Noninvasive Diagnostic Modalities Research Articles

Contrast-enhanced CT radiomics for preoperative prediction of stage in epithelial ovarian cancer: a multicenter study

BackgroundPreoperative prediction of International Federation of Gynecology and Obstetrics (FIGO) stage in patients with epithelial ovarian cancer (EOC) is crucial for determining appropriate treatment strategy. This study aimed to explore the value of contrast-enhanced CT (CECT) radiomics in predicting preoperative FIGO staging of EOC, and to validate the stability of the model through an independent external dataset.MethodsA total of 201 EOC patients from three centers, divided into a training cohort (n = 106), internal (n = 46) and external (n = 49) validation cohorts. The least absolute shrinkage and selection operator (LASSO) regression algorithm was used for screening radiomics features. Five machine learning algorithms, namely logistic regression, support vector machine, random forest, light gradient boosting machine (LightGBM), and decision tree, were utilized in developing the radiomics model. The optimal performing algorithm was selected to establish the radiomics model, clinical model, and the combined model. The diagnostic performances of the models were evaluated through receiver operating characteristic analysis, and the comparison of the area under curves (AUCs) were conducted using the Delong test or F-test.ResultsSeven optimal radiomics features were retained by the LASSO algorithm. The five radiomics models demonstrate that the LightGBM model exhibits notable prediction efficiency and robustness, as evidenced by AUCs of 0.83 in the training cohort, 0.80 in the internal validation cohort, and 0.68 in the external validation cohort. The multivariate logistic regression analysis indicated that carcinoma antigen 125 and tumor location were identified as independent predictors for the FIGO staging of EOC. The combined model exhibited best diagnostic efficiency, with AUCs of 0.95 in the training cohort, 0.83 in the internal validation cohort, and 0.79 in the external validation cohort. The F-test indicated that the combined model exhibited a significantly superior AUC value compared to the radiomics model in the training cohort (P < 0.001).ConclusionsThe combined model integrating clinical characteristics and radiomics features shows potential as a non-invasive adjunctive diagnostic modality for preoperative evaluation of the FIGO staging status of EOC, thereby facilitating clinical decision-making and enhancing patient outcomes.

P259 Clinical characteristics and long-term disease course in patients with Crohn’s disease diagnosed by video capsule endoscopy; A retrospective multicentre matched case-control study

Abstract Background Video capsule endoscopy (VCE) is a non-invasive and accurate diagnostic modality that allows for direct visualization of the small intestinal mucosa in Crohn’s disease (CD). In rare cases, lesions not detected by other diagnostic modalities in patients suspected to have CD are solely identified through VCE. We aim to evaluate the clinical characteristics and long-term outcomes of these rare cases. Methods A retrospective multicentre matched case-control analysis was conducted in patients with CD across three hospitals in Korea, from January 2007 to April 2023. To perform a matched case-control study, we defined cases (VCE group) as patients with normal findings at colonoscopy and cross-sectional imaging, ultimately diagnosed with CD by VCE; the controls were patients with CD diagnosed with specific findings at endoscopy or cross-sectional imaging (non-VCE group). Controls were matched to cases with a ratio of 3:1 for sex, calendar year of diagnosis, and age at diagnosis. Clinical characteristics and outcomes between the two groups were compared. Results Of the 3,137 patients diagnosed with CD during the study period, 24 were diagnosed solely by VCE. When compared to 72 matched patients with CD, the mean duration from symptom onset to diagnosis did not significantly differ (27.2 months [SD 10.2] vs. 25.3 months [SD 8.9], p=0.394). There was a significant difference in the proportion of Montreal behaviour (p&amp;lt;0.001). In the VCE group, non-stricturing and non-penetrating (B1) type and stricturing (B2) type accounted for 91.7 and 8.3%, respectively. However, there was no significant difference in the perianal fistula modifier (25% vs. 33.3%, p=0.446). Within the VCE group, 45.8% underwent the examination due to abdominal pain with diarrhoea, followed by 25.0% with perianal disease, and 20.8% with unexplained iron deficiency anaemia. Regarding capsule findings, the ileum was mostly involved (87.5%), while the jejunum and duodenum were affected in 70.8 and 16.7% of cases, respectively. Fifteen patients had two or three segments affected. The Median Lewis score was 838 [IQR 393–1803]. Concerning the cumulative incidence of clinical outcomes over 10 years, complicated behaviour, need for biologics, and CD-related hospitalization and surgery were all significantly lower in the VCE group than in the non-VCE group (p&amp;lt;0.005). Conclusion Patients diagnosed with CD solely by VCE are rare. In this study, they exhibited different clinical characteristics and a more favourable long-term disease course compared to the general population of patients with CD. This included a lower incidence of complicated behaviour, reduced need for biologics, and CD-related hospitalization and surgery.

Identifying High Gleason Score Prostate Cancer by Prostate Fluid Metabolic Fingerprint-Based Multi-Modal Recognition.

Prostate cancer (PCa) is the second most common cancer in males worldwide. The Gleason scoring system, which classifies the pathological growth pattern of cancer, is considered one of the most important prognostic factors for PCa. Compared to indolent PCa, PCa with high Gleason score (h-GS PCa, GS ≥ 8) has greater clinical significance due to its high aggressiveness and poor prognosis. It is crucial to establish a rapid, non-invasive diagnostic modality to decipher patients with h-GS PCa as early as possible. In this study, ferric nanoparticle-assisted laser desorption/ionization mass spectrometry (FeNPALDI-MS) to extract prostate fluid metabolic fingerprint (PSF-MF) is employed and combined with the clinical features of patients, such as prostate-specific antigen (PSA), to establish a multi-modal diagnosis assisted by machine learning. This approach yields an impressive area under the curve (AUC) of 0.87 to diagnose patients with h-GS, surpassing the results of single-modal diagnosis using only PSF-MF or PSA, respectively. Additionally, using various screening methods, six key metabolites that exhibit greater diagnostic efficacy (AUC = 0.96) are identified. These findings also provide insights into related metabolic pathways, which may provide valuable information for further elucidation of the pathological mechanisms underlying h-GS PCa.

H1N1-associated Cardiomyopathy: A Case Series

Abstract H1N1 influenza, also known as swine flu, is a viral infection that can result in severe respiratory illness. However, it is essential to recognize that it can also lead to cardiac complications such as viral myocarditis, which in turn leads to dilated cardiomyopathy, heart failure, and, in some cases, sudden cardiac death. Noninvasive diagnostic modalities such as transthoracic echocardiography and cardiac magnetic resonance imaging further help in the diagnosis of cardiac complications. Early recognition and timely intervention are critical to improving outcomes in such cases. In most of these cases, just like the viral illness being self-limiting, these cardiac complications are also usually reversible with time. This case series highlights two different cases with H1N1-associated cardiomyopathy, which in turn becomes reversible on treatment.

Molecular basis for non-invasive diagnostics of cardiac amyloids using bone tracers.

Amyloid diseases including Alzheimer's, Parkinson's and over 30 others are incurable life-threatening disorders caused by abnormal protein deposition as fibrils in various organs. Cardiac amyloidosis is particularly challenging to diagnose and treat. Identification of the fibril-forming protein, which in the heart is usually amyloid transthyretin (ATTR) or amyloid immunoglobulin light chain (AL), is paramount to treatment. A transformative non-invasive diagnostic modality is imaging using technetium-labeled pyrophosphate or diphosphonate bone tracers, 99mTc-PYP/DPD/HMDP. For unknown reasons, these tracers show preferential uptake by ATTR deposits. The tracer-binding moiety is unknown and potentially involves amyloid fibrils and/or amyloid-associated calcific deposits. We propose that, like in the bone, the tracers chelate to surface-bound Ca2+ in amyloid. In high-affinity protein sites, Ca2+ is coordinated by pairs of acidic residues. To identify such residues on amyloids, we harnessed atomic structures of patient-derived cardiac amyloids determined using cryogenic electron microscopy since 2019. These structures help explain why most but not all ATTR deposits uptake 99mTc-PYP/DPD/HMDP radiotracers, while in AL the opposite is true. Moreover, fibril structures help explain greater microcalcification observed in ATTR vs. AL deposits. These findings may aid the diagnostics and therapeutic targeting of cardiac amyloidosis and are relevant to other amyloids.

Magnetic Resonance Imaging in diagnosing anterior and posterior cruciate ligament injury of knee joint with arthroscopic correlation

Anterior and posterior cruciate ligaments are the most injured of the major knee ligaments. Magnetic Resonance Imaging (MRI) knee is routinely used to diagnose or support clinical diagnosis for cruciate ligament tear before arthroscopic treatment. MRI of the knee has been regarded as the non-invasive alternative to diagnostic arthroscopy, which is regarded as the gold standard for the diagnosis of traumatic intra-articular knee injuries. A cross-sectional study was carried out in the Department of Radiology in collaboration with Orthopedics among 55 patients with clinically suspected anterior and posterior cruciate ligament injury using the purposive sampling method. MRI diagnosis of anterior and posterior cruciate ligaments tear correlated significantly well with arthroscopic diagnosis as shown by the higher validity test results with 90.91% sensitivity, 97.73% specificity, 96.36% accuracy, 90.91% positive predictive value, and 97.73% negative predictive value. The study also revealed that there is no statistically significant difference (p =0.62) between MRI and arthroscopy in the evaluation of cruciate ligament tears. Therefore, MRI is a reliable tool and non-invasive diagnostic modality in the evaluation of anterior and posterior cruciate ligament tears before surgical management of these cases.

Coronary Microvascular Dysfunction and Hypertension: A Bond More Important than We Think.

Coronary microvascular dysfunction (CMD) is a clinical entity linked with various risk factors that significantly affect cardiac morbidity and mortality. Hypertension, one of the most important, causes both functional and structural alterations in the microvasculature, promoting the occurrence and progression of microvascular angina. Endothelial dysfunction and capillary rarefaction play the most significant role in the development of CMD among patients with hypertension. CMD is also related to several hypertension-induced morphological and functional changes in the myocardium in the subclinical and early clinical stages, including left ventricular hypertrophy, interstitial myocardial fibrosis, and diastolic dysfunction. This indicates the fact that CMD, especially if associated with hypertension, is a subclinical marker of end-organ damage and heart failure, particularly that with preserved ejection fraction. This is why it is important to search for microvascular angina in every patient with hypertension and chest pain not associated with obstructive coronary artery disease. Several highly sensitive and specific non-invasive and invasive diagnostic modalities have been developed to evaluate the presence and severity of CMD and also to investigate and guide the treatment of additional complications that can affect further prognosis. This comprehensive review provides insight into the main pathophysiological mechanisms of CMD in hypertensive patients, offering an integrated diagnostic approach as well as an overview of currently available therapeutical modalities.

Comparison of non-invasive diagnostic modalities for ocular surface squamous neoplasia at a tertiary hospital, South Africa

AimsThe aim of the study is to assess non-invasive diagnostic modalities for ocular surface squamous neoplasia (OSSN) when compared to histology.MethodsA prospective case–control study was conducted of patients presenting with conjunctival masses at a tertiary eye hospital in Johannesburg, South Africa. Patients completed an interview and had three non-invasive diagnostic tests: optical coherence tomography, impression cytology and methylene blue stain. A biopsy with histology was performed as the gold standard to confirm the diagnosis.ResultsOne hundred and eighty-two conjunctival masses of 175 patients were evaluated. There were 135 lesions identified as OSSN on biopsy and 47 lesions were benign on histology. Optical coherence tomography had a sensitivity and specificity of 87.2% (95% CI: 80.0–92.5) and 75.6% (95% CI: 60.5–87.1), respectively, when an epithelial thickness cutoff of 140 um was used. Shadowing was found in 46% of cases due to leukoplakia or increased thickness of the mass. Cytology had a sensitivity of 72.4% (95% CI: 62.5–81.0) and a specificity of 74.3% (95% CI: 56.7–87.5). Twenty-seven per cent of cytology specimens were excluded from analysis due to inadequate cellularity. Methylene blue had a high sensitivity of 91.9% (95% CI: 85.9–95.9), but low specificity of 55.3% (95% CI: 40.1–69.8).ConclusionOptical coherence tomography had a high sensitivity and specificity as a non-invasive test and liquid-based cytology performed well but had a lower sensitivity and specificity than with optical coherence tomography. Methylene blue performed well as a screening test, with a high sensitivity but low specificity.

Dynamic CT Myocardial Perfusion: The Role of Functional Evaluation in the Diagnosis of Coronary Artery Disease.

Coronary computed tomography angiography (CTA) is a widely accepted, non-invasive diagnostic modality for the evaluation of patients with suspected coronary artery disease (CAD). However, a limitation of CTA is its inability to provide information on the hemodynamic significance of the coronary lesion. The recently developed stress dynamic CT perfusion technique has emerged as a potential solution to this diagnostic challenge. Dynamic CT myocardial perfusion provides information on the hemodynamic consequences of coronary stenosis and is used to detect myocardial ischemia. The combination of stress dynamic CT myocardial perfusion with CTA provides a comprehensive assessment that integrates anatomical and functional information. CT myocardial perfusion has been validated in several clinical studies and has shown comparable accuracy to Positron Emission Tomography (PET) and stress magnetic resonance imaging (MRI) in the diagnosis of hemodynamically significant coronary stenosis and superior performance to Single Photon Emission Computed Tomography (SPECT). More importantly, CTP-derived myocardial perfusion has been shown to have a strong correlation with FFR, and the use of CTP results in a reduction of negative catheterizations. In the context of suspected stable coronary artery disease, the CT protocol with dynamic perfusion imaging combined with CTA eliminates the need for additional testing, making it a convenient "one-stop-shop" method and an effective gatekeeper to an invasive approach.

Abstract 14203: Speckle Tracking Analysis During Dobutamine Stress Echocardiography in Patients Undergoing Percutaneous Coronary Intervention for Chronic Total Occlusion

Background: Dobutamine stress echocardiography (DSE) is often used as a non-invasive diagnostic modality for detection of myocardial ischemia and viability. A “biphasic response” in DSE can occur, in which contractility improves in dysfunctional segments with low dose stage and then becomes dysfunctional again at higher doses due to ischemia. We investigated if speckle tracking analysis during DSE can evaluate patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Methods: DSE was performed one day before CTO-PCI in consecutive 30 patients (18 female, age=71±11 years). Since 27 patients had 1 vessel, and 3 patients had 2 vessel CTO lesions, total of 33 regions were analyzed. Global (GLS) and regional longitudinal strain (RLS) were calculated as an averaged value of peak longitudinal strain in the apical 4-, 2-chamber, and long axis views at baseline echo, at low-dose, at high-dose DSE, and 6 months after CTO-PCI using available software (QLAB, Philips Medical Systems). Results: CTO-PCI was successfully done in all patients. GLS and RLS were feasible in all regions. Overall, GLS (-15.5±2.8 at baseline v.s. -17.3±3.8, p&lt;0.001) and left ventricular ejection fraction (LVEF) (56±6% v.s. 58±7%, p&lt;0.01) significantly improved 6 months after CTO-PCI. There was also significant improvement of RLS for the obstructed CTO regions (-13.8±3.6 v.s. -16.5±4.2, p&lt;0.005). Although in 24 patients (26 regions) with biphasic response during DSE (Figure), GLS (-15.7±2.5 v.s. -17.9±3.6, p&lt;0.01), LVEF (54±6% v.s. 56±7%, p&lt;0.05), and RLS (-13.8±3.5 v.s. -16.8±4.0, p&lt;0.01) improved significantly, GLS (-14.9±4.2 v.s. -15.8±5.0, p=n.s.), LVEF (59±3% v.s. 60±3%, p=n.s.), and RLS (-13.9±4.5 v.s. -15.5±5.7, p=n.s.) didn’t change in 6 patients (7 regions) without biphasic response. Conclusion: Speckle tracking analysis is feasible during DSE. CTO-PCI may improve both global and regional cardiac functions in patients with myocardial viability.

'Pitfalls for differentiating basal cell carcinoma from non-basal cell carcinoma on optical coherence tomography: A clinical series'.

Optical coherence tomography (OCT), a non-invasive diagnostic modality, may replace biopsy for diagnosing basal cell carcinoma (BCC) if a high-confidence BCC diagnosis can be established. In other cases, biopsy remains necessary to establish a histopathological diagnosis and treatment regimen. It is, therefore, essential that OCT assessors have a high specificity for differentiating BCC from non-BCC lesions. To establish high-confidence BCC diagnoses, specific morphological BCC characteristics on OCT are used. This study aimed to review several cases of non-BCC lesions that were misclassified as BCC by experienced OCT assessors, thereby providing insight into the causes of these misclassifications and how they may be prevented. The study population consisted of patients who had a histopathologically-verified non-BCC lesion. Patients from Maastricht University Medical Center+ from February 2021 to April 2021 were included in the study. Two independent OCT assessors assessed OCT scans. One OCT assessor recorded the presence or absence of validated morphological BCC characteristics. A false-positive OCT test result was defined as certainty of BCC presence in a non-BCC lesion. The frequency of misclassifications and the presence or absence of morphological BCC features are discussed. A total of 124 patients with non-BCC lesions were included. Six patients were misclassified by both OCT assessors and are discussed in more detail. Histopathological diagnoses were squamous cell carcinoma (n = 2/21), actinic keratosis (n = 2/29), squamous cell carcinoma insitu/Bowen's disease (n = 1/16), or interphase dermatitis (n = 1/4). In all misclassified cases, multiple, apparent morphological BCC characteristics on OCT were present. Most non-BCC lesions are recognized as such by OCT assessors. However, there remains a small risk that a high-confidence BCC diagnosis is established in non-BCC lesions wherein features mimicking validated BCC characteristics are present. Misclassification may be prevented by careful delineation of epidermal layers and good differentiation between dermal ovoid structures typical of BCC versus squamous cell carcinoma.

Chengai Nomogram: A Comprehensive Study of Uroflow Parameters and Characteristics in Healthy Adult Males From South India.

Introduction Uroflowmetry is a widely accepted non-invasive diagnostic modality used in the evaluation of lower urinary tract dysfunction. While various nomograms have been established for different populations and races, there has been a lack of studies that focus on the South Indian populations. Consequently, the objective of the study was to investigate the urinary flow parameters in a healthy adult male South Indian population using uroflowmetry and identify the variations in flow rates. Additionally, the study sought to assess the influence of age and voided volume (VV) on flow rates and create a representative nomogram. Methods A total of 500 uroflowmetry tests were prospectively performed on healthy adult males. The gravimetric method was utilized for uroflowmetry. Flow charts and parameters were analyzed for correlation and linear regression models, and statistical calculations were employed to generate uroflow nomograms. Results The mean age of the participants was 37.77±9.91 years. The mean values for maximum flow rate (Qmax), average flow rate (Qavg), and VV were 23.42±6.64 mL/s, 11.71±3.77 mL/s, and 229.90±59 mL, respectively. A significant correlation was observed between flow rates (Qmax and Qavg) and VV, which indicated that increased VV leads to higher flow rates. Additionally, a significant negative correlation between the flow rates and age was noted. Conclusion The findings provide insight into the uroflow parameters of the South Indian adult male population and contribute to the development of nomograms, establishing normal reference ranges for flow rates across varying VVs. As a tribute to the hospital and the study participants, the nomogram was named the "Chengai Nomogram."

Systematic review of errors on beta-2 transferrin gel electrophoresis testing of rhinorrhea and otorrhea.

Beta-2 transferrin (B2-Tf) gel electrophoresis (GE) is the preferred non-invasive diagnostic modality for confirming cerebrospinal fluid (CSF) in body fluids. While B2-Tf GE testing is highly sensitive and specific for CSF, false-positive (FP) and false-negative (FN) results can lead to diagnostic and therapeutic dilemmas. Several series have demonstrated potential causes of false B2-Tf GE results, but few studies have reported reasons for these errors. The purpose of this systematic review was to describe sources of B2-Tf GE errors. A systematic review was performed by searching OVID, EMBASE, and Web of Science databases for B2-Tf GE studies. After applying exclusion criteria, original research studies directly addressing erroneous B2-Tf GE results underwent qualitative analysis. Of the 243 abstracts screened, 71 underwent full-text review and 18 studies reporting B2-Tf GE errors were included for analysis. There were 15 potential FPs, 12 actual FPs, 12 potential FNs, 19 actual FNs, and 14 indeterminate results. There were also 246 potentially indeterminate results from in vitro studies. Reasons for B2-Tf GE errors included serum transferrin alterations (n=17; all potential), infection related (n=13; 9 potential), orbital or salivary contamination (n=2; 1 potential), and collection related (n=255; 246 potential). There were 31 false or indeterminate results with unspecified reasons. There were no reported errors due to laboratory processing. Multiple potential or actual reasons for false or indeterminate results have been reported for B2-Tf GE testing of rhinorrhea and otorrhea. Future studies should explore reasons for B2-Tf testing errors and how these may affect clinical decision making.

Analysis of Artificial Intelligence-Based Approaches Applied to Non-Invasive Imaging for Early Detection of Melanoma: A Systematic Review.

Melanoma, the deadliest form of skin cancer, poses a significant public health challenge worldwide. Early detection is crucial for improved patient outcomes. Non-invasive skin imaging techniques allow for improved diagnostic accuracy; however, their use is often limited due to the need for skilled practitioners trained to interpret images in a standardized fashion. Recent innovations in artificial intelligence (AI)-based techniques for skin lesion image interpretation show potential for the use of AI in the early detection of melanoma. The aim of this study was to evaluate the current state of AI-based techniques used in combination with non-invasive diagnostic imaging modalities including reflectance confocal microscopy (RCM), optical coherence tomography (OCT), and dermoscopy. We also aimed to determine whether the application of AI-based techniques can lead to improved diagnostic accuracy of melanoma. A systematic search was conducted via the Medline/PubMed, Cochrane, and Embase databases for eligible publications between 2018 and 2022. Screening methods adhered to the 2020 version of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies utilized AI-based algorithms for melanoma detection and directly addressed the review objectives. We retrieved 40 papers amongst the three databases. All studies directly comparing the performance of AI-based techniques with dermatologists reported the superior or equivalent performance of AI-based techniques in improving the detection of melanoma. In studies directly comparing algorithm performance on dermoscopy images to dermatologists, AI-based algorithms achieved a higher ROC (>80%) in the detection of melanoma. In these comparative studies using dermoscopic images, the mean algorithm sensitivity was 83.01% and the mean algorithm specificity was 85.58%. Studies evaluating machine learning in conjunction with OCT boasted accuracy of 95%, while studies evaluating RCM reported a mean accuracy rate of 82.72%. Our results demonstrate the robust potential of AI-based techniques to improve diagnostic accuracy and patient outcomes through the early identification of melanoma. Further studies are needed to assess the generalizability of these AI-based techniques across different populations and skin types, improve standardization in image processing, and further compare the performance of AI-based techniques with board-certified dermatologists to evaluate clinical applicability.

An artificial intelligence-based pipeline for automated detection and localisation of epileptic sources from magnetoencephalography.

Objective.Magnetoencephalography (MEG) is a powerful non-invasive diagnostic modality for presurgical epilepsy evaluation. However, the clinical utility of MEG mapping for localising epileptic foci is limited by its low efficiency, high labour requirements, and considerable interoperator variability. To address these obstacles, we proposed a novel artificial intelligence-based automated magnetic source imaging (AMSI) pipeline for automated detection and localisation of epileptic sources from MEG data.Approach.To expedite the analysis of clinical MEG data from patients with epilepsy and reduce human bias, we developed an autolabelling method, a deep-learning model based on convolutional neural networks and a hierarchical clustering method based on a perceptual hash algorithm, to enable the coregistration of MEG and magnetic resonance imaging, the detection and clustering of epileptic activity, and the localisation of epileptic sources in a highly automated manner. We tested the capability of the AMSI pipeline by assessing MEG data from 48 epilepsy patients.Main results.The AMSI pipeline was able to rapidly detect interictal epileptiform discharges with 93.31% ± 3.87% precision based on a 35-patient dataset (with sevenfold patientwise cross-validation) and robustly rendered accurate localisation of epileptic activity with a lobar concordance of 87.18% against interictal and ictal stereo-electroencephalography findings in a 13-patient dataset. We also showed that the AMSI pipeline accomplishes the necessary processes and delivers objective results within a much shorter time frame (∼12 min) than traditional manual processes (∼4 h).Significance.The AMSI pipeline promises to facilitate increased utilisation of MEG data in the clinical analysis of patients with epilepsy.

Time to be more efficient: reducing wasted transthoracic echocardiography (TTE) diagnostic appointment slots at Guy’s and St Thomas’ NHS Trust

Transthoracic echocardiography (TTE) is one of the most requested non-invasive cardiac imaging diagnostic modalities available in the National Health Service (NHS). There is persistently high demand, but nationally, activity has...

Diagnostic performance of transthoracic ultrasound in patients with pulmonary embolism

Abstract Background Pulmonary embolism (PE) is an acute, significant, and life-threatening condition. Transthoracic ultrasound (TUS) is one of the noninvasive diagnostic modalities that has been presented for detection of numerous chest disorders as well as PE. Objectives The goal of this work was to estimate the accuracy, sensitivity, and specificity of bedside TUS in PE detection. Patients and methods Fifty patients with moderate-to-high clinical suspicion of PE were examined by TUS. Diagnosis of PE depended on clinical suspicion and was confirmed by computed tomography pulmonary angiography. Results Most of the lesions related to PE and detected by US examination were on the right side (60%) and posterior lower lobe (70%) with predominance of A profile. Sensitivity, specificity, accuracy, negative, and positive predictive values of TUS in diagnosis of PE were 93.3, 65, 82, 86.7, and 80%, respectively. Conclusion TUS is an important diagnostic tool as a noninvasive bedside test in detecting PE principally for critically ill or unmoving patients with high sensitivity and moderate specificity.

Long-term prognostic value of stress echocardiography in patients with suspected coronary artery disease - Systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Objective To evaluate the association between results of stress echocardiography and outcomes for patients with suspected coronary artery disease. Design Systematic review and meta-analysis. Data Sources Medline, Embase, Cochrane Library for clinical trials, PubMed, Web of Science, and Clinicaltrials. Eligibility criteria for selecting studies Randomised controlled trials (RCT) evaluating long term outcome of SE in patients suspected of coronary artery disease. Data Synthesis A meta-analysis utilising the fixed effects model to evaluate evidence from recent RCT trials on SE or comparing SE to other non-invasive diagnostic modalities. The primary outcome was the composite of all-cause mortality, or cardiovascular death and non-fatal myocardial infarction. Positive SE result was defined as inducible ischaemia in at least 1 of the 16 left ventricular segments. Results Six trials fulfilled the search criteria. A total of 19477 subjects who underwent either pharmacological (Dobutamine or Dipyridamole) or treadmill SE were recruited in the meta-analysis with a median follow-up of 31 months (range 21–101). The mean age was 59 years, and 55% were male. Fifty six percent had hypertension, 48% dyslipidaemia, 33% history of smoking, 21% diabetes mellitus and 26% history of myocardial infarction. The overall annual event rate was 1.79% for the composite of all-cause mortality or cardiovascular death and non-fatal myocardial infarction and for death 1.82%. Positive SE result was associated with an increased risk of the composite outcome and death with an annual event rate of 1.98% vs 1.26%, Odds Ratio 1.99 (CI 1.75–2.26) and 3.59% vs. 0.93, Odds Ratio 2.06 (CI 1.80–2.35) for the composite outcome and death, respectively Figure A,B. Heterogeneity and inconsistency (Chi2 1.7 P= 0.89) were low. Imprecision was low in the composite outcomes, and the optimal information size was achieved across the studies. Conclusions In this meta -analysis positive SE results were associated with poorer long-term composite outcome of all-cause or cardiovascular mortality and non-fatal myocardial infarction as well as for death only. Figure. Composite of all-cause mortality or cardiovascular death and non-fatal myocardial infarction. (Abstract picture 1) All-cause or cardiovascular death. (Abstract picture 2)

Correlation of RETINAL Artery Diameter with Coronary Artery Disease: The RETINA CAD Pilot Study-Are the Eyes the Windows to the Heart?

This study aimed to determine whether there was any correlation between coronary artery disease (CAD) and retinal artery diameter at an academic tertiary medical center in Trinidad and Tobago. This prospective study evaluated patients (n = 77) with recent invasive coronary angiography (CAG) and the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score who subsequently underwent optical coherence tomography-angiography (OCT-A) at the Eric Williams Medical Sciences Complex (EWMSC) from January 2021 to March 2021. Routine medical history and cardiovascular medications were also recorded. Spearman's rank correlation coefficient and Mann-Whitney U-tests were used to compare correlations and medians between groups. The average patient age was 57.8years old, with the majority being male [n = 55 (71.4%)] and of South Asian ethnicity [n = 53 (68.8%)]. Retinal artery diameter was negatively correlated with the SYNTAX score (-0.332 for the right eye, p=0.003 and -0.237 for the left eye, p=0.038). A statistically significant relationship was also demonstrated in females and diabetic patients. There were no serious adverse events (SAEs). A significantly negative correlation was observed between retinal artery diameter and SYNTAX score. This study alludes to the practical use of optical coherence tomography-angiography (OCT-A) as a noninvasive diagnostic modality for patients with cardiovascular disease (CVD). Further large-scale, multicentric studies are required to confirm these exploratory findings. NCT04233619.

Death and Ultrasound Evidence of the Akinetic Heart in Pediatric Cardiac Arrest.

Point-of-care ultrasound (POCUS) is an expanding noninvasive diagnostic modality used for the management of patients in multiple intensive care and pediatric specialties. POCUS is used to assess cardiac activity and pathology, pulmonary disease, intravascular volume status, intra-abdominal processes, procedural guidance including vascular access, lumbar puncture, thoracentesis, paracentesis, and pericardiocentesis. POCUS has also been used to determine anterograde flow following circulatory arrest when organ donation after circulatory death is being considered. Published guidelines exist from multiple medical societies including the recent guidelines for the use of POCUS in neonatology for diagnostic and procedural purposes.