Diagnostics

20 pages, 31191 KiB

Open AccessGuidelines

Best Practices for the Use of High-Frequency Ultrasound to Guide Esthetic Filler Injections—Part 3: Lower Third of the Face

by Roberta Vasconcelos-Berg, Stella Desyatnikova, Paula Bonavia, Alexander Navarini, Maria Cristina Chammas and Rosa Sigrist

Diagnostics 2025, 15(7), 921; https://doi.org/10.3390/diagnostics15070921 - 2 Apr 2025

Abstract

Background: The lower third of the face plays a crucial role in overall facial harmony, and age-related volume loss in areas such as the pre-jowl region, labiomental folds, and lips can significantly impact esthetic appearance. High-resolution ultrasound is helpful for identifying key structures, [...] Read more.

Background: The lower third of the face plays a crucial role in overall facial harmony, and age-related volume loss in areas such as the pre-jowl region, labiomental folds, and lips can significantly impact esthetic appearance. High-resolution ultrasound is helpful for identifying key structures, such as the facial artery, parotid gland, and masseter muscle, which are critical to avoid during filler injections. Objectives: This article, the final installment in a three-part series on ultrasound-guided facial injections, provides an in-depth analysis of the sonographic anatomy of the lower face, including the mandibular, marionette, and chin regions. Methods: This article outlines step-by-step techniques for ultrasound-guided filler procedures, with a focus on the importance of pre- and intra-procedural scanning to ensure safe and accurate filler placement. Results: By employing techniques like “scan before injecting” and “scan while injecting”, injectors aim to reduce risks such as vascular occlusion, muscle injection, and skin necrosis. Discussion: The use of ultrasound guidance in these regions enhances both esthetic outcomes and patient safety, providing optimal results while minimizing complications. With continued advancements, ultrasound-guided injections will become increasingly precise, enabling more targeted and safer treatments in the lower face. Full article

(This article belongs to the Special Issue Ultrasound in the Diagnosis and Management of Skin Diseases)

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19 pages, 5166 KiB

Open AccessArticle

Federated Learning-Based CNN Models for Orthodontic Skeletal Classification and Diagnosis

by Demet Süer Tümen and Mehmet Nergiz

Diagnostics 2025, 15(7), 920; https://doi.org/10.3390/diagnostics15070920 - 2 Apr 2025

Abstract

Background/Objectives: Accurate skeletal classification is essential for orthodontic diagnosis. This study evaluates the effectiveness of federated convolutional neural network (CNN) models for skeletal classification using cephalometric images from the ISBI and Dicle datasets. This research aims to evaluate the effectiveness of federated learning [...] Read more.

Background/Objectives: Accurate skeletal classification is essential for orthodontic diagnosis. This study evaluates the effectiveness of federated convolutional neural network (CNN) models for skeletal classification using cephalometric images from the ISBI and Dicle datasets. This research aims to evaluate the effectiveness of federated learning (FL) for orthodontic skeletal classification by comparing its performance against centralized learning (CL) and local learning (LL). The objective is to determine whether FL can achieve competitive performance while preserving data privacy and enabling collaborative model training across multiple institutions. Methods: The DenseNet121 model and its augmented versions, incorporating channel attention, spatial attention, squeeze and excitation, and spatial pyramid pooling blocks, are proposed and adapted for the study. Models are evaluated on the ISBI and Dicle datasets using accuracy, sensitivity, and specificity metrics, with performance gains benchmarked across CL, LL, and FL frameworks. Results: Accuracy improvements exceed 26% compared to the baseline model on FL framework. The DenseNet121_SA model, augmented with spatial pyramid pooling blocks, achieves a 20.86% performance gain over LL settings on the ISBI dataset. Similarly, the DenseNet121_SA model, augmented with spatial attention, and DenseNet121_SA_SE model, augmented with spatial attention and squeeze and excitation, obtain 16.58% and 15.22% by not sacrificing performance loss with respect to CL. The inclusion of the Dicle dataset provides additional validation for the models. Conclusions: Federated CNN models exhibit significant promise for orthodontic skeletal classification. These models demonstrate the potential of FL to enhance collaborative model training while preserving data privacy. This approach represents a step forward in leveraging precise orthodontic diagnostics technology by enabling a data-secure collaborative artificial intelligence among various orthodontic clinics. Full article

(This article belongs to the Special Issue Artificial Intelligence in the Diagnostics of Dental Diseases, 2nd Edition)

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24 pages, 979 KiB

Open AccessReview

Ultrasound of Bile Ducts—An Update on Measurements, Reference Values, and Their Influencing Factors: A Scoping Review

by Claudia Lucius, Anja Flückinger, Jennifer Meier, Kathleen Möller, Christian Jenssen, Barbara Braden, Michael Kallenbach, Benjamin Misselwitz, Christian Nolsøe, Michael Sienz, Constantinos Zervides and Christoph Frank Dietrich

Diagnostics 2025, 15(7), 919; https://doi.org/10.3390/diagnostics15070919 - 2 Apr 2025

Abstract

Objective: To provide an overview of the technique and normal values of ultrasound studies of the bile system based on the published literature. Methods: A literature search for ultrasound studies with measurements of the bile ducts in healthy subjects was performed. Relevant data [...] Read more.

Objective: To provide an overview of the technique and normal values of ultrasound studies of the bile system based on the published literature. Methods: A literature search for ultrasound studies with measurements of the bile ducts in healthy subjects was performed. Relevant data published between 1975 and end of 2024 were extracted, discussed, and complemented with the own experiences of the authors. The clinical implications are presented and discussed. Results: For the diameter of the common bile duct, reference values between 5 and 9 mm have been published. The main influencing factors are age and history of cholecystectomy, and other factors to be considered are discussed here. The cut-off for the common bile duct wall is set at 1.5 mm. The literature on measurements of intrahepatic bile ducts is scarce. A diameter of <2–3 mm can be considered normal. The method of ultrasound examination is presented here, as well as a comparison with other imaging methods and their clinical implications. Discussion: Standardized measurement techniques and normal values in the context of influencing factors are crucial for the ultrasound examination of the bile system. Full article

(This article belongs to the Special Issue Imaging Diagnosis in Abdomen, 2nd Edition)

12 pages, 1495 KiB

Open AccessArticle

Phenotypes and Genotypes of Children with Vitamin D-Dependent Rickets Type 1A: A Single Tertiary Pediatric Center in Vietnam

by Thi Anh Thuong Tran, Tran Minh Dien, Ngoc Lan Nguyen, Khanh Ngoc Nguyen, Thi Bich Ngoc Can, Bui Phuong Thao, Nguyen Thi Thuy Hong, Van Khanh Tran, Thinh Huy Tran, Ngo Xuan Khoa, Nguyen Thi Kim Lien, Nguyen Thien Tao, Huy Hoang Nguyen and Chi Dung Vu

Diagnostics 2025, 15(7), 918; https://doi.org/10.3390/diagnostics15070918 - 2 Apr 2025

Abstract

Background: Vitamin D-dependent rickets type 1A (VDDR1A) is a rare autosomal recessive disorder caused by mutations in the CYP27B1 gene, leading to a deficiency in active vitamin D (1,25-dihydroxyvitamin D). This study examines the genotypic and phenotypic characteristics of VDDR1A in Vietnamese [...] Read more.

Background: Vitamin D-dependent rickets type 1A (VDDR1A) is a rare autosomal recessive disorder caused by mutations in the CYP27B1 gene, leading to a deficiency in active vitamin D (1,25-dihydroxyvitamin D). This study examines the genotypic and phenotypic characteristics of VDDR1A in Vietnamese children. Patients and Methods: A retrospective analysis was conducted on 19 Vietnamese children diagnosed with VDDR1A. Clinical, radiological, biochemical, and molecular data were collected. Rickets Severity Scores (RSSs), biochemical parameters, and height standard deviation scores (HtSDSs) were used to assess the severity of the condition. Results: The study included 19 children from 17 families (ten males and nine females). The median age of rickets diagnosis was 19.2 months, while with VDDR1A, the median time of diagnosis was 7.5 months. Common symptoms among the children included thickened wrists and ankles (19/19), genu varum or genu valgum (18/19), failure to thrive (18/19), rachitic rosary (12/19), and delayed walking (11/19). The radiographic features showed that all children had cupping, splaying, and fraying, twelve children had rachitic rosary, and six exhibited pseudofractures. The biochemical findings showed severe hypocalcemia, normal or mildly low serum phosphate, elevated alkaline phosphatase and parathyroid hormone levels, and normal serum 25-hydroxyvitamin D levels. Genetic analysis identified biallelic CYP27B1 variants, including one known pathogenic frameshift mutation, c.1319_1325dup p.(Phe443Profs*24), one novel likely pathogenic missense variant, c.616C>T p.(Arg206Cys), and one novel pathogenic frameshift mutation, c.96_97del p.(Ala33Thrfs*299). The c.1319_1325dup p.(Phe443Profs*24) variant was the most common, present in 18 out of 19 children. Conclusions: The children with VDDR1A in this study presented with growth failure and skeletal deformities. Key findings included severe hypocalcemia, elevated alkaline phosphatase and parathyroid hormone levels, normal or elevated 25(OH)D, and high RSSs. Predominant frameshift mutations in CYP27B1, especially c.1319_1325dup, highlighted the importance of early genetic diagnosis for optimal management. Additionally, two novel CYP27B1 variants were identified, expanding the known mutation spectrum of VDDR1A. Full article

(This article belongs to the Special Issue Diagnosis and Management of Metabolic Bone Diseases: 2nd Edition)

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10 pages, 1230 KiB

Open AccessArticle

Surgical Management of Sacral Bone Tumors: A Retrospective Analysis of Outcomes, Complications, and Survival

by Chiara Cini, Emanuela Asunis, Cristiana Griffoni, Gisberto Evangelisti, Giuseppe Tedesco, Riccardo Ghermandi, Marco Girolami, Valerio Pipola, Silvia Terzi, Giovanni Barbanti Brodano, Stefano Bandiera, Stefano Boriani and Alessandro Gasbarrini

Diagnostics 2025, 15(7), 917; https://doi.org/10.3390/diagnostics15070917 - 2 Apr 2025

Abstract

Background: Primary malignant bone tumors are exceedingly rare, with an incidence of 0.5 to 1 per million, and sacral localization is even more uncommon, representing only 1–3.5% of these tumors. These malignancies are often diagnosed late due to their asymptomatic nature until [...] Read more.

Background: Primary malignant bone tumors are exceedingly rare, with an incidence of 0.5 to 1 per million, and sacral localization is even more uncommon, representing only 1–3.5% of these tumors. These malignancies are often diagnosed late due to their asymptomatic nature until they present as large, advanced intrapelvic tumors. Management is complicated by the need for precise surgical intervention and the consideration of adjuvant therapies based on tumor histology and patient factors. Methods: We conducted a single-center, retrospective analysis of patients who underwent complete, partial, or hemisacrectomy for primary malignant bone tumors or recurrent sacral metastases. Excluded were patients with metastatic disease not necessitating sacrectomy. Data collected included demographics, clinical characteristics, tumor types, resection status, adjuvant therapies, recurrence, metastasis, and complications. Surgical approaches were categorized as posterior, anterior, or combined anterior–posterior. The primary outcomes were overall survival and disease-free survival, while the secondary outcomes focused on complication rates and functional outcomes. Results: The study included 19 patients (7 females, 12 males) with a mean age of 48.9 years at the time of surgery. Primary malignancies were present in 90% of patients. Surgical approaches varied: 20% underwent double access and 5% anterior access only, and the remainder had posterior approaches. High partial sacrectomy (above S3) was performed in 20%, while low sacrectomy (at or below S3) was performed in 80%. Complete resection with clean margins (R0) was achieved in 65% of cases, while 35% had R1 resections with microscopic tumor remnants. Root resection was necessary in 25% of patients. Local recurrence occurred in 25% of patients, with two requiring reoperation and neurological sacrifice. Distant metastases were observed in 20% of cases. Postoperative complications affected 60% of patients. The most common issues were surgical wound dehiscence with delayed healing (35%) and visceral changes affecting the bowel and urination (25%). No mechanical complications were reported. Conclusions: Sacrectomy remains a challenging procedure with substantial morbidity and variability in outcomes. The choice of surgical approach—posterior, anterior, or combined—depends on tumor location and extent. While posterior-only approaches are often preferred for lower sacral lesions, combined approaches may be necessary for more extensive tumors. Survival and disease-free survival rates are influenced by resection margins and the biological behavior of the tumor. Wide-margin resections (R0) are associated with lower local recurrence rates but do not eliminate the risk of distant metastases. Full article

(This article belongs to the Special Issue Diagnosis and Management of Soft Tissue and Bone Tumors)

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15 pages, 1743 KiB

Open AccessArticle

Identification of Eye Diseases Through Deep Learning

by Elena Acevedo, Dinora Orantes, Marco Acevedo and Ricardo Carreño

Diagnostics 2025, 15(7), 916; https://doi.org/10.3390/diagnostics15070916 - 2 Apr 2025

Abstract

Background: Ocular diseases have been a severe problem worldwide, specifically in underdeveloped countries that do not have enough technology or economy to treat them. It would be beneficial to have software with low installation complexity and ease of use, allowing high efficacy [...] Read more.

Background: Ocular diseases have been a severe problem worldwide, specifically in underdeveloped countries that do not have enough technology or economy to treat them. It would be beneficial to have software with low installation complexity and ease of use, allowing high efficacy in diagnosing eye diseases. This study aims to design and implement an algorithm based on deep learning to classify ocular diseases with high precision. Methods: This work describes digital image processing techniques for the easier handling of eye images; in particular, blur filters were used. The Canny filter was also applied to obtain the edges that allow the difference between the analyzed diseases. Once the images were pre-processed, a convolutional neural network of our own design was applied to perform the classification task. The validation algorithm used in this work was the hold-out algorithm (80–20). The metrics used to evaluate our proposal were the confusion matrix, accuracy, recall precision, and F1-score. Results: The dataset has five classes, namely, normal, cataract, diabetic retinopathy, glaucoma, and other retina diseases. The network architecture consists of 11 layers, including three convolutional layers, three max pooling layers, one batch normalization layer, one flattening layer, two hidden layers, and one output layer. This model resulted in 97% efficiency across all metrics. Conclusions: With the individual analysis of each metric, it can be observed that the proposed algorithm is capable of differentiating, first, images of healthy eyes from diseased ones and, second, adequately classifying eye diseases. Full article

(This article belongs to the Special Issue Updates on the Diagnosis and Management of Retinal Diseases)

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13 pages, 1052 KiB

Open AccessArticle

Sex Bias in Frailty Screening: A Cross-Sectional Analysis of PRISMA-7 and the Clinical Frailty Scale in Primary Care

by Christian J. Wiedermann, Verena Barbieri, Dietmar Ausserhofer, Adolf Engl, Giuliano Piccoliori and Angelika Mahlknecht

Diagnostics 2025, 15(7), 915; https://doi.org/10.3390/diagnostics15070915 - 2 Apr 2025

Abstract

Background/Objectives: Frailty screening is essential in primary care for the early identification of vulnerable older adults. PRISMA-7 is a widely used screening tool, but Item 2 (“Are you male?”) introduces potential sex bias and overestimates frailty in men. PRISMA-6, a modified version [...] Read more.

Background/Objectives: Frailty screening is essential in primary care for the early identification of vulnerable older adults. PRISMA-7 is a widely used screening tool, but Item 2 (“Are you male?”) introduces potential sex bias and overestimates frailty in men. PRISMA-6, a modified version that excludes Item 2, might provide a more equitable alternative. This study evaluates PRISMA-6’s alignment with the Clinical Frailty Scale (CFS) and its impact on sex-specific frailty classification. Methods: A cross-sectional study was conducted in 142 general practices across South Tyrol, including 9190 general practice patients aged ≥75 years. Frailty was assessed using PRISMA-7, PRISMA-6, and the CFS. Correlations between tools were calculated using Kendall’s Tau-b, whereas Fisher’s z-test was used to compare differences in alignment. The frailty prevalence and odds ratios were stratified according to sex and age. Results: PRISMA-6 showed a stronger correlation with the CFS (τ = 0.492) than PRISMA-7 (τ = 0.308, z = −10.2, p < 0.001). This effect was pronounced in men (z = −9.8, p < 0.001), whereas no difference was observed in women (z = 0.00, p = 1.000). PRISMA-6 reduced the frailty detection rate in men and was more closely aligned with the CFS. Conclusions: PRISMA-6 demonstrated improved alignment with the CFS and reduced sex bias compared to PRISMA-7. However, its use as a screening tool for men requires prospective validation in diverse settings. PRISMA-6 shows promise as a reliable and equitable frailty screening tool and should be considered for use in future studies, particularly in primary care settings, while awaiting further prospective validation. Full article

(This article belongs to the Special Issue Risk Factors for Frailty in Older Adults)

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26 pages, 15080 KiB

Open AccessArticle

Mesopancreas—Anatomical Insights and Its Implications for Diagnosis and Clinical and Surgical Practice

by Florin-Mihail Filipoiu, Georgian-Theodor Badea, Mihaly Enyedi, Ștefan Oprea, Zoran-Florin Filipoiu and Daniela-Elena Gheoca Mutu

Diagnostics 2025, 15(7), 914; https://doi.org/10.3390/diagnostics15070914 - 2 Apr 2025

Abstract

Background: The concept of mesopancreas is frequently discussed in the surgical literature as the neural pathway for metastatic spread in pancreatic head cancer. It generally refers to a retro-pancreatic plane that should be resected to reduce the incidence of regional metastases. However, this [...] Read more.

Background: The concept of mesopancreas is frequently discussed in the surgical literature as the neural pathway for metastatic spread in pancreatic head cancer. It generally refers to a retro-pancreatic plane that should be resected to reduce the incidence of regional metastases. However, this concept remains poorly defined, both embryologically and anatomically. Our objective was to establish a clear embryological and anatomical definition of the mesopancreas, making anatomical data more applicable in surgical practice. Methods: We examined seven cadavers (5 males, 2 females, aged 62–71) with no medical or surgical history, preserved in 9% formalin at Carol Davila University’s Anatomy Department. Regional dissections were performed in successive planes, highlighting the celiac ganglia and the associated network of neural connections that comprise the mesopancreas. Results: Our study defines the “mesopancreas” as remnants of primordial mesenteries that coalesced into the Treitz fascia. We identified its functional components as nerve fibers linking the celiac ganglia and superior mesenteric plexus to the pancreas, along with vascular structures, lymphatics, and connective and adipose tissue. These components likely contribute to regional metastasis in pancreatic head cancer. While resection of the mesopancreas could help prevent metastasis, its complex anatomy and proximity to major vessels pose significant surgical challenges. Conclusions: Based on our findings, we propose a plausible definition for the term “mesopancreas”. It encompasses the structures that originated as part of the primordial mesenteries, which subsequently coalesced, resulting in the formation of the Treitz fascia. In essence, the mesopancreas is the functional content of a former mesentery. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

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19 pages, 4144 KiB

Open AccessArticle

Assessment of Immunoscore, MRI Tumor Regression Grade, and Neoadjuvant Rectal Score in Predicting Pathologic Response in Locally Advanced Rectal Cancer in the Averectal Study

by Mustafa Natout, Ahmad Machmouchi, Hero Hussain, Laudy Chehade, Noura Abbas, Rim Turfa, Joseph Kattan, Sally Temraz, Ayman Tawil, Mousa Elkhaldi, Omar Jaber, Rula Amarin, Tala Alawabdeh, Maya Charafeddine, Monita Al Darazi and Ali Shamseddine

Diagnostics 2025, 15(7), 913; https://doi.org/10.3390/diagnostics15070913 - 2 Apr 2025

Abstract

Background/Objectives: Predictive tools are needed to assess the response to treatment and guide treatment decisions for locally advanced rectal cancer (LARC). This study explores the value of combining the immunoscore (IS) and magnetic resonance imaging tumor regression grade (mrTRG) with pathologic and [...] Read more.

Background/Objectives: Predictive tools are needed to assess the response to treatment and guide treatment decisions for locally advanced rectal cancer (LARC). This study explores the value of combining the immunoscore (IS) and magnetic resonance imaging tumor regression grade (mrTRG) with pathologic and radiologic neoadjuvant rectal (NAR) scores in predicting pathologic complete response (pCRs). Methods: The scores were assessed for patients with LARC enrolled in the Averectal study (NCT03503630), who received five fractions of short-course radiotherapy, followed by six cycles of mFOLFOX-6 plus avelumab, and total mesorectal excision. The IS was calculated using the mean density percentiles of CD3- and CD8-positive T-cells on baseline biopsy samples. Baseline and post-treatment MRIs were reviewed to measure the mrTRG. NAR scores were calculated using the pre-treatment T stage and post-treatment pathologic and radiologic N and T stages. Results: Fifteen out of thirty-five patients whose data were available achieved pCR (42.8%), and seven out of fourteen patients with mrTRG = 1 (complete response) attained pCR. In patients with both a mrTRG = 1 and high IS, the pCR rate was 66.7% (6/9). All of the patients who achieved pCR had a low or intermediate pathologic NAR score with a significant correlation between pCR and pathologic NAR scores (p < 0.0001). Both pathologic and radiologic NAR scores were correlated with overall survival and disease-free survival. Conclusions: The IS can supplement the mrTRG to better predict TNT outcomes, along with the use of the NAR score. This combination could potentially help with patient selection for non-operative management and guide treatment strategies for those with different recurrence risks. Full article

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

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13 pages, 3601 KiB

Open AccessArticle

Visual Field Improvement by Standardized Automated Perimetry Following Panmacular Subthreshold Diode Micropulse Laser (SDM) in Open-Angle Glaucoma and Other Optic Atrophies

by Jeffrey K. Luttrull and Sathy V. Bhavan

Diagnostics 2025, 15(7), 912; https://doi.org/10.3390/diagnostics15070912 - 2 Apr 2025

Abstract

Purpose: To assess the effect of subthreshold diode micropulse laser (SDM) on visual fields (VF) by standardized automated perimetry (SAP) in open-angle glaucoma (OAG) and other non-glaucomatous optic atrophies (OA). Methods: The electronic medical records in a vitreoretinal practice were searched to identify [...] Read more.

Purpose: To assess the effect of subthreshold diode micropulse laser (SDM) on visual fields (VF) by standardized automated perimetry (SAP) in open-angle glaucoma (OAG) and other non-glaucomatous optic atrophies (OA). Methods: The electronic medical records in a vitreoretinal practice were searched to identify the cohort of eyes with OAG and OA that underwent SAP before and after the initial SDM meeting study inclusion and exclusion criteria. Recorded data included mean deviation (MD), mean sensitivity (MS), and pattern standard deviation (PSD) before and after treatment. Results: A total of 55 eyes of 29 patients, 17 female, aged 62–89 years (avg. 76), with 48 eyes having OAG and 7 with OA, were included in the study. All SAP tests were performed the same day prior to the first SDM treatment, and the postop SAP within one month post-treatment. There were three groups: 36 total treated eyes, 14 treated simultaneously in both eyes prior to repeat SAP, and 22 treated in one eye prior to repeat SAP, along with 19 untreated fellow eye controls. Following SDM, MD and MS were significantly improved in all treated eyes and unilaterally treated eyes (p range 1.0 × 10⁻⁴ to 7.02 × 10⁻⁶). Untreated fellow eyes were also significantly improved (p = 0.03 for both MD and MS), but the MD and MS improvements in the treated eyes were significantly greater than untreated fellow eyes (p = 0.016 for both MD and MS). Conclusions: Panmacular SDM significantly improved VF by SAP in eyes with OAG and OA. This finding has important implications for management in both conditions. Full article

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

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17 pages, 10962 KiB

Open AccessArticle

Impact of Rectangular Collimation on Quality of Intraoral Radiographs: Findings from a Clinical Audit at a Dental Practice

by Lydia Vazquez, Anna Muresan and Cristina Zarauz

Diagnostics 2025, 15(7), 911; https://doi.org/10.3390/diagnostics15070911 - 2 Apr 2025

Abstract

Background/Objectives: Rectangular collimation (RC) reduces patient radiation exposure but is uncommonly used due to cone-cut concerns. An audit at a dental practice was conducted to analyze impact of RC on the quality of intraoral radiographs. Methods: Four X-ray tubes with RC [...] Read more.

Background/Objectives: Rectangular collimation (RC) reduces patient radiation exposure but is uncommonly used due to cone-cut concerns. An audit at a dental practice was conducted to analyze impact of RC on the quality of intraoral radiographs. Methods: Four X-ray tubes with RC were used. 360 intraoral X-rays were collected, blinded and scored to pre-set qualitative criteria: maximum 14 points for bitewing radiographs (BWs), and 13 for periapical radiographs (PAs). Quality of the X-rays was assessed. Results: We found that 48.1% were acceptable, 32.5% were unacceptable and only 19.4% were good X-rays. The loss of image quality was unrelated to RC. Three cone-cuts occurred in PAs without RC. The mean scores for PAs performed without or with RC were as follows: 9.3 +/− 1.9 points and 9.6 +/− 1.9 points, respectively (p = 0.166). The mean scores for BWs performed without or with RC were as follows: 8.0 +/− 1.9 points and 7.1 +/− 1.9 points, respectively (p < 0.001). All scores declined over time. Conclusions: This audit highlighted the need for refresher training on film-holder use and the importance of regular maintenance of dental X-ray equipment. Decline in X-ray quality over time was related to wear and tear of X-ray equipment, incorrect image contrast, and technical errors unrelated to RC. No cone-cuts occurred when using RC. Full article

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

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13 pages, 1323 KiB

Open AccessProtocol

Lung Elastance and Microvascularization as Quantitative Non-Invasive Biomarkers for the Aetiological Diagnosis of Lung Consolidations in Children (ELASMIC Study)

by Sergi Huerta-Calpe, Carmina Guitart, Josep Lluis Carrasco, Bárbara Salas, Francisco José Cambra, Iolanda Jordan and Mònica Balaguer

Diagnostics 2025, 15(7), 910; https://doi.org/10.3390/diagnostics15070910 - 2 Apr 2025

Abstract

Background: Acute lower respiratory tract conditions are highly prevalent in paediatrics. Many of these conditions present as consolidations on imaging studies. One of the most common causes is bacterial pneumonia (BP), which requires an accurate diagnosis to implement the best treatment plan. Despite [...] Read more.

Background: Acute lower respiratory tract conditions are highly prevalent in paediatrics. Many of these conditions present as consolidations on imaging studies. One of the most common causes is bacterial pneumonia (BP), which requires an accurate diagnosis to implement the best treatment plan. Despite the fact that major guidelines constrain the use of invasive tests, chest X-ray (CXR) or blood tests are still routinely used for the diagnosis. In this regard, the introduction of lung ultrasound (LUS) signified an advancement in reducing the invasiveness of diagnosis. However, there are still situations where distinguishing between different aetiologies remains challenging, especially in the case of atelectasis. Methods: This is a prospective cohort study to assess the diagnostic accuracy of new non-invasive, quantifiable, and reproducible imaging biomarkers (lung elastance and microvascularization ratio) for differentiating BP from another major entity that causes the appearance of consolidation in imaging tests, atelectasis. It will be conducted at Sant Joan de Déu Hospital in Spain from June 2025 to June 2027. Firstly, imaging biomarkers will be measured in well-aerated lung tissue without consolidation to establish their values in healthy lung tissue, according to a predefined imaging acquisition protocol. Subsequently, the imaging biomarkers will be assessed in patients with confirmed lung consolidation by LUS (Group 1: BP; Group 2: atelectasis). Results: The study aims to determine whether there are statistically significant differences in the biomarker values in relation to the normal values and between the different etiological groups. Conclusions: The demonstration of the reliable diagnostic accuracy of these biomarkers could significantly reduce the need for invasive techniques and improve the therapeutic management of many patients with BP and other pulmonary conditions presenting with consolidation in imaging tests. Full article

(This article belongs to the Special Issue Recent Developments and Future Trends in Thoracic Imaging)

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14 pages, 1103 KiB

Open AccessProtocol

The Prognostic Value of Transcutaneous Oxygen Pressure (TcPO₂) in Diabetic Foot Ulcer Healing: A Protocol for a Systematic Review

by Andrea Bordonado-Murcia, Javier Marco-Lledó, Pilar Nieto-Gil, Luz Marina Zuluaga-Ríos, Paloma López-Ros, Irene Hernández-Martínez, David Montoro-Cremades and Jonatan García-Campos

Diagnostics 2025, 15(7), 909; https://doi.org/10.3390/diagnostics15070909 - 2 Apr 2025

Abstract

Background/Objectives: Due to poor perfusion, diabetic foot ulcers (DFUs) create hypoxic environments, and their chronicity represents a negative factor in wound healing. Transcutaneous oxygen pressure (TcPO₂) is a non-invasive method that provides information on oxygen supply to microvascular circulation, useful for [...] Read more.

Background/Objectives: Due to poor perfusion, diabetic foot ulcers (DFUs) create hypoxic environments, and their chronicity represents a negative factor in wound healing. Transcutaneous oxygen pressure (TcPO₂) is a non-invasive method that provides information on oxygen supply to microvascular circulation, useful for determining the severity and progression of peripheral arterial disease (PAD) as well as potentially predicting DFU healing. However, the current literature does not provide strong support for the use of TcPO₂ as an independent predictive tool. Methods: This protocol aims to systematically review the available evidence according to PRISMA (2020) guidelines, registered with the International Prospective Register of Systematic Reviews (registration number: CRD42024505907). The following databases will be used: Cochrane Library, EMBASE, Ovid Medline, PubMed, and Web of Science. Additionally, a manual search will be conducted through the references of the included articles. Results: The systematic review will summarize the current evidence on the prognostic value of TcPO₂ in DFU healing, identifying gaps in knowledge and potential areas for future research. Conclusions: The findings of this study may clarify the prognostic value of TcPO₂ in DFU healing, which could ultimately facilitate clinical management, decision-making, patient care, and potentially reduce treatment costs. Full article

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

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33 pages, 20646 KiB

Open AccessReview

Clinical TNM Lung Cancer Staging: A Diagnostic Algorithm with a Pictorial Review

by Ivana Kuhtić, Tinamarel Mandić Paulić, Lucija Kovačević, Sonja Badovinac, Marko Jakopović, Margareta Dobrenić and Maja Hrabak-Paar

Diagnostics 2025, 15(7), 908; https://doi.org/10.3390/diagnostics15070908 - 1 Apr 2025

Abstract

Lung cancer is a prevalent malignant disease with the highest mortality rate among oncological conditions. The assessment of its clinical TNM staging primarily relies on contrast-enhanced computed tomography (CT) of the thorax and proximal abdomen, sometimes with the addition of positron emission tomography/CT [...] Read more.

Lung cancer is a prevalent malignant disease with the highest mortality rate among oncological conditions. The assessment of its clinical TNM staging primarily relies on contrast-enhanced computed tomography (CT) of the thorax and proximal abdomen, sometimes with the addition of positron emission tomography/CT scans, mainly for better evaluation of mediastinal lymph node involvement and detection of distant metastases. The purpose of TNM staging is to establish a universal nomenclature for the anatomical extent of lung cancer, facilitating interdisciplinary communication for treatment decisions and research advancements. Recent studies utilizing a large international database and multidisciplinary insights indicate a need to update the TNM classification to enhance the anatomical categorization of lung cancer, ultimately optimizing treatment strategies. The eighth edition of the TNM classification, issued by the International Association for the Study of Lung Cancer (IASLC), transitioned to the ninth edition on 1 January 2025. Key changes include a more detailed classification of the N and M descriptor categories, whereas the T descriptor remains unchanged. Notably, the N2 category will be split into N2a and N2b based on the single-station or multi-station involvement of ipsilateral mediastinal and/or subcarinal lymph nodes, respectively. The M1c category will differentiate between single (M1c1) and multiple (M1c2) organ system involvement for extrathoracic metastases. This review article emphasizes the role of radiologists in implementing the updated TNM classification through CT imaging for correct clinical lung cancer staging and optimal patient management. Full article

(This article belongs to the Special Issue Advances in Lung Cancer Diagnosis)

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12 pages, 714 KiB

Open AccessArticle

Predominance of Calcium Pyrophosphate Crystals in Synovial Fluid Samples of Patients at a Large Tertiary Center

by Tobias Manigold and Alexander Leichtle

Diagnostics 2025, 15(7), 907; https://doi.org/10.3390/diagnostics15070907 - 1 Apr 2025

Abstract

Background: Crystal arthritides represent the most common inflammatory rheumatologic condition. While the prevalence of gouty arthritis by monosodium urate (MSU) is well established, the prevalences of calciumpyrophosphat (CPP) and basic calcium pyrophosphate (ARP) arthritis are less clear. We herein sought to assess the [...] Read more.

Background: Crystal arthritides represent the most common inflammatory rheumatologic condition. While the prevalence of gouty arthritis by monosodium urate (MSU) is well established, the prevalences of calciumpyrophosphat (CPP) and basic calcium pyrophosphate (ARP) arthritis are less clear. We herein sought to assess the prevalence and inflammatory characteristics of crystal arthritides at our institution, the biggest tertiary center in Switzerland. Methods: A total of 5036 synovial fluid (SF) samples were analyzed with regard to crystal positivity as well as joint, age, and sex distribution in affected patients. We furthermore compared inflammatory and non-inflammatory SF samples for yields of their Polymorphonuclear (PMN) fractions. Results: About half of all samples were derived from knee joints, a male/female ratio up to 10.1:1 among the MSU-positive, and a clear shift towards elder patients with CPP–arthritis was seen. These findings were in line with previous studies and suggest good comparability of our cohort. Of note, 21.9% of all samples were CPP positive, whereas 15.3% and 9.5% were positive for MSU and ARP/alizarin-red positive, respectively. Importantly, CPP crystals were predominant in inflammatory (58.9%) and non-inflammatory (65.7%) samples. By contrast, MSU crystals were significantly more often associated with synovitis (p < 0.001). Interestingly, higher PMN fractions were found in non-inflammatory MSU-positive samples (p < 0.01), whereas a similar trend was seen in CPP-positive samples. Conclusions: CPP arthritis represented the most frequent crystal arthritis form at our center. Higher PMN fractions in non-inflammatory samples with CPP and MSU crystals suggest subclinical inflammation and provide further arguments for earlier anti-inflammatory and uric acid-lowering therapies in patients with crystal deposits. Full article

(This article belongs to the Section Clinical Laboratory Medicine)

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20 pages, 14752 KiB

Open AccessArticle

Multimodality Imaging Features of Papillary Renal Cell Carcinoma

by Rosita Comune, Francesco Tiralongo, Eleonora Bicci, Pietro Paolo Saturnino, Francesco Michele Ronza, Chandra Bortolotto, Vincenza Granata, Salvatore Masala, Mariano Scaglione, Giacomo Sica, Fabio Tamburro and Stefania Tamburrini

Diagnostics 2025, 15(7), 906; https://doi.org/10.3390/diagnostics15070906 - 1 Apr 2025

Abstract

Objectives: To describe the US, CEUS, CT, and MRI features of papillary renal cell carcinoma (PRCC) and to underline the imaging characteristics that are helpful in the differential diagnosis. Methods: Patients with histologically proven papillary renal cell carcinoma who underwent at least two [...] Read more.

Objectives: To describe the US, CEUS, CT, and MRI features of papillary renal cell carcinoma (PRCC) and to underline the imaging characteristics that are helpful in the differential diagnosis. Methods: Patients with histologically proven papillary renal cell carcinoma who underwent at least two imaging examinations (US, CEUS, CT, and MRI) were included in the study. Tumor size, homogeneity, morphology, perilesional stranding, contrast enhancement locoregional extension were assessed. A comparison and the characteristics of the imaging features for each imaging modality were analyzed. Results: A total of 27 patients with an histologically confirmed diagnosis of PRCC were included in the study. US was highly accurate in distinguishing solid masses from cystic masses, supporting the differential diagnosis of PRCC, as well as in patients with a poor representation of the solid component. CEUS significantly increased diagnostic accuracy in delineating the solid intralesional component. Furthermore, when using CEUS, in the arterial phase, PRCC exhibited hypo-enhancement, and in the late phase it showed an inhomogeneous and delayed wash-out compared with the surrounding renal parenchyma. At MRI, PRCC showed a marked restiction of DWI and was hypointense in the T2-weighted compared to the renal parenchyma. Conclusions: In our study, the characteristic hypodensity and hypoenhancement of PRCC make CT the weakest method of their recognition, while US/CEUS and MRI are necessary to reach a definitive diagnosis. Knowledge of the appearance of PRCC can support an early diagnosis and prompt management, and radiologists should be aware that PRCC, when detected using CT, may resemble spurious non-septate renal cyst. Full article

(This article belongs to the Special Issue Imaging Diagnosis in Abdomen, 2nd Edition)

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45 pages, 390 KiB

Open AccessReview

Artificial Intelligence in Inflammatory Bowel Disease Endoscopy

by Sabrina Gloria Giulia Testoni, Guglielmo Albertini Petroni, Maria Laura Annunziata, Giuseppe Dell’Anna, Michele Puricelli, Claudia Delogu and Vito Annese

Diagnostics 2025, 15(7), 905; https://doi.org/10.3390/diagnostics15070905 - 1 Apr 2025

Abstract

Inflammatory bowel diseases (IBDs), comprising Crohn’s disease (CD) and ulcerative colitis (UC), are chronic immune-mediated inflammatory diseases of the gastrointestinal (GI) tract with still-elusive etiopathogeneses and an increasing prevalence worldwide. Despite the growing availability of more advanced therapies in the last two decades, [...] Read more.

Inflammatory bowel diseases (IBDs), comprising Crohn’s disease (CD) and ulcerative colitis (UC), are chronic immune-mediated inflammatory diseases of the gastrointestinal (GI) tract with still-elusive etiopathogeneses and an increasing prevalence worldwide. Despite the growing availability of more advanced therapies in the last two decades, there are still a number of unmet needs. For example, the achievement of mucosal healing has been widely demonstrated as a prognostic marker for better outcomes and a reduced risk of dysplasia and cancer; however, the accuracy of endoscopy is crucial for both this aim and the precise and reproducible evaluation of endoscopic activity and the detection of dysplasia. Artificial intelligence (AI) has drastically altered the field of GI studies and is being extensively applied to medical imaging. The utilization of deep learning and pattern recognition can help the operator optimize image classification and lesion segmentation, detect early mucosal abnormalities, and eventually reveal and uncover novel biomarkers with biologic and prognostic value. The role of AI in endoscopy—and potentially also in histology and imaging in the context of IBD—is still at its initial stages but shows promising characteristics that could lead to a better understanding of the complexity and heterogeneity of IBDs, with potential improvements in patient care and outcomes. The initial experience with AI in IBDs has shown its potential value in the differentiation of UC and CD when there is no ileal involvement, reducing the significant amount of time it takes to review videos of capsule endoscopy and improving the inter- and intra-observer variability in endoscopy reports and scoring. In addition, these initial experiences revealed the ability to predict the histologic score index and the presence of dysplasia. Thus, the purpose of this review was to summarize recent advances regarding the application of AI in IBD endoscopy as there is, indeed, increasing evidence suggesting that the integration of AI-based clinical tools will play a crucial role in paving the road to precision medicine in IBDs. Full article

(This article belongs to the Special Issue Advances in Endoscopy)

15 pages, 1299 KiB

Open AccessReview

The Role of ctDNA for Diagnosis and Histological Prediction in Early Stage Non-Small-Cell Lung Cancer: A Narrative Review

by Carolina Sassorossi, Jessica Evangelista, Alessio Stefani, Marco Chiappetta, Antonella Martino, Annalisa Campanella, Elisa De Paolis, Dania Nachira, Marzia Del Re, Francesco Guerrera, Luca Boldrini, Andrea Urbani, Stefano Margaritora, Angelo Minucci, Emilio Bria and Filippo Lococo

Diagnostics 2025, 15(7), 904; https://doi.org/10.3390/diagnostics15070904 - 1 Apr 2025

Abstract

Background: Circulating tumor DNA (ctDNA) may be released from neoplastic cells into biological fluids through apoptosis, necrosis, or active release. In patients with non-small-cell lung cancer (NSCLC), ctDNA analysis is being introduced in clinical practice only for advanced disease management. Nevertheless, an interesting [...] Read more.

Background: Circulating tumor DNA (ctDNA) may be released from neoplastic cells into biological fluids through apoptosis, necrosis, or active release. In patients with non-small-cell lung cancer (NSCLC), ctDNA analysis is being introduced in clinical practice only for advanced disease management. Nevertheless, an interesting and promising field of application is the analysis of ctDNA in the management of early stage non-small-cell lung cancer, both for evaluation before treatment, such as diagnosis and screening, and for prediction of histology or pathological features. Methods: A thorough review of the literature published between 2000 and 2024 was performed on PubMed, utilizing the advanced search feature to narrow down titles and abstracts containing the following keywords: ctDNA, early stage, and NSCLC. A total of 20 studies that met all inclusion criteria were chosen for this review. Results: In this review, we summarize the increasing evidence suggesting that ctDNA has potential clinical applications in the management of patients with early stage NSCLC. ctDNA levels in early stage cancers are very low, posing many technical challenges in improving the detection rate and sensitivity, especially in clinical practice, if it is to be implemented for early detection. Presently, the main limitation of ctDNA experimental and clinical studies, especially in early stage settings, is the lack of definitive standardization and consensus regarding methodology, the absence of systematically validated analyses, and the lack of adoption of sensitive approaches. Conclusions: Possible applications of this analyte open up new fields of diagnosis, treatment, and follow up, which are less invasive and more precise than other approaches currently in use, especially in early stage NSCLC patients. Full article

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

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17 pages, 394 KiB

Open AccessArticle

Electrocardiogram Abnormality Detection Using Machine Learning on Summary Data and Biometric Features

by Kennette James Basco, Alana Singh, Daniel Nasef, Christina Hartnett, Michael Ruane, Jason Tagliarino, Michael Nizich and Milan Toma

Diagnostics 2025, 15(7), 903; https://doi.org/10.3390/diagnostics15070903 - 1 Apr 2025

Abstract

Background/Objectives: Electrocardiogram data are widely used to diagnose cardiovascular diseases, a leading cause of death globally. Traditional interpretation methods are manual, time-consuming, and prone to error. Machine learning offers a promising alternative for automating the classification of electrocardiogram abnormalities. This study explores the [...] Read more.

Background/Objectives: Electrocardiogram data are widely used to diagnose cardiovascular diseases, a leading cause of death globally. Traditional interpretation methods are manual, time-consuming, and prone to error. Machine learning offers a promising alternative for automating the classification of electrocardiogram abnormalities. This study explores the use of machine learning models to classify electrocardiogram abnormalities using a dataset that combines clinical features (e.g., age, weight, smoking status) with key electrocardiogram measurements, without relying on time-series data. Methods: The dataset included demographic and electrocardiogram-related biometric data. Preprocessing steps addressed class imbalance, outliers, feature scaling, and the encoding of categorical variables. Five machine learning models—Gaussian Naive Bayes, support vector machines, random forest trees, extremely randomized trees, gradient boosted trees, and an ensemble of top-performing classifiers—were trained and optimized using stratified k-fold cross-validation. Model performance was evaluated on a reserved testing set using metrics such as accuracy, precision, recall, and F1-score. Results: The extremely randomized trees model achieved the best performance, with a testing accuracy of 66.79%, recall of 66.79%, and F1-score of 62.93%. Ventricular rate, QRS duration, and QTC (Bezet) were identified as the most important features. Challenges in classifying borderline cases were noted due to class imbalance and overlapping features. Conclusions: This study demonstrates the potential of machine learning models, particularly extremely randomized trees, in classifying electrocardiogram abnormalities using demographic and biometric data. While promising, the absence of time-series data limits diagnostic accuracy. Future work incorporating time-series signals and advanced deep learning techniques could further improve performance and clinical relevance. Full article

(This article belongs to the Special Issue Deep Learning in Biomedical Signal Analysis)

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