Diagnostics最新文献

{"title":"Deep Learning-Based Prediction Model of Surgical Indication of Nasal Bone Fracture Using Waters' View.","authors":"Dong Yun Lee, Soo A Lim, Su Rak Eo","doi":"10.3390/diagnostics15182386","DOIUrl":"10.3390/diagnostics15182386","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The nasal bone is critical to both the functional integrity and esthetic contour of the facial skeleton. Nasal bone fractures constitute the most prevalent facial fracture presentation in emergency departments. The identification of these fractures and the determination of immediate intervention requirements pose significant challenges for inexperienced residents, potentially leading to oversight. <b>Methods:</b> A retrospective analysis was conducted on facial trauma patients undergoing cranial radiography (Waters' view) during initial emergency department assessment between March 2008 and July 2022. This study incorporated 2099 radiographic images. Surgical indications comprised the displacement angle, interosseous gap size, soft tissue swelling thickness, and subcutaneous emphysema. A deep learning-based artificial intelligence (AI) algorithm was designed, trained, and validated for fracture detection on radiographic images. Model performance was quantified through accuracy, precision, recall, and F1 score. Hyperparameters included the batch size (20), epochs (70), 50-layer network architecture, Adam optimizer, and initial learning rate (0.001). <b>Results:</b> The deep learning AI model employing segmentation labeling demonstrated 97.68% accuracy, 82.2% precision, 88.9% recall, and an 85.4% F1 score in nasal bone fracture identification. These outcomes informed the development of a predictive algorithm for guiding conservative versus surgical management decisions. <b>Conclusions:</b> The proposed AI-driven algorithm and criteria exhibit high diagnostic accuracy and operational efficiency in both detecting nasal bone fractures and predicting surgical indications, establishing its utility as a clinical decision-support tool in emergency settings.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"15 18","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173941","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":"Diagnostic Accuracy of Touchscreen-Based Tests for Mild Cognitive Disorders: A Systematic Review and Meta-Analysis.","authors":"Nathavy Um Din, Florian Maronnat, Bruno Oquendo, Sylvie Pariel, Carmelo Lafuente-Lafuente, Fadi Badra, Joël Belmin","doi":"10.3390/diagnostics15182383","DOIUrl":"10.3390/diagnostics15182383","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Mild neurocognitive disorder (mNCD) is a state of vulnerability, in which individuals exhibit cognitive deficits identified by cognitive testing, which do not interfere with their ability to independently perform in daily activities. New touchscreen tools had to be designed for cognitive assessment and had to be at an advanced stage of development but their clinical relevance is still unclear. We aimed to identify digital tools used in the diagnosis of mNCD and assess the diagnostic performance of these tools. <b>Methods</b>: In a systematic review, we searched 4 databases for articles (PubMed, Embase, Web of science, IEEE Xplore). From 6516 studies retrieved, we included 50 articles in the review in which a touchscreen tool was used to assess cognitive function in older adults. Study quality was assessed using the QUADAS-II scale. Data from 34 articles were appropriate for meta-analysis and were analyzed using the bivariate random-effects method (STATA software version 19). <b>Results</b>: The 50 articles in the review totaled 5974 participants and the 34 in the meta-analysis, 4500 participants. Pooled sensitivity and specificity were 0.81 (95%CI: 0.78 to 0.84) and 0.83 (95%CI: 0.79 to 0.86), respectively. High heterogeneity among the studies led us to examine test performance across key characteristics in a subgroup analysis. Tests that are short and self-administered on a touchscreen tablet perform as well as longer tests administered by an assessor or on a fixed device. <b>Conclusions</b>: Cognitive testing with a touchscreen tablet is appropriate for screening for mNCD. Further studies are needed to determine their clinical utility in screening for mNCD in primary care settings and referral to specialized care. This research received no external funding and is registered with PROSPERO under the number CRD42022358725.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"15 18","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173893","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":"First Experiences with Ultrasound-Guided Transthoracic Needle Biopsy of Small Pulmonary Nodules Using One-Lung Flooding: A Brief Report.","authors":"Thomas Lesser, Christian König, Seyed Masoud Mireskandari, Uwe Will, Frank Wolfram, Julia Gohlke","doi":"10.3390/diagnostics15182374","DOIUrl":"10.3390/diagnostics15182374","url":null,"abstract":"<p><p><b>Introduction:</b> Non-surgical biopsy is recommended for diagnosing solid pulmonary nodules measuring >8 mm when the probability of malignancy is low to moderate. However, currently available biopsy methods do not have a sufficient diagnostic yield for nodule size <20 mm. Previous work has shown that one-lung flooding (OLF) enables complete lung sonography and good demarcation of lung nodules. Therefore, here, we report the first experiences with ultrasound-guided transthoracic core needle biopsy (USgTTcNB) under OLF for the histological diagnosis of small pulmonary nodules. <b>Methods:</b> In two patients with small pulmonary nodules, a transbronchial/thoracic biopsy was not indicated due to the size and location of the nodules. Following nodule detection under OLF, the USgTTcNB was performed. The biopsy cylinder was immediately examined via the frozen section procedure. After liquid draining and re-ventilation, the patients were extubated in the operation room and monitored in the intermediate care unit. <b>Results:</b> In both patients, a histological diagnosis was achieved. In the case of malignancy, the patient underwent lobectomy during the same session. In the case of a benign diagnosis, a futile operation was avoided. In case two, a small apical pneumothorax occurred. The hemodynamic values during and after the intervention were in the normal range. Lung function on day 2 after the intervention increased compared with that before the intervention. <b>Conclusions:</b> USgTTcNB under OLF is feasible and enables a histological confirmation of small pulmonary nodules. Nevertheless, this new promising technique should be evaluated in a study with a larger cohort.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"15 18","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174119","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":"How to Perform Cardiac Contrast-Enhanced Ultrasound (cCEUS): Part II-Advanced Applications and Interpretation.","authors":"Harald Becher, Andreas Helfen, Guido Michels, Nicola Gaibazzi, Roxy Senior, Christoph Frank Dietrich","doi":"10.3390/diagnostics15182371","DOIUrl":"10.3390/diagnostics15182371","url":null,"abstract":"<p><p>Ultrasound enhancing agents (UEAs, formerly called contrast agents) have enhanced echocardiographic diagnostics of myocardial disease and masses as well as myocardial perfusion abnormalities. This review provides up-to-date guidance on the procedures and interpretations according to current recommendations of imaging societies and considering the results of recent major studies. For the different indications, a standardized approach has been created including technical aspects, pre-assessment and primary scan planes, contrast-enhanced ultrasound (CEUS) procedure, interpretation and reporting. In a previous publication (part 1) the UEAs, imaging methods, preparation of the patients and assessment of global and regional LV function with UEAs were included. The two parts represent a comprehensive state-of-the-art compendium on how to perform CEUS examinations in clinical echocardiography and provide advice on education, qualification and quality control.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"15 18","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174234","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":"Confirmation of Large Language Models in Head and Neck Cancer Staging.","authors":"Mehmet Kayaalp, Hatice Bölek, Hatime Arzu Yaşar","doi":"10.3390/diagnostics15182375","DOIUrl":"10.3390/diagnostics15182375","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Head and neck cancer (HNC) is a heterogeneous group of malignancies in which staging plays a critical role in guiding treatment and prognosis. Large language models (LLMs) such as ChatGPT, DeepSeek, and Grok have emerged as potential tools in oncology, yet their clinical applicability in staging remains unclear. This study aimed to evaluate the accuracy and concordance of LLMs compared to clinician-assigned staging in patients with HNC. <b>Methods</b>: The medical records of 202 patients with HNC, who presented to our center between 1 January 2010 and 13 February 2025, were retrospectively reviewed. The information obtained from the hospital information system by a junior researcher was re-evaluated by a senior researcher, and standard staging was completed. Except for the stage itself, the data used for staging were provided to a blinded third researcher, who then entered them into the ChatGPT, DeepSeek, and Grok applications with a staging command. After all staging processes were completed, the data were compiled, and clinician-assigned stages were compared with those generated by the LLMs. <b>Results</b>: The majority of the patients had laryngeal (45.5%) and nasopharyngeal cancer (21.3%). Definitive surgery was performed in 39.6% of the patients. Stage 4 was the most common stage among the patients (54%). The overall concordance rates, Cohen's kappa values, and F1 scores were 85.6%, 0.797, and 0.84 for ChatGPT; 67.3%, 0.522, and 0.65 for DeepSeek; and 75.2%, 0.614, and 0.72 for Grok, respectively, with no statistically significant differences between models. Pathological and surgical staging were found to be similar in terms of concordance. The concordance of assessments utilizing only imaging, only pathology notes, only physical examination notes, and comprehensive information was evaluated, revealing no significant differences. <b>Conclusions</b>: Large language models (LLMs) demonstrate relatively high accuracy in staging HNC. With careful implementation and with the consideration of prospective studies, these models have the potential to become valuable tools in oncology practice.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"15 18","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174158","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":"From Detection to Decision: T-Score-Guided Use of STIR MRI After CT in Vertebral Fractures.","authors":"Lior Yehuda Fitoussi, Árpád Viola, Siran Aslan, Réka Viola, Viktor Foglar, Mohammad Walid Al-Smadi","doi":"10.3390/diagnostics15182370","DOIUrl":"10.3390/diagnostics15182370","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Vertebral fractures are frequently underdiagnosed after minor trauma in patients with normal or mildly reduced bone mineral density (BMD). CT, the standard first-line imaging, may miss subtle fractures, while STIR MRI is more sensitive but not routinely applied. We evaluated whether DEXA-derived T-scores can guide selective use of STIR MRI in patients > 50 years. <b>Methods:</b> We retrospectively analyzed 214 patients who underwent CT, sagittal whole-spine STIR MRI, and DEXA within 48 h after minor trauma. Fracture counts were compared using the Wilcoxon signed-rank test. Spearman's correlation examined associations between T-score and fracture counts. Subgroups were defined as normal (≥-1), osteopenia (-2.5 < T-score < -1), osteoporosis (-3.5 < T-score ≤ -2.5), and high-risk osteoporosis (≤-3.5). <b>Results:</b> STIR MRI identified more fractures than CT in 87 patients (40.7%), while CT detected more in 19 (8.9%) (<i>p</i> < 0.0001). MRI outperformed CT across all T-score categories. The osteopenia group had the highest number of additional fractures (<i>n</i> = 53), and even patients with normal BMD showed a notable yield (<i>n</i> = 36). Correlations between T-score and fracture counts were weak and not statistically significant. <b>Conclusions:</b> T-score can support imaging triage but should not be used as a strict threshold. STIR MRI is justified in patients with T-scores < -2.5 when clinical suspicion exists and should be considered in those with higher T-scores if CT is negative but symptoms persist. Integrating T-score into imaging protocols may reduce missed fractures and improve outcomes.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"15 18","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174085","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":"Squamous Cell Carcinoma of the Nail Unit: A Comprehensive Review of Clinical Features, Diagnostic Workflow, Management Strategies and Therapeutic Options.","authors":"Federico Venturi, Elisabetta Magnaterra, Biagio Scotti, Aurora Alessandrini, Leonardo Veneziano, Sabina Vaccari, Carlotta Baraldi, Emi Dika","doi":"10.3390/diagnostics15182378","DOIUrl":"10.3390/diagnostics15182378","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Squamous cell carcinoma of the nail unit (SCCNU) is a rare yet often underrecognized malignancy that can lead to delayed diagnosis and significant functional morbidity. This review aims to comprehensively summarize the current understanding of SCCNU, focusing on its clinical, dermoscopic, and molecular features, diagnostic approaches, and evolving management strategies, including the role of emerging technologies and immunotherapy. <b>Methods:</b> A detailed literature review was conducted using peer-reviewed publications, case series, and institutional guidelines related to SCCNU. Emphasis was placed on studies addressing clinical presentation, dermoscopic patterns, molecular pathology, histologic subtypes, imaging, biopsy techniques, staging systems, and both conventional and novel therapeutic approaches. Comparative analyses of histopathological variants and diagnostic algorithms were included. <b>Results:</b> SCCNU presents in patients with diverse clinical manifestations, often mimicking benign nail disorders, leading to diagnostic delays. Dermoscopy improves lesion visualization, revealing features such as vascular changes and onycholysis. Histologically, SCCNU exhibits two main subtypes: basaloid (HPV-related) and keratinizing (HPV-negative) types. Molecular analyses have identified TP53 as the most frequently mutated gene, with additional alterations in HRAS, BRAF, and TERT. Imaging modalities such as MRI and LC-OCT aid in staging and surgical planning. Management is centered on complete excision-often via Mohs micrographic surgery-while topical, intralesional, and HPV-directed therapies are under investigation. Immunohistochemical markers (p16, Ki-67, AE1/AE3) and neoadjuvant immunotherapy represent promising adjuncts. <b>Conclusions:</b> Early diagnosis through non-invasive imaging, improved molecular characterization, and personalized treatment strategies are essential to advancing care in SCCNU. Future directions include clinical trials evaluating immunotherapy, vaccine strategies, and precision-guided surgical approaches to preserve function and minimize recurrence.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"15 18","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174095","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":"Diagnostic Power of the Fibrinogen-to-Albumin Ratio for Estimating Malignancy in Patients with Adnexal Masses: A Methodological Study.","authors":"Gözde Şahin, Ayşe HazırBulan, Hatice Argun Atalmış, İlkbal Temel Yüksel, Işık Sözen, Alper Koçbıyık, Nilüfer Çetinkaya Kocadal, İsmet Alkış","doi":"10.3390/diagnostics15182372","DOIUrl":"10.3390/diagnostics15182372","url":null,"abstract":"<p><p><b>Background</b>: Adnexal masses are common in women across different age and hormonal states: pregnancy, premenopause, and postmenopause. Ovarian carcinoma, a malignancy arising in the adnexa, poses significant health risks. While malignancy risk increases with age and postmenopausal status, current methods for stratifying borderline cases remain inadequate, potentially leading to over- or undertreatment that may affect fertility or survival. <b>Methods</b>: This retrospective study was conducted with 318 adult women who were diagnosed with adnexal masses and underwent surgery at a university hospital between 2020 and November 2023. Patient data were retrieved from the hospital's electronic medical record system. Routinely measured preoperative serologic parameters-carbohydrate antigen (CA)125, CA19-9, CA15-3, carcinoembryonic antigen (CEA), Alpha-fetoprotein (AFP), Lactate dehydrogenase (LDH), and fibrinogen-to-albumin ratio (FAR) levels-were analyzed alongside final histopathological results. No procedures outside routine clinical practice were performed. Diagnostic performance of each marker was evaluated using receiver operating curve (ROC) analysis. <b>Results:</b> A total of 318 patients with adnexal masses were analyzed. The FAR levels were significantly elevated in malignant compared to borderline and benign groups (<i>p</i> < 0.001), and FAR alone showed 47% sensitivity and 91% specificity for borderline tumors, whereas CA125 showed 70% sensitivity and 85% specificity. Multivariate models combining FAR, CA125, and CA15-3 achieved the highest diagnostic accuracy, with superior AUCs compared to single biomarkers. <b>Conclusions</b>: FAR is a simple, accessible inflammatory marker that complements CA125 by enhancing specificity. Combination of multiple markers with the highest sensitivity and specificity, together with FAR, may reduce the risk of both false negatives, offering a more balanced and accurate diagnostic tool for preoperative stratification of borderline tumor cases.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"15 18","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173961","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":"Monitoring the Biological Impact and Therapeutic Potential of Intermittent Fasting in Oncology: Assessing Strategies and Clinical Translational Challenges.","authors":"Maria Bendykowska, Grażyna Gromadzka","doi":"10.3390/diagnostics15182369","DOIUrl":"10.3390/diagnostics15182369","url":null,"abstract":"<p><p><b>Background:</b> Intermittent fasting (IF) is emerging as a promising non-pharmacological intervention in oncology, with the potential to modulate key biological processes including metabolic reprogramming, inflammation, autophagy, and immune function, particularly through the PI3K/AKT/mTOR pathway. However, translating IF into clinical practice requires robust tools to monitor its biological impact and therapeutic effectiveness. <b>Objective:</b> This narrative review aims to present and critically evaluate current diagnostic and monitoring strategies that can support the safe and effective integration of IF into oncological care. Methods: A comprehensive literature search was conducted across PubMed/Medline, Science Direct, Scopus, Wiley Online Library, and Google Scholar using a combination of free-text and MeSH terms related to intermittent fasting, oncology, biomarkers, immunophenotyping, metabolic pathways, gut microbiome, and diagnostic imaging. <b>Results:</b> Two principal categories of monitoring objectives were identified. The first-mechanistic monitoring-focuses on elucidating IF-induced biological effects, including modulation of insulin/IGF-1 signaling, oxidative stress reduction, autophagy activation, immune reprogramming, and microbiome alterations. Advanced research tools such as single-cell RNA sequencing, proteomics, metabolomics, and circulating tumor DNA (ctDNA) assays offer high-resolution insights but currently remain limited to preclinical or translational settings due to cost and complexity. The second-clinical response monitoring-assesses IF's impact on treatment outcomes, including chemotherapy and immunotherapy response, toxicity reduction, tumor dynamics, and maintenance of nutritional and functional status. This requires clinically validated, accessible, and interpretable diagnostic tools. <b>Conclusions:</b> A dual-layered monitoring framework that integrates both mechanistic insights and clinical applicability is essential for the personalized implementation of IF in oncology. Although preliminary findings are promising, large-scale randomized trials with standardized protocols are necessary to confirm the efficacy, safety, and feasibility of IF in routine oncological care. The integration of IF with modern diagnostics may ultimately contribute to a more individualized, biologically informed cancer treatment paradigm.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"15 18","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173924","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":"Heterotopic Cesarean Scar Pregnancy: A Systematic Review of Diagnosis, Management and Prognosis.","authors":"Maria Sidonia Săndulescu, Andreea Veliscu Carp, Sidonia Cătălina Vrabie, Siminel Anișoara, Anca Vulcănescu, Marin Mihaela, Iliescu Dominic, Ștefan Pătrașcu, Lorena Dijmărescu, Maria Magdalena Manolea","doi":"10.3390/diagnostics15182373","DOIUrl":"10.3390/diagnostics15182373","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Heterotopic cesarean scar pregnancy (HCSP) is an exceptionally rare and potentially life-threatening form of ectopic pregnancy, characterized by the coexistence of a viable intrauterine pregnancy and an ectopic implantation within a previous cesarean section scar. Its incidence has risen in recent years, primarily due to the increased rate of cesarean deliveries and the widespread use of assisted reproductive technologies (ART). This systematic review aims to provide a comprehensive synthesis of published evidence on HCSP, with a focus on epidemiology, diagnostic challenges, therapeutic strategies, complications, and maternal-fetal outcomes. <b>Methods:</b> A systematic literature search was conducted in PubMed, Scopus, and Web of Science up to May 2025, in accordance with PRISMA guidelines. Included studies comprised case reports, case series and retrospective reviews documenting confirmed HCSP cases. Data were extracted on clinical presentation, imaging, treatment approaches, outcomes, and complications. <b>Results:</b> Thirty studies reporting 40 confirmed HCSP cases were included. Transvaginal ultrasonography was the primary diagnostic tool, although diagnosis was often delayed by the presence of a viable intrauterine pregnancy. Management strategies included surgical intervention, local medical therapy and conservative approaches or expectant management. Maternal complications included hemorrhage and uterine rupture, while fetal outcomes were variable. In selected cases, intrauterine pregnancy continued to term. <b>Conclusions:</b> HCSP is a rare but high-risk obstetric entity requiring early recognition and multidisciplinary management. Prompt ultrasound-based diagnosis and individualized treatment can significantly reduce maternal morbidity and improve fetal outcomes. Further multicenter studies are warranted to establish standardized diagnostic and management protocols.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"15 18","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174256","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}