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BackgroundQRS transition criteria during dynamic manoeuvers are the gold-standard for non-invasive confirmation of left bundle branch (LBB) capture, but they are seen in 44 ms criterion was more frequently achieved in ns-LBBP morphologies obtained during lead screwing-in compared to those obtained during dynamic manoeuvres (70.5% vs. 50%, respectively p = 0.036).ConclusionsDuring LBBAP procedure, QRS transition from LVSP to ns-LBBP can be observed as the lead penetrates deep into the IVS with interrupted pacemapping. Shortening of at least 10 ms in paced V6-RWPT may serve as marker of LBB capture.

Background: Multiparametric magnetic resonance imaging (MP-MRI) has high sensitivity for diagnosing breast cancers but cannot always be used as a routine diagnostic tool. The present study aimed to evaluate whether the diagnostic performance of perfluorobutane (PFB) contrast-enhanced ultrasound (CEUS) is similar to that of MP-MRI in breast cancer and whether combining the two methods would enhance diagnostic efficiency. Patients and methods: This was a head-to-head, prospective, multicenter study. Patients with breast lesions diagnosed by US as Breast Imaging Reporting and Data System (BI-RADS) categories 3, 4, and 5 underwent both PFB-CEUS and MP-MRI scans. On-site operators and three reviewers categorized the BI-RADS of all lesions on two images. Logistic-bootstrap 1000-sample analysis and cross-validation were used to construct PFB-CEUS, MP-MRI, and hybrid (PFB-CEUS + MP-MRI) models to distinguish breast lesions. Results: In total, 179 women with 186 breast lesions were evaluated from 17 centers in China. The area under the receiver operating characteristic curve (AUC) for the PFB-CEUS model to diagnose breast cancer (0.89; 95% confidence interval [CI] 0.74, 0.97) was similar to that of the MP-MRI model (0.89; 95% CI 0.73, 0.97) (P = 0.85). The AUC of the hybrid model (0.92, 95% CI 0.77, 0.98) did not show a statistical advantage over the PFB-CEUS and MP-MRI models (P = 0.29 and 0.40, respectively). However, 90.3% false-positive and 66.7% false-negative results of PFB-CEUS radiologists and 90.5% false-positive and 42.8% false-negative results of MP-MRI radiologists could be corrected by the hybrid model. Three dynamic nomograms of PFB-CEUS, MP-MRI and hybrid models to diagnose breast cancer are freely available online. Conclusions: PFB-CEUS can be used in the differential diagnosis of breast cancer with comparable performance to MP-MRI and with less time consumption. Using PFB-CEUS and MP-MRI as joint diagnostics could further strengthen the diagnostic ability. Trial registration Clinicaltrials.gov; NCT04657328. Registered 26 September 2020. IRB number 2020-300 was approved in Chinese PLA General Hospital. Every patient signed a written informed consent form in each center. [ABSTRACT FROM AUTHOR]

Purpose: Ultrasound (US) is the first choice in the detection of thyroid nodules in pediatric and adult patients. The purpose of this study was to evaluate the diagnostic performance of adult-based US risk stratification systems (RSSs) when applied to the pediatric population. Methods: Medline, Embase, and Cochrane Library (CENTRAL) were searched up to 5 March 2023 for studies about the diagnostic performance of adult-based US RSS in pediatric patients. The pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, and diagnostic odds ratio (DOR) were calculated. The summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were also analyzed. Results: The sensitivity was highest in American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) category 4–5 and American Thyroid Association RSS high-intermediate risk (ATA), which was 0.84 [0.79, 0.88] and 0.84 [0.75, 0.90], respectively. The specificity was highest in ACR-TIRADS category 5 and Europe-TIRADS (EU-TIRADS) category 5, which was 0.93 [0.83, 0.97] and 0.93 [0.88, 0.98], respectively. The ACR-TIRADS, ATA, and EU-TIRADS showed moderate diagnostic performance in pediatric thyroid nodule patients. For Korea-TIRADS (K-TRADS) category 5, the summary sensitivity and specificity with a 95% CI were 0.64 [0.40, 0.83] and 0.84 [0.38, 0.99], respectively. Conclusions: In conclusion, the ACR-TIRADS, ATA, and EU-TIRADS have moderate diagnostic performance in pediatric thyroid nodule patients. The diagnostic efficacy of the K-TIRADS was not as high as expected. However, the diagnostic performance of Kwak-TIRADS was uncertain because of the small sample size and small number of studies included. More studies are needed to evaluate these adult-based RSSs in pediatric patients with thyroid nodules. RSSs specific for pediatric thyroid nodules and thyroid malignancies were necessary. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic performance and cost‐effectiveness of calcitonin assays in fine‐needle aspiration washout fluid (FNA‐CT) compared to fine‐needle aspiration cytology (FNAC) for medullary thyroid carcinoma (MTC). Methods: A total of 27,404 patients from three medical centres between January 2020 and May 2022 were screened for serum calcitonin (sCT). Of whom, 223 patients met endpoints and were enroled for analyses. Based on sCT levels, patients were divided into two groups (group 1: 10 pg/ml< sCT ≤100 pg/ml and group 2: sCT > 100 pg/ml). The diagnostic performance and cost‐effectiveness of FNA‐CT and FNAC were compared. Results: Most patients (N = 25,228; 92.1%) with thyroid nodules had normal sCT levels. In group 1, 24 and 167 nodules were diagnosed as MTC and non‐MTC lesions, respectively. FNA‐CT showed better performance in diagnosing MTC than FNAC in terms of sensitivity (100.0% vs. 58.3%), negative predictive value (100.0% vs. 94.3%), and overall accuracy (100.0% vs. 94.7%). In group 2, 67 and 7 nodules were diagnosed as MTC and non‐MTC lesions, respectively. The diagnostic performance of FNA‐CT was superior to FNAC in terms of sensitivity (100.0% vs. 64.2%), negative predictive value (100.0% vs. 22.6%), and overall accuracy (100.0% vs. 67.6%). Furthermore, analysis from the decision tree model showed that FNA‐CT was a cost‐effective tool for diagnosing MTC lesions. Conclusions: FNA‐CT can serve as an auxiliary and cost‐effective approach for patients with indeterminate sCT levels to detect occult MTC lesions. FNA‐CT can be recommended for patients with sCT >100 pg/ml to overcome the high false‐negative rate of FNAC. [ABSTRACT FROM AUTHOR]

Background: The use of supine reference intervals instead of the corresponding seated reference intervals for seated plasma-free metanephrines (MNs) in pheochromocytoma/paraganglioma (PPGL) screening has been controversial in recent years. Each clinical laboratory should choose the optimal sampling posture and diagnostic strategy according to local conditions. Methods: The reference population consisted of 736 cases aged 14–92 years old and the validation population consisted of 1068 patients aged 8–87 years old. Seated MNs were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and the reference intervals and diagnostic cut-off values were established and the diagnostic performance compared with reference intervals established in a supine position. Results: There was no correlation between seated plasma MNs and age (p > 0.05) and there were differences in MNs among the various disease groups (p < 0.05). MNs were different in gender (p < 0.0001). The upper reference limit (URL) established in this study had the same sensitivity (100%) and better specificity (94.6% vs 83.5%) compared with the published age-adjusted supine reference intervals. The proportion of suspected patients with MNs within the URL-2×URL range was lower using seated reference intervals compared to supine intervals (5.3% vs 15.7%). Conclusion: Using the corresponding seated reference intervals for seated plasma MNs can reduce the unnecessary re-examinations of suspected patients with slightly elevated MNs. The cut-off value established by seated plasma MNs has good diagnostic performance in PPGL. Use of seated sampling is an acceptable practice and is more convenient and economical than supine sampling. [ABSTRACT FROM AUTHOR]

To explore the diagnostic performance of routine magnetic resonance imaging (MRI) for the cross-sectional assessment of osteophytes (OPs) in all three knee compartments using computed tomography (CT) as a reference standard. The Strontium Ranelate Efficacy in Knee Osteoarthritis (SEKOIA) trial explored the effect of 3 years of treatment with strontium ranelate in patients with primary knee OA. OPs were scored for the baseline visit only using a modified MRI Osteoarthritis Knee Score (MOAKS) scoring system in the patellofemoral (PFJ), the medial tibiofemoral (TFJ) and the lateral TFJ. Size was assessed from 0 to 3 in 18 locations. Descriptive statistics were used to describe differences in ordinal grading between CT and MRI. In addition, weighted-kappa statistics were employed to assess agreement between scoring using the two methods. Sensitivity, specificity, positive predictive value and negative predictive value as well as area under the curve (AUC) measures of diagnostic performance were employed using CT as the reference standard. Included were 74 patients with available MRI and CT data. Mean age was 62.9 ± 7.5 years. Altogether 1,332 locations were evaluated. For the PFJ, MRI detected 141 (72%) of 197 CT-defined OPs with a w-kappa of 0.58 (95% CI [0.52–0.65]). In the medial TFJ, MRI detected 178 (81%) of 219 CT-OPs with a w-kappa of 0.58 (95% CI [0.51–0.64]). For the lateral compartment these numbers were 84 (70%) of 120 CT-OPs with a w-kappa of 0.58 (95% CI [0.50–0.66]). MRI underestimates presence of osteophytes in all three knee compartments. CT may be helpful particularly regarding assessment of small osteophytes particularly in early disease. [ABSTRACT FROM AUTHOR]

• Diagnosing of health problems with e-devices is an effective means among the elderly. • The overall diagnostic performance of ECG-based index tests was better than VS-based ones. • Multiple signals detection system (combining ECG, VS or PA) was a better and more promising way for diagnosing different kinds of health problems. The aim of this review was to evaluate the overall diagnostic performance of e-devices for detection of health problems in older adults at home. A systematic review was conducted following the PRISMA-DTA guidelines. 31 studies were included with 24 studies included in meta-analysis. The included studies were divided into four categories according to the signals detected: physical activity (PA), vital signs (VS), electrocardiography (ECG) and other. The meta-analysis showed the pooled estimates of sensitivity and specificity were 0.94 and 0.98 respectively in the 'VS' group. The pooled sensitivity and specificity were 0.97 and 0.98 respectively in the 'ECG' group. All kinds of e-devices perform well in diagnosing the common health problems. While ECG-based health problems detection system is more reliable than VS-based ones. For sole signal detection system has limitation in diagnosing specific health problems, more researches should focus on developing new systems combined of multiple signals. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) core antigen (HCVcAg) assay is an alternative for diagnosing HCV infection in a single step. This meta‐analysis aimed to evaluate the Abbott ARCHITECT HCV Ag assay's diagnostic performance (validity and utility) for diagnosing active hepatitis C. PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library were searched until 10 January 2023. The protocol was registered at the prospective international register of systematic reviews (PROSPERO: CRD42022337191). Abbott ARCHITECT HCV Ag assay was the test for evaluation, and nucleic acid amplification tests with a cut‐off ≤50 IU/mL were the gold standard. Statistical analysis was performed using STATA with the MIDAS module and random‐effects models. The bivariate analysis was conducted on 46 studies (18,116 samples). The pooled sensitivity was 0.96 (95% CI = 0.94–0.97), specificity 0.99 (95% CI = 0.99–1.00), positive likelihood ratio 141.81 (95% CI = 72.39–277.79), and negative likelihood ratio 0.04 (95% CI = 0.03–0.06). The area under the summary receiver operating characteristic curve was 1.00 (95% CI = 0.34–1.00). For active hepatitis C prevalence values of 0.1%–15%, the probability that a positive test was a true positive was 12%–96%, respectively, indicating that a confirmatory test should be necessary, particularly with a prevalence ≤5%. However, the probability that a negative test was a false negative was close to zero, indicating the absence of HCV infection. The validity (accuracy) of the Abbott ARCHITECT HCV Ag assay for screening active HCV infection in serum/plasma samples was excellent. Although the HCVcAg assay showed limited diagnostic utility in low prevalence settings (≤1%), it might help diagnose hepatitis C in high prevalence scenarios (≥5%). [ABSTRACT FROM AUTHOR]

Copyright of Ahi Evran Medical Journal is the property of Ahi Evran University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: To evaluate the value of a deep learning-based computer-aided diagnostic system (DL-CAD) in improving the diagnostic performance of acute rib fractures in patients with chest trauma. Materials and methods: CT images of 214 patients with acute blunt chest trauma were retrospectively analyzed by two interns and two attending radiologists independently firstly and then with the assistance of a DL-CAD one month later, in a blinded and randomized manner. The consensusdiagnosis of fib fracture by another two senior thoracic radiologists was regarded as reference standard. The rib fracture diagnostic sensitivity, specificity, positive predictive value, diagnostic confidence and mean reading time with and without DL-CAD were calculated and compared. Results: There were 680 rib fracture lesions confirmed as reference standard among all patients. The diagnostic sensitivity and positive predictive value of interns weresignificantly improved from (68.82%, 84.50%) to (91.76%, 93.17%) with the assistance of DL-CAD, respectively. Diagnostic sensitivity and positive predictive value of attendings aided by DL-CAD (94.56%, 95.67%) or not aided (86.47%, 93.83%), respectively. In addition, when radiologists were assisted by DL-CAD, the mean reading time was significantly reduced, and diagnostic confidence was significantly enhanced. Conclusions: DL-CAD improves the diagnostic performance of acute rib fracture in chest trauma patients, which increases the diagnostic confidence, sensitivity, and positive predictive value for radiologists. DL-CAD can advance the diagnostic consistency of radiologists with different experiences. [ABSTRACT FROM AUTHOR]

Background: The incidence of cryptococcosis amongst HIV-negative persons is increasing. Whilst the excellent performance of the CrAg testing in people living with HIV is well described, the diagnostic performance of the CrAg LFA has not been systematically evaluated in HIV-negative cohorts on serum or cerebrospinal fluid. Methods: We performed a systematic review to characterise the diagnostic performance of IMMY CrAg® LFA in HIV-negative populations on serum and cerebrospinal fluid. A systematic electronic search was performed using Medline, Embase, Global Health, CENTRAL, WoS Science Citation Index, SCOPUS, Africa-Wide Information, LILACS and WHO Global Health Library. Studies were screened and data extracted from eligible studies by two independent reviewers. A fixed effect meta-analysis was used to estimate the diagnostic sensitivity and specificity. Results: Of 447 records assessed for eligibility, nine studies met our inclusion criteria, including 528 participants overall. Amongst eight studies that evaluated the diagnostic performance of the IMMY CrAg® LFA on serum, the pooled median sensitivity was 96% (95% Credible Interval (CrI) 68–100%) with a pooled specificity estimate of 96% (95%CrI 84–100%). Amongst six studies which evaluated the diagnostic performance of IMMY CrAg® LFA on CSF, the pooled median sensitivity was 99% (95%CrI 95–100%) with a pooled specificity median of 99% (95%CrI 95–100%). Conclusions: This review demonstrates a high pooled sensitivity and specificity for the IMMY CrAg® LFA in HIV-negative populations, in keeping with findings in HIV-positive individuals. The review was limited by the small number of studies. Further studies using IMMY CrAg® LFA in HIV-negative populations would help to better determine the diagnostic value of this test. [ABSTRACT FROM AUTHOR]

Aim/Purpose: Fibroblast activation protein (FAP) is overexpressed by cancer-associated fibroblasts. However, activated fibroblasts have been shown to play a significant role also in certain benign conditions such as wound healing or chronic inflammation. Therefore, the current study aimed to identify whether FAPI uptake might differ between malignant lesions and benign conditions. Material and Methods: We retrospectively analyzed 155 patients with various cancer types who received [68 Ga]-FAPI-04/02-PET/CT between July 2017 and March 2020. SUVmax, SUVmean, and lesion-to-background ratios (LBR) of FAPI uptake were measured in benign processes compared to malignant lesions (primary and/or 2 exemplary metastases). In addition, receiver operating characteristic (ROC) curve analysis was conducted to compare the predictive capabilities of semiquantitative PET/CT parameters. Furthermore, the sensitivity, specificity, optimal cutoff value, and 95% confidence interval (CI) were determined for each parameter. Results: Benign lesions exhibited significantly lower FAPI uptake compared to malignant lesions (mean SUVmax benign vs. malignant: 4.2 vs. 10.6; p < 0.001). In ROC analysis, cutoff values of these lesions (benign vs. malignant) were established based on SUVmax, SUVmean, and LBR. The SUVmax cutoff value for all lesions was 5.5 and the corresponding sensitivity, specificity, accuracy, and AUC were 78.8%, 85.1%, 82.0%, and 0.89%, respectively. Conclusion: Our aim was to systematically analyze the pattern of FAPI uptake in benign and malignant processes. This investigation demonstrates that FAPI uptake might be useful to differentiate malignant and benign findings due to different patho-physiological origins. [ABSTRACT FROM AUTHOR]

Planar whole-body bone scanning (WBS) is widely used to evaluate skeletal lesions seen in cancer and noncancer cases. Frequently, degenerative, or other benign bony changes may give rise to indeterminate lesions that mimic bone metastases. In the post-COVID-19 era, there is an evolutionary phase that puts importance on global development and adaptability, which encompasses to include nuclear medicine practices worldwide. Single-photon emission computed tomography/computed tomography (SPECT/CT) can be used to improve the characterization of these lesions and help to resolve the diagnostic conundrum while reducing the need for patients to undergo multiple different examinations at various imaging departments. The fusion of SPECT and CT allows morphological characterization of functional abnormality detected by focal tracer uptake on planar scintigraphy, which provides a one-stop center imaging in nuclear medicine departments. The objective of this study was to review the diagnostic accuracy of SPECT/CT in diagnosing bone metastases in a variety of oncology and nononcology cases and to determine the feasibility of performing bone SPECT/CT in all suspected cancer cases, including cases of bone infection instead of planar imaging alone. The utilization of hybrid SPECT/CT in indeterminate bone lesions detected on planar WBS can significantly increase the diagnostic confidence and accuracy of image interpretation. Recognition of patterns of disease identified using hybrid imaging can improve the management of patients with potentially lower costs in the long term. Currently, hybrid SPECT/CT machines are becoming a norm in nuclear medicine departments, thus potentially making single planar application machines obsolete in the near future. We hypothesize that in the interest of providing a meaningful interpretation of isotope bone scans, the default protocol should involve the option of acquiring SPECT/CT images rather than relying on whole-body scans only. Departments choosing to upgrade existing equipment or those choosing to invest in only one gamma camera should proactively opt for hybrid SPECT/CT systems. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the added value of spectral parameters derived from dual-layer spectral detector CT (SDCT) in diagnosing metastatic lymph nodes (LNs) of pT1-2 (stage 1–2 determined by pathology) rectal cancer. Methods: A total of 80 LNs (57 non-metastatic LNs and 23 metastatic LNs) from 42 patients with pT1-T2 rectal cancer were retrospectively analyzed. The short-axis diameter of LNs was measured, then its border and enhancement homogeneity were evaluated. All spectral parameters, including iodine concentration (IC), effective atomic number (Zeff), normalized IC (nIC), normalized Zeff (nZeff), and slope of the attenuation curve (λ), were measured or calculated. The chi-square test, Fisher's exact test, independent-samples t-test, or Mann–Whitney U test was used to compare the differences of each parameter between the non-metastatic group and the metastatic group. Multivariable logistic regression analyses were used to determine the independent factors for predicting LN metastasis. Diagnostic performances were assessed by ROC curve analysis and compared with the DeLong test. Results: The short-axis diameter, border, enhancement homogeneity, and each spectral parameter of LNs showed significant differences between the two groups (P < 0.05). The nZeff and short-axis diameter were independent predictors of metastatic LNs (P < 0.05), with areas under the curve (AUC) of 0.870 and 0.772, sensitivity of 82.5% and 73.9%, and specificity of 82.6% and 78.9%. After combining nZeff and the short-axis diameter, the AUC (0.966) was the highest with sensitivity of 100% and specificity of 87.7%. Conclusion: The spectral parameters derived from SDCT might help us to improve the diagnostic accuracy of metastatic LNs in patients with pT1-2 rectal cancer, the highest diagnostic performance can be achieved after combining nZeff with the short-axis diameter of LNs. [ABSTRACT FROM AUTHOR]

To assess and compare reader performance in interpreting digital periapical (PA) radiography and cone beam computed tomography (CBCT) in endodontic disease detection, using a free-response, factorial model. A reader performance study of 2 image test sets was undertaken using a factorial, free-response design, accounting for the independent variables: case type, case severity, reader type, and imaging modality. Twenty-two readers interpreted 60 PA and 60 CBCT images divided into 5 categories: diseased–subtle, diseased–moderate, diseased–obvious, nondiseased–subtle, and nondiseased–obvious. Lesion localization fraction, specificity, false positive (FP) marks, and the weighted alternative free-response receiver operating characteristic figure of merit were calculated. CBCT had greater specificity than PA in the obvious nondiseased cases (P =.01) and no significant difference in the subtle nondiseased category. Weighted alternative free-response receiver operating characteristic values were higher for PA than CBCT in the subtle diseased (P =.02) and moderate diseased (P =.01) groups with no significant difference between in the obvious diseased groups. CBCT had higher mean FPs than PA (P <.05) in subtle diseased cases. Mean lesion localization fraction in the moderate diseased group was higher in PA than CBCT (P =.003). No relationships were found between clinical experience and all diagnostic performance measures, except for in the obvious diseased CBCT group, where increasing experience was associated mean FP marks (P =.04). Reader performance in the detection of endodontic disease is better with PA radiography than CBCT. Clinical experience does not impact upon the accuracy of interpretation of both PA radiography and CBCT. [ABSTRACT FROM AUTHOR]

Background: Several blood-based biomarkers are promising to be used in the diagnosis of Alzheimer's disease (AD) including A_42/40, p-tau181, and neurofilament light (NfL). The kidney is associated with the clearance of proteins. It is crucial to evaluate the effect of renal function on the diagnostic performance of these biomarkers before clinical implementation, which is important for the establishment of reference ranges and the interpretation of results. Methods: This study is a cross-sectional analysis based on ADNI cohort. Renal function was determined by the estimated glomerular filtration rate (eGFR). Plasma A_42/40 was measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Plasma p-tau181 and NfL were analyzed by Single Molecule array (Simoa) technique. [18F] florbetapir-PET (A_-PET) was used as a reference standard to estimate the brain amyloid load. The cutoff of A_-PET positivity was defined as =1.11. Linear regression models were used to investigate the associations of continuous eGFR with each plasma biomarker separately. The diagnostic accuracies of plasma biomarkers for positive brain amyloid across different renal function groups were analyzed by Receiver operating characteristic (ROC) curve. Youden-Index was used to determine the cutoff levels. Results: A total of 645 participants were included in this study. The levels and diagnostic performance of A_42/40 were not affected by renal function. eGFR was only found negatively associated with p-tau181 levels in A_-PET negetive sample (_ = -0.09, p = 0.039). eGFR was found negatively associated with NfL levels both in whole sample and A_-PET stratified groups (_ = -0.27, p < 0.001 in whole sample; _ = -0.28, p = 0.004 in A-; _ = -0.27, p < 0.001 in A+). The diagnostic accuracies of p-tau181 and NfL were not affected by renal function. But the cutoff values of p-tau181 and NfL changed in participants with mild to moderate eGFR decline compared to participants with normal eGFR. Conclusion: Plasma A_42/40 was a robust biomarker for AD which was not affected by renal function. Plasma p-tau181 and NfL levels were affected by renal function, specific reference values of them should be considered in populations with different renal function stages. [ABSTRACT FROM AUTHOR]

Introduction: Our meta-analysis aimed to evaluate the diagnostic value of 18FDCFPyL prostate-specific membrane antigen (PSMA) PET in patients with suspected prostate cancer. Methods: We searched for articles that evaluate the diagnostic value of 18FDCFPyL PSMA PET in patients with suspected prostate cancer in PubMed, Embase, Cochrane Library, and Web of Science until 1 August 2022. Using the QUADAS-2 instrument, two researchers independently assessed the effectiveness of the studies that were included. The four-grid table data were analyzed by Meta-disc1.4 and Stata 16.0 software. The heterogeneity of each study was tested. Results: A total of five studies with 258 patients were included, and the pooled sensitivity and specificity of 18F-DCFPyL PSMA PET for primary prostate cancer were 0.92 (95% confidence interval (CI): 0.85-0.96) and 0.59 (95% CI: 0.08-0.96), respectively. 18F-DCFPyL PSMA PET was successful in detecting primary prostate cancer, with an area under the curve (AUC) of 0.92 (95% CI: 0.89-0.94). Conclusions: 18F-DCFPyL PSMA PET has a strong predictive value for primary prostate cancer and is an effective method for the non-invasive diagnosis of prostate cancer. More prospective articles were needed. [ABSTRACT FROM AUTHOR]

To assess the diagnostic performances of prostate specific antigen (PSA) and PSA with prostate magnetic resonance imaging (MRI) to predict prostate cancer in patients with PSA ≤ 20 ng/mL. Patients suspected of prostate cancer with a PSA test and prebiopsy MRI were included (n = 881). Prostate biopsy results or follow-up clinical data for 2 years were used to determine the presence of prostate cancer. The diagnostic performance of PSA, MRI, and PSA with MRI (referred to as the protocol) was evaluated. The positive predictive value (PPV) and negative predictive value (NPV) of the MRI were calculated in subgroups of patients with specific ranges of PSA level. Prostate cancer and CSC were diagnosed in 220 and 162 patients, respectively. Adding MRI to PSA could greatly improve specificity and PPV (0.833 and 0.567) for detecting CSC, compared to PSA ≥ 4 ng/mL alone (0.248 and 0.0219). Even though the sensitivity of the protocol (0.679) was lower than PSA (0.938), the NPV of the protocol was comparable to PSA (0.929 vs. 0.924). The protocol consistently showed the superior PPV and NVP to PSA only in not only patients within the gray zone of PSA, but also in patients with higher PSA. In conclusion, this longitudinal observational study confirmed that adding prebiopsy MRI to PSA was consistently beneficial in patients with PSA ≤ 20 ng/mL for avoiding unnecessary biopsy despite decrease in the sensitivity. [ABSTRACT FROM AUTHOR]

This study seeks to propose and compare different quantitative evaluation methods for identifying patients with peri-device leak (PDL) using cardiac computed tomography angiography (CCTA). Patients who had undergone left atrial appendage (LAA) closure and both transesophageal echocardiography (TEE) and CCTA were enrolled. Hounsfield units (HU) were measured in the proximal and distal regions of the left atrial appendage (p-LAA, d-LAA) on the CCTA, and the average of the two was determined (a-LAA). The relative HU ratios of the LAA to the center of the left atrium (LA) were calculated (p-LAA/c-LA, d-LAA/c-LA, a-LAA/c-LA). The area under the curve (AUC) for the LAA HU and the LAA/LA HU ratio were analyzed and compared. Fifty-one patients were included in this study. Pairwise comparisons showed a statistically significant difference (p = 0.029) in diagnostic performance between the d-LAA (AUC = 0.868) and a-LAA (AUC = 0.972). There were no significant differences between the a-LAA and p-LAA (p = 0.549) or between the d-LAA and p-LAA (p = 0.053). At the optimal cutoff for a-LAA of 115.5 HU, the sensitivity was 100%, the specificity was 88%. At the optimal cutoff for p-LAA of 109 HU, the sensitivity was 100%, the specificity was 84%. The LAA/LA HU ratio did not exhibit better diagnostic performance than HU attenuation in the LAA (p > 0.05). The a-LAA > 115.5 is useful in identifying PDL. Due to its convenience and intuitiveness, p-LAA > 109.0 can also be used as an alternative protocol for a-LAA. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Breast cancer is one of the most common malignancies affecting women worldwide, and an early diagnosis is critical for improving prognosis. The present study aimed to investigate the diagnostic value of mammography (MG) combined with ultrasound shear wave elastography (SWE) and magnetic resonance imaging (MRI) for the early screening of breast cancer. Patients with breast tumors who underwent lumpectomy at a single hospital between December 2021 and January 2023 were selected and categorized into a benign or malignant group based on pathological findings. All patients had undergone examinations with MG, SWE and MRI. Imaging parameters were subsequently compared between the two groups. A total of 93 patients with breast tumors were included in the study, comprising 37 individuals in the benign group and 56 in the malignant group. MG findings revealed that patients in the malignant group exhibited significantly higher incidences of high breast glandular density, irregular mass margins, unclear mass borders and axillary lymph node involvement compared with those in the benign group. SWE results indicated that the elasticity ratio of the lesion to fat, and the mean and maximum values of the elastic modulus were significantly lower in the benign group than in the malignant group. Additionally, MRI findings demonstrated that the MRI-measured maximum diameter was larger, and the prevalence of irregular lesion morphology, irregular mass margins, signal enhancement and type III time-signal intensity curves was greater in the malignant group compared with the benign group. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of MG + SWE + MRI were 94.6, 86.5, 91.4 and 91.4%, respectively. Furthermore, the diagnostic efficacy of this combination surpassed that of MG + SWE, MG + MRI and SWE + MRI (area under the curve, 0.906 vs. 0.767, 0.758 and 0.763, respectively). In conclusion, the combination of MG with SWE and MRI exhibits a superior performance in the early diagnosis of breast cancer, exhibiting higher diagnostic accuracy and reliability compared with pairwise combinations. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether adult and pediatric trauma center status, as well as the presence of dedicated child protection teams, influences radiology resident performance in detecting non-accidental trauma on the Emergent/Critical Care Imaging Simulation (WIDI SIM) exam.We retrospectively analyzed 639 WIDI SIM exam scores for four pediatric non-accidental trauma cases completed by radiology residents across 33 programs. Residents were stratified by level (R1–R4) and institutional factors, including adult trauma center status, pediatric trauma center status, and child protection team presence. Additionally, 2022 pediatric physical abuse counts per state were obtained from the National Child Abuse and Neglect Data System and normalized between 0 and 1. We employed a negative binomial generalized linear model (GLM). The outcome was regressed on resident level, trauma center status variables, child protection team presence, and normalized abuse counts.Higher resident training level was significantly associated with better performance (R1=3.6, R2=5, R3=6.1, R4=7.9; P<0.001). Adult trauma center accreditation was also associated with higher scores (4.6 vs. 3.3; P<0.001). In contrast, pediatric trauma center status, child protection team presence, and normalized state-level abuse counts were not significantly associated with resident performance (all P>0.05).Resident experience and adult trauma center accreditation were significantly associated with better radiology resident performance in detecting non-accidental trauma in a simulated call environment. Pediatric trauma center status, child protection team presence, and statewide abuse prevalence were not associated with detection performance. These findings suggest the need for targeted educational interventions at non-adult trauma centers and emphasize the importance of experience in developing diagnostic proficiency for non-accidental trauma.Materials and methods: To evaluate whether adult and pediatric trauma center status, as well as the presence of dedicated child protection teams, influences radiology resident performance in detecting non-accidental trauma on the Emergent/Critical Care Imaging Simulation (WIDI SIM) exam.We retrospectively analyzed 639 WIDI SIM exam scores for four pediatric non-accidental trauma cases completed by radiology residents across 33 programs. Residents were stratified by level (R1–R4) and institutional factors, including adult trauma center status, pediatric trauma center status, and child protection team presence. Additionally, 2022 pediatric physical abuse counts per state were obtained from the National Child Abuse and Neglect Data System and normalized between 0 and 1. We employed a negative binomial generalized linear model (GLM). The outcome was regressed on resident level, trauma center status variables, child protection team presence, and normalized abuse counts.Higher resident training level was significantly associated with better performance (R1=3.6, R2=5, R3=6.1, R4=7.9; P<0.001). Adult trauma center accreditation was also associated with higher scores (4.6 vs. 3.3; P<0.001). In contrast, pediatric trauma center status, child protection team presence, and normalized state-level abuse counts were not significantly associated with resident performance (all P>0.05).Resident experience and adult trauma center accreditation were significantly associated with better radiology resident performance in detecting non-accidental trauma in a simulated call environment. Pediatric trauma center status, child protection team presence, and statewide abuse prevalence were not associated with detection performance. These findings suggest the need for targeted educational interventions at non-adult trauma centers and emphasize the importance of experience in developing diagnostic proficiency for non-accidental trauma.Results: To evaluate whether adult and pediatric trauma center status, as well as the presence of dedicated child protection teams, influences radiology resident performance in detecting non-accidental trauma on the Emergent/Critical Care Imaging Simulation (WIDI SIM) exam.We retrospectively analyzed 639 WIDI SIM exam scores for four pediatric non-accidental trauma cases completed by radiology residents across 33 programs. Residents were stratified by level (R1–R4) and institutional factors, including adult trauma center status, pediatric trauma center status, and child protection team presence. Additionally, 2022 pediatric physical abuse counts per state were obtained from the National Child Abuse and Neglect Data System and normalized between 0 and 1. We employed a negative binomial generalized linear model (GLM). The outcome was regressed on resident level, trauma center status variables, child protection team presence, and normalized abuse counts.Higher resident training level was significantly associated with better performance (R1=3.6, R2=5, R3=6.1, R4=7.9; P<0.001). Adult trauma center accreditation was also associated with higher scores (4.6 vs. 3.3; P<0.001). In contrast, pediatric trauma center status, child protection team presence, and normalized state-level abuse counts were not significantly associated with resident performance (all P>0.05).Resident experience and adult trauma center accreditation were significantly associated with better radiology resident performance in detecting non-accidental trauma in a simulated call environment. Pediatric trauma center status, child protection team presence, and statewide abuse prevalence were not associated with detection performance. These findings suggest the need for targeted educational interventions at non-adult trauma centers and emphasize the importance of experience in developing diagnostic proficiency for non-accidental trauma.Conclusion: To evaluate whether adult and pediatric trauma center status, as well as the presence of dedicated child protection teams, influences radiology resident performance in detecting non-accidental trauma on the Emergent/Critical Care Imaging Simulation (WIDI SIM) exam.We retrospectively analyzed 639 WIDI SIM exam scores for four pediatric non-accidental trauma cases completed by radiology residents across 33 programs. Residents were stratified by level (R1–R4) and institutional factors, including adult trauma center status, pediatric trauma center status, and child protection team presence. Additionally, 2022 pediatric physical abuse counts per state were obtained from the National Child Abuse and Neglect Data System and normalized between 0 and 1. We employed a negative binomial generalized linear model (GLM). The outcome was regressed on resident level, trauma center status variables, child protection team presence, and normalized abuse counts.Higher resident training level was significantly associated with better performance (R1=3.6, R2=5, R3=6.1, R4=7.9; P<0.001). Adult trauma center accreditation was also associated with higher scores (4.6 vs. 3.3; P<0.001). In contrast, pediatric trauma center status, child protection team presence, and normalized state-level abuse counts were not significantly associated with resident performance (all P>0.05).Resident experience and adult trauma center accreditation were significantly associated with better radiology resident performance in detecting non-accidental trauma in a simulated call environment. Pediatric trauma center status, child protection team presence, and statewide abuse prevalence were not associated with detection performance. These findings suggest the need for targeted educational interventions at non-adult trauma centers and emphasize the importance of experience in developing diagnostic proficiency for non-accidental trauma. [ABSTRACT FROM AUTHOR]

We conducted a systematic review and meta-analysis of studies and reports comparing the performance of antigen rapid diagnostic tests (Ag RDT) for diagnosing Ebola disease (EVD). We searched PubMed, EMBASE, and Web of Science for diagnostic studies published between 1976 and 2023, evaluating them with QUADAS-2. Using a bivariate random-effects model, we estimated the pooled sensitivity and specificity of Ag RDTs. Of 64 eligible full studies and reports, 16 met the inclusion criteria. Pooled sensitivity and specificity were 82.1% (95%CI: 75.2 – 88.0) and 97.0% (95%CI: 95.1-98.2), respectively. We conducted subgroup analysis on 4 Ag RDTs, 3 RT-PCR tests, and 4 sample types, showing varied performance. The high specificity and positive predictive value of Ag RDTs support their use to "rule-in" patients with EVD. However, high-sensitivity RDTs suitable for field settings and capable of detecting multiple ebolavirus species are needed. [ABSTRACT FROM AUTHOR]

Abstract Background Control and elimination of the liver fluke (Opisthorchis viverrini) is a primary preventive strategy against cholangiocarcinoma in Southeast Asia. A sensitive parasitological diagnostic method is required to facilitate a surveillance and control program. In this study, we evaluated the performance of Mini Parasep® SF stool concentrator kit (stool kit) compared with Kato-Katz (KK) and the quantitative formalin-ethyl acetate concentration technique (FECT) for detection of O. viverrini and co-endemic parasitic infections. Methods A cross-sectional survey for parasitic infection in residents aged > 15 years in a community in Kalasin province, Northeast Thailand, was conducted in 2018. Fecal samples were collected and screened by KK method, and a subset of samples was further examined by the stool kit and FECT methods. The results were analyzed for prevalence of parasitic infections in addition to the diagnostic performance of the methods for qualitative and quantitative detection of helminthiases. Results The initial survey of parasitic infection determined by the KK method (n = 567) showed the prevalence of O. viverrini was 32.63%, followed by Taenia 2.65%, echinostomes 1.76%, hookworms 1.41%, Trichuris trichiura 0.53% and Strongyloides stercoralis 0.53%. Within a subset of samples tested with multiple diagnostics (n = 150), the detection rates of O. viverrini by the stool kit, FECT and KK methods were 27.3%, 30.7% and 28.7%, respectively. The diagnostic sensitivity for opisthorchiasis was similar for FECT (75.5%), KK(66.0%) and the stool kit (67.3%). For other parasitic infections, FECT and stool kit methods performed better than KK, particularly in detecting minute intestinal flukes (MIF), S. stercoralis and coinfections. When measuring the intensity of O. viverrini infection (fecal egg counts), the stool kit results showed a significant positive correlation with KK and FECT (P

Abstract Background The aim of this study is to evaluate the impact of experience with traumatic dental injuries (TDI) on paediatric dentists’ performance and self-assessed confidence when radiodiagnosing traumatic dental injuries (TDI) and to explore whether this is influenced by the imaging technique used (2D versus 3D). Materials and methods Both 2D and 3D radiological images of young anterior permanent teeth having experienced dental trauma were assessed randomly by a panel of paediatric dentists using structured scoring sheets. The impact of level of experience with dental traumatology on radiological detection, identification and interpretation of lesions and on observer’s self-assessed confidence was evaluated. Findings were compared to benchmark data deriving from expert consensus of an experienced paediatric endodontologist and dentomaxillofacial radiologist. Results were analysed using generalized linear mixed modelling. Results Overall, observers performed moderately to poor, irrespective of their level of TDI experience and imaging modality used. No proof could be yielded that paediatric dentists with high TDI experience performed better than those with low experience, for any of the outcomes and irrespective of the imaging modality used. When comparing the use of 3D images with 2D images, significantly higher sensitivities for the detection and correct identification of anomalies were observed in the low experienced group (P

• The AI tool mdprostate shows high accuracy in prostate cancer detection and grading using MRI. • Allows to accurately rule out prostate cancer in low-risk lesions. • Detects significant cancers with up to 85.5% sensitivity and 63.2 % specificity. • Matches expert readers' performance reported in PI-RADS v2.1 meta-analyses. • Might standardize MRI readings, reduce variability and clinical workload. This study aims to evaluate the diagnostic performance of a commercial, fully-automated, artificial intelligence (AI) driven software tool in identifying and grading prostate lesions in prostate MRI, using histopathological findings as the reference standard, while contextualizing its performance within the framework of PI-RADS v2.1 criteria. This retrospective study analyzed 123 patients who underwent multiparametric prostate MRI followed by systematic and targeted biopsies. MRI protocols adhered to international guidelines and included T2-weighted, diffusion-weighted, T1-weighted, and dynamic contrast-enhanced imaging. The AI software tool mdprostate was integrated into the Picture Archiving and Communication System to automatically segment the prostate, calculate prostate volume, and classify lesions according to PI-RADS scores using biparametric T2-weighted and diffusion-weighted imaging. Histopathological analysis of biopsy cores served as the reference standard. Diagnostic performance metrics including sensitivity, specificity, positive and negative predictive value (PPV, NPV), and area under the ROC curve (AUC) were calculated. mdprostate demonstrated 100 % sensitivity at a PI-RADS ≥ 2 cutoff, effectively ruling out both clinically significant and non-significant prostate cancers for lesions remaining below this threshold. For detecting clinically significant prostate cancer (csPCa) using a PI-RADS ≥ 4 cutoff, mdprostate achieved a sensitivity of 85.5 % and a specificity of 63.2 %. The AUC for detecting cancers of any grade was 0.803. The performance metrics of mdprostate were comparable to those reported in two meta-analyses of PI-RADS v2.1, with no significant differences in sensitivity and specificity (p > 0.05). The evaluated AI tool demonstrated high diagnostic performance in identifying and grading prostate lesions, with results comparable to those reported in meta-analyses of expert readers using PI-RADS v2.1. Its ability to standardize evaluations and potentially reduce variability underscores its potential as a valuable adjunct in the prostate cancer diagnostic pathway. The high accuracy of mdprostate , particularly in ruling out prostate cancers, highlights its clinical utility by reducing workload and enhancing patient outcomes. [ABSTRACT FROM AUTHOR]

Although the STOP-Bang questionnaire has been validated for its efficacy and diagnostic performance in various settings, there is no review that summarizes the pertinent evidence of the STOP-Bang questionnaire in the different populations. We aimed to review the evidence of the diagnostic performance of the STOP-Bang questionnaire, correlation between STOP-Bang scores and the probability of obstructive sleep apnea (OSA), and its clinical application in various populations. This review guides healthcare providers in the sleep medicine and perioperative medicine disciplines to be better informed when using the STOP-Bang questionnaire in the different populations. It provides a greater understanding for both patients and clinicians when making decisions regarding OSA screening for each population. [ABSTRACT FROM AUTHOR]

ObjectivesThe objective of this study was to compare the diagnostic performance and confidence of conventional, optimized, and ultrashort time to echo (UTE) magnetic resonance (MR) protocols for detection of simulated lumbar spondylolysis in human cadavers. In addition, we sought to demonstrate the feasibility of the UTE technique in subjects with and without spondylolysis.Materials and methodsFour human lumbar spine specimens with 46 individual pars interarticularis were randomly left intact (n = 26) or received experimental osteotomy (n = 20) using a microsurgical saw to simulate spondylolysis. The specimens were imaged using a computed tomography (CT) scan along with 3 "Tiers" of MR protocols at 3 T: Tier 1, conventional lumbar MR protocol; Tier 2, optimized conventional protocol consisting of a sagittal oblique spoiled gradient recall echo and axial oblique T1 and short tau inversion recovery sequences; and Tier 3, a sagittal UTE MR sequence. Two blinded readers evaluated the images using a 4-point scale (1 = spondylolysis certainly absent, 2 = probably absent, 3 = probably present, 4 = certainly present) at each individual pars. For each imaging protocol, diagnostic performance (sensitivity, specificity, and area under the receiver operating characteristic curve, using the surgical osteotomy as the reference) and confidence were assessed and compared using the McNemar test. Furthermore, 2 human subjects were imaged with the conventional and UTE MR protocols to demonstrate feasibility in vivo.ResultsDiagnostic performance was moderate for Tiers 1 and 2, with a moderate sensitivity (0.70 to 0.75) and high (1.00) specificity. In contrast, CT and Tier 3 UTE MR imaging had both high sensitivity (1.00) and specificity (1.00). The sensitivities of CT or Tier 3 were statistically greater than Tier 1 sensitivity (P = 0.041) and neared statistical significance when compared with Tier 2 sensitivity (P = 0.074). Area under the receiver operating characteristic curve was also significantly greater for CT and Tier 3 (each area = 1.00), compared with the areas for Tier 1 (0.89, P = 0.037) or Tier 2 (0.873, P = 0.024). Diagnostic confidences of CT or Tier 3 were much greater than other Tiers: Both Tiers 1 and 2 had a large percentage of uncertain (>60%, P < 0.001) or wrong interpretations (>10%, P < 0.001), unlike CT or Tier 3 (0% uncertain or wrong interpretations). Preliminary in vivo UTE images clearly depicted intact and fractured pars.ConclusionsOur study demonstrated that the detection of pars fractures using a single sagittal UTE MR sequence is superior in performance and confidence to conventional and optimized MR protocols at 3 T, whereas matching those from CT evaluation. Furthermore, we demonstrated the feasibility of in vivo application of the UTE sequence in subjects with and without spondylolysis.

Objectives: This study assesses and compares the performance of different swab types and specimen collection sites for SARS-CoV-2 testing, to reference standard real-time reverse transcriptase-polymerase chain reaction (RT-PCR) and viral culture. Methods: Symptomatic adults with COVID-19 who visited routine COVID-19 testing sites used spun polyester and FLOQSwabs to self-collect specimens from the anterior nares and tongue. We evaluated the self-collected specimen from anterior nares and tongue swabs for the nucleocapsid (N) or spike (S) antigen of SARS-CoV-2 by RT-PCR and then compared these results with results from RT-PCR and viral cultures from nurse-collected nasopharyngeal swabs. Results: Diagnostic sensitivity was highest for RT-PCR testing conducted using specimens from the anterior nares collected on FLOQSwabs (84%; 95% CI 68-94%) and spun polyester swabs (82%; 95% CI 66-92%), compared to RT-PCR tests conducted using specimens from nasopharyngeal swabs. Relative to viral culture from nasopharyngeal swabs, diagnostic sensitivities were higher for RT-PCR and antigen testing of anterior nares swabs (91-100%) than that of tongue swabs (18-81%). Antigen testing of anterior nares swabs had higher sensitivities against viral culture (91%) than against nasopharyngeal RT-PCR (38-70%). All investigational tests had high specificity compared with nasopharyngeal RT-PCR. Spun polyester swabs are equally effective as FLOQSwabs for anterior nasal RT-PCR testing. Conclusions: We found that anterior nares specimens were more sensitive than tongue swab specimens or antigen testing for detecting SARS-CoV-2 by RT-PCR. Thus, self-collected anterior nares specimens may represent an alternative method for diagnostic SARS-CoV-2 testing in some settings.

Abstract Background To evaluate the diagnostic value of metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) in immunocompromised patients for the diagnosis of suspected pneumonia in comparison with that of conventional microbiological tests (CMTs). Methods Sixty-nine immunocompromised patients with suspected pneumonia received both CMTs and mNGS of BALF were analyzed retrospectively. The diagnostic value was compared between CMTs and mNGS, using the clinical composite diagnosis as the reference standard. Results Sixty patients were diagnosed of pneumonia including fifty-two patients with identified pathogens and eight patients with probable pathogens. Taking the composite reference standard as a gold standard, 42 pathogens were identified by CMTs including nine bacteria, 17 fungi, 8 virus, 6 Mycobacterium Tuberculosis, and two Legionella and 19(45%) of which were detected by BALF culture. As for mNGS, it identified 76 pathogens including 20 bacteria, 31 fungi, 14 virus, 5 Mycobacterium Tuberculosis, four Legionella and two Chlamydia psittaci. The overall detection rate of mNGS for pathogens were higher than that of CMTs. However, a comparable diagnostic accuracy of mNGS and CMTs were found for bacterial and viral infections. mNGS exhibited a higher diagnostic accuracy for fungal detection than CMTs (78% vs. 57%, P

Abstract Background No studies have compared the performance of microvascular and microsurface patterns alone with their combination in patients undergoing magnifying endoscopy with narrow-band imaging for diagnosing gastric cancer. This study aimed to clarify the differences in diagnostic performance among these methods. Methods Thirty-three participating endoscopists who had received specialized training in magnifying endoscopy evaluated the microvascular and microsurface patterns of images of 106 cancerous and 106 non-cancerous lesions. If classified as “irregular,” the lesion was diagnosed as gastric cancer. To evaluate diagnostic performance, we compared the diagnostic accuracy, sensitivity, and specificity of these methods. Results Performance-related items did not differ significantly between microvascular and microsurface patterns. However, the diagnostic accuracy and sensitivity were significantly higher when using a combination of these methods than when using microvascular (82.1% [76.4–86.7] vs. 76.4% [70.3–81.6] and 69.8% [60.5–77.8] vs. 63.2% [53.7–71.8]; P

To evaluate diagnostic performance of Neutrophil/lymphocyte ratio (NLR), Platelet to lymphocyte ratio (PLR) and platelecrit in the first and third trimester in preeclampsia. This was a single center case control study conducted between January 2015 and January 2021. Patients diagnosed with preeclampsia were assigned as study population. The preeclamptic patients were assigned into two groups based on gestational weeks at diagnosis. Patients diagnosed before 34th gestational weeks were categorized as early preeclampsia and whereas patients diagnosed after 34th gestational weeks as late preeclampsia. Receiver operating characteristics curve was used to assess diagnostic value of first and third trimester NLR, PLR and platelecrit in preeclampsia. Detection rate of each variable was assessed for a 10% false positive rate. NLR in the first trimester have highest sensitivity of 30 % at a 90 % specificity to detect early preeclampsia. The area under curve (AUC) for NLR was 0.742 respectively. The best cut off for 1st trimester NLR was 4.98. PLR and platelecrit yielded low diagnostic performance. NLR in the first trimester has a moderate predictive performance for early preeclampsia. PLR was not different in preeclamptic cases and controls and platelecrit yielded a low diagnostic performance for preeclampsia. [Med-Science 2022; 11(1.000): 148-53]

BackgroundTumor-specific protein 70 (SP70) was identified as a new biomarker associated with the proliferation and invasion of cancer cells. This study aimed to investigate the expression of SP70 in hepatocellular carcinoma (HCC) and assess its clinical value in the diagnosis and prediction of early HCC recurrence.MethodsA total of 1049 subjects from the First Affiliated Hospital of Nanjing Medical University were recruited in this study. Serum SP70, alpha-fetoprotein (AFP) and prothrombin induced by vitamin K absence II (PIVKA-II) were measured. The diagnostic performance for HCC was obtained using the receiver operating characteristic (ROC) curve, and recurrence-free survival (RFS) was calculated using the Kaplan–Meier method. Univariate and multivariate analyses were performed to identify predictive factors of RFS.ResultsSP70 was highly expressed in HCC cells and HCC tissue. Serum SP70 levels in the HCC group were significantly higher than in the benign liver diseases group and healthy control group (P

IntroductionOur meta-analysis aimed to evaluate the diagnostic value of 18F-DCFPyL prostate-specific membrane antigen (PSMA) PET in patients with suspected prostate cancer.MethodsWe searched for articles that evaluate the diagnostic value of 18F-DCFPyL PSMA PET in patients with suspected prostate cancer in PubMed, Embase, Cochrane Library, and Web of Science until 1 August 2022. Using the QUADAS-2 instrument, two researchers independently assessed the effectiveness of the studies that were included. The four-grid table data were analyzed by Meta-disc1.4 and Stata 16.0 software. The heterogeneity of each study was tested.ResultsA total of five studies with 258 patients were included, and the pooled sensitivity and specificity of 18F-DCFPyL PSMA PET for primary prostate cancer were 0.92 (95% confidence interval (CI): 0.85–0.96) and 0.59 (95% CI: 0.08–0.96), respectively. 18F-DCFPyL PSMA PET was successful in detecting primary prostate cancer, with an area under the curve (AUC) of 0.92 (95% CI: 0.89–0.94).Conclusions18F-DCFPyL PSMA PET has a strong predictive value for primary prostate cancer and is an effective method for the non-invasive diagnosis of prostate cancer. More prospective articles were needed.

ObjectiveTo evaluate the diagnostic performance and inter-observer agreement of the American College of Radiology Ovarian-Adnexal Reporting and Data System Ultrasound (O-RADS) in the diagnosis of ovarian masses in children.MethodsFrom June 2012 to December 2021, 163 ovarian masses in 159 patients with pathologic results were retrospectively analyzed. Each mass was classified into an O-RADS category according to the criteria. The diagnostic performance of O-RADS for detecting malignant ovarian masses was assessed using histopathology as the reference standard. Kappa (k) statistic was used to assess inter-observer agreement between a less-experienced and a well-experienced radiologist.ResultsOut of 163 ovarian masses, 18 (11.0%) were malignant and 145 (89.0%) were benign. The malignancy rates of O-RADS 5, O-RADS 4, and O-RADS 3 masses were 72.7%, 34.6%, and 4.8%, respectively. The area under the receiver operating characteristic curve was 0.944 (95% CI, 0.908–0.981). The optimal cutoff value for predicting malignant ovarian masses was > O-RADS 3 with a sensitivity, specificity, and accuracy of 94.4%, 86.2% and 86.2% respectively. The inter-observer agreement of the O-RADS category was good (k = 0.777).ConclusionsO-RADS has a high diagnostic performance for children with ovarian masses. It provides an effective malignant risk classification for ovarian masses in children, which shows high consistency between radiologists with different levels of experience.

OBJECTIVE: This study aims to analyze the performance of endorectal ultrasound (ERUS) combined with shear wave elastography (SWE) for rectal tumor staging. METHODS: Forty patients with rectal tumors who had surgery were enrolled. They underwent ERUS and SWE examinations before surgery. Pathological results were used as the gold standard for tumor staging. The stiffness values of the rectal tumor, peritumoral fat, distal normal intestinal wall, and distal perirectal fat were analyzed. The diagnostic accuracy of ERUS stage, tumor SWE stage, ERUS combined with tumor SWE stage, and ERUS combined with peritumoral fat SWE stage were compared and evaluated by receiver operating characteristic (ROC) curve to select the best staging index. RESULTS: From T1 to T3 stage, the maximum elasticity (Emax) of the rectal tumor increased gradually (p < 0.05). The cut-off values of adenoma/T1 and T2, T2 and T3 tumors were 36.75 and 85.15kPa, respectively. The diagnostic coincidence rate of tumor SWE stage was higher than that of ERUS stage. Overall diagnostic accuracy of ERUS combined with peritumoral fat SWE Emax restaging was significantly higher than that of ERUS. CONCLUSIONS: ERUS combined with peritumoral fat SWE Emax for tumor restaging can effectively distinguish between stage T2 and T3 rectal tumors, which provides an effective imaging basis for clinical decisions. [ABSTRACT FROM AUTHOR]

Background and Objectives: Intervertebral disc degeneration (IDD) is a common cause of symptomatic axial low back pain. Magnetic resonance imaging (MRI) is currently the standard for the investigation and diagnosis of IDD. Deep learning artificial intelligence models represent a potential tool for rapidly and automatically detecting and visualizing IDD. This study investigated the use of deep convolutional neural networks (CNNs) for the detection, classification, and grading of IDD. Methods: Sagittal images of 1000 IDD T2-weighted MRI images from 515 adult patients with symptomatic low back pain were separated into 800 MRI images using annotation techniques to create a training dataset (80%) and 200 MRI images to create a test dataset (20%). The training dataset was cleaned, labeled, and annotated by a radiologist. All lumbar discs were classified for disc degeneration based on the Pfirrmann grading system. The deep learning CNN model was used for training in detecting and grading IDD. The results of the training with the CNN model were verified by testing the grading of the dataset using an automatic model. Results: The training dataset of the sagittal intervertebral disc lumbar MRI images found 220 IDDs of grade I, 530 of grade II, 170 of grade III, 160 of grade IV, and 20 of grade V. The deep CNN model was able to detect and classify lumbar IDD with an accuracy of more than 95%. Conclusion: The deep CNN model can reliably automatically grade routine T2-weighted MRIs using the Pfirrmann grading system, providing a quick and efficient method for lumbar IDD classification. [ABSTRACT FROM AUTHOR]

Background: Thalassemia trait (TT) and iron deficiency anemia (IDA) are the most common conditions of microcytic hypochromic anemia (MHA) in pregnant women. Accurate discrimination between TT and IDA is an important issue, and better methods are urgently needed. Although considerable RBC formulas and indices have been developed since 1973, distinguishing between IDA and TT is still a challenging problem due to the diversity of various anemic populations. To address this problem, we assessed the diagnostic function of 43 different differential formulas in patients with microcytic anemia by using accuracy measures and recommending a new log-based differential formula. Methods: The data of 430 pregnant women (229 with TT and 201 with IDA) were enrolled, and 44 formula performances were evaluated with receiver operating characteristic (ROC) analysis. Results: The newly introduced logarithm-based formula XS-1 performs better than the general discriminant index with sensitivity and specificity of 82.10 and 89.05, which are better than other formulas. In the pregnant population, the Shine and Lal and Roth..SVM. formulas have shown excellent performance, while other formulas showed poorer discriminative abilities in our study than in the original authors. Conclusion: The logarithm-based formula XS-1 can be used to screen thalassemia and iron deficiency anemia during the first trimester. Considering the particularity of pregnancy, medical personnel in different regions should choose a screening formula similar to that of the local region and population when identifying thalassemia in pregnancy. Any formula should be independently verified locally before use. For the convenience of the health care team and experimental scientists, a web-based tool has been established at http://yyy.yiyiy.top/XS-1/ by which users can easily get their desired screening test result without going through the underlying mathematical and computational details. [ABSTRACT FROM AUTHOR]

Simple Summary: Bladder cancer (BC) is one of the most common cancers worldwide. Early-stage diagnosis is associated with better survival rates and, as such, the timely referral of suspected cases is paramount. Urinary biomarkers have been developed to aid diagnosis, and are largely tested in patients who have been referred for further investigation. Evidence, however, on their diagnostic performance for both detecting and ruling out BC, especially in the general population, is limited. In this review, we systematically identified studies reporting on the diagnostic performance of biomarkers suitable for use in primary and community care settings. Three biomarkers, with relatively little difference in diagnostic performance between them, and some novel biomarkers were identified showing potential to be used as a triage tool in such settings. While promising, further validation studies in the general population are needed. Evidence on the use of biomarkers to detect bladder cancer in the general population is scarce. This study aimed to systematically review evidence on the diagnostic performance of biomarkers which might be suitable for use in community and primary care settings [PROSPERO Registration: CRD42021258754]. Database searches on MEDLINE and EMBASE from January 2000 to May 2022 resulted in 4914 unique citations, 44 of which met inclusion criteria. Included studies reported on 112 biomarkers and combinations. Heterogeneity of designs, populations and outcomes allowed for the meta-analysis of three biomarkers identified in at least five studies (NMP-22, UroVysion, uCyt+). These three biomarkers showed similar discriminative ability (adjusted AUC estimates ranging from 0.650 to 0.707), although for NMP-22 and UroVysion there was significant unexplained heterogeneity between included studies. Narrative synthesis revealed the potential of these biomarkers for use in the general population based on their reported clinical utility, including effects on clinicians, patients, and the healthcare system. Finally, we identified some promising novel biomarkers and biomarker combinations (N < 3 studies for each biomarker/combination) with negative predictive values of ≥90%. These biomarkers have potential for use as a triage tool in community and primary care settings for reducing unnecessary specialist referrals. Despite promising emerging evidence, further validation studies in the general population are required at different stages within the diagnostic pathway. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic equivalency between an ultrafast (1 min 53 s) lumbar MRI protocol using deep learning–based reconstruction and a conventional lumbar MRI protocol (12 min 31 s). Materials and methods: This study included 58 patients who underwent lumbar MRI using both conventional and ultrafast protocols, including sagittal T1-weighted, T2-weighted, short-TI inversion recovery, and axial T2-weighted sequences. Compared with the conventional protocol, the ultrafast protocol shortened the acquisition time to approximately one-sixth. To compensate for the decreased signal-to-noise ratio caused by the acceleration, deep learning–based reconstruction was applied. Three neuroradiologists graded degenerative changes and analyzed for presence of other pathologies. For the grading of degenerative changes, interprotocol intrareader agreement was assessed using kappa statics. Interchangeability between the two protocols was also tested by calculating the individual equivalence index between the intraprotocol interreader agreement and interprotocol interreader agreement. For the detection of other pathologies, interprotocol intrareader agreement was assessed. Results: For the grading of degenerative changes, the kappa values for interprotocol intrareader agreement of all three readers ranged from 0.707 to 0.804, indicating substantial to almost perfect agreement. Except for foraminal stenosis and disc contour on axial images, the 95% confidence interval of the individual equivalence index was < 5%, indicating the two protocols were interchangeable. For the detection of other pathologies, the interprotocol intrareader agreement rates were > 98% for each individual pathology. Conclusions: Our proposed ultrafast lumbar spine MRI protocol provided almost equivalent diagnostic results to that of the conventional protocol, except for some degenerative changes. [ABSTRACT FROM AUTHOR]

Background: The interpretation of coronary computed tomography angiography (CCTA) stenosis may be difficult among radiologists of different experience levels. Artificial intelligence (AI) may improve the diagnostic performance. Purpose: To investigate whether the diagnostic performance and time efficiency of radiologists with different levels of experience in interpreting CCTA images could be improved by using CCTA with AI assistance (CCTA-AI). Material and Methods: This analysis included 200 patients with complete CCTA and invasive coronary angiography (ICA) data, using ICA results as the reference. Eighteen radiologists were divided into three levels based on experience (Levels I, II, and III), and the three levels were divided into groups without (Groups 1, 2, and 3) and with (Groups 4, 5, and 6) AI assistance, totaling six groups (to avoid reader recall bias). The average sensitivity, specificity, NPV, PPV, and AUC were reported for the six groups and CCTA-AI at the patient, vessel, and segment levels. The interpretation time in the groups with and without CCTA-AI was recorded. Results: Compared to the corresponding group without CCTA-AI, the Level I group with CCTA-AI had improved sensitivity (75.0% vs. 83.0% on patient-based; P = 0.003). At Level III, the specificity was better with CCTA-AI. The median interpretation times for the groups with and without CCTA-AI were 413 and 615 s, respectively (P < 0.001). Conclusion: CCTA-AI could assist with and improve the diagnostic performance of radiologists with different experience levels, with Level I radiologists exhibiting improved sensitivity and Level III radiologists exhibiting improved specificity. The use of CCTA-AI could shorten the training time for radiologists. [ABSTRACT FROM AUTHOR]

Background: Ovarian tumors (OTs) are common gynecological tumors in women. It is very important to correctly distinguish benign and malignant OTs. Purpose: To assess the diagnostic performance of the American College of Radiology (ACR) Ovarian-Adnexal Reporting and Data System (O-RADS) and evaluate the clinical value of O-RADS combined with serum carbohydrate antigen 125 (CA125) and human epididymis protein 4 (HE4) in differentiating benign from malignant OTs. Material and Methods: A retrospective analysis was performed on 431 cases including pathology and clinical data. The receiver operating characteristic (ROC) curve was drawn, and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results: In premenopausal women, O-RADS and O-RADS combined with serum CA125 and HE4 showed sensitivity at 92.2% and 94.8%, specificity at 91.8% and 93.4%, and accuracy at 91.9% and 93.8%, respectively. In postmenopausal women, the sensitivity of O-RADS, O-RADS combined with serum CA125 and HE4 was 94.8% and 95.8%, specificity was 83.9% and 93.6%, and accuracy was 90.5% and 95.6%, respectively. The sensitivity, specificity, and accuracy of O-RADS combined with CA125 and HE4 in premenopausal and postmenopausal women were higher than that of O-RADS (P <0.05). Conclusion: O-RADS has high diagnostic performance in OTs. When O-RADS is combined with CA125 and HE4 in the diagnosis of OTs, the sensitivity and specificity are improved, which is helpful to improve the diagnostic efficiency of OTs and has high clinical application value. [ABSTRACT FROM AUTHOR]

Diagnostic performance is uniquely challenging to measure, and providing feedback on diagnostic performance to catalyze diagnostic recalibration remains the exception to the rule in healthcare. Diagnostic accuracy, timeliness, and explanation to the patient are essential dimensions of diagnostic performance that each intersect with a variety of technical, contextual, cultural, and policy barriers. Setting aside assumptions about current constraints, we explore the future of diagnostic performance feedback by describing the "minimum viable products" and the "ideal state" solutions that can be envisioned for each of several important barriers. Only through deliberate and iterative approaches to breaking down these barriers can we improve recalibration and continuously drive the healthcare ecosystem towards diagnostic excellence. [ABSTRACT FROM AUTHOR]

Type 1 abomasal ulcer (AU1) in cattle and buffaloes does not have specific or characteristic clinical signs, and there is a need to identify some early biochemical markers for diagnosis of AU1. The objective of this study was to study the test performance of serum pepsinogen to distinguish healthy buffaloes from the buffaloes with AU1. Blood samples were collected from buffaloes, slaughtered in a buffalo specific slaughter house. Serum was separated for estimation of pepsinogen. After slaughter abomasa were examined for the presence of AU1 and were confirmed by histology. The AU1 were categorized into four subtypes, viz., AU1a, AU1b, AU1c, and AU1d. Buffaloes with AU1 had higher (p < 0.05) mean serum pepsinogen concentration than ulcer negative buffaloes. Among subtypes, AU1b and AU1c had higher (p < 0.05) pepsinogen concentration than other subtypes and ulcer negative buffaloes. The number of ulcers had a positive correlation with the serum pepsinogen concentration, both on overall basis and for each subtype of AU1. As per ROC curve analysis, the optimal value of serum pepsinogen for diagnosis of AU1 was > 3.08 U/L. The values of sensitivity, specificity, positive predictive value, and negative predictive values suggest that serum pepsinogen could be a valid test for the detection of AU1 in buffalo. [ABSTRACT FROM AUTHOR]

Verticillium nonalfalfae and V. albo-atrum are notorious pathogenic fungi that cause a destructive vascular disease called Verticillium wilt worldwide. Thus, timely and quantitative monitoring of fungal progression is highly desirable for early diagnosis and risk assessment. In this study, we developed a droplet digital polymerase chain reaction (ddPCR) assay to detect and quantify V. nonalfalfae and V. albo-atrum. The performance of this assay was validated in comparison with that of a quantitative real-time polymerase chain reaction (qPCR) assay. The standard curve analysis of the ddPCR assay showed good linearity. The ddPCR assay indicated similar detection sensitivity to that of qPCR on pure genomic DNA, while it enhanced the positive rate for low-abundance fungi, especially in alfalfa stems. Receiver operating characteristic analysis revealed that ddPCR provided superior diagnostic performance on field tissues compared to qPCR, and the area under curve values were 0.94 and 0.90 for alfalfa roots and stems, respectively. Additionally, the quantitative results of the two methods were highly concordant (roots: R² = 0.91; stems: R² = 0.76); however, the concentrations determined by ddPCR were generally higher than those determined by qPCR. This discrepancy was potentially caused by differing amplification efficiencies for qPCR between cultured and field samples. Furthermore, the ddPCR assays appreciably improved quantitative precision, as reflected by lower coefficients of variation. Overall, the ddPCR method enables sensitive detection and accurate quantification of V. nonalfalfae and V. albo-atrum, providing a valuable tool for evaluating disease progression and enacting effective disease control. [ABSTRACT FROM AUTHOR]

Objectives: Anti-citrullinated peptide antibodies (ACPA) are specific markers for rheumatoid arthritis (RA) and typically measured by assays employing a cyclic citrullinated peptide (CCP) as antigen. This study was aimed at investigating the diagnostic performance of anti-CCP2 and anti-CCP3 IgG and IgA assays in patients with early RA with a particular focus on the potential prognostic value of IgA ACPA. Methods: The anti-CCP3.1 assay (Inova Diagnostics) measuring IgG and IgA antibodies simultaneously was compared to anti-CCP2 IgG and IgA assays (Thermo Fisher Scientific) employing sera of 184 early RA patients, 360 disease controls and 98 healthy subjects. Results: Anti-CCP2 IgG and IgA assays showed high specificity versus disease controls (98.9%; 99.4%). Sensitivity was 52.2% (IgG) and 28.8% (IgA), resulting in positive likelihood ratios (LR+) of 47.5 (IgG) and 48.0 (IgA). The anti-CCP3.1 assay proved slightly more sensitive than the anti-CCP2 IgG assay (56%) but specificity was markedly lower (90.8% versus disease controls). However, when using a threefold higher cut-off specificity of the anti-CCP3.1 assay increased (97.5%) while sensitivity (52.7%) became comparable to the anti-CCP2 IgG assay resulting in a LR+ of 21.5. Anti-CCP2 IgA antibodies did not increase the diagnostic sensitivity of ACPA testing, but IgA positive patients showed diminished responses to treatment with anti-TNF biologicals compared to patients who had only IgG antibodies. Conclusion: Specificity of ACPA assays should be adjusted to reduce the risk of misclassification and a false positive diagnosis. Determination of ACPA IgA might provide important prognostic information concerning therapeutic responses. [ABSTRACT FROM AUTHOR]

To evaluate the diagnostic performance of cytomegalovirus (CMV) polymerase chain reaction (PCR) on inner ear fluid collected during cochlear implantation and to assess its interest in current practice. This monocentric prospective study included consecutive children presenting with severe to profound sensorineural hearing loss (SNHL) who were candidates for unilateral and/or bilateral cochlear implantation. The etiology of the SNHL was determined before cochlear implantation when possible. During the surgery, drop-like samples of inner ear fluid and blood were collected. CMV PCR was then performed on both samples. Between January 2017 and September 2021, 113 children with severe to profound SNHL underwent cochlear implantation with inner ear fluid collection. Among these children, 77 of them presented with a known cause of SNHL (68%) and 36 of them had an unknown cause of SNHL at the time of surgery (32%). Sensitivity and specificity of the CMV PCR on inner ear fluid were 60% (95% CI: [49–71]) and 98% (95% CI: [96–100]), respectively. Positive and negative predictive values were 90% (95% CI: [83–97]) and 92% (95% CI: [86–98]), respectively. A sensitivity analysis according to age at cochlear implantation showed a decrease with age. Conclusion: Sampling of inner ear fluid during cochlear implant surgery is an interesting, simple and safe way to diagnose CMV-related hearing loss, especially when the diagnosis of congenital infection can no longer be confirmed. However, the sensitivity decreases with age. Trial registration: NCT04724265 What is Known: • Congenital cytomegalovirus infection is the leading infectious cause of neurological disabilities and sensorineural hearing loss in children. In the absence of systematic screening at birth, many cCMV infections go undetected and are often undiagnosed despite the development of sensorineural sequelae. • Nearly 40% of indications for cochlear implantation are of unknown etiology. What is New: • Performing CMV PCR on inner ear fluid at the time of cochlear implantation is a safe way with high diagnostic performance (PPV = 90%, NPV = 92%) to detect a CMV-related hearing loss. • This sample may be interesting in cases of unknown cause of hearing loss in order to identify undiagnosed cCMV infections. [ABSTRACT FROM AUTHOR]

Objective To explore the value of dynamic contrast-enhanced (DCE)-MRI perfusion technique in distinguishing non-mass enhanced (NME) breast pathologies. Methods The clinical records and DCE-MRI of 56 women with NME breast lesions between January 2021 and December 2021 were retrospectively analyzed. Using pathological results as the reference standard, all lesions were divided into benign and malignant groups. The perfusion parameters and hemodynamic features between the two groups were compared using independent samples t-test and Mann-Whitney U test. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of MRI parameters. Results The 56 NME lesions included 33 benign and 23 malignant lesions. The early enhancement ratio (EER) was significantly higher (P<0.05) in malignancy (235.615±49.946) than that of benign lesions (181.243±69.163) whereas the late enhancement ratio (LER) was not significantly higher (P=0.247) in malignancy (197.409±35.261) than benign lesions (184.071±40.842). The DCE-MRI parameters in malignancy including the rate constant (Kep, 1.606±0.671), volume transfer constant(Ktrans, 1.380 ±0.645), initial area under the gadolinium curve (0.651 ±0.263), contrast enhancement ratio (3.026 ±0.872), maximum slope increase (MSI, 0.045) were all significantly higher ( P<0.05) than those of benign lesions (0.732 ±0.326, 0.626±0.387, 0. 356 ±0. 317, 2.270±0.498, 0.023). ROC curve analysis showed that the semi-quantitative EER had better diagnostic performance (74.4%) than that of LER (63.5%). The quantitative parameters also had better diagnostic performance than semi-quantitative parameters with accuracy of 90.3% for Kep, 84.7% for Ktrans, and 86.1% for MSI. Conclusion Quantitative perfusion parameters of DCE-MRI have excellent diagnostic performance and can help differentiating benign from malignant NME breast lesions. [ABSTRACT FROM AUTHOR]

Background: Bloodstream infection (BSI) is a significant cause of mortality among patients with fever of unknown origin (FUO). Inappropriate empiric antimicrobial therapy increases difficulty in BSI diagnosis and treatment. Knowing the risk of BSI at early stage may help improve clinical outcomes and reduce antibiotic overuse. Methods: We constructed a multivariate prediction model based on clinical features and serum inflammatory markers using a cohort of FUO patients over a 5-year period by Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression. Results: Among 712 FUO patients, BSI was confirmed in 55 patients. Five independent predictors available within 24 h after admission for BSI were identified: presence of diabetes mellitus, chills, C-reactive protein level of 50–100 mg/L, procalcitonin > 0.3 ng/mL, neutrophil percentage > 75%. A predictive score incorporating these 5 variables has adequate concordance with an area under the curve of 0.85. The model showed low positive predictive value (22.6%), but excellent negative predictive value (97.4%) for predicting the risk of BSI. The risk of BSI reduced to 2.0% in FUO patients if score < 1.5. Conclusions: A simple tool based on 5 variables is useful for timely ruling out the individuals at low risk of BSI in FUO population. [ABSTRACT FROM AUTHOR]

Objectives: To compare the value of zero echo time (ZTE) and gradient echo "black bone" (BB) MRI sequences for bone assessment of the sacroiliac joint (SI) using computed tomography (CT) as the reference standard.Materials and Methods: Between May 2019 and January 2021, 79 patients prospectively underwent clinically indicated 3-T MRI including ZTE and BB imaging. Additionally, all patients underwent a CT scan covering the SI joints within 12 months of the MRI examination. Two blinded readers performed bone assessment by grading each side of each SI joint qualitatively in terms of seven features (osteophytes, subchondral sclerosis, erosions, ankylosis, joint irregularity, joint widening, and gas in the SI joint) using a 4-point Likert scale (0 = no changes-3 = marked changes). Scores were compared between all three imaging modalities.Results: Interreader agreement was largely good (k values: 0.5-0.83). Except for the feature "gas in SI joint" where ZTE exhibited significantly lower scores than CT (p < 0.001), ZTE and BB showed similar performance relative to CT for all other features (p > 0.52) with inter-modality agreement being substantial to almost perfect (Krippendorff's alpha coefficients: 0.724-0.983). When combining the data from all features except for gas in the SI joint and when binarizing grading scores, combined sensitivity/specificity was 76.7%/98.6% for ZTE and 80.8%/99.1% for BB, respectively, compared to CT.Conclusions: The performance of ZTE and BB sequences was comparable to CT for bone assessment of the SI joint. These sequences may potentially serve as an alternative to CT yet without involving exposure to ionizing radiation. [ABSTRACT FROM AUTHOR]