Additional Diagnostic Information Research Articles

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.

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.

#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.

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.

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.

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.

MP2RAGE vs. MPRAGE surface-based morphometry in focal epilepsy.

In drug-resistant focal epilepsy, detecting epileptogenic lesions using MRI poses a critical diagnostic challenge. Here, we assessed the utility of MP2RAGE-a T1-weighted sequence with self-bias correcting properties commonly utilized in ultra-high field MRI-for the detection of epileptogenic lesions using a surface-based morphometry pipeline based on FreeSurfer, and compared it to the common approach using T1w MPRAGE, both at 3T. We included data from 32 patients with focal epilepsy (5 MRI-positive, 27 MRI-negative with lobar seizure onset hypotheses) and 94 healthy controls from two epilepsy centres. Surface-based morphological measures and intensities were extracted and evaluated in univariate GLM analyses as well as multivariate unsupervised 'novelty detection' machine learning procedures. The resulting prediction maps were analyzed over a range of possible thresholds using alternative free-response receiver operating characteristic (AFROC) methodology with respect to the concordance with predefined lesion labels or hypotheses on epileptogenic zone location. We found that MP2RAGE performs at least comparable to MPRAGE and that especially analysis of MP2RAGE image intensities may provide additional diagnostic information. Secondly, we demonstrate that unsupervised novelty-detection machine learning approaches may be useful for the detection of epileptogenic lesions (maximum AFROC AUC 0.58) when there is only a limited lesional training set available. Third, we propose a statistical method of assessing lesion localization performance in MRI-negative patients with lobar hypotheses of the epileptogenic zone based on simulation of a random guessing process as null hypothesis. Based on our findings, it appears worthwhile to study similar surface-based morphometry approaches in ultra-high field MRI (≥ 7 T).

Diagnostic value of renal biopsy in anti-phospholipase A2 receptor antibody-positive patients with proteinuria in China

Renal biopsy remains the gold standard for diagnosing membranous nephropathy (MN). Recent studies have suggested that renal biopsy can be replaced with the serum phospholipase A2 receptor (PLA2R) antibody test for MN diagnosis in patients with nephrotic syndrome. However, this test has not been validated in the Chinese population. In this study, we investigated whether renal biopsy provides additional diagnostic information on patients with proteinuria who are seropositive for PLA2R antibodies (SAb +). We retrospectively reviewed the clinicopathological characteristics of SAb + adult patients (aged ≥ 18 years) with proteinuria (≥ 0.5 g/24 h) assessed at the Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, from June 2021 to March 2022. Among a total of 801 SAb + patients who received renal biopsy, those with incomplete pathological data, diabetes or any potential cause of secondary MN were excluded. Among the 491 remaining patients, 474 had primary MN (PMN), 16 had atypical MN (AMN, 9 patients with “full house” and 2 patients with HBsAg + /HBcAg + immunofluorescence results), and 1 had focal segmental glomerulosclerosis. In patients with an eGFR of ≥ 60 mL/min/1.73 m2 (n = 451), 436 had PMN, and 71 (16.3%) exhibited additional biopsy findings, with obesity-related glomerulopathy being the most common. In patients with an impaired eGFR (n = 40), 38 had PMN, and 31 (81.6%) showed additional findings, with acute tubular injury being the most common. In conclusion, anti-PLA2R antibody positivity is highly predictive of PMN in Chinese adults but often coexists with other pathological diagnoses. The advantages of renal biopsy for detecting other pathologies should be weighed against the potential risks of the biopsy procedure.

The Application of I-Scan Imaging for Evaluating Benign Vocal Lesions

Current standard methods for evaluating benign vocal lesions, including white light laryngoscopy and video laryngostroboscopy, may struggle to identify smaller lesions. While histopathological results obtained from laryngeal microsurgery provide definitive results, their invasiveness can lead to scarring and impaired phonological outcomes. Intralesional steroid injection has recently gained acceptance, but it lacks pathological diagnostic capabilities. Therefore, there is a growing need for a simple examination that can enhance the diagnosis of benign vocal lesions. NBI, from Olympus Corporation, has shown promising outcomes in detecting and characterizing laryngeal lesions. The i-scan technology by PENTAX, while providing the ability to improve visual clarity during endoscopic procedures, has been addressed less in this field. Our study aims to further investigate the application of i-scan imaging in benign vocal lesions, enrolling patients diagnosed with vocal cysts, polyps, and nodules. We conducted i-scan imaging prior to office-based intralesional steroid injection, assessing the possibility of its providing additional diagnostic information for benign vocal lesions without additional burden.

Retinal vascular dynamics: A window for observing an irregular heartbeat. A case report.

We aimed to characterize several aspects of retinal vascular dynamics in a patient with arrythmia in order to elicit additional diagnostic information on microvascular dysfunction. A 68-year-old male patient with arrythmia and an age- and gender-matched control subject underwent ocular examination including dynamic retinal vessel assessment with flicker light provocation. Retinal vessel diameters were measured continuously following a standard protocol (IMEDOS Systems, Jena, Germany). The data were evaluated using methods of signal analysis. Retinal vessel response following flicker provocation as well as local structural and functional behavior of retinal vessels were comparable between both individuals. The arrhythmia case demonstrated irregular arterial and venous heart rate (HR) pulsation with an average frequency of 1Hz. Moreover, the case showed a higher magnitude and larger periods of low-frequency retinal vessel oscillations as well as lower periodicity of both HR pulsations and low-frequency vasomotions. Besides numerical examination of irregular HR pulsations in case of arrhythmia, from the direct noninvasive assessment of retinal vessel dynamics one can derive more detailed information on microvascular function including the whole spectrum of retinal arterial and venous pulsations and vasomotions. This may have implications for health screening not limited to atrial fibrillation.

Dental anthropology and forensics: Answers to questions related to our past: Review of the literature

Dental science is directly correlated to anthropology, which is attributed to teeth's significant advantages and properties. Meanwhile, justice is better and easier served due to the contribution of forensic odontology. The aim of the present literature review is to present the decisive contribution of dental science to the investigation of human species' evolution, as well as to the demystification of criminal cases. A thorough research has been conducted in scientific databases and scientific textbooks related to our review. It is obvious that the assessment of gradual modifications in human dentition as time passes by is indicative of human species' evolution. Nowadays, it is feasible to determine an excavated skeleton's identity and, as far as the ancient civilizations are concerned, to investigate their intercultural relationships, their dietary customs and their oral health's status. With regard to forensics, the structure of cranial bones is of great assistance in demystificating legal cases. Forensic odontology provides forensic medical examiners with the opportunity to faster identify deceased people and more effectively examine abused victims. Certainly, radiographic techniques, such as periapical radiographs as well as modern radiographic methodologies (CT, CBCT, MRI), offer additional diagnostic information in forensics. So, methodologies introduced by dental science have become a remarkable assist in anthropological researches, as well as in forensics. Nevertheless, there can be noticed a limited application of forensic odontology's principles in Greece. This fact may be attributed to the technological capabilities of our country's forensic laboratories rather than the Greek experts' level of expertise.

Contractility, ventriculoarterial coupling, and stroke work after acute myocardial infarction using CMR-derived pressure-volume loop data.

Noninvasive left ventricular (LV) pressure-volume (PV) loops derived by cardiac magnetic resonance (CMR) have recently been shown to enable characterization of cardiac hemodynamics. Thus, such PV loops could potentially provide additional diagnostic information such as contractility, arterial elastance (Ea ) and stroke work (SW) currently not available in clinical routine. This study sought to investigate to what extent PV-loop variables derived with a novel noninvasive method can provide incremental physiological information over cardiac dimensions and blood pressure in patients with acute myocardial infarction (MI). A total of 100 patients with acute MI and 75 controls were included in the study. All patients underwent CMR 2-6 days after MI including assessment of myocardium at risk (MaR) and infarct size (IS). Noninvasive PV loops were generated from CMR derived LV volumes and brachial blood pressure measurements. The following variables were quantified: Maximal elastance (Emax ) reflecting contractility, Ea , ventriculoarterial coupling (Ea /Emax ), SW, potential energy, external power, energy per ejected volume, and efficiency. All PV-loop variables were significantly different in MI patients compared to healthy volunteers, including contractility (Emax : 1.34 ± 0.48 versus 1.50 ± 0.41 mmHg/mL, p = .024), ventriculoarterial coupling (Ea /Emax : 1.27 ± 0.61 versus 0.73 ± 0.17, p < .001) and SW (0.96 ± 0.32 versus 1.38 ± 0.32 J, p < .001). These variables correlated to both MaR and IS (Emax : r2 = 0.25 and r2 = 0.29; Ea /Emax : r2 = 0.36 and r2 = 0.41; SW: r2 = 0.21 and r2 = 0.25). Noninvasive PV-loops provide physiological information beyond conventional diagnostic variables, such as ejection fraction, early after MI, including measures of contractility, ventriculoarterial coupling, and SW.

Radiomics of fetal magnetic resonance imaging in congenital diaphragmatic hernia

Objectives. Analysis of possibilities of radiomics as a source of additional diagnostic information about the structural maturity of the lungsMaterials and methods. A retrospective study included 72 pregnant women: 35 with congenital fetal diaphragmatic hernia (group 1) and 37 without fetal lung pathology (group 2). Frontal or co-frontal T2 images (T2 FSE) were obtained. Segmentation of regions of interest at the fetal lung level was performed manually with ITK-Snap. A total of 107 radiomic features were extracted using pyradiomics. The statistical analysis was performed using the STATISTICA 10 statistical analysis package (USA) to detect correlation between trait values and the target variable (presence of lung pathology in CDH), and to show differences in the comparison groups according to the detected parameters.Results. Statistically significant features were identified for 2D and 3D segmentations (p &lt; 0.05). For 2D and 3D segmentations, the number of significant features was 14 and 73, respectively. After exclusion of features with cross-correlations, their number decreased to 6 and 8 for single slices and 3D images, respectively. Correlation coefficients between the features and the presence of lung pathology were also calculated. In the case of 3D images, the number of features with significant correlation coefficients (r &gt; 0.4, p &lt; 0.05) equaled 20, while for single-slice images this number was 3.Conclusion. The data obtained allow to conclude that it is reasonable to use texture analysis of the 3D MRI images as a source of additional diagnostic information concerning the structural maturity of the lungs.

Diagnostic and prognostic value of an ejection fraction corrected for myocardial remodelling

Abstract Introduction Despite clinical guideline recommendations to use left ventricular ejection fraction (EF) as a marker of left ventricular function in heart failure (HF), it is prone to measurement error, is load dependent and is skewed during geometric cardiac remodelling. EF also cannot distinguish between patients with HF with preserved EF (HFpEF) and those with a normal heart. By evaluating EF at the ventricular mid-wall layer (the corrected EF (EFc)) instead of the endocardial surface, the geometric dependency shortcomings of EF can be overcome. Purpose We evaluated whether EFc can provide additional diagnostic and prognostic information compared with traditional EF. Methods We conducted a retrospective cohort study using a dataset of all consecutive patients who were admitted to hospital following the request of a troponin across three centres between 2010 and 2017. Patients who underwent an echocardiogram either within 3 months before or 5 months after their hospital admission were included. Patients were classified according to whether their index hospital admission was due to HF, and further classified according to EF ((i) EF&amp;lt;40, HF with reduced EF (HFrEF); (ii) 40≤EF&amp;lt;50, HF with mid-range EF (HFmrEF); (iii) EF≥50, HFpEF). All-cause mortality was assessed as a competing risk to HF admission. Cox-proportional regression models were constructed to compare the EFc to EF in evaluating risk of HF admission. Results The study population consisted of 2752 individuals (56.5% male, age 69.3±16.4 years). Comparing patients with HFpEF to those with an index admission without HF, there was no difference in EF between the groups (62.3% versus 64.2%, p = 0.79), however a significant difference was observed when comparing EFc (56.6% versus 61.8%, p = 0.0007) (Figure 1). Both low EF (&amp;lt;50%) and low EFc (&amp;lt;50%) were associated with a high HF readmission risk, which were comparable. However, in the cohort with a normal EF (EF≥50%), predictive models using EFc were significantly more accurate in predicting HF readmissions within 3 years, where the leave one out cross validation ROC analysis showed a 18.6% reduction in errors when EFc replaces EF in the risk prediction models. Table 1 shows the specific IDI and NRI scores to quantify the improvements to predictions when EF or EFc are added to the baseline model (age, gender and creatinine), for assessing readmissions within 3 years in the EF≥50% cohort. The higher IDI and NRI scores for EFc compared to EF shows that adding EFc to "baseline" improves predictions more than adding EF to "baseline". The results also show that using EFc instead of EF will lead to 12.2% more patients in the event group (HF readmission) being correctly identified as higher risk, and 16.6% more patients in the non-event group (no HF readmission) being correctly identified as lower risk. Conclusions In comparison to EF, the EFc improves the prediction of hospital admissions due to HF for patients where the EF≥50%.Figure 1Table 1

Different diagnostic value of risk factors for ACS in relation to initial troponin level and early dynamic change

Abstract Introduction/background Early rule in/rule out algorithms using high sensitivity cardiac troponin T (hs-cTnT) have improved the evaluation for acute coronary syndrome (ACS) and facilitated the care of chest pain patients in the emergency department (ED). It is still unknown whether risk factors and comorbidities provide additional diagnostic information for ACS to one-hour hs-cTnT dynamics in the ED. Purpose To evaluate whether cardiovascular risk factors and comorbidities are associated with ACS in chest pain patients with elevated and normal initial hs-cTnT, and with and without early dynamic change. Methods 48,283 unique patients with chest pain and a measured hs-cTnT were identified at 4 university hospitals during 2013-2016 where a one-hour algorithm was implemented during the study period. Among these, 7903 patients had two hs-cTnT measurements obtained within 105 minutes. Clinical information was cross-linked to national registers to obtain previous diagnoses, outcomes and prescriptions. Early dynamics of hs-cTnT was defined as a change by 3ng/l or more if the first hs-cTnT was at or below 14 ng/l, or otherwise a change by more than 20% if the first hs-cTnT was above 14ng/l. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for associations between risk factors and ACS in subgroups by different hs-cTnT levels and with or without dynamic change. Results 516 out of 39777 (1.3%) patients with normal and 1999 out of 8506 (23.5%) with elevated hs-cTnT levels were diagnosed with ACS. In patients with normal initial hs-cTnT 55 out of 5936 (0.9%) without and 44 out of 186 patients (23.7%) with dynamic change were diagnosed with ACS. In patients with elevated hs-cTnT 196 out of 1464 (13.4%) without and 202 out of 317 patients (63.7%) with dynamic change had ACS. In patients with normal hs-cTnT, hypertension (OR 3.24, 95% CI, 2.72-3.87), hyperlipidaemia (OR 3.21, 95% CI 2.67-3.85), diabetes (OR 3.46, 95% CI, 2.81-4.27) and atherosclerotic cardiovascular disease (ASCVD) (OR 2.92, 95% CI 3.24-4.70) were associated with increased risk for ACS (figure 1), whereas the opposite or no association for ACS was shown for these conditions when the initial hs-TnT was elevated. Among patients with normal initial hs-cTnT, hypertension (OR 2.52, 95% CI, 1.47-4.30) and hyperlipidaemia (OR 2.63. 95% CI, 1.51-4.57) were only associated with ACS in patients without early dynamic change (p-value for interaction &amp;lt;0.001 and p=0.02 respectively) whereas diabetes and ASCVD were associated with ACS irrespective of early dynamics (figure 2). Conclusion Cardiovascular risk factors and comorbidities have different diagnostic value for ACS depending on whether the initial hs-cTnT level is elevated and whether an early dynamic change in hs-cTnT is present. Further investigations of combined comorbidities, hs-cTnT levels and its correlation with ACS could refine risk stratifying algorithms among these patients.Figure 1troponin - ACSFigure 2troponin, dynamics - ACS

ZNAČAJ KLASIČNE RADIOGRAFIJE PLUĆA U OTKRIVANJU TUBERKULOZE PLUĆA

ABSTRACT&#x0D; &#x0D; Diagnostic radiology provides a non-invasive insight into the anatomy and physiology of the human body and is one of the most useful tools in modern medicine. Accelerated technological development has led to improved image quality and the ability to obtain additional diagnostic information necessary for accurate and rapid diagnostics. As in other fields of medicine, in diagnostic radiology, all elements of risk must be balanced against the benefits arising from the use of a given diagnostic method.&#x0D; Aim: study is to determine the age and gender structure of the subjects who came for radiographs, to prove whether the X-ray has a significant role in detecting lung tuberculosis, whether the radiological record matches the findings of a pneumophysiologist or whether a microbiological analysis is needed, and to determine whether tuberculosis detected by classical radiography is also proven.&#x0D; Prospective method included 50 adult respondents from the Public Health Center of the Canton of Sarajevo, of different age and gender structures, who performed radiographic pulmonary imaging and processing of pneumophysiological findings in the period from 01.01.2018. do 30.05.2019. years. X-rays were taken from the classic Siemens Multix X-ray machine. Patients' medical records, microbiological examination of sputum on BC, pneumophysiological findings, radiographs and radiological findings from the radiological information system and the PACS system were used for the data. We used a retrospective study that included descriptive statistics, standard deviation, arithmetic mean, and correlation coefficient.&#x0D; Results: show that there is no significant statistical difference by gender, the average age of the respondents was 50, 52 years. &#x0D; X-ray imaging as a diagnostic procedure is of great importance in the detection of pulmonary tuberculosis, and 72% of the subjects had pulmonary tuberculosis first compared with the findings of pneumophysiologists, and bacteriological analysis was used in 28% subjects due to suspected pneumophysiologists in the diagnosis. By comparing the correlation of the pneumophysiologist and the bacteriological analysis, the X-ray showed 100% lung tuberculosis.