Diagnostics

10 pages, 1130 KiB

Open AccessCommunication

A Comparability Study Between Intravenous Contrast-Enhanced Cone-Beam Computed Tomography (CBCT) and Magnetic Resonance Angiography (MRA) on the Post-Treatment Follow-Up of Intracranial Aneurysms: A Single-Center Prospective Cohort Study

by Man Cho Lee, King Him Fung, Shing Him Liu, Koel Wei Sum Ko, Nok Lun Chan, Neeraj Ramesh Mahboobani, Ka Wai Shek, Tak Lap Poon and Wai Lun Poon

Diagnostics 2025, 15(14), 1774; https://doi.org/10.3390/diagnostics15141774 (registering DOI) - 14 Jul 2025

Abstract

Background: MRA is used in our center for monitoring post-treatment residual aneurysmal neck and stent patency. IV CBCT offers better spatial resolution and may provide significant advantages. Objective: This study investigates the image quality of IV CBCT compared to that of MRA for [...] Read more.

Background: MRA is used in our center for monitoring post-treatment residual aneurysmal neck and stent patency. IV CBCT offers better spatial resolution and may provide significant advantages. Objective: This study investigates the image quality of IV CBCT compared to that of MRA for the follow-up of intracranial aneurysms. Materials and Methods: In this prospective cohort study, 97 patients (mean age: 63.1 ± 11.7; 75 women and 22 men) with 114 treated cerebral aneurysms were included from July 2023 to April 2024. All patients underwent IV CBCT and MRA on the same day. Two neurointerventional radiologists assessed image quality using a five-point Likert scale on two separate occasions six weeks apart. Diagnostic values were evaluated across six parameters. Intra-observer and inter-observer agreements were calculated. Subgroup analyses were performed. Results: Overall, IV CBCT and MRA are comparable in terms of their ability to assess parent vessel status and the degree of artifacts (p > 0.05) though MRA shows a slight advantage in evaluating residual aneurysmal neck (p = 0.05). For clipped aneurysms, IV CBCT is superior in assessing residual aneurysmal neck (OR = 16.0, p < 0.001) and parent vessel status (OR = 15.1, p < 0.001) with significantly fewer artifacts (OR > 100, p < 0.001). For aneurysms solely treated with stents, IV CBCT is superior in assessing residual aneurysmal neck (OR > 20, p = 0.002) and parent vessel status (OR > 20, p = 0.002) with significantly fewer artifacts (OR > 20, p = 0.002). IV CBCT outperforms MRA in evaluating stent struts and the vessel wall status of a stented segment when MRA is non-diagnostic. Conclusions: IV CBCT and MRA have their own strengths and roles in the follow-up of post-treatment intracranial aneurysms. Overall, IV CBCT is superior in terms of its assessment of intracranial aneurysms treated solely with stents or surgical clips. Full article

(This article belongs to the Special Issue Diagnostic Imaging in Neurological Diseases)

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13 pages, 976 KiB

Open AccessArticle

Prognostic Value of the AST/ALT Ratio in Patients with Septic Shock: A Prospective, Multicenter, Registry-Based Observational Study

by Sungwoo Choi, Sangun Nah, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Tae Ho Lim, Sangchun Choi, Tae Gun Shin and Sangsoo Han

Diagnostics 2025, 15(14), 1773; https://doi.org/10.3390/diagnostics15141773 (registering DOI) - 14 Jul 2025

Abstract

Background/Objectives: Sepsis is a leading cause of mortality. The AST/ALT ratio may serve as a valuable marker for prediction in patients with various diseases. This study analyzed the prognostic value of this ratio in patients with sepsis. Methods: A retrospective analysis [...] Read more.

Background/Objectives: Sepsis is a leading cause of mortality. The AST/ALT ratio may serve as a valuable marker for prediction in patients with various diseases. This study analyzed the prognostic value of this ratio in patients with sepsis. Methods: A retrospective analysis was performed on data from a prospective registry of septic shock patients, collected across multiple centers from October 2015 to December 2022. The main outcome of interest was mortality within 28 days. We evaluated the predictive accuracy of 28-day mortality for variables with the Sequential Organ Failure Assessment (SOFA) score, aspartate transaminase (AST) levels, alanine transaminase (ALT) levels, the AST/ALT ratio, and the combination of the SOFA + AST/ALT ratio using the area under the receiver operating characteristics curve (AUROC). A Kaplan–Meier curve was used to compare the 28-day mortality between the AST/ALT subgroups (≥1.84 and <1.84). Stepwise multivariable Cox proportional hazards analyses were performed to determine the association between 28-day mortality and an AST/ALT ratio ≥ 1.84. Results: The AST/ALT ratio had a significantly higher discriminatory ability for predicting 28-day mortality compared to either AST or ALT. In addition, combining the AST/ALT ratio with the SOFA score improved the predictive accuracy compared to the SOFA alone. A multivariable Cox regression analysis demonstrated that an AST/ALT ratio ≥ 1.84 was associated with a higher risk of death within 28 days. Conclusions: The AST/ALT ratio at emergency department admission in sepsis patients is associated with 28-day mortality and, when combined with the SOFA score, provides additional prognostic information with moderate accuracy. Full article

(This article belongs to the Section Clinical Diagnosis and Prognosis)

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5 pages, 1502 KiB

Open AccessCorrection

Correction: Eroğlu, G. Electroencephalography-Based Neuroinflammation Diagnosis and Its Role in Learning Disabilities. Diagnostics 2025, 15, 764

by Günet Eroğlu

Diagnostics 2025, 15(14), 1772; https://doi.org/10.3390/diagnostics15141772 (registering DOI) - 14 Jul 2025

Abstract

In the original publication [...] Full article

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20 pages, 7255 KiB

Open AccessArticle

Cardiovascular Manifestations of Patients with Long COVID

by Gordana Krljanac, Milika Asanin, Mihajlo Viduljevic, Stefan Stankovic, Kristina Simatovic, Ratko Lasica, Olga Nedeljkovic-Arsenovic, Ruzica Maksimovic, Slavisa Zagorac, Ana Savic-Radojevic, Tatjana Djukic, Goran Stevanovic, Vedrana Pavlovic and Tatjana Simic

Diagnostics 2025, 15(14), 1771; https://doi.org/10.3390/diagnostics15141771 (registering DOI) - 13 Jul 2025

Abstract

Background: This study investigates the potential mechanisms behind changes in cardiac structure and function in long COVID patients. Methods: This study involved 176 consecutive outpatients in follow-up care (average age 55.9 years; 58.5% male) who experienced symptoms for over 12 weeks [...] Read more.

Background: This study investigates the potential mechanisms behind changes in cardiac structure and function in long COVID patients. Methods: This study involved 176 consecutive outpatients in follow-up care (average age 55.9 years; 58.5% male) who experienced symptoms for over 12 weeks (average 6.2 ± 2.7 months), following coronavirus infection (COVID-19). Results: The patients with long COVID and cardiovascular manifestations were significantly more hospitalized (88.5% vs. 75.9%) and had longer hospital stays. Significant echocardiography changes were observed in the left ventricular ejection fraction (LVEF) (59.6 ± 5.4% vs. 62.5 ± 3.8%); longitudinal strain (LS) in the sub-endocardium and intra-myocardium layers (−20.9 vs. −22.0% and −18.6 vs. −19.5%); circumferential strain (CS) in the sub-epicardium layers (−9.6 vs. −10.5%); and CS post-systolic shortening (CS PSS) (0.138 vs. 0.088 s). Additionally, pathological cardiac magnetic resonance (CMR) findings were seen in 58.2% of the group of patients with long COVID and cardiovascular manifestation; 43.3% exhibited positive late gadolinium enhancement (LGE), 21.0% had elevated native T1 mapping, and 22.4% had elevated native T2 mapping. Conclusions: Most patients with long COVID showed structural and functional changes in their cardiovascular systems, primarily caused by prolonged inflammation. Using multimodality imaging is important for uncovering the mechanisms to predict chronic myocarditis, early-stage heart failure, and pre-ischemic states, which can lead to serious complications. Recognizing the specific cardiovascular phenotypes associated with long COVID is essential in order to provide timely and appropriate treatment. Full article

(This article belongs to the Special Issue Advances in Imaging Diagnosis and Management of Cardiovascular and Pulmonary Diseases)

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19 pages, 20763 KiB

Open AccessArticle

Integrated Meta-Analysis Identifies Keratin Family Genes and Associated Genes as Key Biomarkers and Therapeutic Targets in Metastatic Cutaneous Melanoma

by Sumaila Abubakari, Yeşim Aktürk Dizman and Filiz Karaman

Diagnostics 2025, 15(14), 1770; https://doi.org/10.3390/diagnostics15141770 (registering DOI) - 13 Jul 2025

Abstract

Background/Objectives: Cutaneous melanoma is one of the aggressive forms of skin cancer originating from melanocytes. The high incidence of melanoma metastasis continues to rise, partly due to the complex nature of the molecular mechanisms driving its progression. While melanomas generally arise from melanocytes, [...] Read more.

Background/Objectives: Cutaneous melanoma is one of the aggressive forms of skin cancer originating from melanocytes. The high incidence of melanoma metastasis continues to rise, partly due to the complex nature of the molecular mechanisms driving its progression. While melanomas generally arise from melanocytes, we investigated whether aberrant keratinocyte differentiation pathways—like cornified envelope formation—discriminate primary melanoma from metastatic melanoma, revealing novel biomarkers in progression. Methods: In the present study, we retrieved four datasets (GSE15605, GSE46517, GSE8401, and GSE7553) associated with primary and metastatic melanoma tissues and identified differentially expressed genes (DEGs). Thereafter, an integrated meta-analysis and functional enrichment analysis of the DEGs were performed to evaluate the molecular mechanisms involved in melanoma metastasis, such as immune cell deconvolution and protein-protein interaction (PPI) network construction. Hub genes were identified based on four topological methods, including `Betweenness’, `MCC’, `Degree’, and `Bottleneck’. We validated the findings using the TCGA-SKCM cohort. Drug-gene interactions were evaluated using the DGIdb, whereas structural druggability was assessed using the ProteinPlus and AlphaFold databases. Results: We identified a total of eleven hub genes associated with melanoma progression. These included members of the keratin gene family (e.g., KRT5, KRT6A, KRT6B, etc.). Except for the gene CDH1, all the hub genes were downregulated in metastatic melanoma tissues. From a prognostic perspective, these hub genes were associated with poor prognosis (i.e., unfavorable). Using the Human Protein Atlas (HPA), immunohistochemistry evaluation revealed mostly undetected levels in metastatic melanoma. Additionally, the cornified envelope formation was the most enriched pathway, with a gene ratio of 17/33. The tumor microenvironment (TME) of metastatic melanomas was predominantly enriched in NK cell–associated signatures. Finally, several hub genes demonstrated favorable druggable potential for immunotherapy. Conclusions: Through integrated meta-analysis, this study identifies transcriptional, immunological, and structural pathways to melanoma metastasis and highlights keratin family genes as promising biomarkers for therapeutic targeting. Full article

(This article belongs to the Section Pathology and Molecular Diagnostics)

12 pages, 1312 KiB

Open AccessArticle

An Evaluation of Four Radiological Methods for Dental Age Estimation in the Montenegrin Population

by Tina Pajevic, Nemanja Marinkovic, Ivan Arsic, Jovan Markovic, Petar Milovanovic, Zorana Stamenkovic and Nenad Nedeljkovic

Diagnostics 2025, 15(14), 1769; https://doi.org/10.3390/diagnostics15141769 (registering DOI) - 13 Jul 2025

Abstract

Objectives: In this study, we aimed to evaluate the accuracy of four radiological methods for dental age estimation and to test which method is the most reliable in Montenegrin children. Methods: To determine dental age, we examined 351 panoramic radiographs of [...] Read more.

Objectives: In this study, we aimed to evaluate the accuracy of four radiological methods for dental age estimation and to test which method is the most reliable in Montenegrin children. Methods: To determine dental age, we examined 351 panoramic radiographs of 190 female and 161 male children between the ages of 6 and 12 using the Demirjian method, Willems method, the European formula, and the BAF. The estimated dental age was compared with the chronological age, and the average, absolute, and standard deviations were calculated. Results: When comparing dental age to chronological age in females, overestimation occurred when using the Demirjian and Willems methods, whereas the European formula and the BAF resulted in underestimations. Only the European formula underestimated dental age in males, while the other three methods caused overestimations in comparison to chronological age. The European formula and the BAF revealed that, when all age groups were included, approximately 57.1–61% of patients deviated from their chronological age by less than six months. When using Demirjian’s method, nearly 30–35% of patients had dental ages that were either overestimated or underestimated by more than a year. Conclusions: The most accurate method for estimating the dental age of children under 13 in the Montenegrin population is the European formula. The Demirjian method had the lowest accuracy, whereas that in the BAF and the Willems method was similar. Full article

(This article belongs to the Special Issue Advances in Dental Imaging, Oral Diagnosis, and Forensic Dentistry)

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7 pages, 1824 KiB

Open AccessInteresting Images

Apocrine Breast Carcinoma with Thanatosomes (Hyaline Globules)

by Mitsuhiro Tachibana, Masashi Nozawa, Tadahiro Isono, Kei Tsukamoto and Kazuyasu Kamimura

Diagnostics 2025, 15(14), 1768; https://doi.org/10.3390/diagnostics15141768 (registering DOI) - 13 Jul 2025

Abstract

Thanatosomes (hyaline globules or death bodies) are histologically observed in various non-neoplastic and neoplastic conditions. Some of these globules are associated with apoptotic cell death. Only six documented cases of thanatosomes have been reported in breast tumors. In this rare case involving a [...] Read more.

Thanatosomes (hyaline globules or death bodies) are histologically observed in various non-neoplastic and neoplastic conditions. Some of these globules are associated with apoptotic cell death. Only six documented cases of thanatosomes have been reported in breast tumors. In this rare case involving a 64-year-old Japanese woman diagnosed as having rectal cancer, preoperative computed tomography scanning revealed breast cancer in her right breast. Following a right total mastectomy, a tumor characterized as apocrine carcinoma (carcinoma with apocrine differentiation) containing thanatosomes was discovered. These globules are PAS positive and diastase resistant, exhibit deep fuchsinophilic staining with Masson’s trichrome, stain dark blue with PTAH, and are negative for mucin by Alcian blue. The tumor cells tested positive for the androgen receptor, FOXA1, and GCDFP15. Human epidermal growth factor type 2 (HER2)/neu score was 3+/positive, and the Ki-67 labeling index was 60%. Thus, the tumor represented high-grade, HER2-enriched apocrine carcinoma. Thanatosomes are immunoreactive to cleaved caspase-3 and are histological markers of high cell turnover and apoptotic cell death. Therefore, in this nonspecific microscopic neoplastic condition, they are typically linked to high-grade tumors, as this case showed. This report presents a rare case of apocrine breast cancer featuring a limited number of thanatosomes. Full article

(This article belongs to the Section Pathology and Molecular Diagnostics)

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15 pages, 1659 KiB

Open AccessArticle

A Comparative Evaluation of Surgical Techniques Applied in Lumbar Synovial Cysts in Accordance with the Literature

by Mustafa Emre Sarac and Zeki Boga

Diagnostics 2025, 15(14), 1767; https://doi.org/10.3390/diagnostics15141767 (registering DOI) - 13 Jul 2025

Abstract

Background/Objectives: The aim of this study was to compare the clinical outcomes of cyst excision alone and the combination of excision and unilateral dynamic instrumentation in the surgical treatment of lumbar synovial cysts at the L4–L5 level and to determine which surgical approach [...] Read more.

Background/Objectives: The aim of this study was to compare the clinical outcomes of cyst excision alone and the combination of excision and unilateral dynamic instrumentation in the surgical treatment of lumbar synovial cysts at the L4–L5 level and to determine which surgical approach is more effective. Methods: Thirty-three patients who underwent operations on the L4–L5-level synovial cyst in a single center between January 2015 and January 2021 were included in this retrospective study. Patients were divided into two groups: cyst excision only (n = 18) and excision with unilateral dynamic instrumentation (n = 15). The pain levels of the patients were assessed by VAS score, and their functional status was assessed by the Oswestry Disability Index. The mean follow-up period was 28.2 ± 4.0 months in the excision group and 27.6 ± 4.4 months in the instrumentation group. Results: VAS and ODI scores improved significantly in both groups (p < 0.001). The improvement in low back pain VAS scores was more significant in the instrumentation group (delta VAS: −5.8 ± 1.3 vs. −5.0 ± 1.2, p = 0.042). The complication rate was 27.8% in the excision group and 13.3% in the instrumentation group. The development of listhesis was significantly more frequent in the excision group (16.7% vs. 0%, p = 0.028). Reoperation rates were 16.7% in the excision group and 6.7% in the instrumentation group. Conclusion: Although both surgical approaches are effective in the treatment of synovial cysts at the L4–L5 level, the addition of dynamic instrumentation unilaterally seems to be more advantageous, especially in the control of low back pain and prevention of listhesis risk. The choice of surgical technique should be individualized by considering patient-specific factors. Full article

(This article belongs to the Special Issue Diagnosis and Management of Spinal Diseases)

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12 pages, 4853 KiB

Open AccessArticle

Clinical Utility of Duplex Ultrasonography in the Recognition of Transplant Renal Artery Stenosis: A Single Center Experience

by Ahmad Mirza, Usman Baig, Munazza Khan, Shameem Beigh and Imran Gani

Diagnostics 2025, 15(14), 1766; https://doi.org/10.3390/diagnostics15141766 (registering DOI) - 13 Jul 2025

Abstract

Introduction: Renal artery stenosis can significantly impact long-term graft survival rates following kidney transplant. Early recognition and management can improve the longevity of the kidney allograft. We aimed to evaluate the clinical role of duplex ultrasound in the diagnosis of renal artery stenosis [...] Read more.

Introduction: Renal artery stenosis can significantly impact long-term graft survival rates following kidney transplant. Early recognition and management can improve the longevity of the kidney allograft. We aimed to evaluate the clinical role of duplex ultrasound in the diagnosis of renal artery stenosis (RAS). We also wanted to evaluate the current incidence of renal artery stenosis at our institute. Methods: A retrospective, consecutive series of 367 patients who underwent renal transplantation between 1 January 2020 and 30 December 2024 was conducted. We collected data regarding the recipients’ age, body mass index, and comorbidities. All patients diagnosed with renal artery stenosis were identified. The incidence of kidney transplant artery stenosis and presentation were recorded. All general physical parameters and laboratory data were collected and analyzed. Results: A total of 28 patients had initial suspicion of renal artery stenosis, documented via initial dedicated duplex ultrasound of the transplanted kidney. The initial mean systolic BP at initial US was 151 (99–213) mmHg, and mean creatinine was 2.43 (1.28–6.38) mg/dL. However, on repeat duplex ultrasound, three patients showed no features of renal artery stenosis and had no physical parameters consistent with RAS. A total of 25 patients diagnosed with RAS on initial duplex ultrasound underwent angiography. Twenty-four patients were confirmed with RAS on angiography, while one patient had a normal angiogram. Among patients diagnosed with TRAS, the mean resistive index was 0.71 ± 0.17 at the upper pole, 0.73 ± 0.19 at the mid pole, and 0.71 ± 0.21 at the lower pole. The mean peak systolic velocity was 462.57 ± 166.28 cm/s. Conclusions: Duplex ultrasound is an important initial tool for diagnosing transplant renal artery stenosis. An increase in peak systolic velocity was observed in our cohort; however, resistive indices were largely within acceptable limits. Management should be guided by clinical parameters (e.g., elevated systolic BP and rising creatinine) alongside imaging findings. Full article

(This article belongs to the Special Issue Ultrasound in Renal Diseases: A Useful Tool for Diagnostics and Therapy)

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11 pages, 1016 KiB

Open AccessArticle

Diagnostic and Prognostic Value of Lung Ultrasound Performed by Non-Expert Staff in Patients with Acute Dyspnea

by Greta Barbieri, Chiara Del Carlo, Gennaro D’Angelo, Chiara Deri, Alessandro Cipriano, Paolo De Carlo, Massimo Santini and Lorenzo Ghiadoni

Diagnostics 2025, 15(14), 1765; https://doi.org/10.3390/diagnostics15141765 (registering DOI) - 13 Jul 2025

Abstract

Background/Objectives: Dyspnea is one of the main causes of visits to the Emergency Department (ED) and hospitalization, with its differential diagnosis representing a challenge for the clinician. Lung ultrasound (LUS) is a widely used tool in ED. The objective of this study [...] Read more.

Background/Objectives: Dyspnea is one of the main causes of visits to the Emergency Department (ED) and hospitalization, with its differential diagnosis representing a challenge for the clinician. Lung ultrasound (LUS) is a widely used tool in ED. The objective of this study was to evaluate the impact of LUS, performed by a non-expert operator, in determining diagnosis and prognosis of patients with dyspnea. Methods: A total of 60 patients presenting with dyspnea at the ED were prospectively enrolled and underwent LUS examination by a medical student, after brief training, within 3 h of triage. LUS findings were classified into four patterns: N.1, absence of notable ultrasound findings, attributable to COPD/ASMA exacerbation; N.2, bilateral interstitial syndrome, suggestive of acute heart failure; N.3, subpleural changes/parenchymal consolidations, suggestive of pneumoniae; and N.4, isolate polygonal triangular consolidation, attributable to infarction in the context of pulmonary thromboembolism. Results: The diagnostic hypothesis formulated after LUS was compared with the final diagnosis after further investigations in the ED, showing agreement in 90% of cases. The mean LUS score value was higher in patterns N.2 (18.4 ± 8.5) and N.3 (17 ± 6.6), compared to patterns N.1 and N.4 (9.8± 6.7 and 11.5 ± 2.1). Given the high prevalence of pattern N.2, the diagnostic accuracy of LUS in this context was further evaluated, showing a sensitivity of 82% and specificity of 100%. In terms of the prognostic value of LUS, hospitalized patients had a higher LUS score compared to those discharged (17.3 ± 8.1 vs. 8.5 ± 6.8, p value 0.004). A similar trend was obtained in the subgroup of patients requiring non-invasive ventilation (NIV), who present a higher LUS score (21.1 ± 6.6 vs. 13.1 ± 8.1, p value 0.002). When considering a combined outcome (death and NIV), patients with worse outcomes more often had a LUS score > 15 (p value < 0.001). Conclusions: In conclusion, this study confirms that LUS is a very useful tool in the ED, assisting the clinical evaluation for diagnosis, treatment decision, and determination of the appropriate care setting for patients with acute dyspnea. Its short learning curve allows even non-expert staff to use it effectively. Full article

(This article belongs to the Special Issue Diagnostic Tool and Healthcare in Emergency Medicine)

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17 pages, 3260 KiB

Open AccessArticle

The Implementation and Application of a Saudi Voxel-Based Anthropomorphic Phantom in OpenMC for Radiological Imaging and Dosimetry

by Ali A. A. Alghamdi

Diagnostics 2025, 15(14), 1764; https://doi.org/10.3390/diagnostics15141764 (registering DOI) - 12 Jul 2025

Abstract

Objectives: This study aimed to implement a high-resolution Saudi voxel-based anthropomorphic phantom in the OpenMC Monte Carlo (MC) simulation framework. The objective was to evaluate its applicability in radiological simulations, including radiographic imaging and effective dose calculations, tailored to the Saudi population. [...] Read more.

Objectives: This study aimed to implement a high-resolution Saudi voxel-based anthropomorphic phantom in the OpenMC Monte Carlo (MC) simulation framework. The objective was to evaluate its applicability in radiological simulations, including radiographic imaging and effective dose calculations, tailored to the Saudi population. Methods: A voxel phantom comprising 30 segmented organs/tissues and over 32 million voxels were constructed from full-body computed tomography data and integrated into OpenMC. The implementation involved detailed voxel mapping, material definition using ICRP/ICRU-116 recommendations, and lattice geometry construction. The simulations included X-ray radiography projections using mesh tallies and anterior–posterior effective dose calculations across 20 photon energies (10 keV–1 MeV). The absorbed dose was calculated using OpenMC’s heating tally and converted to an effective dose using tissue weighting factors. Results: The phantom was successfully modeled and visualized in OpenMC, demonstrating accurate anatomical representation. Radiographic projections showed optimal contrast at 70 keV. The effective dose values for 29 organs were calculated and compared with MCNPX, the ICRP-116 reference phantom, and XGBoost-based machine learning (ML) predictions. OpenMC results showed good agreement, with maximum deviations of −35.5% against ICRP-116 at 10 keV. Root mean square error (RMSE) comparisons confirmed reasonable alignment, with OpenMC displaying higher RMSEs relative to other methods due to expanded organ modeling and material definitions. Conclusions: The integration of the Saudi voxel phantom into OpenMC demonstrates its utility for high-resolution dosimetry and radiographic simulations. OpenMC’s Python (version 3.10.14) interface and open-source nature make it a promising tool for radiological research. Future work will focus on combining MC and ML approaches for enhanced predictive dosimetry. Full article

(This article belongs to the Section Medical Imaging and Theranostics)

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11 pages, 770 KiB

Open AccessArticle

Investigation of the Effect of Palmaris Longus Presence on the Upper Extremity and Hand Functions in Individuals of Different Ethnic Origins

by Onur Seçgin Nişanci, Rıdvan Yildiz and Sidrenur Aslan Kolukisa

Diagnostics 2025, 15(14), 1763; https://doi.org/10.3390/diagnostics15141763 (registering DOI) - 12 Jul 2025

Abstract

Objectives: This study aims to determine the presence rate of the palmaris longus (PLM) muscle in Turkish and Georgian individuals and to examine its effect on hand/upper extremity function. Methods: The study, conducted at Artvin Çoruh University, included 400 volunteer students [...] Read more.

Objectives: This study aims to determine the presence rate of the palmaris longus (PLM) muscle in Turkish and Georgian individuals and to examine its effect on hand/upper extremity function. Methods: The study, conducted at Artvin Çoruh University, included 400 volunteer students (800 hands). The presence of PLM was evaluated with Schaeffer and Thompson tests. Upper extremity and hand functions were measured by the Upper Extremity Function Index (UEFI-15) and the Sollerman Hand Function Test. Data were evaluated with the chi-square test, Mann–Whitney U, and Linear Mixed Model analysis in the SPSS v22 program. Results: PLM muscle was significantly more common in Georgian individuals compared to Turkish individuals (p < 0.05). This difference was statistically significant, particularly in Georgian men (p < 0.05). There was no significant correlation between the presence of PLM and hand and upper extremity functions (p > 0.05). Conclusions: Although the PLM muscle shows different and significant prevalence rates in relation to ethnicity, it does not show a significant effect on hand function. Ethnicity is a determining factor in anatomical and surgical studies of the PLM, and its minimal functional impact on hand function makes its graft use safe. Full article

(This article belongs to the Special Issue Clinical Impacts and Value of Anatomy)

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13 pages, 1099 KiB

Open AccessArticle

NF-κB as an Inflammatory Biomarker in Thin Endometrium: Predictive Value for Live Birth in Recurrent Implantation Failure

by Zercan Kalı, Pervin Karlı, Fatma Tanılır, Pınar Kırıcı and Serhat Ege

Diagnostics 2025, 15(14), 1762; https://doi.org/10.3390/diagnostics15141762 (registering DOI) - 12 Jul 2025

Abstract

Background: Recurrent implantation failure (RIF) poses a major challenge in assisted reproductive technologies, with thin endometrium (≤7 mm) being a frequently observed yet poorly understood condition. Emerging evidence implicates nuclear factor-kappa B (NF-κB), a key transcription factor in inflammatory signaling, in impaired endometrial [...] Read more.

Background: Recurrent implantation failure (RIF) poses a major challenge in assisted reproductive technologies, with thin endometrium (≤7 mm) being a frequently observed yet poorly understood condition. Emerging evidence implicates nuclear factor-kappa B (NF-κB), a key transcription factor in inflammatory signaling, in impaired endometrial receptivity. However, its clinical relevance and prognostic value for live birth outcomes still need to be fully elucidated. Objective: We aim to evaluate the expression levels of endometrial NF-κB in patients with RIF and thin endometrium and to determine its potential as a predictive biomarker for live birth outcomes following IVF treatment. Methods: In this prospective case–control study, 158 women were categorized into three groups: Group 1 (RIF with thin endometrium, ≤7 mm, n = 52), Group 2 (RIF with normal endometrium, >7 mm, n = 38), and fertile controls (n = 68). NF-κB levels were assessed using ELISA and immunohistochemical histoscore. Pregnancy outcomes were compared across groups. ROC analysis and multivariable logistic regression were performed to assess the predictive value of NF-κB. Results: NF-κB expression was significantly elevated in Group 1 compared to Group 2 and controls (p = 0.0017). ROC analysis identified a cut-off value of 7.8 ng/mg for live birth prediction (AUC = 0.72, sensitivity 74%, specificity 75%). Multivariable analysis confirmed NF-κB is an independent predictor of live birth (p = 0.045). Histological findings revealed increased NF-κB staining in luminal and glandular epithelial cells in the thin endometrium group. Conclusions: Increased endometrial NF-κB expression is associated with thin endometrium and reduced live birth rates in RIF patients. NF-κB may serve not only as a biomarker of pathological inflammation but also as a prognostic tool for treatment stratification in IVF. Based on findings in the literature, the therapeutic targeting of NF-κB may represent a promising strategy to improve implantation outcomes. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Gynecological and Obstetric Diseases)

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13 pages, 5416 KiB

Open AccessArticle

Implant Migration and Clinical Outcomes in Pediatric Symptomatic Flexible Flatfoot Treated with Subtalar Arthroereisis: A Cohort Study with Long-Term Follow-Up Results

by Yu-Po Huang, Nian-Jhen Wu, Shou-En Cheng, Shang-Ming Lin and Tsung-Yu Lan

Diagnostics 2025, 15(14), 1761; https://doi.org/10.3390/diagnostics15141761 - 11 Jul 2025

Abstract

Background/Objectives: Subtalar arthroereisis (STA) is a widely used surgical procedure for symptomatic pediatric flexible flatfoot. However, implant migration remains a concern due to its potential impact on long-term correction and complications. This study evaluated the migration pattern of STA implants and assessed [...] Read more.

Background/Objectives: Subtalar arthroereisis (STA) is a widely used surgical procedure for symptomatic pediatric flexible flatfoot. However, implant migration remains a concern due to its potential impact on long-term correction and complications. This study evaluated the migration pattern of STA implants and assessed long-term clinical and radiographic outcomes. Methods: This retrospective cohort study included 47 feet from children aged 8–13 years who underwent STA with adjunctive soft tissue procedures between 2014 and 2018, following ≥6 months of failed conservative treatment, with a minimum follow-up of 5 years. Exclusion criteria included neuromuscular or rigid flatfoot. Weight-bearing radiographs assessed anteroposterior (AP) and lateral Meary’s angles, reflecting forefoot-to-hindfoot alignment, and calcaneal pitch, indicative of longitudinal arch height. Implant migration was recorded and clinical outcomes were measured by the American Orthopedic Foot and Ankle Society (AOFAS) score. Measurements were recorded preoperatively, immediately postoperatively, and at 1 month, 3 months, 6 months, 1 year, and 5 years. Results: Radiographic correction was significant and sustained at 5 years. The AP Meary’s angle improved from 13.09° to 5.26° at 1 month and 6.69° at 5 years (p < 0.001); lateral Meary’s angle from 9.77° to 4.06° and 4.88° (p < 0.001); and calcaneal pitch from 14.52° to 16.87° and 16.89° (p < 0.001), respectively. AOFAS scores increased from 67.52 to 90.86 at 1 month and 96.33 at 5 years (p < 0.001). Implant migration peaked within the first postoperative month (mean: 3.2 mm on ankle AP view; 3.0 mm on foot AP view) and stabilized thereafter. Four cases of complications included implant dislodgement, subsidence, and persistent sinus tarsi tenderness, which were successfully resolved after appropriate management. No recurrence of deformity was observed. Conclusions: STA implant migration is most pronounced during the first month, likely due to physiological settling as the foot adapts to altered biomechanics. With appropriate implant selection, technique, and follow-up, migration does not compromise long-term correction or outcomes. In general, symptomatic cases can often be managed conservatively prior to implant removal. Full article

(This article belongs to the Special Issue Diagnosis and Management of Spinal Diseases)

16 pages, 3453 KiB

Open AccessArticle

Diagnostic Accuracy of Pre-Biopsy MRI and CT Features for Predicting Vertebral Biopsy Yield in Suspected Vertebral Discitis Osteomyelitis: A Retrospective Single-Center Study

by Amirmasoud Negarestani, Andrew Pasion, Caleb Bhatnagar, Zuhaib Khokhar, Ashima Kundu, Samantha Diulus, Jorge P. Parada and Emad Allam

Diagnostics 2025, 15(14), 1760; https://doi.org/10.3390/diagnostics15141760 - 11 Jul 2025

Abstract

Background/Objectives: Vertebral discitis osteomyelitis (VDO) is a serious infection involving the vertebral bodies and intervertebral discs, often requiring biopsy for pathogen identification. However, biopsy yields are variable, and guidance on patient selection remains limited. This study aimed to assess how biopsy culture [...] Read more.

Background/Objectives: Vertebral discitis osteomyelitis (VDO) is a serious infection involving the vertebral bodies and intervertebral discs, often requiring biopsy for pathogen identification. However, biopsy yields are variable, and guidance on patient selection remains limited. This study aimed to assess how biopsy culture results influence clinical management and to develop imaging-based scoring systems to predict biopsy outcomes. Methods: In this retrospective study, 70 patients who underwent image-guided vertebral biopsy for suspected VDO between 2013 and 2022 were reviewed. Pre-biopsy MRI and CT findings were scored using novel, simplified criteria. MRI was graded based on soft tissue involvement, while CT evaluated the presence or absence of a vacuum phenomenon. Culture results were correlated with imaging scores and subsequent changes in antibiotic management. Statistical analysis included logistic regression, ROC analysis, and interobserver agreement using Cohen’s Kappa. Results: Of the 70 patients, 27 (38.6%) had positive cultures, and 20 (28.5%) experienced changes in management. Among the 48 patients with both MRI and CT imaging, MRI scores indicating soft tissue involvement and absence of the vacuum sign on CT were independent predictors of positive culture (p = 0.022 and p = 0.047, respectively). The combined predictive model showed an AUC of 0.76. Interobserver agreement was excellent (κ = 0.90 for MRI, κ = 0.95 for CT). Conclusions: MRI and CT features can be used to predict biopsy yield and guide clinical decisions in suspected VDO. These scoring systems may help clinicians identify patients most likely to benefit from biopsy, potentially improving outcomes and minimizing unnecessary procedures. Full article

(This article belongs to the Section Medical Imaging and Theranostics)

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12 pages, 3342 KiB

Open AccessArticle

An Additional 30-s Observation of the Right-Sided Colon Using a Novel Endoscopic System with Texture and Color Enhancement Imaging Decreases Polyp Miss Rates: A Multicenter Study

by Yoshikazu Inagaki, Naohisa Yoshida, Hikaru Hashimoto, Yutaka Inada, Takaaki Murakami, Takahito Shimomura, Kyoichi Kassai, Yuri Tomita, Reo Kobayashi, Ken Inoue, Ryohei Hirose, Osamu Dohi and Yoshito Itoh

Diagnostics 2025, 15(14), 1759; https://doi.org/10.3390/diagnostics15141759 - 11 Jul 2025

Abstract

Background/Objectives: White light imaging (WLI) of colonoscopy has a 26% adenoma miss rate. We aimed to evaluate the effectiveness of an additional 30 s (Add-30s) observation of the right-sided colon using a novel system (EVIS X1; Olympus Co.) with texture and color enhancement [...] Read more.

Background/Objectives: White light imaging (WLI) of colonoscopy has a 26% adenoma miss rate. We aimed to evaluate the effectiveness of an additional 30 s (Add-30s) observation of the right-sided colon using a novel system (EVIS X1; Olympus Co.) with texture and color enhancement imaging (TXI). Methods: We reviewed 515 patients who underwent colonoscopy with Add-30s TXI between February 2021 and December 2023 at three affiliated hospitals. After initial right-sided colon observation with WLI, the colonoscope was reinserted into the cecum, and the right-sided colon was re-observed with Add-30s TXI. Adenoma and sessile serrated lesion (SSL) detection rate (ASDR) and adenoma detection rate (ADR) were examined. Multivariate analysis identified factors influencing lesion detection using the Add-30s TXI. The difference in WLI and TXI between the novel and previous scopes was performed using propensity score matching (PSM). The efficacy of WLI with the novel system was compared to that of the previous system. Results: Among the 515 cases, Add-30s TXI observation increased right-sided ADR and ASDR by 7.4% and 9.5%, respectively. The multivariate analysis showed novel scope as an independent factor for adenoma and SSL detection (odds ratio: 2.41, p < 0.01). Right-sided ADR and ASDR for Add-30s TXI were significantly higher in the novel scope than the previous scope (ADR, 25.2% vs. 15.3%; p = 0.04; ASDR, 32.4% vs. 18.9%; p = 0.02). ASDR for WLI observation was significantly higher in the novel system than the previous system (34.8% vs. 25.9%; p < 0.01). Conclusions: Add-30s TXI significantly improved the detection of missed adenomas and SSLs in the right-sided colon. Full article

(This article belongs to the Special Issue Recent Advances and Challenges in Gastrointestinal Endoscopy)

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18 pages, 8645 KiB

Open AccessArticle

CIC-Rearranged Sarcoma: A Clinical and Pathological Study of a Peculiar Entity

by Ward Maaita, Nabil Hasasna, Sameer Yaser, Yacob Saleh, Ramiz Abu-Hijlih, Wafa Asha, Hadeel Halalsheh, Samer Abdel Al, Maysa Al-Hussaini and Omar Jaber

Diagnostics 2025, 15(14), 1758; https://doi.org/10.3390/diagnostics15141758 (registering DOI) - 11 Jul 2025

Abstract

Background: CIC-rearranged sarcoma is a rare and aggressive type of undifferentiated round cell tumor characterized by CIC gene fusion, most commonly CIC::DUX4. This study presents a series of eleven cases, highlighting their clinicopathological features. Methods: Pathology records (2019 to 2024) [...] Read more.

Background: CIC-rearranged sarcoma is a rare and aggressive type of undifferentiated round cell tumor characterized by CIC gene fusion, most commonly CIC::DUX4. This study presents a series of eleven cases, highlighting their clinicopathological features. Methods: Pathology records (2019 to 2024) were searched using “sarcoma with CIC”, identifying eleven cases, of which seven referred cases were initially misdiagnosed. Pathological and clinical analysis was conducted. Treatment was dictated upon multidisciplinary panel discussion based on tumor stage. Follow-up data (1–25 months) was available for all patients. Results: The cohort included six males and five females, with a median age of 43 years (range;14–53), with nine in soft tissue and two in bone. Tumor size ranged from 3.5 cm to 20.0 cm (mean: 9.8 cm). Most cases showed sheets of undifferentiated round- to oval-shaped cells. Two cases showed an Ewing-like pattern, and one case showed spindle cells in a fibrotic stroma transitioning to epithelioid cells. Necrosis was present in nine cases, and mitotic count ranged from 2 to 38/ 10HPFs (mean = 14.2). CD99 was positive in (10/11) cases and WT-1 in (6/9). NKX2.2, S100, and MDM2 were positive in rare cases. CIC::DUX4 fusion was detected in four cases. FISH for CIC gene rearrangement was positive in seven cases, two of them confirmed by methylation analysis. Metastasis at diagnosis was common (n = 8), primarily in the lungs, with later metastasis to the brain and bone. At time of final analysis, eight patients died within a median of 10 months (range: 1–19 months), while three were alive, two with stable disease (for a period of 6 and 25 months) and one with progression after 10 months. Significant correlation was seen between overall survival and the presence of metastasis at diagnosis (p value = 0.03). Conclusions: CIC-rearranged sarcomas are rare, high-grade tumors with predilection for soft tissue. Misdiagnosis is frequent, necessitating molecular confirmation. These tumors are treatment-resistant, often present with lung metastasis, and carry a poor prognosis, especially with initial metastasis. Full article

(This article belongs to the Section Pathology and Molecular Diagnostics)

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12 pages, 1070 KiB

Open AccessArticle

Reproducibility of Breech Progression Angle: Standardization of Transperineal Measurements and Development of Image-Based Checklist for Quality Control

by Ana M. Fidalgo, Adriana Aquise, Francisca S. Molina, Aly Youssef, Otilia González-Vanegas, Elena Brunelli, Ilaria Cataneo, Maria Segata, Marcos J. Cuerva, Valeria Rolle and Maria M. Gil

Diagnostics 2025, 15(14), 1757; https://doi.org/10.3390/diagnostics15141757 - 11 Jul 2025

Abstract

Objectives: To evaluate the reproducibility of measurements of breech progression angle (BPA) by transperineal ultrasound (US) before and after its standardization by applying an image-based checklist. Methods: Eighteen 3-dimensional (3D) volumes of transperineal US from women at 36–40 weeks of gestation with a [...] Read more.

Objectives: To evaluate the reproducibility of measurements of breech progression angle (BPA) by transperineal ultrasound (US) before and after its standardization by applying an image-based checklist. Methods: Eighteen 3-dimensional (3D) volumes of transperineal US from women at 36–40 weeks of gestation with a singleton fetus in breech presentation were provided to eight operators from four maternity units in Spain and Italy. All operators measured the BPA using 3D US volume processing software, and interobserver reproducibility was evaluated using the intraclass correlation coefficient (ICC). Following an online live review of all measurements by the operators, and the identification of sources of disagreement, an image-based scoring system for BPA measurement was collaboratively developed. The checklist included the following: (1) acquisition in the midsagittal plane, avoiding the posterior shadow of the pubic ramus; (2) visualization of the complete “almond-shaped” pubic symphysis; (3) drawing a first line along the longitudinal axis of the symphysis, dividing it equally; (4) extending this line to the inferior edge of the bone; and (5) drawing a second line tangentially from the lower edge of the symphysis to the lowest recognizable fetal part. The BPA measurements were then repeated using this checklist, and reproducibility was reassessed. Results: Eighteen volumes were analyzed by the eight operators, achieving a moderate reproducibility (ICC: 0.70, 95% confidence interval (CI): 0.48 to 0.86). A score was developed to include a series of landmarks for the appropriate assessment of BPA. Subsequently, the same eighteen volumes were reassessed using the new score, resulting in improved reproducibility (ICC: 0.81, 95% CI: 0.66 to 0.92). Conclusions: The measurement of BPA is feasible and reproducible when using a standardized image-based score. Full article

(This article belongs to the Special Issue Advances in Gynecological and Pediatric Imaging)

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14 pages, 785 KiB

Open AccessArticle

Novel Structure–Function Models for Estimating Retinal Ganglion Cell Count Using Pattern Electroretinography in Glaucoma Suspects

by Andrew Tirsi, Isabella Tello, Timothy Foster, Rushil Kumbhani, Nicholas Leung, Samuel Potash, Derek Orshan and Celso Tello

Diagnostics 2025, 15(14), 1756; https://doi.org/10.3390/diagnostics15141756 - 11 Jul 2025

Abstract

Background/Objectives: The early detection of retinal ganglion cell (RGC) dysfunction is critical for timely intervention in glaucoma suspects (GSs). The combined structure–function index (CSFI), which uses visual field and optical coherence tomography (OCT) data to estimate RGC counts, may be of limited [...] Read more.

Background/Objectives: The early detection of retinal ganglion cell (RGC) dysfunction is critical for timely intervention in glaucoma suspects (GSs). The combined structure–function index (CSFI), which uses visual field and optical coherence tomography (OCT) data to estimate RGC counts, may be of limited utility in GSs. This study evaluates whether steady-state pattern electroretinogram (ssPERG)-derived estimates better predict early structural changes in GSs. Methods: Fifty eyes from 25 glaucoma suspects underwent ssPERG and spectral-domain OCT. Estimated RGC counts (eRGCC) were calculated using three parameters: ssPERG-Magnitude (eRGCC_Mag), ssPERG-MagnitudeD (eRGCC_MagD), and CSFI (eRGCC_CSFI). Linear regression and multivariable models were used to assess each model’s ability to predict the average retinal nerve fiber layer thickness (AvRNFLT), average ganglion cell layer–inner plexiform layer thickness (AvGCL-IPLT), and rim area. Results: eRGCC_Mag and eRGCC_MagD were significantly correlated with eRGCC_CSFI. Both PERG-derived models outperformed eRGCC_CSFI in predicting AvRNFLT and AvGCL-IPLT, with eRGCC_MagD showing the strongest association with AvGCL-IPLT. Conversely, the rim area was best predicted by eRGCC_Mag and eRGCC_CSFI. These findings support a linear relationship between ssPERG parameters and early RGC structural changes, while the logarithmic nature of visual field loss may limit eRGCC_CSFI’s predictive accuracy in GSs. Conclusions: ssPERG-derived estimates, particularly eRGCC_MagD, better predict early structural changes in GSs than eRGCC_CSFI. eRGCC_MagD’s superior performance in predicting GCL-IPLT highlights its potential utility as an early biomarker of glaucomatous damage. ssPERG-based models offer a simpler and more sensitive tool for early glaucoma risk stratification, and may provide a clinical benchmark for tracking recoverable RGC dysfunction and treatment response. Full article

(This article belongs to the Special Issue Imaging and AI Applications in Glaucoma)

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12 pages, 4902 KiB

Open AccessArticle

Dynamic Echocardiographic Changes Induced by Exercise in Healthy, Young Individuals with Early Repolarization Pattern

by Loránd Kocsis, Zsuzsanna Pap, István Adorján Szabó and Attila Frigy

Diagnostics 2025, 15(14), 1755; https://doi.org/10.3390/diagnostics15141755 - 11 Jul 2025

Abstract

Background: The early repolarization pattern (ERP) on electrocardiography (ECG) has been associated with an increased risk of ventricular arrhythmias in susceptible individuals. This study aimed to evaluate the impact of exercise on echocardiographic parameters to explore the potential influence of ERP on [...] Read more.

Background: The early repolarization pattern (ERP) on electrocardiography (ECG) has been associated with an increased risk of ventricular arrhythmias in susceptible individuals. This study aimed to evaluate the impact of exercise on echocardiographic parameters to explore the potential influence of ERP on hemodynamic response. Methods: Twenty-five healthy, young males with ERP (ERP+ group) and 25 age-matched healthy males without ERP (ERP− group) were enrolled. Comprehensive transthoracic echocardiography was performed at rest and during the early recovery phase following a treadmill exercise test. Baseline values and exercise-induced changes in both conventional and strain-derived echocardiographic parameters were analyzed and compared between groups. Results: Anthropometric measures and resting vital signs were similar in both groups. At baseline, the ERP+ group had a shorter QRS duration. Both groups demonstrated excellent cardiovascular fitness, with comparable chronotropic and pressor responses to exercise. Resting and early recovery-phase echocardiographic parameters were largely similar between ERP+ and ERP− individuals, with no overt structural or functional abnormalities observed in either group. However, ERP+ individuals showed significantly greater reductions in left ventricular end-diastolic volume and stroke volume following exercise, suggesting a distinct volumetric response to physical stress. Conclusions: ERP in healthy young males is not associated with structural cardiac abnormalities or overt myocardial dysfunction. The observed exercise-induced volumetric changes may indicate subtle differences in hemodynamic adaptation, warranting further investigation. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Management in Cardiology)

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13 pages, 386 KiB

Open AccessArticle

Overall Survival and Complication Rates in the Treatment of Liver Carcinoma: A Comparative Study of Ultrasound, Computed Tomography, and Combined Ultrasound and Computed Tomography Guidance for Radiofrequency Ablation

by Chia-Hsien Chien, Chia-Ling Chiang, Huei-Lung Liang, Jer-Shyung Huang and Chia-Jung Tsai

Diagnostics 2025, 15(14), 1754; https://doi.org/10.3390/diagnostics15141754 - 11 Jul 2025

Abstract

Background: Liver cancer is a major health concern worldwide. Radiofrequency ablation is a safe treatment option that can be guided by either ultrasound, computer tomography (CT), or fluoroscopy. Although ultrasound-guided radiofrequency ablation is commonly used in clinical practice, radiofrequency ablation guided by CT [...] Read more.

Background: Liver cancer is a major health concern worldwide. Radiofrequency ablation is a safe treatment option that can be guided by either ultrasound, computer tomography (CT), or fluoroscopy. Although ultrasound-guided radiofrequency ablation is commonly used in clinical practice, radiofrequency ablation guided by CT is more precise but requires more time and does not offer real-time monitoring, which may result in complications such as pneumothorax or organ damage. Objectives: In this study, we investigated the effect of ultrasound, CT, and combined ultrasound/CT guidance on patient survival and complication development. Methods: A total of 982 radiofrequency ablation sessions conducted on 553 patients were analyzed. Clinical outcomes were assessed during follow-up to determine the survival and recurrence rates of malignant tumors. Results: Overall, the three guidance approaches exhibited significant differences in terms of tumor size, number, complication development, and treatment duration. However, no significant differences were observed in survival rate. A comparison of the effect of CT guidance and ultrasound guidance on complication development revealed a higher odds ratio for CT guidance in some cases. A comparison of combined ultrasound/CT guidance and ultrasound guidance revealed nonsignificant differences in complication development. A comparison of CT guidance and combined ultrasound/CT guidance revealed a higher odds ratio for CT guidance in some cases. Radiofrequency ablation is a safe and effective treatment for liver tumors. However, CT has an increased incidence of complications. Conclusions: Combined ultrasound/computer tomography guidance is recommended for patients with multiple or large tumors or tumors near the hepatic dome or diaphragm. Full article

(This article belongs to the Section Clinical Diagnosis and Prognosis)

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11 pages, 505 KiB

Open AccessArticle

The Role of Musculoskeletal Ultrasound in Biologic Drug Tapering and Relapse Monitoring: Findings from a One-Year Prospective Study in a Cohort of Rheumatoid Arthritis Patients in Sustained Clinical Remission

by Zguro Batalov, Tanya Sapundzhieva, Konstantin Batalov, Rositsa Karalilova and Anastas Batalov

Diagnostics 2025, 15(14), 1753; https://doi.org/10.3390/diagnostics15141753 - 10 Jul 2025

Abstract

Objectives: To assess the role of musculoskeletal ultrasound (MSUS) in selecting patients with rheumatoid arthritis (RA) in sustained clinical remission, suitable for tapering of biologic therapy (BT), and monitoring for a subclinical relapse. Methods: In this prospective study, seventy-eight patients with RA in [...] Read more.

Objectives: To assess the role of musculoskeletal ultrasound (MSUS) in selecting patients with rheumatoid arthritis (RA) in sustained clinical remission, suitable for tapering of biologic therapy (BT), and monitoring for a subclinical relapse. Methods: In this prospective study, seventy-eight patients with RA in sustained Disease Activity for twenty-eight joints (DAS28) clinical remission underwent ultrasound (US) examination of twenty-two joints (bilaterally wrists and metacarpophalangeal and proximal interphalangeal joints). US assessment was performed on gray scale ultrasound (GSUS) and power Doppler US (PDUS) to select patients in imaging remission, defined as a total PD score of synovitis = 0. Group 1 consisted of patients in clinical and imaging remission, in which tapering of BT was done through spacing of the Tumour Necrosis Factor Alpha (TNF-

α

) blocker. Group 2 consisted of patients only in clinical remission (PDUS > 0), who continued standard therapy. Clinical and US assessment was done at months 6 and 12, and the rate of a clinical (defined as DAS28 ≥ 2.6) and an US relapse (PDUS score ≥ 1) was recorded. Results: Thirty-eight patients were in clinical and US remission (group 1) and forty patients only in clinical remission (group 2). At month 6, 26% of patients in group 1 and 10% in group 2 experienced a clinical and an US relapse, whereas 20% and 15% of them, respectively, only an US relapse. At month 12, 26% of patients in group 1 and 20% of patients in group 2 experienced a clinical and an US relapse, whereas 35% and 22% of them, respectively, only an US relapse. Conclusions: Real-world data show that MSUS is a useful tool to identify RA patients in sustained clinical remission appropriate for BT tapering. US monitoring could predict a clinical relapse and the need to re-escalate treatment in patients with subclinical US relapse during BT tapering. Full article

(This article belongs to the Section Medical Imaging and Theranostics)

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20 pages, 3941 KiB

Open AccessArticle

AΚtransU-Net: Transformer-Equipped U-Net Model for Improved Actinic Keratosis Detection in Clinical Photography

by Panagiotis Derekas, Charalampos Theodoridis, Aristidis Likas, Ioannis Bassukas, Georgios Gaitanis, Athanasia Zampeta, Despina Exadaktylou and Panagiota Spyridonos

Diagnostics 2025, 15(14), 1752; https://doi.org/10.3390/diagnostics15141752 - 10 Jul 2025

Abstract

Background: Integrating artificial intelligence into clinical photography offers great potential for monitoring skin conditions such as actinic keratosis (AK) and skin field cancerization. Identifying the extent of AK lesions often requires more than analyzing lesion morphology—it also depends on contextual cues, such as [...] Read more.

Background: Integrating artificial intelligence into clinical photography offers great potential for monitoring skin conditions such as actinic keratosis (AK) and skin field cancerization. Identifying the extent of AK lesions often requires more than analyzing lesion morphology—it also depends on contextual cues, such as surrounding photodamage. This highlights the need for models that can combine fine-grained local features with a comprehensive global view. Methods: To address this challenge, we propose AKTransU-net, a hybrid U-net-based architecture. The model incorporates Transformer blocks to enrich feature representations, which are passed through ConvLSTM modules within the skip connections. This configuration allows the network to maintain semantic coherence and spatial continuity in AK detection. This global awareness is critical when applying the model to whole-image detection via tile-based processing, where continuity across tile boundaries is essential for accurate and reliable lesion segmentation. Results: The effectiveness of AKTransU-net was demonstrated through comparative evaluations with state-of-the-art segmentation models. A proprietary annotated dataset of 569 clinical photographs from 115 patients with actinic keratosis was used to train and evaluate the models. From each photograph, crops of 512 × 512 pixels were extracted using translation lesion boxes that encompassed lesions in different positions and captured different contexts. AKtransU-net exhibited a more robust context awareness and achieved a median Dice score of 65.13%, demonstrating significant progress in whole-image assessments. Conclusions: Transformer-driven context modeling offers a promising approach for robust AK lesion monitoring, supporting its application in real-world clinical settings where accurate, context-aware analysis is crucial for managing skin field cancerization. Full article

(This article belongs to the Special Issue Artificial Intelligence in Dermatology)

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22 pages, 4079 KiB

Open AccessArticle

Breast Cancer Classification with Various Optimized Deep Learning Methods

by Mustafa Güler, Gamze Sart, Ömer Algorabi, Ayse Nur Adıguzel Tuylu and Yusuf Sait Türkan

Diagnostics 2025, 15(14), 1751; https://doi.org/10.3390/diagnostics15141751 - 10 Jul 2025

Abstract

Background/Objectives: In recent years, there has been a significant increase in the number of women with breast cancer. Breast cancer prediction is defined as a medical data analysis and image processing problem. Experts may need artificial intelligence technologies to distinguish between benign and [...] Read more.

Background/Objectives: In recent years, there has been a significant increase in the number of women with breast cancer. Breast cancer prediction is defined as a medical data analysis and image processing problem. Experts may need artificial intelligence technologies to distinguish between benign and malignant tumors in order to make decisions. When the studies in the literature are examined, it can be seen that applications of deep learning algorithms in the field of medicine have achieved very successful results. Methods: In this study, 11 different deep learning algorithms (Vanilla, ResNet50, ResNet152, VGG16, DenseNet152, MobileNetv2, EfficientB1, NasNet, DenseNet201, ensemble, and Tuned Model) were used. Images of pathological specimens from breast biopsies consisting of two classes, benign and malignant, were used for classification analysis. To limit the computational time and speed up the analysis process, 10,000 images, 6172 IDC-negative and 3828 IDC-positive, were selected. Of the images, 80% were used for training, 10% were used for validation, and 10% were used for testing the trained model. Results: The results demonstrate that DenseNet201 achieved the highest classification accuracy of 89.4%, with a precision of 88.2%, a recall of 84.1%, an F1 score of 86.1%, and an AUC score of 95.8%. Conclusions: In conclusion, this study highlights the potential of deep learning algorithms in breast cancer classification. Future research should focus on integrating multi-modal imaging data, refining ensemble learning methodologies, and expanding dataset diversity to further improve the classification accuracy and real-world clinical applicability. Full article

(This article belongs to the Topic Machine Learning and Deep Learning in Medical Imaging)

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27 pages, 583 KiB

Open AccessReview

Non-Coding RNAs in Asthma: Regulators of Eosinophil Biology and Airway Inflammation

by Eglė Vasylė, Andrius Januškevičius and Kęstutis Malakauskas

Diagnostics 2025, 15(14), 1750; https://doi.org/10.3390/diagnostics15141750 - 10 Jul 2025

Abstract

Asthma is a complex and heterogeneous disease characterized by chronic airway inflammation, bronchial hyperresponsiveness, and reversible airflow obstruction. Despite extensive research, its underlying molecular mechanisms remain incompletely understood. Among the key immune cells involved, eosinophils play a central role in asthma pathophysiology through [...] Read more.

Asthma is a complex and heterogeneous disease characterized by chronic airway inflammation, bronchial hyperresponsiveness, and reversible airflow obstruction. Despite extensive research, its underlying molecular mechanisms remain incompletely understood. Among the key immune cells involved, eosinophils play a central role in asthma pathophysiology through their contributions to Type 2 inflammation, tissue remodeling, and immune regulation. Recent studies have shown that non-coding RNAs (ncRNAs) play a crucial role in regulating eosinophil biology and contribute to the molecular mechanisms underlying asthma progression. This review consolidates the current understanding of ncRNAs in the development of eosinophils, their involvement in asthma pathogenesis, and the mechanisms underlying this process. Full article

(This article belongs to the Special Issue Recent Advances in the Diagnosis and Management of Respiratory Diseases)

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12 pages, 600 KiB

Open AccessArticle

Expanded Performance Comparison of the Oncuria 10-Plex Bladder Cancer Urine Assay Using Three Different Luminex xMAP Instruments

by Sunao Tanaka, Takuto Shimizu, Ian Pagano, Wayne Hogrefe, Sherry Dunbar, Charles J. Rosser and Hideki Furuya

Diagnostics 2025, 15(14), 1749; https://doi.org/10.3390/diagnostics15141749 - 10 Jul 2025

Abstract

Background/Objectives: The clinically validated multiplex Oncuria bladder cancer (BC) assay quickly and noninvasively identifies disease risk and tracks treatment success by simultaneously profiling 10 protein biomarkers in voided urine samples. Oncuria uses paramagnetic bead-based fluorescence multiplex technology (xMAP^®; Luminex, Austin, [...] Read more.

Background/Objectives: The clinically validated multiplex Oncuria bladder cancer (BC) assay quickly and noninvasively identifies disease risk and tracks treatment success by simultaneously profiling 10 protein biomarkers in voided urine samples. Oncuria uses paramagnetic bead-based fluorescence multiplex technology (xMAP^®; Luminex, Austin, TX, USA) to simultaneously measure 10 protein analytes in urine [angiogenin, apolipoprotein E, carbonic anhydrase IX (CA9), interleukin-8, matrix metalloproteinase-9 and -10, alpha-1 anti-trypsin, plasminogen activator inhibitor-1, syndecan-1, and vascular endothelial growth factor]. Methods: In a pilot study (N = 36 subjects; 18 with BC), Oncuria performed essentially identically across three different common analyzers (the laser/flow-based FlexMap 3D and 200 systems, and the LED/image-based MagPix system; Luminex). The current study compared Oncuria performance across instrumentation platforms using a larger study population (N = 181 subjects; 51 with BC). Results: All three analyzers assessed all 10 analytes in identical samples with excellent concordance. The percent coefficient of variation (%CV) in protein concentrations across systems was ≤2.3% for 9/10 analytes, with only CA9 having %CVs > 2.3%. In pairwise correlation plot comparisons between instruments for all 10 biomarkers, R² values were 0.999 for 15/30 comparisons and R² ≥ 0.995 for 27/30 comparisons; CA9 showed the greatest variability (R² = 0.948–0.970). Standard curve slopes were statistically indistinguishable for all 10 biomarkers across analyzers. Conclusions: The Oncuria BC assay generates comprehensive urinary protein signatures useful for assisting BC diagnosis, predicting treatment response, and tracking disease progression and recurrence. The equivalent performance of the multiplex BC assay using three popular analyzers rationalizes test adoption by CLIA (Clinical Laboratory Improvement Amendments) clinical and research laboratories. Full article

(This article belongs to the Special Issue Diagnostic Markers of Genitourinary Tumors)

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14 pages, 1975 KiB

Open AccessArticle

A Study on the Diagnosis of Lumbar Spinal Malposition in Chuna Manual Therapy Using X-Ray Images Based on Digital Markers

by Min-Su Ju, Tae-Yong Park, Minho Choi, Younseok Ko, Young Cheol Na, Yeong Ha Jeong, Jun-Su Jang and Jin-Hyun Lee

Diagnostics 2025, 15(14), 1748; https://doi.org/10.3390/diagnostics15141748 - 10 Jul 2025

Abstract

Background/Objectives: This study aimed to evaluate digital markers and establish quantitative diagnostic criteria for spinal malpositions in Chuna manual therapy using lumbar X-rays. Methods: A total of 2000 X-ray images were collected from adult patients at the International St. Mary’s Hospital of Catholic [...] Read more.

Background/Objectives: This study aimed to evaluate digital markers and establish quantitative diagnostic criteria for spinal malpositions in Chuna manual therapy using lumbar X-rays. Methods: A total of 2000 X-ray images were collected from adult patients at the International St. Mary’s Hospital of Catholic Kwandong University. Five Chuna manual medicine experts annotated anatomical landmarks using a digital marker labeling program and diagnosed three types of spinal malpositions: flexion/extension, lateral bending, and rotation. Diagnostic accuracy was evaluated using weighted F1 (F1_W) scores, and the optimal threshold values for each malposition type were determined based on maximum F1_W performance. Results: The results showed high diagnostic performance, with average maximum F1_W scores of 0.76 for flexion/extension, 0.85 for lateral bending, and 0.71 for rotation. Based on this analysis, threshold angles for each type of spinal malposition in Chuna manual diagnosis were determined. Conclusions: This study demonstrates the diagnostic validity of digital marker-based X-ray analysis in Chuna manual therapy and is the first to propose quantitative diagnostic thresholds for spinal malpositions. These findings may serve as a foundation for clinical application in spinal assessment and treatment planning, with further validation studies warranted. Full article

(This article belongs to the Special Issue Medical Imaging in Diagnosis, Prevention and Rehabilitation of Musculoskeletal Injuries)

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12 pages, 2431 KiB

Open AccessArticle

Unsupervised Clustering Successfully Predicts Prognosis in NSCLC Brain Metastasis Cohorts

by Emre Uysal, Gorkem Durak, Ayse Kotek Sedef, Ulas Bagci, Tanju Berber, Necla Gurdal and Berna Akkus Yildirim

Diagnostics 2025, 15(14), 1747; https://doi.org/10.3390/diagnostics15141747 - 10 Jul 2025

Abstract

Background/Objectives: Current developments in computer-aided systems rely heavily on complex and computationally intensive algorithms. However, even a simple approach can offer a promising solution to reduce the burden on clinicians. Addressing this, we aim to employ unsupervised cluster analysis to identify prognostic [...] Read more.

Background/Objectives: Current developments in computer-aided systems rely heavily on complex and computationally intensive algorithms. However, even a simple approach can offer a promising solution to reduce the burden on clinicians. Addressing this, we aim to employ unsupervised cluster analysis to identify prognostic subgroups of non-small-cell lung cancer (NSCLC) patients with brain metastasis (BM). Simple-yet-effective algorithms designed to identify similar group characteristics will assist clinicians in categorizing patients effectively. Methods: We retrospectively collected data from 95 NSCLC patients with BM treated at two oncology centers. To identify clinically distinct subgroups, two types of unsupervised clustering methods—two-step clustering (TSC) and hierarchical cluster analysis (HCA)—were applied to the baseline clinical data. Patients were categorized into prognostic classes according to the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA). Survival curves for the clusters and DS-GPA classes were generated using Kaplan–Meier analysis, and the differences were assessed with the log-rank test. The discriminative ability of three categorical variables on survival was compared using the concordance index (C-index). Results: The mean age of the patients was 61.8 ± 0.9 years, and the majority (77.9%) were men. Extracranial metastasis was present in 71.6% of the patients, with most (63.2%) having a single BM. The DS-GPA classification significantly divided the patients into prognostic classes (p < 0.001). Furthermore, statistical significance was observed between clusters created by TSC (p < 0.001) and HCA (p < 0.001). HCA showed the highest discriminatory power (C-index = 0.721), followed by the DS-GPA (C-index = 0.709) and TSC (C-index = 0.650). Conclusions: Our findings demonstrated that the TSC and HCA models were comparable in prognostic performance to the DS-GPA index in NSCLC patients with BM. These results suggest that unsupervised clustering may offer a data-driven perspective on patient stratification, though further validation is needed to clarify its role in prognostic modeling. Full article

(This article belongs to the Special Issue Artificial Intelligence Approaches for Medical Diagnostics in the USA)

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11 pages, 349 KiB

Open AccessArticle

Reliability of the Polish Version of the Kinesiophobia Causes Scale (KCS) Questionnaire in Assessing the Level of Fear of Movement Among People Suffering from Chronic Nonspecific Low Back Pain

by Edward Saulicz, Andrzej Knapik, Aleksandra Saulicz, Damian Sikora and Mariola Saulicz

Diagnostics 2025, 15(14), 1746; https://doi.org/10.3390/diagnostics15141746 - 9 Jul 2025

Viewed by 154

Abstract

Background: The phenomenon of fear of movement is called kinesiophobia. Kinesiophobia is a significant factor that complicates the treatment process. Fear of movement and physical activity is a risk factor for the transformation of acute pain into chronic pain. Therefore, the assessment of [...] Read more.

Background: The phenomenon of fear of movement is called kinesiophobia. Kinesiophobia is a significant factor that complicates the treatment process. Fear of movement and physical activity is a risk factor for the transformation of acute pain into chronic pain. Therefore, the assessment of the level of kinesiophobia is a prognostic factor for disability and mental stress, thus having a significant impact on the quality of life of people with lower back pain. One of the psychometric diagnostic tools for assessing the level of kinesiophobia is the Kinesiophobia Causes Scale (KCS). The aim of the study was to assess the reliability of the KCS test used in people suffering from chronic nonspecific lower back pain (nsLBP). Methods: The study included a group of 112 people suffering from chronic nsLBP. The subjects completed the same Polish version of the KCS questionnaire 4 weeks apart. Results: Good internal consistency was recorded for both domains—the biological and psychological one—as well as the general KCS index (Cronbach’s alpha index α from 0.8 to 0.9). Reliability was excellent for both domains (95% CI of ICC_3.1 biological domain: 0.86–0.93 and for psychological domain: 0.92–0.96) and for the total score of the Kinesiophobia Causes Scale (95% CI of ICC_3.1: 0.91–0.93). Conclusions: These results indicate very good measurement reliability of the Polish version of the KCS questionnaire among people suffering from chronic nsLBP. Full article

(This article belongs to the Special Issue Low Back Pain: Diagnosis and Management)

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15 pages, 4788 KiB

Open AccessArticle

Long-Term Follow-Up of Professional Soccer Players: The Analyses of Left and Right Heart Morphology and Function by Conventional, Three-Dimensional, and Deformation Analyses

by Joscha Kandels, Michael Metze, Stephan Stöbe, Lisa Do, Maximilian Nicolas Möbius-Winkler, Marios Antoniadis, Andreas Hagendorff and Robert Percy Marshall

Diagnostics 2025, 15(14), 1745; https://doi.org/10.3390/diagnostics15141745 - 9 Jul 2025

Viewed by 135

Abstract

Background: Transthoracic echocardiography (TTE) is the primary imaging modality to assess cardiac morphology and function. In athletes, distinguishing physiological adaptations from pathological changes is essential. This study aimed to evaluate long-term cardiac structural and functional changes in professional soccer players. Methods: This retrospective [...] Read more.

Background: Transthoracic echocardiography (TTE) is the primary imaging modality to assess cardiac morphology and function. In athletes, distinguishing physiological adaptations from pathological changes is essential. This study aimed to evaluate long-term cardiac structural and functional changes in professional soccer players. Methods: This retrospective study included 20 healthy male professional soccer players (mean age 21.2 ± 3.4 years) from the German first division, examined annually from 2016 to 2024 (mean follow-up 5.6 ± 2.0 years). TTE parameters associated with the “athlete’s heart” were assessed, including left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVSD), relative wall thickness (RWT), indexed LV mass (LVMi), and left atrial volume index (LAVi), along with 3D-derived LV and RV volumes. Advanced deformation imaging included global longitudinal strain (GLS), right ventricular strain (RVS), and left/right atrial reservoir strain (LASr and RASr, respectively). Baseline and final follow-up values were compared. Results: No significant changes were observed over time in conventional or advanced echocardiographic parameters (e.g., LVEDD: 54.5 ± 3.1 mm vs. 54.6 ± 3.9 mm; p = 0.868; GLS: −18.7% ± 2.2% vs. −18.4% ± 1.9%; p = 0.670). Ventricular volumes and strain values also remained stable throughout follow-up. Conclusions: Over a mean follow-up of more than five years, professional soccer players showed stable cardiac morphology and function without evidence of pathological remodeling. These findings support the concept that long-term high-level training in mixed-discipline sports leads to balanced, physiological cardiac adaptation. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology—2nd Edition)

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Diagnostics, Volume 15, Issue 14 (July-2 2025) – 46 articles

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