Diagnostics

17 pages, 6650 KB

Open AccessArticle

Internal-Control-Normalized T2 Mapping of Meniscal Abnormalities on a Cartilage MRI Protocol: An Exploratory Retrospective Study

by Wenwen Ni, Mun Sze Khaw, Phey Ming Yeap, Mohammed Taufik Bin Mohamed Shah, Cynthia Assimta Peter, Jamie Xiu Mei Ho, Yi Xian Low, Dickson Hong Him Chau, Jeremy Keng Meng Goh, Steven Bak Siew Wong and Adriel Guang Wei Goh

Diagnostics 2026, 16(16), 2564; https://doi.org/10.3390/diagnostics16162564 (registering DOI) - 14 Aug 2026

Abstract

Background/Objectives: Meniscal pathology is a common consequence of knee injury and a precursor of osteoarthritis, but qualitative MRI grading cannot reliably distinguish low-grade intrasubstance degeneration from more advanced pathology. Quantitative T2 relaxation value (T2RV) mapping is an established cartilage marker, but internal-control [...] Read more.

Background/Objectives: Meniscal pathology is a common consequence of knee injury and a precursor of osteoarthritis, but qualitative MRI grading cannot reliably distinguish low-grade intrasubstance degeneration from more advanced pathology. Quantitative T2 relaxation value (T2RV) mapping is an established cartilage marker, but internal-control normalisation within the same meniscus has not been formalised for incidental meniscal pathology. We hypothesised that pathologic meniscal regions would show elevated T2RV relative to internal-control tissue. Methods: In this retrospective, single-centre study, 61 pathologic meniscal lesions with arthroscopic correlation (12 tears, 40 repaired, 9 myxoid/intrasubstance degeneration) in 55 patients (mean age 47.1 ± 8.8 years) underwent a cartilage T2RV MRI protocol. A pathologic and a remote internal-control region of interest (ROI) were placed on the T2RV colour map for each lesion; the T2RV endpoint was (pathologic − internal-control ROI T2RV)/internal-control ROI T2RV × 100%. Groups were compared using Wilcoxon signed-rank and Kruskal–Wallis (Dunn’s post hoc) tests and multivariable linear regression. Results: Pathologic ROI T2RV exceeded internal-control ROI T2RV (p < 0.001; mean elevation 55.7%). The endpoint varied among pathology groups (p < 0.001): degeneration showed the smallest elevation (17.5%), while repair (60.0%) and tear (69.9%) were similarly higher and indistinguishable, remaining independently associated with a higher endpoint than degeneration after multivariable adjustment. Longer postoperative intervals were associated with a lower endpoint among repaired lesions (β = −6.27 points/100 days). Conclusions: Internal-control-normalised T2RV mapping is a promising quantitative marker of meniscal tissue status that may complement conventional MRI and clinical assessment, with T2RV elevation differing among myxoid/intrasubstance degeneration, tear, and repaired meniscus within this cohort. Prospective, multicenter validation is warranted before clinical adoption. Full article

(This article belongs to the Special Issue Advanced Imaging for Diagnosis and Management of Musculoskeletal Disorders)

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11 pages, 4559 KB

Open AccessInteresting Images

The Usage of Reversed Köle-Type Mandibular Anterior Segmental Subapical Osteotomy: Radiological, Clinical, and Surgical Considerations

by Kamil Nelke, Krisztián Nagy, Angela Rosa Caso, Massimiliano Gilli, Ömer Uranbey, Maciej Janeczek, Agata Małyszek, Maciej Dobrzyński, Wojciech Pawlak and Klaudiusz Łuczak

Diagnostics 2026, 16(16), 2563; https://doi.org/10.3390/diagnostics16162563 (registering DOI) - 14 Aug 2026

Abstract

The currently common procedures in orthognathic surgery are widely used. Different forms of skeletal malocclusion can be treated with great outcomes in terms of bite, bone harmony, function, improved mastication, esthetics, and even decreased problems with breathing. Each type and intensity of malocclusion [...] Read more.

The currently common procedures in orthognathic surgery are widely used. Different forms of skeletal malocclusion can be treated with great outcomes in terms of bite, bone harmony, function, improved mastication, esthetics, and even decreased problems with breathing. Each type and intensity of malocclusion may affect decision-making in terms of distraction, selection of osteotomy design, or even guide clinical and surgical decisions to use a less popular osteotomy protocol. CBCT (cone-beam computed tomography) is currently a milestone in the establishment of the condition of jaw bones, bone structure, temporomandibular joints, and central relation (CR), as well as the scope of maxilla–mandibular and tooth relations. When establishing all of the following in a clinical and radiological (CBCT-based) evaluation, it becomes possible to measure the occlusal plane, height, length, and three-dimensional position of each dental segment, as well as other dentoalveolar features. In the present case, CBCT helped distinguish a localized vertical anterior mandibular dentoalveolar discrepancy from generalized mandibular malposition and supported the planning of a mandibular anterior segmental subapical osteotomy (MASSO) by mapping the osteotomy corridor in relation to the dental roots, cortical bone, periapical bone height, and neurovascular structures. Significant therapeutic complexity emerges when severe skeletal Class III malocclusion (mandibular prognathism) is compounded by transverse maxillary discrepancies and a markedly elevated mandibular anterior segment. This constellation of deformities leads to profound disturbances in the anterior facial height, a disrupted maxillomandibular interincisal relationship, and the loss of a level occlusal plane. The presented case highlights how the patient’s clinical evaluation should be carefully compared with radiological data, status of both cortices in the mandible, the height of the mandibular anterior segment, presence of gum recessions and poor bone status that may affect healing, osteotomies, and occurrence of some unwanted events. Therefore, CBCT was useful not only for diagnosis and planning, but also for understanding the biological limits of movement and the risk of postoperative periodontal complications in this uncommon reversed Köle-type MASSO. Full article

(This article belongs to the Special Issue Recent Advances in Oral and Maxillofacial Surgery: Diagnosis and Management)

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5 pages, 16654 KB

Open AccessInteresting Images

Early First-Trimester Diagnosis of Thoracopagus Conjoined Twins with a Shared Cardiac Structure

by Adelina Staicu, Camelia Albu, Roxana Constantin, Iulian Gabriel Goidescu, Mihai Surcel, Dan Boitor-Borza, Andreea Florian, Georgiana Irina Nemeti, Gheorghe Cruciat, Daniel Muresan and Ioana Cristina Rotar

Diagnostics 2026, 16(16), 2562; https://doi.org/10.3390/diagnostics16162562 - 14 Aug 2026

Abstract

Thoracopagus conjoined twins are the most common type of conjoined twinning and are frequently associated with shared cardiac anatomy, the principal determinant of prognosis and postnatal survival. Early prenatal diagnosis is essential for accurate counseling and timely pregnancy management. We report the diagnosis [...] Read more.

Thoracopagus conjoined twins are the most common type of conjoined twinning and are frequently associated with shared cardiac anatomy, the principal determinant of prognosis and postnatal survival. Early prenatal diagnosis is essential for accurate counseling and timely pregnancy management. We report the diagnosis of thoracopagus conjoined twins with a shared cardiac structure in a 35-year-old primigravid woman at 8 weeks and 3 days of gestation. High-resolution transvaginal ultrasound demonstrated persistent thoracic fusion, fixed relative fetal position, a single yolk sac, a single umbilical cord, and absence of an intertwin membrane. Color Doppler confirmed a single sonographically detectable cardiac complex, while three-dimensional ultrasound enhanced spatial visualization and facilitated parental counseling. Differential diagnoses, including monochorionic twins with close apposition, TRAP sequence, body stalk anomaly, and other forms of conjoined twinning, were systematically excluded. Early first-trimester recognition of thoracopagus conjoined twins with shared cardiac anatomy is feasible using dynamic ultrasound and Doppler imaging. Establishing the diagnosis before the end of the first trimester enables accurate prognostic assessment, timely multidisciplinary counseling, and informed parental decision-making for this condition associated with an extremely poor prognosis. Full article

(This article belongs to the Special Issue Advanced Diagnostics in Women's Health: From Biomarkers to Imaging)

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20 pages, 3364 KB

Open AccessReview

Optical Spectroscopy and Spectral Imaging for Bladder Cancer Detection and Characterisation: A Scoping Review of Diagnostic Evidence and Translational Readiness

by Arthur Vander Stichele and Ben Van Cleynenbreugel

Diagnostics 2026, 16(16), 2561; https://doi.org/10.3390/diagnostics16162561 - 14 Aug 2026

Abstract

Background/Objectives: White-light cystoscopy remains central to bladder cancer detection and surveillance, but diagnostic uncertainty persists in detecting flat lesions, particularly carcinoma in situ, distinguishing inflammatory mimics, and targeting biopsies. Optical spectroscopy and spectral imaging may provide objective tissue information beyond visual inspection. This [...] Read more.

Background/Objectives: White-light cystoscopy remains central to bladder cancer detection and surveillance, but diagnostic uncertainty persists in detecting flat lesions, particularly carcinoma in situ, distinguishing inflammatory mimics, and targeting biopsies. Optical spectroscopy and spectral imaging may provide objective tissue information beyond visual inspection. This scoping review mapped the diagnostic evidence and translational readiness of these technologies. Methods: A scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, Embase and Web of Science were searched from inception to 31 July 2026. Eligible articles evaluated wavelength-dependent optical signals directly in human bladder tissue in clinically relevant in vivo or ex vivo settings. Related articles with the same, overlapping or expanded datasets were grouped into study families. Results: Forty-seven articles were organised into 39 study families. Raman spectroscopy showed the clearest progression from ex vivo discrimination to in vivo cystoscopic feasibility and device development. Fluorescence and reflectance provided early in vivo evidence, although specificity was often limited by inflammation and benign changes. Infrared and near-infrared techniques remained mainly specimen-based, while multimodal systems were evaluated mostly ex vivo. Evidence for spectral imaging was limited, and no clinically integrated endoscopic hyperspectral-imaging study meeting the criteria was identified. Conclusions: Optical spectroscopy and spectral imaging show diagnostic potential for bladder cancer tissue characterisation, but evidence remains heterogeneous and insufficient for routine implementation. Among the included techniques, Raman spectroscopy appears most translationally mature, whereas wide-field spectral imaging remains underdeveloped. Future studies should prioritise prospective in vivo evaluation, standardised acquisition, histopathological correlation, external patient-level validation and clinically meaningful endpoints. Full article

(This article belongs to the Section Biomedical Optics)

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15 pages, 18550 KB

Open AccessArticle

Early Renal Perfusion Scintigraphy Is Associated with Mortality in Experimental Sepsis: A Multimodal Study Integrating Imaging, Survival, and Biomarker Analysis

by Kubilay Kemertaş, Cengiz Dibekoğlu, Mert Zeytinoğlu, Hatice Aygun, Aylin Arslan, Serdar Savaş Gül and Oytun Erbas

Diagnostics 2026, 16(16), 2560; https://doi.org/10.3390/diagnostics16162560 - 14 Aug 2026

Abstract

Background/Objectives:This study aimed to evaluate whether early renal perfusion scintigraphy is associated with sepsis severity and short-term mortality in an experimental polymicrobial sepsis model. Methods: A total of 90 female Wistar albino rats were divided into Control, mild sepsis, and severe sepsis groups [...] Read more.

Background/Objectives:This study aimed to evaluate whether early renal perfusion scintigraphy is associated with sepsis severity and short-term mortality in an experimental polymicrobial sepsis model. Methods: A total of 90 female Wistar albino rats were divided into Control, mild sepsis, and severe sepsis groups using a cecal ligation and puncture (CLP) model. Renal perfusion was evaluated 5 h after sepsis induction using technetium-99m-labeled erythrocyte scintigraphy, expressed as the kidney-to-aorta (R/A) activity ratio. Survival was monitored for 5 days. Histopathological and biochemical analyses were also performed. Results: The kidney-to-aorta (R/A) activity ratio decreased progressively with increasing sepsis severity (all p < 0.001). Kaplan–Meier analysis demonstrated significantly reduced survival in septic animals (log-rank p < 0.001). The R/A ratio showed high discrimination for 5-day mortality (AUC = 0.944, 95% CI 0.902–0.986; p < 0.001). Univariable Cox proportional hazards analysis demonstrated that a lower R/A ratio was significantly associated with an increased hazard of death (HR = 0.005, 95% CI 0.001–0.036; p < 0.001). Histopathological injury scores and biochemical markers (TNF-α, VEGF, STAT3, NGAL, BUN, creatinine, and MDA) increased significantly with sepsis severity. Conclusions: Early Tc-99m-labeled erythrocyte renal perfusion scintigraphy was associated with sepsis severity and short-term mortality in experimental polymicrobial sepsis. These findings support further investigation of this imaging approach as an experimental marker of sepsis severity and outcome; however, external validation is required before clinical translation. Full article

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

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13 pages, 1249 KB

Open AccessArticle

Is the CALLY Index the Best Tool for Predicting Survival in Patients with Primary Soft Tissue Sarcomas?

by Tomoki Nakamura, Tomohito Hagi, Yumi Matsuyama, Hironori Date and Masahiro Hasegawa

Diagnostics 2026, 16(16), 2559; https://doi.org/10.3390/diagnostics16162559 - 14 Aug 2026

Abstract

Background/Objectives: To elucidate the role of the CALLY index in 172 adult patients with primary soft tissue sarcoma (STS) and to evaluate whether the CALLY index is superior to the modified Glasgow prognostic score (mGPS) and prognostic nutrition index (PNI). Methods: [...] Read more.

Background/Objectives: To elucidate the role of the CALLY index in 172 adult patients with primary soft tissue sarcoma (STS) and to evaluate whether the CALLY index is superior to the modified Glasgow prognostic score (mGPS) and prognostic nutrition index (PNI). Methods: The study cohort included 100 men and 72 women with a mean age of 63 years. Receiver operating characteristic (ROC) curve analysis was performed to determine the threshold value of the CALLY index for identifying the risk of identifying oncological events at 2 years. Results: ROC analysis identified 2.07 as the threshold of the CALLY index for predicting the risk of identifying oncological events at 2 years. The 5-year disease-specific survival (DSS) rate was 50.9% in patients with a lower CALLY index compared to 84% in those with a higher CALLY index. All patients with mGPS scores of 1 or 2 had lower CALLY indices, whereas all patients with a higher CALLY index had an mGPS score of 0. Patients with a lower CALLY index and mGPS of 0 had better DSS than those with a lower CALLY index and mGPS of 1 or 2. No substantial differences in DSS and disease-free survival (DFS) were observed between patients with a higher CALLY index and those with a lower CALLY index and an mGPS of 0. Conclusions: The CALLY index is a useful marker for predicting oncological outcomes in patients with primary STS. In particular, the CALLY index was a statistically significant prognostic variable for survival in patients with UPS and DDLPS individually. However, we suggest that the mGPS remains a reliable system for identifying patients with primary STSs who are at a high risk of death and relapse because we showed the significant difference for survival and event-free survival between the patients with mGPS of 1 and 2. Full article

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

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14 pages, 509 KB

Open AccessArticle

Large Language Model Decision Support for Cranial CT in Pediatric Head Trauma

by Ezgi Cesur, Ali Halici and Nursel Kurtoglu

Diagnostics 2026, 16(16), 2558; https://doi.org/10.3390/diagnostics16162558 - 14 Aug 2026

Abstract

Background: Pediatric head trauma is a common reason for emergency department presentation. Although most children have minor injuries, a small proportion harbor clinically important traumatic brain injuries requiring urgent intervention. Artificial intelligence (AI) may offer structured support in computed tomography (CT) decision [...] Read more.

Background: Pediatric head trauma is a common reason for emergency department presentation. Although most children have minor injuries, a small proportion harbor clinically important traumatic brain injuries requiring urgent intervention. Artificial intelligence (AI) may offer structured support in computed tomography (CT) decision making, but evidence regarding the performance of general-purpose large language models in pediatric head trauma remains limited. Objective: To evaluate the association between AI-based cranial CT recommendations and clinically meaningful outcomes in pediatric patients with blunt head trauma and to assess the diagnostic performance and clinical utility of the model. Methods: This retrospective single-center observational study included pediatric patients younger than 18 years with blunt head trauma who underwent cranial CT imaging and had complete outcome data. A general-purpose large language model generated binary CT recommendations (“CT recommended” or “CT not recommended”) using structured clinical information available at the time of emergency department presentation. The primary outcome was a composite adverse clinical outcome defined as the occurrence of at least one of the following: emergency surgical intervention, intensive care unit admission, intubation, neurological sequelae or mortality. Diagnostic performance metrics, calibration analysis and decision curve analysis were performed. Results: A total of 819 pediatric patients were included, and the AI model recommended CT in 530 patients (64.7%). The primary outcome occurred in 143 patients (17.5%) and was significantly more frequent in the CT-recommended group than in the CT-not recommended group (24.5% vs. 4.5%; OR 6.90, 95% CI 3.82–12.45; p < 0.001). Abnormal CT findings, emergency surgery, intubation and neurological sequelae were also significantly more common in patients for whom CT was recommended by the AI system. For the primary outcome, the AI recommendation demonstrated a sensitivity of 90.9%, specificity of 40.8%, positive predictive value of 24.5% and negative predictive value of 95.5%. Calibration analysis showed acceptable agreement between predicted probabilities and observed event rates. Decision curve analysis demonstrated greater net benefit than both the “treat-all” and “treat-none” strategies across a range of threshold probabilities. Conclusions: In this clinically selected cohort of pediatric patients with blunt head trauma who underwent cranial CT imaging, AI-based CT recommendations were strongly associated with adverse clinical outcomes and demonstrated high sensitivity and negative predictive value for identifying children at risk of clinically important events. These findings suggest that, within a clinically selected cohort of children who underwent cranial CT imaging, AI-generated CT recommendations were associated with clinically meaningful outcomes. However, these results should not be interpreted as validation of CT decision making in the broader pediatric head trauma population and require prospective validation in unselected cohorts. Full article

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

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16 pages, 3875 KB

Open AccessArticle

Optimizing In-Hospital Mortality Prediction After Cardiac Surgery: A Machine Learning Approach Using Feature Engineering for Imbalanced Data

by Po-Cheng Kao, Chih-Cheng Wu and Jung-Chun Yeh

Diagnostics 2026, 16(16), 2557; https://doi.org/10.3390/diagnostics16162557 - 13 Aug 2026

Abstract

Background/Objectives: Cardiac surgery involves unique complexities that differ from those of general ICU populations. Traditional scoring systems often underperform due to the significant class imbalance between survival and mortality. This study utilized the MIMIC-IV database, integrating machine learning (ML) and feature engineering to [...] Read more.

Background/Objectives: Cardiac surgery involves unique complexities that differ from those of general ICU populations. Traditional scoring systems often underperform due to the significant class imbalance between survival and mortality. This study utilized the MIMIC-IV database, integrating machine learning (ML) and feature engineering to develop an in-hospital mortality prediction model specifically for open-heart surgery patients. Methods: We included 6941 cases (mortality: 76, 1.095%). Sixty-eight variables from the first ICU day were extracted. Following data preprocessing and imputation, four ML models—logistic regression, random forest (RF), XGBoost, and multilayer perceptron (MLP)—were constructed using stratified 10-fold cross-validation. SMOTE was applied to address class imbalance. A streamlined 17-variable model was developed and compared against the Sequential Organ Failure Assessment (SOFA) and the Oxford Acute Severity of Illness Score (OASIS). Results: Among the 68-variable models, RF achieved the highest area under the receiver operating characteristic curve (AUROC) of 0.915 (95% CI, 0.855–0.966). For the 17-variable models, MLP performed best (AUROC: 0.920; 95% CI, 0.865–0.964), significantly outperforming SOFA (0.688) and OASIS (0.690). Regarding the area under the precision-recall curve (AUCPR), the 17-variable MLP also yielded the highest score (0.203; 95% CI, 0.060–0.389) compared with SOFA (0.161) and OASIS (0.046). SHapley Additive exPlanations (SHAP) analysis identified bicarbonate levels, mechanical ventilation, and mean pulmonary arterial pressure as the top predictors, consistent with clinical expectations. Conclusions: The streamlined MLP model significantly outperforms traditional scoring systems and may serve as a useful tool for early postoperative risk stratification after open-heart surgery. Full article

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

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17 pages, 20948 KB

Open AccessArticle

Systematic Differences in Corneal Curvature and Power Measurements Between the IOLMaster 700 and the Anterion and Mapping Strategies for Cross-Device Use

by Achim Langenbucher, Jascha Armin Wendelstein, Alan Cayless, Peter Hoffmann and Nóra Szentmáry

Diagnostics 2026, 16(16), 2556; https://doi.org/10.3390/diagnostics16162556 - 13 Aug 2026

Abstract

Background/Objectives: Corneal power has the largest impact on the variability of intraocular lens (IOL) power predictions, and corneal data from different biometers cannot be used interchangeably. We quantified the systematic differences between the Zeiss IOLMaster 700 (IOLM) and the Heidelberg Engineering Anterion [...] Read more.

Background/Objectives: Corneal power has the largest impact on the variability of intraocular lens (IOL) power predictions, and corneal data from different biometers cannot be used interchangeably. We quantified the systematic differences between the Zeiss IOLMaster 700 (IOLM) and the Heidelberg Engineering Anterion and derived strategies for using both devices interchangeably in IOL power calculation. Methods: In this retrospective single-centre study, 837 eyes of 837 cataract patients were measured preoperatively with both biometers. Harmonic mean corneal front and back surface radii were derived from the flat and steep meridians, and corneal power referenced to the front apex plane was expressed as spherocylindrical power vectors (spherical equivalent, SEQ; astigmatic components C0 and C45). Three mapping strategies were compared using Bland–Altman and double-angle plots: linear regression of corneal radii without (MR) and with (MRI) intercept and multivariate linear regression of the power vector components (MMV). Results: Corneal front surface radii agreed well between devices (MR slope 1.000), whereas the IOLM reported systematically flatter posterior radii (MR slope 0.943), giving a systematically higher total corneal power (43.105 D versus 42.760 D). MRI mapping largely removed the systematic offset in the corneal radii but did not fully correct the astigmatic centroids, whereas MMV mapping aligned both the SEQ and the astigmatic centroids at the origin and yielded smaller confidence ellipses. Conclusions: Measurements from the two devices are not directly interchangeable, primarily because of systematic discrepancies in the reported posterior corneal curvature. Where identical IOL calculation concepts and formula constants are used across devices, conversion of corneal data is mandatory, and multivariate power vector mapping provides superior harmonisation compared with radius-based approaches. Full article

(This article belongs to the Special Issue Diagnostic Imaging in Ocular Surface)

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21 pages, 4568 KB

Open AccessArticle

Adaptive MDA-Net: Degradation-Aware Retinal Fundus Image Enhancement with Frequency-Domain and Illumination Guidance for Clinical Screening

by Mohamed Loey, M. A. El-Mowafy, Mohamed A. Hemdan, Ramez Yousri and Heba M. Khalil

Diagnostics 2026, 16(16), 2555; https://doi.org/10.3390/diagnostics16162555 - 13 Aug 2026

Abstract

Background/Objective: Retinal fundus image quality directly affects ophthalmic interpretation and automated analysis. Existing multi-degradation methods provide adaptive restoration but offer limited spatial degradation encoding and frequency-level supervision for severely degraded images. This study aims to improve restoration fidelity while preserving retinal structures required [...] Read more.

Background/Objective: Retinal fundus image quality directly affects ophthalmic interpretation and automated analysis. Existing multi-degradation methods provide adaptive restoration but offer limited spatial degradation encoding and frequency-level supervision for severely degraded images. This study aims to improve restoration fidelity while preserving retinal structures required by downstream clinical-analysis models. Methods: Adaptive MDA-Net combines a CNN degradation encoder, coupled synthetic degradation, latent-conditioned attention, a supervised illumination-guidance branch, and a seven-term spatial- and frequency-domain objective. The model was evaluated on held-out EyeQ data and with fixed downstream models on DRIVE and REFUGE. Results: Across five runs, the model achieved 35.86 ± 0.12 dB PSNR and 0.9732 ± 0.0010 SSIM, improvements of 0.62 dB and 0.0064 over RGB-GAP. Downstream evaluation achieved a Dice score of 0.7601 on DRIVE and an mDice score of 0.7917 on REFUGE. Conclusions: Degradation-aware conditioning improves restoration fidelity and recovers part of the downstream performance lost to image degradation. Validation remains limited to image-level EyeQ splits and synthetic supervision. Full article

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

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30 pages, 1459 KB

Open AccessArticle

Predicting ICU Delirium with a Regularized Logistic Regression Model: Device-Support Burden as an Informative Predictor Domain in a Turkish Cohort

by Muhammed Sezai Bazna and Fatih Okumuş

Diagnostics 2026, 16(16), 2554; https://doi.org/10.3390/diagnostics16162554 - 13 Aug 2026

Abstract

Background/Objectives: Delirium is prevalent among intensive care unit (ICU) patients and is associated with prolonged ventilation, longer ICU stays, increased mortality, and post-discharge cognitive impairment. Because most current prediction tools were developed using European cohorts, their transportability to other ICU settings remains unclear. [...] Read more.

Background/Objectives: Delirium is prevalent among intensive care unit (ICU) patients and is associated with prolonged ventilation, longer ICU stays, increased mortality, and post-discharge cognitive impairment. Because most current prediction tools were developed using European cohorts, their transportability to other ICU settings remains unclear. The device support burden has received limited attention, and preprocessing data leakage remains a secondary methodological concern. Methods: This prospective study enrolled consecutive adults from the Internal Medicine ICU of Ankara Etlik City Hospital. Fifty predictors from electronic health records were documented at ICU admission or within the first 24 h. Device support variables were assessed as a distinct domain using ablation analysis. We developed an elastic net regularized logistic regression model and validated it using 5 × 4-fold nested cross-validation. Preprocessing was restricted to the training folds, and gradient boosting was used as a comparison method. We also evaluated a fixed exploratory 11-predictor reduced model. Results: Delirium was detected in 50.8% of patients. The full regularized model achieved an area under the receiver operating characteristic curve (AUROC) of 0.696 (95% CI: 0.613–0.767). The fixed exploratory reduced model had a higher apparent AUROC of 0.756 (95% CI: 0.684–0.819) than the other models. This apparent advantage was absent when feature selection was repeated within each outer training fold (nested reduced model AUROC 0.700). The full-model calibration slope was 0.741 (95% CI: 0.345–1.265). This confidence interval was wide and included the value of 1.0. The fixed reduced-model slope was 0.235 (95% CI: 0.068–0.886), indicating that the predicted probabilities were too extreme. Ablation analysis showed that device support variables added predictive value to clinical and laboratory variables, whereas environmental variables alone did not significantly discriminate between the two groups. Conclusions: In this single-center Turkish ICU cohort, regularized logistic regression showed moderate performance in predicting delirium. Nested feature selection did not reproduce the fixed reduced model’s apparent discrimination advantage. Device support variables are best interpreted as markers of care complexity rather than direct causal factors. External validation and recalibration are required before clinical use. Because delirium onset and device support start times were unavailable, the model estimated delirium risk across the ICU stay from predictors documented at ICU admission or within the first 24 h and was not time-anchored. Full article

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

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16 pages, 1158 KB

Open AccessArticle

Among Five First-Trimester Complete Blood Count Inflammatory Indices, the Systemic Inflammation Response Index Rises Most Consistently with the Severity of Preterm Birth

by Aybekcan Batman, Enes Saraç, Ali Konu, Esra Selvi, Yücel Kaya, Murat İbrahim Toplu, Burak Deniz Aydoğdu and Gökhan Bolluk

Diagnostics 2026, 16(16), 2553; https://doi.org/10.3390/diagnostics16162553 - 13 Aug 2026

Abstract

Background/Objectives: Complete blood count inflammatory indices are widely studied in obstetrics but rarely compared directly. We compared five first-trimester indices, the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), for their associations [...] Read more.

Background/Objectives: Complete blood count inflammatory indices are widely studied in obstetrics but rarely compared directly. We compared five first-trimester indices, the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), for their associations with preterm birth, examined across its severity. Methods: In a retrospective single-centre cohort of 5003 singleton pregnancies with a first-trimester complete blood count, late (34–36 weeks) and early (<34 weeks) preterm births were analysed separately. The association of each index with preterm birth was assessed by logistic regression, per standard deviation, and by quartile, with adjustments made for maternal age, body mass index, parity, fetal sex, and gestational age at sampling; discrimination was compared using the DeLong test. The birthweight category, classified against the INTERGROWTH-21st standards, was a secondary outcome. Results: After adjustment, all indices except for the PLR were associated with preterm delivery, with similar effects per standard deviation. Among the five indices, the SIRI showed the most consistent association with the severity of preterm birth: its values rose at every step from term to late to early birth. It discriminated these births best (area under the curve 0.600, significantly greater than the SII), and its quartile gradient was steepest, with the odds more than doubling from the lowest to the highest quartile. All five remained weak discriminators, with every area under the curve being below 0.70, and none was associated with the birthweight category. Conclusions: These indices are not standalone predictive tests, but among them, the SIRI, which, unlike the SII, captures the monocyte count, was most closely associated with early, more severe preterm birth, consistent with the role of monocytes in the inflammation of labour. Full article

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

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15 pages, 1387 KB

Open AccessArticle

Volumetric Pulp Analysis of Mandibular Molars on CBCT as a Supplementary Indicator for Age-Related Dental Changes: A Preliminary Investigation in a Turkish Population Sample

by Hatice Boyacioglu Erden, Nihal Avcu, Gokcen Akcicek, Nursel Akkaya and Sema Dural

Diagnostics 2026, 16(16), 2552; https://doi.org/10.3390/diagnostics16162552 - 13 Aug 2026

Abstract

Background/Objectives: This study aimed to evaluate the relationship between CBCT-derived total pulp volume and chronological age in mandibular first molars (M1) and second molars (M2), and to explore the preliminary utility of volumetric pulp analysis as a supplementary indicator for age-related dental changes [...] Read more.

Background/Objectives: This study aimed to evaluate the relationship between CBCT-derived total pulp volume and chronological age in mandibular first molars (M1) and second molars (M2), and to explore the preliminary utility of volumetric pulp analysis as a supplementary indicator for age-related dental changes in a Turkish population sample. Methods: CBCT scans of 60 individuals (32 females, 28 males; age range: 18–48 years) were retrospectively analysed. Pulp volumes of 60 mandibular molars (32 first and 28 second molars) were segmented using a semi-automatic thresholding approach with manual correction. Spearman correlation analysis was performed to assess the relationship between pulp volume and chronological age, stratified by sex and tooth type. Following comprehensive regression diagnostics—including the Shapiro–Wilk test, Breusch–Pagan test, and Cook’s distance—Huber M-estimator robust regression was selected as the primary analytical method, with OLS bootstrapped regression retained as a sensitivity analysis. Results: A statistically significant negative correlation was found between pulp volume and chronological age in both mandibular first molars (Spearman ρ = −0.554, p = 0.001) and second molars (ρ = −0.693, p < 0.001). Huber robust regression confirmed pulp volume as a significant predictor in both groups: M1 (β = −0.151, p = 0.001; Age = 33.646 − 0.151 × Volume) and M2 (β = −0.205, p < 0.001; Age = 36.833 − 0.205 × Volume). OLS sensitivity analysis yielded R² = 0.238 (SEE = ±5.978 years, n = 32) for M1 and R² = 0.499 (SEE = ±4.908 years, n = 28) for M2. No statistically significant sex differences were detected in either molar group. Conclusions: This preliminary study suggested that CBCT-derived mandibular molar pulp volumetry demonstrates a statistically significant negative association with chronological age in a predominantly young adult Turkish population. Full article

(This article belongs to the Section Forensic Diagnostics)

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15 pages, 819 KB

Open AccessArticle

Modified 5-Item Frailty Index Is Associated with Postoperative Delirium but Not Survival in Patients Undergoing Surgery for Oral Squamous Cell Carcinoma

by Kenji Yamagata, Satoshi Fukuzawa, Shohei Takaoka, Jumpei Shirakawa, Kie Nakatani, Eri Sasabe, Yukio Yoshioka, Naomi Kanno and Fumihiko Uchida

Diagnostics 2026, 16(16), 2551; https://doi.org/10.3390/diagnostics16162551 - 13 Aug 2026

Abstract

Background/Objectives: Frailty is increasingly recognized as a clinically relevant marker of reduced physiological reserve in surgical oncology. The modified 5-item frailty index (mFI-5) is simple and practical, but its clinical significance in oral squamous cell carcinoma (OSCC) remains incompletely defined. This study evaluated [...] Read more.

Background/Objectives: Frailty is increasingly recognized as a clinically relevant marker of reduced physiological reserve in surgical oncology. The modified 5-item frailty index (mFI-5) is simple and practical, but its clinical significance in oral squamous cell carcinoma (OSCC) remains incompletely defined. This study evaluated the association between mFI-5-defined frailty and postoperative complications, especially postoperative delirium, as well as survival outcomes in patients undergoing surgery for OSCC. Methods: We retrospectively analyzed 127 patients who underwent surgical resection for OSCC with postoperative high care unit (HCU) management between 2013 and 2021. Frailty was defined as an mFI-5 score of ≥2. Clinical characteristics, postoperative outcomes, HCU stay, length of hospital stay, overall survival (OS), and disease-free survival (DFS) were compared between frail and non-frail groups. Univariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for postoperative complications. An exploratory multivariable logistic regression analysis for postoperative delirium was performed using age ≥65 years and sex as covariates. Delirium was retrospectively assessed from clinical documentation considered consistent with DSM-5 criteria. Results: Twenty-one patients (16.5%) were classified as frail. Postoperative delirium occurred more frequently in frail patients than in non-frail patients (42.9% vs. 19.8%; p = 0.023). In a multivariable logistic regression model adjusted for age ≥65 years and sex, mFI-5-defined frailty was significantly associated with postoperative delirium (adjusted OR, 3.07; 95% CI, 1.08–8.60; p = 0.035). No significant association was observed for pneumonia, surgical site infection, or free-flap reoperation. Frailty was not significantly associated with HCU stay, length of hospital stay, OS, or DFS. Conclusions: mFI-5-defined frailty was associated with postoperative delirium but not with survival outcomes in this OSCC cohort. Because this retrospective study was limited by sample size, comorbidity-driven mFI-5 scoring, non-standardized delirium screening, and potential residual confounding, mFI-5 should be interpreted as a convenient screening marker rather than a stand-alone predictor. Comprehensive perioperative assessment incorporating frailty, nutrition, sarcopenia, cognition, tumor burden, and treatment-related factors may better identify patients at risk. Full article

(This article belongs to the Special Issue Recent Advances in Oral and Maxillofacial Surgery: Diagnosis and Management)

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15 pages, 1037 KB

Open AccessArticle

A Risk Scoring System Integrating Clinical and Ultrasonographic Parameters for Predicting Hypothyroidism After Hemithyroidectomy

by Yusuf Öztürk, Hatice Erdoğan Özbuğday, Zuhal Dağ and Muhammet Kocabaş

Diagnostics 2026, 16(16), 2550; https://doi.org/10.3390/diagnostics16162550 - 13 Aug 2026

Abstract

Background/Objectives: Postoperative hypothyroidism is a common complication following hemithyroidectomy and may necessitate lifelong levothyroxine replacement therapy. Although several clinical predictors have been identified, clinically applicable risk models integrating both clinical and ultrasonographic parameters remain limited. This study aimed to identify independent predictors [...] Read more.

Background/Objectives: Postoperative hypothyroidism is a common complication following hemithyroidectomy and may necessitate lifelong levothyroxine replacement therapy. Although several clinical predictors have been identified, clinically applicable risk models integrating both clinical and ultrasonographic parameters remain limited. This study aimed to identify independent predictors of postoperative hypothyroidism and to develop practical risk scoring systems with and without ultrasonographic parameters based on these predictors. Methods: This observational cohort study included 95 patients who underwent hemithyroidectomy and were followed for at least 6 months. Clinical characteristics, thyroid autoantibodies, and ultrasonographic features of the remnant thyroid lobe were evaluated. Independent predictors of postoperative hypothyroidism were identified using multivariable logistic regression analysis, and two simplified risk scoring systems were developed based on the regression coefficients. Results: Postoperative hypothyroidism developed in 39 of the 95 patients (41.1%). In the model incorporating ultrasonographic parameters, preoperative TSH, a low remnant thyroid volume-to-body surface area ratio, and heterogeneous remnant thyroid parenchyma were independent predictors of postoperative hypothyroidism. The corresponding score stratified patients into low-, intermediate-, and high-risk categories with observed hypothyroidism rates of 9.1%, 44.7%, and 100.0%, respectively, and showed an AUC of 0.858. In the model without ultrasonographic parameters, preoperative TSH and thyroid autoantibody positivity were independent predictors; the corresponding score showed an AUC of 0.745. Conclusions: The proposed risk scoring systems may serve as practical tools for identifying patients at increased risk of postoperative hypothyroidism following hemithyroidectomy according to the availability of ultrasonographic assessment. External validation in independent cohorts is warranted before routine clinical implementation. Full article

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

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20 pages, 2356 KB

Open AccessCase Report

Paraneoplastic Neurological Syndromes Associated with Ovarian Tumors: A Case Report and Systematic Review

by Adrianna Zahorowska, Edyta Śliwak, Natalia Lerch, Karolina Engel-Eliasz, Adriana Szczęch, Mariola Krzyścin, Piotr Hajdasz, Aleksandra Marciniak, Agnieszka Brodowska, Andrzej Starczewski and Iwona Szydłowska

Diagnostics 2026, 16(16), 2549; https://doi.org/10.3390/diagnostics16162549 - 12 Aug 2026

Abstract

Paraneoplastic neurological syndromes are rare immune-mediated disorders that may represent the first clinical manifestation of an underlying tumor. This report describes a 58-year-old woman with rapidly progressive cerebellar dysfunction and anti-Yo antibodies in serum and cerebrospinal fluid. Definite PNS was diagnosed according to [...] Read more.

Paraneoplastic neurological syndromes are rare immune-mediated disorders that may represent the first clinical manifestation of an underlying tumor. This report describes a 58-year-old woman with rapidly progressive cerebellar dysfunction and anti-Yo antibodies in serum and cerebrospinal fluid. Definite PNS was diagnosed according to the PNS-Care Score criteria (score: 10/10). Oncological evaluation revealed FIGO IIIC high-grade serous ovarian carcinoma (HGSOC) with extensive peritoneal dissemination. Despite corticosteroids, cytoreductive surgery, and carboplatin–paclitaxel chemotherapy, neurological disability progressed, although tumor control was achieved. A PRISMA-guided review of PubMed and Scopus identified 33 studies of PNSs associated with ovarian tumors published between 2016 and 2026. Anti-NMDAR encephalitis, mainly associated with ovarian teratomas, generally showed favorable recovery, whereas anti-Yo-associated cerebellar degeneration, predominantly linked to epithelial ovarian malignancies, had poor neurological outcomes. Prompt antibody testing, oncological investigation, and multidisciplinary treatment are essential, although anti-Yo-associated neurological deficits may be irreversible. Full article

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

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30 pages, 2852 KB

Open AccessReview

Myocardial Function Assessment After Cardioversion in Persistent Atrial Fibrillation: Current Evidence and Future Directions

by Emma Sokolova, Ainārs Rudzītis and Oskars Kalējs

Diagnostics 2026, 16(16), 2548; https://doi.org/10.3390/diagnostics16162548 - 12 Aug 2026

Abstract

Background/Objectives: Persistent atrial fibrillation (AF) is associated with complex structural, electrical, and functional myocardial remodeling that contributes to impaired cardiac performance, symptom burden, and adverse cardiovascular outcomes. Although restoration of sinus rhythm through electrical cardioversion remains a cornerstone of rhythm-control therapy, treatment [...] Read more.

Background/Objectives: Persistent atrial fibrillation (AF) is associated with complex structural, electrical, and functional myocardial remodeling that contributes to impaired cardiac performance, symptom burden, and adverse cardiovascular outcomes. Although restoration of sinus rhythm through electrical cardioversion remains a cornerstone of rhythm-control therapy, treatment success is traditionally defined by rhythm maintenance and recurrence rates, while myocardial functional recovery receives substantially less attention. This review aims to summarize current evidence regarding myocardial dysfunction in persistent AF, evaluate available approaches for assessing myocardial recovery after cardioversion, and explore future directions for function-guided rhythm-control strategies. Methods: A narrative review of contemporary literature was performed, focusing on studies published in major cardiovascular journals and current international guidelines. Evidence regarding myocardial remodeling, reverse remodeling after restoration of sinus rhythm, echocardiographic assessment, myocardial strain imaging, biomarker dynamics, and post-cardioversion management strategies was synthesized and critically evaluated. Results: Persistent AF induces multidimensional myocardial dysfunction through tachycardia-mediated injury, structural remodeling, neurohormonal activation, inflammation, and fibrosis. Emerging evidence suggests that restoration of sinus rhythm may initiate a process of reverse remodeling characterized by improvements in left ventricular systolic function, global longitudinal strain, atrial mechanical performance, and biomarker profiles. Advanced echocardiographic techniques and serial biomarker assessment provide valuable opportunities to quantify myocardial recovery beyond conventional rhythm-based endpoints. However, current clinical practice and guideline-directed management remain predominantly focused on rhythm outcomes, while functional recovery is not routinely incorporated into therapeutic decision-making. Based on available evidence, a conceptual framework termed the “Post-Cardioversion Functional Window” is proposed to describe a period of potentially enhanced myocardial recovery during which systematic functional assessment may facilitate individualized management and future risk stratification. Conclusions: Myocardial recovery after restoration of sinus rhythm represents an underrecognized component of contemporary AF management. Integration of echocardiographic, biomarker-based, and clinical functional assessment may improve understanding of post-cardioversion remodeling and support the development of personalized rhythm-control strategies. Future prospective studies are needed to validate myocardial recovery endpoints and determine their role in guiding therapeutic decisions after cardioversion. Full article

(This article belongs to the Special Issue Advances in Non-Invasive Diagnostic Technologies for Heart Diseases)

23 pages, 2709 KB

Open AccessReview

Diagnostic Value and Operational Recommendations for Late Iodine Enhancement and ECV Quantification in Single-Energy Computed Tomography: A Narrative Review

by Simone Steffani, Mariagrazia Piscione, Dario Gaudio, Giorgia Meghnagi, Viviana Montella, Francesco Fiorini, Andrea Micillo, Corrado Tagliati, Luigi Asmundo, Guglielmo Manenti, Marcello Chiocchi and Mario Laudazi

Diagnostics 2026, 16(16), 2547; https://doi.org/10.3390/diagnostics16162547 - 12 Aug 2026

Abstract

While traditionally focused on coronary anatomy, cardiac computed tomography now enables non-invasive myocardial tissue characterization. By evaluating late iodine enhancement (LIE) and extracellular volume (ECV), single-energy CT (SECT) provides a valuable alternative to cardiac magnetic resonance for assessing ischemic and non-ischemic pathologies. However, [...] Read more.

While traditionally focused on coronary anatomy, cardiac computed tomography now enables non-invasive myocardial tissue characterization. By evaluating late iodine enhancement (LIE) and extracellular volume (ECV), single-energy CT (SECT) provides a valuable alternative to cardiac magnetic resonance for assessing ischemic and non-ischemic pathologies. However, clinical implementation of SECT faces technical challenges, primarily the low contrast-to-noise ratio (CNR) of iodine and the reliance on image subtraction for ECV quantification, both of which increase radiation exposure and susceptibility to spatial misregistration. To address these issues, protocol optimization is essential. Evidence-based recommendations include using low tube voltages to shift the X-ray spectrum closer to the iodine K-edge, paired with high reference tube currents. Additionally, delayed acquisition timing should be tailored to specific pathological targets to account for differences in contrast kinetics, and advanced iterative or deep learning image reconstructions should be implemented to mitigate noise. Optimized SECT demonstrates diagnostic and prognostic utility in conditions like acute myocardial infarction, hypertrophic cardiomyopathy, cardiac amyloidosis, and left ventricular thrombus detection. While spectral imaging represents the future, optimizing SECT through technical adjustments and standardized training is crucial for integrating myocardial characterization into routine workflows. Full article

(This article belongs to the Special Issue Computed Tomography Imaging in Medical Diagnosis, Third Edition)

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17 pages, 2220 KB

Open AccessArticle

Multimodal MRI Characterization of Structural and Resting-State Functional Brain Alterations in Patients with Low Back Pain: A Retrospective Study

by Xiaopei Sun, Yazhou Lin, Jing Zhang, Weihuan Fang, Zhe Chen, Peng Cao and Yuehuan Zheng

Diagnostics 2026, 16(16), 2546; https://doi.org/10.3390/diagnostics16162546 - 12 Aug 2026

Abstract

Background/Objectives: Low back pain (LBP) is associated with central alterations, but convergence across structural, functional, and network measures remains unclear. We characterized multimodal differences. Methods: Resting-state fMRI included 69 participants (37 patients, 32 controls); VBM retained 23 patients and 32 controls after structural-image [...] Read more.

Background/Objectives: Low back pain (LBP) is associated with central alterations, but convergence across structural, functional, and network measures remains unclear. We characterized multimodal differences. Methods: Resting-state fMRI included 69 participants (37 patients, 32 controls); VBM retained 23 patients and 32 controls after structural-image quality control. Structural, local functional, and thalamic-connectivity measures were assessed. Motion control used realignment-based exclusion and Friston-24 nuisance regression. Mean Power framewise displacement was additionally calculated for all participants and compared between groups, and VBM-retained and excluded patients were compared. Models adjusted for age and sex, plus total intracranial volume for VBM. Directional maps underwent one-tailed Gaussian random field correction (voxel p < 0.001; cluster p < 0.05), without cross-direction or cross-family correction. Extracted-value and imaging–clinical analyses were exploratory. Results: Mean framewise displacement did not differ between groups. Patients showed lower gray matter volume in thalamic–hippocampal regions and right cerebellar lobule VIII and lower local functional measures in thalamic, orbitofrontal–striatal, and right temporal regions. Thalamic connectivity with sensorimotor, parietal, supplementary motor, and middle cingulate regions was higher. Nominal analyses showed positive left thalamic connectivity cluster 1–VAS and negative left cluster 1–JOA and right clusters 1/2–JOA; none survived false-discovery-rate correction. Conclusions: Multimodal MRI delineated lower thalamic structural and local functional measures alongside higher thalamo-sensorimotor and thalamo-parietal connectivity. Nominal, directionally coherent clinical associations remain hypothesis-generating. This thalamus-centered pattern warrants replication in prospectively matched, clinically stratified cohorts. Full article

(This article belongs to the Special Issue Multimodal Imaging in Clinical Diagnostics: Advances and Perspectives)

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