Diagnostics

22 pages, 1068 KiB

Open AccessReview

Activated Factor VII–Antithrombin Complex, a Biomarker of Tissue Factor-Related Pathways in Different Clinical Settings: A Narrative Review from Cardiovascular Diseases to Cancer

by Sara Moruzzi, Annalisa Castagna, Marianna Spizzo, Silvia Udali, Patrizia Pattini, Francesca Pizzolo, Simonetta Friso and Nicola Martinelli

Diagnostics 2024, 14(16), 1711; https://doi.org/10.3390/diagnostics14161711 (registering DOI) - 6 Aug 2024

Abstract

Tissue factor (TF) is a transmembrane glycoprotein that represents the fundamental physiological initiator of the coagulation cascade through its interaction with factor VII. TF belongs to the cytokine receptor protein superfamily and contributes to the transduction of cellular signaling. Therefore, TF-related pathways are [...] Read more.

Tissue factor (TF) is a transmembrane glycoprotein that represents the fundamental physiological initiator of the coagulation cascade through its interaction with factor VII. TF belongs to the cytokine receptor protein superfamily and contributes to the transduction of cellular signaling. Therefore, TF-related pathways are involved in multiple pathophysiological processes, not only in coagulation/thrombosis but in a wider mechanisms’ panorama, ranging from infective to neoplastic diseases. Consistently, the measurement of TF activity could have a diagnostic and/or prognostic meaning in different clinical conditions. However, the transmembrane localization, the expression on different cellular types and circulating extracellular vesicles, and the different conformations (encrypted and decrypted) and variants (such as the soluble alternatively spliced TF) hamper TF assessment in clinical practice. The activated factor VII-antithrombin (FVIIa–AT) complex is proposed as an indirect biomarker of the TF–FVIIa interaction and, consequently, of the functionally active TF expression. In this narrative review, we evaluate the clinical studies investigating the role of plasma concentration of FVIIa–AT in health and disease. Although without conclusive data, high FVIIa–AT concentrations predict the worst clinical outcomes in different pathologic conditions, such as cardiovascular disease and cancer, thereby suggesting that overactivation of TF-related pathways may play an unfavorable role in various clinical settings. Full article

(This article belongs to the Collection Biomarkers in Medicine)

18 pages, 572 KiB

Open AccessReview

Assessment and Management of Maxillary Labial Frenum—A Scoping Review

by Ryan Kinney, Richard C. Burris, Ryan Moffat and Konstantinia Almpani

Diagnostics 2024, 14(16), 1710; https://doi.org/10.3390/diagnostics14161710 (registering DOI) - 6 Aug 2024

Abstract

Background: The maxillary labial frenum (MLF) is a soft tissue fold connecting the upper lip to the alveolar process. Abnormal attachment can cause periodontal, functional, and esthetic problems. Differential diagnosis is important and can prevent unnecessary interventions. This study aims to summarize the [...] Read more.

Background: The maxillary labial frenum (MLF) is a soft tissue fold connecting the upper lip to the alveolar process. Abnormal attachment can cause periodontal, functional, and esthetic problems. Differential diagnosis is important and can prevent unnecessary interventions. This study aims to summarize the current evidence on the assessment and management of abnormal MLF. Methods: A thorough review of the literature was conducted. Five online databases were searched for relevant peer-reviewed human studies. Article screening and data extraction were performed independently by two reviewers using predefined inclusion/exclusion criteria. Information about article type, study design, participants’ characteristics, interventions, and outcomes was extracted and synthesized. Results: 52 articles met the review criteria. MLF is a dynamic structure characterized by a wide normal morphological variation. MLF assessment in infants has not been standardized. Studies in pre-adolescents reported a change in the thickness and position of the MLF observed over time, resulting in a lower prevalence of abnormal MLF morphology. Studies in adolescents and adults reported variable differential diagnosis criteria. Lasers appear as the most advantageous frenectomy modality. Conclusions: There is a need for more objective MLF diagnostic protocols and treatment guidelines, which could prevent unnecessary surgical interventions. Full article

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

10 pages, 895 KiB

Open AccessArticle

Association between Inflammation-Based Prognostic Markers and Mortality in Patients Admitted to Intensive Care Units

by Ah Ran Oh, Jeong-Am Ryu, Seung Joo Lee, Chung Su Kim and Sangmin Maria Lee

Diagnostics 2024, 14(16), 1709; https://doi.org/10.3390/diagnostics14161709 (registering DOI) - 6 Aug 2024

Abstract

Background: We compared the prognostic value of the C-reactive protein (CRP)-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and modified Glasgow prognostic score (mGPS) with the Sequential Organ Failure Assessment (SOFA) score in an intensive care unit (ICUs). Methods: This study used the data of [...] Read more.

Background: We compared the prognostic value of the C-reactive protein (CRP)-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and modified Glasgow prognostic score (mGPS) with the Sequential Organ Failure Assessment (SOFA) score in an intensive care unit (ICUs). Methods: This study used the data of 53,877 adult patients admitted to an ICU between June 2013 and May 2022. Using the CAR, NLR, and mGPS values, as well as the SOFA score from the ICU, we conducted multivariable logistic regression analysis and used the receiver operating characteristic (ROC) curve to compare the predictive value for 28-day and 1-year mortality. Results: A total of 2419 patients (4.5%) died within 28 days, and 6209 (11.5%) patients died within 1 year. After an adjustment, all predictors were found to be independent risk factors for 28-day mortality (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.29–1.33, p < 0.001 for the SOFA score; OR 1.05, 95% CI 1.03–1.07, p < 0.001 for CAR; OR 1.01, 95% CI 1.00–1.02, p < 0.001 for the NLR; and OR 1.19, 95% CI 1.08–1.30, p < 0.001 for the mGPS). This trend persisted for the 1-year mortality. In ROC curve analysis, the CAR showed better predictability than the NLR and mGPS. Furthermore, the predictive power of the CAR was significantly higher than that of the SOFA score for 1-year mortality. Conclusions: The CAR, NLR, and mGPS values at ICU admission were independent risk factors of mortality after ICU admission. The predictive value of CAR was higher than that of the SOFA score for 1-year mortality. CAR assessment at ICU admission may be a feasible predictor of long-term mortality. Full article

(This article belongs to the Special Issue ICU Disease Diagnosis)

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13 pages, 1173 KiB

Open AccessReview

Imaging of Carotid Stenosis: Where Are We Standing? Comparison of Multiparametric Ultrasound, CT Angiography, and MRI Angiography, with Recent Developments

by Emanuele David, Hektor Grazhdani, Lorenzo Aliotta, Livio Maria Gavazzi, Pietro Valerio Foti, Stefano Palmucci, Corrado Inì, Francesco Tiralongo, Davide Castiglione, Maurizio Renda, Patrizia Pacini, Chiara Di Bella, Carmen Solito, Silvia Gigli, Alessandro Fazio, Rita Bella, Antonio Basile and Vito Cantisani

Diagnostics 2024, 14(16), 1708; https://doi.org/10.3390/diagnostics14161708 (registering DOI) - 6 Aug 2024

Abstract

Atherosclerotic disease of the carotid arteries is a crucial risk factor in predicting the likelihood of future stroke events. In addition, emerging studies suggest that carotid stenosis may also be an indicator of plaque load on coronary arteries and thus have a correlation [...] Read more.

Atherosclerotic disease of the carotid arteries is a crucial risk factor in predicting the likelihood of future stroke events. In addition, emerging studies suggest that carotid stenosis may also be an indicator of plaque load on coronary arteries and thus have a correlation with the risk of acute cardiovascular events. Furthermore, although in symptomatic patients the degree of stenosis is the main morphological parameter studied, recent evidence suggests, especially in asymptomatic patients, that plaque vulnerability should also be evaluated as an emerging and significant imaging parameter. The reference diagnostic methods for the evaluation of carotid stenosis are currently ultrasonography, magnetic resonance imaging (MRI), and computed tomography angiography (CTA). In addition, other more invasive methods such as 123I-metaiodobenzylguanidine (MIBG) scintigraphy and PET-CT, as well as digital subtraction angiography, can be used. Each method has advantages and disadvantages, and there is often some confusion in their use. For example, the usefulness of MRI is often underestimated. In addition, implementations for each method have been developed over the years and are already enabling a significant increase in diagnostic accuracy. The purpose of our study is to make an in-depth analysis of all the methods in use and in particular their role in the diagnostic procedure of carotid stenosis, also discussing new technologies. Full article

(This article belongs to the Special Issue Current Perspectives and Advances in Ultrasound Imaging)

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13 pages, 1964 KiB

Open AccessArticle

Pelvic Exenteration in Advanced, Recurrent or Synchronous Cancers—Last Resort or Therapeutic Option?

by Vlad Rotaru, Elena Chitoran, Daniela-Luminita Zob, Sinziana-Octavia Ionescu, Gelal Aisa, Prie Andra-Delia, Dragos Serban, Daniela-Cristina Stefan and Laurentiu Simion

Diagnostics 2024, 14(16), 1707; https://doi.org/10.3390/diagnostics14161707 (registering DOI) - 6 Aug 2024

Abstract

First described some 80 years ago, pelvic exenteration remain controversial interventions with variable results and ever-changing indications. The previous studies are not homogenous and have different inclusion criteria (different populations and different disease characteristics) and methodologies (including evaluation of results), making it extremely [...] Read more.

First described some 80 years ago, pelvic exenteration remain controversial interventions with variable results and ever-changing indications. The previous studies are not homogenous and have different inclusion criteria (different populations and different disease characteristics) and methodologies (including evaluation of results), making it extremely difficult to properly assess the role of pelvic exenteration in cancer treatment. This study aims to describe the indications of pelvic exenterations, the main prognostic factors of oncologic results, and the possible complications of the intervention. Methods: For this purpose, we conducted a retrospective study of 132 patients who underwent various forms of pelvic exenterations in the Institute of Oncology “Prof. Dr. Al. Trestioreanu” in Bucharest, Romania, between 2013 and 2022, collecting sociodemographic data, characteristics of patients, information on the disease treated, data about the surgical procedure, complications, additional cancer treatments, and oncologic results. Results: The study cohort consists of gynecological, colorectal, and urinary bladder malignancies (one hundred twenty-seven patients) and five patients with complex fistulas between pelvic organs. An R0 resection was possible in 76.38% of cases, while on the rest, positive margins on resection specimens were observed. The early morbidity was 40.63% and the mortality was 2.72%. Long-term outcomes included an overall survival of 43.7 months and a median recurrence-free survival of 24.3 months. The most important determinants of OS are completeness of resection, the colorectal origin of tumor, and the presence/absence of lymphovascular invasion. Conclusions: Although still associated with high morbidity rates, pelvic exenterations can deliver important improvements in oncological outcomes in the long-term and should be considered on a case-by-case basis. A good selection of patients and an experienced surgical team can facilitate optimal risks/benefits. Full article

(This article belongs to the Special Issue Contemporary Challenges and Innovations in Oncological Diagnosis and Treatment: The Romanian Landscape)

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18 pages, 1296 KiB

Open AccessArticle

The Pivotal Role of Presepsin in Assessing Sepsis-Induced Cholestasis

by Maria Iuliana Ghenu, Dorin Dragoș, Maria Mirabela Manea, Andra-Elena Balcangiu-Stroescu, Dorin Ionescu, Lucian Negreanu and Adelina Vlad

Diagnostics 2024, 14(16), 1706; https://doi.org/10.3390/diagnostics14161706 (registering DOI) - 6 Aug 2024

Abstract

Background: The serum levels of presepsin correlate with parameters indicating cholestasis in sepsis; however, the probability and significance of this association remain uncertain. We aimed to ascertain whether infection, as signaled by presepsin levels, is the primary determinant of elevated biliary parameters in [...] Read more.

Background: The serum levels of presepsin correlate with parameters indicating cholestasis in sepsis; however, the probability and significance of this association remain uncertain. We aimed to ascertain whether infection, as signaled by presepsin levels, is the primary determinant of elevated biliary parameters in sepsis. Methods: A unicenter, retrospective study included 396 COVID-free emergency-admitted patients, in which presepsin level was determined. Presepsin, neutrophil count, leukocyte count, C reactive protein, and fibrinogen evaluated the septic/inflammatory state. The statistically significant factors associated with cholestasis, ALT, and AST were analyzed by Fisher’s exact test and Spearman regression with Bonferroni’s correction. Results: Presepsin emerged as the most likely variable correlated with all cholestasis markers: alkaline phosphatase (p = 7 × 10⁻⁸), gamma-glutamyl transferase (p = 5 × 10⁻¹⁰), and conjugated bilirubin (p = 4 × 10⁻¹⁵). Thrombocyte count, C reactive protein, age, creatinine, urea, lactate, and blood pressure, were associated with only one or two of these markers. Conclusions: In a sepsis setting, the increase in cholestasis-related parameters is associated with presepsin with a higher probability than hemodynamic, inflammatory, or coagulation-related variables. Determining this robust link between sepsis and cholestasis could eliminate unnecessary imaging procedures in critically ill patients, enabling clinicians to focus efforts on addressing the primary infectious cause. Full article

(This article belongs to the Special Issue Biomarkers: Diagnostic Indicators for Human Ailments)

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12 pages, 1466 KiB

Open AccessArticle

Evaluation of Clinical Variables Affecting Myocardial Glucose Uptake in Cardiac FDG PET

by Yeongjoo Lee, Jaehyuk Jang, Sungmin Lim and Sae Jung Na

Diagnostics 2024, 14(16), 1705; https://doi.org/10.3390/diagnostics14161705 (registering DOI) - 6 Aug 2024

Abstract

Purpose: Cardiac 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography (FDG PET) is widely used to assess myocardial viability in patients with ischemic heart disease. While sufficient glucose uptake is a prerequisite for accurate interpretation of cardiac viability, there are a lack of data on which clinical [...] Read more.

Purpose: Cardiac 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography (FDG PET) is widely used to assess myocardial viability in patients with ischemic heart disease. While sufficient glucose uptake is a prerequisite for accurate interpretation of cardiac viability, there are a lack of data on which clinical variables have the most significant impact on myocardial glucose metabolism. Therefore, this study was designed to evaluate several clinical variables that could affect myocardial glucose metabolism. Methods: A total of 214 consecutive cases were retrospectively enrolled in this study. All subjects received 250 mg of acipimox and underwent glucose loading as preparation for cardiac FDG PET/CT. Three-dimensional regions of interest (ROIs) were drawn on PET/CT fusion images. Myocardial glucose uptake ratio (MGUR = SUVmax of LV myocardium/SUVmean of liver) was then calculated. Multiple clinical variables including body mass index (BMI), blood glucose levels at different times, administered insulin dosage, lipid profiles, and ejection fraction were measured and analyzed for correlation with myocardial glucose uptake. After dichotomizing the subjects based on a BMI of 25, each group’s MGUR was compared. Results: Myocardial uptake showed significant correlations with BMI (r = −0.162, p = 0.018), HbA1c (r = −0.150, p = 0.030), and triglyceride levels (r = −0.137, p = 0.046). No other clinical variables showed a significant correlation with myocardial glucose uptake. After multiple linear regression analysis, BMI (p = 0.032) and HbA1c (p = 0.050) showed a correlation with MGUR. In group analysis, after dividing patients based on BMI, the obese group showed significantly lower myocardial uptake than the non-obese group (3.8 ± 1.9 vs. 4.4 ± 2.1, p = 0.031). Conclusions: Among several clinical variables, BMI and HbA1c levels were related to myocardial glucose uptake. A prospective study would be needed to examine whether a protocol that additionally considers BMI and HbA1c levels is necessary for the current cardiac FDG PET protocol. Full article

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

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6 pages, 1492 KiB

Open AccessBrief Report

Micro-Computed Tomography Whole-Block Imaging Reveals Origin and Path of Rectal Cancer Tumor Deposits: A Pilot Study

by Canan Firat, Nil Urganci, Alexei Teplov, Emine Cesmecioglu, Nilay Bakoglu, Efsevia Vakiani, Peter Ntiamoah, Martin R. Weiser, Julio Garcia-Aguilar, Meera Hameed, Yukako Yagi and Jinru Shia

Diagnostics 2024, 14(16), 1704; https://doi.org/10.3390/diagnostics14161704 (registering DOI) - 6 Aug 2024

Abstract

In colorectal carcinoma (CRC), tumor deposits (TDs) are described as macroscopic/microscopic nests/nodules in the lymph drainage area discontinuous with the primary mass, without identifiable lymph node (LN) tissue, and not confined to vascular or perineural spaces. A TD is categorized as pN1C only [...] Read more.

In colorectal carcinoma (CRC), tumor deposits (TDs) are described as macroscopic/microscopic nests/nodules in the lymph drainage area discontinuous with the primary mass, without identifiable lymph node (LN) tissue, and not confined to vascular or perineural spaces. A TD is categorized as pN1C only when no bona fide LN metastasis exists. However, there has been an ongoing debate on whether TDs should be counted as LNs. The fact that the origin of TDs is not fully understood adds further uncertainty. This pilot study aims to evaluate whether whole-block imaging by micro-computed tomography (micro-CT WBI) that enables three-dimensional reconstruction of whole-mount (WM) blocks can serve as a tool to assess the origin and path of CRC TDs. We evaluated whole-slide imaging (WSI) and micro-CT WBI of 20 WM blocks from a rectal cancer resection that contained TDs. Each TD was tracked through the contiguous blocks to define their origin and path. Of eleven TDs identified on WSI, six were detected on WBI. Strikingly, six of six TDs trackable through the blocks on WBI revealed an origin from the main tumor. This pilot study provided evidence that micro-CT WBI can serve as an effective tool to evaluate the origin and path of CRC TDs. Full article

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

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9 pages, 791 KiB

Open AccessArticle

Assessing the Predictive Accuracy of the Eaton–Littler Classification in Thumb Carpometacarpal Osteoarthritis: A Comparative Analysis with the Outerbridge Classification in a Cohort of 51 Cases

by Enrico Carità, Alberto Donadelli, Mara Laterza, Giacomo Rossettini, Jorge Hugo Villafañe and Pier Giuseppe Perazzini

Diagnostics 2024, 14(16), 1703; https://doi.org/10.3390/diagnostics14161703 (registering DOI) - 6 Aug 2024

Abstract

(1) Background: The objective of this study is to evaluate the predictive value of the Eaton–Littler radiologic classification for thumb carpometacarpal osteoarthritis (CMC OA) relating to intra-articular cartilage damage assessed by the Outerbridge arthroscopic classification. (2) Methods: A total of 51 thumb CMC [...] Read more.

(1) Background: The objective of this study is to evaluate the predictive value of the Eaton–Littler radiologic classification for thumb carpometacarpal osteoarthritis (CMC OA) relating to intra-articular cartilage damage assessed by the Outerbridge arthroscopic classification. (2) Methods: A total of 51 thumb CMC OA arthroscopies were performed on patients classified as Eaton stages 1, 2, or 3. Post-arthroscopic evaluations of cartilage damage were categorized using the Outerbridge classification. Comparative analyses were conducted between the radiological Eaton stages and the arthroscopic Outerbridge stages. (3) Results: Arthroscopic examination revealed Outerbridge stage 3 and 4 cartilage damage in 26 cases classified as Eaton stage 2 and in 18 cases classified as Eaton stage 3. The detection of severe cartilage damage in patients classified as Eaton stage 2 was unexpected. (4) Conclusions: Arthroscopy demonstrated that many patients with mild radiological degenerative signs exhibited significant cartilage destruction. Although the Eaton classification is widely used for staging thumb CMC OA, it may not accurately reflect the severity of intra-articular damage. The Eaton classification does not reliably predict intra-articular damage in Eaton stage 2 cases. Full article

(This article belongs to the Special Issue Arthroscopy Techniques in Diagnosis and Treatment)

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15 pages, 1718 KiB

Open AccessArticle

MyACR: A Point-of-Care Medical Device for Determination of Albumin–Creatinine Ratio (uACR) in Random Urine Samples as a Marker of Nephropathy

by Nadda Muhamad, Napaporn Youngvises, Tullayakorn Plengsuriyakarn, Wanchai Meesiri, Wanna Chaijaroenkul and Kesara Na-Bangchang

Diagnostics 2024, 14(16), 1702; https://doi.org/10.3390/diagnostics14161702 (registering DOI) - 6 Aug 2024

Abstract

Chronic kidney disease (CKD) is a progressive condition that affects more than 10% of the world’s population. Monitoring urine albumin-to-creatinine ratio (uACR) has become the gold standard for nephropathy diagnosis and control. The objective of the present study was to develop a simple, [...] Read more.

Chronic kidney disease (CKD) is a progressive condition that affects more than 10% of the world’s population. Monitoring urine albumin-to-creatinine ratio (uACR) has become the gold standard for nephropathy diagnosis and control. The objective of the present study was to develop a simple, accurate, sensitive, and rapid point-of-care test (PoCT) device, MyACR, for uACR measurement, intended for use in community healthcare to screen for the risk and monitor the progress of CKD. Albumin and creatinine concentrations in urine samples were determined using spectrophotometric dye (tetrabromophenol blue)-binding and colorimetric Jaffe assay, respectively. Urine samples were diluted with distilled water (1:80) and mixed separately with albumin and creatinine reaction mixture. The creatinine reaction was incubated at room temperature (25 °C) for 30 min before analysis. Optical density (OD) was measured at the wavelengths of 625 nm (albumin) and 515 nm (creatinine). All calibration curves (0–60 mg/L and 0–2 mg/dL for albumin and creatinine) yielded linear relationships with correlation coefficients (R²) of >0.997. Good accuracy (% deviation of mean value (DMV) ≤ 5.42%) and precision (% coefficients of variation (CV) ≤ 12.69%) were observed from both the intra- and inter-day assays for the determination of albumin and creatinine using MyACR. The limit of quantification (LOQ) of albumin and creatinine in urine samples determined using MyACR and a laboratory spectrophotometer were 5 mg/L and 0.25 mg/dL, respectively, using 37.5 μL urine spiked samples (n = 5). The device was well-applied with clinical samples from 20 CKD patients. The median (range) of %DMV of the central (hospital) laboratory method (immune-based assay) was 3.48 (−17.05 to 21.64)%, with a high correlation coefficient (R² > 0.98). In conclusion, MyACR showed satisfactory test performance in terms of accuracy, reproducibility, and sensitivity. Cost-effectiveness and improvement in clinical decision making need to be proven in future multisite community and home studies. Full article

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

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12 pages, 2971 KiB

Open AccessArticle

Prognostic Implication of Ventricular Volumetry in Early Brain Computed Tomography after Cardiac Arrest

by Ae Kyung Gong, Sang Hoon Oh, Jinhee Jang, Kyu Nam Park, Han Joon Kim, Ji Young Lee, Chun Song Youn, Jee Yong Lim, Hyo Joon Kim and Hyo Jin Bang

Diagnostics 2024, 14(16), 1701; https://doi.org/10.3390/diagnostics14161701 (registering DOI) - 6 Aug 2024

Abstract

Brain swelling after cardiac arrest may affect brain ventricular volume. This study aimed to investigate the prognostic implications of ventricular volume on early thin-slice brain computed tomography (CT) after cardiac arrest. We measured the gray-to-white matter ratio (GWR) and the characteristics and volumes [...] Read more.

Brain swelling after cardiac arrest may affect brain ventricular volume. This study aimed to investigate the prognostic implications of ventricular volume on early thin-slice brain computed tomography (CT) after cardiac arrest. We measured the gray-to-white matter ratio (GWR) and the characteristics and volumes of the lateral, third, and fourth ventricles. The primary outcome was a poor 6-month neurological outcome. Of the 166 patients, 115 had a poor outcome. The fourth ventricle was significantly smaller in the poor outcome group (0.58 cm³ [95% CI, 0.43–0.80]) than in the good outcome group (0.74 cm³ [95% CI, 0.68–0.99], p < 0.001). Ventricular characteristics and other ventricular volumes did not differ between outcome groups. The area under the curve for the fourth ventricular volume was 0.68, comparable to 0.69 for GWR. Lower GWR (<1.09) and lower fourth ventricular volume (<0.41 cm³) predicted poor outcomes with 100% specificity and sensitivities of 8.7% (95% CI, 4.2–15.4) and 20.9% (95% CI, 13.9–29.4), respectively. Combining these measures improved the sensitivity to 25.2% (95% CI, 17.6–34.2). After adjusting for covariates, the fourth ventricular volume was independently associated with neurologic outcome. A marked decrease in fourth ventricular volume, with concomitant hypoattenuation on CT scans, more accurately predicted outcomes. Full article

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

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14 pages, 7762 KiB

Open AccessReview

The Role of Cone Beam Computed Tomography (CBCT) in the Diagnosis and Clinical Management of Medication-Related Osteonecrosis of the Jaw (MRONJ)

by Yui Yin Ko, Wei-Fa Yang and Yiu Yan Leung

Diagnostics 2024, 14(16), 1700; https://doi.org/10.3390/diagnostics14161700 (registering DOI) - 6 Aug 2024

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Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a debilitating condition associated with antiresorptive and antiangiogenic medications that are frequently used in treating osteoporosis and cancers. With the ability to produce high-resolution images with a lower radiation dose, cone beam computed tomography (CBCT) is [...] Read more.

Medication-related osteonecrosis of the jaw (MRONJ) is a debilitating condition associated with antiresorptive and antiangiogenic medications that are frequently used in treating osteoporosis and cancers. With the ability to produce high-resolution images with a lower radiation dose, cone beam computed tomography (CBCT) is an emerging technology in maxillofacial imaging that offers several advantages in evaluating MRONJ. This review aims to summarise the radiological features of MRONJ as observed via CBCT and highlight its advantages over two-dimensional plain films in assessing MRONJ. CBCT has the capability to detect early MRONJ lesions, characterise the extent and nature of lesions, distinguish MRONJ from other osseous pathologies, and assist in treatment planning. By leveraging the advantages of CBCT, clinicians can enhance their understanding of MRONJ, improve decision making, and ultimately optimize patient care. Full article

(This article belongs to the Special Issue Application of Cone Beam Computed Tomography for Maxillofacial Diseases, Second Edition)

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17 pages, 6217 KiB

Open AccessArticle

Machine-Learning-Enabled Diagnostics with Improved Visualization of Disease Lesions in Chest X-ray Images

by Md Fashiar Rahman, Tzu-Liang (Bill) Tseng, Michael Pokojovy, Peter McCaffrey, Eric Walser, Scott Moen, Alex Vo and Johnny C. Ho

Diagnostics 2024, 14(16), 1699; https://doi.org/10.3390/diagnostics14161699 (registering DOI) - 6 Aug 2024

Viewed by 133

Abstract

The class activation map (CAM) represents the neural-network-derived region of interest, which can help clarify the mechanism of the convolutional neural network’s determination of any class of interest. In medical imaging, it can help medical practitioners diagnose diseases like COVID-19 or pneumonia by [...] Read more.

The class activation map (CAM) represents the neural-network-derived region of interest, which can help clarify the mechanism of the convolutional neural network’s determination of any class of interest. In medical imaging, it can help medical practitioners diagnose diseases like COVID-19 or pneumonia by highlighting the suspicious regions in Computational Tomography (CT) or chest X-ray (CXR) film. Many contemporary deep learning techniques only focus on COVID-19 classification tasks using CXRs, while few attempt to make it explainable with a saliency map. To fill this research gap, we first propose a VGG-16-architecture-based deep learning approach in combination with image enhancement, segmentation-based region of interest (ROI) cropping, and data augmentation steps to enhance classification accuracy. Later, a multi-layer Gradient CAM (ML-Grad-CAM) algorithm is integrated to generate a class-specific saliency map for improved visualization in CXR images. We also define and calculate a Severity Assessment Index (SAI) from the saliency map to quantitatively measure infection severity. The trained model achieved an accuracy score of 96.44% for the three-class CXR classification task, i.e., COVID-19, pneumonia, and normal (healthy patients), outperforming many existing techniques in the literature. The saliency maps generated from the proposed ML-GRAD-CAM algorithm are compared with the original Gran-CAM algorithm. Full article

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

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Diagnostics, Volume 14, Issue 16 (August-2 2024) – 13 articles

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