Diagnostics

3 pages, 973 KiB

Open AccessInteresting Images

“Rosary Sign” at Somatostatin Receptor PET in a Case of Recurrent Meningioma

by Cesare Michele Iacovitti, Davide Giovanni Bosetti, Barbara Muoio, Marco Cuzzocrea, Gaetano Paone and Giorgio Treglia

Diagnostics 2024, 14(22), 2608; https://doi.org/10.3390/diagnostics14222608 (registering DOI) - 20 Nov 2024

Abstract

We present the case of a 60-year-old male with recurrent atypical meningioma in the right parietal lobe, previously treated with surgery and radiation therapy. Magnetic resonance imaging (MRI) performed 5 years after radiation therapy suggested a possible recurrence. A somatostatin receptor positron emission [...] Read more.

We present the case of a 60-year-old male with recurrent atypical meningioma in the right parietal lobe, previously treated with surgery and radiation therapy. Magnetic resonance imaging (MRI) performed 5 years after radiation therapy suggested a possible recurrence. A somatostatin receptor positron emission tomography/computed tomography (SR-PET/CT) scan with Gallium-68 DOTATATE was performed to confirm this suspicion. SR-PET/CT confirmed the presence of recurrent meningioma, showing a novel “rosary sign” with multiple adjacent areas of focal tracer uptake along the resection margins of the previous surgical site in the right parietal region. This novel imaging pattern improved diagnostic accuracy by detailing disease extent and identifying additional lesions not visible via MRI. Given the failure of prior treatments and high SR expression, peptide receptor radionuclide therapy (PRRT) was proposed as a therapeutic option for the patient. Full article

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

10 pages, 439 KiB

Open AccessArticle

Predictive Model of Paraaortic Lymph Node Involvement in cN0 Locally Advanced Cervical Cancers: PET/CT Technology Matters

by Judicael Hotton, Emilie Raimond, Fabien Reyal, Sophie Michel, Vivien Ceccato, Abdenasser Moubtakir, Dimitri Papathanassiou and David Morland

Diagnostics 2024, 14(22), 2607; https://doi.org/10.3390/diagnostics14222607 (registering DOI) - 20 Nov 2024

Abstract

Background: The aim is to propose a model for predicting occult paraaortic lymph node (PALN) involvement in locally advanced cervical cancer (LACC) patients by including parameters such as reconstruction detection technology (use of time-of-flight) and parameters related to the primary tumor. This [...] Read more.

Background: The aim is to propose a model for predicting occult paraaortic lymph node (PALN) involvement in locally advanced cervical cancer (LACC) patients by including parameters such as reconstruction detection technology (use of time-of-flight) and parameters related to the primary tumor. This model will then be compared with the scores used in routine clinical practice; Methods: This retrospective observational cohort study included patients diagnosed with LACC who underwent ¹⁸F-FDG PET/CT prior to PALN surgical staging between February 2012 and May 2020. The following parameters were collected on PET/CT: tumor SUVmax, tumor MTV, number of common and distal pelvic node involvements. A multivariate regression analysis estimating the probability of PALN involvement was performed, with optimal thresholds determined via ROC curves; Results: In total, 71 patients met the inclusion criteria. Occult PALN involvement was detected in 12.7% of patients. A derived multivariate PET model selected four variables: number of common and distal iliac lymph nodes (OR 5.9 and 2.7, respectively), tumor-to-liver SUV ratio (OR 0.9) and the use of time-of-flight technology (OR 21.4 if no time-of-flight available). At the optimal threshold, a sensitivity of 77.8% and specificity of 88.7% was found. The model’s performances varied significantly between patients whose PET/CT used time-of-flight and those whose PET/CT did not. No significant differences were found between our model and the one used in clinical practice (p = 0.55); Conclusions: This study shows that PET/CT technology influences the ability to detect occult PALN involvement in LACC. This parameter should be considered in the regular revision of PET-based scores. Full article

(This article belongs to the Special Issue Advances in Diagnosis of Gynecological Cancers)

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11 pages, 4030 KiB

Open AccessArticle

Ultrasound Imaging Comparison of Crural Fascia Thickness and Muscle Stiffness in Stroke Patients with Spasticity

by Jongwon Choi, Yerim Do and Haneul Lee

Diagnostics 2024, 14(22), 2606; https://doi.org/10.3390/diagnostics14222606 (registering DOI) - 20 Nov 2024

Abstract

Background/Objective: Spasticity following stroke causes structural changes in the muscles and fascia, affecting the mobility and functional recovery of patients. Understanding these structural changes is critical to optimizing the rehabilitation strategies for patients. Therefore, in this study, we aimed to investigate the differences [...] Read more.

Background/Objective: Spasticity following stroke causes structural changes in the muscles and fascia, affecting the mobility and functional recovery of patients. Understanding these structural changes is critical to optimizing the rehabilitation strategies for patients. Therefore, in this study, we aimed to investigate the differences in crural and epimysial fascia thickness and muscle stiffness in the affected and unaffected lower limbs of chronic stroke patients with spasticity. Methods: A total of 88 patients with chronic stroke (mean age: 62.7 ± 10.2 years) were included in this study. Ankle range of motion, crural fascial thickness, and muscle stiffness in affected and unaffected lower limbs were assessed using ultrasound. Results: For the affected lower limbs, 59 patients (67.1%) exhibited a modified Ashworth scale score of 2, whereas 29 patients (32.9%) exhibited a score of 3. Ankle range of motion, fascia thickness, and muscle stiffness were also measured. The range of motion in ankle dorsiflexion and plantar flexion was significantly reduced on the affected side (p < 0.05). Crural fascia thickness was significantly greater in all regions of the affected side (anterior: 0.96 ± 0.14 vs. 0.72 ± 0.08 mm [p < 0.001]; lateral: 1.01 ± 0.14 vs. 0.75 ± 0.14 mm [p < 0.001]), and the epimysial fascia of the tibialis anterior muscle was similarly greater in the affected side (0.46 ± 0.07 vs. 0.34 ± 0.03 mm [p < 0.001]). However, no significant differences in muscle stiffness were observed between the affected and unaffected sides (p > 0.05). Conclusions: Overall, these findings revealed significant fascial thickening with only minimal changes in muscle stiffness on the affected side, highlighting the importance of controlling fascial changes for post-stroke spasticity management. Full article

(This article belongs to the Special Issue Advances in Ultrasound Imaging for Musculoskeletal Diseases)

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13 pages, 860 KiB

Open AccessArticle

Multi-Scale 3D Cephalometric Landmark Detection Based on Direct Regression with 3D CNN Architectures

by Chanho Song, Yoosoo Jeong, Hyungkyu Huh, Jee-Woong Park, Jun-Young Paeng, Jaemyung Ahn, Jaebum Son and Euisung Jung

Diagnostics 2024, 14(22), 2605; https://doi.org/10.3390/diagnostics14222605 (registering DOI) - 20 Nov 2024

Abstract

Background: Cephalometric analysis is important in diagnosing and planning treatments for patients, traditionally relying on 2D cephalometric radiographs. With advancements in 3D imaging, automated landmark detection using deep learning has gained prominence. However, 3D imaging introduces challenges due to increased network complexity and [...] Read more.

Background: Cephalometric analysis is important in diagnosing and planning treatments for patients, traditionally relying on 2D cephalometric radiographs. With advancements in 3D imaging, automated landmark detection using deep learning has gained prominence. However, 3D imaging introduces challenges due to increased network complexity and computational demands. This study proposes a multi-scale 3D CNN-based approach utilizing direct regression to improve the accuracy of maxillofacial landmark detection. Methods: The method employs a coarse-to-fine framework, first identifying landmarks in a global context and then refining their positions using localized 3D patches. A clinical dataset of 150 CT scans from maxillofacial surgery patients, annotated with 30 anatomical landmarks, was used for training and evaluation. Results: The proposed method achieved an average RMSE of 2.238 mm, outperforming conventional 3D CNN architectures. The approach demonstrated consistent detection without failure cases. Conclusions: Our multi-scale-based 3D CNN framework provides a reliable method for automated landmark detection in maxillofacial CT images, showing potential for other clinical applications. Full article

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

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30 pages, 2346 KiB

Open AccessArticle

A Novel Method for 3D Lung Tumor Reconstruction Using Generative Models

by Hamidreza Najafi, Kimia Savoji, Marzieh Mirzaeibonehkhater, Seyed Vahid Moravvej, Roohallah Alizadehsani and Siamak Pedrammehr

Diagnostics 2024, 14(22), 2604; https://doi.org/10.3390/diagnostics14222604 - 20 Nov 2024

Abstract

Background: Lung cancer remains a significant health concern, and the effectiveness of early detection significantly enhances patient survival rates. Identifying lung tumors with high precision is a challenge due to the complex nature of tumor structures and the surrounding lung tissues. Methods: To [...] Read more.

Background: Lung cancer remains a significant health concern, and the effectiveness of early detection significantly enhances patient survival rates. Identifying lung tumors with high precision is a challenge due to the complex nature of tumor structures and the surrounding lung tissues. Methods: To address these hurdles, this paper presents an innovative three-step approach that leverages Generative Adversarial Networks (GAN), Long Short-Term Memory (LSTM), and VGG16 algorithms for the accurate reconstruction of three-dimensional (3D) lung tumor images. The first challenge we address is the accurate segmentation of lung tissues from CT images, a task complicated by the overwhelming presence of non-lung pixels, which can lead to classifier imbalance. Our solution employs a GAN model trained with a reinforcement learning (RL)-based algorithm to mitigate this imbalance and enhance segmentation accuracy. The second challenge involves precisely detecting tumors within the segmented lung regions. We introduce a second GAN model with a novel loss function that significantly improves tumor detection accuracy. Following successful segmentation and tumor detection, the VGG16 algorithm is utilized for feature extraction, preparing the data for the final 3D reconstruction. These features are then processed through an LSTM network and converted into a format suitable for the reconstructive GAN. This GAN, equipped with dilated convolution layers in its discriminator, captures extensive contextual information, enabling the accurate reconstruction of the tumor’s 3D structure. Results: The effectiveness of our method is demonstrated through rigorous evaluation against established techniques using the LIDC-IDRI dataset and standard performance metrics, showcasing its superior performance and potential for enhancing early lung cancer detection. Conclusions:This study highlights the benefits of combining GANs, LSTM, and VGG16 into a unified framework. This approach significantly improves the accuracy of detecting and reconstructing lung tumors, promising to enhance diagnostic methods and patient results in lung cancer treatment. Full article

(This article belongs to the Special Issue AI and Digital Health for Disease Diagnosis and Monitoring)

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8 pages, 1018 KiB

Open AccessArticle

Agreement Between Resting Energy Expenditure Predictive Formulas and Indirect Calorimetry in Non-Dialysis Dependent Chronic Kidney Disease

by Mariana Cassani de Oliveira, Marina Nogueira Berbel Bufarah, Rodrigo Bueno de Oliveira, Cassiana Regina de Góes and André Luís Balbi

Diagnostics 2024, 14(22), 2603; https://doi.org/10.3390/diagnostics14222603 - 20 Nov 2024

Abstract

Background and Aims: The gold standard method for measuring resting energy expenditure (REE) is indirect calorimetry (IC) using an expensive device that requires specialized training. To overcome the limitations of IC, REE prediction formulas are used in patients with chronic kidney disease (CKD). [...] Read more.

Background and Aims: The gold standard method for measuring resting energy expenditure (REE) is indirect calorimetry (IC) using an expensive device that requires specialized training. To overcome the limitations of IC, REE prediction formulas are used in patients with chronic kidney disease (CKD). However, it is still controversial which of these formulas has greater accuracy compared to IC. We aimed to determine the accuracies of REE measured by IC and estimated by formulas in patients with CKD. Methods: Fifty-three patients with stage 4–5 CKD underwent IC and five current REE prediction formulas. Accuracy was measured by Lin’s correlation coefficient. Bland–Altman repeated measures analysis was used to assess the agreement of the formulas’ results with those of IC. Precision was measured by the predicted IC ± 10% and 20%. Systematic bias was assessed by the Student’s t-test, and linear regression was used to assess proportionality bias. Results: Patients had a mean estimated glomerular filtration rate (eGFR) of 12 ± 4 mL/min/1.73 m², a mean age of 65 years, and 62% were male. The mean REE measured by IC was 1341 ± 37 Kcal/day, and the formula with the lowest mean bias (0.1509 [−653.5121; 398.9056]), best correlation (r = 0.789; p = 0.000), and best accuracy (85%) was the formula developed by Fernandes and Cols (REE (kcal/day) = 854 + (7.4 × body weight) + (179 × sex) − (3.3 × age) + (2.1 × eGFR) + 26 (if diabetes)). Conclusions: The Fernandes and Cols equation had good accuracy and was valuable for estimating energy requirements in the population studied. Full article

(This article belongs to the Special Issue Current Issues on Kidney Diseases Diagnosis and Management 2025)

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17 pages, 1073 KiB

Open AccessReview

The Bleeding Edge: Managing Coagulation and Bleeding Risk in Patients with Cirrhosis Undergoing Interventional Procedures

by Rareș Crăciun, Cristiana Grapă, Tudor Mocan, Cristian Tefas, Iuliana Nenu, Alina Buliarcă, Horia Ștefănescu, Andrada Nemes, Bogdan Procopeț and Zeno Spârchez

Diagnostics 2024, 14(22), 2602; https://doi.org/10.3390/diagnostics14222602 - 20 Nov 2024

Abstract

This review addresses the peri-procedural bleeding risks in patients with cirrhosis, emphasizing the need for careful coagulation assessment and targeted correction strategies. Liver disease presents a unique hemostatic challenge, where traditional coagulation tests may not accurately predict bleeding risk, complicating the management of [...] Read more.

This review addresses the peri-procedural bleeding risks in patients with cirrhosis, emphasizing the need for careful coagulation assessment and targeted correction strategies. Liver disease presents a unique hemostatic challenge, where traditional coagulation tests may not accurately predict bleeding risk, complicating the management of procedures like paracentesis, endoscopic therapy, and various interventional procedures. As such, this paper aims to provide a comprehensive analysis of current data, guidelines, and practices for managing coagulation in cirrhotic patients, with a focus on minimizing bleeding risk while avoiding unnecessary correction with blood products. The objectives of this review are threefold: first, to outline the existing evidence on bleeding risks associated with common invasive procedures in cirrhotic patients; second, to evaluate the efficacy and limitations of standard and advanced coagulation tests in predicting procedural bleeding; and third, to examine the role of blood product transfusions and other hemostatic interventions, considering potential risks and benefits in this delicate population. In doing so, this review highlights patient-specific and procedure-specific factors that influence bleeding risk and informs best practices to optimize patient outcomes. This review progresses through key procedures often performed in cirrhotic patients. The discussion begins with paracentesis, a low-risk procedure, followed by endoscopic therapy for varices, and concludes with high-risk interventions requiring advanced hemostatic considerations. Each chapter addresses procedural techniques, bleeding risk assessment, and evidence-based correction approaches. This comprehensive structure aims to guide clinicians in making informed, evidence-backed decisions in managing coagulation in cirrhosis, ultimately reducing procedural complications and improving care quality for this high-risk population. Full article

(This article belongs to the Special Issue Diagnosis and Management of Liver Diseases—2nd Edition)

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5 pages, 1888 KiB

Open AccessInteresting Images

Compound Heterozygous Variants in the IFT140 Gene Associated with Skeletal Ciliopathies

by Katia Margiotti, Marco Fabiani, Antonella Cima, Antonella Viola, Francesca Monaco, Chiara Alì, Costanza Zangheri, Carmela Abramo, Claudio Coco, Alvaro Mesoraca and Claudio Giorlandino

Diagnostics 2024, 14(22), 2601; https://doi.org/10.3390/diagnostics14222601 - 20 Nov 2024

Abstract

Ciliopathies are rare congenital disorders caused by defects in the structure or function of cilia, which can lead to a wide range of clinical manifestations. Among them, a subset known as skeletal ciliopathies exhibits significant phenotypic overlap and primarily affects skeletal development. This [...] Read more.

Ciliopathies are rare congenital disorders caused by defects in the structure or function of cilia, which can lead to a wide range of clinical manifestations. Among them, a subset known as skeletal ciliopathies exhibits significant phenotypic overlap and primarily affects skeletal development. This group includes several syndromes with overlapping but distinct clinical features, such as short-rib polydactyly syndrome (SRPS), Jeune asphyxiating thoracic dystrophy (JATD), Mainzer–Saldino syndrome (MZSDS), and cranioectodermal dysplasia (CED), also called Sensenbrenner syndrome. The most characterized features of skeletal ciliopathies are short stature, rhizomelic limb shortening, and thoracic narrowing to varying extents, with JATD presenting the most severe form. Here, we report a fetus with an extension of skeletal ciliopathy phenotype and compound heterozygous variants in the IFT140 gene. The affected fetus had multiple malformations, including increased nuchal transparency (NT), shortened and thick long bones, hypoplastic tibia and fibula, absence of bladder, flat nose, and frontal bossing. Our findings expand the mutation spectrum of IFT140, and the clinical spectrum associated with skeletal ciliopathies, highly relevant in diagnosis prenatal settings. Full article

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

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12 pages, 2016 KiB

Open AccessArticle

Validation of Ultrasound Measurement of Vastus Lateralis for Appendicular Skeletal Muscle Mass in Chronic Kidney Disease Patients with Hemodialysis

by Peng-Ta Liu, Ta-Sen Wei and Congo Tak-Shing Ching

Diagnostics 2024, 14(22), 2600; https://doi.org/10.3390/diagnostics14222600 - 20 Nov 2024

Abstract

Background: Chronic kidney disease patients undergoing hemodialysis (HD) are at a high risk of developing sarcopenia. This study aimed to validate the performance of ultrasound (US) measurements of the vastus lateralis (VL) for estimating muscle mass and diagnosing sarcopenia in CKD patients with [...] Read more.

Background: Chronic kidney disease patients undergoing hemodialysis (HD) are at a high risk of developing sarcopenia. This study aimed to validate the performance of ultrasound (US) measurements of the vastus lateralis (VL) for estimating muscle mass and diagnosing sarcopenia in CKD patients with HD. Methods: Forty-six patients were enrolled in this study. Muscle thickness (MT) and echo intensity (EI) of VL, physical performance, and biochemical markers were collected to establish a linear regression model for predicting appendicular skeletal muscle mass (ASM), using dual-energy X-ray absorptiometry (DXA) as the reference standard. The model’s performance was validated, and its diagnostic accuracy for sarcopenia was also evaluated. Results: An ASM prediction model was derived: −20.17 + 1.90 × MT_VL (cm) + 1.58 × male + 0.16 × Height (cm) + 0.09 × Weight (kg) + 0.05 × Age (year), with a standard estimated error of 1.44 kg and adjusted R-squared of 0.84. The model exhibited high correlation and an acceptable limit of agreement, compared to DXA measurement. EI displayed a negative correlation with ASM and MT. Conclusions: The ASM adjusted with BMI demonstrated superior performance in diagnosing sarcopenia compared to the ASM adjusted with height. Ultrasound provides a cost-effective bedside tool for evaluating muscle conditions in HD patients. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Kidney Disease)

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13 pages, 2296 KiB

Open AccessSystematic Review

A Systematic Review and Meta-Analysis of Molecular Characteristics on Colistin Resistance of Acinetobacter baumannii

by Ihsan Hakki Ciftci, Elmas Pinar Kahraman Kilbas and Imdat Kilbas

Diagnostics 2024, 14(22), 2599; https://doi.org/10.3390/diagnostics14222599 - 19 Nov 2024

Abstract

Background: This study aimed to determine the molecular epidemiology of colistin-resistant A. baumannii in the last ten years and the frequency of gene regions related to pathogenesis, to compare the methods used to detect genes, and to confirm colistin resistance. Methods: This meta-analysis [...] Read more.

Background: This study aimed to determine the molecular epidemiology of colistin-resistant A. baumannii in the last ten years and the frequency of gene regions related to pathogenesis, to compare the methods used to detect genes, and to confirm colistin resistance. Methods: This meta-analysis study was conducted under Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines. In the meta-analysis, research articles published in English and Turkish in electronic databases between January 2012 and November 2023 were examined. International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) Statistics for Macbook (Version 25.0. Armonk, NY, USA) was used for statistical analysis. The Comprehensive Meta-Analysis (CMA) (Version 3.0. Biostat, NJ, USA) program was used for heterogeneity assessment in the articles included in the meta-analysis. Results: After evaluating the studies according to the elimination criteria, 18 original articles were included. Among colistin-resistant strains, bla_OXA-51 positivity was 243 (19.61%), bla_OXA-23 was 113 (9.12%), bla_OXA-58 was 7 (0.56%), bla_OXA-143 was 15 (1.21%), and bla_OXA-72 was seen in two (0.16%) strains. The positivity rates of pmrA, pmrB, and pmrC were found to be 22 (1.77%), 26 (2.09%), and 6 (0.48%). The mcr-1 rate was found to be 91 (7.34%), the mcr-2 rate was 78 (6.29%), and the mcr-3 rate was 82 (6.61%). Conclusions: The colistin resistance rate in our study was found to be high. However, only some research articles report and/or investigate more than one resistance gene together. Additionally, it may be challenging to explain colistin resistance solely by expressing resistance genes without discussing accompanying components such as efflux pumps, virulence factors, etc. Full article

(This article belongs to the Special Issue Advances in the Diagnosis of Infectious Diseases and Microorganisms)

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13 pages, 730 KiB

Open AccessArticle

Predictive Value of Clinical and Dual-Energy Computed Tomography Parameters for Hemorrhagic Transformation and Long-Term Outcomes Following Endovascular Thrombectomy

by Shiu-Yuan Huang, Nien-Chen Liao, Jin-An Huang, Wen-Hsien Chen and Hung-Chieh Chen

Diagnostics 2024, 14(22), 2598; https://doi.org/10.3390/diagnostics14222598 - 19 Nov 2024

Abstract

Objective: This study’s objective was to explore whether certain parameters measurable by dual-energy computed tomography (DECT) performed 24 h after endovascular thrombectomy (EVT) can predict subsequent hemorrhagic transformation. Material and Methods: We retrospectively reviewed patients with acute ischemic stroke (AIS) managed with EVT [...] Read more.

Objective: This study’s objective was to explore whether certain parameters measurable by dual-energy computed tomography (DECT) performed 24 h after endovascular thrombectomy (EVT) can predict subsequent hemorrhagic transformation. Material and Methods: We retrospectively reviewed patients with acute ischemic stroke (AIS) managed with EVT who had follow-up DECT within 24 h post-EVT between January 2019 and December 2023. Clinical and image parameters were recorded for predictive factor analysis. The primary outcome was hemorrhagic transformation, which was determined by using follow-up computed tomography (CT) or magnetic resonance imaging (MRI). The secondary outcomes were in-hospital mortality and 3-month post-EVT favorable functional outcome, as defined by a modified ranking scale (mRS) score of ≤2. Results: A total of 152 patients were included in this study. Multivariable analysis showed that the VNC-ASPECT score (p = 0.002) and superior sagittal sinus density (p = 0.01) were significantly associated with hemorrhagic transformation. For in-hospital survival rate analysis, post-EVT NIHSS measured 24 h post-EVT was an effective predictor, with a cutoff value of 23 (≤23: 88% vs. >23: 52.1%; p < 0.001). For functional outcome analysis, age (p < 0.001), tPA prior to EVT (p = 0.017), NIHSS 24 h post-EVT (p = 0.001), and VNC-ASPECT score (p < 0.003) were associated with a favorable functional outcome 3 months after EVT. Conclusions: The VNC-ASPECT score was associated with both hemorrhagic transformation and a 3-month post-EVT favorable functional outcome, and could therefore be an useful predictor for the development of hemorrhagic transformation. Full article

(This article belongs to the Special Issue Updates on Stroke: Diagnosis and Management)

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5 pages, 5400 KiB

Open AccessInteresting Images

Candidemia in an Orthopedic Patient Detected Coincidentally by Peripheral Blood Smear

by Eirini Spatha, Loredana-Mariana Gheorghe, Ioulia Chaliori, Nikolaos J. Tsagarakis, Nikolaos Patsiogiannis and Sofia K. Chaniotaki

Diagnostics 2024, 14(22), 2597; https://doi.org/10.3390/diagnostics14222597 - 19 Nov 2024

Abstract

An elderly male, with a recent COVID-19 infection and cardiovascular comorbidities, experienced a prolonged hospitalization due to a periprosthetic joint infection (PJI) and bacteremia, post hip hemiarthroplasty. Despite the initial clinical improvement while on targeted antimicrobial therapy, the patient later developed a low-grade [...] Read more.

An elderly male, with a recent COVID-19 infection and cardiovascular comorbidities, experienced a prolonged hospitalization due to a periprosthetic joint infection (PJI) and bacteremia, post hip hemiarthroplasty. Despite the initial clinical improvement while on targeted antimicrobial therapy, the patient later developed a low-grade fever and signs of myelosuppression. In the May–Grünwald–Giemsa stain of peripheral blood smear (PBS), pseudohyphae among red blood cells (RBCs) and phagocytosed blastospores in neutrophils and monocytes were detected, indicating candidemia rather than contamination of the stain. Echinocandin treatment was immediately initiated, and Candida albicans was identified from the blood culture, using multiplex polymerase chain reaction (PCR). Despite the early initiation of antifungal therapy and the removal of the central venous line (CVL), the patient passed away within 24 h. Candidemia is a leading cause of nosocomial bloodstream infections with high morbidity and mortality and is associated with multiple risk factors including surgery, CVLs, prolonged hospitalization, concomitant bacterial infection, broad-spectrum antibiotics, and immunosuppression. Isolation from blood cultures remains the gold standard for diagnosing candidemia. Detection of candidemia by PBS is extremely rare, requires an experienced microscopist, and is considered to be an emergency. Clinical suspicion, early laboratory identification, and immediate clinician notification are crucial for prompt antifungal treatment. Full article

(This article belongs to the Special Issue Laboratory Medicine: Extended Roles in Healthcare Delivery)

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10 pages, 1271 KiB

Open AccessArticle

Unsedated or On-Demand Minimally Sedated Water-Aided Outpatient Colonoscopy in Colorectal Cancer Screening and Surveillance: A Step Forward or Backward? Experience from Daily Practice in a Regional (Nonacademic) Hospital

by Stijn Arnaert, Diederik Persyn, Mike Cool, Guy Lambrecht and Guido Deboever

Diagnostics 2024, 14(22), 2596; https://doi.org/10.3390/diagnostics14222596 - 19 Nov 2024

Abstract

Background: By using optimal insertion techniques with water infusion and dynamic position changes, pain during colonoscopy is greatly reduced and the procedures can usually be performed without sedation. We investigated whether the excellent results with water-aided colonoscopy reported by experts are reproducible in [...] Read more.

Background: By using optimal insertion techniques with water infusion and dynamic position changes, pain during colonoscopy is greatly reduced and the procedures can usually be performed without sedation. We investigated whether the excellent results with water-aided colonoscopy reported by experts are reproducible in daily practice in a regional hospital. Methods: During the year 2023, 500 consecutive outpatients 50–75 years old presenting for colorectal cancer screening and surveillance could choose between unsedated or on-demand minimally sedated colonoscopy, moderate sedation with midazolam, or deep sedation with propofol. A total of 57% opted for unsedated colonoscopy, and of those patients, 250 consecutive patients were included. The primary outcome was the feasibility of the procedure. Cecal intubation rate (CIR), pain scores, use of midazolam, and willingness to repeat future procedures in the same way were registered periprocedural. Additional outcomes were cecal intubation time (CIT), detection rate of lesions, polyp resection rate, rate of adequate bowel preparation, and volume of water aspirated during insertion. Results: 250 consecutive sedation-free or on-demand minimally sedated water-based colonoscopies were analyzed. The CIR was 98%. A total of 96.5% completed without sedation and 5% of the procedures were perceived as moderately painful, but none had severe pain. The willingness to repeat was 97%. The mean CIT was 8.2 min. Conclusions: Using water-aided insertion techniques, comfortable sedation-free, or on-demand minimally sedated colonoscopy in daily practice in a regional hospital is feasible in the vast majority of patients presenting for colorectal cancer screening and surveillance, and the willingness to repeat is very high. Full article

(This article belongs to the Special Issue Endoscopy in Diagnosis of Gastrointestinal Disorders—2nd Edition)

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13 pages, 3345 KiB

Open AccessArticle

Comparison of Craniofacial Anthropometric Measurement Accuracy of Manual Technique vs. Cone-Beam CT Scanning

by Alexandru Misăiloaie, Ionuț Tărăboanță, Cristinel Ionel Stan, Cristian Constantin Budacu, Denisa-Mihaela Misăiloaie and Anca Sava

Diagnostics 2024, 14(22), 2595; https://doi.org/10.3390/diagnostics14222595 - 19 Nov 2024

Abstract

Background: This study aimed to compare the accuracy of linear measurements obtained using the classical (manual) method versus cone-beam computed tomography (CBCT) in craniofacial anthropometry, specifically targeting the infraorbital foramen (IOF). Methods: This study involved two sample groups: one of 40 dry skulls [...] Read more.

Background: This study aimed to compare the accuracy of linear measurements obtained using the classical (manual) method versus cone-beam computed tomography (CBCT) in craniofacial anthropometry, specifically targeting the infraorbital foramen (IOF). Methods: This study involved two sample groups: one of 40 dry skulls measured manually using digital calipers, and the other of 40 CBCT 3D images digitally measured. Measurements included IOF height, distances between the IOF and nasion (N), IOF and frontomalar orbital (FMO), and between the two IOFs. Statistical analysis was performed using an ANOVA, t-test, and Fisher’s test with a significance level of 0.05. Results: The manual method recorded a mean IOF height of 2.1 mm, while CBCT showed a mean of 3.52 mm. Significant differences were recorded between the two methods when measuring IOF height, with a p < 0.001. However, CBCT measurements generally yielded higher accuracy and lower variance due to the absence of significant differences (p > 0.05). The distance between the two IOFs measured by both methods differed significantly (p = 0.03157), with CBCT measurements showing higher values. Conclusions: In conclusion, although no significant differences were found in the overall accuracy of the two methods, CBCT proved to be a more reliable tool for detailed craniofacial measurements due to its higher accuracy and reproducibility. CBCT demonstrated superior consistency in measurements, offering enhanced precision in assessing craniofacial structures. These findings support the growing preference for CBCT in maxillofacial surgery, where precision is critical for successful outcomes. Nonetheless, manual techniques remain valuable in settings where advanced imaging is not accessible. Full article

(This article belongs to the Special Issue Advances in Oral and Maxillofacial Radiology)

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12 pages, 990 KiB

Open AccessArticle

The Immediate Effect of a Single Treatment of Neuromuscular Electrical Stimulation with the StimaWELL 120MTRS System on Multifidus Stiffness in Patients with Chronic Low Back Pain

by Daniel Wolfe, Geoffrey Dover, Mathieu Boily and Maryse Fortin

Diagnostics 2024, 14(22), 2594; https://doi.org/10.3390/diagnostics14222594 - 19 Nov 2024

Abstract

Background/Objectives: Individuals with chronic low back pain (CLBP) have altered lumbar multifidus stiffness properties compared to healthy controls. Although neuromuscular electrical stimulation (NMES) application to the multifidus might affect stiffness, this has never been investigated. The aims of this study were to examine [...] Read more.

Background/Objectives: Individuals with chronic low back pain (CLBP) have altered lumbar multifidus stiffness properties compared to healthy controls. Although neuromuscular electrical stimulation (NMES) application to the multifidus might affect stiffness, this has never been investigated. The aims of this study were to examine the effect of a single NMES treatment on multifidus stiffness and pain intensity in CLBP patients. Methods: 30 participants (13 male, 17 female) were randomized to one of two intervention (‘phasic’ and ‘combined’) protocols with the StimaWELL 120MTRS system. Multifidus stiffness at L4 and L5 was measured via shear-wave elastography (SWE) at rest and in standing prior to, and 15 min after, a 20 min NMES treatment. Pain intensity was measured pre- and post-treatment with the numerical pain rating scale (NPRS). Results: There were significant increases in resting shear modulus at right L4 (p = 0.001) and bilaterally at L5 (p = 0.017; p = 0.020) in the ‘combined’ intervention group, and a significant between-group difference at right L4 (p < 0.001). There were significant decreases in standing shear modulus at right L4 (p = 0.015) and left L5 (p = 0.036) in the ‘combined’ intervention group, and a significant between-group difference at left L5 (p = 0.016). Both groups experienced significant decreases in pain intensity (MD combined group = 1.12, 95% CI [0.34, 1.90], p = 0.011) (MD phasic group = 1.42, 95% CI [0.68, 2.16], p = 0.001). Conclusions: There were multiple significant changes in multifidus stiffness in the combined group, but not in the phasic group. Both groups experienced significant decreases in low back pain intensity. Full article

(This article belongs to the Special Issue Imaging in Musculoskeletal Disorders)

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11 pages, 2927 KiB

Open AccessArticle

Effect of Intravenous Contrast on CT Body Composition Measurements in Patients with Intraductal Papillary Mucinous Neoplasm

by Ranjit S. Chima, Tetiana Glushko, Margaret A. Park, Pamela Hodul, Evan W. Davis, Katelyn Martin, Aliya Qayyum, Jennifer B. Permuth and Daniel Jeong

Diagnostics 2024, 14(22), 2593; https://doi.org/10.3390/diagnostics14222593 - 18 Nov 2024

Abstract

Background: The effect of differing post-contrast phases on CT body composition measurements is not yet known. Methods: A fully automated AI-based body composition analysis using DAFS was performed on a retrospective cohort of 278 subjects undergoing pre-treatment triple-phase CT for pancreatic intraductal papillary [...] Read more.

Background: The effect of differing post-contrast phases on CT body composition measurements is not yet known. Methods: A fully automated AI-based body composition analysis using DAFS was performed on a retrospective cohort of 278 subjects undergoing pre-treatment triple-phase CT for pancreatic intraductal papillary mucinous neoplasm. The CT contrast phases included noncontrast (NON), arterial (ART), and venous (VEN) phases. The software selected a single axial CT image at mid-L3 on each phase for body compartment segmentation. The areas (cm²) were calculated for skeletal muscle (SM), intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). The mean Hounsfield units of skeletal muscle (SMHU) within the segmented regions were calculated. Bland–Altman and Chi Square analyses were performed. Results: SM-NON had a lower percentage of bias [LOA] than SM-ART, −0.7 [−7.6, 6.2], and SM-VEN, −0.3 [−7.6, 7.0]; VAT-NON had a higher percentage of bias than ART, 3.4 [−18.2, 25.0], and VEN, 5.8 [−15.0, 26.6]; and this value was lower for SAT-NON than ART, −0.4 [−14.9, 14.2], and VEN, −0.5 [−14.3, 13.4]; and higher for IMAT-NON than ART, 5.9 [−17.9, 29.7], and VEN, 9.5 [−17.0, 36.1]. The bias in SMHU NON [LOA] was lower than that in ART, −3.8 HU [−9.8, 2.1], and VEN, −7.8 HU [−14.8, −0.8]. Conclusions: IV contrast affects the voxel HU of fat and muscle, impacting CT analysis of body composition. We noted a relatively smaller bias in the SM, VAT, and SAT areas across the contrast phases. However, SMHU and IMAT experienced larger bias. During threshold risk stratification for CT-based measurements of SMHU and IMAT, the IV contrast phase should be taken into consideration. Full article

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

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14 pages, 5903 KiB

Open AccessArticle

Diagnostic Performance of Artificial Intelligence in Chest Radiographs Referred from the Emergency Department

by Julia López Alcolea, Ana Fernández Alfonso, Raquel Cano Alonso, Ana Álvarez Vázquez, Alejandro Díaz Moreno, David García Castellanos, Lucía Sanabria Greciano, Chawar Hayoun, Manuel Recio Rodríguez, Cristina Andreu Vázquez, Israel John Thuissard Vasallo and Vicente Martínez de Vega

Diagnostics 2024, 14(22), 2592; https://doi.org/10.3390/diagnostics14222592 - 18 Nov 2024

Abstract

Background: The increasing integration of AI in chest X-ray evaluation holds promise for enhancing diagnostic accuracy and optimizing clinical workflows. However, understanding its performance in real-world clinical settings is essential. Objectives: In this study, we evaluated the sensitivity (Se) and specificity (Sp) of [...] Read more.

Background: The increasing integration of AI in chest X-ray evaluation holds promise for enhancing diagnostic accuracy and optimizing clinical workflows. However, understanding its performance in real-world clinical settings is essential. Objectives: In this study, we evaluated the sensitivity (Se) and specificity (Sp) of an AI-based software (Arterys MICA v29.4.0) alongside a radiology resident in interpreting chest X-rays referred from the emergency department (ED), using a senior radiologist’s assessment as the gold standard (GS). We assessed the concordance between the AI system and the resident, noted the frequency of doubtful cases for each category, identified how many were considered positive by the GS, and assessed variables that AI was not trained to detect. Methods: We conducted a retrospective observational study analyzing chest X-rays from a sample of 784 patients referred from the ED at our hospital. The AI system was trained to detect five categorical variables—pulmonary nodule, pulmonary opacity, pleural effusion, pneumothorax, and fracture—and assign each a confidence label (“positive”, “doubtful”, or “negative”). Results: Sensitivity in detecting fractures and pneumothorax was high (100%) for both AI and the resident, moderate for pulmonary opacity (AI = 76%, resident = 71%), and acceptable for pleural effusion (AI = 60%, resident = 67%), with negative predictive values (NPV) above 95% and areas under the curve (AUC) exceeding 0.8. The resident showed moderate sensitivity (75%) for pulmonary nodules, while AI’s sensitivity was low (33%). AI assigned a “doubtful” label to some diagnoses, most of which were deemed negative by the GS; the resident expressed doubt less frequently. The Kappa coefficient between the resident and AI was fair (0.3) across most categories, except for pleural effusion, where concordance was moderate (0.5). Our study highlighted additional findings not detected by AI, including 16% prevalence of mediastinal abnormalities, 20% surgical materials, and 20% other pulmonary findings. Conclusions: Although AI demonstrated utility in identifying most primary findings—except for pulmonary nodules—its high NPV suggests it may be valuable for screening. Further training of the AI software and broadening its scope to identify additional findings could enhance its detection capabilities and increase its applicability in clinical practice. Full article

(This article belongs to the Special Issue Lesion Detection and Analysis Using Artificial Intelligence—2nd Edition)

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15 pages, 643 KiB

Open AccessArticle

Elevated Calprotectin Levels Reveal Loss of Vascular Pattern and Atrophy of Villi in Ileum by Digital Chromoendoscopy and Magnification Colonoscopy in Patients with Spondyloarthritis Without Having Inflammatory Bowel Disease

by Juliette De Avila, Cristian Flórez-Sarmiento, Viviana Parra-Izquierdo, Wilson Bautista-Molano, Magaly Chamorro-Melo, Adriana Beltrán-Ostos, Diego Alejandro Jaimes, Valery Khoury, Lorena Chila-Moreno, Alejandro Ramos-Casallas, Juan Manuel Bello-Gualtero, Jaiber Gutiérrez, Cesar Pacheco-Tena, Philippe Selim Chalem Choueka and Consuelo Romero-Sánchez

Diagnostics 2024, 14(22), 2591; https://doi.org/10.3390/diagnostics14222591 - 18 Nov 2024

Abstract

Objective: This study aimed to establish a correlation between fecal calprotectin levels (FC) and intestinal inflammation in patients with spondyloarthritis without inflammatory bowel disease. Methods: A total of 180 SpA patients were included in the study of them 20.6% required Digital chromoendoscopy (DCE). [...] Read more.

Objective: This study aimed to establish a correlation between fecal calprotectin levels (FC) and intestinal inflammation in patients with spondyloarthritis without inflammatory bowel disease. Methods: A total of 180 SpA patients were included in the study of them 20.6% required Digital chromoendoscopy (DCE). FC, C-reactive protein (CRP), HLA-B*27 and clinical indices were assessed. Results: Positive fecal calprotectin (PFC) and high fecal calprotectin (HFC) levels were observed in 27.0% and 16.0% of patients, respectively. HFC correlated with a Bath Ankylosing Spondylitis Functional Index (BASFI) score > 4.0 (p = 0.036) and a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score > 4.0 (p = 0.047). Loss of vascular pattern in the ileum (LVPI) was observed in approximately 70.0% of patients (p = 0.005), which was associated with PFC and abdominal bloating (p = 0.020). LVPI was also linked to microscopic inflammation (p = 0.012) and PFC with abdominal pain (p = 0.007). HFC was significantly associated with alterations in the ileal mucosa (p = 0.009) and LVPI (p = 0.001). Additionally, HFC and diarrhea were associated with LVPI in 27.3% of patients (p = 0.037) and with erosions in the ileum (p = 0.031). Chronic ileal inflammation correlated with HFC (p = 0.015), ASDAS-CRP > 2.1 (p = 0.09), LVPI (p = 0.001), and villous atrophy (p = 0.014). Factorial analysis of mixed data (FAMD) identified significant associations between micro/macroscopic changes in chronic inflammation and HFC (CC = 0.837); increased levels of CRP and microscopic acute inflammation (CC = 0.792); and clinical activity scores of ASDAS-CRP and BASDAI (CC = 0.914). Conlusions: FC levels were significantly elevated in patients with SpA, particularly those with LVPI, suggesting their potential as a valuable biomarker for managing SpA when joint manifestations coincide with ileal villous atrophy. This indicates a shared immune pathway linked to chronic gut damage. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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20 pages, 4029 KiB

Open AccessStudy Protocol

Four-Dimensional Flow MRI for Cardiovascular Evaluation (4DCarE): A Prospective Non-Inferiority Study of a Rapid Cardiac MRI Exam: Study Protocol and Pilot Analysis

by Jiaxing Jason Qin, Mustafa Gok, Alireza Gholipour, Jordan LoPilato, Max Kirkby, Christopher Poole, Paul Smith, Rominder Grover and Stuart M. Grieve

Diagnostics 2024, 14(22), 2590; https://doi.org/10.3390/diagnostics14222590 - 18 Nov 2024

Abstract

Background: Accurate measurements of flow and ventricular volume and function are critical for clinical decision-making in cardiovascular medicine. Cardiac magnetic resonance (CMR) is the current gold standard for ventricular functional evaluation but is relatively expensive and time-consuming, thus limiting the scale of clinical [...] Read more.

Background: Accurate measurements of flow and ventricular volume and function are critical for clinical decision-making in cardiovascular medicine. Cardiac magnetic resonance (CMR) is the current gold standard for ventricular functional evaluation but is relatively expensive and time-consuming, thus limiting the scale of clinical applications. New volumetric acquisition techniques, such as four-dimensional flow (4D-flow) and three-dimensional volumetric cine (3D-cine) MRI, could potentially reduce acquisition time without loss in accuracy; however, this has not been formally tested on a large scale. Methods: 4DCarE (4D-flow MRI for cardiovascular evaluation) is a prospective, multi-centre study designed to test the non-inferiority of a compressed 20 min exam based on volumetric CMR compared with a conventional CMR exam (45–60 min). The compressed exam utilises 4D-flow together with a single breath-hold 3D-cine to provide a rapid, accurate quantitative assessment of the whole heart function. Outcome measures are (i) flow and chamber volume measurements and (ii) overall functional evaluation. Secondary analyses will explore clinical applications of 4D-flow-derived parameters, including wall shear stress, flow kinetic energy quantification, and vortex analysis in large-scale cohorts. A target of 1200 participants will enter the study across three sites. The analysis will be performed at a single core laboratory site. Pilot Results: We present a pilot analysis of 196 participants comparing flow measurements obtained by 4D-flow and conventional 2D phase contrast, which demonstrated moderate–good consistency in ascending aorta and main pulmonary artery flow measurements between the two techniques. Four-dimensional flow underestimated the flow compared with 2D-PC, by approximately 3 mL/beat in both vessels. Conclusions: We present the study protocol of a prospective non-inferiority study of a rapid cardiac MRI exam compared with conventional CMR. The pilot analysis supports the continuation of the study. Study Registration: This study is registered with the Australia and New Zealand Clinical Trials Registry (Registry number ACTRN12622000047796, Universal Trial Number: U1111-1270-6509, registered 17 January 2022—Retrospectively registered). Full article

(This article belongs to the Special Issue Advances in Imaging Diagnosis and Management of Cardiovascular and Pulmonary Diseases)

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