Diagnostics

16 pages, 668 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

12 pages, 3342 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

18 pages, 8645 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

12 pages, 1070 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

14 pages, 785 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

12 pages, 4902 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

13 pages, 386 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

11 pages, 505 KiB

Open AccessArticle

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

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

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

Abstract

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

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

α

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

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

► Show Figures

Figure 1

20 pages, 3941 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

22 pages, 4079 KiB

Open AccessArticle

Breast Cancer Classification with Various Optimized Deep Learning Methods

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

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

Abstract

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

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

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

► Show Figures

Figure 1

27 pages, 583 KiB

Open AccessReview

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

by Eglė Vasylė, Andrius Januškevičius and Kęstutis Malakauskas

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

Abstract

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

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

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

► Show Figures

Figure 1

12 pages, 600 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

14 pages, 1975 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

12 pages, 2431 KiB

Open AccessArticle

Unsupervised Clustering Successfully Predicts Prognosis in NSCLC Brain Metastasis Cohorts

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

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

Abstract

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

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

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

► Show Figures

Figure 1

11 pages, 349 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

15 pages, 4788 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

13 pages, 1371 KiB

Open AccessArticle

Deep Learning-Based Detection of Separated Root Canal Instruments in Panoramic Radiographs Using a U²-Net Architecture

by Nildem İnönü, Umut Aksoy, Dilan Kırmızı, Seçil Aksoy, Nurullah Akkaya and Kaan Orhan

Diagnostics 2025, 15(14), 1744; https://doi.org/10.3390/diagnostics15141744 - 9 Jul 2025

Abstract

Background: Separated endodontic instruments are a significant complication in root canal treatment, affecting disinfection and long-term prognosis. Their detection on panoramic radiographs is challenging, particularly in complex anatomy or for less experienced clinicians. Objectives: This study aimed to develop and evaluate a deep [...] Read more.

Background: Separated endodontic instruments are a significant complication in root canal treatment, affecting disinfection and long-term prognosis. Their detection on panoramic radiographs is challenging, particularly in complex anatomy or for less experienced clinicians. Objectives: This study aimed to develop and evaluate a deep learning model using the U²-Net architecture for automated detection and segmentation of separated instruments in panoramic radiographs from multiple imaging systems. Methods: A total of 36,800 panoramic radiographs were retrospectively reviewed, and 191 met strict inclusion criteria. Separated instruments were manually segmented using the Computer Vision Annotation Tool. The U²-Net model was trained and evaluated using standard performance metrics: Dice coefficient, IoU, precision, recall, and F1 score. Results: The model achieved a Dice coefficient of 0.849 (95% CI: 0.840–0.857) and IoU of 0.790 (95% CI: 0.781–0.799). Precision was 0.877 (95% CI: 0.869–0.884), recall was 0.847 (95% CI: 0.839–0.855), and the F1-score was 0.861 (95% CI: 0.853–0.869). Conclusions: These results demonstrate a strong overlap between predictions and ground truth, indicating high segmentation accuracy. The U²-Net model showed robust performance across radiographs from various systems, suggesting its clinical utility in aiding detection and treatment planning. Further multicenter studies are recommended to confirm generalizability. Full article

(This article belongs to the Special Issue Advancements in Artificial Intelligence for Dentomaxillofacial Radiology—2nd Edition)

► Show Figures

Figure 1

24 pages, 11588 KiB

Open AccessReview

How to Perform Cardiac Contrast-Enhanced Ultrasound (cCEUS): Part I

by Harald Becher, Andreas Helfen, Guido Michels, Nicola Gaibazzi, Roxy Senior and Christoph Frank Dietrich

Diagnostics 2025, 15(14), 1743; https://doi.org/10.3390/diagnostics15141743 - 9 Jul 2025

Abstract

Ultrasound enhancing agents (UEAs, formerly called contrast agents) for assessments of the left heart have improved the applicability of echocardiography and the accuracy of echocardiographic measurements. UEAs have been recommended for several diagnostic echocardiographic procedures by national and supernational agencies. The increased use [...] Read more.

Ultrasound enhancing agents (UEAs, formerly called contrast agents) for assessments of the left heart have improved the applicability of echocardiography and the accuracy of echocardiographic measurements. UEAs have been recommended for several diagnostic echocardiographic procedures by national and supernational agencies. The increased use of UEAs during the last years provided more evidence and experience in clinical practice data which is helpful for optimizing the UEA procedures and which will be useful for both newcomers to UEA in echocardiography and sonographers/physicians with experience in echocardiography with UEAs. In two parts, this review focuses on the “how to do” for the approved UEA applications. This is part 1, covering the available UEAs and providing specific guidance on the assessment of global and regional LV function. Part 2 covers the imaging of myocardial disease and masses as well as myocardial perfusion. Recommendations include the application of UEAs in two-dimensional echocardiography as there is limited data on three-dimensional echocardiography. A step-by-step approach is proposed for each of the procedures as well as guidance on how to interpret recordings and how to report them. Full article

(This article belongs to the Special Issue New Perspectives in Cardiac Imaging)

► Show Figures

Figure 1

17 pages, 1960 KiB

Open AccessArticle

Radiographic Evidence of Immature Bone Architecture After Sinus Grafting: A Multidimensional Image Analysis Approach

by Ibrahim Burak Yuksel, Fatma Altiparmak, Gokhan Gurses, Ahmet Akti, Merve Alic and Selin Tuna

Diagnostics 2025, 15(14), 1742; https://doi.org/10.3390/diagnostics15141742 - 9 Jul 2025

Abstract

Background: Radiographic evaluation of bone regeneration following maxillary sinus floor elevation commonly emphasizes volumetric gains. However, the qualitative microarchitecture of the regenerated bone, particularly when assessed via two-dimensional imaging modalities, such as panoramic radiographs, remains insufficiently explored. This study aimed to evaluate early [...] Read more.

Background: Radiographic evaluation of bone regeneration following maxillary sinus floor elevation commonly emphasizes volumetric gains. However, the qualitative microarchitecture of the regenerated bone, particularly when assessed via two-dimensional imaging modalities, such as panoramic radiographs, remains insufficiently explored. This study aimed to evaluate early trabecular changes in grafted maxillary sinus regions using fractal dimension, first-order statistics, and gray-level co-occurrence matrix analysis. Methods: This retrospective study included 150 patients who underwent maxillary sinus floor augmentation with bovine-derived xenohybrid grafts. Postoperative panoramic radiographs were analyzed at 6 months to assess early healing. Four standardized regions of interest representing grafted sinus floors and adjacent tuberosity regions were analyzed. Image processing and quantitative analyses were performed to extract fractal dimension (FD), first-order statistics (FOS), and gray-level co-occurrence matrix (GLCM) features (contrast, homogeneity, energy, correlation). Results: A total of 150 grafted sites and 150 control tuberosity sites were analyzed. Fractal dimension (FD) and contrast values were significantly lower in grafted areas than in native tuberosity bone (p < 0.001 for both), suggesting reduced trabecular complexity and less distinct transitions. In contrast, higher homogeneity (p < 0.001) and mean gray-level intensity values (p < 0.001) were observed in the grafted regions, reflecting a more uniform but immature trabecular pattern during the early healing phase. Energy and correlation values also differed significantly between groups (p < 0.001). No postoperative complications were reported, and resorbable collagen membranes appeared to support graft stability. Conclusions: Although the grafted sites demonstrated radiographic volume stability, their trabecular architecture remained immature at 6 months, implying that volumetric measurements alone may be insufficient to assess biological bone maturation. These results support the utility of advanced textural and fractal analysis in routine imaging to optimize clinical decision-making regarding implant placement timing in grafted sinuses. Full article

(This article belongs to the Special Issue Technological Advances in Oral and Maxillofacial Surgery for Diagnosis)

► 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