFD is a fast, easy-to-apply, and low-cost modality that can further increase the diagnostic confidence and rule out selected infectious and non-infectious differential diagnoses if added to conventional dermatoscopic diagnosis. Full article
(This article belongs to the Special Issue Advances in Non-invasive Skin Imaging Techniques)
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15 pages, 959 KiB  
Article
CD24 Gene Expression as a Risk Factor for Non-Alcoholic Fatty Liver Disease
by Mona A. Amin, Halla M. Ragab, Nabila Abd El Maksoud and Wafaa Abd Elaziz
Diagnostics 2023, 13(5), 984; https://doi.org/10.3390/diagnostics13050984 - 4 Mar 2023
Cited by 1 | Viewed by 1661
Abstract
In light of increasing NAFLD prevalence, early detection and diagnosis are needed for decision-making in clinical practice and could be helpful in the management of patients with NAFLD. The goal of this study was to evaluate the diagnostic accuracy of CD24 gene expression [...] Read more.
In light of increasing NAFLD prevalence, early detection and diagnosis are needed for decision-making in clinical practice and could be helpful in the management of patients with NAFLD. The goal of this study was to evaluate the diagnostic accuracy of CD24 gene expression as a non-invasive tool to detect hepatic steatosis for diagnosis of NAFLD at early stage. These findings will aid in the creation of a viable diagnostic approach. Methods: This study enrolled eighty individuals divided into two groups; a study group included forty cases with bright liver and a group of healthy subjects with normal liver. Steatosis was quantified by CAP. Fibrosis assessment was performed by FIB-4, NFS, Fast-score, and Fibroscan. Liver enzymes, lipid profile, and CBC were evaluated. Utilizing RNA extracted from whole blood, the CD24 gene expression was detected using real-time PCR technique. Results: It was detected that expression of CD24 was significantly higher in patients with NAFLD than healthy controls. The median fold change was 6.56 higher in NAFLD cases compared to control subjects. Additionally, CD24 expression was higher in cases with fibrosis stage F1 compared to those with fibrosis stage F0, as the mean expression level of CD24 was 7.19 in F0 cases as compared to 8.65 in F1 patients but without significant difference (p = 0.588). ROC curve analysis showed that CD24 ∆CT had significant diagnostic accuracy in the diagnosis of NAFLD (p = 0.034). The optimum cutoff for CD24 was 1.83 for distinguishing patients with NAFLD from healthy control with sensitivity 55% and specificity 74.4%; and an area under the ROC curve (AUROC) of 0.638 (95% CI: 0.514–0.763) was determined. Conclusion: In the present study, CD24 gene expression was up-regulated in fatty liver. Further studies are required to confer its diagnostic and prognostic value in the detection of NAFLD, clarify its role in the progression of hepatocyte steatosis, and to elucidate the mechanism of this biomarker in the progression of disease. Full article
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10 pages, 2373 KiB  
Case Report
Multisystem Inflammatory Syndrome in Adults Associated with Recent Infection with COVID-19
by Ondrej Zahornacky, Štefan Porubčin, Alena Rovnakova and Pavol Jarcuska
Diagnostics 2023, 13(5), 983; https://doi.org/10.3390/diagnostics13050983 - 4 Mar 2023
Cited by 3 | Viewed by 1539
Abstract
Multisystem inflammatory syndrome in adults (MIS-A) is an uncommon but severe and still understudied post-infectious complication of COVID-19. Clinically, the disease manifests itself most often 2–6 weeks after overcoming the infection. Young and middle-aged patients are especially affected. The clinical picture of the [...] Read more.
Multisystem inflammatory syndrome in adults (MIS-A) is an uncommon but severe and still understudied post-infectious complication of COVID-19. Clinically, the disease manifests itself most often 2–6 weeks after overcoming the infection. Young and middle-aged patients are especially affected. The clinical picture of the disease is very diverse. The dominant symptoms are mainly fever and myalgia, usually accompanied by various, especially extrapulmonary, manifestations. Cardiac damage (often in the form of cardiogenic shock) and significantly increased inflammatory parameters are often associated with MIS-A, while respiratory symptoms, including hypoxia, are less frequent. Due to the seriousness of the disease and the possibility of rapid progression, the basis of a successful treatment of the patient is early diagnosis, based mainly on anamnesis (overcoming the disease of COVID-19 in the recent past) and clinical symptoms, which often imitate other severe conditions such as, e.g., sepsis, septic shock, or toxic shock syndrome. Because of the danger of missing the treatment, it is necessary to initiate it immediately after the suspicion of MIS-A is expressed, without waiting for the results of microbiological and serological examinations. The cornerstone of pharmacological therapy is the administration of corticosteroids and intravenous immunoglobulins, to which the majority of patients clinically react. In this article, the authors describe the case report of a 21-year-old patient admitted to the Clinic of Infectology and Travel Medicine for febrility up to 40.5 °C, myalgia, arthralgia, headache, vomiting, and diarrhea three weeks after overcoming COVID-19. However, as part of the routine differential diagnosis of fevers (imaging and laboratory examinations), their cause was not clarified. Due to the overall worsening of the condition, the patient was transferred to the ICU with suspicion of developing MIS-A (he met all clinical and laboratory criteria). Given the above, reserve antibiotics, intravenous corticosteroids, and immunoglobulins were added to the treatment due to the risk of missing them, with a good clinical and laboratory effect. After stabilizing the condition and adjusting the laboratory parameters, the patient was transferred to a standard bed and sent home. Full article
(This article belongs to the Special Issue COVID-19, Post-COVID and Autoimmunity)
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11 pages, 2780 KiB  
Article
Artificial Intelligence for Evaluation of Retinal Vasculopathy in Facioscapulohumeral Dystrophy Using OCT Angiography: A Case Series
by Martina Maceroni, Mauro Monforte, Rossella Cariola, Benedetto Falsini, Stanislao Rizzo, Maria Cristina Savastano, Francesco Martelli, Enzo Ricci, Sara Bortolani, Giorgio Tasca and Angelo Maria Minnella
Diagnostics 2023, 13(5), 982; https://doi.org/10.3390/diagnostics13050982 - 4 Mar 2023
Viewed by 1751
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is a slowly progressive muscular dystrophy with a wide range of manifestations including retinal vasculopathy. This study aimed to analyse retinal vascular involvement in FSHD patients using fundus photographs and optical coherence tomography-angiography (OCT-A) scans, evaluated through artificial intelligence [...] Read more.
Facioscapulohumeral muscular dystrophy (FSHD) is a slowly progressive muscular dystrophy with a wide range of manifestations including retinal vasculopathy. This study aimed to analyse retinal vascular involvement in FSHD patients using fundus photographs and optical coherence tomography-angiography (OCT-A) scans, evaluated through artificial intelligence (AI). Thirty-three patients with a diagnosis of FSHD (mean age 50.4 ± 17.4 years) were retrospectively evaluated and neurological and ophthalmological data were collected. Increased tortuosity of the retinal arteries was qualitatively observed in 77% of the included eyes. The tortuosity index (TI), vessel density (VD), and foveal avascular zone (FAZ) area were calculated by processing OCT-A images through AI. The TI of the superficial capillary plexus (SCP) was increased (p < 0.001), while the TI of the deep capillary plexus (DCP) was decreased in FSHD patients in comparison to controls (p = 0.05). VD scores for both the SCP and the DCP results increased in FSHD patients (p = 0.0001 and p = 0.0004, respectively). With increasing age, VD and the total number of vascular branches showed a decrease (p = 0.008 and p < 0.001, respectively) in the SCP. A moderate correlation between VD and EcoRI fragment length was identified as well (r = 0.35, p = 0.048). For the DCP, a decreased FAZ area was found in FSHD patients in comparison to controls (t (53) = −6.89, p = 0.01). A better understanding of retinal vasculopathy through OCT-A can support some hypotheses on the disease pathogenesis and provide quantitative parameters potentially useful as disease biomarkers. In addition, our study validated the application of a complex toolchain of AI using both ImageJ and Matlab to OCT-A angiograms. Full article
(This article belongs to the Special Issue Artificial Intelligence in Eye Disease – Volume 2)
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13 pages, 2019 KiB  
Article
Predicting Overall Survival with Deep Learning from 18F-FDG PET-CT Images in Patients with Hepatocellular Carcinoma before Liver Transplantation
by Yung-Chi Lai, Kuo-Chen Wu, Chao-Jen Chang, Yi-Jin Chen, Kuan-Pin Wang, Long-Bin Jeng and Chia-Hung Kao
Diagnostics 2023, 13(5), 981; https://doi.org/10.3390/diagnostics13050981 - 4 Mar 2023
Cited by 1 | Viewed by 1668
Abstract
Positron emission tomography and computed tomography with 18F-fluorodeoxyglucose (18F-FDG PET-CT) were used to predict outcomes after liver transplantation in patients with hepatocellular carcinoma (HCC). However, few approaches for prediction based on 18F-FDG PET-CT images that leverage automatic liver segmentation and deep learning were [...] Read more.
Positron emission tomography and computed tomography with 18F-fluorodeoxyglucose (18F-FDG PET-CT) were used to predict outcomes after liver transplantation in patients with hepatocellular carcinoma (HCC). However, few approaches for prediction based on 18F-FDG PET-CT images that leverage automatic liver segmentation and deep learning were proposed. This study evaluated the performance of deep learning from 18F-FDG PET-CT images to predict overall survival in HCC patients before liver transplantation (LT). We retrospectively included 304 patients with HCC who underwent 18F-FDG PET/CT before LT between January 2010 and December 2016. The hepatic areas of 273 of the patients were segmented by software, while the other 31 were delineated manually. We analyzed the predictive value of the deep learning model from both FDG PET/CT images and CT images alone. The results of the developed prognostic model were obtained by combining FDG PET-CT images and combining FDG CT images (0.807 AUC vs. 0.743 AUC). The model based on FDG PET-CT images achieved somewhat better sensitivity than the model based on CT images alone (0.571 SEN vs. 0.432 SEN). Automatic liver segmentation from 18F-FDG PET-CT images is feasible and can be utilized to train deep-learning models. The proposed predictive tool can effectively determine prognosis (i.e., overall survival) and, thereby, select an optimal candidate of LT for patients with HCC. Full article
(This article belongs to the Special Issue AI/ML-Based Medical Image Processing and Analysis)
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18 pages, 13798 KiB  
Review
Recent Advances in Ultrasound Breast Imaging: From Industry to Clinical Practice
by Orlando Catalano, Roberta Fusco, Federica De Muzio, Igino Simonetti, Pierpaolo Palumbo, Federico Bruno, Alessandra Borgheresi, Andrea Agostini, Michela Gabelloni, Carlo Varelli, Antonio Barile, Andrea Giovagnoni, Nicoletta Gandolfo, Vittorio Miele and Vincenza Granata
Diagnostics 2023, 13(5), 980; https://doi.org/10.3390/diagnostics13050980 - 4 Mar 2023
Cited by 5 | Viewed by 4162
Abstract
Breast ultrasound (US) has undergone dramatic technological improvement through recent decades, moving from a low spatial resolution, grayscale-limited technique to a highly performing, multiparametric modality. In this review, we first focus on the spectrum of technical tools that have become commercially available, including [...] Read more.
Breast ultrasound (US) has undergone dramatic technological improvement through recent decades, moving from a low spatial resolution, grayscale-limited technique to a highly performing, multiparametric modality. In this review, we first focus on the spectrum of technical tools that have become commercially available, including new microvasculature imaging modalities, high-frequency transducers, extended field-of-view scanning, elastography, contrast-enhanced US, MicroPure, 3D US, automated US, S-Detect, nomograms, images fusion, and virtual navigation. In the subsequent section, we discuss the broadened current application of US in breast clinical scenarios, distinguishing among primary US, complementary US, and second-look US. Finally, we mention the still ongoing limitations and the challenging aspects of breast US. Full article
(This article belongs to the Special Issue Advances in Breast Imaging and Analytics)
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17 pages, 905 KiB  
Review
Fatty Acid Profile and Genetic Variants of Proteins Involved in Fatty Acid Metabolism Could Be Considered as Disease Predictor
by Raja Chaaba, Aicha Bouaziz, Asma Ben Amor, Wissem Mnif, Mohamed Hammami and Sounira Mehri
Diagnostics 2023, 13(5), 979; https://doi.org/10.3390/diagnostics13050979 - 4 Mar 2023
Cited by 3 | Viewed by 3735
Abstract
Circulating fatty acids (FA) have an endogenous or exogenous origin and are metabolized under the effect of many enzymes. They play crucial roles in many mechanisms: cell signaling, modulation of gene expression, etc., which leads to the hypothesis that their perturbation could be [...] Read more.
Circulating fatty acids (FA) have an endogenous or exogenous origin and are metabolized under the effect of many enzymes. They play crucial roles in many mechanisms: cell signaling, modulation of gene expression, etc., which leads to the hypothesis that their perturbation could be the cause of disease development. FA in erythrocytes and plasma rather than dietary FA could be used as a biomarker for many diseases. Cardiovascular disease was associated with elevated trans FA and decreased DHA and EPA. Increased arachidonic acid and decreased Docosahexaenoic Acids (DHA) were associated with Alzheimer’s disease. Low Arachidonic acid and DHA are associated with neonatal morbidities and mortality. Decreased saturated fatty acids (SFA), increased monounsaturated FA (MUFA) and polyunsaturated FA (PUFA) (C18:2 n-6 and C20:3 n-6) are associated with cancer. Additionally, genetic polymorphisms in genes coding for enzymes implicated in FA metabolism are associated with disease development. FA desaturase (FADS1 and FADS2) polymorphisms are associated with Alzheimer’s disease, Acute Coronary Syndrome, Autism spectrum disorder and obesity. Polymorphisms in FA elongase (ELOVL2) are associated with Alzheimer’s disease, Autism spectrum disorder and obesity. FA-binding protein polymorphism is associated with dyslipidemia, type 2 diabetes, metabolic syndrome, obesity, hypertension, non-alcoholic fatty liver disease, peripheral atherosclerosis combined with type 2 diabetes and polycystic ovary syndrome. Acetyl-coenzyme A carboxylase polymorphisms are associated with diabetes, obesity and diabetic nephropathy. FA profile and genetic variants of proteins implicated in FA metabolism could be considered as disease biomarkers and may help with the prevention and management of diseases. Full article
(This article belongs to the Special Issue Recent Advances in the Diagnosis of Metabolic Disorders)
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17 pages, 1931 KiB  
Review
[18F]FDG PET/CT in the Evaluation of Melanoma Patients Treated with Immunotherapy
by María Mangas Losada, Leonardo Romero Robles, Alejandro Mendoza Melero, Irene García Megías, Amós Villanueva Torres, Puy Garrastachu Zumarán, Xavier Boulvard Chollet, Egesta Lopci, Rafael Ramírez Lasanta and Roberto C. Delgado Bolton
Diagnostics 2023, 13(5), 978; https://doi.org/10.3390/diagnostics13050978 - 4 Mar 2023
Cited by 4 | Viewed by 1927
Abstract
Immunotherapy is based on manipulation of the immune system in order to act against tumour cells, with growing evidence especially in melanoma patients. The challenges faced by this new therapeutic tool are (i) finding valid evaluation criteria for response assessment; (ii) knowing and [...] Read more.
Immunotherapy is based on manipulation of the immune system in order to act against tumour cells, with growing evidence especially in melanoma patients. The challenges faced by this new therapeutic tool are (i) finding valid evaluation criteria for response assessment; (ii) knowing and distinguishing between “atypical” response patterns; (iii) using PET biomarkers as predictive and response evaluation parameters and (iv) diagnosis and management of immunorelated adverse effects. This review is focused on melanoma patients analysing (a) the role of [18F]FDG PET/CT in the mentioned challenges; (b) the evidence of its efficacy. For this purpose, we performed a review of the literature, including original and review articles. In summary, although there are no clearly established or globally accepted criteria, modified response criteria are potentially appropriate for evaluation of immunotherapy benefit. In this context, [18F]FDG PET/CT biomarkers appear to be promising parameters in prediction and assessment of response to immunotherapy. Moreover, immunorelated adverse effects are recognized as predictors of early response to immunotherapy and may be associated with better prognosis and clinical benefit. Full article
(This article belongs to the Special Issue Advances in PET/CT Imaging)
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28 pages, 2876 KiB  
Article
A Bimodal Emotion Recognition Approach through the Fusion of Electroencephalography and Facial Sequences
by Farah Muhammad, Muhammad Hussain and Hatim Aboalsamh
Diagnostics 2023, 13(5), 977; https://doi.org/10.3390/diagnostics13050977 - 4 Mar 2023
Cited by 4 | Viewed by 1993
Abstract
In recent years, human–computer interaction (HCI) systems have become increasingly popular. Some of these systems demand particular approaches for discriminating actual emotions through the use of better multimodal methods. In this work, a deep canonical correlation analysis (DCCA) based multimodal emotion recognition method [...] Read more.
In recent years, human–computer interaction (HCI) systems have become increasingly popular. Some of these systems demand particular approaches for discriminating actual emotions through the use of better multimodal methods. In this work, a deep canonical correlation analysis (DCCA) based multimodal emotion recognition method is presented through the fusion of electroencephalography (EEG) and facial video clips. A two-stage framework is implemented, where the first stage extracts relevant features for emotion recognition using a single modality, while the second stage merges the highly correlated features from the two modalities and performs classification. Convolutional neural network (CNN) based Resnet50 and 1D-CNN (1-Dimensional CNN) have been utilized to extract features from facial video clips and EEG modalities, respectively. A DCCA-based approach was used to fuse highly correlated features, and three basic human emotion categories (happy, neutral, and sad) were classified using the SoftMax classifier. The proposed approach was investigated based on the publicly available datasets called MAHNOB-HCI and DEAP. Experimental results revealed an average accuracy of 93.86% and 91.54% on the MAHNOB-HCI and DEAP datasets, respectively. The competitiveness of the proposed framework and the justification for exclusivity in achieving this accuracy were evaluated by comparison with existing work. Full article
(This article belongs to the Section Machine Learning and Artificial Intelligence in Diagnostics)
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11 pages, 894 KiB  
Article
Plasma Fibrinogen as a Predictor of Perioperative-Blood-Component Transfusion in Major-Nontraumatic-Orthopedic-Surgery Patients: A Cohort Study
by Eugenio Pagnussatt Neto, Paula Daniele Lopes da Costa, Sanderland J. Tavares Gurgel, Paula Schmidt Azevedo, Norma S. Pinheiro Modolo and Paulo do Nascimento Junior
Diagnostics 2023, 13(5), 976; https://doi.org/10.3390/diagnostics13050976 - 4 Mar 2023
Cited by 1 | Viewed by 1525
Abstract
There is a trend towards increased perioperative bleeding in patients with plasma fibrinogen levels < 200 mg/dL−1. This study aimed to assess whether there is an association between preoperative fibrinogen levels and perioperative blood-product transfusion up to 48 h after major [...] Read more.
There is a trend towards increased perioperative bleeding in patients with plasma fibrinogen levels < 200 mg/dL−1. This study aimed to assess whether there is an association between preoperative fibrinogen levels and perioperative blood-product transfusion up to 48 h after major orthopedic surgery. This cohort study included 195 patients who underwent primary or revision hip arthroplasty for nontraumatic etiologies. Plasma fibrinogen, blood count, coagulation tests, and platelet count were measured preoperatively. A plasma fibrinogen level of 200 mg/dL−1 was the cutoff value used to predict blood transfusion. The mean (SD) plasma fibrinogen level was 325 (83) mg/dL−1. Only thirteen patients had levels < 200 mg/dL−1, and only one of them received a blood transfusion, with an absolute risk of 7.69% (1/13; 95%CI: 1.37–33.31%). Preoperative plasma fibrinogen levels were not associated with the need for blood transfusion (p = 0.745). The sensitivity and the positive predictive value of plasma fibrinogen < 200 mg/dL−1 as a predictor of blood transfusion were 4.17% (95%CI: 0.11–21.12%) and 7.69% (95%CI: 1.12–37.99%), respectively. Test accuracy was 82.05% (95%CI: 75.93–87.17%), but positive and negative likelihood ratios were poor. Therefore, preoperative plasma fibrinogen level in hip-arthroplasty patients was not associated with the need for blood-product transfusion. Full article
(This article belongs to the Section Clinical Laboratory Medicine)
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25 pages, 728 KiB  
Article
Models and Algorithms for the Refinement of Therapeutic Approaches for Retinal Diseases
by Elfriede Friedmann, Simon Dörsam and Gerd U. Auffarth
Diagnostics 2023, 13(5), 975; https://doi.org/10.3390/diagnostics13050975 - 3 Mar 2023
Viewed by 1282
Abstract
We are developing a Virtual Eye for in silico therapies to accelerate research and drug development. In this paper, we present a model for drug distribution in the vitreous body that enables personalized therapy in ophthalmology. The standard treatment for age-related macular degeneration [...] Read more.
We are developing a Virtual Eye for in silico therapies to accelerate research and drug development. In this paper, we present a model for drug distribution in the vitreous body that enables personalized therapy in ophthalmology. The standard treatment for age-related macular degeneration is anti-vascular endothelial growth factor (VEGF) drugs administered by repeated injections. The treatment is risky, unpopular with patients, and some of them are unresponsive with no alternative treatment. Much attention is paid to the efficacy of these drugs, and many efforts are being made to improve them. We are designing a mathematical model and performing long-term three-dimensional Finite Element simulations for drug distribution in the human eye to gain new insights in the underlying processes using computational experiments. The underlying model consists of a time-dependent convection-diffusion equation for the drug coupled with a steady-state Darcy equation describing the flow of aqueous humor through the vitreous medium. The influence of collagen fibers in the vitreous on drug distribution is included by anisotropic diffusion and the gravity via an additional transport term. The resulting coupled model was solved in a decoupled way: first the Darcy equation with mixed finite elements, then the convection-diffusion equation with trilinear Lagrange elements. Krylov subspace methods are used to solve the resulting algebraic system. To cope with the large time steps resulting from the simulations over 30 days (operation time of 1 anti-VEGF injection), we apply the strong A-stable fractional step theta scheme. Using this strategy, we compute a good approximation to the solution that converges quadratically in both time and space. The developed simulations were used for the therapy optimization, for which specific output functionals are evaluated. We show that the effect of gravity on drug distribution is negligible, that the optimal pair of injection angles is (50,50), that larger angles can result in 38% less drug at the macula, and that in the best case only 40% of the drug reaches the macula while the rest escapes, e.g., through the retina, that by using heavier drug molecules, more of the drug concentration reaches the macula in an average of 30 days. As a refined therapy, we have found that for longer-acting drugs, the injection should be made in the center of the vitreous, and for more intensive initial treatment, the drug should be injected even closer to the macula. In this way, we can perform accurate and efficient treatment testing, calculate the optimal injection position, perform drug comparison, and quantify the effectiveness of the therapy using the developed functionals. We describe the first steps towards virtual exploration and improvement of therapy for retinal diseases such as age-related macular degeneration. Full article
(This article belongs to the Special Issue Refining Diagnosis in Ophthalmology through Laboratory Research)
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