Noninvasive Diagnostic Modalities Research Articles

Intestinal ultrasound detects an increased diameter and submucosal layer thickness in the appendix of patients with ulcerative colitis compared to healthy controls - a prospective cohort study.

Increasing evidence suggests that appendicectomy as alternative treatment for ulcerative colitis (UC), especially in patients with histopathological appendiceal inflammation. Intestinal ultrasound (IUS) is a non-invasive diagnostic modality to characterise appendiceal inflammation. To assess appendiceal IUS characteristics in UC patients and compare findings to healthy controls (HC). In this prospective study, appendiceal IUS was performed in consecutive UC patients with active (A; n=35) or quiescent (Q; n=30) disease and in HC (n=30). Transverse appendiceal diameter (TAD) and additional IUS parameters (bowel wall thickness, submucosal layer thickness and colour Doppler signal) were assessed. The appendix was visualised in 41/65 UC patients (63.1%; A vs. Q: 23/35 vs. 18/30, p=0.67) and 18/30 (60%) HC. UC patients had a higher TAD (A: 5.5 mm, Q: 5.0 mm, HC: 4.3 mm; A-HC p < 0.01; Q-HC p=0.01, A-Q p=ns) and submucosal layer thickness (A: 1.0 mm, Q: 1.0 mm, HC: 0.7 mm; A-HC p < 0.01, Q-HC: p=0.01, A-Q: p=ns) when compared to HC. A TAD ≥6 mm corresponding to an ultrasonographic suspicion of acute appendicitis was mainly reported in A-UC patients (A: 43%; Q: 6%; HC: 0%, p=0.01) and occurred irrespective of disease extent. However, none of the patients had a clinical suspicion of acute appendicitis. A TAD ≥6 mm was predominantly seen in A-UC. TAD was higher in UC patients compared to HC irrespective of disease activity and was characterised by an increased submucosal layer thickness. IUS therefore has the potential to identify UC patients with appendiceal inflammation.

Orally Administered Platinum Nanomarkers for Urinary Monitoring of Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is a chronic relapsing autoimmune disease with rising incidence worldwide. There is an increasing desire for non-invasive diagnostic tools to enable simple and sensitive IBD monitoring. Here, we report an orally administered nanosensor which will dissociate into ultrasmall platinum nanoclusters (PtNCs) in IBD-related inflammatory microenvironments. By exploiting the enzyme-mimicking activity of PtNCs and the precise bandpass filterability of kidney, the released-PtNCs can be detected in a scalable urinary readout, such as fluorescence and volumetric bar-chart chip (V-Chip), for point-of-care (POC) analysis. Our results demonstrate that the nanosensors exhibit significant signal differences between IBD-model mice and healthy mice, which is more sensitive than clinical ELISA assay based on fecal calprotectin. Such a non-invasive diagnostic modality significantly assists in the personalized assessment of pharmacological and follow-up efficacy. We envision that this modular conception will promote the rapid diagnosis of diverse diseases by changing specific responsive components.

Dextran Fluorescent Probes Containing Sulfadiazine and Rhodamine B Groups.

Fluorescent imaging has been expanded, as a non-invasive diagnostic modality for cancers, in recent years. Fluorescent probes in the near-infrared window can provide high sensitivity, resolution, and signal-to-noise ratio, without the use of ionizing radiation. Some fluorescent compounds with low molecular weight, such as rhodamine B (RhB) and indocyanine green (ICG), have been used in fluorescent imaging to improve imaging contrast and sensitivity; however, since these probes are excreted from the body quickly, they possess significant restrictions for imaging. To find a potential solution to this, this work investigated the synthesis and properties of novel macromolecular fluorescent compounds. Herein, water-soluble dextran fluorescent compounds (SD-Dextran-RhB) were prepared by the attachment of RhB and sulfadiazine (SD) derivatives to dextran carrier. These fluorescent compounds were then characterized through IR, 1H NMR, 13C NMR, UV, GPC, and other methods. Assays of their cellular uptake and cell cytotoxicity and fluorescent imaging were also performed. Through this study, it was found that SD-Dextran-RhB is sensitive to acidic conditions and possesses low cell cytotoxicities compared to normal 293 cells and HepG2 and HeLa tumor cells. Moreover, SD-Dextran-RhB demonstrated good fluorescent imaging in HepG2 and HeLa cells. Therefore, SD-Dextran-RhB is suitable to be potentially applied as a probe in the fluorescent imaging of tumors.

The diagnostic yield of pan-enteric capsule endoscopy in inflammatory bowel disease: A systematic review and meta-analysis.

Capsule endoscopy (CE) is a non-invasive diagnostic modality enabling real time video imaging of the gastrointestinal (GI) mucosa. Pan-enteric capsule endoscopy (PCE) is now able to thoroughly assess the entire GI tract, including for inflammatory bowel disease (IBD). Our aim was to evaluate the diagnostic accuracy of PCEs in IBD. We comprehensively searched electronic databases (MEDLINE, SCOPUS, EMBASE, and Cochrane Central Register of Controlled Trials) for studies comparing the diagnostic accuracy of PCE with endoscopic evaluation, intestinal ultrasoundor magnetic resonance enterography (MRE). Data were analyzed by calculating forest plots and the use of the I2 statistic for heterogeneity. Fourteen studies were identified, with seven studies evaluating PCE diagnostic yield in Crohn's disease (CD) and seven studies in ulcerative colitis (UC). In CD, there was a trend to superiority of PCE over MRE and colonoscopy with a pooled odds ratio (OR) of 1.25 (95% CI, 0.85-1.86%) for the detection of CD. This translates to an increased diagnostic yield of 5% and 7% for PCE compared with MRE and colonoscopy, respectively. PCEs had a diagnostic sensitivity for the detection of UC of 93.8% (95% CI, 87.6-97.0%) and a specificity of 69.8% (95% CI, 38.2-89.6%). PCEs have a comparable diagnostic yield to colonoscopy and MRE in Crohn's disease. The major difficulty remains standardization of PCE scoring systems and the lack of transmural assessment. In UC, PCE has an excellent diagnostic sensitivity and positive predictive value, but there are limitations to its use including the lack of histologic assessment and poor specificity.

A clinicoepidemiological study on topical steroid misuse in a tertiary-care hospital in North India and the role of dermoscopy as a non-invasive diagnostic modality

Background: Topical corticosteroids (TCs) are one of the most frequently prescribed medications by dermatologists, yet may lead to an array of side effects due to prolonged and improper use. Because of the easy availability of topical corticosteroids as over-the-counter medications in India, these drugs are misused and abused. Objective: The objective was to determine the extent and the side effect profile of topical corticosteroid misuse/abuse in patients attending the OPD, to determine the demographic data and the reason and source of procuring TCs, and to characterize the dermoscopic findings of TSDF. Materials and Methods: This was a prospective, cross-sectional, clinical study conducted over a period of two years in which a predesigned, questionnaire-based proforma was employed. Patients above the age of fifteen reporting to the OPD giving a history of the application of a steroid cream continuously or intermittently for the minimum duration of four weeks were included in the study. A total of two hundred patients who met the clinical criteria were subjected to dermoscopic examination with a handheld dermoscope (DermLite DL4; 3Gen, U.S.; 10×). Results: A total of 2400 patients (fifteen-year-old or older) were enrolled in the study, in which 65% of the patients were females while 35% were males. Mostly, the patients procured these medicines from the pharmacist or paramedic, followed by general practitioners. The most common indications for which topical preparations were used included acne, followed by photodermatoses and ephelides. Most of the patients used combination creams, followed by potent steroids such as clobetasol propionate and betamethasone valerate. The most common side effects were erythema (74%), followed by photosensitivity (49%), hypertrichosis (47%), telangiectasia (42%), acneiform eruption (33%), contact dermatitis (21%), wrinkles (23.50%), etc. The main findings noticed on dermoscopy were irregularly dilated, branching, tortuous vessels almost interconnecting with each other in 79.78%, followed by hypertrichosis in 56.34%, white structureless areas representing atrophy in 42.33%, red dots in 7.22%, and a reddish background in 92.20%. Conclusion: The rampant use of TCs by patients for a prolonged period of time leads to a variety of side effects. Due to the topographical location, the climate of the valley, and the lighter skin type of the local population, the indications for which TCs were employed in our study group and the side effect profile were unique from the rest of the country. Dermoscopy may play a vital role in improving the diagnostic accuracy of TSDF and help us to differentiate it from close mimics.

Noninvasive diagnostic modalities for the diagnosis of coronary artery disease: A guide for acute care NPs.

Selecting noninvasive diagnostic tests for coronary artery disease can be a daunting task to acute care NPs. This article provides an overview of the pathophysiology of coronary artery disease, relevant noninvasive diagnostic imaging modalities, and an evidence-based approach to guide subsequent diagnostic and therapeutic interventions.

Noninvasive diagnostic modalities for the diagnosis of coronary artery disease: A guide for acute care NPs.

Noninvasive diagnostic modalities for the diagnosis of coronary artery disease: A guide for acute care NPs.

Evolving concepts of the vulnerable atherosclerotic plaque and the vulnerable patient: implications for patient care and future research.

Understanding the natural history of coronary artery atherosclerosis is necessary to determine prognosis and prescribe effective therapies. Traditional management of coronary artery disease has focused on the treatment of flow-limiting anatomical obstructions that lead to ischaemia. In most scenarios, revascularization of these atherosclerotic plaques has not substantially improved freedom from death or myocardial infarction, questioning the utility of contemporary revascularization strategies to improve prognosis. Advances in non-invasive and invasive imaging techniques have helped to identify the characteristics of obstructive and non-obstructive plaques that are precursors for plaque progression and future acute coronary syndromes as well as cardiac death. These 'vulnerable plaques' develop as a consequence of systemic inflammation and are prone to inducing thrombosis. Vulnerable plaques most commonly have a large plaque burden with a well-formed necrotic core and thin fibrous cap and are metabolically active. Perivascular adipose tissue might, in some patients, be used as a surrogate for coronary inflammation and predict future risk of adverse cardiac events. Vulnerable plaques can be identified in their quiescent state, offering the potential for therapeutic passivation. In this Review, we describe the biological and compositional features of vulnerable plaques, the non-invasive and invasive diagnostic modalities to characterize vulnerable plaques, the prognostic utility of identifying vulnerable plaques, and the future studies needed to explore the value of intensified pharmacological and focal treatments of vulnerable plaques.

The role of shear wave elastography in differentiation between benign and malignant portal vein thrombosis in hepatocellular carcinoma

BackgroundHepatocellular carcinomas (HCC) most commonly complicate liver cirrhosis and it may coexist with malignant portal vein invasion (PVI) that minimizes its possible treatment opportunities and negatively affects its prognosis. However, liver cirrhosis may also be associated with non-tumoral portal vein thrombosis (PVT) particularly in decompensated cirrhosis. Thus, discrimination between tumoral and non-tumoral PVT most preferably by non-invasive imaging techniques is mandatory before treatment decision. Based on the concept of changing tissue elasticity according to tissue pathological changes, Shear wave elastography (SWE) could quantitatively assess tissue stiffness in malignant PVI. We aimed in this work to evaluate the performance of SWE as a novel fast non-invasive diagnostic modality for malignant PVI in cirrhotic patients with HCC.ResultsSeventy-eight HCC patients with PVT included in this prospective cross-sectional study, tumoral and non-tumoral PVT were differentiated using triphasic CT and/or dynamic MRI, then SWE was blindly and independently done for all included patients. non-tumoral PVT was present in 21.8% of our HCC patients mostly in decompensated cirrhosis. All of our evaluated predictor factors were evaluated by univariate logistic regression analysis to identify the significant factors in prediction of malignant PVI (SWE, AFP, HCC size, HCC multi-focality, and PVD). By using the multivariate logistic regression we identified that the most independent significant factors were SWE and PVD (sig.: 0.012 and 0.045 respectively). SWE was evaluated versus the criteria of PVT and we found that malignant PVI has significant higher SWE values than benign non-tumoral PVT (sig: 0.012). Two cutoff values were calculated for SWE using ROC curve; the 1st cutoff point was selected to rule in malignant PVI for values ≥ 13 kps, while the 2nd cutoff point was selected to rule out malignant PVI for values ≤ 9 kps with a significant discriminatory performance (AUC: 0.984; sig: 0.000).ConclusionsSWE could be used as a novel fast and non-invasive indicator of malignant portal vein invasion in cirrhotic patients with HCC especially for values ≥ 13 kps and particularly if coexists with larger values of PVD and AFP.

Plasmonically enhanced two-photon absorption induced photoacoustic microscopy with laser-synthesized TiN nanoparticles

Combining photonic excitation and acoustic detection, photoacoustic imaging (PAI) presents one of the most promising noninvasive biomedical diagnostic modalities, but this technique still lacks efficient nano-sized contrast agents absorbing light in the region of relative tissue transparency (630–900 nm). Here, we explore the use of titanium nitride (TiN) nanoparticles (NPs) fabricated by methods of pulsed laser ablation in liquids as a contrast agent in PAI. When prepared in acetone, the NPs are spherical, have an average size of 25 nm, and exhibit a broad plasmonic absorption peak around 700 nm. We show that solutions of these NPs render possible a strong nonlinear photoacoustic response and the generation of photoacoustic images with 67 μm resolution within the biological transparency window. The observed effect is explained by a plasmonically enhanced two-photon absorption process in TiN NPs. Combined with earlier demonstrated capability of generating photothermal therapeutic effect, relative chemical purity, and excellent biocompatibility, laser-synthesized TiN NPs promise attractive applications in biomedical theranostics involving imaging modalities based on photoacoustics microscopy or tomography.

CTSC-Net: an effectual CT slice classification network to categorize organ and non-organ slices from a 3-D CT image.

Computed tomography (CT) is a non-invasive diagnostic imaging modality that reveals more insight into human organs than conventional X-rays. In general, the CT output is a 3-D image that is formed by combining multiple 2D images or slices together. It is essential to keep in mind that not all of the slices provide significant information to detect tumours. Usually, a 3-D CT image obtained from the CT scanners has a significant number of unwanted non-organ slices in it. Radiologists typically devote a significant amount of time to select the slices with organ from a 3-D CT image. The presence of a tumour is only evident in the organ slice; hence, radiologists must be cautious not to skip any organ slices. This work is evaluated on the LITS, 3DIRCADb and COVID-19 CT datasets. The three datasets collectively contain 22,435 organ slices and 53,661 non-organ slices, and there is a huge gap between the number of organ and non-organ slices. There is a need for the automatic elimination of non-organ slices in 3-D CT volumes to assist the physicians, and hence, this work focuses on the automatic recognition of organ slices from 3-D CT volumes. In this paper, a new deep model called the computed tomography slice classification network (CTSC-Net) is proposed for CT slice classification between organ and non-organ slices. The model is trained on 77,980 CT slices, validated on 9748 slices and tested on 12,571 slices. Nine CNN architectures with different layer settings are trained and tested to arrive at the final optimal model. The performance measures are computed in terms of true positive rate, true negative rate, sensitivity, specificity and accuracy. The 20-layer CTSC-Net achieves a validation accuracy of 95.04% and an overall testing accuracy of 99.96%. The proposed model is compared to eight different pre-trained CNN models, and the results of the proposed CTSC-Net surpassed all the comparable models. The activation feature maps of different layers of the CTSC-Net are visualized to verify the discriminative features learned by the network. Hence, the proposed CTSC-Net can be employed as a computer-aided diagnosis tool to help physicians discard unnecessary non-organ slices from the 3-D CT volume and to speed up the CT diagnosis process.

Optimizing the diagnostic approach of functional popliteal artery entrapment syndrome

ObjectiveFunctional popliteal artery entrapment syndrome (fPAES) is an underdiagnosed and undertreated etiology of atypical claudication. Symptoms of fPAES include deep posterior muscle cramping and pain with exercise and, unlike anatomic PAES, there are seldom vascular complications. Common noninvasive diagnostic modalities include ankle-brachial index, arterial duplex Doppler ultrasound (DUS) examination, and cross-sectional imaging such as magnetic resonance angiography (MRA). Entrapment can be difficult to reproduce during diagnostic testing, requiring provocative maneuvers. Because we believed different provocative maneuvers provide different diagnostic efficacy, we sought to optimize our diagnostic approach to fPAES. MethodsWe performed a retrospective review of patients before and after optimizing our noninvasive imaging protocol comparing patients with fPAES versus other atypical claudicants with chronic compartment syndrome. ResultsArterial DUS examination and exercise ankle-brachial index were important components of our protocol with a significant decrease in systolic posterior tibial blood pressure of –14 mm Hg after exercise, whereas nonentrapment release patients had an overall increase of 8 mm Hg (P = .006). Arterial DUS examination of the distal PA with forced plantarflexion demonstrated a trend toward an increase in the measured velocity ratio, especially in the middle and distal PA. MRA with stressed plantar flexion findings were positive in 6 of 11 patients with fPAES, with false negatives likely owing to patients’ inability to maintain a provocative position for the duration of the MRA. ConclusionsDiagnosing fPAES is challenging owing to a lack of standardized diagnostic testing and provocative maneuvers. Different maneuvers demonstrated varying diagnostic yields for fPAES. Exercise ABIs were the most reliable vascular laboratory test to detect changes attributable to fPAES and to distinguish it from chronic compartment syndrome. Segmental PA DUS examination seems to be promising as a means of detecting PA impingement. Stress positional MRA effectively demonstrates anatomic PAES, but has a false-negative rate for fPAES.

ANALYSIS THE EFFECT OF SENSORY INTERVENTION ON PATIENT’S ANXIETY ACCORDING TO MAGNETIC RESONANCE IMAGING-ANXIETY QUESTIONNAIRE (MRI-AQ) AND HEART RATE IN MRI LUMBAL EXAMINATION

Background: The use of MRI as a non-invasive diagnostic radiological examination modality is painless. However, patients may experience claustrophobia and anxiety. Sensory intervention is a method of providing sensory stimulation to an individual, which is expected to reduce the anxiety. Purpose: To determine the effect of the sensory intervention on the anxiety level of patients using an intervention scent by inhalation and intervention sound based on heart rate and MRI-AQ in patients with MRI lumbal examination. Method: 24 samples were divided into three groups: intervention scent, combination intervention scent-sound, and control, with eight samples each. Intervention scent is given using lavender essential oil as aromatherapy, drop three drops on the mask, then put the mask on for 5 minutes before the examination until the examination is completed. Intervention sound is given by playing music (nature-sound) during the examination. Result: Sensory intervention, specifically the use of combination intervention scent-sound, significantly reduces anxiety in patients during MRI lumbal examination significantly p = 0.004 (p&lt;0.05). Conclusion: The use of a combination between lavender and nature-sound as media for sensory intervention has a positive effect on reducing anxiety during MRI lumbal examination based on heart rate. Due to the easy administration of this aromatherapy and the minimal risk for this treatment, it is recommended that it is applied to reduce anxiety during MRI.

Lupus myocarditis: review of current diagnostic modalities and their application in clinical practice.

Lupus myocarditis (LM) is a potentially fatal manifestation of SLE, occurring in 5-10% of patients. Clinical manifestations may vary from an unexplained tachycardia to fulminant congestive cardiac failure (CCF). With no single clinical or imaging modality being diagnostic, a rational and practical approach to the patient presenting with possible LM is essential. Markers of myocyte injury (including troponin I and creatine kinase) may be unelevated and do not exclude a diagnosis of LM. Findings on ECG are non-specific but remain essential to exclude other causes of CCF such as an acute coronary syndrome or conduction disorders. Echocardiographic modalities including wall motion abnormalities and speckle tracking echocardiography may demonstrate regional and/or global left ventricular dysfunction and is more sensitive than conventional echocardiography, especially early in the course of LM. Cardiac magnetic resonance imaging (CMRI) is regarded as the non-invasive diagnostic modality of choice in myocarditis. While more sensitive and specific than echocardiography, CMRI has certain limitations in the context of SLE, including technical challenges in acutely unwell and uncooperative patients, contraindications to gadolinium use in the context of renal impairment (including lupus nephritis) and limited literature regarding the application of recommended diagnostic CMRI criteria in SLE. Both echocardiography as well as CMRI may detect subclinical myocardial dysfunction and/or injury of which the clinical significance remains uncertain. Considering these challenges, a combined decision-making approach by rheumatologists and cardiologists interpreting diagnostic test results within the clinical context of the patient is essential to ensure an accurate, early diagnosis of LM.

QS2. High Frequency Spectral Ultrasound Imaging Detects Early Post Traumatic Muscle Fibrosis in Rodents

Purpose: Muscle fibrosis is a devastating condition that can occur following traumatic injury leading to loss of function and poor outcomes. Limited noninvasive modalities exist to diagnose and characterize the extent of muscle damage. Here we investigate spectral ultrasound imaging (SUSI), a quantitative imaging technique which detects tissue parameters based on intrinsic structure and composition, to identify early muscle fibrosis based on fibrotic changes established in a rat model. We hypothesize that SUSI will detect early traumatic muscle fibrosis in a clinically translational rat muscle injury model. Methods: Adult male Sprague Dawley rats were sedated, prepped, and underwent a soft tissue crush injury that generated 20lbs/in2 of pressure using a digital force gauge. A superficial 1.5 cm incisional wound was then made over the quadriceps and closed. Injured and contralateral uninjured hind limbs were collected and fixed for SUSI imaging. Imaging was performed with a VisualSonics VEVO770 high resolution small animal ultrasound imaging system, using a 30 MHz center frequency single element transducer. Injured muscles were imaged at the crush injury and the corresponding place on the contralateral limb. Analysis of radiofrequency data was done as previously described in literature and SUSI parameters were calculated using the average acoustic concentration (AAC) of the fibrotic region and the corresponding region in the contralateral muscle. AAC values were grouped by time point and tissue type for statistical comparison using unpaired t tests. Results: In our rodent model, SUSI identified muscle fibrosis as early as 7 days post injury. The average AAC of injured fibrotic versus uninjured muscle was significantly increased at post injury day 7 (36.33 vs 18.36 db/mm3, injured versus uninjured, p = 0.003) and day 28 (54.64 vs 28.29 db/mm3, injured versus uninjured, p<0.0001). Though not statistically significant at day 14 (38.69 vs 27.61 db/mm3, injured vs uninjured, p=0.14) the fibrotic muscle did trend toward a higher AAC value. These results indicate that at day 7 and 28, the SUSI measurement AAC can be used to distinguish injured fibrotic muscle from uninjured muscle. Conclusions: SUSI offers a portable, non-invasive, and safe diagnostic modality to detect muscle fibrosis, making it an ideal modality for post traumatic injuries. Here, we show SUSI distinguishes muscle fibrosis from healthy tissue at day 7 and 28 post injury in our model allowing for early treatment. Unlike qualitative grayscale imaging, SUSI determines unique parameters of the tissue based on a calibrated spectrum related to the inherent properties of the tissue, making it less user-dependent and more reproducible.

Multicenter prospective clinical trial of molecular genetic markers for non-invasive differential diagnosis of benign and malignant melanocytic skin lesions.

e21581 Background: Improving the accuracy of non-invasive diagnosis of skin tumors is becoming an urgent problem, given the clear increase in the incidence of melanoma in many countries. Dermoscopy and examination by an experienced dermatologist can reduce the NNE to 5–10 per melanoma (M) detected, however, achieving even this, clearly suboptimal, rate requires a long specialist training. Methods: We report results of prospective nonrandomized trial evaluating sensitivity and specificity of RNA profiling of cytological samples from adhesive transparent patches (ATP) applied to skin lesions. Routine pathology reports were obtained for all surgery samples. RNA extracted from ATP specimens (N = 126) was tested for mRNA expression of PRAME and LINC00518 genes. GAPDH was used as a reference gene. Sample was considered marker-positive if either PRAME or LINC00518 expression was detected. Results: Between June 2021 and November 2021, 126 pts undegoing excisional biopsy of skin lesions were included in the study at 5 centers. On pathology, invasive M was detected in 49 (38.9%) patients (mean Breslow thickness was 2.41 mm [95%CI 1,44 to 3.37]), M in situ in 6 (4.8%), non-melanoma skin cancer in 4 (3.2%) and dysplastic nevus in 56 (44.4%). In the day of preplanned excision ATP was applied to the target lesion for 5–6 min and sent to the central lab. Amplifiable mRNA was found in all 126 ATP samples. 82 samples of 126 (65,1%) tested marker-positive. Sensitivity of RNA profiling for detection of skin cancers reached 88.14% (95% CI 77.07% – 95.09%), while specificity was only 53.85% (41.03% – 66.30%), with PPV of 63.41% (56.74% – 69.61%), NPV of 83.33% (70.65% – 91.22%) and accuracy of 70.16% (61.29% – 78.04%). Among the seven false negative results there were 3 M in situ and 4 invasive M. Conclusions: RNA profiling of skin ATP specimens is feasible and has high sensitivity but rather low specificity. Randomized studies are needed to evaluate if this technique can add anything to dermoscopy or other noninvasive diagnostic modalities. Clinical trial information: NCT04353050. [Table: see text]

Liquid-biopsy-derived glycoproteomic profiling as a novel means for noninvasive diagnosis of ovarian cancer.

e17604 Background: Ovarian cancer (OC) is the fifth- leading cause of cancer-related deaths among women, and the most lethal gynecological cancer. Currently available biomarkers, including CA-125 and HE4, show suboptimal diagnostic performance for differentiating among benign and malignant pelvic tumors, and the early recognition of OC. Differentiation of benign and malignant pelvic tumors is required for proper patient triaging and management, yet non-invasive methods remain a largely unmet medical need. Methods: We applied a novel platform for characterizing peripheral blood glycoproteomic biomarkers, combining liquid-chromatography/mass spectrometry (LC-MS) with artificial intelligence/neural networks (AI-NN) for the targeted quantification of serum protein glycosylation at intact glycopeptide level to analyze serum samples from 296 treatment-naïve women with histopathology-confirmed diagnosis of either benign (n = 151) or malignant (n = 145) tumors, and from 55 healthy control subjects, procured from a commercial biobank. Using data-dependent acquisition, a panel of 683 serum glycosylated and non-glycosylated peptides, representing 71 serum proteins, was interrogated. Samples were randomly divided into a training and a testing set for multivariable analysis. Data processing was performed using PB-Net, an in-house-developed high-throughput peak integration software. Raw data were normalized, processed by statistical analysis, and applied to machine learning models. Results: Comparison of glycopeptide abundances among patients with OC and benign pelvic tumors yielded 428 statistically significantly differentially expressed glycopeptides/peptides (at FDR &lt; 0.05). A subpanel of these markers used to generate a score for predicting OC yielded areas under the receiver-operating-characteristic of 0.955 and 0.894 in the training and testing sets, respectively. The predicted probability of malignancy increased with cancer stage, and probability distributions were similar across training and test sets. Applying the model to healthy subjects, not utilized in training, resulted in few misclassifications and a spread nearly equivalent to that of the benign tumor cases. This indicates the signature robustly predicts malignancy and severity of disease. Conclusions: Our novel approach exhibited impressive levels of accuracy for the noninvasive differentiation of benign and malignant pelvic masses, compared with existing biomarkers and algorithms, thereby demonstrating the utility of glycoprotein profiles as a powerful, noninvasive new diagnostic modality.

A Spotlight on the Role of Radiomics and Machine-Learning Applications in the Management of Intracranial Meningiomas: A New Perspective in Neuro-Oncology: A Review.

Background: In recent decades, the application of machine learning technologies to medical imaging has opened up new perspectives in neuro-oncology, in the so-called radiomics field. Radiomics offer new insight into glioma, aiding in clinical decision-making and patients’ prognosis evaluation. Although meningiomas represent the most common primary CNS tumor and the majority of them are benign and slow-growing tumors, a minor part of them show a more aggressive behavior with an increased proliferation rate and a tendency to recur. Therefore, their treatment may represent a challenge. Methods: According to PRISMA guidelines, a systematic literature review was performed. We included selected articles (meta-analysis, review, retrospective study, and case–control study) concerning the application of radiomics method in the preoperative diagnostic and prognostic algorithm, and planning for intracranial meningiomas. We also analyzed the contribution of radiomics in differentiating meningiomas from other CNS tumors with similar radiological features. Results: In the first research stage, 273 papers were identified. After a careful screening according to inclusion/exclusion criteria, 39 articles were included in this systematic review. Conclusions: Several preoperative features have been identified to increase preoperative intracranial meningioma assessment for guiding decision-making processes. The development of valid and reliable non-invasive diagnostic and prognostic modalities could have a significant clinical impact on meningioma treatment.

Correlation between MRI and diagnostic arthroscopy in shoulder injuries

Background: Shoulder injuries tend to present mainly as pain and often leads to considerable disability. It is essential that a diagnosis of the shoulder pathology is made and treatment started immediately to attain prompt recovery and avoid chronicity and complications. The current gold standard diagnostic investigation is arthroscopy. MRI is a proven sensitive and accurate non-invasive tool for detecting internal derangement and assessing overall joint structures, but many studies have reported false positive and negative results. The aim of the study is to compare the accuracy of the two Diagnostic Modalities, Arthroscopy and MRI, in bony and ligamentous structure injury of the shoulder joint. Methods: Twenty one cases of the age group 18-60 years presenting with shoulder pain following injury were included in our study, where MRI was performed followed by Arthroscopy. The data were analyzed for sensitivity, specificity, positive predictive value and negative predictive value and the correlation between MRI and Arthroscopy is done with the help of these statistics. Results: In the study highest sensitivity was found in full-thickness Supraspinatus tear, Bankart’s lesion and Hill-Sachs lesion. The highest specificity and highest positive predictive value was found in Impingement syndrome, full thickness supraspinatus tear, Hill-Sachs lesion and Adhesive capsulitis. The highest negative predictive value was found in full-thickness supraspinatus tear, Bankart’s lesion and Hill-Sachs lesion. Conclusion: MRI is an accurate, practical, efficient, non-invasive diagnostic modality in shoulder injuries, specially in conditions like full- thickness supraspinatus tear, impingement syndrome, Hill-Sachs lesion and Bankart’s lesion.

Transvaginal Colour Doppler Ultrasound Study of Uterine Tumours with Histopathological Correlation

A cross-sectional study was conducted in the Department of Radiology &amp; Imaging, in collaboration with the Department of Obstetrics &amp; Gynaecology, in Dhaka Medical College Hospital and Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka, Bangladesh, between July 2010 and March 2012, to evaluate the diagnostic usefulness of transvaginal color doppler ultrasonography (TVCDU) in differentiating benign and malignant uterine tumours. A total of fifty women, diagnosed as having uterine tumours both clinically and using ultrasound, participated in the study. They were evaluated preoperatively using TVCDU. All the study participants underwent surgical operation and resected specimens were sent for histopathological examination. Histopathology reports were correlated with the of colour Doppler findings. The mean age of the patients was 47.72±8.79 years. Major complaints were menorrhagia (58%), dysmenorrhoea (50%) and lump in the lower abdomen (48%). Neovascularization was found in 16(32%) cases. The mean resistance index and pulsatility index were much lower in malignant tumours than that of the benign counterpart (0.35±0.03 vs. 0.67±0.01 and 0.65±0.14 vs. 1.35±0.11 respectively); the difference was statistically significant (P&lt;0.001). The sensitivity, specificity, positive and negative predictive values of TVCDU were found 86.7%, 97.14%, 92.85% and 94.4% respectively. Overall diagnostic accuracy was 94%. To summarize, blood flow characteristics of benign and malignant uterine tumours, as evident on color Doppler imaging, have distinct diagnostic value. Hence, transvaginal colour Doppler ultrasound examination can be used as an easily available, efficient, and non-invasive diagnostic modality in differentiation of uterine tumours, which can be histologically confirmed later.&#x0D; CBMJ 2021 January: vol. 10 no. 02 P: 105-110