BackgroundHysterosalpingography (HSG) plays an important role in assessing the patency and functional integrity of the fallopian tubes and is crucial for female fertility evaluation. This study explored the feasibility of shortening delayed radiography time by comparing the consistency of 2- and 24-hour post-HSG radiographs for tubal patency diagnosis.Material/MethodsThis prospective comparative study enrolled 2 cohorts: the experimental group underwent delayed radiographs at 2 hours after HSG, and the control group at 24 hours after HSG. To confirm radiographic findings and inform therapeutic interventions aimed at improving fertility, all patients subsequently underwent hysteroscopy with chromopertubation (HSC) within the following month, establishing the reference standard for tubal assessment. Using HSC findings as the benchmark, we assessed the diagnostic value of the 2-hour and 24-hour delayed images. All patients were followed for clinical pregnancy outcomes via telephone or email for 12 months.ResultsA total of 194 patients underwent delayed radiographs 24 hours after HSG, and 203 at 2 hours after HSG. The McNemar-Bowker test indicated that both the 2-hour and 24-hour delayed radiograph results differed significantly from the HSC reference (P<0.001), although with moderate agreement (kappa, approximately 0.6). The accuracy, precision, sensitivity, and specificity of the 2 groups were similar. There was no significant difference in pregnancy rate within 1 year between the groups (P=0.596).ConclusionsA 2-hour delayed radiograph is a viable alternative to a conventional 24-hour delayed radiograph. However, these preliminary findings require validation through randomized trials, in which each patient serves as their own control.

Around 18% to 33% of couples with infertility present with tubal occlusion (blocked or damaged fallopian tubes) or hydrosalpinx (fluid-filled tubes). Diagnostic laparoscopy (keyhole surgery) with chromopertubation (methylene blue dye tubal patency testing) is considered the reference standard for ruling out tubal occlusion and hydrosalpinx. However, due to its invasiveness and high costs, alternative, less invasive tests have been carried out using imaging techniques. They include sono-hysterosalpingography (sono-HSG), hysterosalpingography (HSG), outpatient transvaginal hydrolaparoscopy (THL), and magnetic resonance hysterosalpingography (MR-HSG). The choice of test varies in different settings; the choice of contrast, operator skill and test technology are factors that can influence diagnostic quality. Furthermore, the performance of the visual tubal patency tests can vary in different populations, depending on whether the test is carried out in an unselected group or in one classified as high or low risk for having tubal pathology. To determine and compare the diagnostic accuracy of visual tubal patency tests (sono-HSG, HSG, THL, and MR-HSG) for the diagnosis of tubal occlusion. Secondary objectives are to determine and compare the diagnostic accuracy of visual tubal patency tests (sono-HSG, HSG, THL, and MR-HSG) for the diagnosis of hydrosalpinx and to evaluate heterogeneity concerning population characteristics (population risk stratification) and index test characteristics (contrast media, technology, operator skills). We searched CENTRAL, MEDLINE, Embase and CINAHL, and two trials registers. We also contacted experts in the field for any additional studies (last date of search: 6 November 2023). We included studies on the diagnostic accuracy of a single index test and studies on the comparative diagnostic accuracy of two or more index tests. Index tests included were: sono-HSG, HSG, THL, and MR-HSG. Laparoscopy with methylene blue dye tubal patency testing was the reference standard. We included participants who had been trying to conceive for at least one year. All participants in the included studies should have undergone this reference standard. Target conditions were bilateral tubal occlusion, at least one-sided tubal occlusion, tubal occlusion by tube, and hydrosalpinx. Two review authors independently extracted data. We performed random-effects meta-analysis in a bivariate model. For each index test, we presented pairs of sensitivity and specificity with their 95% confidence intervals (CIs) for each study, as well as the pooled sensitivity and specificity in a forest plot. We used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool for risk of bias assessments. We identified 11,787 records and included 21 studies (1939 participants). Two studies directly compared both sono-HSG and HSG to the reference test, while the other 19 reported on the diagnostic accuracy of one of the index tests (10 on sono-HSG, 10 on HSG, and 3 on THL). We did not include any studies of MR-HSG. Sono-HSG: for bilateral tubal occlusion, the pooled sensitivity was 0.98 (95% CI 0.19 to 1.00; 3 studies, 259 women; moderate-certainty evidence) and specificity was 0.99 (95% CI 0.93 to 1.00; 4 studies, 259 women; high-certainty evidence). Subgroup analyses showed that colour Doppler was associated with higher specificity than standard ultrasound, but with similar sensitivity. We did not find differences in diagnostic accuracy in the use of 3-dimensional/2-dimensional or 2-dimensional ultrasound, or the use of foam or saline as contrast media. We were unable to perform meta-analysis on the diagnosis of hydrosalpinx. HSG: for bilateral tubal occlusion, the pooled sensitivity was 0.77 (95% CI 0.58 to 0.89; 7 studies, 670 women; very low-certainty evidence) and the pooled specificity was 0.94 (95% CI 0.87to 0.97; 7 studies, 670 women; moderate-certainty evidence). For hydrosalpinx by tube, the pooled sensitivity was 1.00 and specificity was 0.96 (95% CI 0.96 to 0.98; 2 studies, 360 tubes). THL: for bilateral tubal occlusion, the pooled sensitivity and specificity were 0.95 (95% CI 0.30 to 1.00; 3 studies, 172 women; low-certainty evidence) and 0.99 (95% CI 0.84 to 1.00; 3 studies, 172 women; moderate-certainty evidence), respectively. We were unable to perform meta-analysis on the diagnosis of hydrosalpinx. There was insufficient information on operator skills and patient risk stratification for all index tests to carry out further analyses. The evidence showed that sono-HSG, HSG and THL are all reliable tests for the diagnosis of double-sided tubal occlusion. Evidence for comparative diagnostic accuracy studies is very limited. We did not include any studies on the diagnostic accuracy of MR-HSG. The certainty of evidence ranged from very low to high. This was mainly due to unclear or high risk of bias, heterogeneity and imprecision. Limited reporting on population risk and operator experience may reduce the generalisability of the findings to routine clinical practice. This Cochrane review had no dedicated funding. Protocol (2022) available via: https://doi.org/10.1002/14651858.CD014968.

This prospective, comparative diagnostic accuracy study was designed to assess the diagnostic value of weight-bearing computed tomography (WBCT) with three-dimensional reconstruction in detecting ligamentous injuries associated with chronic ankle instability (CAI) and to compare its efficacy with that of conventional magnetic resonance imaging (MRI). The goal was to assess the potential of WBCT as a more precise imaging modality to guide clinical decision-making. Twenty patients with clinically suspected CAI, recruited between January 2024 and March 2025, underwent both WBCT (Planmed Verity; load equivalent to 100% body weight) and MRI (GE 1.5T; standard imaging protocols). Two senior musculoskeletal radiologists independently evaluated ligament integrity using a blinded protocol. Arthroscopic or intraoperative findings were used as the reference standard. Diagnostic parameters, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for each method. Interobserver agreement was quantified using the Kappa statistic. WBCT demonstrated significantly higher sensitivity for detecting anterior talofibular ligament (ATFL) injuries compared to MRI (90% vs. 70%, P < 0.05), particularly in cases with osseous abnormalities such as talar dome lesions and syndesmotic widening (P < 0.01). WBCT also yielded superior interobserver agreement (Kappa = 0.82) relative to MRI (Kappa = 0.68). WBCT with three-dimensional reconstruction offers enhanced diagnostic accuracy and reproducibility in assessing ATFL injuries, especially in the presence of functional instability or coexisting bony pathology. These findings support the use of WBCT as a complementary modality to MRI in the comprehensive evaluation of CAI.

Investigate performances and turnaround time of Resistell Phenotech antibiotic susceptibility testing (AST), a device using the new nanomotion technology, compared with reference methods. This is a prospective, observational, and comparative diagnostic accuracy study including adult patients, who signed informed consent, hospitalized at a single 1200-bed tertiary-care centre in Switzerland, with Escherichia coli or Klebsiella pneumoniae bacteraemia from 18 June 2021 to 19 February 2024. Outcome measures were categorical agreement (very major discrepancies, major discrepancies, and minor discrepancies), as well as time from positive blood cultures to AST results, from matrix-assisted laser desoprtion ionisation time-of-flight mass spectrometry (MALDI-TOF MS) identification to AST results and AST start to end. Sensitivity, specificity, and accuracy were also assessed. VITEK 2 (Biomérieux) and Kirby-Bauer were used as reference directly on positive blood cultures per laboratory routine. The study was registered at ClinicalTrials.gov (NCT05002413). We included 253 adult patients, hospitalized with E. coli or K. pneumoniae bacteraemia. Resistell Phenotech AST showed 97.6% (95% CI, 94.6-99.0) (98.0% [95% CI, 94.2-99.3]) overall sensitivity compared with Kirby-Bauer (and VITEK 2). Concerning susceptibility, for both ceftriaxone-pathogen combinations, sensitivity reached 100% compared with Kirby-Bauer (E. coli 95% CI, 95.8-100.0; K. pneumoniae 95% CI, 89.0-100.0) (and VITEK 2 [E. coli 95% CI, 93.9-100.0; K. pneumoniae 95% CI, 85.7-100.0]); specificity was 94.1% (95% CI, 73.0-99.0) (91.7% [95% CI, 64.6-98.5]) for E. coli and 100% (72.2-100.0 Kirby-Bauer; 67.6-100.0 VITEK 2) for K. pneumoniae. Ciprofloxacin-E. coli reached 94.6% (95% CI, 87.9-97.7) (95.5% [95% CI, 87.6-98.5]) sensitivity and 83.3% (95% CI, 66.4-92.7) (79.2% [95% CI, 59.5-90.8]) specificity. The Resistell Phenotech AST analysis was >10 hours faster than reference method, averaging 15.7 hours (SD ± 6) from blood culture positivity to results, 10.9 (SD ± 7.3) from MALDI-TOF MS identification to AST, and 4.1 (SD ± 0.1) from start to end of AST. Nanomotion enables rapid AST with strong ceftriaxone results but needs improvement for ciprofloxacin. Further device developments are required, including multi-channel device and sensitive at high dose category.

Multi-model Artificial Intelligence Evaluation in Sudden Sensorineural Hearing Loss.

We evaluated three multimodal LLMs, ChatGPT (GPT-5.2), Gemini 3, and Microsoft Copilot, in pediatric ECG interpretation, focusing on clinically significant abnormalities and emergency arrhythmias with likelihood ratios as primary outcome measures. This prospective comparative diagnostic accuracy study (STARD/STARD-AI) included 264 pediatric patients with 12-lead ECGs (November 2024–November 2025). De-identified images were submitted via standardized zero-shot prompt. Three blinded pediatric cardiologists established the reference diagnosis by majority-vote consensus. Cases were classified as Tier 1 (normal), Tier 2 (abnormal, non-urgent), or Tier 3 (urgent). Two binary endpoints were assessed: clinically significant abnormality (Tier 2 + 3 vs Tier 1) and emergency abnormality (Tier 3 vs Tier 1 + 2). Clinically significant abnormalities were present in 54.5% of patients. AUC values ranged from 0.550 to 0.623, reflecting modest discrimination. For the clinically significant endpoint, + LR values were 2.05 (ChatGPT), 1.26 (Gemini), and 1.21 (Copilot); − LR values were 0.68, 0.55, and 0.81, indicating limited rule-in and insufficient rule-out utility. For the emergency endpoint, Gemini achieved 100% sensitivity (95% CI = 85.1–100.0) with − LR 0.07 (95% CI = 0.00–1.12) in a small subgroup (n = 22); however, specificity of 30.2% and + LR of 1.40 indicate overcalling rather than diagnostic precision. No model achieved clinically meaningful rule-in utility for either endpoint.Conclusions: Current multimodal LLMs showed limited diagnostic utility in pediatric ECG interpretation, with + LR values near 1.0 across both endpoints. Standalone deployment is not supported; these tools may at most serve as adjunctive screening aids under clinician oversight.What is Known:• Deep learning algorithms trained on large ECG datasets perform well in adult populations, but evidence in pediatric ECG interpretation is limited.• General-purpose LLMs show variable accuracy in medical examinations; reliability in subspecialty domains such as pediatric cardiology remains unproven.What is New:• This is the[FCA1] first head-to-head comparative diagnostic accuracy study of multimodal LLMs in pediatric ECG evaluation, using likelihood ratios as primary outcome measures.• All three LLMs showed limited rule-in utility (+LR near 1.0); Gemini achieved potentially meaningful rule-out performance for emergency arrhythmias (−LR = 0.07), but with wide confidence intervals reflecting the small emergency subgroup (n = 22).• Gemini’s 100% sensitivity in the emergency subgroup reflects overcalling (specificity 30.2%) consistent with a triage/screening behavior rather than diagnostic precision.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00431-026-06874-x.

AI at the Sella Turcica: Multi-Model Large Language Model Evaluation in Pituitary Adenomas

Objectives: To evaluate the diagnostic accuracy of ultrasonography (US) in comparison with magnetic resonance imaging (MRI) for anterior knee pathologies, while also assessing their cost-effectiveness and clinical utility. Methodology: This prospective comparative diagnostic accuracy study was conducted between January 2022 and March 2024 at a tertiary care center in Erbil, Iraq, enrolling 80 adult patients with isolated anterior knee pain (AKP) through consecutive sampling. All participants underwent both high-resolution US and MRI within two weeks. The imaging protocols focused on key anterior knee structures, enabling complementary evaluation of soft tissue, vascular, and osteochondral abnormalities, thereby strengthening the validity and clinical applicability of the comparative findings. Data were analyzed using the McNemar test and descriptive statistics to assess sensitivity, diagnostic performance, and cost-effectiveness. Results: US demonstrated higher sensitivity than MRI for patellar tendinopathy (95% vs. 87%, p=0.04) and prepatellar bursitis (100% vs. 90%, p=0.03). Conversely, MRI outperformed US in detecting cartilage defects (93% vs. 70%, p&lt;0.001) and trochlear dysplasia (91% vs. 35%, p&lt;0.001). The US offered shorter median wait times (3.5 vs. 16.1 days), reduced scan duration (19.1 vs. 34.5 minutes), and 41% lower costs compared to MRI. Conclusion: Ultrasonography offers distinct advantages in the evaluation of superficial soft tissue disorders of the anterior knee, demonstrating greater sensitivity in detecting early structural alterations such as tendon thickening, hypoechoic regions, and neovascularization. In contrast, MRI remains the preferred modality for assessing deeper structural and osteochondral abnormalities. Implementing a stepwise imaging approach, with ultrasonography as the initial modality, may enhance diagnostic efficiency while simultaneously reducing healthcare costs.

Background Early diagnosis of acute coronary syndrome (ACS) in patients presenting with acute chest pain is challenging, particularly within the first few hours after symptom onset, when cardiac troponin levels may remain below diagnostic thresholds. This diagnostic delay contributes to uncertainty in emergency triage and postponement of definitive therapy. Heart-type fatty acid–binding protein (H-FABP), a small cytosolic protein rapidly released following myocardial injury, may offer diagnostic advantage during this early phase. Objective To evaluate the diagnostic accuracy of H-FABP for early detection of ACS and to compare its temporal performance with cardiac troponin in emergency department presentations. Methods In this prospective diagnostic accuracy study, 245 patients presenting with acute chest pain within 12 hours of symptom onset were enrolled. Plasma H-FABP and cardiac troponin levels were measured at two predefined intervals: 0–4 hours and 6–10 hours after symptom onset. Acute coronary syndrome was defined using troponin-based criteria. Diagnostic performance indices, including sensitivity, specificity, predictive values, overall accuracy, and receiver operating characteristic (ROC) curve analysis, were calculated. Subgroup analyses and differentiation between cardiac and non-cardiac chest pain were performed. Results Within the early 0–4-hour window, H-FABP demonstrated high diagnostic accuracy, with a sensitivity of 89.5%, specificity of 91.4%, and an AUC of 0.874, outperforming troponin measured during the same period (AUC 0.689). Troponin sensitivity in the early window was low (25.7%) despite high specificity. H-FABP identified 98.1% of ACS cases that were troponin-negative at presentation. At 6–10 hours, troponin showed superior diagnostic performance (AUC 1.000), while H-FABP sensitivity declined. H-FABP maintained consistent performance across major cardiovascular risk subgroups and effectively differentiated cardiac from non-cardiac chest pain early. Conclusion H-FABP provides significant diagnostic advantage during the early phase of ACS presentation and complements troponin in emergency department triage, enabling earlier identification of ACS and reducing diagnostic delay.

Left atrial enlargement (LAE) is predictive of cardiovascular morbidity and mortality. Prior studies of point-of-care ultrasound (POCUS) interpretation methods for identifying LAE utilized older echocardiographic reference ranges. Compare the test characteristics of hospitalist-performed POCUS techniques for identifying LAE as compared to contemporary echocardiographic reference ranges. Fully paired, comparative diagnostic accuracy study of two index tests applied to archived echocardiogram images: visual assessment of the left atrium to aorta diameter (LAE sign) and left atrial (LA) anteroposterior diameter >4 cm in the parasternal long axis view. The reference test was moderate to severe LAE by echocardiography-derived left atrial volumetric index. After exclusion criteria, 239 of 321 (74.5%) exams were included. The LAE sign had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 67.5%, 71.4%, 32.1%, and 91.6%. LA diameter of >4 cm had a sensitivity, specificity, PPV, and NPV of 87.5%, 75.9%, 42.2%, and 96.8%. The difference in sensitivity (p = .005) and specificity (p = .049) between the index tests was statistically significant. The diameter measurement had better positive and negative likelihood ratios (LR + 3.63, LR-0.16) than the LAE sign (LR + 2.36, LR- 0.46). Both POCUS techniques for diagnosing LAE performed reasonably well compared to current echocardiographic reference ranges, with LA diameter >4 cm having better sensitivity and specificity than visual estimation of the LAE sign. These tests can help identify patients at risk for cardiovascular disease who may benefit from echocardiogram referral.

Objective: To evaluate the diagnostic accuracy of artificial intelligence (AI) tools compared with human clinicians in identifying oral lesions. Material and Methods: A comparative cross-sectional diagnostic accuracy (quantitative) study research has been conducted at the Department of Oral and Maxillofacial Surgery, Fatima Jinnah Dental College, Jinnah Hospital, Karachi, following approval from the ethical board, from November 2023 to January 2024.involved an examination consisting of 20 MCQs. These questions had options of responses titled A to D. The exam, aligned as multiple-choice questionnaire by an expert of that content field, was administered via Google Forms. Results: Among the 35 participants, 14.3% were LLMs and 85.7% were house officers, with the mean ages of house officer’s 29.07±4.05 years. The majority of participants were male. In terms of diagnostic accuracy, LLMs and house officers performed similarly, with correct answer rates of 80.0% and 83.3%, respectively, and no statistically significant difference (p=0.855). Additionally, artificial intelligence tools demonstrated varying efficiencies, with OpenAI achieving 91.4% correct answers, PopAI at 77.1%, and Gemini at 80.0%. Conclusion: The findings notably demonstrate that LLMs exhibit a level of performance that is on par with that of senior dental house officers, thus underlining their promise as a valuable tool in augmenting diagnostic capabilities within clinical settings. Keywords: Artificial intelligence, Diagnosis, Human intelligence, Large language models, Oral lesions.

Seven-Tesla Magnetic Resonance Imaging Has Increased Sensitivity but Decreased Specificity in Diagnosing Cartilage Defects in the Knee Compared With 1.5- and 3-Tesla Magnetic Resonance Imaging

BACKGROUNDCutaneous melanoma is an aggressive skin cancer with high metastatic potential. Accurate staging is critical to guide therapeutic strategies and improve prognosis. Whole-body magnetic resonance imaging (WB-MRI), particularly when combined with diffusion-weighted imaging (DWI), has emerged as promising tool for comprehensive, radiation-free assessment of metastatic spread.AIMTo systematically review the diagnostic performance and clinical utility of WB-MRI in the staging and restaging of cutaneous melanoma, with comparison to conventional imaging modalities such as computed tomography (CT) and positron emission tomography/CT (PET/CT).METHODSA systematic literature review was conducted using PubMed, Embase, Scopus and Web of Science databases for studies published in the last 10 years. Inclusion criteria focused on comparative diagnostic accuracy studies of WB-MRI vs CT and PET/CT for melanoma staging. The methodological quality of the studies was appraised using the QUADAS-2 tool.RESULTSSixteen studies involving over 700 patients met the inclusion criteria. WB-MRI showed high sensitivity (73%-90%) and specificity (up to 98%) in detecting metastases, particularly in bone, liver and soft tissue. DWI enhanced lesion detection, and WB-MRI often influenced clinical management decisions. However, CT outperformed WB-MRI in identifying small pulmonary nodules. AI-assisted analysis and contrast-enhanced sequences further improved diagnostic confidence.CONCLUSIONWB-MRI represents a robust imaging modality for staging cutaneous melanoma, offering superior soft-tissue contrast and functional imaging without ionizing radiation. Its strengths lie in detecting bone, liver and brain metastases. Challenges include limited lung lesion detection, cost, and availability. Advances in artificial intelligence, Hybrid PET/MRY systems, and radiomics are poised to expand WB-MRI’s role in personalized melanoma management.

BackgroundCurrently 18F-Fluorocholine (FCH)-PET/CT is a choice beyond widely used techniques like ultrasound (US) and technetium-99m sestamibi (MIBI) for primary hyperparathyroidism (pHPT). It remains uncertain how FCH-PET/CT collaborates with those two traditional modalities. This study aims to prospectively evaluate the effectiveness of individual, complementary, and combined utilization of FCH-PET/CT for preoperative localization.MethodsAll participants underwent US, MIBI, and FCH-PET/CT examinations, and eligible patients underwent parathyroid surgery based on surgical indications and patient preferences. McNemar’s test compared diagnostic performance between imaging techniques and Spearman’s rank correlation correlated FCH-PET/CT parameters with lesion volume, laboratory, and histological features.Results63 out of 83 recruited patients underwent parathyroidectomy. Histologically confirmed parathyroid lesions were found in 69 glands among 63 patients. FCH-PET/CT exhibited higher sensitivity than US, MIBI, and US/MIBI combination (87.0% vs. 49.3%, P <0.001; vs. 49.3%, P <0.001; vs. 66.7%, P=0.006). As a second-line modality after US, MIBI, and US/MIBI combination, FCH-PET/CT achieved sensitivities of 88.6%, 77.1%, and 80.9% in detecting US-negative lesions, MIBI-negative lesions, and lesions with negative or conflicting US/MIBI results, respectively. Among various imaging combinations, the combined use of US and FCH-PET/CT showed significantly higher sensitivity than FCH-PET/CT alone (94.2% vs. 87.0%, P=0.025) and similar sensitivity with higher specificity than the combination of all three modalities (sensitivity: 94.2% vs. 95.7%, P=0.317; specificity: 98.9% vs. 95.1%, P=0.008).ConclusionsFCH-PET/CT is effective as a first-line or complementary technique, irrespective of prior US, MIBI or US/MIBI combination. US combined with FCH-PET/CT appears to be the most effective localization strategy among the modalities evaluated in this study. Our findings support an ultrasound-first approach for localizing primary hyperparathyroidism, with FCH-PET/CT referral in uncertain cases to enhance success rates.

BackgroundThyroid nodules are increasingly detected with high-resolution imaging. While most are benign, accurate risk stratification is essential for identifying those requiring further investigation. Various classification systems have been developed to standardize assessment, with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) being widely adopted internationally. The Chinese TIRADS (C-TIRADS) offers an alternative approach with potential advantages in simplicity and practicality. These systems are well-studied in nodules > 10 mm, but their comparative diagnostic performance in small thyroid nodules (< 10 mm) remains understudied. This study aimed to compare ACR-TIRADS and C-TIRADS diagnostic performance for predicting malignancy in small thyroid nodules (< 10 mm). ResultsThis study included 128 thyroid nodules (84.3% benign and 15.6% malignant). The most common benign pathology was benign goiter (87%), while the most frequent malignancy was papillary thyroid carcinoma (85%). The ROC curves analyses indicated an AUC of 0.797 for ACR-TIRADS and 0.794 for C-TIRADS, with optimal cutoff points at ACR-TIR4 (sensitivity 80% and specificity 75.9%) and C-TIR4b (sensitivity 70% and specificity 83.3%). The ACR-TIRADS demonstrated higher sensitivity, but lower specificity compared to C-TIRADS. Both systems had high negative predictive values (> 94%), ensuring reliable exclusion of malignancy. The C-TIRADS exhibited higher overall accuracy (81.3%) than ACR-TIRADS (76.5%) due to a better balance of sensitivity and specificity.ConclusionsBoth systems showed comparable diagnostic accuracy (AUCs: 0.797 vs 0.794) for small nodule stratification, suggesting complementary roles with distinct advantages. Given the modest sample size, particularly limited malignant cases, findings require validation in larger multicenter studies before definitive recommendations.

To perform a systematic review comparing diagnostic test accuracy of FDG PET-CT versus CT for assessing recurrence in post-treatment pancreatic adenocarcinoma (PAC). Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews (Ovid), Cochrane Central Register of Controlled Trials (Ovid), and Web of Science searched until February 2024 for comparative diagnostic accuracy studies assessing PET-CT versus CT in post-treated subjects with PAC to evaluate diagnostic accuracy for recurrence. The reference standard was histopathology when available or clinical follow-up. Data extraction, risk of bias (ROB), and applicability assessment were performed by two authors. QUADAS-C was used for ROB assessment. Bivariate random-effects model meta-analysis, and meta-regression were performed for test comparison with 95% confidence intervals (95%CI). Of 5345 citations retrieved, nine articles met all inclusion criteria, with 400 PAC patients who had 320 recurrences included. Three studies were considered at low risk of bias, while the remaining six studies were at high risk for bias. The sensitivity/specificity (95%CI) and AUC of PET-CT was 89% (83-92%)/83% (73-90%) and 0.927 and for CT was 72% (64-79%)/76% (64-85%) and 0.803. A meta-regression model demonstrated a higher sensitivity for PET-CT than CT alone (P<0.001), with no significant difference in specificity (P=0.243). Risk of bias had no significant impact on CT or PET-CT diagnostic accuracy (P=0.072-0.775). PET-CT exhibited greater sensitivity compared to CT alone, with no significant variance in specificity between the two modalities, for recurrence evaluation in PAC.

Background and objective Dengue is a common febrile illness in tropical countries; serological detection of non-structural protein-1 (NS1) antigen or IgM is the gold standard for diagnosis. Thrombocytopenia, leukopenia, eosinopenia, and hem concentration are common hematological manifestations in dengue, andactivated lymphocytes are seen in these patients. We intend to analyze the utility of a parameter called a high fluorescent cell (HFC) on Mindray BC-6000 for suspecting dengue infection in patients with febrile illness. Thrombocytopenia, when present, is taken as a warning sign and creates serious concerns for the treating physician. We studied HFC as a cost-effective tool to predict platelet recovery. Methods This is a facility-based single-gate cross-sectional comparative diagnostic accuracy study. Patients presenting with febrile illness and undergoing dengue serology testing and complete blood count (CBC) test with HFC enumeration on the same day were analyzed. Dengue-positive patients with thrombocytopenia were serially monitored for both platelet count and HFC, along with other platelet parameters. Results A total of 515 febrile patients were included. The median age of the patients was 18 (11-31) years, and 281 (54.56%) patients were males. Overall, the lab positivity rate for dengue was 33% (170 patients out of 515). The HFCin dengue-positive patients ranged from 0 to 20.1%. The sensitivity and specificity of absolute HFC count at a cut-off of 0.02 were 74% and 32%, respectively; similarly, the sensitivity and specificity of HFC percentageat a cut-off of 0.2 were 92% and 25%, respectively. Eighty-nine (out of 170)dengue-positive patients had thrombocytopenia. In 15 cases, multiple serial HFC and platelet counts were available. The falling trend in HFC was followed by platelet recovery within 24 hours in 13(86.6%) patients. Conclusion HFC serves as a sensitive but not specific marker for dengue infection in cases with febrile illness. The role of HFC in predicting platelet recovery in dengue cases should be further explored.

Background: Timely and accurate diagnosis of large vessel occlusions in CT head and CTA scans is crucial for stroke patient management. Maximum Intensity Projection (MIP) reconstructions have emerged as a potential aid in improving diagnostic accuracy for large vessel occlusions. Methods: This comparative diagnostic accuracy study was conducted at the Dammam Medical Complex in Saudi Arabia, involving ten radiology residents from different experience levels. Residents reviewed 10 cases each, with half accompanied by MIP reconstructions. They assessed occlusion presence and rated their confidence using a Likert scale. Results: Junior and senior residents exhibited similar correct detection rates (86.0% vs. 78.0%, p = 0.298) and confidence levels (4.3 vs. 4.3, p = 0.772) but differed in evaluation time (201.9 seconds vs. 133.7 seconds, p &lt; 0.001). MIP usage exhibited positive trends in correct detection rates and shorter evaluation times for senior residents but lacked statistical significance. In the feedback analysis, a clear majority of 90% of the residents expressed agreement or strong agreement that MIP enhanced their confidence in scan interpretation. Conclusion: While no statistically significant differences were found in accuracy or confidence levels, MIP reconstructions showed promise in enhancing correct detection rates and expediting case evaluations, especially among senior residents. The majority of participants expressed strong confidence enhancement due to MIP usage.

Background The rising incidence of melanoma and the high number of benign lesions excised due to diagnostic uncertainty highlight the need for effective patient triage. This study assesses the safety and accuracy of teledermoscopic triage on a high-prevalence case set with pre-triaged, challenging, melanoma-suspicious lesions. Methods Five dermatologists independently reviewed 250 retrospectively extracted patient cases. Teledermoscopy assessments were simulated for panels of 1, 2, 3 and 5 assessors using two distinct consensus strategies, Caution Protocol and Majority Vote, and the sensitivity and specificity of the patient triages were calculated. Results Triage by a single teledermatologist showed a sensitivity of 92.3% and a specificity of 58.7%. Sensitivity improved with the number of assessors, particularly when using the Caution Protocol, though with a considerable drop in specificity. The Majority Vote showed a more balanced improvement in sensitivity and specificity. Safety analyses indicated that diagnostic accuracy decreased with poor image quality and increased case difficulty. Discussion Expert teledermoscopic triage of melanocytic skin lesions is highly sensitive and lowers the need for unnecessary excision procedures by half while dismissing as few as 0.4% (95% confidence interval 0–0.6%) of melanomas, even when applied to a high-prevalence pre-triaged subpopulation. Implementation of safety procedures increases accuracy. Using multiple teledermatologists increases sensitivity but at the cost of specificity unless a Majority Vote consensus strategy is applied. Future teledermoscopy guidelines should encompass safety procedures and protocols for disagreement between assessors.

BackgroundThis study aimed to compare targeted next-generation sequencing (tNGS) with metagenomic next-generation sequencing (mNGS) for pathogen detection in infants with severe postoperative pneumonia after congenital heart surgery.MethodsWe conducted a retrospective observational study using data from the electronic medical record system of infants who developed severe pneumonia after surgery for congenital heart disease from August 2021 to August 2022. Infants were divided into tNGS and mNGS groups based on the pathogen detection methods. The primary outcome was the efficiency of pathogen detection, and the secondary outcomes were the timeliness and cost of each method.ResultsIn the study, 91 infants were included, with tNGS detecting pathogens in 84.6% (77/91) and mNGS in 81.3% (74/91) of cases (P = 0.55). No significant differences were found in sensitivity, specificity, PPA, and NPA between the two methods (P > 0.05). tNGS identified five strains with resistance genes, while mNGS detected one strain. Furthermore, tNGS had a faster detection time (12 vs. 24 h) and lower cost ($150 vs. $500) compared to mNGS.ConclusiontNGS offers similar sensitivity to mNGS but with greater efficiency and cost-effectiveness, making it a promising approach for respiratory pathogen detection.