Diagnostics

11 pages, 1713 KiB

Open AccessArticle

Cardiac Magnetic Resonance Imaging with Myocardial Strain Assessment Correlates with Cardiopulmonary Exercise Testing in Patients with Pectus Excavatum

by André Lollert, Tariq Abu-Tair, Tilman Emrich, Karl-Friedrich Kreitner, Alexander Sterlin, Christoph Kampmann and Gundula Staatz

Diagnostics 2024, 14(23), 2758; https://doi.org/10.3390/diagnostics14232758 (registering DOI) - 7 Dec 2024

Abstract

Objectives: To evaluate correlations between cardiac magnetic resonance imaging (cMRI) at rest including strain imaging and variables derived from quantitative cardiopulmonary exercise testing using a treadmill in patients with pectus excavatum. Methods: We retrospectively correlated the results of cMRI and cardiopulmonary [...] Read more.

Objectives: To evaluate correlations between cardiac magnetic resonance imaging (cMRI) at rest including strain imaging and variables derived from quantitative cardiopulmonary exercise testing using a treadmill in patients with pectus excavatum. Methods: We retrospectively correlated the results of cMRI and cardiopulmonary exercise testing in 17 patients with pectus excavatum, in whom both examinations were performed during their pre-operative clinical evaluation. In addition to cardiac volumetry, we assessed the strain rates of both ventricles using a feature-tracking algorithm of a piece of commercially available post-processing software. Results: Right ventricular (RV) ejection fraction correlated negatively with heart rate at anaerobic threshold (rho = −0.543, p = 0.024). A positive correlation between radial strain rate at the RV base and percentage of predicted maximum heart rate (rho = 0.72, p = 0.001) was shown, with equivalent results for circumferential strain rate (rho = −0.64, p = 0.005). Radial strain rate at the RV base correlated in a strongly negative way with maximum oxygen uptake (rho = −0.8, p < 0.001), with a correspondingly positive correlation for circumferential strain rate (rho = 0.73, p = 0.001). Conclusions: Quantitative parameters derived from cMRI at rest, especially those acquired at the most severely compressed RV base, correlated with cardiopulmonary exercise testing variables. The compression of the RV base by the sternum might be partially compensated by an increased strain rate to induce higher heart frequencies during exercise. However, high strain rates were associated with a higher disease severity and a lower maximum oxygen uptake, indicating a limitation of this compensation mechanism. Full article

(This article belongs to the Special Issue Diagnosis of Valvular Heart Disease and Myocardial Function)

► Show Figures

Figure 1

11 pages, 819 KiB

Open AccessArticle

Lipoprotein(a) as a Risk Factor for Recurrent Acute Myocardial Infarction and Mortality: Insights from Routine Clinical Practice

by David Šuran, Vojko Kanič, Peter Kokol, Tadej Završnik, Florjan Verhnjak, Bojan Žlahtič, Andreja Sinkovič and Franjo Husam Naji

Diagnostics 2024, 14(23), 2757; https://doi.org/10.3390/diagnostics14232757 (registering DOI) - 7 Dec 2024

Abstract

Background: Lipoprotein(a) [Lp(a)] is a well-established risk factor for incident atherosclerotic cardiovascular (CV) disease. However, evidence regarding its association with recurrent events is limited. To address this gap, we conducted a retrospective analysis of routine clinical data, focusing on patients hospitalized for acute [...] Read more.

Background: Lipoprotein(a) [Lp(a)] is a well-established risk factor for incident atherosclerotic cardiovascular (CV) disease. However, evidence regarding its association with recurrent events is limited. To address this gap, we conducted a retrospective analysis of routine clinical data, focusing on patients hospitalized for acute myocardial infarction (AMI) between 2000 and 2022 with available admission Lp(a) results. Methods: Patients were stratified into three groups based on their Lp(a) level (≤50 mg/dL, 51–90 mg/dL, and >90 mg/dL). A multivariable-adjusted Cox regression analysis was performed to assess the associations of Lp(a) with recurrent AMI, CV mortality, and all-cause mortality. Results: A total of 2248 patients (31.5% women), with a mean age of 64.7 ± 12.2 years, were retrospectively followed until 31 December 2022, or death. The multivariable-adjusted hazard ratios (HRs) for recurrent AMI were 1.01 (p = 0.921) for levels 51–90 mg/dL and 1.51 (p = 0.013) for levels > 90 mg/dL, compared with levels ≤ 50 mg/dL. The corresponding HRs for CV mortality were 1.13 (p = 0.300) and 1.14 (p = 0.348), and those for all-cause mortality were 1.09 (p = 0.310) and 1.20 (p = 0.090), respectively. Stratification by sex and age revealed a significant association of Lp(a) with recurrent AMI only in women aged > 65 years, with adjusted HRs of 2.34 (p = 0.013) for levels 51–90 mg/dL and 3.94 (p < 0.001) for levels > 90 mg/dL, compared with levels ≤ 50 mg/dL. Conclusions: In the presented study, Lp(a) was associated with a significantly higher risk of recurrent AMI only in women aged > 65 years with Lp(a) levels > 50 mg/dL. We found no significant associations between Lp(a) and CV or all-cause mortality. Full article

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

► Show Figures

Figure 1

15 pages, 3529 KiB

Open AccessArticle

Analysis of the Sagittal Root Position of the Maxillary and Mandibular Anterior Teeth in the Alveolar Bone Using Cone-Beam Computed Tomography

by Rawa Jamal Abdul, Darwn Saeed Abdulateef, Ara Omer Fattah and Ranjdar Mahmood Talabani

Diagnostics 2024, 14(23), 2756; https://doi.org/10.3390/diagnostics14232756 (registering DOI) - 6 Dec 2024

Abstract

Background/Objectives: The purpose of this study was to measure the bone thickness and angulation of the maxillary and mandibular anterior teeth on the buccal and palatal/lingual sides and also to analyze the sagittal root position (SRP) in the alveolar bone in relation to [...] Read more.

Background/Objectives: The purpose of this study was to measure the bone thickness and angulation of the maxillary and mandibular anterior teeth on the buccal and palatal/lingual sides and also to analyze the sagittal root position (SRP) in the alveolar bone in relation to age and gender using cone-beam computed tomography (CBCT) in an Iraqi subpopulation. Methods: CBCT images of 1200 maxillary and mandibular central and lateral incisors and canines from 100 patients (48 males and 52 females) were retrospectively analyzed. These patients were categorized by age into group I ≤ 25, group II 26–40, and group III ≥ 41 years old. The SRP in the alveolar bone was classified as class I, class II, class III, and class IV, and the buccal type was further classified into subtypes I, II, and III. In addition, the buccolingual inclination of the tooth and buccal/palatal/lingual bone thickness at the coronal, middle, and apical thirds were evaluated and then compared based on age and gender. The data were analyzed using the Pearson chi-square test. Descriptive statistics, Kruskal–Wallis and Mann–Whitney U test were used to compare the thickness and angulation according to the SRP classes. Results: The mean frequency distribution of SRP of maxillary anterior teeth indicated that most of them were located buccally and were classified as (Class I) and subtype (III). Moreover, for mandibular anterior teeth, the majority were classified as (Class IV) and subtype (II). The mean sagittal angulation of maxillary anterior teeth approximately ranged from 5.9 for tooth 12# to 8.2 for teeth 13# and 23#, while for mandibular anterior teeth it ranged from 7.4 for tooth 33# to 10.3 for tooth 41#. The thickness of bone in the apical third of the buccal side of all maxillary and mandibular teeth was significantly related to age (p < 0.05). In the middle third, the thickness of bone in the buccal and palatal side of all maxillary anterior teeth and in the apical third of most mandibular teeth in the lingual side was significantly higher in males (p < 0.05). Conclusions: A majority of the maxillary anterior tooth roots were positioned close to the buccal cortical plate, while most of the mandibular anterior teeth were engaging both the buccal and lingual cortical plates. Males had more alveolar bone thickness for both maxillary and mandibular anterior teeth, and only the apical portion significantly changed with age. CBCT of the buccal and palatal/lingual bone and SRP is recommended for the selection of the appropriate treatment approach and implant placement. Full article

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

► Show Figures

Figure 1

10 pages, 640 KiB

Open AccessArticle

The Condition of the Masseter Muscles After Orthodontic Treatment with Fixed Appliances

by Sebastian Szajkowski, Jarosław Pasek and Grzegorz Cieślar

Diagnostics 2024, 14(23), 2755; https://doi.org/10.3390/diagnostics14232755 - 6 Dec 2024

Abstract

Background: One of the methods used in malocclusion treatment is the use of fixed appliances. Research conducted so far has revealed that changes in bite force occurring over the course of orthodontic treatment are directly related to the functional status of the masticatory [...] Read more.

Background: One of the methods used in malocclusion treatment is the use of fixed appliances. Research conducted so far has revealed that changes in bite force occurring over the course of orthodontic treatment are directly related to the functional status of the masticatory muscles. It is therefore advisable to find out how the biomechanical parameters of the masseter muscles change after treatment with the application of fixed appliances. Methods: The study material comprised 74 individuals, divided into the study group (n = 37) treated by means of fixed orthodontic appliances over the average time of 12.27 months and the control group (n = 37) consisting of individuals did not undergo orthodontic treatment. The biomechanical properties of the masseter muscles were examined by means of myotonometry. Results: Upon completion of orthodontic treatment, the values of the parameters of tension, stiffness, and elasticity of masseter muscles located on both sides did not statistically significantly differ between patients from the study group who were treated by means of fixed orthodontic appliances and patients from control group who did not undergo orthodontic treatment. Conclusions: Treatment of malocclusions with the use of fixed appliances does not affect the biomechanical and visco-elastic properties of the masseter muscles (stiffness, tension, and elasticity) assessed by means of myotonometry and it appears safe for masticatory muscles. Full article

(This article belongs to the Special Issue Challenges Related to the Oral Cavity, Head and Neck: From Diagnosis to Therapy)

17 pages, 916 KiB

Open AccessArticle

From Binary to Multi-Class Classification: A Two-Step Hybrid CNN-ViT Model for Chest Disease Classification Based on X-Ray Images

by Yousra Hadhoud, Tahar Mekhaznia, Akram Bennour, Mohamed Amroune, Neesrin Ali Kurdi, Abdulaziz Hadi Aborujilah and Mohammed Al-Sarem

Diagnostics 2024, 14(23), 2754; https://doi.org/10.3390/diagnostics14232754 - 6 Dec 2024

Abstract

Background/Objectives: Chest disease identification for Tuberculosis and Pneumonia diseases presents diagnostic challenges due to overlapping radiographic features and the limited availability of expert radiologists, especially in developing countries. The present study aims to address these challenges by developing a Computer-Aided Diagnosis (CAD) system [...] Read more.

Background/Objectives: Chest disease identification for Tuberculosis and Pneumonia diseases presents diagnostic challenges due to overlapping radiographic features and the limited availability of expert radiologists, especially in developing countries. The present study aims to address these challenges by developing a Computer-Aided Diagnosis (CAD) system to provide consistent and objective analyses of chest X-ray images, thereby reducing potential human error. By leveraging the complementary strengths of convolutional neural networks (CNNs) and vision transformers (ViTs), we propose a hybrid model for the accurate detection of Tuberculosis and for distinguishing between Tuberculosis and Pneumonia. Methods: We designed a two-step hybrid model that integrates the ResNet-50 CNN with the ViT-b16 architecture. It uses the transfer learning on datasets from Guangzhou Women’s and Children’s Medical Center for Pneumonia cases and datasets from Qatar and Dhaka (Bangladesh) universities for Tuberculosis cases. CNNs capture hierarchical structures in images, while ViTs, with their self-attention mechanisms, excel at identifying relationships between features. Combining these approaches enhances the model’s performance on binary and multi-class classification tasks. Results: Our hybrid CNN-ViT model achieved a binary classification accuracy of 98.97% for Tuberculosis detection. For multi-class classification, distinguishing between Tuberculosis, viral Pneumonia, and bacterial Pneumonia, the model achieved an accuracy of 96.18%. These results underscore the model’s potential in improving diagnostic accuracy and reliability for chest disease classification based on X-ray images. Conclusions: The proposed hybrid CNN-ViT model demonstrates substantial potential in advancing the accuracy and robustness of CAD systems for chest disease diagnosis. By integrating CNN and ViT architectures, our approach enhances the diagnostic precision, which may help to alleviate the burden on healthcare systems in resource-limited settings and improve patient outcomes in chest disease diagnosis. Full article

(This article belongs to the Special Issue Artificial Intelligence in Clinical Medical Imaging: 2nd Edition)

12 pages, 3748 KiB

Open AccessArticle

Late Enhancement Computed Tomography for Left Atrial Fibrosis Imaging: A Pilot “Proof-of-Concept” Study

by Pietro G. Lacaita, Christoph Beyer, Fabian Plank, Markus Stühlinger and Gudrun M. Feuchtner

Diagnostics 2024, 14(23), 2753; https://doi.org/10.3390/diagnostics14232753 - 6 Dec 2024

Abstract

Background/Objective: Left atrial (LA) fibrosis imaging improves the guidance of LA catheter ablation. Cardiac computed tomography (CT) may be a reasonable alternative to CMR. The aim was to evaluate late enhancement (LE) fibrosis mapping by CT, and to correlate the results with [...] Read more.

Background/Objective: Left atrial (LA) fibrosis imaging improves the guidance of LA catheter ablation. Cardiac computed tomography (CT) may be a reasonable alternative to CMR. The aim was to evaluate late enhancement (LE) fibrosis mapping by CT, and to correlate the results with low-voltage areas on electroanatomical mapping (EAM). Methods: In patients with atrial fibrillation who underwent 128-slice dual-source CT angiography (CTA) prior to LA catheter ablation, an additional LE-CT scan was performed 7 min after CTA. (1) Left atrial wall thickness (LAWT) was measured at three sites along the LA ridge. (2) Late enhancement (LE) was quantified co-axially aligned to LAWT and compared with low-voltage areas (LVA) on EAM. Results: Of 137 patients (age: 59.8 years; 27.7% females), 108 were included. The prevalence of LE was higher in patients with LAWT > 2 mm compared with 1.5 mm, with 78 (91.7%) vs. 77 (80.2%) (p = 0.022). Of 78 patients with LE, 60 (77.1%) had focal, 13 (16.5%) had diffuse, and 5 (6.3%) had mixed LE patterns. The CT density of focal LE was not different from that of diffuse patterns (104.2 +/− 21 HU vs. 98.9 +/− 18 HU; p = 0.360). Increasing LAWT and LE-HU were weakly correlated (r = 0.229; p = 0.041). LA wall artifacts had higher CT density compared with LE (154.1 HU vs. 114.2 HU; p = 0.002). The effective radiation dose was 0.95 mSv (range, 0.52–1.2 mSv) for LE-CT. The agreement of LE-CT was 80% for LVA < 0.5 mV and 86.6% for LVA < 0.7 mV in a subset of 30 patients. Conclusions: Left atrial fibrosis mapping by LE-CT is feasible. Late enhancement was found more frequently in LAWTs of more than 2 mm, and LE was correlated with increasing LA remodeling and low-voltage areas. Full article

(This article belongs to the Special Issue Advancements in Cardiovascular CT Imaging)

► Show Figures

Figure 1

14 pages, 2975 KiB

Open AccessReview

Daily Measurements from Cardiac Implantable Electronic Devices to Assess Health Status

by Eva Roseboom, Fenna Daniëls, Michiel Rienstra and Alexander H. Maass

Diagnostics 2024, 14(23), 2752; https://doi.org/10.3390/diagnostics14232752 - 6 Dec 2024

Abstract

Cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable cardioverter-defibrillators (ICDs) are increasingly used in the aging population. Modern CIEDs perform daily measurements, mainly aimed at discovering early signs of battery depletion or electrode dysfunction. Changes in thresholds, intracardiac signals, and pacing [...] Read more.

Cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable cardioverter-defibrillators (ICDs) are increasingly used in the aging population. Modern CIEDs perform daily measurements, mainly aimed at discovering early signs of battery depletion or electrode dysfunction. Changes in thresholds, intracardiac signals, and pacing impedances can be caused by exacerbation of existing conditions or novel clinical problems. Pacing percentages and heart rate histograms can be used to optimize pacemaker programming, but can also be a measure of altered cardiac health status. Several measurements, such as thoracic impedance and patient activity, have been added to inform practitioners about worsening heart failure. In addition, remote monitoring of daily CIED measurements may accommodate for the prevention of the deterioration of clinical conditions. In this review, we discuss the evidence base of CIED algorithms and suggest how to use standard daily measurements to monitor the cardiac and extracardiac health status of patients with CIEDs. Full article

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

► Show Figures

Figure 1

11 pages, 769 KiB

Open AccessArticle

The Evaluation of Radiolabeled Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Initial Staging in Intermediate-Risk Prostate Cancer Patients: A Retrospective Multicenter Analysis

by Laura Evangelista, Priscilla Guglielmo, Giulia Giacoppo, Lucia Setti, Demetrio Aricò, Lorenzo Muraglia, Katia Marzo, Nicolò Buffi, Vittorio Fasulo, Marcello Rodari, Jelena Jandric, Antonio Salvaggio, Manuela Bonacina, Massimo Lazzeri and Giovanni Lughezzani

Diagnostics 2024, 14(23), 2751; https://doi.org/10.3390/diagnostics14232751 - 6 Dec 2024

Abstract

Objectives. The aim of the present study was to assess the performance of radiolabeled-PSMA PET/CT in a cohort of intermediate-risk prostate cancer (PCa) patients for initial staging. Methods. This is a retrospective, multicenter analysis of patients diagnosed with intermediate-risk PCa who were staged [...] Read more.

Objectives. The aim of the present study was to assess the performance of radiolabeled-PSMA PET/CT in a cohort of intermediate-risk prostate cancer (PCa) patients for initial staging. Methods. This is a retrospective, multicenter analysis of patients diagnosed with intermediate-risk PCa who were staged using radiolabeled PSMA PET/CT to evaluate the extent of the disease before initiating appropriate treatment. The study included patients from the Nuclear Medicine Units of the Humanitas group between 2021 and 2024. The change in management due to the PSMA PET/CT examination was assessed. Results. A total of 181 patients were enrolled across all three centers. Histopathological assessment from biopsy revealed that 51.4% of patients had favorable PCa, while 48.6% had unfavorable disease. PET/CT was positive for the primary lesions in all patients, but it revealed a positivity rate in 23 (12.7%) patients for nodes and distant organs, with a positivity rate of 0.21 in the unfavorable group and 0.05 in the favorable group (p < 0.005). Based on follow-up data, diagnostic accuracy was higher than 90% in both the favorable and unfavorable groups for lymph node and distant metastases. The inclusion of PSMA PET/CT in the diagnostic algorithm for patients with intermediate-risk PCa impacted patient management in 24 (13.3%) cases, based on the multidisciplinary team decision. Conclusions. PSMA PET/CT can affect the management of patients with intermediate-risk PCa in up to 13% of cases, mainly for unfavorable diseases. New imaging techniques as a first-line imaging procedure can help to plan the correct therapeutic approach in the intermediate-risk PCa group. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Prostate Cancer, Second Edition)

► Show Figures

Figure 1

14 pages, 1054 KiB

Open AccessArticle

Optimizing Endoscopic Respiratory Diagnostics with Cytology: An Update on Touch Imprints with a Comparative Literature Review

by Hatice Elmas, Binnur Önal, Selda Yilmaz, Stefan Steurer and Lutz Welker

Diagnostics 2024, 14(23), 2750; https://doi.org/10.3390/diagnostics14232750 - 6 Dec 2024

Abstract

Background: Major diagnostic and therapeutic changes led to the implementation of the ‘lung cancer diagnosis in small biopsies and cytology specimens’ concept in the WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart in 2015. Touch imprints are an established technique [...] Read more.

Background: Major diagnostic and therapeutic changes led to the implementation of the ‘lung cancer diagnosis in small biopsies and cytology specimens’ concept in the WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart in 2015. Touch imprints are an established technique in cytology that provides a rapid and minimally invasive method for morphological diagnoses of clinical specimens, accurate subtyping, and molecular characterizations of malignancies. The extended diagnostic requirements from the increasingly limited material provided by minimally invasive biopsy techniques pose major challenges for pathology. Recognizing the relevant features and potential pitfalls is essential for cytologists to avoid misinterpretation. Materials and Methods: A retrospective analysis of endoscopic and surgical biopsy diagnostics was performed on 717 patients (303 women and 414 men; average age of 66.9 years) with clinically suspicious tumor findings at the LungenClinic Grosshansdorf in 2020. A total of 1363 cytological samples were obtained pre-therapeutically from 986 distinct biopsies covering 330 surgically and 656 endoscopically examined pulmonary, mediastinal, and bronchial regions. These samples were then compared with the histological diagnoses that were critical for determining the final therapy. Results: Out of a total of 656 endoscopically examined cases, 322 were classified as malignant, 308 as benign, and 26 as undetermined. While touch imprints and histological analysis separately achieved specificity values of 95.4% and 98.8%, both methods showed sensitivity values of 82.1% and 86.5%, respectively. In contrast, combining the two methods improved the sensitivity by 8 percentage points to 94.6%. Out of 330 cases of surgically examined samples, 137 were malignant, 190 were benign, and 3 were undetermined. The specificity of the morphological examinations for these samples was comparably high at 97.9% and 100%, respectively. In this surgical setting, touch imprints alone achieved a sensitivity of 75.9% (n = 104/137 cases), with a specificity of 97.9% (n = 186/190 cases). The outcome of the histological approach alone and in combination with touch imprints reached a sensitivity of 96.4% (n = 132/137 cases). Conclusions: Cytology and histology achieved comparably high sensitivity and specificity values on small biopsies. Under optimal conditions for morphological analysis in a surgical setting, the sensitivity of cytology for detecting malignant tumors was only 6 percentage points lower compared with the clinical endoscopic setting. A combined approach of cytologic–histologic evaluation for endoscopically examined specimens significantly increased the sensitivity by approximately 8% compared with the surgical setting (p < 0.003). Full article

(This article belongs to the Special Issue Cyto-Histological Correlations in Pathology Diagnosis)

► Show Figures

Figure 1

11 pages, 4742 KiB

Open AccessArticle

Diabetic Mastopathy: A Monocentric Study to Explore This Uncommon Breast Disease

by Luciano Mariano, Luca Nicosia, Sofia Scolari, Sara Pasi, Sofia Netti, Giovanni Mazzarol, Antuono Latronico and Enrico Cassano

Diagnostics 2024, 14(23), 2749; https://doi.org/10.3390/diagnostics14232749 - 6 Dec 2024

Abstract

Background: Diabetic Mastopathy (DMP) is an uncommon benign fibro-inflammatory condition that occurs in women with long-standing diabetes mellitus (DM), particularly type 1. It often mimics breast cancer (BC) in clinical and imaging presentations, leading to diagnostic challenges. Methods: A retrospective monocentric study was [...] Read more.

Background: Diabetic Mastopathy (DMP) is an uncommon benign fibro-inflammatory condition that occurs in women with long-standing diabetes mellitus (DM), particularly type 1. It often mimics breast cancer (BC) in clinical and imaging presentations, leading to diagnostic challenges. Methods: A retrospective monocentric study was conducted, analyzing clinical, radiologic, and pathological data from 28 women diagnosed with DMP over 10 years at the European Institute of Oncology. Data on DM type, age at DMP diagnosis, associated autoimmune conditions, imaging features, and surgical outcomes were collected and compared with the existing literature. Results: The majority (82%) of the patients had type 1 DM, with most diagnosed with DMP before age 40. Common complications included retinopathy (46%) and neuropathy (35%). Imaging often suggested malignancy, necessitating core needle biopsies for diagnosis. Surgical intervention occurred in 55% of cases, with a recurrence rate of 32%. One case of BC was observed. Conclusions: DMP remains challenging due to its resemblance to BC. Conservative management is typical, but the recurrence rate post-surgery highlights the importance of ongoing monitoring. Although DMP does not significantly increase BC risk, caution is advised, especially for immunocompromised patients. Further studies are needed to comprehensively understand DMP’s relationship with BC. Full article

(This article belongs to the Special Issue Advances in Breast Imaging and Analytics)

► Show Figures

Figure 1

13 pages, 1054 KiB

Open AccessArticle

Epileptic Patients with More Clinic Visits Are More Likely to Be Diagnosed with Dementia—A Population-Based Retrospective Cohort Study

by Pao-Sheng Yen, Chih-Hsin Muo, Chung-Hsin Yeh and Fung-Chang Sung

Diagnostics 2024, 14(23), 2748; https://doi.org/10.3390/diagnostics14232748 - 6 Dec 2024

Abstract

Objective: This retrospective cohort study assessed dementia risk in epilepsy patients associated with the compliance to epileptic treatment visits. Methods: We used Taiwanese insurance claims data to establish an epilepsy cohort (N = 39,216) diagnosed in 2000–2015 and a matched control cohort [...] Read more.

Objective: This retrospective cohort study assessed dementia risk in epilepsy patients associated with the compliance to epileptic treatment visits. Methods: We used Taiwanese insurance claims data to establish an epilepsy cohort (N = 39,216) diagnosed in 2000–2015 and a matched control cohort without epilepsy (N = 156,864), evaluating the incident dementia by the end of 2016. Results: The dementia incidence was 2.9-fold higher in the epilepsy cohort than in comparisons (4.68 vs. 1.59 per 1000 person-years). Only 9.3% of epilepsy patients were compliant to ≥80% of scheduled treatment visits, but they exhibited a 7.2-fold higher dementia incidence than those without treatment. The contrast was greater in younger patients than in the elderly (20-fold versus 5.5-fold). Dementia incidence increased with the frequency of neurological consultations, peaking in the first year after epilepsy diagnosis. Conclusions: Epileptic patients with more clinical visits for active treatment had a higher chance of dementia diagnosis, highlighting the importance of close neurological monitoring post-epilepsy diagnosis to address potential dementia complications. Full article

(This article belongs to the Special Issue Assessment and Diagnosis of Cognitive Disorders)

► Show Figures

Figure 1

13 pages, 1847 KiB

Open AccessArticle

The Occurrence and Risk Factors of Black Triangles Between Central Incisors After Orthodontic Treatment

by Ji-Song Jung, Ho-Kyung Lim, You-Sun Lee and Seok-Ki Jung

Diagnostics 2024, 14(23), 2747; https://doi.org/10.3390/diagnostics14232747 - 6 Dec 2024

Abstract

Background/Objectives: To assess the incidence of and risk factors for black triangles between the central incisors after orthodontic treatment; Methods: Ninety-seven post-treatment patients (29 men and 68 women; mean age, 22.7 years) were retrospectively divided into two groups based on the presence or [...] Read more.

Background/Objectives: To assess the incidence of and risk factors for black triangles between the central incisors after orthodontic treatment; Methods: Ninety-seven post-treatment patients (29 men and 68 women; mean age, 22.7 years) were retrospectively divided into two groups based on the presence or absence of black triangles, using intraoral photographs. Based on the Jemt Index, the black triangle occurrence group was further classified into mild, moderate, and severe groups. Parameters from periapical radio graphs, lateral cephalograms, and study models were compared between the occurrence and the non-occurrence groups by using independent t-tests. Logistic regression analysis was performed to identify the risk factors for black triangles; Results: The incidence of black triangles between the central incisors was 51% and 64% in the maxilla and in the mandible, respectively. The factors significantly associated with the occurrence of black triangles were age, treatment duration, the lingual inclination of the maxillary incisors in the maxilla, and age in the mandible (p < 0.05); Conclusions: This study showed the diverse risk factors associated with black triangles between central incisors after orthodontic treatment and revealed that the formation of black triangles is relatively common. Considering these risk factors during orthodontic diagnosis and treatment planning can help minimize the occurrence of black triangles. Full article

(This article belongs to the Special Issue Advances in the Diagnosis of Oral and Maxillofacial Disease)

► Show Figures

Figure 1

10 pages, 620 KiB

Open AccessArticle

Serum Tau Species in Progressive Supranuclear Palsy: A Pilot Study

by Costanza Maria Cristiani, Luana Scaramuzzino, Elvira Immacolata Parrotta, Giovanni Cuda, Aldo Quattrone and Andrea Quattrone

Diagnostics 2024, 14(23), 2746; https://doi.org/10.3390/diagnostics14232746 - 5 Dec 2024

Abstract

Background/Objectives: Progressive Supranuclear Palsy (PSP) is a tauopathy showing a marked symptoms overlap with Parkinson’s Disease (PD). PSP pathology suggests that tau protein might represent a valuable biomarker to distinguish between the two diseases. Here, we investigated the presence and diagnostic value of [...] Read more.

Background/Objectives: Progressive Supranuclear Palsy (PSP) is a tauopathy showing a marked symptoms overlap with Parkinson’s Disease (PD). PSP pathology suggests that tau protein might represent a valuable biomarker to distinguish between the two diseases. Here, we investigated the presence and diagnostic value of six different tau species (total tau, 4R-tau isoform, tau aggregates, p-tau202, p-tau231 and p-tau396) in serum from 13 PSP and 13 PD patients and 12 healthy controls (HCs). Methods: ELISA commercial kits were employed to assess all the tau species except for t-tau, which was assessed by a single molecule array (SIMOA)-based commercial kit. Possible correlations between tau species and biological and clinical features of our cohorts were also evaluated. Results: Among the six tau species tested, only p-tau396 was detectable in serum. Concentration of p-tau396 was significantly higher in both PSP and PD groups compared to HC, but PSP and PD patients showed largely overlapping values. Moreover, serum concentration of p-tau396 strongly correlated with disease severity in PSP and not in PD. Conclusions: Overall, we identified serum p-tau396 as the most expressed phosphorylated tau species in serum and as a potential tool for assessing PSP clinical staging. Moreover, we demonstrated that other p-tau species may be present at too low concentrations in serum to be detected by ELISA, suggesting that future work should focus on other biological matrices. Full article

(This article belongs to the Special Issue Novel Biomarkers for Alzheimer’s Disease and Other Neurodegenerative Diseases)

► Show Figures

Figure 1

15 pages, 320 KiB

Open AccessReview

The Association Between Antipsychotics and Bone Fragility: An Updated Comprehensive Review

by Michele Mercurio, Giovanna Spina, Olimpio Galasso, Giorgio Gasparini, Cristina Segura-Garcia, Pasquale De Fazio and Renato de Filippis

Diagnostics 2024, 14(23), 2745; https://doi.org/10.3390/diagnostics14232745 - 5 Dec 2024

Abstract

Background: Antipsychotic drugs appear to be related to reduced bone mineral density (BMD). We conducted a narrative review to collect the available literature investigating the relationship between antipsychotic use and bone fragility. Methods: A review of the published literature was conducted and reported [...] Read more.

Background: Antipsychotic drugs appear to be related to reduced bone mineral density (BMD). We conducted a narrative review to collect the available literature investigating the relationship between antipsychotic use and bone fragility. Methods: A review of the published literature was conducted and reported through PubMed/Scopus/Cochrane libraries. We included studies using any antipsychotic treatment where the bone metabolism, osteoporosis, and/or risk of fractures has been assessed. Results: After screening 1707 items, we finally included 15 papers. A total of 3245 initial patients were identified, of whom 1357 patients with a mean age of 43.8 years underwent antipsychotic treatment and were analyzed. The mean antipsychotic treatment duration of the treated group was 15.8 ± 13.9 years. Among the included studies, two reported a statistically significant difference in lumbar BMD reduction between the antipsychotic exposed group and the control group. Femoral neck BMD levels had been reported in four of the case–control studies; two reported a statistically significant difference in femoral neck BMD reduction between the antipsychotic exposed group and the control group. Conclusions: Prolonged use of antipsychotic treatment seems to be associated with an increased risk of reduced BMD, and, consequentially, with an augmented risk of bone fragility and fractures. This effect is not limited to vulnerable groups, such as those with significant medical comorbidities, the elderly, and postmenopausal women, but may also apply to anyone using antipsychotics in the long-term. Clinicians’ awareness of antipsychotic prescriptions should optimize their potential while reducing this risk. Full article

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

17 pages, 6285 KiB

Open AccessArticle

Instrument-Free Point-of-Care Diagnostic for Leishmania Parasites

by Taralyn J. Wiggins, Ruonan Peng, Ruth V. Bushnell, John K. Tobin, David A. MacLeod, Ke Du, Gregory J. Tobin and Stephen J. Dollery

Diagnostics 2024, 14(23), 2744; https://doi.org/10.3390/diagnostics14232744 - 5 Dec 2024

Abstract

Background/Objective: Leishmaniasis is the second deadliest parasitic disease in the world, after malaria, with an estimated 1.6 million new cases each year. While cutaneous leishmaniasis can result in permanent scars from lesions after treatment, the mucocutaneous and visceral diseases can result in life-altering [...] Read more.

Background/Objective: Leishmaniasis is the second deadliest parasitic disease in the world, after malaria, with an estimated 1.6 million new cases each year. While cutaneous leishmaniasis can result in permanent scars from lesions after treatment, the mucocutaneous and visceral diseases can result in life-altering and life-threatening complications. Accurate species diagnosis is critical for treatment and follow-up, and while PCR-based diagnostics can provide sensitive parasite detection and species identification, they are slow, expensive, and not suitable for low-resource settings. In this publication, we describe our efforts to develop a simple, affordable, and instrument-free Leishmania DNA diagnostic that can be used in both high-tech settings and the field. Methods: Computational biology was utilized to design region-targeted RPA oligos and the corresponding CRISPR guides for the detection of all Leishmania species as well as the specific identification of L. (V.) panamensis as a predictor of mucocutaneous disease. Then, we executed systematic approaches for parasite lysis, RPA amplification of DNA, and fluorescent CRISPR crRNA detection. Results: We have demonstrated the ability to detect single-digit parasites without compromising the specificity in identifying single species as the proof of concept for a point-of-care diagnostic. Individual assays were carried out in succession, culminating in an unquenched fluorescent signal quantifiable over negative control. Conclusions: The described work is the foundation which will be implemented into a three-track [all Leishmania, mucocutaneous or visceral only, and a human positive control] assay that we plan to utilize in a Funnel Adapted Sensing Tube (FAST) single use, instrument-free, and affordable diagnostic. Full article

(This article belongs to the Section Point-of-Care Diagnostics and Devices)

► Show Figures

Figure 1

10 pages, 464 KiB

Open AccessArticle

The Clinical Utility of Assessing Orthostatic Intolerance in Adolescents with Sport-Related Concussion, a Retrospective Study

by Mohammad N. Haider, Jule Deren, Karim Khaled, Cathlyn Corrado, Haley M. Chizuk, Jeffrey C. Miecznikowski and John J. Leddy

Diagnostics 2024, 14(23), 2743; https://doi.org/10.3390/diagnostics14232743 - 5 Dec 2024

Abstract

Background/Objective: Assessing Orthostatic Intolerance (OI, symptoms upon standing from supine) is recommended in athletes with sport-related concussions (SRCs), as this is caused by impairments in the cardiovascular autonomic nervous system (cANS). Early Exercise Intolerance (Early EI, symptoms on light physical exertion) is also [...] Read more.

Background/Objective: Assessing Orthostatic Intolerance (OI, symptoms upon standing from supine) is recommended in athletes with sport-related concussions (SRCs), as this is caused by impairments in the cardiovascular autonomic nervous system (cANS). Early Exercise Intolerance (Early EI, symptoms on light physical exertion) is also due to impairments in the cANS but is difficult to incorporate into outpatient clinical practice (cost of personnel, time, equipment). The purpose of this study was to determine if we could use OI to screen for Early EI, as well as understand differences between adolescents who do and do not report OI. Methods: Retrospective chart review. Adolescents with physician-diagnosed SRC performed the 2 min supine to 1 min standing OI test and the Buffalo Concussion Treadmill Test (BCTT) during their first post-SRC visit. Early EI was defined as more-than-mild symptom exacerbation at a heart rate (HR) below 135 bpm on the BCTT; OI was defined as new or increased symptoms of dizziness or lightheadedness on postural change. The sensitivity, specificity and diagnostic accuracy were calculated. Participants with and without OI were compared. Results: In total, 166 adolescents (mean 15.4 years, 58.8% male) were seen a mean of 5.5 days after injury; 48.2% had OI and 52.4% had Early EI, but there was no association between the two measures (Phi = 0.122, p = 0.115). The sensitivity and specificity (with 95% confidence intervals) for OI to screen for Early EI were 54.0% (43.5, 64.3) and 58.2% (47.2, 68.7), respectively. Adolescents with OI had a higher incidence of delayed recovery (24% vs. 9%, p = 0.012). Conclusions: Although both measures seem to be related to impaired autonomic function after SRC, OI has limited accuracy in screening for Early EI, which suggests that their etiologies may be different. Nevertheless, the assessment of OI has clinical utility in the management of SRC. Full article

(This article belongs to the Special Issue The Assessment, Diagnosis, and Management of Sport-Related Concussion in Childhood and Adolescence)

► Show Figures

Figure 1

15 pages, 11818 KiB

Open AccessArticle

Two-Step Image Registration for Dual-Layer Flat-Panel Detectors

by Dong Sik Kim and Dayeon Lee

Diagnostics 2024, 14(23), 2742; https://doi.org/10.3390/diagnostics14232742 - 5 Dec 2024

Abstract

Background: For a single exposure in radiography, a dual-layer flat-panel detector (DFD) can provide spectral images and efficiently utilize the transmitted X-ray photons to improve the detective quantum efficiency (DQE) performance. In this paper, to acquire high DQE performance, we present a registration [...] Read more.

Background: For a single exposure in radiography, a dual-layer flat-panel detector (DFD) can provide spectral images and efficiently utilize the transmitted X-ray photons to improve the detective quantum efficiency (DQE) performance. In this paper, to acquire high DQE performance, we present a registration method for X-ray images acquired from a DFD, considering only spatial translations and scale factors. The conventional registration methods have inconsistent estimate accuracies depending on the captured object scene, even when using entire pixels, and have deteriorated frequency performance because of the interpolation method employed. Methods: The proposed method consists of two steps; the first step is conducting a spatial translation according to the Fourier shift theorem with a subpixel registration, and the second step is conducting a scale transformation using cubic interpolation to process the X-ray projections. To estimate the subpixel spatial translation, a maximum-amplitude method using a small portion of the slant-edge phantom is used. Results: The performance of the proposed two-step method is first theoretically analyzed and then observed by conducting extensive experiments and measuring the noise power spectrum and DQE. An example for registering chest images is also shown. For a DFD, the proposed method shows a better registration result than the conventional one-step registration. The DQE improvement was more than 56% under RQA 9 compared to the single flat-panel detector case. Conclusions: The proposed two-step registration method can efficiently provide aligned image pairs from the DFD to improve the DQE performance at low doses and, thus, increase the accuracy of clinical diagnosis. Full article

(This article belongs to the Special Issue Optimization of Clinical Imaging: From Diagnosis to Prognosis)

► Show Figures

Figure 1

11 pages, 468 KiB

Open AccessSystematic Review

Quality Assessment of MRI-Radiomics-Based Machine Learning Methods in Classification of Brain Tumors: Systematic Review

by Shailesh S. Nayak, Saikiran Pendem, Girish R. Menon, Niranjana Sampathila and Prakashini Koteshwar

Diagnostics 2024, 14(23), 2741; https://doi.org/10.3390/diagnostics14232741 - 5 Dec 2024

Abstract

Background: Brain tumors present a complex challenge in clinical oncology, where precise diagnosis and classification are pivotal for effective treatment planning. Radiomics, a burgeoning field in neuro-oncology, involves extracting and analyzing numerous quantitative features from medical images. This approach captures subtle spatial and [...] Read more.

Background: Brain tumors present a complex challenge in clinical oncology, where precise diagnosis and classification are pivotal for effective treatment planning. Radiomics, a burgeoning field in neuro-oncology, involves extracting and analyzing numerous quantitative features from medical images. This approach captures subtle spatial and textural information imperceptible to the human eye. However, implementation in clinical practice is still distant, and concerns have been raised regarding the methodological quality of radiomic studies. Methodology: A systematic literature search was performed to identify original articles focused on the use of radiomics for brain tumors from 2015 based on the inclusion and exclusion criteria. The radiomic features train machine learning models for glioma classification, and data are split into training and testing subsets to validate the model accuracy, reliability, and generalizability. The present study systematically reviews the status of radiomic studies concerning brain tumors, also using the radiomics quality score (RQS) to assess the quality of the methodology used in each study. Results: A systematic search of PubMed identified 300 articles, with 18 studies meeting the inclusion criteria for qualitative synthesis. These studies collectively demonstrate the potential of radiomics-based machine learning models in accurately distinguishing between glioma subtypes and grades. Various imaging modalities, including MRI, PET/CT, and advanced techniques like ASL and DTI, were utilized to extract radiomic features for analysis. Machine learning algorithms such as deep learning networks, support vector machines, random forests, and logistic regression were applied to develop predictive models. Conclusions: The present study indicates high accuracies in glioma classification, outperforming traditional imaging methods and inexperienced radiologists in some cases. Further validation and standardization efforts are warranted to facilitate the clinical integration of radiomics into routine practice, ultimately enhancing glioma management and patient outcomes. Open science practices: Machine learning using MRI radiomic features provides a simple, noninvasive, and cost-effective method for glioma classification, enhancing transparency, reproducibility, and collaboration within the scientific community. Full article

(This article belongs to the Special Issue Research Update on Magnetic Resonance Imaging)

► Show Figures

Graphical abstract

19 pages, 5352 KiB

Open AccessArticle

Interpretable Multi-Label Classification for Tibiofibula Fracture 2D CT Images with Selective Attention and Data Augmentation

by Chan Sik Han, Sun Woo Jeong, Hyung Won Kim, Seung Myung Choi and Keon Myung Lee

Diagnostics 2024, 14(23), 2740; https://doi.org/10.3390/diagnostics14232740 - 5 Dec 2024

Abstract

Background: Tibiofibula fractures occur across all age groups, and postoperative complications are frequent. An accurate and rapid classification methodology for these fractures could significantly assist physicians. Clinically, tibiofibula fractures occur at various locations, and the fracture types are not evenly distributed. Methods: This [...] Read more.

Background: Tibiofibula fractures occur across all age groups, and postoperative complications are frequent. An accurate and rapid classification methodology for these fractures could significantly assist physicians. Clinically, tibiofibula fractures occur at various locations, and the fracture types are not evenly distributed. Methods: This paper presents a deep learning model for the interpretable multi-label classification of tibiofibula fractures in two-dimensional (2D) CT scan images, addressing the challenges posed by a limited sample size and an uneven distribution of fracture types. We retrospectively collected 2494 2D CT images from 168 patients with tibia or fibula fractures. The types of fractures identified in the CT scan images were classified according to the AO/OTA fracture classification. A deep learning model was developed to classify composite fractures in 2D CT images, providing visual interpretation for each identified class. The visual interpretation was given with the saliency maps constructed by the Grad-CAM++ method. The deep learning model was trained using data augmentation techniques to address class imbalance and the limited dataset size. Results: Our experiments demonstrated that the proposed model achieved a mean average precision (mAP) of 95.71%. Conclusions: The saliency map-based visual interpretation enables the verification of whether the model provides reliable decision-making for classification. Full article

(This article belongs to the Special Issue Advanced Musculoskeletal Imaging in Clinical Diagnostics)

► Show Figures

Figure 1

Journal Description

Diagnostics

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI