Diagnostics最新文献

The aim of this paper is to highlight the combined role of ultrasound elastography and contrast-enhanced ultrasound in terms of diagnosis, staging, and follow-up of the post-treatment response. Contrast-enhanced ultrasound (CEUS) and ultrasound elastography are natural extensions of conventional USs that have created new opportunities, facilitating the implementation of multiparametric ultrasounds in the characterization of thyroid nodules, in risk stratification, and in the selection of nodules that request Fine Needle Aspiration (FNA), management, and follow-up of the nodules with indeterminate cytology, evaluation of pre-operative prognostic features, and treatment efficiency.

Objectives: Randomized evidence on the role of heart failure guideline-directed medical therapy for patients with functional mitral regurgitation (FMR) is lacking. The present meta-analysis sought to investigate the prognostic impact of different pharmacotherapy categories recommended in heart failure on subjects with FMR. Methods: A systematic literature review was conducted to identify studies reporting the association of renin angiotensin system inhibitors (RASi), beta-blockers (BB), and mineralocorticoid receptor antagonists (MRA) with outcomes in FMR. A random-effects meta-analysis was conducted to quantify the unadjusted and adjusted hazard ratios [(a)HRs] for all-cause death and the composite outcome in each medical category. Results: Twelve studies with 6,715 FMR patients were included. The use of RASi and BB was associated with a significantly lower risk of all-cause mortality (HR 0.52 [0.39-0.68]; p < 0.00001, I² = 62% and HR 0.62 [0.49-0.77]; p < 0.0001, I² = 44%, respectively) and the composite outcome (HR 0.54 [0.44-0.67]; p < 0.00001, I² = 33% and HR 0.62 [0.52-0.75], p < 0.00001, I² = 35%, respectively) in unadjusted models. Both RASi (aHR 0.73 [0.56-0.95], p = 0.02, I² = 52%) and BB (aHR 0.60 [0.41-0.88], p = 0.009, I² = 55%) retained their association with the composite outcome in pooled adjusted models. The prognostic benefit of using RASi or BB was retained in subgroup analyses including only (1) patients with moderate or severe FMR and (2) patients with reduced or mildly reduced left ventricular ejection fraction. MRA did not demonstrate a significant association with improved outcomes. Conclusions: RASi and BB administration appear to have a favorable prognostic impact on patients with FMR, regardless of the severity of regurgitation.

Background/Objectives: This study compared the image quality of conventional multiplexed sensitivity-encoding diffusion-weighted imaging (MUSE-DWI) and deep learning MUSE-DWI with that of vendor-specific deep learning (DL) reconstruction applied to bladder MRI. Methods: This retrospective study included 57 patients with a visible bladder mass. DWI images were reconstructed using a vendor-provided DL algorithm (AIR^TM Recon DL; GE Healthcare)-a CNN-based algorithm that reduces noise and enhances image quality-applied here as a prototype for MUSE-DWI. Two radiologists independently assessed qualitative features using a 4-point scale. For the quantitative analysis, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), signal intensity ratio (SIR), and apparent diffusion coefficient (ADC) of the bladder lesions were recorded by two radiologists. The weighted kappa test and intraclass correlation were used to evaluate the interobserver agreement in the qualitative and quantitative analyses, respectively. Wilcoxon signed-rank test was used to compare the image quality of the two sequences. Results: DL MUSE-DWI demonstrated significantly improved qualitative image quality, with superior sharpness and lesion conspicuity. There were no significant differences in the distortion or artifacts. The qualitative analysis of the images by the two radiologists was in good to excellent agreement (κ ≥ 0.61). Quantitative analysis revealed higher SNR, CNR, and SIR in DL MUSE-DWI than in MUSE-DWI. The ADC values were significantly higher in DL MUSE-DWI. Interobserver agreement was poor (ICC ≤ 0.32) for SNR and CNR and excellent (ICC ≥ 0.85) for SIR and ADC values in both DL MUSE-DWI and MUSE-DWI. Conclusions: DL MUSE-DWI significantly enhanced the image quality in terms of lesion sharpness, conspicuity, SNR, CNR, and SIR, making it a promising tool for clinical imaging.

Background: Dupuytren's fibroproliferative disease affecting the hand's palmar fascia leads to progressive finger contractures and functional limitations. Management of this condition relies heavily on the expertise of hand surgeons, who tailor interventions based on clinical assessment. With the growing interest in artificial intelligence (AI) in medical decision-making, this study aims to evaluate the feasibility of integrating AI into the clinical management of Dupuytren's disease by comparing AI-generated recommendations with those of expert hand surgeons. Methods: This multicentric comparative study involved three experienced hand surgeons and five AI systems (ChatGPT, Gemini, Perplexity, DeepSeek, and Copilot). Twenty-two standardized clinical prompts representing various Dupuytren's disease scenarios were used to assess decision-making. Surgeons and AI systems provided management recommendations, which were analyzed for concordance, rationale, and predicted outcomes. Key metrics included union accuracy, surgeon agreement, precision, recall, and F1 scores. The study also evaluated AI performance in unanimous versus non-unanimous cases and inter-AI agreements. Results: Gemini and ChatGPT demonstrated the highest union accuracy (86.4% and 81.8%, respectively), while Copilot showed the lowest (40.9%). Surgeon agreement was highest for Gemini (45.5%) and ChatGPT (42.4%). AI systems performed better in unanimous cases (accuracy up to 92.0%) than in non-unanimous cases (accuracy as low as 35.0%). Inter-AI agreements ranged from 75.0% (ChatGPT-Gemini) to 48.0% (DeepSeek-Copilot). Precision, recall, and F1 scores were consistently higher for ChatGPT and Gemini than for other systems. Conclusions: AI systems, particularly Gemini and ChatGPT, show promise in aligning with expert surgical recommendations, especially in straightforward cases. However, significant variability exists, particularly in complex scenarios. AI should be viewed as complementary to clinical judgment, requiring further refinement and validation for integration into clinical practice.

Background/Objectives: Gantry-free cone-beam CT (CBCT) allows for ultra-high-resolution (UHR) upper extremity imaging in a comfortable tableside position. The aim of this study was to assess the organ-specific radiation burden and the effect of dedicated lead shielding in the UHR-CBCT of the wrist and elbow. Methods: A modified Alderson-Rando phantom was scanned with the tableside UHR-CBCT mode of a twin robotic X-ray system employing identical scan parameters for wrist and elbow imaging. An ion chamber was used in conjunction with an electrometer to obtain representative organ dose measurements for the eye lens, thyroid gland, breast tissue, and abdomen. All measurements were performed with and without lead shielding. Results: Irrespective of the examined upper extremity joint, the highest absorbed dose among the assessed organs was determined for the eye lens (wrist imaging: 0.10 ± 0.01 mGy, elbow imaging: 0.12 ± 0.01 mGy). The most effective organ dose reduction by means of shielding in wrist CBCT was achieved for the thyroid gland (-17%). In elbow CBCT, the abdomen (-48%) and the ipsilateral breast (-39%) benefited particularly from shield protection. Conclusions: Although shielding was more effective in elbow than wrist scans, the overall impact in terms of absolute dose reduction was marginal.

Background/Objectives: In situ preservation is the primary strategy to preserve parathyroid gland (PG) function during thyroid surgery, while autotransplantation is used when inadvertent removal or devascularization occurs. Deciding on the optimal approach intraoperatively for exposed PGs remains challenging. This study evaluates intraoperative PG management strategies and long-term outcomes of PG function following total thyroidectomy. Methods: This retrospective study included 543 patients undergoing primary total thyroidectomy, excluding those with comorbid parathyroid disease. A stabbing test assessed the vascular supply of exposed PGs. PGs with fresh blood oozing after the test were preserved in situ; otherwise, they were autotransplanted. Intact parathyroid hormone (iPTH) and ionized calcium (iCa) were measured preoperatively and on postoperative day 1 (PO-1D), and during follow-up. Permanent hypoparathyroidism (PHPS) was defined as iPTH < 15 pg/mL, iCa < 4.2 mg/dL, or continued need for calcitriol or calcium supplementation after a postoperative period of 12 months (PO-12M). The PHPS rate was compared with the corresponding intraoperative PG status. Results: A total of 528 patients were enrolled in this study. At PO-1D, 434 patients (82.2%) had iPTH ≥ 15 pg/mL, 65 (12.3%) had iPTH between 4 and 15 pg/mL, and 29 (5.5%) had iPTH < 4 pg/mL. At PO-12M, 527 patients (99.81%) had iPTH ≥ 15 pg/mL, 1 (0.19%) had iPTH between 4 and 15 pg/mL, and none had iPTH < 4 pg/mL. Five patients (0.95%) were in PHPS after PO-12M. Among the 462 patients with at least one viable PG preserved in situ, the PHPS rate was 0.2%, compared to 6.1% (66 patients) for those without a viable PG preserved in situ (p < 0.001). Conclusions: Permanent hypoparathyroidism is rare when at least one viable PG is preserved in situ during total thyroidectomy. The stabbing test is a simple, useful, and cost-effective method to assess the vascular supply of exposed PGs, providing surgeons with essential information for intraoperative PG management.

Guyon's canal, or the ulnar tunnel, is a critical anatomical structure at the wrist that houses the ulnar nerve and artery, making it susceptible to various pathological conditions. Pathologies affecting this canal include traumatic injuries, compressive neuropathies like ulnar tunnel syndrome, and space-occupying lesions such as ganglion cysts. Ulnar tunnel syndrome, characterised by numbness, tingling, and weakness in the ulnar nerve distribution, is a prevalent condition that can severely impair hand function. The canal's intricate anatomy is defined by surrounding ligaments and bones, divided into three zones, each containing distinct neural structures. Variations, including aberrant muscles and vascular anomalies, can complicate diagnosis and treatment. Imaging techniques are essential for evaluating these conditions; ultrasound provides real-time, dynamic assessments, while magnetic resonance imaging (MRI) offers detailed visualisation of soft tissues and bony structures, aiding in pre-surgical documentation and pathology evaluation. This review article explores the anatomy, pathologies, and imaging modalities associated with Guyon's canal and underscores the necessity of understanding Guyon's canal's anatomy and associated pathologies to improve diagnostic accuracy and management strategies. By integrating anatomical insights with advanced imaging techniques, clinicians can enhance patient outcomes and preserve hand function, emphasising the need for increased awareness and research in this often-neglected area of hand anatomy.

Meticulous clinical examination is essential for spinal disorders to utilize the diagnostic methods and technologies that strongly support physicians and enhance clinical practice. A significant change in the approach to diagnosing spinal disorders has occurred in the last three decades, which has enhanced a more nuanced understanding of spine pathology. Traditional radiographic methods such as conventional and functional X-rays and CT scans are still the first line in the diagnosis of spinal disorders due to their low cost and accessibility. As more advanced imaging technologies become increasingly available worldwide, there is a constantly increasing trend in MRI scans for detecting spinal pathologies and making treatment decisions. Not only do MRI scans have superior diagnostic capabilities, but they also assist surgeons in performing meticulous preoperative planning, making them currently the most widely used diagnostic tool for spinal disorders. Positron Emission Tomography (PET) can help detect inflammatory lesions, infections, and tumors. Other advanced diagnostic tools such as CT/MRI fusion image, Functional Magnetic Resonance Imaging (fMRI), Upright and Kinetic MRI, magnetic resonance spectroscopy (MRS), diffusion-weighted imaging (DWI), and diffusion tensor imaging (DTI) could play an important role when it comes to detecting more special pathologies. However, some technical difficulties in the daily praxis and their high costs act as obstacles to their further spread. Integrating artificial intelligence and advancements in data analytics and virtual reality promises to enhance spinal procedures' precision, safety, and efficacy. As these technologies continue to develop, they will play a critical role in transforming spinal surgery. This paradigm shift emphasizes the importance of continuous innovation and adaptability in improving the diagnosis and treatment of spinal disorders.

Background/Objectives: Chronic heart failure (CHF) remains a significant global health burden, with high morbidity, prolonged hospitalizations, and increased mortality. Traditional biomarkers such as NT-proBNP provide prognostic value; however, novel biomarker ratios may enhance risk stratification. This study evaluated the predictive utility of the NT-proBNP-to-albumin ratio (NTAR), red cell distribution width-to-eGFR ratio (RGR), and red cell distribution width-to-fibrinogen ratio (RFR) for hospital length of stay (LOS), extended hospitalization (ELOS), in-hospital mortality, and 6-month all-cause mortality. Methods: A retrospective observational pilot study was conducted on 382 CHF admissions (2022-2024) with comprehensive laboratory assessment. Biomarker performance was assessed through uni- and multivariate logistic regression, receiver operating characteristic curve, and Cox proportional hazards stepwise methods of analyses for refining predictive models. Results: NTAR and RGR emerged as significant predictors of hospitalization outcomes. NTAR demonstrated a moderate correlation with prolonged LOS (r = 0.45, p < 0.001) and was an independent predictor of ELOS (AUC = 0.697, OR = 2.438, p < 0.001), outperforming NT-proBNP. Additionally, NTAR significantly predicted in-hospital mortality (AUC = 0.768, OR = 4.461, p < 0.001) and 6-month all-cause mortality (AUC = 0.766, OR = 4.185, p < 0.001). RGR was the strongest predictor of in-hospital mortality (AUC = 0.785, HR = 2.18, p = 0.005), highlighting its role in renal dysfunction and erythropoietic alterations in CHF. The RFR observed prognostic value was minimal. Conclusions: In our study, NTAR and RGR offered valuable prognostic value underscoring the interplay of cardiac stress, nutritional status, and renal function in CHF prognosis. Further multicenter validation is warranted for these biomarkers.

Background/Objective: The prognostic value of specific hot-spot mutations within KRAS, NRAS, and BRAF genes in metastatic colorectal cancer (mCRC) genes remains debatable. This study explores whether certain KRAS, NRAS, and BRAF mutations are associated with the risk of all-cause mortality in mCRC. Methods: We retrospectively analyzed records of 494 patients with mCRC treated at the University of Texas Medical Branch between January 2016 and July 2023. Data on genetic mutations and clinicopathological features were collected for this analysis. We estimated survival probabilities and conducted multivariable Cox proportional hazards regression to evaluate the impact of specific mutations on all-cause mortality risk. Results:KRAS c.35G>T (p.Gly12Val) and c.34G>T (p.Gly12Cys) mutations were significantly associated with an increased risk of all-cause mortality in the overall mCRC population and the treated mCRC subgroup. KRAS c.38G>A (p.Gly13Asp) was significantly associated with an increased risk of all-cause mortality in the treated mCRC subgroup but BRAF c.1799T>A (p.Val600Glu) was significantly associated with an increased risk of all-cause mortality in the overall mCRC population. No significant association was observed between NRAS mutations and mortality risk in mCRC, possibly due to their lower frequency or different biological effects compared to KRAS and BRAF mutations. Conclusions: These findings suggest that specific KRAS [c.35G>T (p.Gly12Val), c.34G>T (p.Gly12Cys), and c.38G>A (p.Gly13Asp)] and BRAF c.1799T>A (p.Val600Glu) mutations may have prognostic value in mCRC. However, given the single-center study design and lack of direct therapeutic implications, larger multicenter studies are needed to substantiate these results and better define the clinical relevance of these mutations.