Diagnostics最新文献

{"title":"Artificial Intelligence for Thyroid Nodule Diagnosis: From Multimodal Integration to Clinical Utility.","authors":"Jie Li, Xiaofei Wang","doi":"10.3390/diagnostics16193255","DOIUrl":"10.3390/diagnostics16193255","url":null,"abstract":"<p><p>Artificial intelligence (AI) for thyroid nodules should be evaluated against the decisions it changes, not diagnostic accuracy alone. This critical narrative review examines ultrasound, cytology, histology, and molecular models and distinguishes modality-specific prediction from implemented multimodal learning. The original PubMed/MEDLINE search through 10 August 2026 was supplemented on 25 September 2026 by targeted OpenAlex searches and checks of primary publications, reporting standards, and regulatory sources. Selected studies are compared by sample size, reference standard, acquisition setting, testing design, and performance with confidence intervals where available. We explain feature concatenation, intermediate representation learning, cross-attention, and decision-level fusion, and examine whether integration improves on the strongest component. Reported gains are inconsistent, and complete-case multimodal datasets may exclude the low-risk nodules most relevant to avoiding biopsy. High discrimination for histological malignancy or occult nodal disease does not demonstrate reduced overdiagnosis, fewer operations, or improved survival. A thyroid-specific translation roadmap therefore addresses active surveillance, partial verification and spectrum bias, Hashimoto thyroiditis and multinodular disease, cytology preparation shifts, category-specific thresholds, operator dependence, reporting frameworks, and regulatory change control. The priority is a calibrated, externally tested tool using information available at a defined clinical decision, followed by prospective evaluation of patient and workflow outcomes. A unified imaging-pathology-omics system and reliable AI prediction of surveillance progression remain research objectives rather than established clinical capabilities.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Removal of a Tricuspid Valve Vegetation Using the AngioVac System in a Young Woman Who Injects Drugs.","authors":"Tomasz Skowerski, Andrzej Kułach, Marek Grabka, Piotr Pysz, Paulina Kudzia, Eliza Adamczyk-Filipek, Radosław Gocoł, Grzegorz Smolka","doi":"10.3390/diagnostics16193248","DOIUrl":"10.3390/diagnostics16193248","url":null,"abstract":"<p><p>Right-sided infective endocarditis (RSIE) is a difficult clinical problem, particularly among people who inject drugs (PWID), in whom large tricuspid vegetations may be complicated by severe regurgitation and septic pulmonary embolization. We describe a woman in her twenties with tricuspid valve infective endocarditis and bilateral cavitary pulmonary lesions consistent with septic emboli, in whom the vegetation enlarged from 18 × 11 mm to 18 × 20 mm and tricuspid regurgitation (TR) progressed from moderate to severe (vena contracta 12 mm, effective regurgitant orifice area 1.5 cm², regurgitant volume 110 mL) over ten days of empirical anti-staphylococcal therapy. Surgery was considered by an individualized Heart Team assessment of the complete clinical course, but the patient declined open-heart surgery. After multidisciplinary Heart Team discussion, transesophageal echocardiography (TEE)-guided percutaneous aspiration with the AngioVac system was undertaken as an individualized debulking and source-control strategy, not as an equivalent alternative to surgery. Under general anesthesia, bilateral femoral venous access was obtained and seven aspiration passes retrieved four large vegetation fragments, with no residual intracardiac mass on completion TEE. Culture of the aspirated material yielded <i>Serratia marcescens</i> and <i>Escherichia coli</i>, neither of which was covered by the empirical regimen, which was replaced by susceptibility-guided ciprofloxacin and co-trimoxazole; ceftazidime was added when <i>Pseudomonas aeruginosa</i> was later isolated from blood. Residual regurgitation arose from a flail, prolapsing posterior leaflet rather than from mass effect-a finding that may reflect pre-existing infective leaflet destruction, leaflet injury during aspiration, or both-and was quantitatively reduced three to four weeks after the procedure (vena contracta 6 mm, effective regurgitant orifice area 0.55 cm², regurgitant volume 36 mL); at six months it was moderate-to-severe and stable, with preserved right ventricular function (TAPSE 30 mm) and no recurrent vegetation. This case supports a potential diagnostic and therapeutic role for AngioVac-assisted debulking as an individualized adjunct in highly selected patients with RSIE who refuse surgery, with the caveat that aspiration reduces vegetation and embolic burden without correcting the underlying valvular lesion.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Critical Clock: Time-Dependent Inflammation, Catabolism and Immunosuppression Syndrome Is Associated with ICU Mortality.","authors":"Valery Likhvantsev, Levan Berikashvili, Petr Polyakov, Mikhail Yadgarov, Artem Kuzovlev, Alexey Yakovlev, Andrey Grechko","doi":"10.3390/diagnostics16193254","DOIUrl":"10.3390/diagnostics16193254","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Chronic critical illness (CCI) is increasingly recognized as a major challenge in intensive care, yet its definition remains heterogeneous. The triad of inflammation, catabolism, and immunosuppression (ICS) is central to proposed CCI pathophysiology, but the association between its changing components and prognosis has not been systematically evaluated. We examined whether the current presence of the biomarker-defined ICS syndrome was associated with ICU mortality. <b>Methods</b>: In this retrospective single-center cohort study, we analyzed 820 ICU patients from the Russian Intensive Care Dataset (RICD v3.0) who had at least one episode of the biomarker-defined ICS syndrome, operationally defined by concurrent C-reactive protein > 20 mg/L, albumin < 30 g/L, and absolute lymphocyte count < 0.8 × 10⁹/L within a 24 h period. After the index ICS syndrome event, each patient's ICU course was classified according to the current syndrome status: ICS syndrome present (all three criteria met) or ICS syndrome absent (at least one criterion not met). We compared organ dysfunction, laboratory parameters, life-support interventions, and mortality between periods with the syndrome present and absent using linear mixed-effects models, generalized estimating equations, and time-dependent Cox regression. Mortality density was calculated per 1000 patient-days. <b>Results</b>: Periods with the ICS syndrome present accounted for 5271 (22.2%) of 23,796 post-index patient-days and periods with the syndrome absent accounted for 18,525 (77.8%). Variables not used to define the syndrome showed greater contemporaneous severity while the ICS syndrome was present, including higher SOFA and SOFA-2 scores, worse neurological status, lower platelet and total protein levels, and more frequent mechanical ventilation initiation (32.8% vs. 23.6%; OR: 1.59, <i>p</i> < 0.001). The ICS syndrome was present at the time of 133 of 243 deaths (54.7%), with a mortality density of 25.23 versus 5.94 per 1000 patient-days (IRR: 4.25, 95% CI: 3.30-5.47). In time-dependent Cox regression, the current presence versus absence of the biomarker-defined ICS syndrome was associated with a higher hazard of ICU death (unadjusted HR: 4.02, 95% CI: 2.14-7.55; adjusted HR: 3.86, 95% CI: 1.86-8.02). <b>Conclusions</b>: In this cohort, the current presence of the biomarker-defined ICS syndrome was associated with substantially higher ICU mortality risk than its absence. These findings support dynamic risk assessment and closer clinical evaluation; however, the biomarker combination may partly reflect contemporaneous illness severity, and the present analysis does not establish a causal effect of syndrome presence or an independent effect of cumulative prior time with the syndrome present.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incremental Diagnostic Value of Cell-Block-Based Targeted BRAF and RAS Testing in TBSRTC Category III-IV Thyroid Nodules: A Single-Center Retrospective Study.","authors":"Cumhur Selçuk Topal, Yaşar Kemal Duymaz, Büşra Sönmez, Hanife Şeyda Genç","doi":"10.3390/diagnostics16193258","DOIUrl":"10.3390/diagnostics16193258","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Risk stratification of thyroid nodules classified as categories III-IV in The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) remains challenging. This study evaluated the incremental diagnostic value of cell-block-based targeted molecular testing beyond TBSRTC cytology within the 2023 TBSRTC and WHO 2022 frameworks. <b>Methods:</b> This retrospective study included 126 TBSRTC category III-VI thyroid fine-needle aspiration samples. BRAF exon 15 and KRAS/NRAS exons 2-4 were assessed by bidirectional Sanger sequencing; TERT testing was limited to six selected cases. Histopathology was available for 69 nodules, including 59 TBSRTC category III-IV nodules in the primary diagnostic-performance cohort. Logistic regression, ROC analysis, bootstrap correction, repeated stratified five-fold cross-validation, calibration, and exploratory decision curve analysis were performed. <b>Results:</b> BRAF/KRAS/NRAS mutations were detected in 35 of 126 nodules (27.8%). Among resected nodules, mutations occurred in 23 of 32 malignant (71.9%) and 10 of 37 benign/NIFTP cases (27.0%; <i>p</i> < 0.001); BRAF showed the strongest association with malignancy (50.0% vs. 2.7%; <i>p</i> < 0.001). In the resected cohort, combined cytology and molecular testing yielded an AUC of 0.81 versus 0.70 for cytology alone (bootstrap ΔAUC 0.10; 95% CI, 0.03-0.18). In the surgically verified, surgery-enriched TBSRTC category III-IV subgroup (<i>n</i> = 59), the combined model improved AUC from 0.65 to 0.81 (bootstrap ΔAUC 0.15; 95% CI, 0.01-0.29) and achieved 57.7% sensitivity, 90.9% specificity, 83.3% positive predictive value, and 76.3% accuracy. <b>Conclusions:</b> In the surgically verified TBSRTC category III-IV subgroup, targeted BRAF/RAS testing provided incremental rule-in information beyond cytology but had limited rule-out capability. BRAF V600E was strongly associated with malignancy, whereas non-V600 BRAF and RAS alterations required morphologic and clinical context. Negative molecular results should not be used in isolation to exclude malignancy. External validation is required.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Flow Velocity Reserve by Stress Echocardiography: The Prognostic Key of Multiple Heart Diseases.","authors":"Jorge Lowenstein","doi":"10.3390/diagnostics16193256","DOIUrl":"10.3390/diagnostics16193256","url":null,"abstract":"<p><p>Although evaluating coronary flow velocity reserve (CFVR) via stress echocardiography (SE) has been available for over three decades, its integration into routine clinical practice remains underutilized globally despite substantial technical and conceptual advances. A diminished CFVR serves as a potent predictor of major adverse cardiovascular events (MACE) and all-cause mortality across a broad spectrum of cardiovascular diseases. Its prognostic value is particularly robust in epicardial coronary artery disease, heart failure, coronary microvascular dysfunction, nonischemic cardiomyopathies, metabolic disorders (e.g., diabetes mellitus and obesity), hypertrophic cardiomyopathy, systemic autoimmune diseases, and cardiac allograft vasculopathy. This comprehensive narrative review details the technical methodology for interrogating resting and stress-induced coronary flow velocity (CFV) under physical and pharmacological protocols. Furthermore, it highlights the clinical applicability of CFVR by synthesizing single-center observational insights with evidence from large-scale multicenter registries, advocating for its broader adoption into diagnostic workflows to refine risk stratification and guide therapeutic management.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Posture-Adaptive Non-Contact Respiratory Rate Measurement Inside a Moving Ambulance Using RGB and Thermal Cameras.","authors":"Daiga Nemoto, Nozomi Takahashi, Fumitaka Mukouyama, Taka-Aki Nakada, Yukihiro Nomura, Toshiya Nakaguchi","doi":"10.3390/diagnostics16193244","DOIUrl":"10.3390/diagnostics16193244","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Monitoring and evaluating respiratory rate (RR) plays a critical role during emergency transport. Conventional RR measurement methods have primarily relied on electrocardiogram-based approaches, which are susceptible to large errors caused by patient body movement and impose a burden on patients due to their contact-based nature. This study aimed to develop a non-contact RR measurement method using RGB and thermal cameras that can be applied inside a moving ambulance. <b>Methods</b>: One of the key challenges in non-contact RR measurement inside an ambulance is accommodating changes in patient posture. We addressed this by patient posture-adaptive automatic image registration between RGB and thermal cameras and developing a nostril detection method robust to posture changes. <b>Results</b>: The image registration error of the proposed method was evaluated at various distances from the camera, and the error was confirmed to remain within 1 pixel. RR measurement experiments simulating various respiratory conditions were then conducted inside a moving ambulance. The average of mean absolute error (MAE) was 0.95, 0.59, and 2.80 breaths per minute (breaths/min) for bradypnea, normal, and tachypnea, respectively, in the supine position, and 1.08, 1.90, and 4.38 breaths/min, respectively, in the semi-sitting position. Evaluation of the proposed nostril detection method further confirmed improved RR estimation accuracy compared with the conventional method. <b>Conclusions</b>: This study achieved patient posture-adaptive automatic image registration and robust nostril detection and successfully conducted experiments under realistic and challenging conditions, representing a substantial step toward the real-world implementation of a non-contact RR measurement system in ambulances.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative 0.55 T MRI of the Infraclavicular Brachial Plexus: Topography and Neurovascular Morphometry Relevant to Infraclavicular Block.","authors":"Petar-Preslav Petrov, Delyan Dimitrov, Tanya Kitova, Pavel Timonov, Antoaneta Fasova, Darina Barbutska, Nikoleta Dimitrova, Yasen Getsov, Milena Sandeva","doi":"10.3390/diagnostics16193247","DOIUrl":"10.3390/diagnostics16193247","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Quantitative MRI data describing the infraclavicular brachial plexus cords together with both axillary vessels remain limited. This study characterized artery-centered cord topography and neurovascular morphometry on 0.55 T MRI and discussed the potential anatomical implications for infraclavicular block. <b>Methods:</b> This prospective cross-sectional imaging study included 100 adults undergoing clinically indicated MRI. One infraclavicular region was analyzed per participant. Within the mid-infraclavicular retropectoral region posterior to the pectoralis minor muscle, the axial T1-weighted image providing the clearest simultaneous visualization of the lateral cord (LC), medial cord (MC), posterior cord (PC), axillary artery (AA), and axillary vein (AV) was selected. The LC, MC, PC, and AV were mapped using a 12-sector clock-face model centered on the AA, and center-to-center intercord, cord-to-AA, and cord-to-AV distances were measured. <b>Results:</b> The LC was most frequently located at 11 o'clock (62%), the MC at 3 o'clock (41%), the PC at 6 o'clock (40%), and the AV at 2 o'clock (71.1%; n = 90). Mean intercord distances were 11.73 ± 3.17 mm (LC-MC), 11.09 ± 2.43 mm (LC-PC), and 8.13 ± 2.83 mm (MC-PC). Mean cord-to-AA distances were 6.33 ± 1.69, 7.36 ± 2.03, and 7.13 ± 1.83 mm for LC, MC, and PC, respectively. In 92 participants with complete cord-to-AV measurements, corresponding means were 17.01 ± 5.01, 9.61 ± 2.90, and 16.54 ± 3.87 mm. <b>Conclusions:</b> At the mid-infraclavicular retropectoral level, 0.55 T MRI demonstrated a structured but non-equidistant neurovascular arrangement. These imaging-derived data provide quantitative anatomical reference information but are not procedural safety margins or predictors of block success.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculous Cervical Lymphadenitis (Scrofula) Associated with Massive Pleural Effusion in an Immunocompetent Adult: A Rare Presentation of Extrapulmonary Tuberculosis Confirmed by GeneXpert MTB/RIF.","authors":"Sergiu Ioan Murg, Maria Daniela Moț, Flavius Ioan Moț, Andreea Sorina Joldea, Laura Ioana Rădoi, Florin Mihai Șandor, Ana-Liana Bouros-Tătaru, Cristina Georgiana Firu, Denis Bogdan Butari, Paula Irina Barata","doi":"10.3390/diagnostics16193249","DOIUrl":"10.3390/diagnostics16193249","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: Tuberculous cervical lymphadenitis (scrofula) is the most common form of extrapulmonary tuberculosis, although its coexistence with massive pleural effusion is uncommon and may delay diagnosis because of its nonspecific clinical presentation. We report the case of a 47-year-old man presenting with a large right-sided pleural effusion associated with a suppurative cervical lymphadenitis, in whom rapid molecular testing established the diagnosis of disseminated extrapulmonary tuberculosis. &lt;b&gt;Case Presentation&lt;/b&gt;: A 47-year-old male presented with progressive right-sided chest pain, exertional dyspnea, intermittent fever, night sweats, weight loss, and a progressively enlarging left laterocervical mass. Physical examination revealed multiple enlarged, fluctuant cervical lymph nodes and clinical signs of a massive right pleural effusion. Thoracic computed tomography demonstrated a large right pleural effusion with compressive atelectasis and enlarged cervical and mediastinal lymph nodes. Ultrasound-guided cervical lymph node drainage and tube thoracostomy were performed, followed by repeated pleural fluid evacuations through the chest tube. Purulent material obtained from the cervical abscess and pleural fluid were subjected to microbiological, cytological, and molecular investigations, including Xpert MTB/RIF (GeneXpert MTB/RIF). GeneXpert MTB/RIF detected &lt;i&gt;Mycobacterium tuberculosis&lt;/i&gt; complex in both the drained cervical purulent material and pleural fluid, with no evidence of rifampicin resistance. Conventional bacterial cultures remained negative, while mycobacterial cultures were subsequently positive for &lt;i&gt;M. tuberculosis&lt;/i&gt;. Pleural fluid analysis was consistent with an exudative lymphocytic effusion with elevated adenosine deaminase levels. Histopathological examination of the cervical tissue demonstrated necrotizing granulomatous inflammation with central caseous necrosis, epithelioid histiocytes, and Langhans-type multinucleated giant cells, supporting the diagnosis of tuberculous lymphadenitis. HIV serology was negative, and no additional immunodeficiency was identified. Standard first-line antituberculous therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) was initiated promptly following microbiological confirmation, leading to progressive regression of the cervical lesions, complete resolution of the pleural effusion, and favorable clinical evolution during follow-up. &lt;b&gt;Conclusions&lt;/b&gt;: The simultaneous occurrence of tuberculous cervical lymphadenitis and massive pleural tuberculosis represents an uncommon presentation of extrapulmonary tuberculosis that requires a high index of clinical suspicion. The combination of histopathological examination and rapid molecular testing of extrapulmonary specimens allowed definitive and timely confirmation of tuberculosis and facilitated prompt initiation of appropriate therapy. Clinicians should consider tuberculosis in patients presenting with cervical s","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of the ApoB/ApoA1 Ratio with Angiographically Documented Coronary Artery Disease: Comparison with Conventional Lipid Markers.","authors":"Tiberiu-Liviu Dragomir, Horia Silviu Branea, Minodora Andor, Ioana Mihaela Cîtu, Florina Rozina Căruntu, Monica Maria Șușan, Cristina Marinela Oprean, Raul-Tiberiu Dragomir, Răzvan Mihai Șușan, Delia Huțanu, Dan Dumitru Vulcanescu, Adriana Daniela Dragomir","doi":"10.3390/diagnostics16193245","DOIUrl":"10.3390/diagnostics16193245","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio has been proposed as an integrated marker of atherogenic and anti-atherogenic lipoprotein balance. This study assessed its association with the presence and angiographic severity of coronary artery disease (CAD) and compared its discriminatory performance with conventional lipid markers. <b>Methods</b>: This retrospective, observational, cross-sectional study included 63 adults undergoing coronary angiography for suspected or established CAD. Pre-procedural ApoB, ApoA1, and conventional lipid parameters were measured. Significant CAD was defined as ≥50% stenosis in at least one major epicardial coronary artery. Associations with angiographic severity were assessed using Gensini and SYNTAX scores. Statistical analyses included between-group comparisons, Spearman correlations, ROC analysis with DeLong comparisons, and logistic regression. <b>Results</b>: Significant CAD was present in 46 patients (73.02%). ApoB and ApoB/ApoA1 were higher in patients with significant CAD (<i>p</i> = 0.011 and <i>p</i> = 0.013), whereas ApoA1 was not (<i>p</i> = 0.101). ApoB/ApoA1 correlated weakly with Gensini score (ρ = 0.30, <i>p</i> = 0.046), but not with SYNTAX Scores I or II. In the complete-case subset (<i>n</i> = 55), ApoB/ApoA1 had an AUC of 0.68, with no significant differences versus LDL-C, HDL-C, total cholesterol, or triglycerides. Each 0.1-unit increase in ApoB/ApoA1 was associated with higher odds of significant CAD after adjustment for age, diabetes mellitus, and smoking (adjusted OR 1.63, 95% CI 1.08-2.48; <i>p</i> = 0.021). <b>Conclusions</b>: ApoB/ApoA1 was associated with significant CAD after adjustment for selected clinical variables, but this association was attenuated after additional adjustment for LDL-C. Its discriminatory performance was modest and not significantly different from conventional lipid markers, requiring further evaluation as a potential pre-angiographic risk marker.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated CMR Quantification of Pulmonary Artery Size-Based and Slow-Flow Metrics in Pulmonary Hypertension.","authors":"Khalid Alghamdi, Alireza Hokmabadi, Rob van der Geest, Pankaj Garg, Turki Alnasser, Daniel J Taylor, Michael Sharkey, Smitha Rajaram, David G Kiely, Samer Alabed, Andrew J Swift","doi":"10.3390/diagnostics16193257","DOIUrl":"10.3390/diagnostics16193257","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Pulmonary artery (PA) dilatation and slow-flow are imaging features of pulmonary hypertension (PH), but their quantitative assessment on routine cardiovascular magnetic resonance (CMR) remains limited. This study aimed to develop and evaluate an automated CMR pipeline for quantifying PA size-based and slow-flow metrics from routine white-blood (WB) and black-blood (BB) acquisitions. <b>Methods:</b> A total of 205 CMR acquisitions (106 WB and 99 BB) were used for model development and independent testing. Separate deep learning nnU-Net-based segmentation models were developed for WB and BB acquisitions using a two-stage cascaded framework. Automated measurements included PA volume and PA slow-flow. The trained models were subsequently applied to a larger cohort of 1471 patients using available WB and BB acquisitions to assess automated measurement extraction and agreement with clinical reports. <b>Results:</b> Automated PA volumetric measurements demonstrated excellent agreement with manual reference measurements for both the WB and BB models (ICC 0.94 and 0.93, respectively), with high segmentation accuracy (Dice 0.86 and 0.80, respectively). Automated slow-flow measurements also demonstrated excellent volumetric agreement (ICC 0.94), despite lower spatial overlap (Dice 0.61). Automated slow-flow classification demonstrated 83% agreement with qualitative clinical reporting (κ = 0.58). <b>Conclusions:</b> Automated PA volumetric quantification from routine CMR is feasible. Automated slow-flow quantification showed promising performance but requires validation across scanner vendors and BB acquisition protocols before broader clinical application.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}