Diagnostics

7 pages, 2958 KiB

Open AccessCase Report

Unusual Presentation of Clear Cell Odontogenic Carcinoma: Case Report and Literature Review

by Raúl Verdeja, Edouard Stauffer and Tommaso Lombardi

Diagnostics 2022, 12(4), 1019; https://doi.org/10.3390/diagnostics12041019 - 18 Apr 2022

Cited by 2 | Viewed by 2404

Clear cell odontogenic carcinoma (CCOC) is a rare, aggressive epithelial neoplasm of the jaw first described in 1985 by Hansen and classified as an odontogenic malignant tumor in the 2005 WHO classification. To date, only 117 cases have been reported in the literature [...] Read more.

Clear cell odontogenic carcinoma (CCOC) is a rare, aggressive epithelial neoplasm of the jaw first described in 1985 by Hansen and classified as an odontogenic malignant tumor in the 2005 WHO classification. To date, only 117 cases have been reported in the literature written in English. In this paper, we report the atypical presentation of a pericoronal localized tumor in the right mandibular wisdom tooth discovered during a routine radiologic examination. The patient, a 44-year-old healthy female, was referred by her general dental practitioner for examination of temporomandibular dysfunction and recurrent myofascial pain. Anamnesis and clinical examination did not suggest tumoral disease. The osteolytic lesion was removed, and histological examination revealed a clear cell odontogenic tumor (CCOT) of the right posterior lower jaw. Segmental lower jaw resection was performed, and a free iliac crest bone transplant was fixed with mandibular reconstruction plate. No cervical neck dissection was needed. A five-year follow-up examination shows excellent local and systemic recovery and no sign of tumor recurrence. The patient still suffers from bruxism and myofascial related pain, which are treated conservatively with a Michigan splint and physiotherapy. Based on this additional case, we review the literature and discuss the challenging diagnostic aspects, the unusual clinical presentation, and the treatment of CCOC. Full article

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

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12 pages, 1170 KiB

Open AccessArticle

Glioma Tumors’ Classification Using Deep-Neural-Network-Based Features with SVM Classifier

by Ghazanfar Latif, Ghassen Ben Brahim, D. N. F. Awang Iskandar, Abul Bashar and Jaafar Alghazo

Diagnostics 2022, 12(4), 1018; https://doi.org/10.3390/diagnostics12041018 - 18 Apr 2022

Cited by 48 | Viewed by 3354

Abstract

The complexity of brain tissue requires skillful technicians and expert medical doctors to manually analyze and diagnose Glioma brain tumors using multiple Magnetic Resonance (MR) images with multiple modalities. Unfortunately, manual diagnosis suffers from its lengthy process, as well as elevated cost. With [...] Read more.

The complexity of brain tissue requires skillful technicians and expert medical doctors to manually analyze and diagnose Glioma brain tumors using multiple Magnetic Resonance (MR) images with multiple modalities. Unfortunately, manual diagnosis suffers from its lengthy process, as well as elevated cost. With this type of cancerous disease, early detection will increase the chances of suitable medical procedures leading to either a full recovery or the prolongation of the patient’s life. This has increased the efforts to automate the detection and diagnosis process without human intervention, allowing the detection of multiple types of tumors from MR images. This research paper proposes a multi-class Glioma tumor classification technique using the proposed deep-learning-based features with the Support Vector Machine (SVM) classifier. A deep convolution neural network is used to extract features of the MR images, which are then fed to an SVM classifier. With the proposed technique, a 96.19% accuracy was achieved for the HGG Glioma type while considering the FLAIR modality and a 95.46% for the LGG Glioma tumor type while considering the T2 modality for the classification of four Glioma classes (Edema, Necrosis, Enhancing, and Non-enhancing). The accuracies achieved using the proposed method were higher than those reported by similar methods in the extant literature using the same BraTS dataset. In addition, the accuracy results obtained in this work are better than those achieved by the GoogleNet and LeNet pre-trained models on the same dataset. Full article

(This article belongs to the Special Issue AI as a Tool to Improve Hybrid Imaging in Cancer)

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19 pages, 4544 KiB

Open AccessArticle

Novel User-Friendly Application for MRI Segmentation of Brain Resection following Epilepsy Surgery

by Roberto Billardello, Georgios Ntolkeras, Assia Chericoni, Joseph R. Madsen, Christos Papadelis, Phillip L. Pearl, Patricia Ellen Grant, Fabrizio Taffoni and Eleonora Tamilia

Diagnostics 2022, 12(4), 1017; https://doi.org/10.3390/diagnostics12041017 - 18 Apr 2022

Cited by 5 | Viewed by 2479

Abstract

Delineation of resected brain cavities on magnetic resonance images (MRIs) of epilepsy surgery patients is essential for neuroimaging/neurophysiology studies investigating biomarkers of the epileptogenic zone. The gold standard to delineate the resection on MRI remains manual slice-by-slice tracing by experts. Here, we proposed [...] Read more.

Delineation of resected brain cavities on magnetic resonance images (MRIs) of epilepsy surgery patients is essential for neuroimaging/neurophysiology studies investigating biomarkers of the epileptogenic zone. The gold standard to delineate the resection on MRI remains manual slice-by-slice tracing by experts. Here, we proposed and validated a semiautomated MRI segmentation pipeline, generating an accurate model of the resection and its anatomical labeling, and developed a graphical user interface (GUI) for user-friendly usage. We retrieved pre- and postoperative MRIs from 35 patients who had focal epilepsy surgery, implemented a region-growing algorithm to delineate the resection on postoperative MRIs and tested its performance while varying different tuning parameters. Similarity between our output and hand-drawn gold standards was evaluated via dice similarity coefficient (DSC; range: 0–1). Additionally, the best segmentation pipeline was trained to provide an automated anatomical report of the resection (based on presurgical brain atlas). We found that the best-performing set of parameters presented DSC of 0.83 (0.72–0.85), high robustness to seed-selection variability and anatomical accuracy of 90% to the clinical postoperative MRI report. We presented a novel user-friendly open-source GUI that implements a semiautomated segmentation pipeline specifically optimized to generate resection models and their anatomical reports from epilepsy surgery patients, while minimizing user interaction. Full article

(This article belongs to the Special Issue Brain Imaging in Epilepsy)

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Graphical abstract

17 pages, 1265 KiB

Open AccessReview

Diagnosis and Management of Malignant Pleural Effusion: A Decade in Review

by Blake Jacobs, Ghias Sheikh, Houssein A. Youness, Jean I. Keddissi and Tony Abdo

Diagnostics 2022, 12(4), 1016; https://doi.org/10.3390/diagnostics12041016 - 18 Apr 2022

Cited by 8 | Viewed by 7314

Abstract

Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality. Treatment is mainly palliative, with symptomatic management achieved via effusion drainage and pleurodesis. Pleurodesis may be hastened by administering a sclerosing agent through a [...] Read more.

Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality. Treatment is mainly palliative, with symptomatic management achieved via effusion drainage and pleurodesis. Pleurodesis may be hastened by administering a sclerosing agent through a thoracostomy tube, thoracoscopy, or an indwelling pleural catheter (IPC). Over the last decade, several randomized controlled studies shaped the current management of MPE in favor of an outpatient-based approach with a notable increase in IPC usage. Patient preferences remain essential in choosing optimal therapy, especially when the lung is expandable. In this article, we reviewed the last 10 to 15 years of MPE literature with a particular focus on the diagnosis and evolving management. Full article

(This article belongs to the Special Issue Advances in Interventional Pulmonology)

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10 pages, 659 KiB

Open AccessArticle

Prevalence of Occult Hepatitis C Virus Infection in Egyptian Patients with Lymphoma: A New Vision

by Kholoud A. Elkashef, Wafaa A. Emam, Noha M. Mesbah, Dina M. Abo-Elmatty and Asmaa R. Abdel-Hamed

Diagnostics 2022, 12(4), 1015; https://doi.org/10.3390/diagnostics12041015 - 17 Apr 2022

Cited by 1 | Viewed by 1780

Abstract

Occult hepatitis C virus infection (OCI) is the absence of HCV RNA in serum and the presence of actively replicating HCV RNA in hepatocytes and peripheral blood mononuclear cells (PBMCs), as evidenced by the presence of antigenomic negative sense single-stranded RNA. This study [...] Read more.

Occult hepatitis C virus infection (OCI) is the absence of HCV RNA in serum and the presence of actively replicating HCV RNA in hepatocytes and peripheral blood mononuclear cells (PBMCs), as evidenced by the presence of antigenomic negative sense single-stranded RNA. This study aimed to determine the prevalence of OCI in Egyptian lymphoma patients and assess changes in biochemical parameters in patients with confirmed OCI. The current study was conducted on 100 apparently healthy subjects as control group and 100 patients with lymphoma as a case group. HCV RNA was extracted and detected in both plasma and PBMCs using qRT-PCR. Total protein, albumin, ALT, AST, and total and direct bilirubin were measured in serum. OCI was detected in 6% of the patient group. OCI patients had lower levels of total protein and serum albumin and higher ALT and AST compared with lymphoma patients without OCI. Our study revealed that six out of 100 patients with lymphoma disorders had occult HCV infection (6%). Therefore, the possibility of this infection should be considered in patients with lymphoma. Full article

(This article belongs to the Special Issue Diagnosis and Management of Hepatitis C)

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9 pages, 1881 KiB

Open AccessArticle

Semiautomated Segmentation and Volume Measurements of Cervical Carotid High-Signal Plaques Using 3D Turbo Spin-Echo T1-Weighted Black-Blood Vessel Wall Imaging: A Preliminary Study

by Katsuhiro Inoue, Ryohei Nakayama, Shiho Isoshima, Shinichi Takase, Tsunehiro Yamahata, Maki Umino, Masayuki Maeda and Hajime Sakuma

Diagnostics 2022, 12(4), 1014; https://doi.org/10.3390/diagnostics12041014 - 17 Apr 2022

Cited by 2 | Viewed by 1493

Abstract

Unstable carotid plaques are visualized as high-signal plaques (HSPs) on 3D turbo spin-echo T1-weighted black-blood vessel wall imaging (3D TSE T1-BB VWI). The purpose of this study was to compare manual segmentation and semiautomated segmentation for the quantification of carotid HSPs using 3D [...] Read more.

Unstable carotid plaques are visualized as high-signal plaques (HSPs) on 3D turbo spin-echo T1-weighted black-blood vessel wall imaging (3D TSE T1-BB VWI). The purpose of this study was to compare manual segmentation and semiautomated segmentation for the quantification of carotid HSPs using 3D TSE T1-BB VWI. Twenty cervical carotid plaque lesions in 19 patients with a plaque contrast ratio of > 1.3 compared to adjacent muscle were studied. Using the mean voxel value for the adjacent muscle multiplied by 1.3 as a threshold value, the semiautomated software exclusively segmented and measured the HSP volume. Manual and semiautomated HSP volumes were well correlated (r = 0.965). Regarding reproducibility, the inter-rater ICC was 0.959 (bias: 24.63, 95% limit of agreement: −96.07, 146.35) for the manual method and 0.998 (bias: 15.2, 95% limit of agreement: −17.83, 48.23) for the semiautomated method, indicating improved reproducibility by the semiautomated method compared to the manual method. The time required for semiautomated segmentation was significantly shorter than that of manual segmentation times (81.7 ± 7.8 s versus 189.5 ± 49.6 s; p < 0.01). The results obtained in this study demonstrate that the semiautomated segmentation method allows for reliable assessment of the HSP volume in patients with carotid plaque lesions, with reduced time and effort for the analysis. Full article

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

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9 pages, 504 KiB

Open AccessArticle

Faecal Immunochemical Test Impact on Prognosis of Colorectal Cancer Detected in Symptomatic Patients

by Jesús Daniel Fernández de Castro, Franco Baiocchi Ureta, Raquel Fernández González, Noel Pin Vieito and Joaquín Cubiella Fernández

Diagnostics 2022, 12(4), 1013; https://doi.org/10.3390/diagnostics12041013 - 17 Apr 2022

Viewed by 1505

Abstract

The use of the faecal immunochemical test (FIT) to stratify the risk of colorectal cancer (CRC) in symptomatic patients in primary healthcare enables improved referrals to colonoscopy. However, its effect on diagnostic delays or the prognosis of patients has been poorly evaluated in [...] Read more.

The use of the faecal immunochemical test (FIT) to stratify the risk of colorectal cancer (CRC) in symptomatic patients in primary healthcare enables improved referrals to colonoscopy. However, its effect on diagnostic delays or the prognosis of patients has been poorly evaluated in this setting. We performed a retrospective cohort study that included symptomatic patients with outpatient CRC diagnosis between 2009 and 2017. We identified whether FIT had been analysed between initial healthcare contact and diagnostic confirmation. We included 589 patients (male = 65%, 71.7 ± 11.6 years, TNM IV = 17.1%) in the analysis. FIT was performed in 411 (69.8%) patients with a positive result (≥10 µg/g of faeces) in 96.4% of the evaluated patients. The use of FIT was associated with increased diagnostic delay (yes = 159 ± 277 days, no = 111 ± 172 days; p = 0.01). At five years follow up, 193 (32.8%) patients died (151 due to CRC). Mean survival was not modified by the use of FIT or its result (not performed = 46.8 ± 1.5 months, FIT+ = 48.9 ± 1 months, FIT− = 45.6 ± 5.5 months; p = 0.5) in Kaplan–Meier analysis, and was confirmed later in multivariate Cox regression analysis. In conclusion, FIT determination in symptomatic patients in primary healthcare did not modify CRC prognosis. Full article

(This article belongs to the Special Issue Fecal Immunochemical Test: Colorectal Cancer Screening and Beyond)

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12 pages, 2537 KiB

Open AccessReview

Splenic Artery Pseudoaneurysms: The Role of ce-CT for Diagnosis and Treatment Planning

by Fabio Corvino, Francesco Giurazza, Anna Maria Ierardi, Pierleone Lucatelli, Antonello Basile, Antonio Corvino and Raffaella Niola

Diagnostics 2022, 12(4), 1012; https://doi.org/10.3390/diagnostics12041012 - 17 Apr 2022

Cited by 12 | Viewed by 2692

Abstract

Splenic artery pseudoaneurysm (PSA) is a contained vascular wall lesion associated with a high mortality rate, generally related to pancreatitis, trauma, malignancy, iatrogenic injury, and segmental arterial mediolysis. Computed tomography angiography allows us to visualize the vascular anatomy, differentiate a PSA from an [...] Read more.

Splenic artery pseudoaneurysm (PSA) is a contained vascular wall lesion associated with a high mortality rate, generally related to pancreatitis, trauma, malignancy, iatrogenic injury, and segmental arterial mediolysis. Computed tomography angiography allows us to visualize the vascular anatomy, differentiate a PSA from an aneurysm, and provide adequate information for endovascular/surgical treatment. The present review reports on the main state-of-the-art splenic artery PSA diagnosis, differentiating between the pros and cons of the imaging methods and about the endovascular treatment. Full article

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

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11 pages, 864 KiB

Open AccessSystematic Review

Utility of Red Cell Distribution Width (RDW) as a Noninvasive Biomarker for the Diagnosis of Acute Appendicitis: A Systematic Review and Meta-Analysis of 5222 Cases

by Sachit Anand, Nellai Krishnan, Miro Jukić, Zvonimir Križanac, Carlos Martin Llorente Muñoz and Zenon Pogorelić

Diagnostics 2022, 12(4), 1011; https://doi.org/10.3390/diagnostics12041011 - 17 Apr 2022

Cited by 14 | Viewed by 2806

Abstract

Background: Despite great advances in medicine, numerous available laboratory markers, and radiological imaging, the diagnosis of acute appendicitis (AA) in some cases still remains controversial and challenging for clinicians. Because of that, clinicians are still looking for an ideal marker that would [...] Read more.

Background: Despite great advances in medicine, numerous available laboratory markers, and radiological imaging, the diagnosis of acute appendicitis (AA) in some cases still remains controversial and challenging for clinicians. Because of that, clinicians are still looking for an ideal marker that would be specific to AA. The red blood cell distribution width (RDW) has been recently investigated in several studies as a potential biomarker for AA. The aim of this systematic review and meta-analysis was to systematically summarize and compare all relevant data on RDW as a diagnostic biomarker for AA. Methods: This systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Scientific databases (PubMed, Scopus, Web of Science, and Excerpta Medica database—EMBASE) were systematically searched for relevant comparative studies by two independent researches using keywords ((red cell distribution width) OR rdw) AND (appendicitis). An independent assessment of the methodological quality was performed by two authors using the Downs and Black scale. RevMan 5.4 software was used to perform the meta-analysis. Results: Fifteen studies were included in the final meta-analysis; the majority of the studies was retrospective. Nine studies compared the RDW values between AA and non-AA; four studies compared the same between AA and healthy controls, while two studies compared the RDW values among all three groups. The estimated heterogeneity among the studies for all outcome was statistically significant (I² = 92–99%, p < 0.00001). The pooling the data demonstrated no statistically significant difference in the RDW values (weighted mean difference (WMD) = 0.03, 95% CI = (−0.46, 0.52), p = 0.91) between AA and healthy controls as well as between AA and non-AA cases (WMD = 0.23, 95%CI = (–0.19, 0.65), p = 0.28). A separate subanalysis was performed to evaluate the utility of this biomarker for the pediatric age group. Pooling the data demonstrated no significant difference among the AA and non-AA groups in terms of the RDW values (WMD = 0.99, 95% CI = (–0.35, 2.33), p = 0.15). Conclusion: The RDW value difference demonstrated no statistically significant difference in AA versus healthy individuals and AA versus non-AA individuals. At the moment, there is no evidence of RDW utility in diagnostic testing of AA. Further research with prospective, multicenter studies and studies targeting special patient groups with a large sample size are needed in this field. Full article

(This article belongs to the Special Issue Advances in the Diagnosis of Gastrointestinal Diseases)

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12 pages, 3416 KiB

Open AccessArticle

Assessment of Maxillary Molars Interradicular Septum Morphological Characteristics as Criteria for Ideal Immediate Implant Placement—The Advantages of Cone Beam Computed Tomography Analysis

by Zlata Rajkovic Pavlovic, Pavle Milanovic, Milica Vasiljevic, Nemanja Jovicic, Aleksandra Arnaut, Djurdjina Colic, Marijana Petrovic, Momir Stevanovic, Dragica Selakovic and Gvozden Rosic

Diagnostics 2022, 12(4), 1010; https://doi.org/10.3390/diagnostics12041010 - 16 Apr 2022

Cited by 2 | Viewed by 2441

Abstract

The aim of this study was to evaluate the interradicular septum bone morphometric characteristics using cone beam computed tomography (CBCT) images, as well as to establish quantitative shortcuts to allow clinicians to make a faster and more reliable plan for immediate implant placement [...] Read more.

The aim of this study was to evaluate the interradicular septum bone morphometric characteristics using cone beam computed tomography (CBCT) images, as well as to establish quantitative shortcuts to allow clinicians to make a faster and more reliable plan for immediate implant placement in the maxillary molars area. This retrospective quantitative study was conducted on CBCT images obtained from 100 patients. The morphometric analysis of the maxillary molars region was based on the parameters obtained on the sagittal and axial slices. The analysis performed on sagittal slices showed that the first maxillary molars had a wider interradicular septum when compared to the second molars, but the septum height in the first molars was significantly below the height in the second maxillary molars. The axial CBCT slices analysis showed that both interradicular septum perimeter and surface area were significantly more pronounced in the first than in the second maxillary molars. The interradicular furcation angle significantly correlated with the surface area (positively) and septum height (negatively) for both molars. The results of this study may recommend CBCT image analysis as a useful tool in predefining the circumstances that can allow for substantially better planning of immediate implant placement procedures in the region of maxillary molars. Full article

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

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11 pages, 1852 KiB

Open AccessArticle

Use of a Feed-Forward Back Propagation Network for the Prediction of Small for Gestational Age Newborns in a Cohort of Pregnant Patients with Thrombophilia

by Petronela Vicoveanu, Ingrid Andrada Vasilache, Ioana Sadiye Scripcariu, Dragos Nemescu, Alexandru Carauleanu, Dragos Vicoveanu, Ana Roxana Covali, Catalina Filip and Demetra Socolov

Diagnostics 2022, 12(4), 1009; https://doi.org/10.3390/diagnostics12041009 - 16 Apr 2022

Cited by 10 | Viewed by 1685

Abstract

(1) Background: Fetal growth restriction is a relatively common disorder in pregnant patients with thrombophilia. New artificial intelligence algorithms are a promising option for the prediction of adverse obstetrical outcomes. The aim of this study was to evaluate the predictive performance of a [...] Read more.

(1) Background: Fetal growth restriction is a relatively common disorder in pregnant patients with thrombophilia. New artificial intelligence algorithms are a promising option for the prediction of adverse obstetrical outcomes. The aim of this study was to evaluate the predictive performance of a Feed-Forward Back Propagation Network (FFBPN) for the prediction of small for gestational age (SGA) newborns in a cohort of pregnant patients with thrombophilia. (2) Methods: This observational retrospective study included all pregnancies in women with thrombophilia who attended two tertiary maternity hospitals in Romania between January 2013 and December 2020. Bivariate associations of SGA and each predictor variable were evaluated. Clinical and paraclinical predictors were further included in a FFBPN, and its predictive performance was assessed. (3) Results: The model had an area under the curve (AUC) of 0.95, with a true positive rate of 86.7%, and a false discovery rate of 10.5%. The overall accuracy of our model was 90%. (4) Conclusion: This is the first study in the literature that evaluated the performance of a FFBPN for the prediction of pregnant patients with thrombophilia at a high risk of giving birth to SGA newborns, and its promising results could lead to a tailored prenatal management. Full article

(This article belongs to the Special Issue Artificial Intelligence in Clinical Medical Imaging Analysis)

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14 pages, 2532 KiB

Open AccessArticle

Urine Flow Cytometry Parameter Cannot Safely Predict Contamination of Urine—A Cohort Study of a Swiss Emergency Department Using Machine Learning Techniques

by Martin Müller, Nadine Sägesser, Peter M. Keller, Spyridon Arampatzis, Benedict Steffens, Simone Ehrhard and Alexander B. Leichtle

Diagnostics 2022, 12(4), 1008; https://doi.org/10.3390/diagnostics12041008 - 16 Apr 2022

Cited by 3 | Viewed by 3983

Abstract

Background: Urine flow cytometry (UFC) analyses urine samples and determines parameter counts. We aimed to predict different types of urine culture growth, including mixed growth indicating urine culture contamination. Methods: A retrospective cohort study (07/2017–09/2020) was performed on pairs of urine samples and [...] Read more.

Background: Urine flow cytometry (UFC) analyses urine samples and determines parameter counts. We aimed to predict different types of urine culture growth, including mixed growth indicating urine culture contamination. Methods: A retrospective cohort study (07/2017–09/2020) was performed on pairs of urine samples and urine cultures obtained from adult emergency department patients. The dataset was split into a training (75%) and validation set (25%). Statistical analysis was performed using a machine learning approach with extreme gradient boosting to predict urine culture growth types (i.e., negative, positive, and mixed) using UFC parameters obtained by UF-4000, sex, and age. Results: In total, 3835 urine samples were included. Detection of squamous epithelial cells, bacteria, and leukocytes by UFC were associated with the different types of culture growth. We achieved a prediction accuracy of 80% in the three-class approach. Of the n = 126 mixed cultures in the validation set, 11.1% were correctly predicted; positive and negative cultures were correctly predicted in 74.0% and 96.3%. Conclusions: Significant bacterial growth can be safely ruled out using UFC parameters. However, positive urine culture growth (rule in) or even mixed culture growth (suggesting contamination) cannot be adequately predicted using UFC parameters alone. Squamous epithelial cells are associated with mixed culture growth. Full article

(This article belongs to the Special Issue Urinary Stones and Infections)

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17 pages, 298 KiB

Open AccessArticle

Multicentric Evaluation of SeeGene Allplex Real-Time PCR Assays Targeting 28 Bacterial, Microsporidal and Parasitic Nucleic Acid Sequences in Human Stool Samples

by Felix Weinreich, Andreas Hahn, Kirsten Alexandra Eberhardt, Simone Kann, Thomas Köller, Philipp Warnke, Susann Dupke, Denise Dekker, Jürgen May, Hagen Frickmann and Ulrike Loderstädt

Diagnostics 2022, 12(4), 1007; https://doi.org/10.3390/diagnostics12041007 - 16 Apr 2022

Cited by 7 | Viewed by 2589

Abstract

Prior to the implementation of new diagnostic techniques, a thorough evaluation is mandatory in order to ensure diagnostic reliability. If positive samples are scarcely available, however, such evaluations can be difficult to perform. Here, we evaluated four SeeGene Allplex real-time PCR assays amplifying [...] Read more.

Prior to the implementation of new diagnostic techniques, a thorough evaluation is mandatory in order to ensure diagnostic reliability. If positive samples are scarcely available, however, such evaluations can be difficult to perform. Here, we evaluated four SeeGene Allplex real-time PCR assays amplifying a total of 28 bacteria, microsporidal and parasitic nucleic acid sequence targets in human stool samples in a multicentric approach. In the assessments with strongly positive samples, sensitivity values ranging between 13% and 100% were recorded for bacteria, between 0% and 100% for protozoa and between 7% and 100% for helminths and microsporidia; for the weakly positive samples, the recorded sensitivity values for bacteria ranged from 0% to 100%; for protozoa, from 0% to 40%; and for helminths and microsporidia, from 0% to 53%. For bacteria, the recorded specificity was in the range between 87% and 100%, while a specificity of 100% was recorded for all assessed PCRs targeting parasites and microsporidia. The intra- and inter-assay variations were generally low. Specifically for some helminth species, the sensitivity could be drastically increased by applying manual nucleic acid extraction instead of the manufacturer-recommended automatic procedure, while such effects were less obvious for the bacteria and protozoa. In summary, the testing with the chosen positive control samples showed varying degrees of discordance between the evaluated Allplex assays and the applied in-house reference assays associated with higher cycle threshold values in the Allplex assays, suggesting that samples with very low pathogen densities might be missed. As the targeted species can occur as harmless colonizers in the gut of individuals in high-endemicity settings as well, future studies should aim at assessing the clinical relevance of the latter hint. Full article

(This article belongs to the Special Issue Advancements in Bacterial Pathogen Diagnostic Tools)

15 pages, 10410 KiB

Open AccessReview

Imaging of the Temporomandibular Joint

by Seyed Mohammad Gharavi, Yujie Qiao, Armaghan Faghihimehr and Josephina Vossen

Diagnostics 2022, 12(4), 1006; https://doi.org/10.3390/diagnostics12041006 - 16 Apr 2022

Cited by 12 | Viewed by 15543

Abstract

Temporomandibular disorder (TMD) is a common musculoskeletal condition that causes pain and disability for patients and imposes a high financial burden on the healthcare system. The most common cause of TMD is internal derangement, mainly secondary to articular disc displacement. Multiple other pathologies [...] Read more.

Temporomandibular disorder (TMD) is a common musculoskeletal condition that causes pain and disability for patients and imposes a high financial burden on the healthcare system. The most common cause of TMD is internal derangement, mainly secondary to articular disc displacement. Multiple other pathologies such as inflammatory arthritis, infection, and neoplasm can mimic internal derangement. MRI is the modality of choice for evaluation of the TMJ. Radiologists need to be familiar with the normal anatomy and function of the TMJ and MR imaging of the internal derangement and other less common pathologies of the TMJ. Full article

(This article belongs to the Special Issue Skeletal Radiology)

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11 pages, 269 KiB

Open AccessReview

Surgical Treatment in Silicone Oil-Associated Glaucoma

by Catalin Cornacel, Otilia-Maria Dumitrescu, Alexandra Catalina Zaharia, Ruxandra Angela Pirvulescu, Mihnea Munteanu, Calin Petru Tataru and Sinziana Istrate

Diagnostics 2022, 12(4), 1005; https://doi.org/10.3390/diagnostics12041005 - 16 Apr 2022

Cited by 5 | Viewed by 2186

Abstract

Glaucoma is a vision threatening, not uncommon complication of eyes that have undergone pars plana vitrectomy with silicone oil endotamponade. Although most patients respond well to medical antiglaucoma therapy, there are refractory cases where surgery is required to control the intraocular pressure. This [...] Read more.

Glaucoma is a vision threatening, not uncommon complication of eyes that have undergone pars plana vitrectomy with silicone oil endotamponade. Although most patients respond well to medical antiglaucoma therapy, there are refractory cases where surgery is required to control the intraocular pressure. This review, following a comprehensive literature search in the Medline database, aims to present the most important surgical techniques currently in use for glaucoma associated with silicone oil endotamponade and their indication depending on the mechanism of glaucoma. In cases of pupillary block, the presence of a patent iridotomy or iridectomy must be ensured, either by laser or surgically. When silicone oil is in excess and whenever the retinal status permits it, partial or complete removal of the silicone oil should be performed. Trabeculectomy has shown higher failure rates and more complications in these cases compared to other indications, so alternate methods are warranted. For very high intraocular pressures, glaucoma drainage devices and transscleral cyclophotocoagulation are the most used options, with good efficacy and safety profiles, although rarely they may have serious complications. The Ex-PRESS mini shunt has shown excellent results and lower rates of complications. For less important IOP elevations, minimally invasive glaucoma surgery and selective laser trabeculoplasty may be used, either alone or in conjunction with other methods. Full article

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

17 pages, 3488 KiB

Open AccessArticle

Decision Support for Oropharyngeal Cancer Patients Based on Data-Driven Similarity Metrics for Medical Case Comparison

by Julia Buyer, Alexander Oeser, Nora Grieb, Andreas Dietz, Thomas Neumuth and Matthaeus Stoehr

Diagnostics 2022, 12(4), 999; https://doi.org/10.3390/diagnostics12040999 - 15 Apr 2022

Cited by 2 | Viewed by 1668

Abstract

Making complex medical decisions is becoming an increasingly challenging task due to the growing amount of available evidence to consider and the higher demand for personalized treatment and patient care. IT systems for the provision of clinical decision support (CDS) can provide sustainable [...] Read more.

Making complex medical decisions is becoming an increasingly challenging task due to the growing amount of available evidence to consider and the higher demand for personalized treatment and patient care. IT systems for the provision of clinical decision support (CDS) can provide sustainable relief if decisions are automatically evaluated and processed. In this paper, we propose an approach for quantifying similarity between new and previously recorded medical cases to enable significant knowledge transfer for reasoning tasks on a patient-level. Methodologically, 102 medical cases with oropharyngeal carcinoma were analyzed retrospectively. Based on independent disease characteristics, patient-specific data vectors including relevant information entities for primary and adjuvant treatment decisions were created. Utilizing the ϕK correlation coefficient as the methodological foundation of our approach, we were able to determine the predictive impact of each characteristic, thus enabling significant reduction of the feature space to allow for further analysis of the intra-variable distances between the respective feature states. The results revealed a significant feature-space reduction from initially 19 down to only 6 diagnostic variables (ϕK correlation coefficient ≥ 0.3, ϕK significance test ≥ 2.5) for the primary and 7 variables (from initially 14) for the adjuvant treatment setting. Further investigation on the resulting characteristics showed a non-linear behavior in relation to the corresponding distances on intra-variable level. Through the implementation of a 10-fold cross-validation procedure, we were further able to identify 8 (primary treatment) matching cases with an evaluation score of 1.0 and 9 (adjuvant treatment) matching cases with an evaluation score of 0.957 based on their shared treatment procedure as the endpoint for similarity definition. Based on those promising results, we conclude that our proposed method for using data-driven similarity measures for application in medical decision-making is able to offer valuable assistance for physicians. Furthermore, we consider our approach as universal in regard to other clinical use-cases, which would allow for an easy-to-implement adaptation for a range of further medical decision-making scenarios. Full article

(This article belongs to the Special Issue Advances in Diagnostics of Head and Neck Cancer)

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6 pages, 17661 KiB

Open AccessCase Report

POEMS Syndrome: Presented as Idiopathic Multicentric Castleman Disease of Plasma Cell Variant for Eight Years and Dramatic Treatment with Siltuximab Followed by Autologous Peripheral Blood Stem Cell Transplantation

by Yong-Moon Lee, Yoon Seok Choi and Jin-Man Kim

Diagnostics 2022, 12(4), 998; https://doi.org/10.3390/diagnostics12040998 - 15 Apr 2022

Cited by 3 | Viewed by 2148

Abstract

Background: POEMS syndrome (POEMS) is a rare plasma cell clonal paraneoplastic syndrome consisting of polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes presenting with idiopathic multicentric Castleman disease (iMCD) histology, the treatment of which has not yet been well established. iMCD is also [...] Read more.

Background: POEMS syndrome (POEMS) is a rare plasma cell clonal paraneoplastic syndrome consisting of polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes presenting with idiopathic multicentric Castleman disease (iMCD) histology, the treatment of which has not yet been well established. iMCD is also a distinctive rare non-clonal lymphoproliferative disorder, of which dramatic response to Siltuximab, a monoclonal anti-IL-6 antibody, has been reported recently. Methods: the differential diagnosis between POEMS and iMCD can be very challenging because of the identical histology, overlapping similar symptoms such as polyneuropathy, and vital signs insidiously presented to diagnose POEMS. Results: here, we report the case of a 53-year-old man with iMCD treated for 8 years developing sequential polyneuropathy, monoclonal gammopathy, and bone lytic lesions, all of which were confirmed after his iMCD achieved complete remission resulting from siltuximab administration and finally confirmed as POEMS. Conclusions: we describe the clinical ambiguity of disease presenting that we can face in the real world between iMCD and POEMS and emphasise careful, enduring observation lasting several years. Full article

(This article belongs to the Topic Diagnostic Imaging and Pathology in Cancer Research)

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11 pages, 2017 KiB

Open AccessArticle

Predictive Value of ¹⁸F-FDG PET/CT-Based Radiomics Model for Occult Axillary Lymph Node Metastasis in Clinically Node-Negative Breast Cancer

by Kun Chen, Guotao Yin and Wengui Xu

Diagnostics 2022, 12(4), 997; https://doi.org/10.3390/diagnostics12040997 - 15 Apr 2022

Cited by 9 | Viewed by 2031

Abstract

Background: To develop and validate a radiomics model based on ¹⁸F-FDG PET/CT images to preoperatively predict occult axillary lymph node (ALN) metastases in patients with invasive ductal breast cancer (IDC) with clinically node-negative (cN0); Methods: A total of 180 patients (mean age, [...] Read more.

Background: To develop and validate a radiomics model based on ¹⁸F-FDG PET/CT images to preoperatively predict occult axillary lymph node (ALN) metastases in patients with invasive ductal breast cancer (IDC) with clinically node-negative (cN0); Methods: A total of 180 patients (mean age, 55 years; range, 31–82 years) with pathologically proven IDC and a preoperative ¹⁸F-FDG PET/CT scan from January 2013 to January 2021 were included in this retrospective study. According to the intraoperative pathological results of ALN, we divided patients into the true-negative group and ALN occult metastasis group. Radiomics features were extracted from PET/CT images using Pyradiomics implemented in Python, t-tests, and LASSO were used to screen the feature, and the random forest (RF), support vector machine (SVM), stochastic gradient descent (SGD), and k-nearest neighbor (KNN) were used to build the prediction models. The best-performing model was further tested by the permutation test; Results: Among the four models, RF had the best prediction results, the AUC range of RF was 0.661–0.929 (mean AUC, 0.817), and the accuracy range was 65.3–93.9% (mean accuracy, 81.2%). The p-values of the permutation tests for the RF model with maximum and minimum accuracy were less than 0.01; Conclusions: The developed RF model was able to predict occult ALN metastases in IDC patients based on preoperative ¹⁸F-FDG PET/CT radiomic features. Full article

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

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11 pages, 977 KiB

Open AccessReview

Single-Cell Sequencing: Ariadne’s Thread in the Maze of Acute Myeloid Leukemia

by Immacolata Redavid, Maria Rosa Conserva, Luisa Anelli, Antonella Zagaria, Giorgina Specchia, Pellegrino Musto and Francesco Albano

Diagnostics 2022, 12(4), 996; https://doi.org/10.3390/diagnostics12040996 - 15 Apr 2022

Cited by 2 | Viewed by 2048

Abstract

Acute myeloid leukemia (AML) is a haematological neoplasm resulting from the accumulation of genetic and epigenetic alterations. Patients’ prognoses vary with AML genetic heterogeneity, which hampers successful treatments. Single-cell approaches have provided new insights of the clonal architecture of AML, revealing the mutational [...] Read more.

Acute myeloid leukemia (AML) is a haematological neoplasm resulting from the accumulation of genetic and epigenetic alterations. Patients’ prognoses vary with AML genetic heterogeneity, which hampers successful treatments. Single-cell approaches have provided new insights of the clonal architecture of AML, revealing the mutational history from diagnosis, during treatment and to relapse. In this review, we imagine single-cell technologies as the Ariadne’s thread that will guide us out of the AML maze, provide a precise identikit of the leukemic cell at single-cell resolution and explore genomic, transcriptomic, epigenetic and proteomic levels. Full article

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

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16 pages, 1642 KiB

Open AccessArticle

A Multi-Branch Convolutional Neural Network with Squeeze-and-Excitation Attention Blocks for EEG-Based Motor Imagery Signals Classification

by Ghadir Ali Altuwaijri, Ghulam Muhammad, Hamdi Altaheri and Mansour Alsulaiman

Diagnostics 2022, 12(4), 995; https://doi.org/10.3390/diagnostics12040995 - 15 Apr 2022

Cited by 35 | Viewed by 3836

Abstract

Electroencephalography-based motor imagery (EEG-MI) classification is a critical component of the brain-computer interface (BCI), which enables people with physical limitations to communicate with the outside world via assistive technology. Regrettably, EEG decoding is challenging because of the complexity, dynamic nature, and low signal-to-noise [...] Read more.

Electroencephalography-based motor imagery (EEG-MI) classification is a critical component of the brain-computer interface (BCI), which enables people with physical limitations to communicate with the outside world via assistive technology. Regrettably, EEG decoding is challenging because of the complexity, dynamic nature, and low signal-to-noise ratio of the EEG signal. Developing an end-to-end architecture capable of correctly extracting EEG data’s high-level features remains a difficulty. This study introduces a new model for decoding MI known as a Multi-Branch EEGNet with squeeze-and-excitation blocks (MBEEGSE). By clearly specifying channel interdependencies, a multi-branch CNN model with attention blocks is employed to adaptively change channel-wise feature responses. When compared to existing state-of-the-art EEG motor imagery classification models, the suggested model achieves good accuracy (82.87%) with reduced parameters in the BCI-IV2a motor imagery dataset and (96.15%) in the high gamma dataset. Full article

(This article belongs to the Special Issue Intelligent Data Analysis for Medical Diagnosis)

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10 pages, 1307 KiB

Open AccessCommunication

Programming Optimization in Implantable Cardiac Monitors to Reduce False-Positive Arrhythmia Alerts: A Call for Research

by Fabrizio Guarracini, Martina Testolina, Daniele Giacopelli, Marta Martin, Francesco Triglione, Alessio Coser, Silvia Quintarelli, Roberto Bonmassari and Massimiliano Marini

Diagnostics 2022, 12(4), 994; https://doi.org/10.3390/diagnostics12040994 - 15 Apr 2022

Cited by 6 | Viewed by 2291

Abstract

No studies have investigated whether optimizing implantable cardiac monitors (ICM) programming can reduce false-positive (FP) alerts. We identified patients implanted with an ICM (BIOMONITOR III) who had more than 10 FP alerts in a 1-month retrospective period. Uniform adjustments of settings were performed [...] Read more.

No studies have investigated whether optimizing implantable cardiac monitors (ICM) programming can reduce false-positive (FP) alerts. We identified patients implanted with an ICM (BIOMONITOR III) who had more than 10 FP alerts in a 1-month retrospective period. Uniform adjustments of settings were performed based on the mechanism of FP triggers and assessed at 1 month. Eight patients (mean age 57.5 ± 23.2 years; 37% female) were enrolled. In 4 patients, FPs were caused by undersensing of low-amplitude premature ventricular contractions (PVCs). No further false bradycardia was observed with a more aggressive decay of the dynamic sensing threshold. Furthermore, false atrial fibrillation (AF) alerts decreased in 2 of 3 patients. Two patients had undersensing of R waves after high-amplitude PVCs; false bradycardia episodes disappeared or were significantly reduced by limiting the initial value of the sensing threshold. Finally, the presence of atrial ectopic activity or irregular sinus rhythm generated false alerts of AF in 2 patients that were reduced by increasing the R-R variability limit and the confirmation time. In conclusion, adjustments to nominal settings can reduce the number of FP episodes in ICM patients. More research is needed to provide practical recommendations and assess the value of extended ICM programmability. Full article

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

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9 pages, 418 KiB

Open AccessArticle

Analysis of Septin 9 Gene Hypermethylation as Follow-Up Biomarker of Colorectal Cancer Patients after Curative Surgery

by Miguel Leon Arellano, Mariano García-Arranz, Héctor Guadalajara, Rocío Olivera-Salazar, Teresa Valdes-Sanchez and Damián García-Olmo

Diagnostics 2022, 12(4), 993; https://doi.org/10.3390/diagnostics12040993 - 15 Apr 2022

Cited by 6 | Viewed by 1879

Abstract

Background: The Septin 9 test analyzes the methylation status of the SEPT9 gene, which appears to be hypermethylated in patients with colorectal cancer (CRC). This has been validated as a colorectal cancer screening test. Due to the high sensitivity and specificity found, the [...] Read more.

Background: The Septin 9 test analyzes the methylation status of the SEPT9 gene, which appears to be hypermethylated in patients with colorectal cancer (CRC). This has been validated as a colorectal cancer screening test. Due to the high sensitivity and specificity found, the justification was to use it as a biomarker tool for monitoring minimal residual disease after radical surgery and recurrence. Methods: A prospective study was carried out at the Fundación Jiménez Díaz University Hospital extracting peripheral blood from 28 patients and 4 healthy donors. Free circulating DNA was obtained and subsequently a PCR reaction to quantify the number of methylated genes. Samples were obtained preoperatively and postoperatively at five to seven days, one and three months after surgery. Results: A total of 32 preoperative samples were analyzed. The sensitivity of the test to detect CRC was 55.6% and specificity was 100%. There were 22 postsurgical samples obtained at 5–7 days after surgery, the sensitivity to detect tumor recurrences was 100% and specificity was 75%. There were 21 samples analyzed 1 month after surgery exhibiting a sensitivity and specificity of 100% and 94.7%, respectively. At 3 months, 31 postsurgical samples were analyzed and the sensitivity and specificity were 66.7% and 80%. Conclusions: Detection of methylation of Septin 9 gene in circulating plasma DNA, obtained from a peripheral blood sample, may be a useful, non-invasive and effective method for detecting minimal residual disease and could therefore predict CRC tumor recurrences. The optimal time in our series to obtain the best prediction results based on Septin 9 methylation levels was one month after surgery. Despite these considerable findings, a study with more patients is necessary to obtain more robust conclusions. Full article

(This article belongs to the Special Issue Cell-Free Nucleic Acids—New Insights into Physico-Chemical Properties, Analytical Considerations, and Clinical Applications)

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Graphical abstract

9 pages, 1879 KiB

Open AccessArticle

Predicting Factors for Pancreatic Malignancy with Computed Tomography and Endoscopic Ultrasonography in Chronic Pancreatitis

by Jian-Han Lai, Keng-Han Lee, Chen-Wang Chang, Ming-Jen Chen and Ching-Chung Lin

Diagnostics 2022, 12(4), 1004; https://doi.org/10.3390/diagnostics12041004 - 15 Apr 2022

Cited by 2 | Viewed by 1539

Abstract

Diagnosing pancreatic malignancy is challenging, especially in patients with chronic pancreatitis (CP). Endoscopic ultrasonography (EUS) is a promising diagnostic procedure for discriminating between malignancy and CP. We aimed to investigate the predictive factors and reliability of computed tomography (CT) and EUS for differentiating [...] Read more.

Diagnosing pancreatic malignancy is challenging, especially in patients with chronic pancreatitis (CP). Endoscopic ultrasonography (EUS) is a promising diagnostic procedure for discriminating between malignancy and CP. We aimed to investigate the predictive factors and reliability of computed tomography (CT) and EUS for differentiating pancreatic mass lesions and the diagnostic accuracy of EUS-FNA or FNB in patients with CP. Forty patients with CP, receiving CT and EUS-FNA or FNB for pancreatic mass lesion evaluation, were enrolled in the study. Patients’ data, CT and EUS characteristics, image-based diagnosis, cytopathology, and final diagnosis were recorded. EUS was superior to CT in terms of diagnostic accuracy (92.5% vs. 82.5%, p = 0.02). Both CT and EUS showed significant predictive factors (all p < 0.05) with the tumor image hypoattenuation pattern or vessel invasion on CT and pancreatic duct dilatation, or distal pancreatic atrophy on EUS. EUS imaging is a reliable modality for evaluating pancreatic lesions, even with a CP background. The EUS image has a higher diagnostic accuracy than CT. Predicting factors, including hypoechoic pattern, pancreatic duct dilatation, and distal pancreas atrophy, may help to differentiate benign or malignant in patients with CP. Full article

(This article belongs to the Special Issue Advances in Diagnostic and Therapeutic Endoscopic Ultrasonography for Gastrointestinal Diseases)

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9 pages, 2813 KiB

Open AccessCase Report

Total Pancreatectomy for Multicentric Cystic Neuroendocrine Tumor of the Pancreas: A Case Report

by Milica Mitrovic-Jovanovic, Nikica Grubor, Stefan Milosevic, Aleksandra Jankovic, Katarina Stosic, Slavenko Ostojic, Aleksandar Ninic, Marjan Micev and Jelena Djokic Kovac

Diagnostics 2022, 12(4), 1003; https://doi.org/10.3390/diagnostics12041003 - 15 Apr 2022

Cited by 1 | Viewed by 1804

Abstract

Pancreatic neuroendocrine tumors (PNETs) are uncommon pancreatic neoplasms with malignant potential, heterogeneous clinical behavior, as well as imaging appearance. These tumors represent less than 3% of all pancreatic neoplasms with typical CT presentation as solid, well-circumscribed, hypervascular lesions. Cystic PNET is a rare [...] Read more.

Pancreatic neuroendocrine tumors (PNETs) are uncommon pancreatic neoplasms with malignant potential, heterogeneous clinical behavior, as well as imaging appearance. These tumors represent less than 3% of all pancreatic neoplasms with typical CT presentation as solid, well-circumscribed, hypervascular lesions. Cystic PNET is a rare pancreatic tumor which is nowadays more often detected due to the widespread use of high-resolution cross-sectional imaging. They are mainly solitary lesions most commonly localized in the body and the tail of the pancreas. Due to cystic presentation these lesions often present a diagnostic challenge to both experienced radiologists and pathologists. Herein, we present a rare case of synchronous, multiple cystic and solid pancreatic neuroendocrine tumors, which due to their extensiveness required total dudenopancreatectomy with splenectomy. Histopathological findings confirmed microscopic and macroscopic cystic components as well as typical solid variants of neuroendocrine tumors along the entire pancreas. Full article

(This article belongs to the Special Issue Advances in the Diagnosis of Gastrointestinal Diseases)

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13 pages, 2188 KiB

Open AccessArticle

Radiomics for the Prediction of Response to Antifibrotic Treatment in Patients with Idiopathic Pulmonary Fibrosis: A Pilot Study

by Cheng-Chun Yang, Chin-Yu Chen, Yu-Ting Kuo, Ching-Chung Ko, Wen-Jui Wu, Chia-Hao Liang, Chun-Ho Yun and Wei-Ming Huang

Diagnostics 2022, 12(4), 1002; https://doi.org/10.3390/diagnostics12041002 - 15 Apr 2022

Cited by 9 | Viewed by 2350

Abstract

Antifibrotic therapy has changed the treatment paradigm for idiopathic pulmonary fibrosis (IPF); however, a subset of patients still experienced rapid disease progression despite treatment. This study aimed to determine whether CT-based radiomic features can predict therapeutic response to antifibrotic agents. In this retrospective [...] Read more.

Antifibrotic therapy has changed the treatment paradigm for idiopathic pulmonary fibrosis (IPF); however, a subset of patients still experienced rapid disease progression despite treatment. This study aimed to determine whether CT-based radiomic features can predict therapeutic response to antifibrotic agents. In this retrospective study, 35 patients with IPF on antifibrotic treatment enrolled from two centers were divided into training (n = 26) and external validation (n = 9) sets. Clinical and pulmonary function data were collected. The patients were categorized into stable disease (SD) and progressive disease (PD) groups based on functional or radiologic criteria. From pretreatment non-enhanced high-resolution CT (HRCT) images, twenty-six radiomic features were extracted through whole-lung texture analysis, and six parenchymal patterns were quantified using dedicated imaging platforms. The predictive factors for PD were determined via univariate and multivariate logistic regression analyses. In the training set (SD/PD: 12/14), univariate analysis identified eight radiomic features and ground-glass opacity percentage (GGO%) as potential predicators of PD. However, multivariate analysis found that the single independent predictor was the sum entropy (accuracy, 80.77%; AUC, 0.75). The combined sum entropy-GGO% model improved the predictive performance in the training set (accuracy, 88.46%; AUC, 0.77). The overall accuracy of the combined model in the validation set (SD/PD: 7/2) was 66.67%. Our preliminary results demonstrated that radiomic features based on pretreatment HRCT could predict the response of patients with IPF to antifibrotic treatment. Full article

(This article belongs to the Special Issue Artificial Intelligence in Lung Diseases 2.0)

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11 pages, 3281 KiB

Open AccessArticle

Parkinson’s Disease Symptoms Associated with Developing On-State Axial Symptoms Early after Subthalamic Deep Brain Stimulation

by Gustavo Fernández-Pajarín, Ángel Sesar, José Luis Relova, Begoña Ares, Isabel Jiménez, Miguel Gelabert-González, Eduardo Arán and Alfonso Castro

Diagnostics 2022, 12(4), 1001; https://doi.org/10.3390/diagnostics12041001 - 15 Apr 2022

Cited by 1 | Viewed by 1732

Abstract

Background: The relationship between axial symptoms in Parkinson’s disease (PD) and subthalamic deep brain stimulation (STN-DBS) is still unclear. Purpose: We searched for particular clinical characteristics before STN-DBS linked to on-state axial problems after surgery. Methods: We retrospectively analyzed baseline motor, emotional and [...] Read more.

Background: The relationship between axial symptoms in Parkinson’s disease (PD) and subthalamic deep brain stimulation (STN-DBS) is still unclear. Purpose: We searched for particular clinical characteristics before STN-DBS linked to on-state axial problems after surgery. Methods: We retrospectively analyzed baseline motor, emotional and cognitive features from PD patients with early axial symptoms (within 4 years after STN-DBS) and late axial symptoms (after 4 years). We also considered a group of PD patients without axial symptoms for at least 4 years after surgery. Results: At baseline, early-axial PD patients (n = 28) had a higher on-state Unified Parkinson’s Disease Rating Scale III (15.0 ± 5.6 to 11.6 ± 6.2, p = 0.020), higher axial score (2.4 ± 1.8 to 0.7 ± 1.0, p < 0.001) and worse dopaminergic response (0.62 ± 0.12 to 0.70 ± 0.11, p = 0.005), than non-axial PD patients (n = 51). Early-axial PD patients had short-term recall impairment, not seen in non-axial PD (36.3 ± 7.6 to 40.3 ± 9.3, p = 0.041). These variables were similar between late-axial PD (n = 18) and non-axial PD, but late-axial PD showed worse frontal dysfunction. Conclusions: PD patients with early axial symptoms after DBS may have a significantly worse presurgical motor phenotype, poorer dopaminergic response and memory impairment. This may correspond to a more severe form of PD. Full article

(This article belongs to the Special Issue Clinical Diagnostics, Biomarkers and Pathology in Parkinson's Disease)

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5 pages, 938 KiB

Open AccessCase Report

The Tyndall Effect in High-Resolution Computed Tomography of Semicircular Canalolithiasis with Benign Paroxysmal Positional Vertigo

by Jiann-Jy Chen, Chun-Chung Lui, Tien-Yu Chen, Ping-Tao Tseng and Chao-Ming Hung

Diagnostics 2022, 12(4), 1000; https://doi.org/10.3390/diagnostics12041000 - 15 Apr 2022

Viewed by 1726

Abstract

To date, along with the progress of new technology and computer program development, the high-resolution computed tomography (HRCT) had been applied in different clinical application, such as HRCT for coronary angiography. In the current neuroimaging reports, we present HRCT images of the head/neck [...] Read more.

To date, along with the progress of new technology and computer program development, the high-resolution computed tomography (HRCT) had been applied in different clinical application, such as HRCT for coronary angiography. In the current neuroimaging reports, we present HRCT images of the head/neck of two cases, in which one had a diagnosis of benign paroxysmal positional vertigo (BPPV) and the other did not, to represent the Tyndall effect, which describes the scattering of light by particles (i.e., semicircular canalolithiasis) in the path of light and enables clinicians to see a specific signal on the HRCT images. On the HRCT image of the patient with canalolithiasis with BPPV, we could obviously see the scattering effect (i.e., Tyndall effect) in the horizontal/posterior semicircular canal; however, on the HRCT image of the other without canalolithiasis, we could not see such findings. Therefore, through the assistance of technological progress, HRCT might be beneficial in the diagnosis of semicircular canalolithiasis, which has the advantage of being noninvasive and having a low risk of complications. However, because of the disadvantages of expense and risk of radiation exposure, HRCT should be reserved for patients who are difficult to diagnose. Full article

(This article belongs to the Special Issue Head and Neck Imaging)

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11 pages, 1312 KiB

Open AccessArticle

Doppler and Spectral Ultrasound of Sacroiliac Joints in Pediatric Patients with Suspected Juvenile Spondyloarthritis

by Paolo Falsetti, Edoardo Conticini, Carla Gaggiano, Caterina Baldi, Maria Tarsia, Marco Bardelli, Stefano Gentileschi, Roberto D’Alessandro, Suhel Gabriele Al Khayyat, Alessandra Cartocci, Claudia Fabiani, Luca Cantarini, Maria Antonietta Mazzei and Bruno Frediani

Diagnostics 2022, 12(4), 992; https://doi.org/10.3390/diagnostics12040992 - 14 Apr 2022

Cited by 3 | Viewed by 2091

Abstract

Background: Power Doppler ultrasound (PDUS) with spectral wave analysis (SWA) has been compared with magnetic resonance imaging (MRI) in documenting active sacroiliitis in early spondyloarthritis (SpA) but, to date, PDUS/SWA has not been yet applied to the study of sacroiliac joints (SIJs) in [...] Read more.

Background: Power Doppler ultrasound (PDUS) with spectral wave analysis (SWA) has been compared with magnetic resonance imaging (MRI) in documenting active sacroiliitis in early spondyloarthritis (SpA) but, to date, PDUS/SWA has not been yet applied to the study of sacroiliac joints (SIJs) in children. Methods: A group of 20 children (13 F/7 M, mean age 14.2 y) with suspected juvenile SpA (jSpA) underwent PDUS/SWA and, subsequently, MRI of the SIJs. SIJs PDUS scoring and resistance index (RI) of the SIJs flows were recorded. The accuracy of PDUS/SWA for the diagnosis of active sacroiliitis was evaluated, with MRI as the gold standard. Results: PDUS signals were detected in 19 patients and 30 SIJs. Bone marrow edema (BME) lesions on MRI were detected in 12 patients (diagnosed as jSpA) and 22 SIJs. PDUS scoring on SIJs were higher in patients with a final diagnosis of jSpA (p = 0.003). On SWA, the mean RIs in patients with or without final diagnosis of active sacroiliitis were, respectively, 0.604 and 0.767 (p = 0.005) at joint level. A RI < 0.55 and PDUS > 1 showed the higher specificity for sacroiliitis (AUROC curve 0.854 for PDUS and 0.920 for RI). SIJs PDUS/SWA showed an overall concordance of 82.35%, with substantial agreement (k = 0.627) with MRI on the diagnosis of sacroiliitis. Conclusions: In children with sacroiliitis, PDUS demonstrates a rich vascularization into SIJs and low RIs (<0.55) have high specificity for this condition. SIJs PDUS/SWA could be useful as a screening method in children with suspected jSpA. Full article

(This article belongs to the Special Issue Ultrasound Imaging in Medicine 2022)

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18 pages, 7925 KiB

Open AccessArticle

Artificial Intelligence (Enhanced Super-Resolution Generative Adversarial Network) for Calcium Deblooming in Coronary Computed Tomography Angiography: A Feasibility Study

by Zhonghua Sun and Curtise K. C. Ng

Diagnostics 2022, 12(4), 991; https://doi.org/10.3390/diagnostics12040991 - 14 Apr 2022

Cited by 15 | Viewed by 2431

Abstract

Background: The presence of heavy calcification in the coronary artery always presents a challenge for coronary computed tomography angiography (CCTA) in assessing the degree of coronary stenosis due to blooming artifacts associated with calcified plaques. Our study purpose was to use an advanced [...] Read more.

Background: The presence of heavy calcification in the coronary artery always presents a challenge for coronary computed tomography angiography (CCTA) in assessing the degree of coronary stenosis due to blooming artifacts associated with calcified plaques. Our study purpose was to use an advanced artificial intelligence (enhanced super-resolution generative adversarial network [ESRGAN]) model to suppress the blooming artifact in CCTA and determine its effect on improving the diagnostic performance of CCTA in calcified plaques. Methods: A total of 184 calcified plaques from 50 patients who underwent both CCTA and invasive coronary angiography (ICA) were analysed with measurements of coronary lumen on the original CCTA, and three sets of ESRGAN-processed images including ESRGAN-high-resolution (ESRGAN-HR), ESRGAN-average and ESRGAN-median with ICA as the reference method for determining sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: ESRGAN-processed images improved the specificity and PPV at all three coronary arteries (LAD-left anterior descending, LCx-left circumflex and RCA-right coronary artery) compared to original CCTA with ESRGAN-median resulting in the highest values being 41.0% (95% confidence interval [CI]: 30%, 52.7%) and 26.9% (95% CI: 22.9%, 31.4%) at LAD; 41.7% (95% CI: 22.1%, 63.4%) and 36.4% (95% CI: 28.9%, 44.5%) at LCx; 55% (95% CI: 38.5%, 70.7%) and 47.1% (95% CI: 38.7%, 55.6%) at RCA; while corresponding values for original CCTA were 21.8% (95% CI: 13.2%, 32.6%) and 22.8% (95% CI: 20.8%, 24.9%); 12.5% (95% CI: 2.6%, 32.4%) and 27.6% (95% CI: 24.7%, 30.7%); 17.5% (95% CI: 7.3%, 32.8%) and 32.7% (95% CI: 29.6%, 35.9%) at LAD, LCx and RCA, respectively. There was no significant effect on sensitivity and NPV between the original CCTA and ESRGAN-processed images at all three coronary arteries. The area under the receiver operating characteristic curve was the highest with ESRGAN-median images at the RCA level with values being 0.76 (95% CI: 0.64, 0.89), 0.81 (95% CI: 0.69, 0.93), 0.82 (95% CI: 0.71, 0.94) and 0.86 (95% CI: 0.76, 0.96) corresponding to original CCTA and ESRGAN-HR, average and median images, respectively. Conclusions: This feasibility study shows the potential value of ESRGAN-processed images in improving the diagnostic value of CCTA for patients with calcified plaques. Full article

(This article belongs to the Special Issue Innovation in Cardiac CT)

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16 pages, 28311 KiB

Open AccessArticle

Fast Segmentation of Metastatic Foci in H&E Whole-Slide Images for Breast Cancer Diagnosis

by Muhammad-Adil Khalil, Yu-Ching Lee, Huang-Chun Lien, Yung-Ming Jeng and Ching-Wei Wang

Diagnostics 2022, 12(4), 990; https://doi.org/10.3390/diagnostics12040990 - 14 Apr 2022

Cited by 15 | Viewed by 2557

Abstract

Breast cancer is the leading cause of death for women globally. In clinical practice, pathologists visually scan over enormous amounts of gigapixel microscopic tissue slide images, which is a tedious and challenging task. In breast cancer diagnosis, micro-metastases and especially isolated tumor cells [...] Read more.

Breast cancer is the leading cause of death for women globally. In clinical practice, pathologists visually scan over enormous amounts of gigapixel microscopic tissue slide images, which is a tedious and challenging task. In breast cancer diagnosis, micro-metastases and especially isolated tumor cells are extremely difficult to detect and are easily neglected because tiny metastatic foci might be missed in visual examinations by medical doctors. However, the literature poorly explores the detection of isolated tumor cells, which could be recognized as a viable marker to determine the prognosis for T1NoMo breast cancer patients. To address these issues, we present a deep learning-based framework for efficient and robust lymph node metastasis segmentation in routinely used histopathological hematoxylin–eosin-stained (H–E) whole-slide images (WSI) in minutes, and a quantitative evaluation is conducted using 188 WSIs, containing 94 pairs of H–E-stained WSIs and immunohistochemical CK(AE1/AE3)-stained WSIs, which are used to produce a reliable and objective reference standard. The quantitative results demonstrate that the proposed method achieves 89.6% precision, 83.8% recall, 84.4% F1-score, and 74.9% mIoU, and that it performs significantly better than eight deep learning approaches, including two recently published models (v3_DCNN and Xception-65), and three variants of Deeplabv3+ with three different backbones, namely, U-Net, SegNet, and FCN, in precision, recall, F1-score, and mIoU (

p < 0.001

). Importantly, the proposed system is shown to be capable of identifying tiny metastatic foci in challenging cases, for which there are high probabilities of misdiagnosis in visual inspection, while the baseline approaches tend to fail in detecting tiny metastatic foci. For computational time comparison, the proposed method takes 2.4 min for processing a WSI utilizing four NVIDIA Geforce GTX 1080Ti GPU cards and 9.6 min using a single NVIDIA Geforce GTX 1080Ti GPU card, and is notably faster than the baseline methods (4-times faster than U-Net and SegNet, 5-times faster than FCN, 2-times faster than the 3 different variants of Deeplabv3+, 1.4-times faster than v3_DCNN, and 41-times faster than Xception-65). Full article

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

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Diagnostics, Volume 12, Issue 4 (April 2022) – 249 articles

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