Pathology In Clinical Practice Research Articles

Relationship between SLAP Lesions and Shoulder Joint Capsule Thickness: An MR Arthrographic Study.

Background and Objectives: This study aimed to evaluate the relationship between SLAP lesions and the shoulder joint capsule thickness via MR arthrography. Understanding the relationship between SLAP lesions and the joint capsule thickness is important because an increased capsule thickness may indicate chronic inflammation and contribute to persistent pain and dysfunction. These findings have significant clinical implications for the diagnosis, management, and treatment strategies of shoulder joint pathologies. Materials and Methods: We retrospectively analyzed the MR arthrography results of 78 patients who underwent shoulder imaging at Düzce University Medical Faculty between October 2021 and November 2024. The study included patients diagnosed with SLAP lesions and compared them with a control group without such pathology. Data on joint capsule thickness at the level of the axillary recess, SLAP lesion type, cuff pathology, and demographic information were collected and analyzed. Results: The study included 32 patients with SLAP lesions and 46 control subjects. The mean age of the patients was 44.75 ± 14.18 years, whereas the control group had a mean age of 38.76 ± 13 years. The patient group presented a significantly greater mean anterior capsule thickness (3.13 ± 1.28 mm vs. 1.72 ± 0.7 mm, p = 0.0001), posterior capsule thickness (3.35 ± 1.32 mm vs. 1.95 ± 1.06 mm, p = 0.0001), and maximum capsule thickness (3.6 ± 1.32 mm vs. 2.06 ± 1.01 mm, p = 0.0001) in the axillary recess. SLAP type 2 lesions were the most common type (43.76%) in the patient group. Conclusions: This study revealed a significant association between SLAP lesions and an increased shoulder joint capsule thickness. These findings suggest that MR arthrography is an effective tool for assessing the joint capsule changes associated with labral tears, contributing to the better diagnosis and management of shoulder joint pathologies in clinical practice.

Electrogastrography measurement systems and analysis methods used in clinical practice and research: comprehensive review.

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Accelerated musculoskeletal magnetic resonance imaging with deep learning-based image reconstruction at 0.55 T-3 T

Magnetic resonance imaging (MRI) is acentral component of musculoskeletal imaging. However, long image acquisition times can pose practical barriers in clinical practice. MRI is the established modality of choice in the diagnostic workup of injuries and diseases of the musculoskeletal system due to its high spatial resolution, excellent signal-to-noise ratio (SNR), and unparalleled soft tissue contrast. Continuous advances in hardware and software technology over the last few decades have enabled four-fold acceleration of 2D turbo-spin-echo (TSE) without compromising image quality or diagnostic performance. The recent clinical introduction of deep learning (DL)-based image reconstruction algorithms helps to minimize further the interdependency between SNR, spatial resolution and image acquisition time and allows the use of higher acceleration factors. The combined use of advanced acceleration techniques and DL-based image reconstruction holds enormous potential to maximize efficiency, patient comfort, access, and value of musculoskeletal MRI while maintaining excellent diagnostic accuracy. Accelerated MRI with DL-based image reconstruction has rapidly found its way into clinical practice and proven to be of added value. Furthermore, recent investigations suggest that the potential of this technology does not yet appear to be fully harvested. Deep learning-reconstructed fast musculoskeletal MRI examinations can be reliably used for diagnostic work-up and follow-up of musculoskeletal pathologies in clinical practice.

Evaluation and Comparison of Tolerance of Ambiguity in Veterinary Pathology Professionals and Trainees

Ambiguity is ubiquitous in veterinary medicine, including in clinical and anatomic pathology. Tolerance of ambiguity (TOA) relates to how individuals navigate uncertainty. It is associated with psychological well-being in health professionals yet has been little investigated in veterinarians or veterinary pathologists. In this study, we used the Tolerance of Ambiguity of Veterinary Students (TAVS) scale and eight previously evaluated items specific to clinical pathology to evaluate and compare TOA in pathology professionals and trainees. We hypothesized that scores would be higher (reflecting greater TOA) for professionals than for trainees, that scores would increase with years of diagnostic experience for professionals and year of study for trainees, and that scores would be higher for clinical than anatomic pathologists due to the frequent ambiguity of clinical pathology practice. One hundred eighty one pathology professionals and trainees participated. TAVS scores were significantly higher for professionals than for trainees, and scores increased significantly with year of experience for professionals but not with year of study for trainees. When comparing disciplines, TAVS scores for all clinical pathologists were significantly lower than scores for all anatomic pathologists. Scores for clinical pathology specific items showed similar trends to TAVS scores, except when comparing disciplines (clinical pathologists tended to have higher scores for these items). Results suggest pathology professionals become more tolerant of ambiguity throughout their careers, independent of increasing TOA with age, and that navigating ambiguity might be more difficult for trainees than for professionals. Educational interventions might help trainees learn to successfully navigate ambiguity, which could impact psychological well-being.

Contrastive learning-based histopathological features infer molecular subtypes and clinical outcomes of breast cancer from unannotated whole slide images

The artificial intelligence-powered computational pathology has led to significant improvements in the speed and precision of tumor diagnosis, while also exhibiting substantial potential to infer genetic mutations and gene expression levels. However, current studies remain limited in predicting molecular subtypes and clinical outcomes in breast cancer. In this paper, we proposed a weakly supervised contrastive learning framework to address this challenge. Our framework first performed contrastive learning pretraining on a large number of unlabeled patches tiled from whole slide images (WSIs) to extract patch-level features. The gated attention mechanism was leveraged to aggregate patch-level features to produce slide feature that was then applied to various downstream tasks. To confirm the effectiveness of the proposed method, three public cohorts and one external independent cohort of breast cancer have been used to conducted evaluation experiments. The predictive powers of our model to infer gene expression, molecular subtypes, recurrence events and drug responses were validated across cohorts. In addition, the learned patch-level attention scores enabled us to generate heatmaps that were highly consistent with pathologist annotations and spatial transcriptomic data. These findings demonstrated that our model effectively established the high-order genotype-phenotype associations, thereby potentially extend the application of digital pathology in clinical practice.

Examining the Dimensions of the Bicipital Groove: A Human Cadaveric Study.

Introduction Understanding the mechanisms and risk factors associated with bicipital groove (BG) morphology is essential for optimizing patient outcomes. Despite interest in the topic of BG morphology, there remains a lack of clarity and consensus on the parameters of BG morphology due tosignificant methodological limitations in the existing research. The purpose of this study is to explore the dimensions of BG morphologywith a methodology rooted in recent research findings to better understand the human anatomy, potentially underpinning various shoulder pathologies. Methods The right shoulders of seventeen cadavers (nine male and eight female; median age of death: 88.0 years; age of death range: 66.0 - 97.0 years) were included in this cadaveric study. Dissection was done by removing the deltoid musculature and reflecting the long head of the biceps tendon to expose the BG. Measurements for BG morphology included BG width (millimeters, mm), depth (mm), and length (mm). Statistical comparisons were done between male and female measurements using the independent-samples Mann-Whitney U test due to the small sample size. Results The median width of the BG at the narrowest point was 4.3mm(mean: 4.7 ± 1.4 mm; range: 3.0 - 7.7 mm) with male cadavers having a significantly wider BG as compared to female cadavers (median: 5.0 mm versus 3.7 mm; p=0.006). The median depth of the BG was 5.1 mm (mean: 5.0 ± 0.7 mm; range: 3.8 - 6.3 mm) with no statistically significant differencebetween male and female cadavers (median: 4.8 mm versus 5.3 mm; p=0.370). The median length of the BG was 25.1 mm (mean: 25.1 ± 3.3 mm; range: 18.1 - 31.3 mm) with no statistically significant differencebetween male and female cadavers (median: 25.4 mm versus 23.9 mm; p=0.673). Conclusion The width of the BG at the narrowest point was significantly larger in male cadavers as compared to female cadavers in this study. However, there was no difference between male and female cadavers in terms of depth and length of the BG.This study contributes to the understanding of BG morphology by exploring the dimensions forwidth, depth, and length of the BG, which may contribute to biceps tendon pathology in clinical practice. Future research should focus on reducing measurement variability and exploring the possible relationship between BG morphology and biceps tendon conditions to further enhance the understanding of this complex relationship.

Recommendations for Performance Evaluation of Machine Learning in Pathology: A Concept Paper From the College of American Pathologists.

Machine learning applications in the pathology clinical domain are emerging rapidly. As decision support systems continue to mature, laboratories will increasingly need guidance to evaluate their performance in clinical practice. Currently there are no formal guidelines to assist pathology laboratories in verification and/or validation of such systems. These recommendations are being proposed for the evaluation of machine learning systems in the clinical practice of pathology. To propose recommendations for performance evaluation of in vitro diagnostic tests on patient samples that incorporate machine learning as part of the preanalytical, analytical, or postanalytical phases of the laboratory workflow. Topics described include considerations for machine learning model evaluation including risk assessment, predeployment requirements, data sourcing and curation, verification and validation, change control management, human-computer interaction, practitioner training, and competency evaluation. An expert panel performed a review of the literature, Clinical and Laboratory Standards Institute guidance, and laboratory and government regulatory frameworks. Review of the literature and existing documents enabled the development of proposed recommendations. This white paper pertains to performance evaluation of machine learning systems intended to be implemented for clinical patient testing. Further studies with real-world clinical data are encouraged to support these proposed recommendations. Performance evaluation of machine learning models is critical to verification and/or validation of in vitro diagnostic tests using machine learning intended for clinical practice.

Discordance in amyloid positivity defined by Visual Reads VR and Centiloids CL

AbstractBackgroundAmyloid PET VR is the most common method to determine Aβ pathology in clinical practice. Amyloid positivity by VR or CL cut‐off generally shows a good concordance, however, it is possible to have discordant cases whereby the VR is positive, but CL is below the cut‐off of amyloid positivity, or vice versa. The objective of this analysis was to assess the rate and cause of discordance in defining amyloid pathology using VR and CL in Eisai’s Elenbecestat MissionAD Phase 3 program.MethodFlorbetaben, Florbetapir, and Flutemetamol amyloid PET scans from 3412 participants with MCI due to AD or mild AD dementia were visually read at screening by trained neuroradiologists and quantitated using CLs. VR classification of the amyloid status is based on the higher or equal grey matter (GM) uptake relative to uptake in the white matter (WM) in at least one area, as per manufacturer’s guidance. Quantitatively, amyloid negativity was defined as CL<30. The number of positive cortical regions (SUVR>1.17) was also calculated.ResultThe positivity concordance between VR and CL was 92%, while the negativity concordance was 94.6%. VR+/CL‐ discordance was 8% (n = 1814 VR+, n = 145 CL‐) whereas VR‐/CL+ discordance was 5.4% (n = 1598 VR‐, n = 86 CL+). VR+/CL‐ discordant cases had significantly fewer positive cortical regions than both VR+/CL+ and VR‐/CL+ cases (Figure 1). VR‐/CL+ had a significantly higher WM uptake than both VR‐/CL‐ and VR+/CL‐ cases (Figure 2).ConclusionVR+/CL‐ discordant cases show fewer amyloid positive cortical regions, computing CLs results in below cut‐off values due to a dilution effect. These cases are considered VR+ as per manufacturer’s guidelines as they show at least one area of amyloid accumulation. On the other hand, VR‐/CL+ discordant cases result from an increased WM uptake, reducing GM/WM contrast required to determine visual read positivity. VR represents a robust and validated method to determine the presence of amyloid deposition and enables enrolling patients with amyloid beta pathology, as visible on amyloid PET scans, while CLs are optimal for assessing longitudinal changes over time and are a more sensitive measure to assess disease progression.

Mathematical modelling and deep learning algorithms to automate assessment of single and digitally multiplexed immunohistochemical stains in tumoural stroma

Whilst automated analysis of immunostains in pathology research has focused predominantly on the epithelial compartment, automated analysis of stains in the stromal compartment is challenging and therefore requires time-consuming pathological input and guidance to adjust to tissue morphometry as perceived by pathologists. This study aimed to develop a robust method to automate stromal stain analyses using 2 of the commonest stromal stains (SMA and desmin) employed in clinical pathology practice as examples. An effective computational method capable of automatically assessing and quantifying tumour-associated stromal stains was developed and applied on cores of colorectal cancer tissue microarrays. The methodology combines both mathematical models and deep learning techniques with the former requiring no training data and the latter as many inputs as possible. The novel mathematical model was used to produce a digital double marker overlay allowing for fast automated digital multiplex analysis of stromal stains. The results show that deep learning methodologies in combination with mathematical modelling allow for an accurate means of quantifying stromal stains whilst also opening up new possibilities of digital multiplex analyses.

How Molecular Discoveries Have Changed Liver Tumor Pathology: A Brief Review.

Recent molecular discoveries have led to improved understanding of tumor biology and the development of new diagnostic assays. To review primarily 3 examples of liver tumors and to briefly illustrate how recent molecular discoveries have altered clinical liver pathology practice. First, we will discuss fibrolamellar carcinoma, which will be the main focus of discussion, as an example for new diagnostic tests that have been developed as a result of molecular discoveries. Additional information on the role of molecular diagnostics in hepatocellular adenoma and hepatocellular carcinoma will be provided. Second, we will use the example of epithelioid hemangioendothelioma as an example of how new diagnostic tools, based on molecular discoveries, may support improved prognostication. Finally, we will use the example of intrahepatic cholangiocarcinoma as an example of a liver tumor where new molecular discoveries have identified tractable therapeutic targets and led to new effective therapies. This portion of the manuscript will also include a description of the anatomic and molecular differences between intrahepatic, hilar, and extrahepatic cholangiocarcinoma. Fueled by molecular discoveries, new and better diagnostic tests and therapeutic targets have improved clinical care in patients affected by liver tumors.

Method for Collection of Tear Fluid for Evaluation Its Antioxidant Properties.

A technique of collection of the tear fluid with Schirmer strips for evaluation of the activity of the main antioxidant defense enzymes (superoxide dismutase, catalase, and glutathione peroxidase) in the tear fluid was proposed. The degree of extraction of the studied enzymes from the Schirmer strip is >85%. Cytometry showed that conjunctival and corneal cells can be transferred to the Schirmer strips during tear collection, which leads to sample contamination with intracellular fractions of the antioxidant enzymes. The approach proposed by us allows avoiding this contamination during tear fluid sampling. This technique makes it possible to increase the accuracy of determining the activity of antioxidant protection enzymes in the tear fluid and can be used for diagnostics of ocular surface pathologies in clinical practice.

Immunohistochemistry in the Diagnosis and Classification of Breast Tumors.

In the clinical practice of breast pathology, immunohistochemistry (IHC) of different markers is widely used for the diagnosis and classification of breast lesions. To provide an overview of currently used and recently identified IHC stains that have been implemented in the field of diagnostic breast pathology. Data were obtained from literature review and clinical experience of the authors as breast pathologists. In the current review, we summarize the common uses of IHC stains for diagnosing different types of breast lesions, especially invasive and noninvasive breast lesions, and benign and malignant spindle cell lesions. In addition, the cutting-edge knowledge of diagnostic carcinoma markers will lead us to further understand the different types of breast carcinoma and differentiate breast carcinomas from other carcinomas of similar morphology. Knowing the strengths and limitations of these markers is essential to the clinical practice of breast pathology.

Interprofessional Interviewing in Intraprofessional Athletic Training Student Pairs: A Multi-Institutional Educational Technique

Context The Commission on Accreditation of Athletic Training Education 2020 Standards for Professional Programs highlight the need to further incorporate interprofessional education components into the curricula for athletic training programs. Interprofessional education can be a challenging component to integrate into the curriculum on an ongoing and routine basis, especially when access, quantity, and quality of interprofessional education resources are limited at individual universities. Objective To promote professional socialization between athletic training students of different universities while also promoting teamwork and collaboration values and skills through the use of shared interprofessional resources. Background This educational technique was developed as a means to address the lack of access to interprofessional resources faced by 3 professional athletic training programs in order to help meet compliance with 2020 Commission on Accreditation of Athletic Training Education standards 8, 57, and 79. Description Athletic training students from 3 professional athletic training programs were paired with one athletic training student from another institution to research a nonorthopaedic, general medical condition. They were assigned a 3-part project: (1) review the existing literature for peer-reviewed articles on their assigned pathology, (2) interview a non–athletic trainer health care provider who has worked with the pathology, and (3) create an education infographic of the information to use as an educational tool for patients. The project helped to promote collaborative and team-based skills critical to interprofessional and intraprofessional success as a health care provider. Clinical Advantage(s) Students learned with, from, and about how non–athletic trainer health care professionals manage their assigned nonorthopaedic, general medical pathologies in clinical practice. Conclusion(s) This collaborative project allowed athletic training students to develop intraprofessional and interprofessional skills by working with both athletic training students and non–athletic training health care professionals. Informative feedback on how the students perceived their interactions was received at the conclusion of the assignments.

Chronic Obstructive Pulmonary Disease and Sleep Apnea Syndrome – a Multidisciplinary Problem of Clinical Medicine

Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are more common pathologies in clinical practice, which are accompanied very often by cardiovascular comorbidity. The objective: to analyze the clinical features of chronic obstructive pulmonary disease course in combination with the risk of sleep apnea syndrome. Materials and methods. 47 patients with COPD III degree of bronchial obstruction, group E participated in the study: 9 (19.1%) women and 38 (80.9%) men. The study participants were divided into two groups: I group (COPD) – 32 persons, II group (COPD + apnea syndrome) – 15 individuals. Clinical, spirographic laboratory, X-ray, ultrasound, and electrocardiographic examinations were performed to the patients, the STOP-Bang questionnaire was used to determine the risk of sleep apnea syndrome development, and the influence of bronchial obstruction on the daytime sleepiness (Epworth scale) and depression (Beck questionnaire) was studied. Results. The analysis of the results of the study presented that among the examined patients with COPD 32 (68.1%) subjects were identified with a high risk of sleep apnea syndrome. In this cohort of patients there were signs of daytime sleepiness according to the Epworth scale, and according to the Beck questionnaire they scored more than 10 points, that is, a mild level of depression of situational or neurotic origin was found. It was found that among patients with COPD in combination with the risk of night apnea (II group), coronary heart disease was diagnosed in 24 (75%) cases, arterial hypertension – in 22 (68.8%) cases, diabetes – in 15 (46.9%). At the same time, the prevalence of these nosologies in patients with COPD without the risk of night apnea was significantly (p<0.05) lower. The Charlson comorbidity index in patients with COPD and risk of apnea was within 3–4 points, 10-year survival was within 77–53%. Conclusions. The high risk of apnea syndrome according to the results of the screening questionnaire, excessive daytime sleepiness, and depressive states in patients with COPD should prompt primary care physicians to refer such patients to a comprehensive polysomnography examination to confirm OSAS. After all, COPD, OSAS and cardiovascular comorbidity are characterized by a more unfavorable clinical course and prognosis than each of these diseases separately.

Malignant hyperthermia (literature review)

The objective – to summarize the current literature data on the etiology, pathogenesis, diagnosis and treatment of malignant hyperthermia. The search and analysis of literature data on malignant hyperthermia in the medical information systems PubMed, Сochrane librarу, Cyberleninka for the last 10 years was performed with using the keywords: «malignant hyperthermia», «dantrolene», «general anesthesia», «succinylcholine», «inhalation anesthetics». The search criteria were met by 96 publications. In addition, references to selected articles were manually checked for applicable articles including recent reports of malignant hyperthermia, in addition to works of historical significance. It was shown that malignant hyperthermia develops in susceptible individuals during or after general anesthesia with the use of trigger agents – inhaled halogen-containing anesthetics and succinylcholine. Until recently, the problem of treatment in Russia remained unresolved, since specific therapy for this syndrome was not available. In connection with the official registration of Dantrolene in the Russian Federation, this problem no longer has a life-threatening potential. Doctors should recognize the symptoms of this disease as early as possible in order to quickly begin the pathogenetic treatment of malignant hyperthermia in order to prevent fatal complications. The material is intended for a wide audience of anesthesiologists, resuscitators and surgeons who may encounter this pathology in clinical practice.

Medium and long-term radiographic and clinical outcomes of Dynesys dynamic stabilization versus instrumented fusion for degenerative lumbar spine diseases

BackgroundDynesys stabilization (DS) is utilized to preserve mobility at the instrumental segments and prevent adjacent segment pathology in clinical practice. However, the advantages of DS method in medium and long-term follow-up remain controversial.ObjectiveTo compare the radiographic and clinical outcomes between DS and instrumented fusion in the treatment of degenerative lumbar spine disease with or without grade I spondylolisthesis with a minimum follow-up period of 2 years.MethodsWe conducted a comprehensive search of PubMed, EMBASE, Cochrane, and Web of Science databases, Chinese National Knowledge Databases, and Wanfang Database for potentially eligible articles. Clinical outcomes were assessed in terms of VAS and ODI scores, screw loosening and breakage, and surgical revision. Radiographic outcomes were assessed in terms of postoperative range of movement (ROM) and disc heigh. Moreover, adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) were evaluated.ResultsSeventeen studies with 1296 patients were included in the meta-analysis. The DS group was associated with significantly lower postoperative VAS scores for low-back and leg pain, and lower rate of surgical revision than the fusion group. Moreover, the Dynesys group showed significantly less ASDeg than the fusion group but showed no significant advantage over the fusion group in terms of preventing ASDis. Additionally, the ROM at the stabilized segments of the fusion group decreased significantly and that at the adjacent segments increased significantly compared with those of the DS group.ConclusionDS showed comparable clinical outcomes and provided benefits in preserving the motion at the stabilized segments, thus limiting the hypermobility at the adjacent segments and preventing ASDeg compared with the fusion method in degenerative disease with or without grade I spondylolisthesis.

A web application to support the coordination of reflexive, interpretative toxicology testing

BackgroundReflexive laboratory testing workflows can improve the assessment of patients receiving pain medications chronically, but complex workflows requiring pathologist input and interpretation may not be well-supported by traditional laboratory information systems. In this work, we describe the development of a web application that improves the efficiency of pathologists and laboratory staff in delivering actionable toxicology results. MethodBefore designing the application, we set out to understand the entire workflow including the laboratory workflow and pathologist review. Additionally, we gathered requirements and specifications from stakeholders. Finally, to assess the performance of the implementation of the application, we surveyed stakeholders and documented the approximate amount of time that is required in each step of the workflow. ResultsA web-based application was chosen for the ease of access for users. Relevant clinical data was routinely received and displayed in the application. The workflows in the laboratory and during the interpretation process served as the basis of the user interface. With the addition of auto-filing software, the return on investment was significant. The laboratory saved the equivalent of one full-time employee in time by automating file management and result entry. DiscussionImplementation of a purpose-built application to support reflex and interpretation workflows in a clinical pathology practice has led to a significant improvement in laboratory efficiency. Custom- and purpose-built applications can help reduce staff burnout, reduce transcription errors, and allow staff to focus on more critical issues around quality.

Current Biological, Pathological and Clinical Landscape of HER2-Low Breast Cancer.

HER2-low breast cancer (BC) is a newly defined subset of HER2-negative BC that has HER2 immunohistochemical (IHC) score of 1+ or score of 2+/in situ hybridization (ISH) negative phenotype. Recent clinical trials have demonstrated significant clinical benefits of novel HER2 directing antibody-drug conjugates (ADCs) in treating this group of tumors. Trastuzumab-deruxtecan (T-Dxd), a HER2-directing ADC was recently approved by the U.S. Food and Drug Administration as the first targeted therapy to treat HER2-low BC. However, HER2-low BC is still not well characterized clinically and pathologically. This review aims to update the current biological, pathological and clinical landscape of HER2-low BC based on the English literature published in the past two years and to propose the future directions on clinical management, pathology practice, and translational research in this subset of BC. We hope it would help better understand the tumor biology of HER2-low BC and the current efforts for identifying and treating this newly recognized targetable group of BC.

Challenges and strategies of imaging-guided fine needle aspiration cytology/biopsy in clinical pathology practice

近年来，随着成像技术和细针穿刺技术的进步，超声、CT及MRI等成像技术引导细针穿刺细胞学/活检的临床应用得到了广泛推广和普及，各类细针穿刺细胞/活检标本明显增多。同一病例细针穿刺标本往往既包括细胞学材料，也包括小的组织学材料，分别涉及细胞病理学和组织病理学专科领域。在临床病理实现专科化发展的大趋势下，如何综合利用、恰当分配有限的细针穿刺材料，整合细胞和组织病理医师的观点，在作出明确诊断的同时，又能够尽可能满足临床对治疗相关免疫及分子检测的需要，已经成为病理临床实践中必须面对的一个挑战。本文拟结合学科发展前沿方向和国内病理界的实际情况，对成像技术引导细针穿刺细胞学/活检应用概况、对临床病理实践的挑战及完善操作程序、提高诊断获益的应对策略等相关问题进行讨论，以期引起国内同仁的关注。.

Visualizing diastolic failure: Non-invasive imaging-biomarkers in patients with heart failure with preserved ejection fraction.

Heart failure with preserved ejection fraction is an increasing challenge for modern day medicine and has been drawing more attention recently. Invasive right heart catheterization represents the mainstay for the diagnosis of diastolic dysfunction, however due to its attributable risk of an invasive procedure, other non-invasive clinical pathways are trying to approach this pathology in clinical practice. Diastolic failure is complex, and imaging is based on various parameters. In addition to transthoracic echocardiography, numerous novel imaging approaches, such as cardiac magnetic resonance imaging, computed tomography, positron emission (computed) tomography or single photon emission computed tomography techniques are being used to supplement deeper insights into causal pathology and might open targets for dedicated therapy options. This article provides insights into these sophisticated imaging techniques, their incremental value for the diagnosis of this poorly understood disease and recent promising results for an enhanced prognostication of outcome and therapy monitoring.