Diagnostics

16 pages, 1001 KiB

Open AccessArticle

Quantitative Characterization of Corneal Collagen Architecture Using Intensity Gradient Modeling and Gaussian PDF Fitting

by Enrique J. Fernandez and Juan M. Bueno

Diagnostics 2025, 15(14), 1738; https://doi.org/10.3390/diagnostics15141738 - 8 Jul 2025

Abstract

Background/Objectives: The transparency and biomechanical properties of the human cornea are governed by the precise organization of collagen fibers. A novel quantitative technique to analyze corneal collagen organization, based on intensity gradient modeling and probability density function (PDF) fitting, is proposed. Methods: Derived [...] Read more.

Background/Objectives: The transparency and biomechanical properties of the human cornea are governed by the precise organization of collagen fibers. A novel quantitative technique to analyze corneal collagen organization, based on intensity gradient modeling and probability density function (PDF) fitting, is proposed. Methods: Derived from second-harmonic generation (SHG) images, the method calculates image gradients, derives PDFs of gradient orientations, and fits them to Gaussian models. Results: Tested across species and temporal healing stages, this approach is an advantageous alternative to traditional methods like Fourier transform and structure tensor analyses, particularly in noisy or low-contrast conditions. Conclusions: The technique offers a scalable, robust framework suitable for research, clinical diagnostics, and treatment monitoring. Full article

(This article belongs to the Special Issue Latest Advances in Ophthalmic Imaging)

15 pages, 650 KiB

Open AccessArticle

Culture Positivity and Antibiotic Resistance in Respiratory Intensive Care Patients: Evaluation of Readmission and Clinical Outcomes

by Oral Menteş, Deniz Çelik, Murat Yildiz, Kerem Ensarioğlu, Maşide Ari, Mustafa Özgür Cırık, Abdullah Kahraman, Zehra Nur Şeşen, Savaş Gegin and Yusuf Taha Güllü

Diagnostics 2025, 15(14), 1737; https://doi.org/10.3390/diagnostics15141737 - 8 Jul 2025

Abstract

Background: Multidrug-resistant bacteria (MDRB) represent a significant challenge in intensive care units (ICUs), as they limit treatment options, prolong hospital stays, and escalate healthcare costs. Respiratory ICUs are particularly affected due to the high prevalence of chronically ill patients with recurrent infections. Understanding [...] Read more.

Background: Multidrug-resistant bacteria (MDRB) represent a significant challenge in intensive care units (ICUs), as they limit treatment options, prolong hospital stays, and escalate healthcare costs. Respiratory ICUs are particularly affected due to the high prevalence of chronically ill patients with recurrent infections. Understanding the impact of culture positivity and MDRB on clinical outcomes and readmission rates is essential for enhancing patient care and addressing the growing burden of antimicrobial resistance. Methods: This retrospective study was conducted in a specialized respiratory ICU at a tertiary care hospital between 1 January 2019, and 1 January 2020. A total of 695 ICU admissions were analyzed, with patients grouped based on readmission status and culture results. Demographic, clinical, and laboratory data were reviewed. Statistical analyses were performed using appropriate tests, with p-values ≤ 0.05 considered statistically significant. Results: Among the 519 unique patients, 65 experienced ICU readmissions. Male patients were significantly more likely to be readmitted (p = 0.008). Culture positivity was predominantly observed in respiratory samples, with Klebsiella spp. identified as the most common pathogen. MDRB prevalence exceeded 60% in both groups, significantly prolonging ICU stays (p = 0.013). However, no significant differences in survival rates were observed between MDRB-positive and MDRB-negative groups. Notably, patients with readmissions had lower C-reactive protein (CRP) levels both during admission and at discharge compared to non-readmitted patients (p = 0.004). This paradox may reflect a subclinical inflammatory response associated with bacterial colonization rather than active infection, particularly in patients with chronic respiratory diseases. Conclusions: MDRB infections and culture positivity are key contributors to prolonged ICU stays, resulting in increased healthcare costs. Implementing effective strategies to manage MDRB infections is critical for improving outcomes in respiratory ICUs and reducing associated risks. This study underscores the growing burden of MDRB and highlights the importance of enhanced antimicrobial stewardship in respiratory ICUs. Full article

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

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17 pages, 5547 KiB

Open AccessArticle

A Stepwise Anatomy-Based Protocol for Total Laparoscopic Hysterectomy: Educational Tool with Broad Clinical Utility

by Rudolf Lampé, Nóra Margitai, Péter Török, Luca Lukács and Mónika Orosz

Diagnostics 2025, 15(14), 1736; https://doi.org/10.3390/diagnostics15141736 (registering DOI) - 8 Jul 2025

Abstract

Background: Total laparoscopic hysterectomy (TLH) is widely accepted as the preferred minimally invasive technique for the treatment of benign gynecologic conditions. However, significant heterogeneity persists in the literature regarding the operative sequence, particularly for steps such as uterine artery ligation, ureteral identification, and [...] Read more.

Background: Total laparoscopic hysterectomy (TLH) is widely accepted as the preferred minimally invasive technique for the treatment of benign gynecologic conditions. However, significant heterogeneity persists in the literature regarding the operative sequence, particularly for steps such as uterine artery ligation, ureteral identification, and vaginal cuff closure. This lack of standardization may affect complication rates, reproducibility in surgical training, and procedural efficiency. The objective of this study was to develop and evaluate a standardized, anatomically justified surgical protocol for TLH primarily designed for training purposes but applicable to most clinical cases. Methods: This retrospective observational study analyzed 109 patients who underwent TLH between January 2016 and July 2020 at a single tertiary care center. A fixed sequence of surgical steps was applied in all cases, emphasizing early uterine artery ligation at its origin, broad ligament fenestration above the ureter, and laparoscopic figure-of-eight vaginal cuff closure. Patient demographics, operative data, and perioperative outcomes were extracted and analyzed. Results: The mean operative time was 67.2 ± 18.4 min, and the mean uterine weight was 211.9 ± 95.3 g. Intraoperative complications were observed in 3.7% of cases and included bladder injury in 1.8% and small bowel injury in 1.8%, all of which were managed laparoscopically without conversion. Vaginal cuff dehiscence occurred in 1.8%, and postoperative vaginal bleeding in 3.7% of patients. One patient (0.9%) required reoperation due to a vaginal cuff hematoma/abscess. No postoperative infections requiring intervention were reported. The mean hemoglobin drop on the first postoperative day was 1.2 ± 0.9 g/dL. Conclusions: Our findings support the feasibility, reproducibility, and safety of a structured TLH protocol based on anatomical landmarks and early vascular control. Widespread adoption of similar protocols may improve consistency and training, with broad applicability in routine surgical practice and potential adaptation in severely complex cases; however, further validation in multicenter studies is warranted. Full article

(This article belongs to the Special Issue Endoscopy in Gynecology and Gynecologic Oncology)

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31 pages, 4399 KiB

Open AccessArticle

Confident Learning-Based Label Correction for Retinal Image Segmentation

by Tanatorn Pethmunee, Supaporn Kansomkeat, Patama Bhurayanontachai and Sathit Intajag

Diagnostics 2025, 15(14), 1735; https://doi.org/10.3390/diagnostics15141735 (registering DOI) - 8 Jul 2025

Abstract

Background/Objectives: In automatic medical image analysis, particularly for diabetic retinopathy, the accuracy of labeled data is crucial, as label noise can significantly complicate the analysis and lead to diagnostic errors. To tackle the issue of label noise in retinal image segmentation, an innovative [...] Read more.

Background/Objectives: In automatic medical image analysis, particularly for diabetic retinopathy, the accuracy of labeled data is crucial, as label noise can significantly complicate the analysis and lead to diagnostic errors. To tackle the issue of label noise in retinal image segmentation, an innovative label correction framework is introduced that combines Confident Learning (CL) with a human-in-the-loop re-annotation process to meticulously detect and rectify pixel-level labeling inaccuracies. Methods: Two CL-oriented strategies are assessed: Confident Joint Analysis (CJA) employing DeeplabV3+ with a ResNet-50 architecture, and Prune by Noise Rate (PBNR) utilizing ResNet-18. These methodologies are implemented on four publicly available retinal image datasets: HRF, STARE, DRIVE, and CHASE_DB1. After the models have been trained on the original labeled datasets, label noise is quantified, and amendments are executed on suspected misclassified pixels prior to the assessment of model performance. Results: The reduction in label noise yielded consistent advancements in accuracy, Intersection over Union (IoU), and weighted IoU across all the datasets. The segmentation of tiny structures, such as the fovea, demonstrated a significant enhancement following refinement. The Mean Boundary F1 Score (MeanBFScore) remained invariant, signifying the maintenance of boundary integrity. CJA and PBNR demonstrated strengths under different conditions, producing variations in performance that were dependent on the noise level and dataset characteristics. CL-based label correction techniques, when amalgamated with human refinement, could significantly enhance the segmentation accuracy and evaluation robustness for Accuracy, IoU, and MeanBFScore, achieving values of 0.9156, 0.8037, and 0.9856, respectively, with regard to the original ground truth, reflecting increases of 4.05%, 9.95%, and 1.28% respectively. Conclusions: This methodology represents a feasible and scalable solution to the challenge of label noise in medical image analysis, holding particular significance for real-world clinical applications. Full article

(This article belongs to the Special Issue Deep Learning in Biomedical Image and Signal Processing: Recent Advancements and Applications)

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39 pages, 5584 KiB

Open AccessReview

Artificial Intelligence in Thoracic Surgery: Transforming Diagnostics, Treatment, and Patient Outcomes

by Sara Lopes, Miguel Mascarenhas, João Fonseca, Maria Gabriela O. Fernandes and Adelino F. Leite-Moreira

Diagnostics 2025, 15(14), 1734; https://doi.org/10.3390/diagnostics15141734 - 8 Jul 2025

Abstract

Background/Objectives: Artificial intelligence is revolutionizing healthcare. In the recent years, AI tools have been incorporated by medical specialties that heavily rely on imaging techniques to aid in the diagnosis, management, and monitoring of a wide array of clinical conditions. Methods: Thoracic surgery is [...] Read more.

Background/Objectives: Artificial intelligence is revolutionizing healthcare. In the recent years, AI tools have been incorporated by medical specialties that heavily rely on imaging techniques to aid in the diagnosis, management, and monitoring of a wide array of clinical conditions. Methods: Thoracic surgery is not an exception: AI is becoming a reality, although it is only the beginning. AI-based tools can be employed in medicine, and by extracting useful information from big data, they allow for the early diagnosis of diseases like lung cancer. Diagnostic imaging is the most promising clinical application of AI in medicine. Results: As for other specialties, ethical issues represent a challenge in thoracic surgery and must be addressed before introducing these applications. Data protection and biases, privacy, ‘the black box’ problem (explainability), and responsibility are some challenges that AI must supplant. Conclusions: In this review, the authors aim to highlight the importance of AI in thoracic surgery. AI applications, future directions, and clinical benefits and challenges, particularly in this area, will be addressed, highlighting solutions to successfully incorporate AI into healthcare protocols. Full article

(This article belongs to the Section Machine Learning and Artificial Intelligence in Diagnostics)

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10 pages, 514 KiB

Open AccessReview

Dysbiosis of Gut Microbiota in Microscopic Colitis: Diagnostic and Therapeutic Implications

by Sanja Dragasevic, Andreja Nikolic, Sanja Zgradic, Milica Stojkovic Lalosevic, Stefan Stojkovic, Vera Matovic Zaric, Snezana Lukic, Tijana Glisic, Stefan Kmezic, Dusan Saponjski and Dragan Popovic

Diagnostics 2025, 15(14), 1733; https://doi.org/10.3390/diagnostics15141733 - 8 Jul 2025

Abstract

Microscopic colitis (MC) is an idiopathic inflammatory bowel disease characterized by watery, non-bloody diarrhea and histopathological changes but normal endoscopic findings. Increasing evidence now suggests that alterations in the gut microbiota contribute to the pathogenesis of MC. In this narrative review, we summarize [...] Read more.

Microscopic colitis (MC) is an idiopathic inflammatory bowel disease characterized by watery, non-bloody diarrhea and histopathological changes but normal endoscopic findings. Increasing evidence now suggests that alterations in the gut microbiota contribute to the pathogenesis of MC. In this narrative review, we summarize evidence from nine case-control studies examining microbial composition using sequencing technology. The research presented here illustrates reduced alpha diversity, high dysbiosis, and pro-inflammatory oral-associated taxa enrichment, such as Veillonella dispar, and loss of protective microbes such as Akkermansia muciniphila and Bacteroides stercoris. These microbial changes have the potential to be non-invasive diagnostic biomarkers that can differentiate MC from other etiologies. In addition, the characterization of gut microbiota in MC can guide personalized therapeutic strategies, such as directed probiotic therapy or fecal microbiota transplantation, to help restore microbial balance. These microbial patterns can be applied to guide the creation of diagnostic biomarkers and personalized therapy. Despite differences in sample types and sequencing methods, general microbial trends highlight the need for further longitudinal and standardized investigations. Full article

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

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18 pages, 2630 KiB

Open AccessArticle

Multimodal Imaging of Diabetic Retinopathy: Insights from Optical Coherence Tomography Angiography and Adaptive Optics

by Andrada-Elena Mirescu, Dan George Deleanu, Sanda Jurja, Alina Popa-Cherecheanu, Florian Balta, Gerhard Garhofer, George Balta, Irina-Elena Cristescu and Ioana Teodora Tofolean

Diagnostics 2025, 15(14), 1732; https://doi.org/10.3390/diagnostics15141732 - 8 Jul 2025

Abstract

Background/Objectives: To investigate the role of multimodal imaging, specifically optical coherence tomography angiography (OCTA) and adaptive optics (AO), in the diagnosis and monitoring of diabetic retinopathy. Methods: Our study represents an observational, cross-sectional analysis including sixty-nine patients from four distinct groups: [...] Read more.

Background/Objectives: To investigate the role of multimodal imaging, specifically optical coherence tomography angiography (OCTA) and adaptive optics (AO), in the diagnosis and monitoring of diabetic retinopathy. Methods: Our study represents an observational, cross-sectional analysis including sixty-nine patients from four distinct groups: a control group (17 patients), diabetic patients without diabetic retinopathy (no DR) (14 patients), diabetic patients with non-proliferative diabetic retinopathy (NPDR) (18 patients), and diabetic patients with proliferative diabetic retinopathy (PDR patients). A comprehensive ophthalmological evaluation, along with high-resolution imaging using OCTA and AO, was performed. OCTA images of the superficial capillary plexus, acquired with the OCT Angio Topcon, were analyzed using a custom-developed MATLAB algorithm, while AO retinal vascular images were evaluated with the manufacturer’s software of the Adaptive Optics Retinal Camera rtx1™. Results: Our findings demonstrated statistically significant reductions in foveal avascular zone circularity, superficial capillary plexus density, vessel length density, and fractal dimension, correlating with the severity of diabetic retinopathy, particularly in the PDR. Additionally, mean wall thickness and wall-to-lumen ratio were significantly increased in patients with diabetic retinopathy, notably in PDR. Conclusions: In conclusion, our findings demonstrate that the combined use of OCTA and AO imaging offers complementary insights into the microvascular alterations associated with diabetic retinopathy progression and severity. These high-resolution modalities together reveal both perfusion deficits and structural vascular changes, underscoring their utility as essential tools for early detection, staging, monitoring, and informed management of DR. Full article

(This article belongs to the Special Issue OCT and OCTA Assessment of Retinal and Choroidal Diseases)

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12 pages, 1157 KiB

Open AccessArticle

Performance of Computed Tomography of the Kidneys, Ureter and Bladder in Non-Calculus Diagnoses: A Comparative Review of Non-Enhanced with Intravenous Contrast-Enhanced Imaging

by Alexander T. O’Mahony, Michael G. Waldron, David J. Ryan, Brian Carey, Sahil Shet, Eid Kakish, Patrick O'Regan, David Glynn, Josephine Barry, Owen J. O'Connor and Michael M. Maher

Diagnostics 2025, 15(14), 1731; https://doi.org/10.3390/diagnostics15141731 - 8 Jul 2025

Abstract

Background/Objectives: Non-enhanced computed tomography of the kidneys, ureters and bladder (NECT KUB) is the initial imaging modality for suspected nephroureterolithiasis. However, for alternative diagnoses, NECT may not be the ideal technique. Our institution changed the protocol for this cohort from NECT to [...] Read more.

Background/Objectives: Non-enhanced computed tomography of the kidneys, ureters and bladder (NECT KUB) is the initial imaging modality for suspected nephroureterolithiasis. However, for alternative diagnoses, NECT may not be the ideal technique. Our institution changed the protocol for this cohort from NECT to intravenous contrast-enhanced CT (CECT) KUB. We aimed to retrospectively compare the rate of alternative diagnosis seen and the rates of calculus detection in CECT versus NECT KUB as a means of assessing performance. Our secondary aim was to compare the radiation dose between CECT and NECT KUB. Methods: Patients referred from the emergency department with suspected nephroureterolithiasis who underwent NECT and CECT KUB over two years were included. Key performance metrics included calculus detection rate, alternative findings, and negative studies. The metrics were compared between genders and age groups. Categorical variables were analysed using Chi-squared or Fisher’s Exact Test and continuous with T-testing. Results: A total of 423 patients had CT KUB imaging (209 NECT, 214 CECT). The incidence of alternative findings in the NECT group was 23% and 40% in CECT (p < 0.001). There were 48 findings (13 major, 11 moderate and 24 minor) in NECT studies and 85 findings (23 major, 43 moderate and 19 minor) in CECT (p < 0.001). Major diagnoses ranged from acute emergencies to more indolent findings, including suspicious nodules/masses. The calculus detection rate (NECT 56%, CECT 54%, p = 0.643) and negative studies (NECT 28%, CECT 22%, p = 0.168) did not significantly differ between protocols. CECT had a mean effective dose of 8.71 ± 2.58 mSv representing 2.4 times the exposure of NECT (p < 0.001). Conclusions: CECT is associated with a greater alternative diagnosis rate with similar calculus detection rates compared to NECT KUB, suggesting superior performance. However, CECT exposes patients to significantly greater levels of ionizing radiation. Full article

(This article belongs to the Special Issue Recent Advancements in MRI and PET/CT Technologies in the Field of Urologic Oncology)

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23 pages, 5584 KiB

Open AccessArticle

Machine Learning and Deep Learning Hybrid Approach Based on Muscle Imaging Features for Diagnosis of Esophageal Cancer

by Yuan Hong, Hanlin Wang, Qi Zhang, Peng Zhang, Kang Cheng, Guodong Cao, Renquan Zhang and Bo Chen

Diagnostics 2025, 15(14), 1730; https://doi.org/10.3390/diagnostics15141730 - 8 Jul 2025

Abstract

Background: The rapid advancement of radiomics and artificial intelligence (AI) technology has provided novel tools for the diagnosis of esophageal cancer. This study innovatively combines muscle imaging features with conventional esophageal imaging features to construct deep learning diagnostic models. Methods: This [...] Read more.

Background: The rapid advancement of radiomics and artificial intelligence (AI) technology has provided novel tools for the diagnosis of esophageal cancer. This study innovatively combines muscle imaging features with conventional esophageal imaging features to construct deep learning diagnostic models. Methods: This retrospective study included 1066 patients undergoing radical esophagectomy. Preoperative computed tomography (CT) images covering esophageal, stomach, and muscle (bilateral iliopsoas and erector spinae) regions were segmented automatically with manual adjustments. Diagnostic models were developed using deep learning (2D and 3D neural networks) and traditional machine learning (11 algorithms with PyRadiomics-derived features). Multimodal features underwent Principal Component Analysis (PCA) for dimension reduction and were fused for final analysis. Results: Comparative analysis of 1066 patients’ CT imaging revealed the muscle-based model outperformed the esophageal plus stomach model in predicting N2 staging (0.63 ± 0.11 vs. 0.52 ± 0.11, p = 0.03). Subsequently, multimodal fusion models were established for predicting pathological subtypes, T staging, and N staging. The logistic regression (LR) fusion model showed optimal performance in predicting pathological subtypes, achieving accuracy (ACC) of 0.919 in the training set and 0.884 in the validation set. For predicting T staging, the support vector machine (SVM) model demonstrated the highest accuracy, with training and validation accuracies of 0.909 and 0.907, respectively. The multilayer perceptron (MLP) fusion model achieved the best performance among all models tested for N staging prediction, although the accuracy remained moderate (ACC = 0.704 in the training set and 0.685 in the validation set), indicating potential for further optimization. Fusion models significantly outperformed single-modality models. Conclusions: Based on CT imaging data from 1066 patients, this study systematically constructed predictive models for pathological subtypes, T staging, and N staging of esophageal cancer. Comparative analysis of models using esophageal, esophageal plus stomach, and muscle modalities demonstrated that muscle imaging features contribute to diagnostic accuracy. Multimodal fusion models consistently showed superior performance. Full article

(This article belongs to the Special Issue Deep Learning and Multimodal Feature Fusion for Advanced Medical Imaging Diagnosis)

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25 pages, 3304 KiB

Open AccessArticle

Diagnostics and Group Therapy in Patients with Persistent Postural-Perceptual Dizziness and Anxiety Disorder: Biomarkers and Neurofunctional Correlates of Underlying Treatment Effects

by Maximilian Maywald, Oliver Pogarell, Agnieszka Chrobok, Susanne Levai, Daniel Keeser, Nadja Tschentscher, Boris-Stephan Rauchmann, Sophia Stöcklein, Birgit Ertl-Wagner, Boris Papazov, Marco Paolini and Susanne Karch

Diagnostics 2025, 15(14), 1729; https://doi.org/10.3390/diagnostics15141729 - 8 Jul 2025

Abstract

Background: There is a certain degree of overlap between persistent postural-perceptual dizziness (PPPD) (ICD-11) and anxiety disorders (ANX) with regard to the phenomenological, pathological and neurobiological characteristics of both conditions. The implementation of an integrative psychotherapy programme may potentially result in the [...] Read more.

Background: There is a certain degree of overlap between persistent postural-perceptual dizziness (PPPD) (ICD-11) and anxiety disorders (ANX) with regard to the phenomenological, pathological and neurobiological characteristics of both conditions. The implementation of an integrative psychotherapy programme may potentially result in the generation of synergistic effects across both patient groups. Objectives: This study assessed (1) whether psychological mechanisms similarly influence symptom severity in PPPD and ANX group, (2) the effectiveness of psychotherapy, and (3) potential neurofunctional biomarkers. Methods: Patients with PPPD (n = 14) and ANX (n = 20) underwent an integrative psychotherapy programme with balance training and mindfulness-based interventions. Emotional and neutral pictures were presented during MRI scans before and after therapy, with healthy controls (HC = 29) for comparison. Clinical and psychological questionnaires were administered, and brain activity was analysed in key regions. Results: The only diagnostic difference in the direct comparison between patients with PPPD and with ANX were the vertigo intensity values before and after therapy. PPPD with comorbid anxiety disorder had significantly more fear of physical symptoms than patients without comorbid anxiety disorder. PPPD showed no change regarding vertigo intensity (VSS), anxiety, or depression scores, but reported decreased impact of vertigo on social functioning (VHQ), and improved personal control after therapy (IPQ). By contrast, anxiety, dizziness, depression, alexithymia, and IPQ scores were significantly reduced after therapy in the ANX group. Neuroimaging revealed decreased activity in the hippocampus and superior temporal gyri (STG) in the PPPD group post-therapy as compared to the pre-therapy measurement, while the ANX group showed reduced activity in the insula, thalamus, hippocampus, and inferior frontal gyrus. Compared to the ANX and HC groups, patients with PPPD showed increased activity in the supramarginal gyrus and STG, both of which could serve as biomarkers for PPPD patients but need to be further validated. Conclusions: Anxiety and vertigo may reinforce each other in PPPD, as symptoms persisted post-therapy, whereas ANX patients improved significantly. Nevertheless, there is some evidence for a successful management of symptoms in the PPPD group. Findings are limited by small sample size and require further research. Full article

(This article belongs to the Special Issue Diagnosis and Management of Postural Disorders)

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17 pages, 1532 KiB

Open AccessArticle

RADAI: A Deep Learning-Based Classification of Lung Abnormalities in Chest X-Rays

by Hanan Aljuaid, Hessa Albalahad, Walaa Alshuaibi, Shahad Almutairi, Tahani Hamad Aljohani, Nazar Hussain and Farah Mohammad

Diagnostics 2025, 15(13), 1728; https://doi.org/10.3390/diagnostics15131728 - 7 Jul 2025

Abstract

Background: Chest X-rays are rapidly gaining prominence as a prevalent diagnostic tool, as recognized by the World Health Organization (WHO). However, interpreting chest X-rays can be demanding and time-consuming, even for experienced radiologists, leading to potential misinterpretations and delays in treatment. Method: The [...] Read more.

Background: Chest X-rays are rapidly gaining prominence as a prevalent diagnostic tool, as recognized by the World Health Organization (WHO). However, interpreting chest X-rays can be demanding and time-consuming, even for experienced radiologists, leading to potential misinterpretations and delays in treatment. Method: The purpose of this research is the development of a RadAI model. The RadAI model can accurately detect four types of lung abnormalities in chest X-rays and generate a report on each identified abnormality. Moreover, deep learning algorithms, particularly convolutional neural networks (CNNs), have demonstrated remarkable potential in automating medical image analysis, including chest X-rays. This work addresses the challenge of chest X-ray interpretation by fine tuning the following three advanced deep learning models: Feature-selective and Spatial Receptive Fields Network (FSRFNet50), ResNext50, and ResNet50. These models are compared based on accuracy, precision, recall, and F1-score. Results: The outstanding performance of RadAI shows its potential to assist radiologists to interpret the detected chest abnormalities accurately. Conclusions: RadAI is beneficial in enhancing the accuracy and efficiency of chest X-ray interpretation, ultimately supporting the timely and reliable diagnosis of lung abnormalities. Full article

(This article belongs to the Section Machine Learning and Artificial Intelligence in Diagnostics)

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13 pages, 933 KiB

Open AccessArticle

Bisphosphonate Use and Cardiovascular Outcomes According to Kidney Function Status in Post-Menopausal Women: An Emulated Target Trial from the Multi-Ethnic Study of Atherosclerosis

by Elena Ghotbi, Nikhil Subhas, Michael P. Bancks, Sammy Elmariah, Jonathan L. Halperin, David A. Bluemke, Bryan R Kestenbaum, R. Graham Barr, Wendy S. Post, Matthew Budoff, João A. C. Lima and Shadpour Demehri

Diagnostics 2025, 15(13), 1727; https://doi.org/10.3390/diagnostics15131727 - 7 Jul 2025

Abstract

Background/Objectives: Bisphosphonates may influence vascular calcification and atheroma formation via farnesyl pyrophosphate synthase inhibition in the mevalonate pathway regulating bone and lipid metabolism. However, the clinical impact of NCB use on cardiovascular outcomes remains uncertain, largely due to methodological heterogeneity in prior studies. [...] Read more.

Background/Objectives: Bisphosphonates may influence vascular calcification and atheroma formation via farnesyl pyrophosphate synthase inhibition in the mevalonate pathway regulating bone and lipid metabolism. However, the clinical impact of NCB use on cardiovascular outcomes remains uncertain, largely due to methodological heterogeneity in prior studies. We aimed to evaluate the association between nitrogen-containing bisphosphonate (NCB) therapy and coronary artery calcium (CAC) progression, as well as the incidence of cardiovascular disease (CVD) and coronary heart disease (CHD) events. Methods: From 6814 participants in MESA Exam 1, we excluded males (insufficient male NCB users in the MESA cohort), pre-menopausal women, baseline NCB users, and users of hormone replacement therapy, raloxifene, or calcitonin. Among 166 NCB initiators and 1571 non-users with available CAC measurements, propensity score matching was performed using the available components of FRAX, namely age, race, BMI, LDL cholesterol, alcohol, smoking, and steroid use, and baseline CAC yielded 165 NCB initiators matched to 473 non-users (1:3 ratio). Linear mixed-effects models evaluated CAC progression, and Cox models analyzed incident CVD and CHD events. Results: In the overall cohort, NCB use was not significantly associated with CAC progression (annual change: −0.01 log Agatston units; 95% CI: −0.05 to 0.01). However, among participants with a baseline estimated glomerular filtration rate (eGFR) < 65 mL/min/1.73 m², NCB use was associated with attenuated CAC progression compared with non-users (−0.06 log Agatston units/year; 95% CI: −0.12 to −0.007). No significant association was observed between NCB use and incident CVD events in the overall cohort (HR: 0.90; 95% CI: 0.60−1.36) or within kidney function subgroups. Conclusions: Incident NCB use among postmenopausal women with mild or no CAC at baseline was associated with reduced CAC progression only in women with impaired kidney function. However, this association did not correspond to a decreased risk of subsequent cardiovascular events, suggesting that the observed imaging benefit may not translate into meaningful clinical association. Full article

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

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9 pages, 1417 KiB

Open AccessReview

Pressure Gradient-Driven Embolization b-TACE for HCC: Technical and Diagnostic Step-by-Step Procedural Guide and Literature Review

by Bianca Rocco, David C. Madoff, Fabrizio Basilico, Elio Damato, Paolo Vetri, Valeria Panebianco, Carlo Catalano and Pierleone Lucatelli

Diagnostics 2025, 15(13), 1726; https://doi.org/10.3390/diagnostics15131726 - 7 Jul 2025

Abstract

Background: Hepatocellular carcinoma (HCC) is one of the leading cause of cancer death worldwide. Transarterial therapies represent an important tool in the management of different clinical scenarios, from a patient with a single nodule to a patient with multinodular disease. Up to 30% [...] Read more.

Background: Hepatocellular carcinoma (HCC) is one of the leading cause of cancer death worldwide. Transarterial therapies represent an important tool in the management of different clinical scenarios, from a patient with a single nodule to a patient with multinodular disease. Up to 30% of patients are diagnosed with intermediate-stage HCC, and transarterial chemoembolization (TACE) represents the mainstay of treatment. Overall survival in patients with HCC undergoing TACE is strongly influenced by obtaining a sustained complete response, which is strongly affected by the HCC’s dimension. Methods: Pressure gradient-driven embolization, achieved by employing a microballoon catheter in the balloon-occluded TACE (bTACE), represents the most novel innovation in the field of transarterial therapies in the last decade. In fact, bTACE, thanks to its ability to redistribute flow towards tumor territories, can allow higher chemotherapeutic drug concentrations, leading to better oncological performance, especially in patients in which standard TACE struggles to obtain a complete response. Conclusions: This technical and diagnostic intraprocedural step-by-step guide, discussed with a review of the existing literature, will enable readers to achieve an optimal procedure and to convey to their patients the full clinical benefits of these procedures. Full article

(This article belongs to the Special Issue Advancements in Interventional Radiology Techniques in Vascular and Extravascular Diseases)

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10 pages, 205 KiB

Open AccessArticle

The Effect of Intrauterine Device Use on the Quality of Sampling Material in Patients Undergoing Endometrial Biopsy

by Hüseyin Aksoy, Mehmet Çopuroğlu, Mehmet Genco, Merve Genco and Mürüvet Korkmaz Baştürk

Diagnostics 2025, 15(13), 1725; https://doi.org/10.3390/diagnostics15131725 - 7 Jul 2025

Abstract

Objective: This retrospective study aims to evaluate the effect of copper intrauterine device (Cu-IUD) use on the adequacy and diagnostic quality of endometrial biopsy specimens in women with abnormal uterine bleeding (AUB). Patients with levonorgestrel-releasing intrauterine systems (LNG-IUS, e.g., Mirena) were excluded from [...] Read more.

Objective: This retrospective study aims to evaluate the effect of copper intrauterine device (Cu-IUD) use on the adequacy and diagnostic quality of endometrial biopsy specimens in women with abnormal uterine bleeding (AUB). Patients with levonorgestrel-releasing intrauterine systems (LNG-IUS, e.g., Mirena) were excluded from the study. The study compares the histopathological adequacy of endometrial samples between Cu-IUD users and non-users, highlighting potential interpretation challenges in routine pathological assessment. Methods: The study was conducted on 409 women aged 25–55 who presented with abnormal uterine bleeding (AUB) to the Gynecology and Obstetrics Outpatient Clinic at Kayseri City Hospital between 1 April 2021 and 1 April 2023. The patients were divided into two groups: copper IUD (Cu-IUD) users (n = 215) and non-IUD users (n = 194). Patients using levonorgestrel-releasing intrauterine systems (LNG-IUS, e.g., Mirena) were excluded from the study. Endometrial biopsies were obtained using the Pipelle curette technique without anesthesia, preserved in 10% formalin, and assessed for pathological classification and diagnostic adequacy. Results: The proportion of unclassifiable pathological categories was significantly higher in copper IUD users (63.93%) compared to non-IUD users (36.05%) (p = 0.013). Additionally, a negative correlation was observed between pathological category and endometrial thickness (r = −0.3147, p < 0.001), suggesting that thinner endometrial lining may reflect atrophic or diagnostically ambiguous tissue patterns. However, no significant association was found between IUD use and endometrial thickness (p = 0.073). Conclusions: The findings indicate that copper IUD use may affect the diagnostic adequacy of endometrial biopsy specimens, likely due to inflammatory or structural changes in the endometrium. These results underline the importance of considering IUD-related alterations when interpreting biopsy findings. Further research is needed to refine diagnostic approaches and better understand the clinical implications of these effects. Full article

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

18 pages, 1297 KiB

Open AccessArticle

Changing Etiological Spectrum of Premature Ovarian Insufficiency over the Past Decades: A Comparative Analysis of Two Cohorts from a Single Center

by Szilvia Csehely, Adrienn Kun, Edina Orbán, Tamás Katona, Mónika Orosz, Zoárd Tibor Krasznai, Tamás Deli and Attila Jakab

Diagnostics 2025, 15(13), 1724; https://doi.org/10.3390/diagnostics15131724 - 6 Jul 2025

Abstract

Background: Premature ovarian insufficiency (POI) is a complex and heterogeneous condition affecting women of reproductive age. Historically, most POI cases have been classified as idiopathic due to limited diagnostic capabilities. However, due to the success of oncologic treatments and the increasing number [...] Read more.

Background: Premature ovarian insufficiency (POI) is a complex and heterogeneous condition affecting women of reproductive age. Historically, most POI cases have been classified as idiopathic due to limited diagnostic capabilities. However, due to the success of oncologic treatments and the increasing number of gynecologic surgeries enabled by improved diagnostics, the proportion of iatrogenic POI cases has risen substantially. Objectives: To investigate the current prevalence of POI etiologies, to compare the etiological distribution between two POI cohorts from a single tertiary center—one historical (1978–2003) and one contemporary (2017–2024)—and to explore how the spectrum of underlying causes has changed over the past four decades. Methods: Data from 111 women diagnosed with POI between 2017 and 2024 were retrospectively reviewed and compared with those from a historical cohort of 172 patients. Etiologies were classified as genetic, autoimmune, iatrogenic, or idiopathic. Statistical comparisons were performed using chi-square and z-tests. Hormonal profiles and reproductive outcomes were also analyzed. Results: The current prevalence of POI etiologies is as follows: genetic 9.9%, autoimmune 18.9%, iatrogenic 34.2%, idiopathic 36.9%. In the historical POI cohort, etiologies were classified as genetic in 11.6%, autoimmune in 8.7%, iatrogenic in 7.6%, and idiopathic in 72.1%. The changes in the prevalence of autoimmune, iatrogenic, and idiopathic POI were statistically significant (p < 0.05). Reproductive outcomes remained limited: 10 pregnancies occurred in each cohort, with 7 live births in the contemporary group. Conclusions: Our findings suggest a significant shift in the etiological landscape of POI, with a notable, more than fourfold rise in identifiable iatrogenic cases and a twofold increase in the autoimmune group, resulting in a halving of idiopathic POI. Prevalence of genetic etiology remained unchanged. While diagnostic capabilities have improved, reproductive outcomes remain largely unchanged and suboptimal. Full article

(This article belongs to the Special Issue Diagnosis and Management of Gynecological Diseases: Advancements and Challenges)

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16 pages, 1322 KiB

Open AccessArticle

Perioperative Risk Prediction in Major Gynaecological Oncology Surgery: A National Diagnostic Survey of UK Clinical Practice

by Lusine Sevinyan, Anil Tailor, Pradeep Prabhu, Peter Williams, Melanie Flint and Thumuluru Kavitha Madhuri

Diagnostics 2025, 15(13), 1723; https://doi.org/10.3390/diagnostics15131723 - 6 Jul 2025

Abstract

Background: Gynaecological oncology (GO) surgery involves a wide range of procedures, from minor diagnostic interventions to highly complex cytoreductive operations. Accurate perioperative diagnostics—particularly in major surgery—are critical to optimise patient care, predict morbidity, and facilitate shared decision-making. This study aimed to evaluate [...] Read more.

Background: Gynaecological oncology (GO) surgery involves a wide range of procedures, from minor diagnostic interventions to highly complex cytoreductive operations. Accurate perioperative diagnostics—particularly in major surgery—are critical to optimise patient care, predict morbidity, and facilitate shared decision-making. This study aimed to evaluate current practices in perioperative risk assessment amongst UK GO specialists, focusing on the use, perception, and applicability of diagnostic risk prediction tools. Methods: A national multicentre survey was distributed via the British Gynaecological Cancer Society (BGCS) to consultants, trainees, and nurse specialists. The questionnaire examined clinician familiarity with and use of existing tools such as POSSUM, P-POSSUM, and ACS NSQIP, as well as perceived reliability and areas for improvement. Results: Fifty-four clinicians responded, two-thirds of whom were consultant gynaecological oncologists. While 51.9% used morbidity prediction tools selectively, only 7.4% used them routinely for all major surgeries. The most common models were P-POSSUM (39.6%) and ACS NSQIP (25%), though over 20% did not use any formal tool. Despite this, 80% of respondents expressed a desire for more accurate, GO-specific models. Conclusions: This study reveals a gap between available perioperative diagnostics and real-world clinical use in GO surgical planning. There is an urgent need for validated, user-friendly, and GO-specific risk prediction tools—particularly for high-risk, complex surgical cases. Further research should focus on prospective validation of tools such as ACS NSQIP and their integration into routine practice to improve outcomes in gynaecological oncology. Full article

(This article belongs to the Special Issue New Insights into the Diagnosis of Gynecological Diseases)

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15 pages, 2598 KiB

Open AccessCase Report

Two Cases of Chronic Tubular Necrosis Presenting as Fanconi Syndrome Induced by Red Yeast Rice Choleste-Help

by Kanako Mita, Shunsuke Takahashi, Satoshi Yanagida, Akihiro Aoyama, Takayuki Shiraishi, Takayuki Hamada, Yumiko Nakamura, Mariko Sato, Kento Hirose, Ryo Yamamoto, Yuya Shioda, Kaori Takayanagi, Izumi Nagayama, Yuko Ono, Hajime Hasegawa and Akito Maeshima

Diagnostics 2025, 15(13), 1722; https://doi.org/10.3390/diagnostics15131722 - 6 Jul 2025

Abstract

Background and Clinical Significance: Although dietary supplements have often been deemed safe, some have been linked to drug-induced nephropathy due to their diverse ingredients. The aim of this report is to enhance clinical awareness of a novel and emerging cause of Fanconi syndrome [...] Read more.

Background and Clinical Significance: Although dietary supplements have often been deemed safe, some have been linked to drug-induced nephropathy due to their diverse ingredients. The aim of this report is to enhance clinical awareness of a novel and emerging cause of Fanconi syndrome due to red yeast rice supplements and to contribute new histopathological and clinical data. Case Presentation: We report two cases of renal dysfunction and Fanconi syndrome associated with the use of red yeast rice supplements. Both patients presented with renal impairment accompanied by elevated markers of tubular injury, hypouricemia, hypokalemia, and glucosuria, consistent with Fanconi syndrome. Following the discontinuation of the red yeast rice supplement and initiation of steroid therapy, Fanconi syndrome resolved, however, moderate renal dysfunction persisted. Urinary NGAL levels improved after treatment in both cases. KIM-1 normalized in one case but remained elevated in the other. Uromodulin recovery was complete in one case and partial in the other. Renal biopsy revealed mild tubulointerstitial nephritis, with notable shedding of proximal tubular epithelial cells. Immunohistochemical analysis demonstrated reduced expression of URAT-1, Na-K ATPase, and Na-Pi IIa in some tubules. Conclusions: These findings suggest that renal injury induced by red yeast rice supplements is mediated by direct proximal tubular necrosis caused by a harmful substance in the supplement, resulting in persistence of tubular dysfunction. Full article

(This article belongs to the Special Issue Kidney Disease: Biomarkers, Diagnosis, and Prognosis: 3rd Edition)

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12 pages, 1407 KiB

Open AccessArticle

Radix Entomolaris and Complex Incisor Anatomy in a Saudi Cohort: A Retrospective Study

by Mubashir Baig Mirza

Diagnostics 2025, 15(13), 1721; https://doi.org/10.3390/diagnostics15131721 - 6 Jul 2025

Abstract

Background/Objectives: A thorough understanding of tooth anatomy is essential for effective root canal treatment. This study aims to investigate the root canal morphology of mandibular incisors (MIs) and the presence of distolingual roots in mandibular first molars (MFMs) and to explore the potential [...] Read more.

Background/Objectives: A thorough understanding of tooth anatomy is essential for effective root canal treatment. This study aims to investigate the root canal morphology of mandibular incisors (MIs) and the presence of distolingual roots in mandibular first molars (MFMs) and to explore the potential correlation between these anatomical variations. Methods: A total of 562 CBCT scans were retrospectively analyzed, corresponding to 1124 mandibular central incisors (MCIs), mandibular lateral incisors (MLIs), and MFMs each. The DLR in MFMs was correlated with the complex anatomy in MIs and analyzed using a chi-square test, with the odds ratio obtained through binary regression analysis. Differences related to gender, site, and age were analyzed using the chi-square test. Results: Most MI scans revealed Vertucci Type I canal morphology, with a higher percentage in MCIs (71.1%) than MLIs (64.9%). Additionally, 5.25% of MFM scans indicated a DLR, with a higher prevalence in males (3.5%) and younger individuals (3.4%); however, a statistically significant difference was observed only in MCIs (p = 0.035) across different age groups. The study also identified a highly significant difference in complex canal anatomy, comparing both MIs on either side and the presence of DLR in MFMs (p < 0.001). Furthermore, the relationship between complex canal systems in MIs and MFMs with DLR was confirmed. Conclusions: In conclusion, the Vertucci Type I canal configuration was predominant in both MIs, followed by Type III. The DLR was present in 5.25% of the total scans, and its presence strongly correlated with complex morphology in both MIs. Full article

(This article belongs to the Special Issue Advances in Dental Imaging)

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10 pages, 1137 KiB

Open AccessArticle

Assessing the Reliability of D-Dimer Measurement in EDTA Plasma: A Comparison to the Established Citrate Method

by Daniel Pfingst, Adriana Méndez, Peter Neyer, Henning Nilius, Nicole Schaub, Patricia Keusch, Michael Nagler and Angelika Hammerer-Lercher

Diagnostics 2025, 15(13), 1720; https://doi.org/10.3390/diagnostics15131720 - 6 Jul 2025

Abstract

Background: D-dimer determined in citrated plasma is a well-established and efficient biomarker, particularly for ruling out venous thromboembolism. In certain clinical settings, the availability of citrated plasma may pose challenges when not readily available. To address this issue, we investigated the feasibility of [...] Read more.

Background: D-dimer determined in citrated plasma is a well-established and efficient biomarker, particularly for ruling out venous thromboembolism. In certain clinical settings, the availability of citrated plasma may pose challenges when not readily available. To address this issue, we investigated the feasibility of using ethylenediaminetetraacetic acid (EDTA) plasma as an alternative specimen for D-dimer measurement. Methods: Our study evaluated anonymized plasma samples (n = 99, for both citrate and EDTA) using the INNOVANCE^® D-dimer assay, an automated particle-enhanced immunoassay, and the INNOVANCE^® LOCI hs D-dimer assay, leveraging the luminescent oxygen channeling assay (LOCI) method. Results: The assays demonstrated a correlation of r ≥ 0.97 (95% CI 0.96 to 0.98) within citrated plasma and maintained a similar correlation r ≥ 0.96 (95% CI 0.94 to 0.97) between citrate and EDTA plasma upon correction for the dilution effect of the sodium citrate solution. Conclusions: These results indicate that the utilization of EDTA instead of citrate plasma is feasible and may provide similar diagnostic information. However, the observed variance could have an impact on clinical interpretation and risk assessment. Therefore, future studies are needed to confirm the results and, if necessary, determine cut-off values and clinical performance. Full article

(This article belongs to the Section Clinical Laboratory Medicine)

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