Additional Diagnostic Information Research Articles

Machine Learning Platform for Disease Diagnosis with Contrast CT Scans

Machine learning has gained significant recognition as a powerful approach for medical diagnosis using medical images. Among various medical imaging modalities, contrast-enhanced CT (CECT) is utilized to obtain additional diagnostic information that improves visualization and evaluation of certain abnormalities in the human body, as well as to observe temporal changes in lesions and tumors across different time phases. However, developing such medical diagnostic systems presents two significant challenges: high technical complexity and substantial development effort. This paper presents a software platform that effectively addresses these challenges. Specifically, we propose a unified software process that fully automates contrast-enhanced CT (CECT)-specific disease diagnosis, with key tasks performed by leveraging task-specific machine learning models to enhance accuracy. The platform incorporates a suite of specialized machine learning models into the diagnostic process, enabling precise diagnosis of lesions, malignancies, tumors, tumor characteristics, and temporal changes over phases. Moreover, the platform has been designed according to the Open–Closed Principle, allowing it to be applicable to a wide range of CECT-based diagnostic systems. The platform has been implemented in Python using the Scikit-learn and TensorFlow libraries. To validate its applicability and reusability, a hepatocellular carcinoma (HCC) diagnosis system has been implemented.

Preoperative breast MR imaging influences surgical management in patients with invasive lobular carcinoma.

The purpose of the study is to assess the role of preoperative magnetic resonance (MR) imaging on the surgical management of invasive lobular carcinoma (ILC) and to evaluate whether breast density and background parenchymal enhancement (BPE) influence surgical treatment. This retrospective study was conducted on 56 patients who were diagnosed with ILC between 2014 and 2020. All patients had mammogram and ultrasound. Preoperative MRI was available in 34 patients. Age, menopausal status, breast density, BPE, multifocality/multicentricity and surgical treatment were collected. Mean pathological tumour size was 36.4 mm (range 5-140 mm). Dense breasts had larger tumours compared to non-dense breasts (P = 0.072). Of the 34 patients with MRI, 6 opted for mastectomy. Of the remaining 28 cases, MRI findings upgraded surgery to mastectomy in 54% (15/28) because mammogram/ultrasound underestimated tumour extent in 25% (7/28), or multifocal/multicentric disease was identified in 29% (8/28). Tumour size was underestimated by MRI in 7% (2/28). In the non-MRI subgroup, 64% (14/22) of patients underwent breast-conserving surgery, but 29% of them (4/14) required a second-stage mastectomy due to extensive margin involvement. There was no difference in mastectomy rate between patients with MRI (62%) and without MRI (55%) (P = 0.061). Tumour size correlation between MRI and histopathology demonstrated an excellent intraclass correlation coefficient (P < 0.001). Surgical treatment recommendation was not significantly impacted by breast density or BPE. Breast MRI improves surgical management of patients with ILC in providing additional diagnostic information often missed with standard imaging modalities, and without increasing mastectomy rate. Surgical treatment is not impacted by breast density or BPE.

Positronium lifetime validation measurements using a long-axial field-of-view positron emission tomography scanner

BackgroundPositron emission tomography (PET) traditionally uses coincident annihilation photons emitted from a positron interacting with an electron to localize cancer within the body. The formation of positronium (Ps), a bonded electron-positron pair, has not been utilized in clinical applications of PET due to the need to detect either the emission of a prompt gamma ray or the decay of higher-order coincident events. Assessment of the lifetime of the formed Ps, however, can potentially yield additional diagnostic information of the surrounding tissue because Ps properties vary due to void size and molecular composition. To assess the feasibility of measuring Ps lifetimes with a PET scanner, experiments were performed in a Biograph Vision Quadra (Siemens Healthineers). Quadra is a long-axial field-of-view (LA-FOV) PET scanner capable of producing list-mode data from single interaction events.ResultsOrtho-Ps (o-Ps) lifetimes were measured for quartz-glass and polycarbonate samples using a 22Na\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{22}\ ext{Na}$$\\end{document} positron source. Results produced o-Ps lifetimes of 1.538 ± 0.036 ns for the quartz glass and 1.927 ± 0.042 ns for the polycarbonate. Both o-Ps lifetimes were determined using a double-exponential fit to the time-difference distribution between the emission of a prompt gamma ray and the annihilation of the correlated positron. The measured values match within a single standard deviation of previously published results. The quartz-glass samples were additional measured with 82Rb\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${^{82}}\ ext{Rb}$$\\end{document}, 68\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{68}$$\\end{document}Ga and 124I\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{124}\ ext{I}$$\\end{document} to validate the lifetime using clinically available sources. A double-exponential fit was initially chosen as a similar methodology to previously published works, however, an exponentially-modified Gaussian distribution fit to each lifetime more-accurately models the data. A Bayesian method was used to estimate the variables of the fit and o-Ps lifetime results are reported using this methodology for the three clinical isotopes: 1.59 ± 0.03 ns for 82Rb\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{82}\ ext{Rb}$$\\end{document}, 1.58 ± 0.07 ns for 68Ga\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{68}\ ext{Ga}$$\\end{document} and 1.62 ± 0.01 ns for 124I\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{124}\ ext{I}$$\\end{document}. The impact of scatter and attenuation on the o-Ps lifetime was also assessed by analyzing a water-filled uniform cylinder (20 ϕ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\phi$$\\end{document}×\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ imes$$\\end{document} 30 cm3\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{3}$$\\end{document}) with an added 82Rb\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{82}\ ext{Rb}$$\\end{document} solution. Lifetimes were extracted for various regions of the cylinder and while there is a shape difference in the lifetime due to scatter, the extracted o-Ps lifetime of the water, 1.815 ± 0.013 ns, agrees with previously published results.ConclusionOverall, the methodology presented in this manuscript demonstrates the repeatability of Ps lifetime measurements with clinically available isotopes in a commercially-available LA-FOV PET scanner. This validation work lays the foundation for future in-vivo patient scans with Quadra.

Postmortem CT and MRI for detecting bowel obstruction in cases of pediatric sepsis deaths.

This article describes the utility of postmortem CT and MRI in diagnosing pediatric bowel obstruction (BO) as the cause of septic shock-induced death. Six pediatric cases with confirmed septic shock were retrospectively analyzed. Postmortem CT scans revealed clear signs of BO in all cases, with volvulus, intussusception, diaphragmatic hernia, or Meckel's diverticulum identified. MRI scans, performed in three cases, did not provide additional diagnostic information. The presented case series highlights the potential of postmortem CT for diagnosing BO in children, potentially aiding in understanding the cause and manner of death. While MRI offered limited additional benefits, its role in conjunction with CT and autopsy warrants further exploration. Combining these modalities could enhance diagnostic accuracy and provide a more complete picture of the cause of death in children.

The clinical meaning and significance of OVEMP morphology.

While some OVEMP recordings are morphologically straightforward, some are poor in appearance, which can create a challenge, as they often require a "second look" by another experienced assessor. Even OVEMPs in normal subjects are sometimes poorly formed, but we wondered if the morphological assessment of the OVEMP response might provide some additional diagnostic information. A single experienced assessor evaluated the OVEMP recordings of 60 patients referred sequentially to a tertiary care centre, and categorized them as "easy to assess" (i.e. obvious to a minimally trained assessor) or "difficult to assess", often requiring a second look by another experienced assessor. In 48 patients, the results were easy to assess (regardless of the actual clinical results) while 12 were classified as "difficult". This figure reflected the rate of morphologically poor responses we found in our population of normative data. Our clinical concern is that many centres have given up relying on OVEMP assessment because the morphology of the wave may be challenging to interpret. OVEMP assessment often calls for a "second look", requiring a collaboration between two experienced assessors. It seems that this feature may not be diagnostically useful and poor OVEMP morphology may present a challenge in interpretation, but this should not be used as a reason to defer OVEMP testing.

Scout images acquired prior to cone beam CT acquisitions: reproducibility of findings and added diagnostic information.

The aim of the present study was to assess the reproducibility of findings in cone beam computed tomography (CBCT) scout images. Furthermore, the study aimed to assess whether a scout image shows pathology not seen within the CBCT volume (ie, added diagnostic information) and therefore must be assessed on the same terms as the full volume. Using a retrospective design, 233 CBCT reports and scout images were assessed. Kappa statistics and percentage of accordance were used to evaluate intra- and interobserver reproducibility as well as agreement between scout and CBCT report. Intra- and interobserver reproducibility were overall low (kappa ranging from -0.008 to 1.000). Agreement between findings reported in the CBCT and scout was also low. One-hundred-fourteen impacted teeth, one apical periodontitis, and two sinus conditions seen in the scout image were not registered in the full volume report due to the extended size of the scout image. Reproducibility of findings in scout images compared to CBCT volumes was low, and the scout showed very little additional diagnostic information. This study shows that although the reproducibility of viewing scout images is low, rare findings can go undetected if the scout is not assessed. Legislation regarding interpretation of scout images needs to be discussed.

Does delayed phase imaging in CT angiography provide additional information in patients with suspected active bleeding?

We hypothesize that delayed phase imaging does not provide additional diagnostic information in patients who undergo multi-phasic CTA for suspected active bleeding. Data on patients who underwent multiphasic CTA (pre-contrast, arterial, porto-venous, and delayed phases) for suspected acute bleed were retrospectively collected between January 2019 and November 2021. CTA images were reviewed by a general radiologist, an interventional radiologist, and a body imaging radiologist independently. Each reader evaluated if delayed phase images provided additional information that would change the final impression of the CTA report. Additional information regarding bleeding location, time needed for delayed image acquisition, and radiation exposure were also obtained. A total of 104 patients with CTAs were analyzed with an average age of 58 years ± 22. Studies rated with absent additional findings on delayed images were 102 (98.1%) by the interventional radiologist, 101 (97.1%) by the body imaging radiologist, and 100 (96.1%) by the general radiologist with percent agreement of 96.15% (kappa 0.54, p < 0.001). All the findings were characterized as unlikely to be clinically significant. Mean time added to complete a delayed phase images was 3.61 ± 3.4min. The average CT dose length product (DLP) for the total exam was 3621.78 ± 2129.57 mGy.cm with delayed acquisition adding a mean DLP of 847.75 ± 508.8 mGy.cm. Delayed phase imaging does not provide significant additional diagnostic information in evaluating patients with suspected active bleeding but is associated with increased examination time and radiation exposure.

MV-MFF: Multi-View Multi-Feature Fusion Model for Pneumonia Classification.

Pneumonia ranks among the most prevalent lung diseases and poses a significant concern since it is one of the diseases that may lead to death around the world. Diagnosing pneumonia necessitates a chest X-ray and substantial expertise to ensure accurate assessments. Despite the critical role of lateral X-rays in providing additional diagnostic information alongside frontal X-rays, they have not been widely used. Obtaining X-rays from multiple perspectives is crucial, significantly improving the precision of disease diagnosis. In this paper, we propose a multi-view multi-feature fusion model (MV-MFF) that integrates latent representations from a variational autoencoder and a β-variational autoencoder. Our model aims to classify pneumonia presence using multi-view X-rays. Experimental results demonstrate that the MV-MFF model achieves an accuracy of 80.4% and an area under the curve of 0.775, outperforming current state-of-the-art methods. These findings underscore the efficacy of our approach in improving pneumonia diagnosis through multi-view X-ray analysis.

Rectal organoid morphology analysis (ROMA) as a novel physiological assay for diagnostic classification in cystic fibrosis

BackgroundDiagnosing cystic fibrosis (CF) is not always straightforward, in particular when sweat chloride concentration (SCC) is intermediate and <2 CF-causing CFTR variants are identified. The physiological CFTR assays proposed in...

Association of results of the glutaraldehyde coagulation test with plasma acute phase protein concentrations and hematologic findings in hospitalized cows.

The glutaraldehyde test (GAT) allows for animal-side semi-quantitative estimation of fibrinogen and gamma-globulin concentrations in blood samples of adult cattle and therefore detection of inflammatory disease conditions. However, the test has potential limitations, especially due to the latency period until sufficiently high fibrinogen and/or gamma-globulin concentrations are reached. The aim of the present study was therefore to assess the association between results of GAT with other inflammatory markers including hematologic variables, fibrinogen, plasma haptoglobin and serum amyloid A (SAA) concentrations. For the purpose of this prospective observational study, a convenience sample of 202 cows with a broad range of inflammatory and non-inflammatory clinical conditions was included. The GAT was run on EDTA blood, fibrinogen was measured using the Clauss and the heat precipitation method, and commercially available ELISA tests were used for determination of plasma haptoglobin and SAA concentrations. Shortened GAT coagulation times were more closely correlated to serum globulin (rs = -0.72) than to plasma fibrinogen concentrations measured with the heat precipitation (rs = -0.64) and the Clauss method (rs = -0.70). Cows with a markedly (≤3 min) or moderately (4-6 min) shortened coagulation time had higher (p < 0.001) plasma haptoglobin and SAA concentrations than cows with a negative test result. Total leukocyte, monocyte and neutrophil concentrations did not differ significantly between groups. An identified cut-off for the GAT coagulation time of ≤14 min had a sensitivity and specificity of 54.4 and 100%, respectively, for the prediction of an inflammatory state based on clinical findings and/or increased plasma haptoglobin or SAA concentrations. In conclusion, this study demonstrates considerable diagnostic agreement between positive GAT results and increased plasma concentrations of haptoglobin and SAA. Despite high specificity, the test lacks sensitivity in case of acute inflammatory conditions indicating that plasma acute phase protein concentrations and hematologic findings can provide additional diagnostic information if the GAT is negative.

Patterns of longitudinal subcortical atrophy over one year in amnestic mild cognitive impairment and its impact on cognitive performance: a preliminary study.

Amnestic mild cognitive impairment (aMCI) is a risk factor for dementia, and thus, it is of interest to enlighten specific brain atrophy patterns in aMCI patients. We aim to define the longitudinal atrophy pattern in subcortical structures and its effect on cognition in patients with aMCI. Twenty patients with aMCI and 20 demographically matched healthy controls with baseline and longitudinal structural magnetic resonance imaging scans and neuropsychological assessments were studied. The algorithm FIRST (FMRIB's integrated registration and segmentation tool) was used to obtain volumes of subcortical structures (thalamus, putamen, caudate nucleus, nucleus accumbens, globus pallidus, hippocampus, and amygdala). Correlations between volumes and cognitive performance were assessed. Compared with healthy controls, aMCI demonstrated subcortical atrophies in the hippocampus (p = 0.001), nucleus accumbens (p = 0.003), and thalamus (p = 0.003) at baseline. Significant associations were found for the baseline volumes of the thalamus, nucleus accumbens, and hippocampus with memory, the thalamus with visuospatial skills. aMCI demonstrated subcortical atrophies associated with cognitive deficits. The thalamus, nucleus accumbens, and hippocampus may provide additional diagnostic information for aMCI.

Endoscopic Ultrasound-Guided Liver Biopsy (EUS-LB): An Endoscopic Solution to the Unmet Needs of Liver Tissue Acquisition and Beyond

Abstract Aim and Objective Endoscopic ultrasound-guided liver biopsy (EUS-LB) is now increasingly being used across the globe as a method of liver tissue acquisition. This method is widely accepted by many professionals as it can overcome many shortcomings of percutaneous liver biopsy and transjugular liver biopsy. The aim of the study is to obtain the adequate and optimal biopsy rate associated with EUS-LB. Materials and Methods This is a retrospective observational study. Consecutive patients undergoing EUS-LB during the study period who were willing to consent were taken up for the study. Results Total 91 patients were taken up for the study. Median age of study population was 44 years out of which 39 patients were males and 52 were females (42.9 and 57.1%). Adequate biopsy rate (according to European Association for the Study of Liver Disease criteria) and optimal biopsy rate (according to American Association for the Study of Liver Diseases criteria) were 89 (81/91) and 60.4% (55/91), respectively. Rate of conclusive diagnosis was 95.6% (86/91). The commonest diagnosis encountered was nonalcoholic steatohepatitis) (23, 25.3%), followed by autoimmune hepatitis (17, 18.7%). Additional diagnostic information was obtained by endosonography during EUS-LB in 21 patients (23.1%). Gallstone disease was found in four (4.8%) patients, chronic calcific pancreatitis in two (1.9%) patients, significant abdominal lymphadenopathy defined as lymph node more than 1.5 cm in five (5.8%) patients, and esophageal or gastric varices in ten (10.6%) patients. One case of self-limiting biopsy site ooze was seen in EUS-LB and the patient was having cirrhosis. Conclusion This study showed a high diagnostic outcome and safety profile with EUS-LB technique. EUS-LB can achieve excellent histological yield when performed with optimal technique. Moreover, it is possible to obtain additional information during the procedure from diagnostic endosonography that is done as a part of EUS-LB.

Oxygen Sensor-Guided Fine Needle Biopsy Studies of Human Cancer Xenografts in Mice.

An oxygen sensor-mounted fine-needle biopsy tool was used for in vivo measurement of oxygen levels in tumor xenografts. The system provides a means of measuring the oxygen content in harvested tumor tissue from specific locations. Oxygen in human tumor xenografts in a murine model was observed for over 1 min. Tissues were mapped in relation to oxygen tension (pO2) readings and sampled for conventional cytological examination. Careful modeling of the pO2 readings over 60 seconds yielded a diffusion coefficient for oxygen at the sensor tip, providing additional diagnostic information about the tissue before sampling. Oxygen level measurement may provide a useful adjunct to the use of biomarkers in tumor diagnosis.

#613 Is there a relationship between kidney stiffness identified by 2D shear wave elastography and the estimated glomerular filtration rate?

Abstract Background and Aims Ultrasound-based elastography has been utilized as an imaging method with high utility in the liver or thyroid, but it is not yet being implemented in evaluating the chronic kidney disease (CKD) because current research indicates a high level of heterogeneity between studies. We aimed to investigate if there is a connection between kidney stiffness measured with a new, specially designed elastography software for kidneys and estimated glomerular filtration rate (eGFR). Method In 2022 and 2023 we performed a cross-sectional study in 150 participants (50 healthy, 50 kidney-transplanted, 50 with chronic glomerulonephritis). The mean value of five different measurements for each kidney were correlated with biological and clinical parameters. To examine the variations amongst the three groups, one-way between-groups ANOVA was employed. Results The mean kidney stiffness for the healthy cohort was 31.9 ± 2.9 kiloPascal (kPa), for kidney transplanted (Ktx) patients 25.9 ± 6.9 kPa and for the chronic glomerulonephritis (GN) 23.8 ± 7.45 kPa. We discovered correlations between kidney stiffness and eGFR in all three groups: healthy r = 0.61, p &amp;lt; 0.0001, Ktx r = 0.56, p &amp;lt; 0.0001, GN r = 0.70, p &amp;lt; 0.0001. We also found a value of under 26 kPa for the detection of an eGFR under 60 mL/min/1.73 m2 with 94.3% sensitivity and 84% specificity (AUC = 0.905, p &amp;lt; 0.0001). The healthy group showed significant higher values than Ktx or GN groups, but without significant differences between the latter two. Conclusion Our findings demonstrate a correlation between renal function, with very good diagnostic accuracy, and these novel imaging techniques. A decrease in renal stiffness with the progression of CKD could prove to be an easy, reproducible approach to provide additional diagnostic information. However, given the limited number of participants, additional studies are required before they can be incorporated into standard clinical practice.

Metabolic dysfunction-associated fatty liver disease and low muscle strength: A comment

The diagnosis of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease only on the basis of laboratory parameter score such as Hepatic Steatosis Index which includes liver enzymes, gender, basal metabolic index, and presence of diabetic mellitus is not sufficient to exclude other causes of deranged liver enzymes especially medications and autoimmune related liver diseases. As the guideline suggests ultrasound is the preferred first-line diagnostic procedure for imaging of NAFLD, as it provides additional diagnostic information and the combination of biomarkers/scores and transient elastography might confer additional diagnostic accuracy and evident from previous similar studies too.

Development of a biotechnical system for intraoperative diagnosis of perfusion and metabolic parameters of biological tissues during minimally invasive surgical interventions

The development of modern technologies, tendencies to reduce traumatization and extent of surgical interventions have created conditions for intensive implementation and widespread use of minimally invasive surgery (MIS). For all their advantages, MIS interventions have a number of peculiarities, primarily related to limited access to the organ. This drives the need to improve and expand the range of technologies used in MIS to provide additional diagnostic information about the functional state of biological tissues. The indications for MIS interventions are very broad, but from the pathophysiological point of view, many diseases, syndromes and conditions can be described in terms of unified disorders of perfusion and metabolic parameters of biological tissues. There is no alternative to optical diagnostic methods for the determination of perfusion and metabolic parameters of biological tissues in vivo, thus making it possible to obtain additional diagnostic information in MIS practice. In particular, diffuse reflectance spectroscopy is used to measure the absorption and scattering properties of optically inhomogeneous media, such as biological tissues, and to estimate their structural and biochemical properties. Fluorescence spectroscopy is based on the registration of the autofluorescence of biological tissues when excited by optical radiation. Most endogenous fluorophores are related to the structure or to various metabolic processes responsible for the functional state of biological tissues. The main method of studying blood microcirculation is laser Doppler flowmetry – a technology based on the analysis of laser radiation reflected from the surface layer of biological tissues. Another method for assessing perfusion disorders in clinical medicine is laser speckle contrast imaging, which is based on the registration of a random interference pattern that is formed on a camera detector when an object is illuminated by coherent laser radiation. The aim of the study is to develop a biotechnical system (BTS) for intraoperative diagnostics of perfusion and metabolic parameters of biological tissues during MIS interventions based on optical diagnostic methods, which enables surgeons to obtain additional diagnostic information about the state of operated organs and tissues in real time. To achieve this goal, the possibility of assessing perfusion and metabolic disorders of biological tissues using optical diagnostic methods was scientifically substantiated. A formalized scheme of BTS for intraoperative diagnostics of perfusion and metabolic parameters of biological tissues was developed. Fiber optic probes of different designs compatible with instruments for MIS interventions were described. An example of the implementation of intraoperative optical diagnostics in gynecology based on the developed BTS is presented. A study of changes in the perfusion and metabolic characteristics of the myometrium, myoma, and pseudocapsule during myomectomy is described. It is shown that the pseudocapsule is better supplied with blood than the myoma and the myometrium, confirming the data that this structure is a vascular capsule that surrounds and nourishes the myoma. The use of modern methods of optical diagnostics based on the analysis of the interaction of optical radiation with biological tissues, together with the integration of optical technologies into modern surgical equipment, is the next technological innovation in the era of MIS development. The proposed and described methodology of building BTS of intraoperative diagnostics of perfusion and metabolic parameters of biological tissues is the basis for creating new-generation medical systems, which provide the possibility of obtaining reliable diagnostic data in conditions of limited access to biological tissues associated with the specifics of MIS interventions and allow to improve the quality and safety of surgical care.

Comparison of cytomorphology and histomorphology in myelodysplastic syndromes.

Gold standard for the establishment of the diagnosis of myelodysplastic syndromes (MDS) are cytomorphological features of hematopoietic cells in peripheral blood and bone marrow aspirates. There is increasing evidence that bone marrow histomorphology not only aids in the diagnosis of MDS but can provide additional prognostic information, particularly through assessment of fibrosis and cellularity. However, there is only sparse data on direct comparison between histological and cytomorphological findings within the same MDS patient cohort. Therefore, we performed such an analysis under exceptionally well-standardized conditions. We reexamined biopsy material of 128 patients from the Düsseldorf MDS registry who underwent bone marrow trephine biopsy (in addition to bone marrow aspiration) at the time of diagnosis, addressing the following items: a. Analysis of concordance of diagnoses made by histology and cytomorphology b. Analysis of additional information by histology with regard to the diagnosis and prognosis. The respective biomaterials were available at our institution and had been processed according to unchanged protocols between 1992 and 2010. Fresh histopathological sections were obtained from the tissue blocks, stained under identical conditions and re-assessed by a designated expert pathologist (C.B.) without knowledge of the previous histopathological report or the respective cytomorphological diagnosis. The latter, likewise, was uniformly made by the same expert cytomorphologist (U.G.). Histopathology of bone marrow trephine biopsies reliably captured the diagnosis of MDS. Assignment to the diagnostic WHO subgroup was not entirely concordant with cytomorphology, mainly due to incongruences between the proportion of CD34-positive cells on histopathology and the cytomorphological blast count. Histopathology provided additional diagnostic and prognostic information with high diagnostic and prognostic significance, such as fibrosis. Likewise, histopathology allowed more reliable estimation of bone marrow cellularity.

Fetal Cardiac MRI Using Doppler US Gating: Emerging Technology and Clinical Implications.

Fetal cardiac MRI using Doppler US gating is an emerging technique to support prenatal diagnosis of congenital heart disease and other cardiovascular abnormalities. Analogous to postnatal electrocardiographically gated cardiac MRI, this technique enables directly gated MRI of the fetal heart throughout the cardiac cycle, allowing for immediate data reconstruction and review of image quality. This review outlines the technical principles and challenges of cardiac MRI with Doppler US gating, such as loss of gating signal due to fetal movement. A practical workflow of patient preparation for the use of Doppler US-gated fetal cardiac MRI in clinical routine is provided. Currently applied MRI sequences (ie, cine or four-dimensional flow imaging), with special consideration of technical adaptations to the fetal heart, are summarized. The authors provide a literature review on the clinical benefits of Doppler US-gated fetal cardiac MRI for gaining additional diagnostic information on cardiovascular malformations and fetal hemodynamics. Finally, future perspectives of Doppler US-gated fetal cardiac MRI and further technical developments to reduce acquisition times and eliminate sources of artifacts are discussed. Keywords: MR Fetal, Ultrasound Doppler, Cardiac, Heart, Congenital, Obstetrics, Fetus Supplemental material is available for this article. © RSNA, 2024.

The molecular profile people of different ages in «normal» and with dilated cardiomyopathy

Background: Dilated cardiomyopathy (DCMP) is a cardiovascular pathology promising for consideration as a clinical model of premature aging of the body. According to the literature, sirtuins-1, 2, 3, 6; melatonin and its receptors (MT-1 and MT-2); markers of cellular aging (proteins p16, p21) and apoptosis (BAX) may have clinical significance for assessing premature aging of the body on the DCMP model. A comparative study of the expression of these molecules in people of different ages, depending on the presence of DCMP, has not been conducted before. The aim of the study: To identify and compare molecular profiles by the level of expression of the studied signaling molecules in the buccal epithelium and autopsy material of the myocardium in people of different ages with the absence of cardiovascular diseases and the presence of dilated cardiomyopathy. Materials and methods: A study of buccal epithelium (174 people) and autopsy material of myocardium (175 people) in patients aged 45-89 years for the expression of signaling molecules: sirtuins 1, 2, 3, 6, proteins p16, p21 and BAX, was conducted. Methods of immunocytochemical and immunohistochemical studies were used. Groups of middle, elderly and senile age with DCMP and without a history of cardiovascular pathology were identified. Results: Characteristic changes in the molecular profile (the level of the studied signaling molecules) in the buccal epithelium associated with age and the presence of DCMP were revealed: in middle–aged patients – a decrease in the expression of sirtuins 3 and 6 by 2,2-2,3 times, melatonin by 1,8 times and its receptors by 1,4-2,5 times; in elderly patients – a decrease in the expression of sirtuins 1 and 3 by 2,5 times; sirtuin 2 by 2,3 times; melatonin and its receptors by 1,4-1,8 times; in elderly patients – a decrease in the expression of sirtuins 3 and 6 by 3,0-4,7 times; sirtuins 1 and 2 by 6,7-7,3 times; melatonin by 2,8 times; MT-1 – 4,1 times and MT-2 – 23,7 times. An increase in the expression of p16 and BAX proteins by 0,6-0,8 times in the buccal epithelium has additional diagnostic information in the diagnosis of DCMP in individuals of different age groups. There is a correlation between changes in the expression of these molecules in the buccal epithelium and the autopsy material of the myocardium. Conclusion: Molecular profiles in people of different age groups, determined by the level of expression of the studied signaling molecules, significantly differ depending on the presence of DCMP. It is characteristic that the direction of changes in the buccal epithelium is similar to the corresponding molecular profile in the autopsy material of the myocardium.

A new biomarker panel for differential diagnosis of cholangiocarcinoma: Results from an exploratory analysis.

Diagnosis of cholangiocarcinoma (CCA) can be challenging due to unclear imaging criteria and difficulty obtaining adequate tissue biopsy. Although serum cancer antigen 19-9 and carcinoembryonic antigen have been proposed as potential diagnostic aids, their use remains limited by insufficient sensitivity and specificity. This exploratory analysis aimed to identify individual- and combinations of serum biomarkers to distinguish CCA from hepatocellular carcinoma (HCC) and chronic liver disease (CLD) controls using samples from a published study. This prospective, multicenter, case-control study included patients aged ≥18 years at high-risk of HCC. Serum and ethylene diamine tetraacetic acid-plasma samples were collected prior to any treatment and confirmed diagnosis of HCC or CCA. Fourteen biomarkers (measured by electrochemiluminescence immunoassays or enzyme-linked immunosorbent assays) were subjected to univariate analysis and 13 included in a multivariate analysis (per selected combinations and exhaustive search). Overall, 55 CCA, 306 HCC, and 733 CLD control samples were analyzed. For distinguishing CCA from HCC, alpha-fetoprotein and matrix metalloproteinase-2 (MMP-2) showed the best individual performance (area under the curve (AUC) 86.6% and 84.4%, respectively); tissue inhibitor of metalloproteinase-1 (TIMP-1) was most able to distinguish CCA from CLD (AUC 94.5%) and from HCC + CLD (AUC 88.6%). The combination of MMP-2 and TIMP-1 was the best-performing two-marker panel, with AUC >90% for all comparisons. MMP-2 and TIMP-1 are promising biomarkers that could support differential diagnosis of CCA. Incorporating these assays into the diagnostic algorithm could provide additional diagnostic information in a non-invasive, rapid manner, and could supplement existing diagnostic methods.