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van der Pol CB, Costa AF, Lam E, Dawit H, Bashir MR, McInnes MDF. Best Practice for MRI Diagnostic Accuracy Research With Lessons and Examples from the LI-RADS Individual Participant Data Group. J Magn Reson Imaging 2024; 60:21-28. [PMID: 37818955 DOI: 10.1002/jmri.29049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023] Open
Abstract
Medical imaging diagnostic test accuracy research is strengthened by adhering to best practices for study design, data collection, data documentation, and study reporting. In this review, key elements of such research are discussed, and specific recommendations provided for optimizing diagnostic accuracy study execution to improve uniformity, minimize common sources of bias and avoid potential pitfalls. Examples are provided regarding study methodology and data collection practices based on insights gained by the liver imaging reporting and data system (LI-RADS) individual participant data group, who have evaluated raw data from numerous MRI diagnostic accuracy studies for risk of bias and data integrity. The goal of this review is to outline strategies for investigators to improve research practices, and to help reviewers and readers better contextualize a study's findings while understanding its limitations. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Christian B van der Pol
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eric Lam
- Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Haben Dawit
- Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mustafa R Bashir
- Departments of Radiology and Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew D F McInnes
- Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
- Rm c-159 Departments of Radiology and Epidemiology, The Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada
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Halligan S, Boone D, Burling D, Helbren E, Mallett S, Plumb A. Doug Altman, medical statistician par excellence: What can radiologists learn from his legacy? Clin Radiol 2024; 79:479-484. [PMID: 38729906 DOI: 10.1016/j.crad.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 05/12/2024]
Abstract
This narrative review describes our experience of working with Doug Altman, the most highly cited medical statistician in the world. Doug was particularly interested in diagnostics, and imaging studies in particular. We describe how his insights helped improve our own radiological research studies and we provide advice for other researchers hoping to improve their own research practice.
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Affiliation(s)
- S Halligan
- Centre for Medical Imaging, Division of Medicine, University College London, United Kingdom.
| | - D Boone
- Department of Radiology, University College Hospitals, London, United Kingdom
| | - D Burling
- Department of Radiology, St. Mark's Hospital, London, United Kingdom
| | - E Helbren
- Department of Radiology, Hull & East Yorkshire Hospitals NHS Trust, Hull, United Kingdom
| | - S Mallett
- Centre for Medical Imaging, Division of Medicine, University College London, United Kingdom
| | - A Plumb
- Department of Radiology, University College Hospitals, London, United Kingdom
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Kühl J, Elhakim MT, Stougaard SW, Rasmussen BSB, Nielsen M, Gerke O, Larsen LB, Graumann O. Population-wide evaluation of artificial intelligence and radiologist assessment of screening mammograms. Eur Radiol 2024; 34:3935-3946. [PMID: 37938386 DOI: 10.1007/s00330-023-10423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES To validate an AI system for standalone breast cancer detection on an entire screening population in comparison to first-reading breast radiologists. MATERIALS AND METHODS All mammography screenings performed between August 4, 2014, and August 15, 2018, in the Region of Southern Denmark with follow-up within 24 months were eligible. Screenings were assessed as normal or abnormal by breast radiologists through double reading with arbitration. For an AI decision of normal or abnormal, two AI-score cut-off points were applied by matching at mean sensitivity (AIsens) and specificity (AIspec) of first readers. Accuracy measures were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and recall rate (RR). RESULTS The sample included 249,402 screenings (149,495 women) and 2033 breast cancers (72.6% screen-detected cancers, 27.4% interval cancers). AIsens had lower specificity (97.5% vs 97.7%; p < 0.0001) and PPV (17.5% vs 18.7%; p = 0.01) and a higher RR (3.0% vs 2.8%; p < 0.0001) than first readers. AIspec was comparable to first readers in terms of all accuracy measures. Both AIsens and AIspec detected significantly fewer screen-detected cancers (1166 (AIsens), 1156 (AIspec) vs 1252; p < 0.0001) but found more interval cancers compared to first readers (126 (AIsens), 117 (AIspec) vs 39; p < 0.0001) with varying types of cancers detected across multiple subgroups. CONCLUSION Standalone AI can detect breast cancer at an accuracy level equivalent to the standard of first readers when the AI threshold point was matched at first reader specificity. However, AI and first readers detected a different composition of cancers. CLINICAL RELEVANCE STATEMENT Replacing first readers with AI with an appropriate cut-off score could be feasible. AI-detected cancers not detected by radiologists suggest a potential increase in the number of cancers detected if AI is implemented to support double reading within screening, although the clinicopathological characteristics of detected cancers would not change significantly. KEY POINTS • Standalone AI cancer detection was compared to first readers in a double-read mammography screening population. • Standalone AI matched at first reader specificity showed no statistically significant difference in overall accuracy but detected different cancers. • With an appropriate threshold, AI-integrated screening can increase the number of detected cancers with similar clinicopathological characteristics.
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Affiliation(s)
- Johanne Kühl
- Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, 2ndfloor, 5000, Odense C, Denmark
| | - Mohammad Talal Elhakim
- Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, 2ndfloor, 5000, Odense C, Denmark.
- Department of Radiology, Odense University Hospital, Kløvervænget 47, Ground Floor, 5000, Odense C, Denmark.
| | - Sarah Wordenskjold Stougaard
- Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, 2ndfloor, 5000, Odense C, Denmark
| | - Benjamin Schnack Brandt Rasmussen
- Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, 2ndfloor, 5000, Odense C, Denmark
- Department of Radiology, Odense University Hospital, Kløvervænget 47, Ground Floor, 5000, Odense C, Denmark
- CAI-X - Centre for Clinical Artificial Intelligence, Odense University Hospital, Kløvervænget 8C, 5000, Odense C, Denmark
| | - Mads Nielsen
- Department of Computer Science, University of Copenhagen, Universitetsparken 1, 2100, Copenhagen, Denmark
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, 2ndfloor, 5000, Odense C, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Kløvervænget 47, 5000, Odense C, Denmark
| | - Lisbet Brønsro Larsen
- Department of Radiology, Odense University Hospital, Kløvervænget 47, Ground Floor, 5000, Odense C, Denmark
| | - Ole Graumann
- Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, 2ndfloor, 5000, Odense C, Denmark
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark
- Department of Clinical Research, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark
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Benomar A, Diestro JDB, Darabid H, Saydy K, Tzaneva L, Li J, Zarour E, Tanguay W, El Sayed N, Padilha IG, Létourneau-Guillon L, Bard C, Nelson K, Weill A, Roy D, Eneling J, Boisseau W, Nguyen TN, Abdalkader M, Najjar AA, Nehme A, Lemoine É, Jacquin G, Bergeron D, Brunette-Clément T, Chaalala C, Bojanowski MW, Labidi M, Jabre R, Ignacio KHD, Omar AT, Volders D, Dmytriw AA, Hak JF, Forestier G, Holay Q, Olatunji R, Alhabli I, Nico L, Shankar JJS, Guenego A, Pascual JLR, Marotta TR, Errázuriz JI, Lin AW, Alves AC, Fahed R, Hawkes C, Lee H, Magro E, Sheikhi L, Darsaut TE, Raymond J. Nonaneurysmal perimesencephalic subarachnoid hemorrhage on noncontrast head CT: An accuracy, inter-rater, and intra-rater reliability study. J Neuroradiol 2024; 51:101184. [PMID: 38387650 DOI: 10.1016/j.neurad.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND PURPOSE To evaluate the reliability and accuracy of nonaneurysmal perimesencephalic subarachnoid hemorrhage (NAPSAH) on Noncontrast Head CT (NCCT) between numerous raters. MATERIALS AND METHODS 45 NCCT of adult patients with SAH who also had a catheter angiography (CA) were independently evaluated by 48 diverse raters; 45 raters performed a second assessment one month later. For each case, raters were asked: 1) whether they judged the bleeding pattern to be perimesencephalic; 2) whether there was blood anterior to brainstem; 3) complete filling of the anterior interhemispheric fissure (AIF); 4) extension to the lateral part of the sylvian fissure (LSF); 5) frank intraventricular hemorrhage; 6) whether in the hypothetical presence of a negative CT angiogram they would still recommend CA. An automatic NAPSAH diagnosis was also generated by combining responses to questions 2-5. Reliability was estimated using Gwet's AC1 (κG), and the relationship between the NCCT diagnosis of NAPSAH and the recommendation to perform CA using Cramer's V test. Multi-rater accuracy of NCCT in predicting negative CA was explored. RESULTS Inter-rater reliability for the presence of NAPSAH was moderate (κG = 0.58; 95%CI: 0.47, 0.69), but improved to substantial when automatically generated (κG = 0.70; 95%CI: 0.59, 0.81). The most reliable criteria were the absence of AIF filling (κG = 0.79) and extension to LSF (κG = 0.79). Mean intra-rater reliability was substantial (κG = 0.65). NAPSAH weakly correlated with CA decision (V = 0.50). Mean sensitivity and specificity were 58% (95%CI: 44%, 71%) and 83 % (95%CI: 72 %, 94%), respectively. CONCLUSION NAPSAH remains a diagnosis of exclusion. The NCCT diagnosis was moderately reliable and its impact on clinical decisions modest.
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Affiliation(s)
- Anass Benomar
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. https://twitter.com/AnassBenomarMD
| | - Jose Danilo B Diestro
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, ON, Canada. https://twitter.com/DanniDiestro
| | - Houssam Darabid
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Karim Saydy
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Lora Tzaneva
- Department of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Jimmy Li
- Division of Neurology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada. https://twitter.com/neuroloJimmy
| | - Eleyine Zarour
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. https://twitter.com/eleyine
| | - William Tanguay
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Nohad El Sayed
- Department of Radiology, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Igor Gomes Padilha
- Division of Neuroradiology, Diagnósticos da América SA - DASA, São Paulo, SP, Brazil; Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil; Division of Neuroradiology, United Health Group, São Paulo, SP, Brazil
| | - Laurent Létourneau-Guillon
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. https://twitter.com/LaurentLetG
| | - Céline Bard
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Kristoff Nelson
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Alain Weill
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Daniel Roy
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Johanna Eneling
- Department of Neurosurgery, Linköping University Hospital, Linköping, Sweden
| | - William Boisseau
- Department of Interventional Neuroradiology, Fondation Adolphe de Rothschild, Paris, France
| | - Thanh N Nguyen
- Department of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, MA, USA. https://twitter.com/NguyenThanhMD
| | - Mohamad Abdalkader
- Department of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, MA, USA. https://twitter.com/AbdalkaderMD
| | - Ahmed A Najjar
- Division of Neurosurgery, Department of Surgery, College of Medicine, Taibah University, Medina, Saudi Arabia. https://twitter.com/AhmedANajjar
| | - Ahmad Nehme
- Université Caen-Normandie, Neurology, CHU Caen-Normandie, Caen, France. https://twitter.com/ANehme
| | - Émile Lemoine
- Division of Neurology, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. https://twitter.com/lemoineemile
| | - Gregory Jacquin
- Division of Neurology, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - David Bergeron
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. https://twitter.com/David__Bergeron
| | - Tristan Brunette-Clément
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. https://twitter.com/BrunetteClement
| | - Chiraz Chaalala
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Moujahed Labidi
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Roland Jabre
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Katrina H D Ignacio
- Calgary Stroke Program, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada. https://twitter.com/Katha_MD
| | - Abdelsimar T Omar
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Division of Neurosurgery, McMaster University, Hamilton, ON, Canada. https://twitter.com/atomar_md
| | - David Volders
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Adam A Dmytriw
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, ON, Canada; Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. https://twitter.com/AdamDmytriw
| | - Jean-François Hak
- Department of Medical Imaging, University Hospital Timone APHM, Marseille, France. https://twitter.com/JFHak
| | - Géraud Forestier
- Department of neuroradiology, University Hospital of Limoges, Limoges, France. https://twitter.com/GeraudForestier
| | - Quentin Holay
- Department of Radiology, Sainte-Anne Military Hospital, Toulon, France
| | - Richard Olatunji
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria. https://twitter.com/RICHARDOlat
| | - Ibrahim Alhabli
- Calgary Stroke Program, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada. https://twitter.com/ialhabli
| | - Lorena Nico
- Department of Neuroradiology, University Hospital Of Padova, Padova, Italy
| | - Jai J S Shankar
- Department of Radiology, Health Sciences Centre, Winnipeg, MB, Canada. https://twitter.com/shivajai1
| | - Adrien Guenego
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium. https://twitter.com/GuenegoAdrien
| | - Jose L R Pascual
- Department of Anatomy, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines. https://twitter.com/drbrainhacker
| | - Thomas R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, ON, Canada. https://twitter.com/trmarot
| | - Juan I Errázuriz
- Department of Radiology, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Amy W Lin
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Aderaldo Costa Alves
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. https://twitter.com/jr_aderaldo
| | - Robert Fahed
- Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Christine Hawkes
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. https://twitter.com/CMHawkes
| | - Hubert Lee
- Division of Neurosurgery, Trillium Health Partners, Toronto, ON, Canada
| | - Elsa Magro
- Department of Neurosurgery, Hôpital de la Cavale Blanche, CHRU de Brest, Brest, France
| | - Lila Sheikhi
- Department of Neurology, University of Kentucky, Lexington, KY, USA. https://twitter.com/lila_sheikhi
| | - Tim E Darsaut
- Department of Surgery, Division of Neurosurgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, AB, Canada. https://twitter.com/tdarsaut
| | - Jean Raymond
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
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Kim PE, Yang H, Kim D, Sunwoo L, Kim CK, Kim BJ, Kim JT, Ryu WS, Kim HS. Automated Prediction of Proximal Middle Cerebral Artery Occlusions in Noncontrast Brain Computed Tomography. Stroke 2024; 55:1609-1618. [PMID: 38787932 PMCID: PMC11122774 DOI: 10.1161/strokeaha.123.045772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Early identification of large vessel occlusion (LVO) in patients with ischemic stroke is crucial for timely interventions. We propose a machine learning-based algorithm (JLK-CTL) that uses handcrafted features from noncontrast computed tomography to predict LVO. METHODS We included patients with ischemic stroke who underwent concurrent noncontrast computed tomography and computed tomography angiography in seven hospitals. Patients from 5 of these hospitals, admitted between May 2011 and March 2015, were randomly divided into training and internal validation (9:1 ratio). Those from the remaining 2 hospitals, admitted between March 2021 and September 2021, were designated for external validation. From each noncontrast computed tomography scan, we extracted differences in volume, tissue density, and Hounsfield unit distribution between bihemispheric regions (striatocapsular, insula, M1-M3, and M4-M6, modified from the Alberta Stroke Program Early Computed Tomography Score). A deep learning algorithm was used to incorporate clot signs as an additional feature. Machine learning models, including ExtraTrees, random forest, extreme gradient boosting, support vector machine, and multilayer perceptron, as well as a deep learning model, were trained and evaluated. Additionally, we assessed the models' performance after incorporating the National Institutes of Health Stroke Scale scores as an additional feature. RESULTS Among 2919 patients, 83 were excluded. Across the training (n=2463), internal validation (n=275), and external validation (n=95) datasets, the mean ages were 68.5±12.4, 67.6±13.8, and 67.9±13.6 years, respectively. The proportions of men were 57%, 53%, and 59%, with LVO prevalences of 17.0%, 16.4%, and 26.3%, respectively. In the external validation, the ExtraTrees model achieved a robust area under the curve of 0.888 (95% CI, 0.850-0.925), with a sensitivity of 80.1% (95% CI, 72.0-88.1) and a specificity of 88.6% (95% CI, 84.7-92.5). Adding the National Institutes of Health Stroke Scale score to the ExtraTrees model increased sensitivity (from 80.1% to 92.1%) while maintaining specificity. CONCLUSIONS Our algorithm provides reliable predictions of LVO using noncontrast computed tomography. By enabling early LVO identification, our algorithm has the potential to expedite the stroke workflow.
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Affiliation(s)
- Pyeong Eun Kim
- Artificial Intelligence Research Center, JLK Inc, Seoul, Republic of Korea (P.E.K., H.Y., D.K., W.-S.R.)
| | - Hyojung Yang
- Artificial Intelligence Research Center, JLK Inc, Seoul, Republic of Korea (P.E.K., H.Y., D.K., W.-S.R.)
- Department of Computer Science and Technology, University of Cambridge, United Kingdom (H.Y.)
| | - Dongmin Kim
- Artificial Intelligence Research Center, JLK Inc, Seoul, Republic of Korea (P.E.K., H.Y., D.K., W.-S.R.)
| | - Leonard Sunwoo
- Department of Radiology, Seoul National University College of Medicine, Republic of Korea (L.S.)
- Department of Radiology (L.S.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea (C.K.K.)
| | - Beom Joon Kim
- Department of Neurology (B.J.K.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (J.-T.K.)
| | - Wi-Sun Ryu
- Artificial Intelligence Research Center, JLK Inc, Seoul, Republic of Korea (P.E.K., H.Y., D.K., W.-S.R.)
| | - Ho Sung Kim
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles (H.S.K.)
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Ben-Sasson A, Guedalia J, Ilan K, Shaham M, Shefer G, Cohen R, Tamir Y, Gabis LV. Predicting autism traits from baby wellness records: A machine learning approach. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241253311. [PMID: 38808667 DOI: 10.1177/13623613241253311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
LAY ABSTRACT Timely identification of autism spectrum conditions is a necessity to enable children to receive the most benefit from early interventions. Emerging technological advancements provide avenues for detecting subtle, early indicators of autism from routinely collected health information. This study tested a model that provides a likelihood score for autism diagnosis from baby wellness visit records collected during the first 2 years of life. It included records of 591,989 non-autistic children and 12,846 children with autism. The model identified two-thirds of the autism spectrum condition group (boys 63% and girls 66%). Sex-specific models had several predictive features in common. These included language development, fine motor skills, and social milestones from visits at 12-24 months, mother's age, and lower initial growth but higher last growth measurements. Parental concerns about development or hearing impairment were other predictors. The models differed in other growth measurements and birth parameters. These models can support the detection of early signs of autism in girls and boys by using information routinely recorded during the first 2 years of life.
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Affiliation(s)
| | | | | | | | | | | | | | - Lidia V Gabis
- Maccabi Healthcare Services, Israel
- Faculty of Medicine and Health Sciences, Tel Aviv University, Israel
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Ramírez-Giraldo C, Conde Monroy D, Arbelaez-Osuna K, Isaza-Restrepo A, Sabogal Olarte JC, Upegui D, Rojas-López S. Evaluation of postoperative pancreatic fistula prediction scales following pancreatoduodenectomies based on magnetic resonance imaging: A diagnostic test study. Pancreatology 2024:S1424-3903(24)00635-5. [PMID: 38824072 DOI: 10.1016/j.pan.2024.05.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/04/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is one of the most feared and common complications following pancreatoduodenectomies. This study aims to evaluate the performance of different scales in predicting POPF using magnetic resonance imaging (MRI), including estimation of the pancreatic duct diameter, pancreatic texture, main duct index, relation to the portal vein, and intra-abdominal fat thickness. MATERIALS AND METHODS A retrospective diagnostic test study was designed. Between January 2017 and December 2021, 133 pancreatoduodenectomies were performed at our institution. The performance for predicting overall POPF and clinically relevant POPF (CR-POPF) was evaluated using a receiver operating characteristic (ROC) curve. RESULTS A total of 96 patients were included in the study, of whom 26 patients experienced overall POPF, and 8 patients had CR-POPF. When analyzing the predictive value of each of the different scores applied, the Birmingham score showed the highest performance for predicting overall POPF and CR-POPF with an AUC (area under the curve) of 0.815 (95 % CI 0.725-0.906) and 0.813 (0.679-0.947), respectively. CONCLUSION The Birmingham scale demonstrated the highest predictive performance for POPF. It is a simple scale with only two variables that can be obtained preoperatively using MRI. Based on these results, we recommend its use in patients undergoing pancreatoduodenectomy.
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Affiliation(s)
- Camilo Ramírez-Giraldo
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia; Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
| | | | | | - Andrés Isaza-Restrepo
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia; Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | | | - Daniel Upegui
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia
| | - Susana Rojas-López
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia
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Horiuchi D, Tatekawa H, Oura T, Oue S, Walston SL, Takita H, Matsushita S, Mitsuyama Y, Shimono T, Miki Y, Ueda D. Comparing the Diagnostic Performance of GPT-4-based ChatGPT, GPT-4V-based ChatGPT, and Radiologists in Challenging Neuroradiology Cases. Clin Neuroradiol 2024:10.1007/s00062-024-01426-y. [PMID: 38806794 DOI: 10.1007/s00062-024-01426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/06/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE To compare the diagnostic performance among Generative Pre-trained Transformer (GPT)-4-based ChatGPT, GPT‑4 with vision (GPT-4V) based ChatGPT, and radiologists in challenging neuroradiology cases. METHODS We collected 32 consecutive "Freiburg Neuropathology Case Conference" cases from the journal Clinical Neuroradiology between March 2016 and December 2023. We input the medical history and imaging findings into GPT-4-based ChatGPT and the medical history and images into GPT-4V-based ChatGPT, then both generated a diagnosis for each case. Six radiologists (three radiology residents and three board-certified radiologists) independently reviewed all cases and provided diagnoses. ChatGPT and radiologists' diagnostic accuracy rates were evaluated based on the published ground truth. Chi-square tests were performed to compare the diagnostic accuracy of GPT-4-based ChatGPT, GPT-4V-based ChatGPT, and radiologists. RESULTS GPT‑4 and GPT-4V-based ChatGPTs achieved accuracy rates of 22% (7/32) and 16% (5/32), respectively. Radiologists achieved the following accuracy rates: three radiology residents 28% (9/32), 31% (10/32), and 28% (9/32); and three board-certified radiologists 38% (12/32), 47% (15/32), and 44% (14/32). GPT-4-based ChatGPT's diagnostic accuracy was lower than each radiologist, although not significantly (all p > 0.07). GPT-4V-based ChatGPT's diagnostic accuracy was also lower than each radiologist and significantly lower than two board-certified radiologists (p = 0.02 and 0.03) (not significant for radiology residents and one board-certified radiologist [all p > 0.09]). CONCLUSION While GPT-4-based ChatGPT demonstrated relatively higher diagnostic performance than GPT-4V-based ChatGPT, the diagnostic performance of GPT‑4 and GPT-4V-based ChatGPTs did not reach the performance level of either radiology residents or board-certified radiologists in challenging neuroradiology cases.
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Affiliation(s)
- Daisuke Horiuchi
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroyuki Tatekawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tatsushi Oura
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Satoshi Oue
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shannon L Walston
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hirotaka Takita
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shu Matsushita
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yasuhito Mitsuyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Taro Shimono
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Daiju Ueda
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
- Center for Health Science Innovation, Osaka Metropolitan University, Osaka, Japan.
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Lee YD, Kim HG, Seo M, Moon SK, Park SJ, You MW. Machine learning-based response assessment in patients with rectal cancer after neoadjuvant chemoradiotherapy: radiomics analysis for assessing tumor regression grade using T2-weighted magnetic resonance images. Int J Colorectal Dis 2024; 39:78. [PMID: 38789861 PMCID: PMC11126485 DOI: 10.1007/s00384-024-04651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE This study aimed to assess tumor regression grade (TRG) in patients with rectal cancer after neoadjuvant chemoradiotherapy (NCRT) through a machine learning-based radiomics analysis using baseline T2-weighted magnetic resonance (MR) images. MATERIALS AND METHODS In total, 148 patients with locally advanced rectal cancer(T2-4 or N+) who underwent MR imaging at baseline and after chemoradiotherapy between January 2010 and May 2021 were included. A region of interest for each tumor mass was drawn by a radiologist on oblique axial T2-weighted images, and main features were selected using principal component analysis after dimension reduction among 116 radiomics and three clinical features. Among eight learning models that were used for prediction model development, the model showing best performance was selected. Treatment responses were classified as either good or poor based on the MR-assessed TRG (mrTRG) and pathologic TRG (pTRG). The model performance was assessed using the area under the receiver operating curve (AUROC) to classify the response group. RESULTS Approximately 49% of the patients were in the good response (GR) group based on mrTRG (73/148) and 26.9% based on pTRG (28/104). The AUCs of clinical data, radiomics models, and combined radiomics with clinical data model for predicting mrTRG were 0.80 (95% confidence interval [CI] 0.73, 0.87), 0.74 (95% CI 0.66, 0.81), and 0.75(95% CI 0.68, 0.82), and those for predicting pTRG was 0.62 (95% CI 0.52, 0.71), 0.74 (95% CI 0.65, 0.82), and 0.79 (95% CI 0.71, 0.87). CONCLUSION Radiomics combined with clinical data model using baseline T2-weighted MR images demonstrated feasible diagnostic performance in predicting both MR-assessed and pathologic treatment response in patients with rectal cancer after NCRT.
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Affiliation(s)
- Yong Dae Lee
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, #23 Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea
- Department of Medicine, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - Hyug-Gi Kim
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, #23 Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - Miri Seo
- Department of Medicine, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - Sung Kyoung Moon
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, #23 Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - Seong Jin Park
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, #23 Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - Myung-Won You
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, #23 Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea.
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Schalekamp S, van Leeuwen K, Calli E, Murphy K, Rutten M, Geurts B, Peters-Bax L, van Ginneken B, Prokop M. Performance of AI to exclude normal chest radiographs to reduce radiologists' workload. Eur Radiol 2024:10.1007/s00330-024-10794-5. [PMID: 38758252 DOI: 10.1007/s00330-024-10794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION This study investigates the performance of a commercially available artificial intelligence (AI) system to identify normal chest radiographs and its potential to reduce radiologist workload. METHODS Retrospective analysis included consecutive chest radiographs from two medical centers between Oct 1, 2016 and Oct 14, 2016. Exclusions comprised follow-up exams within the inclusion period, bedside radiographs, incomplete images, imported radiographs, and pediatric radiographs. Three chest radiologists categorized findings into normal, clinically irrelevant, clinically relevant, urgent, and critical. A commercial AI system processed all radiographs, scoring 10 chest abnormalities on a 0-100 confidence scale. AI system performance was evaluated using the area under the ROC curve (AUC), assessing the detection of normal radiographs. Sensitivity was calculated for the default and a conservative operating point. the detection of negative predictive value (NPV) for urgent and critical findings, as well as the potential workload reduction, was calculated. RESULTS A total of 2603 radiographs were acquired in 2141 unique patients. Post-exclusion, 1670 radiographs were analyzed. Categories included 479 normal, 332 clinically irrelevant, 339 clinically relevant, 501 urgent, and 19 critical findings. The AI system achieved an AUC of 0.92. Sensitivity for normal radiographs was 92% at default and 53% at the conservative operating point. At the conservative operating point, NPV was 98% for urgent and critical findings, and could result in a 15% workload reduction. CONCLUSION A commercially available AI system effectively identifies normal chest radiographs and holds the potential to lessen radiologists' workload by omitting half of the normal exams from reporting. CLINICAL RELEVANCE STATEMENT The AI system is able to detect half of all normal chest radiographs at a clinically acceptable operating point, thereby potentially reducing the workload for the radiologists by 15%. KEY POINTS The AI system reached an AUC of 0.92 for the detection of normal chest radiographs. Fifty-three percent of normal chest radiographs were identified with a NPV of 98% for urgent findings. AI can reduce the workload of chest radiography reporting by 15%.
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Affiliation(s)
| | | | - Erdi Calli
- Department of Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Keelin Murphy
- Department of Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Matthieu Rutten
- Department of Imaging, Radboudumc, Nijmegen, The Netherlands
- Department of Radiology, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands
| | - Bram Geurts
- Department of Imaging, Radboudumc, Nijmegen, The Netherlands
| | | | | | - Mathias Prokop
- Department of Imaging, Radboudumc, Nijmegen, The Netherlands
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Rocco G, Pennazza G, Tan KS, Vanstraelen S, Santonico M, Corba RJ, Park BJ, Sihag S, Bott MJ, Crucitti P, Isbell JM, Ginsberg MS, Weiss H, Incalzi RA, Finamore P, Longo F, Zompanti A, Grasso S, Solomon SB, Vincent A, McKnight A, Cirelli M, Voli C, Kelly S, Merone M, Molena D, Gray K, Huang J, Rusch VW, Bains MS, Downey RJ, Adusumilli PS, Jones DR. A Real-World Assessment of Stage I Lung Cancer Through Electronic Nose Technology. J Thorac Oncol 2024:S1556-0864(24)00211-9. [PMID: 38762120 DOI: 10.1016/j.jtho.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/03/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Electronic nose (E-nose) technology has reported excellent sensitivity and specificity in the setting of lung cancer screening. However, the performance of E-nose specifically for early-stage tumors remains unclear. Therefore, the aim of our study was to assess the diagnostic performance of E-nose technology in clinical stage I lung cancer. METHODS This phase IIc trial (NCT04734145) included patients diagnosed with a single greater than or equal to 50% solid stage I nodule. Exhalates were prospectively collected from January 2020 to August 2023. Blinded bioengineers analyzed the exhalates, using E-nose technology to determine the probability of malignancy. Patients were stratified into three risk groups (low-risk, [<0.2]; moderate-risk, [≥0.2-0.7]; high-risk, [≥0.7]). The primary outcome was the diagnostic performance of E-nose versus histopathology (accuracy and F1 score). The secondary outcome was the clinical performance of the E-nose versus clinicoradiological prediction models. RESULTS Based on the predefined cutoff (<0.20), E-nose agreed with histopathologic results in 86% of cases, achieving an F1 score of 92.5%, based on 86 true positives, two false negatives, and 12 false positives (n = 100). E-nose would refer fewer patients with malignant nodules to observation (low-risk: 2 versus 9 and 11, respectively; p = 0.028 and p = 0.011) than would the Swensen and Brock models and more patients with malignant nodules to treatment without biopsy (high-risk: 27 versus 19 and 6, respectively; p = 0.057 and p < 0.001). CONCLUSIONS In the setting of clinical stage I lung cancer, E-nose agrees well with histopathology. Accordingly, E-nose technology can be used in addition to imaging or as part of a "multiomics" platform.
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Affiliation(s)
- Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Giorgio Pennazza
- Department of Engineering, Unit of Electronics for Sensor Systems, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stijn Vanstraelen
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marco Santonico
- Department of Science and Technology for Sustainable Development and One Health, Unit of Electronics for Sensor Systems, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Robert J Corba
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pierfilippo Crucitti
- Department of Thoracic Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hallie Weiss
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raffaele Antonelli Incalzi
- Department of Geriatrics, Research Unit of Internal Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Panaiotis Finamore
- Department of Thoracic Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Filippo Longo
- Department of Thoracic Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Alessandro Zompanti
- Department of Engineering, Unit of Electronics for Sensor Systems, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Simone Grasso
- Department of Science and Technology for Sustainable Development and One Health, Unit of Electronics for Sensor Systems, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alain Vincent
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexa McKnight
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Cirelli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carmela Voli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan Kelly
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mario Merone
- Department of Engineering, Unit of Computational Systems and Bioinformatics, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katherine Gray
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Manjit S Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert J Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
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12
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de Bloeme CM, van Elst S, Galluzzi P, Jansen RW, de Haan J, Göricke S, Moll AC, Bot JCJ, Munier FL, Beck-Popovic M, Puccinelli F, Aerts I, Hadjistilianou T, Sirin S, Koob M, Brisse HJ, Cardoen L, Maeder P, de Jong MC, de Graaf P. MR Imaging of Adverse Effects and Ocular Growth Decline after Selective Intra-Arterial Chemotherapy for Retinoblastoma. Cancers (Basel) 2024; 16:1899. [PMID: 38791976 PMCID: PMC11120425 DOI: 10.3390/cancers16101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
This retrospective multicenter study examines therapy-induced orbital and ocular MRI findings in retinoblastoma patients following selective intra-arterial chemotherapy (SIAC) and quantifies the impact of SIAC on ocular and optic nerve growth. Patients were selected based on medical chart review, with inclusion criteria requiring the availability of posttreatment MR imaging encompassing T2-weighted and T1-weighted images (pre- and post-intravenous gadolinium administration). Qualitative features and quantitative measurements were independently scored by experienced radiologists, with deep learning segmentation aiding total eye volume assessment. Eyes were categorized into three groups: eyes receiving SIAC (Rb-SIAC), eyes treated with other eye-saving methods (Rb-control), and healthy eyes. The most prevalent adverse effects post-SIAC were inflammatory and vascular features, with therapy-induced contrast enhancement observed in the intraorbital optic nerve segment in 6% of patients. Quantitative analysis revealed significant growth arrest in Rb-SIAC eyes, particularly when treatment commenced ≤ 12 months of age. Optic nerve atrophy was a significant complication in Rb-SIAC eyes. In conclusion, this study highlights the vascular and inflammatory adverse effects observed post-SIAC in retinoblastoma patients and demonstrates a negative impact on eye and optic nerve growth, particularly in children treated ≤ 12 months of age, providing crucial insights for clinical management and future research.
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Affiliation(s)
- Christiaan M. de Bloeme
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Sabien van Elst
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Paolo Galluzzi
- Department of Neuroimaging Unit, Siena University Hospital, 53100 Siena, Italy
| | - Robin W. Jansen
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Joeka de Haan
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | - Sophia Göricke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Annette C. Moll
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Joseph C. J. Bot
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Francis L. Munier
- Unit of Pediatric Ocular Oncology, Jules-Gonin Eye Hospital, University of Lausanne, 1015 Lausanne, Switzerland
| | - Maja Beck-Popovic
- Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Francesco Puccinelli
- Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Isabelle Aerts
- Pediatricic Department, Institut Curie, PSL Research University, 75005 Paris, France
| | - Theodora Hadjistilianou
- Unit of Ophthalmology and Referral Center for Retinoblastoma, Department of Surgery, Policlinico “Santa Maria alle Scotte”, 53100 Siena, Italy
| | - Selma Sirin
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Mériam Koob
- Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Hervé J. Brisse
- Imaging Department, Institut Curie, Paris University, 75005 Paris, France
| | - Liesbeth Cardoen
- Imaging Department, Institut Curie, Paris University, 75005 Paris, France
| | - Philippe Maeder
- Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Marcus C. de Jong
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Pim de Graaf
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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Larsen A, Timmermann AM, Kring M, Mathisen SB, Bak EEF, Weltz TK, Ørholt M, Vester-Glowinski P, Elberg JJ, Trillingsgaard J, Mielke LV, Hölmich LR, Damsgaard TE, Roslind A, Herly M. Development and Validation of a Diagnostic Histopathological Scoring System for Capsular Contracture Based on 720 Breast Implant Capsules. Aesthet Surg J 2024; 44:NP391-NP401. [PMID: 38429010 DOI: 10.1093/asj/sjae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Capsular contracture is traditionally evaluated with the Baker classification, but this has notable limitations regarding reproducibility and objectivity. OBJECTIVES The aim of this study was to develop and validate procedure-specific histopathological scoring systems to assess capsular contracture severity. METHODS Biopsies of breast implant capsules were used to develop histopathological scoring systems for patients following breast augmentation and breast reconstruction. Ten histological parameters were evaluated by multivariable logistic regression to identify those most associated with capsular contracture. Significant parameters (P < .05) were selected for the scoring systems and assigned weighted scores (1-10). Validation was assessed from the area under the curve (AUC) and the mean absolute error (MAE). RESULTS A total of 720 biopsies from 542 patients were included. Four parameters were selected for the augmentation scoring system, namely, collagen layer thickness, fiber organization, inflammatory infiltration, and calcification, providing a combined maximum score of 26. The AUC and MAE for the augmentation scoring system were 81% and 0.8%, which is considered strong. Three parameters were selected for the reconstruction scoring system, namely, fiber organization, collagen layer cellularity, and inflammatory infiltration, providing a combined maximum score of 19. The AUC and MAE of the reconstruction scoring system were 72% and 7.1%, which is considered good. CONCLUSIONS The new histopathological scoring systems provide an objective, reproducible, and accurate assessment of capsular contracture severity. We propose these novel scoring systems as a valuable tool for confirming capsular contracture diagnosis in the clinical setting, for research, and for implant manufacturers and insurance providers in need of a confirmed capsular contracture diagnosis. LEVEL OF EVIDENCE: 3
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Kim H, Kim K, Oh SJ, Lee S, Woo JH, Kim JH, Cha YK, Kim K, Chung MJ. AI-assisted Analysis to Facilitate Detection of Humeral Lesions on Chest Radiographs. Radiol Artif Intell 2024; 6:e230094. [PMID: 38446041 PMCID: PMC11140509 DOI: 10.1148/ryai.230094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 01/10/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
Purpose To develop an artificial intelligence (AI) system for humeral tumor detection on chest radiographs (CRs) and evaluate the impact on reader performance. Materials and Methods In this retrospective study, 14 709 CRs (January 2000 to December 2021) were collected from 13 468 patients, including CT-proven normal (n = 13 116) and humeral tumor (n = 1593) cases. The data were divided into training and test groups. A novel training method called false-positive activation area reduction (FPAR) was introduced to enhance the diagnostic performance by focusing on the humeral region. The AI program and 10 radiologists were assessed using holdout test set 1, wherein the radiologists were tested twice (with and without AI test results). The performance of the AI system was evaluated using holdout test set 2, comprising 10 497 normal images. Receiver operating characteristic analyses were conducted for evaluating model performance. Results FPAR application in the AI program improved its performance compared with a conventional model based on the area under the receiver operating characteristic curve (0.87 vs 0.82, P = .04). The proposed AI system also demonstrated improved tumor localization accuracy (80% vs 57%, P < .001). In holdout test set 2, the proposed AI system exhibited a false-positive rate of 2%. AI assistance improved the radiologists' sensitivity, specificity, and accuracy by 8.9%, 1.2%, and 3.5%, respectively (P < .05 for all). Conclusion The proposed AI tool incorporating FPAR improved humeral tumor detection on CRs and reduced false-positive results in tumor visualization. It may serve as a supportive diagnostic tool to alert radiologists about humeral abnormalities. Keywords: Artificial Intelligence, Conventional Radiography, Humerus, Machine Learning, Shoulder, Tumor Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Harim Kim
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Kyungsu Kim
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Seong Je Oh
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Sungjoo Lee
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Jung Han Woo
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Jong Hee Kim
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Yoon Ki Cha
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Kyunga Kim
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Myung Jin Chung
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
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15
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Paslı S, Topçuoğlu H, Yılmaz M, Yadigaroğlu M, İmamoğlu M, Karaca Y. Diagnostic accuracy of apple watch ECG outputs in identifying dysrhythmias: A comparison with 12-Lead ECG in emergency department. Am J Emerg Med 2024; 79:25-32. [PMID: 38330880 DOI: 10.1016/j.ajem.2024.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Wearable devices, particularly smartwatches like the Apple Watch (AW), can record important cardiac information, such as single‑lead electrocardiograms (ECGs). Although they are increasingly used to detect conditions such as atrial fibrillation (AF), research on their effectiveness in detecting a wider range of dysrhythmias and abnormal ECG findings remains limited. The primary objective of this study is to evaluate the accuracy of the AW in detecting various cardiac rhythms by comparing it with standard ECG's lead-I. METHODS This single-center prospective observational study was conducted in a tertiary care emergency department (ED) between 1.10.2023 and 31.10.2023. The study population consisted of all patients assessed in the critical care areas of the ED, all of whom underwent standard 12‑lead ECGs for various clinical reasons. Participants in the study were included consecutively. An AW was attached to patients' wrists and an ECG lead-I printout was obtained. Heart rate, rhythm and abnormal findings were evaluated and compared with the lead-I of standard ECG. Two emergency medicine specialists performed the ECG evaluations. Rhythms were categorized as normal sinus rhythm and abnormal rhythms, while ECG findings were categorized as the presence or absence of abnormal findings. AW and 12‑lead ECG outputs were compared using the McNemar test. Predictive performance analyses were also performed for subgroups. Bland-Altman analysis using absolute mean differences and concordance correlation coefficients was used to assess the level of heart rate agreement between devices. RESULTS The study was carried out on 721 patients. When analyzing ECG rhythms and abnormal findings in lead-I, the effectiveness of AW in distinguishing between normal and abnormal rhythms was similar to standard ECGs (p = 0.52). However, there was a significant difference between AW and standard ECGs in identifying abnormal findings in lead-I (p < 0.05). Using Bland-Altman analysis for heart rate assessment, the absolute mean difference for heart rate was 0.81 ± 6.12 bpm (r = 0.94). There was strong agreement in 658 out of 700 (94%) heart rate measurements. CONCLUSION Our study indicates that the AW has the potential to detect cardiac rhythms beyond AF. ECG tracings obtained from the AW may help evaluate cardiac rhythms prior to the patient's arrival in the ED. However, further research with a larger patient cohort is essential, especially for specific diagnoses.
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Affiliation(s)
- Sinan Paslı
- Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey.
| | - Hazal Topçuoğlu
- Siirt Education & Research Hospital, Department of Emergency Medicine, Siirt, Turkey
| | - Mutlu Yılmaz
- Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
| | - Metin Yadigaroğlu
- Samsun University, Faculty of Medicine, Department of Emergency Medicine, Samsun, Turkey
| | - Melih İmamoğlu
- Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
| | - Yunus Karaca
- Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
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16
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Dou J, Jiang N, Zeng J, Wang S, Tian S, Shan S, Li Y, Xu Z, Lin X, Jin S, Dong J, Chen H. Novel 3D morphological characteristics for congenital biliary dilatation diagnosis: a case-control study. Int J Surg 2024; 110:2614-2624. [PMID: 38376858 DOI: 10.1097/js9.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/04/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Congenital biliary dilatation (CBD) necessitates the timely removal of dilated bile ducts. Accurate differentiation between CBD and secondary biliary dilatation (SBD) is crucial for treatment decisions, and identification of CBD with intrahepatic involvement is vital for surgical planning and supportive care. This study aimed to develop quantitative models based on bile duct morphology to distinguish CBD from SBD and further identify CBD with intrahepatic involvement. MATERIALS AND METHODS The retrospective study included 131 CBD and 209 SBD patients between December 2014 and December 2021 for model development, internal validation, and testing. A separate cohort of 15 CBD and 34 SBD patients between January 2022 and December 2022 was recruited for temporally-independent validation. Quantitative shape-based (Shape) and diameter-based (Diam) morphological characteristics of bile ducts were extracted to build a CBD diagnosis model to distinguish CBD from SBD and an intrahepatic involvement identification model to classify CBD with/without intrahepatic involvement. The diagnostic performance of the models was compared with that of experienced hepatobiliary surgeons. RESULTS The CBD diagnosis model using clinical, Shape, and Diam characteristics showed good performance with an AUROC of 0.942 (95% CI: 0.890-0.994), AUPRC of 0.917 (0.855-0.979), accuracy of 0.891, sensitivity of 0.950, and F1-score of 0.864. The model outperformed two experienced surgeons in accuracy, sensitivity, and F1-score. The intrahepatic involvement identification model using clinical, Shape, and Diam characteristics yielded outstanding performance with an AUROC of 0.944 (0.879-1.000), AUPRC of 0.982 (0.947-1.000), accuracy of 0.932, sensitivity of 0.971, and F1-score of 0.957. The models demonstrated generalizable performance on the temporally-independent validation cohort. CONCLUSIONS This study developed two robust quantitative models for distinguishing CBD from SBD and identifying CBD with intrahepatic involvement, respectively, based on morphological characteristics of the bile ducts, showing great potential in risk stratification and surgical planning of CBD.
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Affiliation(s)
- Jiaqi Dou
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine
| | - Nan Jiang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology, Ministry of Education, School of Clinical Medicine
- Institute for Precision Medicine, Tsinghua University
- Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences
| | - Jianping Zeng
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology, Ministry of Education, School of Clinical Medicine
- Institute for Precision Medicine, Tsinghua University
- Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences
| | - Siyuan Wang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology, Ministry of Education, School of Clinical Medicine
- Institute for Precision Medicine, Tsinghua University
- Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences
| | - Song Tian
- Philips Healthcare, Beijing, People's Republic of China
| | - Siqiao Shan
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology, Ministry of Education, School of Clinical Medicine
- Institute for Precision Medicine, Tsinghua University
- Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences
| | - Yuze Li
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine
| | - Ziming Xu
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine
| | - Xiaoqi Lin
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine
| | - Shuo Jin
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology, Ministry of Education, School of Clinical Medicine
- Institute for Precision Medicine, Tsinghua University
- Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences
| | - Jiahong Dong
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology, Ministry of Education, School of Clinical Medicine
- Institute for Precision Medicine, Tsinghua University
- Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences
| | - Huijun Chen
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine
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Crimì F, Cabrelle G, Campi C, Schillaci A, Bao QR, Pepe A, Spolverato G, Pucciarelli S, Vernuccio F, Quaia E. Nodal staging with MRI after neoadjuvant chemo-radiotherapy for locally advanced rectal cancer: a fast and reliable method. Eur Radiol 2024; 34:3205-3214. [PMID: 37930408 DOI: 10.1007/s00330-023-10265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES In patients with locally advanced rectal carcinoma (LARC), negative nodal status after neoadjuvant chemoradiotherapy (nCRT) may allow for rectum-sparing protocols rather than total mesorectal excision; however, current MRI criteria for nodal staging have suboptimal accuracy. The aim of this study was to compare the diagnostic accuracy of different MRI dimensional criteria for nodal staging after nCRT in patients with LARC. MATERIALS AND METHODS Patients who underwent MRI after nCRT for LARC followed by surgery were retrospectively included and divided into a training and a validation cohort of 100 and 39 patients, respectively. Short-, long-, and cranial-caudal axes and volume of the largest mesorectal node and nodal status based on European Society of Gastrointestinal Radiology consensus guidelines (i.e., ESGAR method) were assessed by two radiologists independently. Inter-reader agreement was assessed in the training cohort. Histopathology was the reference standard. ROC curves and the best cut-off were calculated, and accuracies compared with the McNemar test. RESULTS The study population included 139 patients (median age 62 years [IQR 55-72], 94 men). Inter-reader agreement was high for long axis (κ = 0.81), volume (κ = 0.85), and ESGAR method (κ = 0.88) and low for short axis (κ = 0.11). Accuracy was similar (p > 0.05) for long axis, volume, and ESGAR method both in the training (71%, 74%, and 65%, respectively) and in the validation (83%, 78%, and 75%, respectively) cohorts. CONCLUSION Accuracy of the measurement of long axis and volume of the largest lymph node is not inferior to the ESGAR method for nodal staging after nCRT in LARC. CLINICAL RELEVANCE STATEMENT In MRI restaging of rectal cancer, measurement of the long axis or volume of largest mesorectal lymph node after preoperative chemoradiotherapy is a faster and reliable alternative to ESGAR criteria for nodal staging. KEY POINTS • Current MRI criteria for nodal staging in locally advanced rectal cancer after chemo-radiotherapy have suboptimal accuracy and are time-consuming. • Measurement of long axis or volume of the largest mesorectal lymph node on MRI showed good accuracy for assessment of loco-regional nodal status in locally advanced rectal cancer. • MRI measurement of the long axis and volume of largest mesorectal lymph node after chemo-radiotherapy could be a faster and reliable alternative to ESGAR criteria for nodal staging.
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Affiliation(s)
- Filippo Crimì
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Giulio Cabrelle
- Department of Radiology, University Hospital of Padova, Via Niccolò Giustiniani N.2, 35128, Padua, Italy
| | - Cristina Campi
- Department of Mathematics, University of Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessio Schillaci
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Quoc Riccardo Bao
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences (DiSCOG), University of Padova, Padua, Italy
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Gaya Spolverato
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences (DiSCOG), University of Padova, Padua, Italy
| | - Salvatore Pucciarelli
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences (DiSCOG), University of Padova, Padua, Italy
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padova, Via Niccolò Giustiniani N.2, 35128, Padua, Italy.
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, Padua, Italy
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18
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Cesur T, Güneş YC. Optimizing Diagnostic Performance of ChatGPT: The Impact of Prompt Engineering on Thoracic Radiology Cases. Cureus 2024; 16:e60009. [PMID: 38854352 PMCID: PMC11162509 DOI: 10.7759/cureus.60009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Background Recent studies have highlighted the diagnostic performance of ChatGPT 3.5 and GPT-4 in a text-based format, demonstrating their radiological knowledge across different areas. Our objective is to investigate the impact of prompt engineering on the diagnostic performance of ChatGPT 3.5 and GPT-4 in diagnosing thoracic radiology cases, highlighting how the complexity of prompts influences model performance. Methodology We conducted a retrospective cross-sectional study using 124 publicly available Case of the Month examples from the Thoracic Society of Radiology website. We initially input the cases into the ChatGPT versions without prompting. Then, we employed five different prompts, ranging from basic task-oriented to complex role-specific formulations to measure the diagnostic accuracy of ChatGPT versions. The differential diagnosis lists generated by the models were compared against the radiological diagnoses listed on the Thoracic Society of Radiology website, with a scoring system in place to comprehensively assess the accuracy. Diagnostic accuracy and differential diagnosis scores were analyzed using the McNemar, Chi-square, Kruskal-Wallis, and Mann-Whitney U tests. Results Without any prompts, ChatGPT 3.5's accuracy was 25% (31/124), which increased to 56.5% (70/124) with the most complex prompt (P < 0.001). GPT-4 showed a high baseline accuracy at 53.2% (66/124) without prompting. This accuracy increased to 59.7% (74/124) with complex prompts (P = 0.09). Notably, there was no statistical difference in peak performance between ChatGPT 3.5 (70/124) and GPT-4 (74/124) (P = 0.55). Conclusions This study emphasizes the critical influence of prompt engineering on enhancing the diagnostic performance of ChatGPT versions, especially ChatGPT 3.5.
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Affiliation(s)
- Turay Cesur
- Radiology, Ankara Mamak State Hospital, Ankara, TUR
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Nagendrababu V, Pigg M, Duncan HF, Abbott PV, Fouad AF, Kruse C, Patel S, Rechenberg DK, Setzer FC, Rossi-Fedele G, Dummer PMH. PRIDASE 2024 guidelines for reporting diagnostic accuracy studies in endodontics: A consensus-based development. Int Endod J 2024. [PMID: 38669132 DOI: 10.1111/iej.14075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Studies investigating the accuracy of diagnostic tests should provide data on how effectively they identify or exclude disease in order to inform clinicians responsible for managing patients. This consensus-based project was undertaken to develop reporting guidelines for authors submitting manuscripts, which describe studies that have evaluated the accuracy of diagnostic tests in endodontics. These guidelines are known as the Preferred Reporting Items for Diagnostic Accuracy Studies in Endodontics (PRIDASE) 2024 guidelines. A nine-member steering committee created an initial checklist by integrating and modifying items from the Standards for Reporting of Diagnostic Accuracy (STARD) 2015 checklist and the Clinical and Laboratory Images in Publications (CLIP) principles, as well as adding a number of new items specific to the specialty of endodontics. Thereafter, the steering committee formed the PRIDASE Delphi Group (PDG) and the PRIDASE Online Meeting Group (POMG) in order to collect expert feedback on the preliminary draft checklist. Members of the Delphi group engaged in an online Delphi process to reach consensus on the clarity and suitability of the items in the checklist. The online meeting group then held an in-depth discussion on the online Delphi-generated items via the Zoom platform on 20 October 2023. According to the feedback obtained, the steering committee revised the PRIDASE checklist, which was then piloted by several authors when preparing manuscripts describing diagnostic accuracy studies in endodontics. Feedback from this process resulted in the final version of the PRIDASE 2024 checklist, which has 11 sections and 66 items. Authors are encouraged to use the PRIDASE 2024 guidelines when developing manuscripts on diagnostic accuracy in endodontics in order to improve the quality of reporting in this area. Editors of relevant journals will be invited to include these guidelines in their instructions to authors.
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Affiliation(s)
- Venkateshbabu Nagendrababu
- Department of Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Maria Pigg
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Henry F Duncan
- Division of Restorative Dentistry, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Paul V Abbott
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
| | - Ashraf F Fouad
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Casper Kruse
- Section of Oral Radiology and Endodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Center for Oral Health in Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Shanon Patel
- Department of Endodontics, Faculty of Dentistry, Oral and Craniofacial Sciences at Kings' College London, London, UK
| | - Dan K Rechenberg
- Department of Conservative and Preventive Dentistry, University of Zürich, Zürich, Switzerland
| | - Frank C Setzer
- University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Giampiero Rossi-Fedele
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Tomlinson E, Cooper C, Davenport C, Rutjes AWS, Leeflang M, Mallett S, Whiting P. Common challenges and suggestions for risk of bias tool development: a systematic review of methodological studies. J Clin Epidemiol 2024; 171:111370. [PMID: 38670243 DOI: 10.1016/j.jclinepi.2024.111370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES To review the findings of studies that have evaluated the design and/or usability of key risk of bias (RoB) tools for the assessment of RoB in primary studies, as categorized by the Library of Assessment Tools and InsTruments Used to assess Data validity in Evidence Synthesis Network (a searchable library of RoB tools for evidence synthesis): Prediction model Risk Of Bias ASessment Tool (PROBAST) , Risk of Bias-2 (RoB2), Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I), Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C), Quality Assessment of Prognostic Accuracy Studies (QUAPAS), Risk Of Bias in Non-randomised Studies of Exposures (ROBINS-E), and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) RoB checklist. STUDY DESIGN AND SETTING Systematic review of methodological studies. We conducted a forward citation search from the primary report of each tool, to identify primary studies that aimed to evaluate the design and/or usability of the tool. Two reviewers assessed studies for inclusion. We extracted tool features into Microsoft Word and used NVivo for document analysis, comprising a mix of deductive and inductive approaches. We summarized findings within each tool and explored common findings across tools. RESULTS We identified 13 tool evaluations meeting our inclusion criteria: PROBAST (3), RoB2 (3), ROBINS-I (4), and QUADAS-2 (3). We identified no evaluations for the other tools. Evaluations varied in clinical topic area, methodology, approach to bias assessment, and tool user background. Some had limitations affecting generalizability. We identified common findings across tools for 6/14 themes: (1) challenging items (eg, RoB2/ROBINS-I "deviations from intended interventions" domain), (2) overall RoB judgment (concerns with overall risk calculation in PROBAST/ROBINS-I), (3) tool usability (concerns about complexity), (4) time to complete tool (varying demands on time, eg, depending on number of outcomes assessed), (5) user agreement (varied across tools), and (6) recommendations for future use (eg, piloting) and development (add intermediate domain answer to QUADAS-2/PROBAST; provide clearer guidance for all tools). Of the other eight themes, seven only had findings for the QUADAS-2 tool, limiting comparison across tools, and one ("reorganization of questions") had no findings. CONCLUSION Evaluations of key RoB tools have posited common challenges and recommendations for tool use and development. These findings may be helpful to people who use or develop RoB tools. Guidance is necessary to support the design and implementation of future RoB tool evaluations.
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Affiliation(s)
- Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Chris Cooper
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Clare Davenport
- Test and Prediction Group, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham B15 2TT, UK
| | - Anne W S Rutjes
- Department of Medical and Surgical Sciences for Children and Adults (SMECHIMAI), University of Modena and Reggio Emilia, Modena, Italy
| | - Mariska Leeflang
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sue Mallett
- Centre for Medical Imaging, University College London, London, UK
| | - Penny Whiting
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Geboers B, Meijer D, Counter W, Blazevski A, Thompson J, Doan P, Gondoputro W, Katelaris A, Haynes AM, Delprado W, O'Neill G, Yuen C, Vis AN, van Leeuwen PJ, Ho B, Liu V, Lee J, Donswijk ML, Oprea-Lager D, Scheltema MJ, Emmett L, Stricker PD. Prostate-specific membrane antigen positron emission tomography in addition to multiparametric magnetic resonance imaging and biopsies to select prostate cancer patients for focal therapy. BJU Int 2024; 133 Suppl 4:14-22. [PMID: 37858931 DOI: 10.1111/bju.16207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To evaluate the additional value of prostate-specific membrane antigen positron emission tomography (PSMA-PET) to conventional diagnostic tools to select patients for hemi-ablative focal therapy (FT). PATIENTS AND METHODS We performed a retrospective analysis on a multicentre cohort (private and institutional) of 138 patients who underwent multiparametric magnetic resonance imaging (mpMRI), PSMA-PET, and systematic biopsies prior to radical prostatectomy between January 2011 and July 2021. Patients were eligible when they met the consensus criteria for FT: PSA <15 ng/mL, clinical/radiological T stage ≤T2b, and International Society of Urological Pathology (ISUP) grade 2-3. Clinically significant prostate cancer (csPCa) was defined as ISUP grade ≥2, extracapsular extension >0.5 mm or seminal vesicle involvement at final histopathology. The diagnostic accuracy of mpMRI, systematic biopsies and PSMA-PET for csPCa (separate and combined) was calculated within a four-quadrant prostate model by receiver-operating characteristic and 2 × 2 contingency analysis. Additionally, we assessed whether the diagnostic tools correctly identified patients suitable for hemi-ablative FT. RESULTS In total 552 prostate quadrants were analysed and 272 (49%) contained csPCa on final histopathology. The area under the curve, sensitivity, specificity, positive predictive value and negative predictive value for csPCa were 0.79, 75%, 83%, 81% and 77%, respectively, for combined mpMRI and systematic biopsies, and improved after addition of PSMA-PET to 0.84, 87%, 80%, 81% and 86%, respectively (P < 0.001). On final histopathology 46/138 patients (33%) were not suitable for hemi-ablative FT. Addition of PSMA-PET correctly identified 26/46 (57%) non-suitable patients and resulted in 4/138 (3%) false-positive exclusions. CONCLUSIONS Addition of PSMA-PET to the conventional work-up by mpMRI and systematic biopsies could improve selection for hemi-ablative FT and guide exclusion of patients for whom whole-gland treatments might be a more suitable treatment option.
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Affiliation(s)
- Bart Geboers
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
- Department of Radiology and Nuclear Medicine, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - Dennie Meijer
- Department of Urology, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - William Counter
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Alexandar Blazevski
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
| | - James Thompson
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
- Department of Urology, St. George Hospital, Sydney, NSW, Australia
| | - Paul Doan
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
| | - William Gondoputro
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
| | - Athos Katelaris
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
| | | | - Gordon O'Neill
- Department of Urology, St. Vincent's Hospital and Private Clinic, Sydney, NSW, Australia
| | - Carlo Yuen
- Department of Urology, St. Vincent's Hospital and Private Clinic, Sydney, NSW, Australia
| | - Andre N Vis
- Department of Urology, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bao Ho
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Victor Liu
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Jonathan Lee
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Maarten L Donswijk
- Department of Radiology and Nuclear Medicine, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daniela Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - Matthijs J Scheltema
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
- Department of Urology, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Phillip D Stricker
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Hospital and Private Clinic, Sydney, NSW, Australia
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Elfer K, Gardecki E, Garcia V, Ly A, Hytopoulos E, Wen S, Hanna MG, Peeters DJE, Saltz J, Ehinger A, Dudgeon SN, Li X, Blenman KRM, Chen W, Green U, Birmingham R, Pan T, Lennerz JK, Salgado R, Gallas BD. Reproducible Reporting of the Collection and Evaluation of Annotations for Artificial Intelligence Models. Mod Pathol 2024; 37:100439. [PMID: 38286221 DOI: 10.1016/j.modpat.2024.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/14/2023] [Accepted: 01/21/2024] [Indexed: 01/31/2024]
Abstract
This work puts forth and demonstrates the utility of a reporting framework for collecting and evaluating annotations of medical images used for training and testing artificial intelligence (AI) models in assisting detection and diagnosis. AI has unique reporting requirements, as shown by the AI extensions to the Consolidated Standards of Reporting Trials (CONSORT) and Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklists and the proposed AI extensions to the Standards for Reporting Diagnostic Accuracy (STARD) and Transparent Reporting of a Multivariable Prediction model for Individual Prognosis or Diagnosis (TRIPOD) checklists. AI for detection and/or diagnostic image analysis requires complete, reproducible, and transparent reporting of the annotations and metadata used in training and testing data sets. In an earlier work by other researchers, an annotation workflow and quality checklist for computational pathology annotations were proposed. In this manuscript, we operationalize this workflow into an evaluable quality checklist that applies to any reader-interpreted medical images, and we demonstrate its use for an annotation effort in digital pathology. We refer to this quality framework as the Collection and Evaluation of Annotations for Reproducible Reporting of Artificial Intelligence (CLEARR-AI).
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Affiliation(s)
- Katherine Elfer
- United States Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Imaging Diagnostics and Software Reliability, Silver Spring, Maryland; National Institutes of Health, National Cancer Institute, Division of Cancer Prevention, Cancer Prevention Fellowship Program, Bethesda, Maryland.
| | - Emma Gardecki
- United States Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Imaging Diagnostics and Software Reliability, Silver Spring, Maryland
| | - Victor Garcia
- United States Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Imaging Diagnostics and Software Reliability, Silver Spring, Maryland
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Si Wen
- United States Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Imaging Diagnostics and Software Reliability, Silver Spring, Maryland
| | - Matthew G Hanna
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dieter J E Peeters
- Department of Pathology, University Hospital Antwerp/University of Antwerp, Antwerp, Belgium; Department of Pathology, Sint-Maarten Hospital, Mechelen, Belgium
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | - Anna Ehinger
- Department of Clinical Genetics, Pathology and Molecular Diagnostics, Laboratory Medicine, Lund University, Lund, Sweden
| | - Sarah N Dudgeon
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kim R M Blenman
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, Yale University, New Haven, Connecticut; Department of Computer Science, School of Engineering and Applied Science, Yale University, New Haven, Connecticut
| | - Weijie Chen
- United States Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Imaging Diagnostics and Software Reliability, Silver Spring, Maryland
| | - Ursula Green
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
| | - Ryan Birmingham
- United States Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Imaging Diagnostics and Software Reliability, Silver Spring, Maryland; Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
| | - Tony Pan
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
| | - Jochen K Lennerz
- Department of Pathology, Center for Integrated Diagnostics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Roberto Salgado
- Division of Research, Peter Mac Callum Cancer Centre, Melbourne, Australia; Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
| | - Brandon D Gallas
- United States Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Imaging Diagnostics and Software Reliability, Silver Spring, Maryland
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23
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Frenzel M, Ucar FA, Brockmann C, Altmann S, Abello MAM, Uphaus T, Ringel F, Korczynski O, Mukhopadhyay A, Sanner AP, Schmidtmann I, Brockmann MA, Othman AE. Comparison of Ultra-High-Resolution and Normal-Resolution CT-Angiography for Intracranial Aneurysm Detection in Patients with Subarachnoid Hemorrhage. Acad Radiol 2024; 31:1594-1604. [PMID: 37821348 DOI: 10.1016/j.acra.2023.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 10/13/2023]
Abstract
RATIONALE AND OBJECTIVES Ruptured intracranial aneurysms (IAs) are the leading cause for atraumatic subarachnoid hemorrhage. In case of aneurysm rupture, patients may face life-threatening complications and require aneurysm occlusion. Detection of the aneurysm in computed tomography (CT) imaging is therefore essential for patient outcome. This study provides an evaluation of the diagnostic accuracy of Ultra-High-Resolution Computed Tomography Angiography (UHR-CTA) and Normal-Resolution Computed Tomography Angiography (NR-CTA) concerning IA detection and characterization. MATERIALS AND METHODS Consecutive patients with atraumatic subarachnoid hemorrhage who received Digital Subtraction Angiography (DSA) and either UHR-CTA or NR-CTA were retrospectively included. Three readers evaluated CT-Angiography regarding image quality, diagnostic confidence and presence of IAs. Sensitivity and specificity were calculated on patient-level and segment-level with reference standard DSA-imaging. CTA patient radiation exposure (effective dose) was compared. RESULTS One hundred and eight patients were identified (mean age = 57.8 ± 14.1 years, 65 women). UHR-CTA revealed significantly higher image quality and diagnostic confidence (P < 0.001) for all readers and significantly lower effective dose (P < 0.001). Readers correctly classified ≥55/56 patients on UHR-CTA and ≥44/52 patients on NR-CTA. We noted significantly higher patient-level sensitivity for UHR-CTA compared to NR-CTA for all three readers (reader 1: 41/41 [100%] vs. 28/34 [82%], reader 2: 41/41 [100%] vs. 30/34 [88%], reader 3: 41/41 [100%] vs. 30/34 [88%], P ≤ 0.04). Segment-level analysis also revealed significantly higher sensitivity for UHR-CTA compared to NR-CTA for all three readers (reader 1: 47/49 [96%] vs. 34/45 [76%], reader 2: 47/49 [96%] vs. 37/45 [82%], reader 3: 48/49 [98%] vs. 37/45 [82%], P ≤ 0.04). Specificity was comparable for both techniques. CONCLUSION We found Ultra-High-Resolution CT-Angiography to provide higher sensitivity than Normal-Resolution CT-Angiography for the detection of intracranial aneurysms in patients with aneurysmal subarachnoid hemorrhage while improving image quality and reducing patient radiation exposure.
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Affiliation(s)
- Marius Frenzel
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (M.F., F.A.U., C.B., S.A., M.A.M., O.K., A.P.S., M.A.B., A.E.O.)
| | - Felix A Ucar
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (M.F., F.A.U., C.B., S.A., M.A.M., O.K., A.P.S., M.A.B., A.E.O.)
| | - Carolin Brockmann
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (M.F., F.A.U., C.B., S.A., M.A.M., O.K., A.P.S., M.A.B., A.E.O.)
| | - Sebastian Altmann
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (M.F., F.A.U., C.B., S.A., M.A.M., O.K., A.P.S., M.A.B., A.E.O.)
| | - Mario A Mercado Abello
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (M.F., F.A.U., C.B., S.A., M.A.M., O.K., A.P.S., M.A.B., A.E.O.)
| | - Timo Uphaus
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (T.U.)
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (F.R.)
| | - Oliver Korczynski
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (M.F., F.A.U., C.B., S.A., M.A.M., O.K., A.P.S., M.A.B., A.E.O.)
| | | | - Antoine P Sanner
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (M.F., F.A.U., C.B., S.A., M.A.M., O.K., A.P.S., M.A.B., A.E.O.); Technical University, Darmstadt, Germany (A.M., A.P.S.)
| | - Irene Schmidtmann
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (I.S.)
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (M.F., F.A.U., C.B., S.A., M.A.M., O.K., A.P.S., M.A.B., A.E.O.)
| | - Ahmed E Othman
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (M.F., F.A.U., C.B., S.A., M.A.M., O.K., A.P.S., M.A.B., A.E.O.).
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24
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Ruitenbeek HC, Oei EHG, Schmahl BL, Bos EM, Verdonschot RJCG, Visser JJ. Towards clinical implementation of an AI-algorithm for detection of cervical spine fractures on computed tomography. Eur J Radiol 2024; 173:111375. [PMID: 38377894 DOI: 10.1016/j.ejrad.2024.111375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Artificial intelligence (AI) applications can facilitate detection of cervical spine fractures on CT and reduce time to diagnosis by prioritizing suspected cases. PURPOSE To assess the effect on time to diagnose cervical spine fractures on CT and diagnostic accuracy of a commercially available AI application. MATERIALS AND METHODS In this study (June 2020 - March 2022) with historic controls and prospective evaluation, we evaluated regulatory-cleared AI-software to prioritize cervical spine fractures on CT. All patients underwent non-contrast CT of the cervical spine. The time between CT acquisition and the moment the scan was first opened (DNT) was compared between the retrospective and prospective cohorts. The reference standard for determining diagnostic accuracy was the radiology report created in routine clinical workflow and adjusted by a senior radiologist. Discrepant cases were reviewed and clinical relevance of missed fractures was determined. RESULTS 2973 (mean age, 55.4 ± 19.7 [standard deviation]; 1857 men) patients were analyzed by AI, including 2036 retrospective and 938 prospective cases. Overall prevalence of cervical spine fractures was 7.6 %. The DNT was 18 % (5 min) shorter in the prospective cohort. In scans positive for cervical spine fracture according to the reference standard, DNT was 46 % (16 min) shorter in the prospective cohort. Overall sensitivity of the AI application was 89.8 % (95 % CI: 84.2-94.0 %), specificity was 95.3 % (95 % CI: 94.2-96.2 %), and diagnostic accuracy was 94.8 % (95 % CI: 93.8-95.8 %). Negative predictive value was 99.1 % (95 % CI: 98.5-99.4 %) and positive predictive value was 63.0 % (95 % CI: 58.0-67.8 %). 22 fractures were missed by AI of which 5 required stabilizing therapy. CONCLUSION A time gain of 16 min to diagnosis for fractured cases was observed after introducing AI. Although AI-assisted workflow prioritization of cervical spine fractures on CT shows high diagnostic accuracy, clinically relevant cases were missed.
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Affiliation(s)
- Huibert C Ruitenbeek
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Edwin H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Bart L Schmahl
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Eelke M Bos
- Department of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Rob J C G Verdonschot
- Emergency Department, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Jacob J Visser
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
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25
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Ratneswaren T, Chan N, Aeron-Thomas J, Sait S, Adesalu O, Alhawamdeh M, Benger M, Garnham J, Dixon L, Tona F, McNamara C, Taylor E, Lobotesis K, Lim E, Goldberg O, Asmar N, Evbuomwan O, Banerjee S, Holm-Mercer L, Senor J, Tsitsiou Y, Tantrige P, Taha A, Ballal K, Mattar A, Daadipour A, Elfergani K, Barker R, Chakravartty R, Murchison AG, Kemp BJ, Simister R, Davagnanam I, Wong OY, Werring D, Banaras A, Anjari M, Mak JKC, Falzon AM, Rodrigues JCL, Thompson CAS, Haines IR, Burnett TA, Zaher REY, Reay VL, Banerjee M, Sew Hee CSL, Oo AP, Lo A, Rogers P, Hughes T, Marin A, Mukherjee S, Jaber H, Sanders E, Owen S, Bhandari M, Sundayi S, Bhagat A, Elsakka M, Hashmi OH, Lymbouris M, Gurung-Koney Y, Arshad M, Hasan I, Singh N, Patel V, Rahiminejad M, Booth TC. COVID-19 Stroke Apical Lung Examination Study 2: a national prospective CTA biomarker study of the lung apices, in patients presenting with suspected acute stroke (COVID SALES 2). Neuroimage Clin 2024; 42:103590. [PMID: 38513535 PMCID: PMC10966308 DOI: 10.1016/j.nicl.2024.103590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19. OBJECTIVE To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients. METHODS In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed. RESULTS CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality. CONCLUSION Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage.
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Affiliation(s)
- T Ratneswaren
- Charing Cross Hospital, London, UK; Addenbrooke's Hospital, Cambridge, UK
| | - N Chan
- Royal London Hospital, London, UK
| | | | - S Sait
- King's College Hospital, London, UK
| | | | | | - M Benger
- King's College Hospital, London, UK
| | | | - L Dixon
- Charing Cross Hospital, London, UK
| | - F Tona
- Charing Cross Hospital, London, UK
| | | | - E Taylor
- Charing Cross Hospital, London, UK
| | | | - E Lim
- Charing Cross Hospital, London, UK
| | | | - N Asmar
- Charing Cross Hospital, London, UK
| | | | | | | | - J Senor
- Charing Cross Hospital, London, UK
| | | | - P Tantrige
- Princess Royal University Hospital, Orpington, UK
| | - A Taha
- Princess Royal University Hospital, Orpington, UK
| | - K Ballal
- Princess Royal University Hospital, Orpington, UK
| | - A Mattar
- Princess Royal University Hospital, Orpington, UK
| | - A Daadipour
- Princess Royal University Hospital, Orpington, UK
| | - K Elfergani
- Princess Royal University Hospital, Orpington, UK
| | - R Barker
- Frimley Park Hospital, Surrey, UK
| | | | | | - B J Kemp
- John Radcliffe Hospital, Oxford, UK
| | | | | | - O Y Wong
- University College Hospital, London, UK
| | - D Werring
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - A Banaras
- University College Hospital, London, UK
| | - M Anjari
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, UK
| | - J K C Mak
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, UK
| | - A M Falzon
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, UK
| | | | | | | | | | - R E Y Zaher
- Southampton General Hospital, Southampton, UK
| | - V L Reay
- Southampton General Hospital, Southampton, UK
| | - M Banerjee
- Southampton General Hospital, Southampton, UK
| | | | - A P Oo
- Southampton General Hospital, Southampton, UK
| | - A Lo
- Addenbrooke's Hospital, Cambridge, UK
| | - P Rogers
- Addenbrooke's Hospital, Cambridge, UK
| | - T Hughes
- Cardiff and Vale University Health Board, Cardiff, UK
| | - A Marin
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S Mukherjee
- Cardiff and Vale University Health Board, Cardiff, UK
| | - H Jaber
- Cardiff and Vale University Health Board, Cardiff, UK
| | - E Sanders
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S Owen
- Cardiff and Vale University Health Board, Cardiff, UK
| | | | - S Sundayi
- Watford General Hospital, Watford, UK
| | - A Bhagat
- Watford General Hospital, Watford, UK
| | - M Elsakka
- Watford General Hospital, Watford, UK
| | - O H Hashmi
- Norfolk and Norwich University Hospital, Norwich, UK
| | - M Lymbouris
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | - M Arshad
- Norfolk and Norwich University Hospital, Norwich, UK
| | - I Hasan
- Norfolk and Norwich University Hospital, Norwich, UK
| | - N Singh
- Norfolk and Norwich University Hospital, Norwich, UK
| | - V Patel
- St Thomas' Hospital, London, UK
| | | | - T C Booth
- King's College Hospital, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
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26
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Larsen E, Murton O, Song X, Joachim D, Watts D, Kapczinski F, Venesky L, Hurowitz G. Validating the efficacy and value proposition of mental fitness vocal biomarkers in a psychiatric population: prospective cohort study. Front Psychiatry 2024; 15:1342835. [PMID: 38505797 PMCID: PMC10948552 DOI: 10.3389/fpsyt.2024.1342835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/14/2024] [Indexed: 03/21/2024] Open
Abstract
Background The utility of vocal biomarkers for mental health assessment has gained increasing attention. This study aims to further this line of research by introducing a novel vocal scoring system designed to provide mental fitness tracking insights to users in real-world settings. Methods A prospective cohort study with 104 outpatient psychiatric participants was conducted to validate the "Mental Fitness Vocal Biomarker" (MFVB) score. The MFVB score was derived from eight vocal features, selected based on literature review. Participants' mental health symptom severity was assessed using the M3 Checklist, which serves as a transdiagnostic tool for measuring depression, anxiety, post-traumatic stress disorder, and bipolar symptoms. Results The MFVB demonstrated an ability to stratify individuals by their risk of elevated mental health symptom severity. Continuous observation enhanced the MFVB's efficacy, with risk ratios improving from 1.53 (1.09-2.14, p=0.0138) for single 30-second voice samples to 2.00 (1.21-3.30, p=0.0068) for data aggregated over two weeks. A higher risk ratio of 8.50 (2.31-31.25, p=0.0013) was observed in participants who used the MFVB 5-6 times per week, underscoring the utility of frequent and continuous observation. Participant feedback confirmed the user-friendliness of the application and its perceived benefits. Conclusions The MFVB is a promising tool for objective mental health tracking in real-world conditions, with potential to be a cost-effective, scalable, and privacy-preserving adjunct to traditional psychiatric assessments. User feedback suggests that vocal biomarkers can offer personalized insights and support clinical therapy and other beneficial activities that are associated with improved mental health risks and outcomes.
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Affiliation(s)
| | | | | | | | - Devon Watts
- Neuroscience Graduate Program, Department of Health Sciences, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Flavio Kapczinski
- Neuroscience Graduate Program, Department of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Ruan C, Jiang W, Lu W, Wang Y, Hu X, Ma W. Incidence and Risk Factors for the Development of Axial Symptoms Following Posterior Single-Door Laminoplasty: A Retrospective Analysis. World Neurosurg 2024; 183:e603-e612. [PMID: 38185458 DOI: 10.1016/j.wneu.2023.12.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Posterior single-door laminoplasty is a widely practiced clinical procedure, but the occurrence of postoperative axial syndrome (AS) remains a significant concern. The aim of this study was to identify risk factors associated with AS and develop a risk prediction model. METHODS Clinical data from 226 patients who underwent posterior single-door laminoplasty between June 2017 and June 2022 were collected. Through Logistic model analysis, the risk factors of AS are clarified and the intensity of each risk factor is explained in the form of forest plot. Subsequently, we constructed a predictive model and plotted receiver operating characteristic curves to assess the model's predictive value. RESULTS In the end, 87 cases were diagnosed with AS, resulting in an incidence rate of 38.5%. Logistic regression analysis revealed that preoperative encroachment rate of anterior spinal canal (pre-op ERASC), intraoperative facet joints destruction, intraoperative open-door angle, postoperative loss of cervical curvature, and postoperative loss of cervical range of motion were independent risk factors for AS. Conversely, preoperative cervical curvature (pre-op CC) and postoperation early function training were protective factors against AS. The Youden index indicated that the cutoff values for pre-op ERASC and pre-op CC were 26.6°and 16.5, respectively. The risk prediction model for AS was constructed and a nomogram was plotted. The model has high clinical value. CONCLUSIONS Pre-op ERASC, pre-op CC, intraoperative facet joints destruction, intraoperative open-door angle, postoperative loss of cervical curvature, postoperative loss of cervical range of motion, and postoperation early function training are independent influencing factors for AS occurrence. The risk model has good practicability.
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Affiliation(s)
- Chaoyue Ruan
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Weiyu Jiang
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Wenjie Lu
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Yang Wang
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Xudong Hu
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Weihu Ma
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China.
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Kim PH, Yoon HM, Jung AY, Lee JS, Cho YA, Oh SH, Namgoong JM. Diagnostic accuracy of CT and Doppler US for hepatic outflow obstruction after pediatric liver transplantation using left lobe or left lateral section grafts. Ultrasonography 2024; 43:110-120. [PMID: 38369738 PMCID: PMC10915118 DOI: 10.14366/usg.23190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/22/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
PURPOSE The aim of this study was to evaluate diagnostic accuracy and to establish computed tomography (CT) and Doppler ultrasonography (US) criteria for hepatic outflow obstruction after pediatric liver transplantation (LT) using left lobe (LL) or left lateral section (LLS) grafts. METHODS Pediatric patients who underwent LT using LL or LLS grafts between January 1999 and December 2021 were retrospectively included. The diagnostic performance of Doppler US and CT parameters for hepatic outflow obstruction was calculated using receiver operating characteristic (ROC) curve analysis. A diagnostic decision tree model combining the imaging parameters was developed. RESULTS In total, 288 patients (150 girls; median age at LT, 1.8 years [interquartile range, 0.9 to 3.6 years]) were included. Among the Doppler US parameters, venous pulsatility index (VPI) showed excellent diagnostic performance (area under the ROC curve [AUROC], 0.90; 95% confidence interval [CI], 0.86 to 0.93; Youden cut-off value, 0.40). Among the CT parameters, anastomotic site diameter (AUROC, 0.92; 95% CI, 0.88 to 0.95; Youden cut-off, 4.2 mm) and percentage of anastomotic site stenosis (AUROC, 0.88; 95% CI, 0.84 to 0.92; Youden cut-off, 35%) showed excellent and good diagnostic performance, respectively. A decision tree model combining the VPI, peak systolic velocity, and percentage of anastomotic site stenosis stratified patients according to the risk of hepatic outflow obstruction. CONCLUSION VPI, anastomotic site diameter, and percentage of anastomotic site stenosis were reliable imaging parameters for diagnosing hepatic outflow obstruction after pediatric LT using LL or LLS grafts.
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Affiliation(s)
- Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seak Hee Oh
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Man Namgoong
- Department of Pediatric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Shor N, Lamirel C, Rebbah S, Vignal C, Vasseur V, Savatovsky J, de la Motte MB, Gout O, Lecler A, Hage R, Deschamps R. High diagnostic accuracy of T2FLAIR at 3 T in the detection of optic nerve head edema in acute optic neuritis. Eur Radiol 2024; 34:1453-1460. [PMID: 37668695 DOI: 10.1007/s00330-023-10139-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Optic nerve head edema (ONHE) detected by fundoscopy is observed in one-third of patients presenting optic neuritis (ON). While ONHE is an important semiological feature, the correlation between ONHE and optic nerve head MRI abnormalities (ONHMA), sometimes called "optic nerve head swelling," remains unknown. Our study aimed to assess the diagnostic accuracy of T2 fluid-attenuated inversion recovery (FLAIR) MRI sequence in detecting ONHE in patients with acute ON. METHODS In the present single-center study, data were extracted from two prospective cohort studies that consecutively included adults with a first episode of acute ON treated between 2015 and 2020. Two experienced readers blinded to study data independently analyzed imaging. A senior neuroradiologist resolved any discrepancies. The primary judgment criterion of ONHMA was assessed as optic nerve head high signal intensity on gadolinium-enhanced T2FLAIR MRI sequence. Its diagnostic accuracy was evaluated with both the gold standard of ONHE on fundus photography (FP) and peripapillary retinal nerve fiber layer thickening on optic coherence tomography (OCT). RESULTS A total of 102 patients were included, providing 110 affected and 94 unaffected optic nerves. Agreement was high between the different modalities: 92% between MRI and FP (k = 0.77, 95% CI: 0.67-0.88) and 93% between MRI and OCT (k = 0.77, 95% CI: 0.67-0.87). MRI sensitivity was 0.84 (95% CI: 0.70-0.93) and specificity was 0.94 (95% CI: 0.89-0.97) when compared with the FP. CONCLUSION Optic nerve head high T2FLAIR signal intensity corresponds indeed to the optic nerve head edema diagnosed by the ophthalmologists. MRI is a sensitive tool for detecting ONHE in patients presenting acute ON. CLINICAL RELEVANCE STATEMENT In patients with optic neuritis the high T2FLAIR (fluid-attenuated inversion recovery) signal intensity of the optic nerve head corresponds indeed to optic nerve head edema, which is a useful feature in optic neuritis etiological evaluation and treatment. KEY POINTS Optic nerve head edema is a prominent clinical feature of acute optic neuritis and is usually diagnosed during dilated or non-dilated eye fundus examination. Agreement was high between magnetic resonance imaging, fundus photography, and optical coherence tomography. Optic nerve head high T2 fluid attenuation inversion recovery signal intensity is a promising detection tool for optic nerve head edema in patients presenting acute optic neuritis.
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Affiliation(s)
- Natalia Shor
- Department of Neuroradiology, Foundation Adolphe de Rothschild Hospital, Paris, France.
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
- Department of Neuroradiology, C.H.N.O. des Quinze-Vingt, Paris, France.
| | - Cedric Lamirel
- Department of Neuro-ophthalmology, Foundation Adolphe de Rothschild Hospital, Paris, France
| | - Sana Rebbah
- Data Analysis Core, Paris Brain Institute (ICM), Sorbonne University, Paris, France
| | - Catherine Vignal
- Department of Neuro-ophthalmology, Foundation Adolphe de Rothschild Hospital, Paris, France
| | - Vivien Vasseur
- Clinical Research Department, Foundation Adolphe de Rothschild Hospital, Paris, France
| | - Julien Savatovsky
- Department of Neuroradiology, Foundation Adolphe de Rothschild Hospital, Paris, France
| | | | - Olivier Gout
- Department of Neurology, Foundation Adolphe de Rothschild Hospital, Paris, France
| | - Augustin Lecler
- Department of Neuroradiology, Foundation Adolphe de Rothschild Hospital, Paris, France
| | - Rabih Hage
- Department of Neuro-ophthalmology, Foundation Adolphe de Rothschild Hospital, Paris, France
| | - Romain Deschamps
- Department of Neurology, Foundation Adolphe de Rothschild Hospital, Paris, France
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Atzen SL. Top 10 Tips for Writing Materials and Methods in Radiology: A Brief Guide for Authors. Radiology 2024; 310:e240306. [PMID: 38501956 DOI: 10.1148/radiol.240306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Sarah L Atzen
- From the Radiological Society of North America, 820 Jorie Blvd, Oak Brook, IL 60523
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Gitto S, Annovazzi A, Nulle K, Interlenghi M, Salvatore C, Anelli V, Baldi J, Messina C, Albano D, Di Luca F, Armiraglio E, Parafioriti A, Luzzati A, Biagini R, Castiglioni I, Sconfienza LM. X-rays radiomics-based machine learning classification of atypical cartilaginous tumour and high-grade chondrosarcoma of long bones. EBioMedicine 2024; 101:105018. [PMID: 38377797 PMCID: PMC10884340 DOI: 10.1016/j.ebiom.2024.105018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/03/2024] [Accepted: 02/04/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Atypical cartilaginous tumour (ACT) and high-grade chondrosarcoma (CS) of long bones are respectively managed with active surveillance or curettage and wide resection. Our aim was to determine diagnostic performance of X-rays radiomics-based machine learning for classification of ACT and high-grade CS of long bones. METHODS This retrospective, IRB-approved study included 150 patients with surgically treated and histology-proven lesions at two tertiary bone sarcoma centres. At centre 1, the dataset was split into training (n = 71 ACT, n = 24 high-grade CS) and internal test (n = 19 ACT, n = 6 high-grade CS) cohorts, respectively, based on the date of surgery. At centre 2, the dataset constituted the external test cohort (n = 12 ACT, n = 18 high-grade CS). Manual segmentation was performed on frontal view X-rays, using MRI or CT for preliminary identification of lesion margins. After image pre-processing, radiomic features were extracted. Dimensionality reduction included stability, coefficient of variation, and mutual information analyses. In the training cohort, after class balancing, a machine learning classifier (Support Vector Machine) was automatically tuned using nested 10-fold cross-validation. Then, it was tested on both the test cohorts and compared to two musculoskeletal radiologists' performance using McNemar's test. FINDINGS Five radiomic features (3 morphology, 2 texture) passed dimensionality reduction. After tuning on the training cohort (AUC = 0.75), the classifier had 80%, 83%, 79% and 80%, 89%, 67% accuracy, sensitivity, and specificity in the internal (temporally independent) and external (geographically independent) test cohorts, respectively, with no difference compared to the radiologists (p ≥ 0.617). INTERPRETATION X-rays radiomics-based machine learning accurately differentiates between ACT and high-grade CS of long bones. FUNDING AIRC Investigator Grant.
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Affiliation(s)
- Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Alessio Annovazzi
- Nuclear Medicine Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Kitija Nulle
- Radiology Department, Riga East Clinical University Hospital, Riga, Latvia
| | | | - Christian Salvatore
- DeepTrace Technologies s.r.l., Milan, Italy; Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Pavia, Italy
| | - Vincenzo Anelli
- Radiology and Diagnostic Imaging Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Jacopo Baldi
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy
| | - Filippo Di Luca
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | | | | | | | - Roberto Biagini
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Castiglioni
- Department of Physics "G. Occhialini", Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
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Choi HU, Cho J, Hwang J, Lee S, Chang W, Park JH, Lee KH. Diagnostic performance and image quality of an image-based denoising algorithm applied to radiation dose-reduced CT in diagnosing acute appendicitis. Abdom Radiol (NY) 2024:10.1007/s00261-024-04246-3. [PMID: 38411690 DOI: 10.1007/s00261-024-04246-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To evaluate diagnostic performance and image quality of ultralow-dose CT (ULDCT) in diagnosing acute appendicitis with an image-based deep-learning denoising algorithm (IDLDA). METHODS This retrospective multicenter study included 180 patients (mean ± standard deviation, 29 ± 9 years; 91 female) who underwent contrast-enhanced 2-mSv CT for suspected appendicitis from February 2014 to August 2016. We simulated ULDCT from 2-mSv CT, reducing the dose by at least 50%. Then we applied an IDLDA on ULDCT to produce denoised ULDCT (D-ULDCT). Six radiologists with different experience levels (three board-certified radiologists and three residents) independently reviewed the ULDCT and D-ULDCT. They rated the likelihood of appendicitis and subjective image qualities (subjective image noise, diagnostic acceptability, and artificial sensation). One radiologist measured image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). We used the receiver operating characteristic (ROC) analyses, Wilcoxon's signed-rank tests, and paired t-tests. RESULTS The area under the ROC curves (AUC) for diagnosing appendicitis ranged 0.90-0.97 for ULDCT and 0.94-0.97 for D-ULDCT. The AUCs of two residents were significantly higher on D-ULDCT (AUC difference = 0.06 [95% confidence interval, 0.01-0.11; p = .022] and 0.05 [0.00-0.10; p = .046], respectively). D-ULDCT provided better subjective image noise and diagnostic acceptability to all six readers. However, the response of board-certified radiologists and residents differed in artificial sensation (all p ≤ .003). D-ULDCT showed significantly lower image noise, higher SNR, and higher CNR (all p < .001). CONCLUSION An IDLDA can provide better ULDCT image quality and enhance diagnostic performance for less-experienced radiologists.
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Affiliation(s)
- Hyeon Ui Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
| | - Jinhee Hwang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Seungjae Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Won Chang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Korea
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Chen L, Zeng B, Shen J, Xu J, Cai Z, Su S, Chen J, Cai X, Ying T, Hu B, Wu M, Chen X, Zheng Y. Bone age assessment based on three-dimensional ultrasound and artificial intelligence compared with paediatrician-read radiographic bone age: protocol for a prospective, diagnostic accuracy study. BMJ Open 2024; 14:e079969. [PMID: 38401893 PMCID: PMC10895244 DOI: 10.1136/bmjopen-2023-079969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/31/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION Radiographic bone age (BA) assessment is widely used to evaluate children's growth disorders and predict their future height. Moreover, children are more sensitive and vulnerable to X-ray radiation exposure than adults. The purpose of this study is to develop a new, safer, radiation-free BA assessment method for children by using three-dimensional ultrasound (3D-US) and artificial intelligence (AI), and to test the diagnostic accuracy and reliability of this method. METHODS AND ANALYSIS This is a prospective, observational study. All participants will be recruited through Paediatric Growth and Development Clinic. All participants will receive left hand 3D-US and X-ray examination at the Shanghai Sixth People's Hospital on the same day, all images will be recorded. These image related data will be collected and randomly divided into training set (80% of all) and test set (20% of all). The training set will be used to establish a cascade network of 3D-US skeletal image segmentation and BA prediction model to achieve end-to-end prediction of image to BA. The test set will be used to evaluate the accuracy of AI BA model of 3D-US. We have developed a new ultrasonic scanning device, which can be proposed to automatic 3D-US scanning of hands. AI algorithms, such as convolutional neural network, will be used to identify and segment the skeletal structures in the hand 3D-US images. We will achieve automatic segmentation of hand skeletal 3D-US images, establish BA prediction model of 3D-US, and test the accuracy of the prediction model. ETHICS AND DISSEMINATION The Ethics Committee of Shanghai Sixth People's Hospital approved this study. The approval number is 2022-019. A written informed consent will be obtained from their parent or guardian of each participant. Final results will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2200057236.
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Affiliation(s)
- Li Chen
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bolun Zeng
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Shen
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiangchang Xu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zehang Cai
- Shantou Institute of Ultrasonic Instruments Co., Ltd, Shantou, China
| | - Shudian Su
- Shantou Institute of Ultrasonic Instruments Co., Ltd, Shantou, China
| | - Jie Chen
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Cai
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Ying
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Wu
- Department of Pediatrics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Yuanyi Zheng
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Valdeolmillos E, Sakhi H, Tortigue M, Audié M, Isorni MA, Lecerf F, Sitbon O, Montani D, Jais X, Savale L, Humbert M, Azarine A, Hascoët S. 4D flow cardiac MRI to assess pulmonary blood flow in patients with pulmonary arterial hypertension associated with congenital heart disease. Diagn Interv Imaging 2024:S2211-5684(24)00034-2. [PMID: 38368175 DOI: 10.1016/j.diii.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the accuracy of four-dimensional flow cardiac magnetic resonance imaging (4D flow MRI) compared to right heart catheterization in measuring pulmonary flow (Qp), systemic flow (Qs) and pulmonary-to-systemic flow ratio (Qp/Qs) in patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD). MATERIALS AND METHODS The study was registered on Clinical-trial.gov (NCT03928002). Sixty-four patients with PAH-CHD who underwent 4D flow MRI were included. There were 16 men and 48 women with a mean age of 45.3 ± 13.7 (standard deviation [SD]) years (age range: 21-77 years). Fifty patients (50/64; 78%) presented with pre-tricuspid shunt. Qp (L/min), Qs (L/min) and Qp/Qs were measured invasively using direct Fick method during right heart catheterization and compared with measurements assessed by 4D flow MRI within a 24-48-hour window. RESULTS The average mean pulmonary artery pressure was 51 ± 17 (SD) mm Hg with median pulmonary vascular resistance of 8.8 Wood units (Q1, Q3: 5.3, 11.7). A strong linear correlation was found between Qp measurements obtained with 4D flow MRI and those obtained with the Fick method (r = 0.96; P < 0.001). Bland Altman analysis indicated a mean difference of 0.15 ± 0.48 (SD) L/min between Qp estimated by 4D flow MRI and by right heart catheterization. A strong correlation was found between Qs and Qp/Qs measured by 4D flow MRI and those obtained with the direct Fick method (r = 0.85 and r = 0.92; P < 0.001 for both). CONCLUSION Qp as measured by 4D flow MRI shows a strong correlation with measurements derived from the direct Fick method. Further investigation is needed to develop less complex and standardized methods for measuring essential PAH parameters, such as pulmonary arterial pressures and pulmonary vascular resistance.
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Affiliation(s)
- Estibaliz Valdeolmillos
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France; Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France.
| | - Hichem Sakhi
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France; Department of Cardiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France; Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, 92350 Le Plessis-Robinson, France
| | - Marine Tortigue
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France
| | - Marion Audié
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France
| | - Marc-Antoine Isorni
- Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, 92350 Le Plessis-Robinson, France
| | - Florence Lecerf
- Research and Innovation Department, Marie Lannelongue Hospital, Paris Saclay University, 92350 Le Plessis-Robinson, France
| | - Olivier Sitbon
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - David Montani
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Xavier Jais
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Laurent Savale
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Arshid Azarine
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, 92350 Le Plessis-Robinson, France
| | - Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France; Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France
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Wheeler CM, Torrez-Martinez NE, Torres-Chavolla E, Parvu V, Andrews JC, Du R, Robertson M, Joste NE, Cuzick J. Comparing the performance of 2 human papillomavirus assays for a new use indication: a real-world evidence-based evaluation in the United States. Am J Obstet Gynecol 2024; 230:243.e1-243.e11. [PMID: 37806613 DOI: 10.1016/j.ajog.2023.09.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The US Food and Drug Administration supports innovations to facilitate new indications for high-risk human papillomavirus testing. This report describes the retrospective testing of stored specimens and analysis of existing data to efficiently and cost-effectively support a new indication for the Onclarity human papillomavirus assay (Becton, Dickinson and Company, BD Life Sciences - Integrated Diagnostic Solutions, Sparks, MD). The performance of this index test was compared with that of a predicate test, the cobas human papillomavirus assay (Roche Diagnostics, Indianapolis, IN). Both human papillomavirus assays are based on real-time polymerase chain reaction platforms that detect the presence of 14 high-risk human papillomavirus genotypes. The predicate assay reports human papillomavirus types 16 and 18 as individual results and the other 12 human papillomavirus genotypes as 1 pooled result. The index assay reports 9 independent results (human papillomavirus types 16, 18, 31, 33/58, 35/39/68, 45, 51, 52, and 56/59/66). Both the index and predicate assays are approved by the Food and Drug Administration for cervical cancer screening, but at the time that this study was initiated, the index human papillomavirus assay was not approved for use with cervical specimens collected in PreservCyt (Hologic, Inc, San Diego, CA) liquid-based cytology media. OBJECTIVE The performance of the index human papillomavirus assay was compared with that of the predicate human papillomavirus assay for the detection of cervical intraepithelial neoplasia grades 2 or greater and 3 or greater (≥CIN2 or ≥CIN3) using PreservCyt liquid-based cytology specimens collected from women aged 21 to 65 years. In addition, the ability of the index test's extended genotyping to stratify ≥CIN2 and ≥CIN3 risks, using these specimens, was evaluated. STUDY DESIGN The New Mexico HPV Pap Registry was used to select an age- and cytology-stratified random sample of 19,879 women undergoing opportunistic cervical screening and follow-up in routine clinical practice across New Mexico. A subset (n = 4820) of PreservCyt specimens was selected from 19,879 women for paired testing by the index and predicate human papillomavirus assays within age and cytology strata and included women with or without cervical biopsy follow-up. Point estimate differences and ratios were calculated for cervical disease detection and positivity rates, respectively, with 95% confidence intervals to determine statistical significance. The cumulative risk of ≥CIN2 or ≥CIN3, with up to 5-year follow-up, was estimated for the index assay using Kaplan-Meier methods. RESULTS The 5-year cumulative ≥CIN3 detection rates were 5.6% for the index assay and 4.6% for the predicate assay (difference, 1.0%; 95% confidence interval, 0.5%-1.5%). The ≥CIN3 positivity rates within <1 year were 95.3% for the index assay and 94.5% for the predicate assay (ratio, 1.01; 95% confidence interval, 0.98-1.06). The ≥CIN3 cumulative positivity rates for the index and predicate assays were also similar at 5 years. Among cases of ≥CIN3, the positive agreement rates between the index and predicate assays for human papillomavirus types 16 and 18 were 100.0% (95% confidence interval, 95.0%-100.0%) and 90.9% (95% confidence interval, 62.3%-98.4%), respectively. Human papillomavirus type 16 carried the highest ≥CIN2 or ≥CIN3 risk, followed by human papillomavirus types 18/31/33/58/52/45 and human papillomavirus types 35/56/59/51/56/59/66. CONCLUSION The index and predicate human papillomavirus assays demonstrated equivalent performance, and extended human papillomavirus genotyping, using the index assay, provided effective ≥CIN2 and ≥CIN3 risk stratification, supporting a new indication for use of the index assay with PreservCyt.
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Affiliation(s)
- Cosette M Wheeler
- Center for HPV Prevention, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM; Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | - Norah E Torrez-Martinez
- Center for HPV Prevention, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Edith Torres-Chavolla
- Becton, Dickinson and Company, BD Life Sciences - Integrated Diagnostic Solutions, Sparks, MD
| | - Valentin Parvu
- Becton, Dickinson and Company, BD Life Sciences - Integrated Diagnostic Solutions, Sparks, MD
| | - Jeffrey C Andrews
- Becton, Dickinson and Company, BD Life Sciences - Integrated Diagnostic Solutions, Sparks, MD
| | - Ruofei Du
- Center for HPV Prevention, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Michael Robertson
- Center for HPV Prevention, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Nancy E Joste
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Jack Cuzick
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Klontzas ME, Vassalou EE, Spanakis K, Meurer F, Woertler K, Zibis A, Marias K, Karantanas AH. Deep learning enables the differentiation between early and late stages of hip avascular necrosis. Eur Radiol 2024; 34:1179-1186. [PMID: 37581656 PMCID: PMC10853078 DOI: 10.1007/s00330-023-10104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES To develop a deep learning methodology that distinguishes early from late stages of avascular necrosis of the hip (AVN) to determine treatment decisions. METHODS Three convolutional neural networks (CNNs) VGG-16, Inception ResnetV2, InceptionV3 were trained with transfer learning (ImageNet) and finetuned with a retrospectively collected cohort of (n = 104) MRI examinations of AVN patients, to differentiate between early (ARCO 1-2) and late (ARCO 3-4) stages. A consensus CNN ensemble decision was recorded as the agreement of at least two CNNs. CNN and ensemble performance was benchmarked on an independent cohort of 49 patients from another country and was compared to the performance of two MSK radiologists. CNN performance was expressed with areas under the curve (AUC), the respective 95% confidence intervals (CIs) and precision, and recall and f1-scores. AUCs were compared with DeLong's test. RESULTS On internal testing, Inception-ResnetV2 achieved the highest individual performance with an AUC of 99.7% (95%CI 99-100%), followed by InceptionV3 and VGG-16 with AUCs of 99.3% (95%CI 98.4-100%) and 97.3% (95%CI 95.5-99.2%) respectively. The CNN ensemble the same AUCs Inception ResnetV2. On external validation, model performance dropped with VGG-16 achieving the highest individual AUC of 78.9% (95%CI 51.6-79.6%) The best external performance was achieved by the model ensemble with an AUC of 85.5% (95%CI 72.2-93.9%). No significant difference was found between the CNN ensemble and expert MSK radiologists (p = 0.22 and 0.092 respectively). CONCLUSION An externally validated CNN ensemble accurately distinguishes between the early and late stages of AVN and has comparable performance to expert MSK radiologists. CLINICAL RELEVANCE STATEMENT This paper introduces the use of deep learning for the differentiation between early and late avascular necrosis of the hip, assisting in a complex clinical decision that can determine the choice between conservative and surgical treatment. KEY POINTS • A convolutional neural network ensemble achieved excellent performance in distinguishing between early and late avascular necrosis. • The performance of the deep learning method was similar to the performance of expert readers.
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Affiliation(s)
- Michail E Klontzas
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
- Department of Medical Imaging, University Hospital of Heraklion, 71110, Voutes, Crete, Greece
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), Nikolaou Plastira 100, 70013, Heraklion, Crete, Greece
| | - Evangelia E Vassalou
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Konstantinos Spanakis
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Felix Meurer
- Musculoskeletal Radiology Section, TUM School of Medicine, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Klaus Woertler
- Musculoskeletal Radiology Section, TUM School of Medicine, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Aristeidis Zibis
- Department of Anatomy, Medical School, University of Thessaly, Neofytou 9 St., 41223, Larissa, Greece
| | - Kostas Marias
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece
- Department of Electrical & Computer Engineering, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Apostolos H Karantanas
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece.
- Department of Medical Imaging, University Hospital of Heraklion, 71110, Voutes, Crete, Greece.
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece.
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), Nikolaou Plastira 100, 70013, Heraklion, Crete, Greece.
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Sebro R. Advancing Diagnostics and Patient Care: The Role of Biomarkers in Radiology. Semin Musculoskelet Radiol 2024; 28:3-13. [PMID: 38330966 DOI: 10.1055/s-0043-1776426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
The integration of biomarkers into medical practice has revolutionized the field of radiology, allowing for enhanced diagnostic accuracy, personalized treatment strategies, and improved patient care outcomes. This review offers radiologists a comprehensive understanding of the diverse applications of biomarkers in medicine. By elucidating the fundamental concepts, challenges, and recent advancements in biomarker utilization, it will serve as a bridge between the disciplines of radiology and epidemiology. Through an exploration of various biomarker types, such as imaging biomarkers, molecular biomarkers, and genetic markers, I outline their roles in disease detection, prognosis prediction, and therapeutic monitoring. I also discuss the significance of robust study designs, blinding, power and sample size calculations, performance metrics, and statistical methodologies in biomarker research. By fostering collaboration between radiologists, statisticians, and epidemiologists, I hope to accelerate the translation of biomarker discoveries into clinical practice, ultimately leading to improved patient care.
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Affiliation(s)
- Ronnie Sebro
- Department of Radiology, Center for Augmented Intelligence, Mayo Clinic, Jacksonville, Florida
- Department of Biostatistics, Center for Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida
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Träger AP, Günther JS, Raming R, Paulus LP, Lang W, Meyer A, Kempf J, Caranovic M, Li Y, Wagner AL, Tan L, Danko V, Trollmann R, Woelfle J, Klett D, Neurath MF, Regensburger AP, Eckstein M, Uter W, Uder M, Herrmann Y, Waldner MJ, Knieling F, Rother U. Hybrid ultrasound and single wavelength optoacoustic imaging reveals muscle degeneration in peripheral artery disease. PHOTOACOUSTICS 2024; 35:100579. [PMID: 38312805 PMCID: PMC10835356 DOI: 10.1016/j.pacs.2023.100579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/18/2023] [Accepted: 11/29/2023] [Indexed: 02/06/2024]
Abstract
Peripheral arterial disease (PAD) leads to chronic vascular occlusion and results in end organ damage in critically perfused limbs. There are currently no clinical methods available to determine the muscular damage induced by chronic mal-perfusion. This monocentric prospective cross-sectional study investigated n = 193 adults, healthy to severe PAD, in order to quantify the degree of calf muscle degeneration caused by PAD using a non-invasive hybrid ultrasound and single wavelength optoacoustic imaging (US/SWL-OAI) approach. While US provides morphologic information, SWL-OAI visualizes the absorption of pulsed laser light and the resulting sound waves from molecules undergoing thermoelastic expansion. US/SWL-OAI was compared to multispectral data, clinical disease severity, angiographic findings, phantom experiments, and histological examinations from calf muscle biopsies. We were able to show that synergistic use of US/SWL-OAI is most likely to map clinical degeneration of the muscle and progressive PAD.
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Affiliation(s)
- Anna P. Träger
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Josefine S. Günther
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Roman Raming
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Lars-Philip Paulus
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Alexander Meyer
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Julius Kempf
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Milenko Caranovic
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Yi Li
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Alexandra L. Wagner
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Lina Tan
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Vera Danko
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Daniel Klett
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), University Hospital Erlangen, Ulmenweg 18, D-91054 Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Straße 6, D-91052 Erlangen, Germany
| | - Adrian P. Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Markus Eckstein
- Department of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstrasse 8-10, D-91054 Erlangen, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürrnberg (FAU), Waldstraße 6, D-91054 Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander, Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, D-91054 Erlangen, Germany
| | - Yvonne Herrmann
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Maximilian J. Waldner
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), University Hospital Erlangen, Ulmenweg 18, D-91054 Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Straße 6, D-91052 Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Ulrich Rother
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
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Gibbons T, Rahmioglu N, Zondervan KT, Becker CM. Crimson clues: advancing endometriosis detection and management with novel blood biomarkers. Fertil Steril 2024; 121:145-163. [PMID: 38309818 DOI: 10.1016/j.fertnstert.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 02/05/2024]
Abstract
Endometriosis is an inflammatory condition affecting approximately 10% of the female-born population. Despite its prevalence, the lack of noninvasive biomarkers has contributed to an established global diagnostic delay. The intricate pathophysiology of this enigmatic disease may leave signatures in the blood, which, when detected, can be used as noninvasive biomarkers. This review provides an update on how investigators are utilizing the established disease pathways and innovative methodologies, including genome-wide association studies, next-generation sequencing, and machine learning, to unravel the clues left in the blood to develop blood biomarkers. Many blood biomarkers show promise in the discovery phase, but because of a lack of standardized and robust methodologies, they rarely progress to the development stages. However, we are now seeing biomarkers being validated with high diagnostic accuracy and improvements in standardization protocols, providing promise for the future of endometriosis blood biomarkers.
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Affiliation(s)
- Tatjana Gibbons
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.
| | - Nilufer Rahmioglu
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom; Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Krina T Zondervan
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom; Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Christian M Becker
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
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Don-Wauchope AC, Rodriguez-Capote K, Assaad RS, Bhargava S, Zemlin AE. A guide to conducting systematic reviews of clinical laboratory tests. Clin Chem Lab Med 2024; 62:218-233. [PMID: 37531554 DOI: 10.1515/cclm-2023-0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
Clinical laboratory professionals have an instrumental role in supporting clinical decision making with the optimal use of laboratory testing for screening, risk stratification, diagnostic, prognostic, treatment selection and monitoring of different states of health and disease. Delivering evidence-based laboratory medicine relies on review of available data and literature. The information derived, supports many national policies to improve patient care through clinical practice guidelines or best practice recommendations. The quality, validity and bias of this literature is variable. Hence, there is a need to collate similar studies and data and analyse them critically. Systematic review, thus, becomes the most important source of evidence. A systematic review, unlike a scoping or narrative review, involves a thorough understanding of the procedure involved and a stepwise methodology. There are nuances that need some consideration for laboratory medicine systematic reviews. The purpose of this article is to describe the process of performing a systematic review in the field of laboratory medicine, describing the available methodologies, tools and software packages that can be used to facilitate this process.
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Affiliation(s)
- Andrew C Don-Wauchope
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Ramy Samir Assaad
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Seema Bhargava
- Department of Biochemistry, Sir Ganga Ram Hospital, New Delhi, India
| | - Annalise E Zemlin
- Division of Chemical Pathology, Faculty of Medicine and Health Sciences, University of Stellenbosch and National Health Laboratory Service, Belville, Tygerberg, Western Cape, South Africa
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Smits M, Rockall A, Constantinescu SN, Sardanelli F, Martí-Bonmatí L. Translating radiological research into practice-from discovery to clinical impact. Insights Imaging 2024; 15:13. [PMID: 38228934 DOI: 10.1186/s13244-023-01596-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/17/2023] [Indexed: 01/18/2024] Open
Abstract
At the European Society of Radiology (ESR), we strive to provide evidence for radiological practices that improve patient outcomes and have a societal impact. Successful translation of radiological research into clinical practice requires multiple factors including tailored methodology, a multidisciplinary approach aiming beyond technical validation, and a focus on unmet clinical needs. Low levels of evidence are a threat to radiology, resulting in low visibility and credibility. Here, we provide the background and rationale for the thematic series Translating radiological research into practice-from discovery to clinical impact, inviting authors to describe their processes of achieving clinically impactful radiological research. We describe the challenges unique to radiological research. Additionally, a survey was sent to non-radiological clinical societies. The majority of respondents (6/11) were in the field of gastrointestinal/abdominal medicine. The implementation of CT/MRI techniques for disease characterisation, detection and staging of cancer, and treatment planning and radiological interventions were mentioned as the most important radiological developments in the past years. The perception was that patients are substantially unaware of the impact of these developments. Unmet clinical needs were mostly early diagnosis and staging of cancer, microstructural/functional assessment of tissues and organs, and implant assessment. All but one respondent considered radiology important for research in their discipline, but five indicated that radiology is currently not involved in their research. Radiology research holds the potential for being transformative to medical practice. It is our responsibility to take the lead in studies including radiology and strive towards the highest levels of evidence.Critical relevance statement For radiological research to make a clinical and societal impact, radiologists should take the lead in radiological studies, go beyond the assessment of technical feasibility and diagnostic accuracy, and-in a multidisciplinary approach-address clinical unmet needs.Key points• Multiple factors are essential for radiological research to make a clinical and societal impact.• Radiological research needs to go beyond diagnostic accuracy and address unmet clinical needs.• Radiologists should take the lead in radiological studies with a multidisciplinary approach.
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Affiliation(s)
- Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.
- Medical Delta, Delft, The Netherlands.
| | - Andrea Rockall
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Stefan N Constantinescu
- Ludwig Institute for Cancer Research, Brussels, Belgium
- de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
- WEL Research Institute, WELBIO Department, Wavre, Belgium
- Ludwig Institute for Cancer Research, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luis Martí-Bonmatí
- Department of Radiology and GIBI230 Research Group On Biomedical Imaging, Hospital Universitario y Politécnico La Fe and Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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Miamidian JL, Toler K, McLaren A, Deirmengian C. Synovial Fluid C-reactive Protein Clinical Decision Limit and Diagnostic Accuracy for Periprosthetic Joint Infection. Cureus 2024; 16:e52749. [PMID: 38268994 PMCID: PMC10806382 DOI: 10.7759/cureus.52749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 01/26/2024] Open
Abstract
Introduction C-reactive protein (CRP) has long served as a prototypical biomarker for periprosthetic joint infection (PJI). Recently, synovial fluid (SF)-CRP has garnered interest as a diagnostic tool, with several studies demonstrating its diagnostic superiority over serum CRP for the diagnosis of PJI. Although previous studies have identified diagnostic thresholds for SF-CRP, they have been limited in scope and employed various CRP assays without formal validation for PJI diagnosis. This study aimed to conduct a formal single clinical laboratory validation to determine the optimal clinical decision limit of SF-CRP for the diagnosis of PJI. Methods A retrospective analysis of prospectively collected data was performed using receiver operating characteristic (ROC) and area under the curve (AUC) analyses. Synovial fluid samples from hip and knee arthroplasties, received from over 2,600 institutions, underwent clinical testing for PJI at a single clinical laboratory (CD Laboratories, Zimmer Biomet, Towson, MD) between 2017 and 2022. Samples were assayed for SF-CRP, alpha-defensin, white blood cell count, neutrophil percentage, and microbiological culture. After applying selection criteria, the samples were classified with the 2018 ICM PJI scoring system as "infected," "not infected," or "inconclusive." Data were divided into training and validation sets. The Youden Index was employed to optimize the clinical decision limit. Results A total of 96,061 samples formed the training (n = 67,242) and validation (n = 28,819) datasets. Analysis of the biomarker median values, culture positivity, anatomic distribution, and days from aspiration to testing revealed nearly identical specimen characteristics in both the training set and validation set. SF-CRP demonstrated an AUC of 0.929 (95% confidence interval (CI): 0.926-0.932) in the training set, with an optimal SF-CRP clinical decision limit for PJI diagnosis of 4.45 mg/L. Applying this cutoff to the validation dataset yielded a sensitivity of 86.1% (95% CI: 85.0-87.1%) and specificity of 87.1% (95% CI: 86.7-87.5%). No statistically significant difference in diagnostic performance was observed between the validation and training sets. Conclusion This study represents the largest single clinical laboratory evaluation of an SF-CRP assay for PJI diagnosis. The optimal CRP cutoff (4.45 mg/L) for PJI, which yielded a sensitivity of 86.1% and a specificity of 87.1%, is specific to the assay methodology and laboratory performing the assay. We propose that an SF-CRP test with a laboratory-validated optimal clinical decision limit for PJI may be preferable, in a clinical diagnostic setting, to serum CRP tests that do not have laboratory-validated clinical decision limits for PJI.
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Affiliation(s)
- John L Miamidian
- Department of Diagnostics Research and Development, Zimmer Biomet, Warsaw, USA
| | - Krista Toler
- Department of Diagnostics Research and Development, Zimmer Biomet, Warsaw, USA
| | - Alex McLaren
- Orthopaedic Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | - Carl Deirmengian
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
- Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, USA
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Horiuchi D, Tatekawa H, Shimono T, Walston SL, Takita H, Matsushita S, Oura T, Mitsuyama Y, Miki Y, Ueda D. Accuracy of ChatGPT generated diagnosis from patient's medical history and imaging findings in neuroradiology cases. Neuroradiology 2024; 66:73-79. [PMID: 37994939 DOI: 10.1007/s00234-023-03252-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE The noteworthy performance of Chat Generative Pre-trained Transformer (ChatGPT), an artificial intelligence text generation model based on the GPT-4 architecture, has been demonstrated in various fields; however, its potential applications in neuroradiology remain unexplored. This study aimed to evaluate the diagnostic performance of GPT-4 based ChatGPT in neuroradiology. METHODS We collected 100 consecutive "Case of the Week" cases from the American Journal of Neuroradiology between October 2021 and September 2023. ChatGPT generated a diagnosis from patient's medical history and imaging findings for each case. Then the diagnostic accuracy rate was determined using the published ground truth. Each case was categorized by anatomical location (brain, spine, and head & neck), and brain cases were further divided into central nervous system (CNS) tumor and non-CNS tumor groups. Fisher's exact test was conducted to compare the accuracy rates among the three anatomical locations, as well as between the CNS tumor and non-CNS tumor groups. RESULTS ChatGPT achieved a diagnostic accuracy rate of 50% (50/100 cases). There were no significant differences between the accuracy rates of the three anatomical locations (p = 0.89). The accuracy rate was significantly lower for the CNS tumor group compared to the non-CNS tumor group in the brain cases (16% [3/19] vs. 62% [36/58], p < 0.001). CONCLUSION This study demonstrated the diagnostic performance of ChatGPT in neuroradiology. ChatGPT's diagnostic accuracy varied depending on disease etiologies, and its diagnostic accuracy was significantly lower in CNS tumors compared to non-CNS tumors.
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Affiliation(s)
- Daisuke Horiuchi
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroyuki Tatekawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Taro Shimono
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shannon L Walston
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hirotaka Takita
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shu Matsushita
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tatsushi Oura
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yasuhito Mitsuyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Daiju Ueda
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
- Smart Life Science Lab, Center for Health Science Innovation, Osaka Metropolitan University, Osaka, Japan.
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Zhong J, Xing Y, Lu J, Zhang G, Mao S, Chen H, Yin Q, Cen Q, Jiang R, Hu Y, Ding D, Ge X, Zhang H, Yao W. The endorsement of general and artificial intelligence reporting guidelines in radiological journals: a meta-research study. BMC Med Res Methodol 2023; 23:292. [PMID: 38093215 PMCID: PMC10717715 DOI: 10.1186/s12874-023-02117-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Complete reporting is essential for clinical research. However, the endorsement of reporting guidelines in radiological journals is still unclear. Further, as a field extensively utilizing artificial intelligence (AI), the adoption of both general and AI reporting guidelines would be necessary for enhancing quality and transparency of radiological research. This study aims to investigate the endorsement of general reporting guidelines and those for AI applications in medical imaging in radiological journals, and explore associated journal characteristic variables. METHODS This meta-research study screened journals from the Radiology, Nuclear Medicine & Medical Imaging category, Science Citation Index Expanded of the 2022 Journal Citation Reports, and excluded journals not publishing original research, in non-English languages, and instructions for authors unavailable. The endorsement of fifteen general reporting guidelines and ten AI reporting guidelines was rated using a five-level tool: "active strong", "active weak", "passive moderate", "passive weak", and "none". The association between endorsement and journal characteristic variables was evaluated by logistic regression analysis. RESULTS We included 117 journals. The top-five endorsed reporting guidelines were CONSORT (Consolidated Standards of Reporting Trials, 58.1%, 68/117), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 54.7%, 64/117), STROBE (STrengthening the Reporting of Observational Studies in Epidemiology, 51.3%, 60/117), STARD (Standards for Reporting of Diagnostic Accuracy, 50.4%, 59/117), and ARRIVE (Animal Research Reporting of In Vivo Experiments, 35.9%, 42/117). The most implemented AI reporting guideline was CLAIM (Checklist for Artificial Intelligence in Medical Imaging, 1.7%, 2/117), while other nine AI reporting guidelines were not mentioned. The Journal Impact Factor quartile and publisher were associated with endorsement of reporting guidelines in radiological journals. CONCLUSIONS The general reporting guideline endorsement was suboptimal in radiological journals. The implementation of reporting guidelines for AI applications in medical imaging was extremely low. Their adoption should be strengthened to facilitate quality and transparency of radiological study reporting.
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Affiliation(s)
- Jingyu Zhong
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Yue Xing
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Junjie Lu
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Guangcheng Zhang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Shiqi Mao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Haoda Chen
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Qian Yin
- Department of Pathology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Qingqing Cen
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Run Jiang
- Department of Pharmacovigilance, Shanghai Hansoh BioMedical Co., Ltd., Shanghai, 201203, China
| | - Yangfan Hu
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Defang Ding
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Xiang Ge
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Weiwu Yao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
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Chen CM, Tang YC, Huang SH, Pan KT, Lui KW, Lai YH, Tsui PH. Ultrasound tissue scatterer distribution imaging: An adjunctive diagnostic tool for shear wave elastography in characterizing focal liver lesions. ULTRASONICS SONOCHEMISTRY 2023; 101:106716. [PMID: 38071854 PMCID: PMC10755484 DOI: 10.1016/j.ultsonch.2023.106716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/29/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVES Focal liver lesion (FLL) is a prevalent finding in cross-sectional imaging, and distinguishing between benign and malignant FLLs is crucial for liver health management. While shear wave elastography (SWE) serves as a conventional quantitative ultrasound tool for evaluating FLLs, ultrasound tissue scatterer distribution imaging (TSI) emerges as a novel technique, employing the Nakagami statistical distribution parameter to estimate backscattered statistics for tissue characterization. In this prospective study, we explored the potential of TSI in characterizing FLLs and evaluated its diagnostic efficacy with that of SWE. METHODS A total of 235 participants (265 FLLs; the study group) were enrolled to undergo abdominal examinations, which included data acquisition from B-mode, SWE, and raw radiofrequency data for TSI construction. The area under the receiver operating characteristic curve (AUROC) was used to evaluate performance. A dataset of 20 patients (20 FLLs; the validation group) was additionally acquired to further evaluate the efficacy of the TSI cutoff value in FLL characterization. RESULTS In the study group, our findings revealed that while SWE achieved a success rate of 49.43 % in FLL measurements, TSI boasted a success rate of 100 %. In cases where SWE was effectively implemented, the AUROCs for characterizing FLLs using SWE and TSI stood at 0.84 and 0.83, respectively. For instances where SWE imaging failed, TSI achieved an AUROC of 0.78. Considering all cases, TSI presented an overall AUROC of 0.81. There was no statistically significant difference in AUROC values between TSI and SWE (p > 0.05). In the validation group, using a TSI cutoff value of 0.67, the AUROC for characterizing FLLs was 0.80. CONCLUSIONS In conclusion, ultrasound TSI holds promise as a supplementary diagnostic tool to SWE for characterizing FLLs.
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Affiliation(s)
- Chien-Ming Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ya-Chun Tang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Shin-Han Huang
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Tse Pan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kar-Wai Lui
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yan-Heng Lai
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Liver Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Research Center for Radiation Medicine, Chang Gung University, Taoyuan, Taiwan.
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Li K, Zhang S, Hu Y, Cai A, Ao Y, Gong J, Liang M, Yang S, Chen X, Li M, Tian J, Shan H. Radiomics Nomogram with Added Nodal Features Improves Treatment Response Prediction in Locally Advanced Esophageal Squamous Cell Carcinoma: A Multicenter Study. Ann Surg Oncol 2023; 30:8231-8243. [PMID: 37755566 DOI: 10.1245/s10434-023-14253-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE We aimed to develop and validate a radiomics nomogram and determine the value of radiomic features from lymph nodes (LNs) for predicting pathological complete response (pCR) to neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced esophageal squamous cell carcinoma (ESCC). METHODS In this multicenter retrospective study, eligible participants who had undergone NCRT followed by radical esophagectomy were consecutively recruited. Three radiomics models (modelT, modelLN, and modelTLN) based on tumor and LN features, alone and combined, were developed in the training cohort. The radiomics nomogram was developed by incorporating the prediction value of the radiomics model and clinicoradiological risk factors using multivariate logistic regression, and was evaluated using the receiver operating characteristic curve, validated in two external validation cohorts. RESULTS Between October 2011 and December 2018, 116 patients were included in the training cohort. Between June 2015 and October 2020, 51 and 27 patients from two independent hospitals were included in validation cohorts 1 and 2, respectively. The radiomics modelTLN performed better than the radiomics modelT for predicting pCR. The radiomics nomogram incorporating the predictive value of the radiomics modelTLN and heterogeneous after NCRT outperformed the clinicoradiological model, with an area under the curve (95% confidence interval) of 0.833 (0.765-0.894) versus 0.764 (0.686-0.833) [p = 0.088, DeLong test], 0.824 (0.718-0.909) versus 0.692 (0.554-0.809) [p = 0.012], and 0.902 (0.794-0.984) versus 0.696 (0.526-0.857) [p = 0.024] in all three cohorts. CONCLUSIONS Radiomic features from LNs could provide additional value for predicting pCR in ESCC patients, and the radiomics nomogram provided an accurate prediction of pCR, which might aid treatment decision.
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Affiliation(s)
- Kunwei Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
| | - Shuaitong Zhang
- School of Medical Technology, Beijing Institute of Technology, Beijing, People's Republic of China
| | - Yi Hu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Aiqun Cai
- Department of Radiology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, People's Republic of China
| | - Yong Ao
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Jun Gong
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
| | - Mingzhu Liang
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
| | - Songlin Yang
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
| | - Xiangmeng Chen
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong Province, People's Republic of China
| | - Man Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, People's Republic of China.
- Key Laboratory of Big Data-Based Precision Medicine, Beihang University, Ministry of Industry and Information Technology, Beijing, People's Republic of China.
| | - Hong Shan
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China.
- Department of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China.
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Harskamp RE, De Clercq L, Veelers L, Schut MC, van Weert HCPM, Handoko ML, Moll van Charante EP, Himmelreich JCL. Diagnostic properties of natriuretic peptides and opportunities for personalized thresholds for detecting heart failure in primary care. Diagnosis (Berl) 2023; 10:432-439. [PMID: 37667563 DOI: 10.1515/dx-2023-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Heart failure (HF) is a prevalent syndrome with considerable disease burden, healthcare utilization and costs. Timely diagnosis is essential to improve outcomes. This study aimed to compare the diagnostic performance of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in detecting HF in primary care. Our second aim was to explore if personalized thresholds (using age, sex, or other readily available parameters) would further improve diagnostic accuracy over universal thresholds. METHODS A retrospective study was performed among patients without prior HF who underwent natriuretic peptide (NP) testing in the Amsterdam General Practice Network between January 2011 and December 2021. HF incidence was based on registration out to 90 days after NP testing. Diagnostic accuracy was evaluated with AUROC, sensitivity and specificity based on guideline-recommended thresholds (125 ng/L for NT-proBNP and 35 ng/L for BNP). We used inverse probability of treatment weighting to adjust for confounding. RESULTS A total of 15,234 patients underwent NP testing, 6,870 with BNP (4.5 % had HF), and 8,364 with NT-proBNP (5.7 % had HF). NT-proBNP was more accurate than BNP, with an AUROC of 89.9 % (95 % CI: 88.4-91.2) vs. 85.9 % (95 % CI 83.5-88.2), with higher sensitivity (95.3 vs. 89.7 %) and specificity (59.1 vs. 58.0 %). Differentiating NP cut-off by clinical variables modestly improved diagnostic accuracy for BNP and NT-proBNP compared with a universal threshold. CONCLUSIONS NT-proBNP outperforms BNP for detecting HF in primary care. Personalized instead of universal diagnostic thresholds led to modest improvement.
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Affiliation(s)
- Ralf E Harskamp
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Lukas De Clercq
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Lieke Veelers
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn C Schut
- Department of Laboratory Medicine, Translational AI. Amsterdam UMC, Amsterdam, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC Location VU University, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jelle C L Himmelreich
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
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Klontzas ME, Leventis D, Spanakis K, Karantanas AH, Kranioti EF. Post-mortem CT radiomics for the prediction of time since death. Eur Radiol 2023; 33:8387-8395. [PMID: 37329460 DOI: 10.1007/s00330-023-09746-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/27/2023] [Accepted: 04/22/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Post-mortem interval (PMI) estimation has long been relying on sequential post-mortem changes on the body as a function of extrinsic, intrinsic, and environmental factors. Such factors are difficult to account for in complicated death scenes; thus, PMI estimation can be compromised. Herein, we aimed to evaluate the use of post-mortem CT (PMCT) radiomics for the differentiation between early and late PMI. METHODS Consecutive whole-body PMCT examinations performed between 2016 and 2021 were retrospectively included (n = 120), excluding corpses without an accurately reported PMI (n = 23). Radiomics data were extracted from liver and pancreas tissue and randomly split into training and validation sets (70:30%). Following data preprocessing, significant features were selected (Boruta selection) and three XGBoost classifiers were built (liver, pancreas, combined) to differentiate between early (< 12 h) and late (> 12 h) PMI. Classifier performance was assessed with receiver operating characteristics (ROC) curves and areas under the curves (AUC), which were compared by bootstrapping. RESULTS A total of 97 PMCTs were included, representing individuals (23 females and 74 males) with a mean age of 47.1 ± 23.38 years. The combined model achieved the highest AUC reaching 75% (95%CI 58.4-91.6%) (p = 0.03 compared to liver and p = 0.18 compared to pancreas). The liver-based and pancreas-based XGBoost models achieved AUCs of 53.6% (95%CI 34.8-72.3%) and 64.3% (95%CI 46.7-81.9%) respectively (p > 0.05 for the comparison between liver- and pancreas-based models). CONCLUSION The use of radiomics analysis on PMCT examinations differentiated early from late PMI, unveiling a novel image-based method with important repercussions in forensic casework. CLINICAL RELEVANCE STATEMENT This paper introduces the employment of radiomics in forensic diagnosis by presenting an effective automated alternative method of estimating post-mortem interval from targeted tissues, thus paving the way for improvement in speed and quality of forensic investigations. KEY POINTS • A combined liver-pancreas radiomics model differentiated early from late post-mortem intervals (using a 12-h threshold) with an area under the curve of 75% (95%CI 58.4-91.6%). • XGBoost models based on liver-only or pancreas-only radiomics demonstrated inferior performance to the combined model in predicting the post-mortem interval.
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Affiliation(s)
- Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece
- Department of Radiology, Medical School, University of Crete, Voutes, Heraklion, 71110, Crete, Greece
- Advanced Hybrid Imaging Systems, Institute of Computer Science - FORTH, Voutes, Heraklion, 71110, Crete, Greece
| | - Dimitrios Leventis
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece
| | - Konstantinos Spanakis
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece
| | - Apostolos H Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, Heraklion, 71110, Crete, Greece.
- Department of Radiology, Medical School, University of Crete, Voutes, Heraklion, 71110, Crete, Greece.
- Advanced Hybrid Imaging Systems, Institute of Computer Science - FORTH, Voutes, Heraklion, 71110, Crete, Greece.
| | - Elena F Kranioti
- Forensic Medicine Unit, Department of Forensic Sciences, Faculty of Medicine, University of Crete, Voutes, Heraklion, 71110, Greece.
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49
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García del Álamo Hernández Y, Cano-Valderrama Ó, Cerdán-Santacruz C, Pereira Pérez F, Aldrey Cao I, Núñez Fernández S, Álvarez Sarrado E, Obregón Reina R, Dujovne Lindenbaum P, Taboada Ameneiro M, Ambrona Zafra D, Pérez Farré S, Pascual Damieta M, Frago Montanuy R, Flor Lorente B, Biondo S. Diagnostic Accuracy of Abdominal CT for Locally Advanced Colon Tumors: Can We Really Entrust Certain Decisions to the Reliability of CT? J Clin Med 2023; 12:6764. [PMID: 37959229 PMCID: PMC10648183 DOI: 10.3390/jcm12216764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Many different options of neoadjuvant treatments for advanced colon cancer are emerging. An accurate preoperative staging is crucial to select the most appropriate treatment option. A retrospective study was carried out on a national series of operated patients with T4 tumors. Considering the anatomo-pathological analysis of the surgical specimen as the gold standard, a diagnostic accuracy study was carried out on the variables T and N staging and the presence of peritoneal metastases (M1c). The parameters calculated were sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios, as well as the overall accuracy. A total of 50 centers participated in the study in which 1950 patients were analyzed. The sensitivity of CT for correct staging of T4 colon tumors was 57%. Regarding N staging, the overall accuracy was 63%, with a sensitivity of 64% and a specificity of 62%; however, the positive and negative likelihood ratios were 1.7 and 0.58, respectively. For the diagnosis of peritoneal metastases, the accuracy was 94.8%, with a sensitivity of 40% and specificity of 98%; in the case of peritoneal metastases, the positive and negative likelihood ratios were 24.4 and 0.61, respectively. The diagnostic accuracy of CT in the setting of advanced colon cancer still has some shortcomings for accurate diagnosis of stage T4, correct classification of lymph nodes, and preoperative detection of peritoneal metastases.
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Affiliation(s)
- Yaiza García del Álamo Hernández
- Colorectal Surgery Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
| | - Óscar Cano-Valderrama
- Colorectal Surgery Department, Complejo Hospitalario Universitario de Vigo, 36312 Vigo, Spain;
| | - Carlos Cerdán-Santacruz
- Colorectal Surgery Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
| | | | - Inés Aldrey Cao
- Colorectal Surgery Department, Complexo Hospitalario Universitario de Ourense, 32005 Ourense, Spain; (I.A.C.)
| | - Sandra Núñez Fernández
- Colorectal Surgery Department, Complexo Hospitalario Universitario de Ourense, 32005 Ourense, Spain; (I.A.C.)
| | - Eduardo Álvarez Sarrado
- Colorectal Surgery Department, Hospital Politécnico Universitario la Fe, 46026 Valencia, Spain
| | - Rosángela Obregón Reina
- Colorectal Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Paula Dujovne Lindenbaum
- Colorectal Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - María Taboada Ameneiro
- Colorectal Surgery Department, Complejo Hospitalario Universitario de A Coruña (CHUAC), 15006 A Coruña, Spain;
| | - David Ambrona Zafra
- Colorectal Surgery Department, Hospital Arnau de Vilanova de Lleida, 25198 Lleida, Spain
| | - Silvia Pérez Farré
- Colorectal Surgery Department, Hospital Arnau de Vilanova de Lleida, 25198 Lleida, Spain
| | - Marta Pascual Damieta
- Colorectal Surgery Department, Hospital del Mar de Barcelona, 08003 Barcelona, Spain;
| | - Ricardo Frago Montanuy
- Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, 08908 L’Hospitalet de Llobregat, Spain (S.B.)
| | - Blas Flor Lorente
- Colorectal Surgery Department, Hospital Politécnico Universitario la Fe, 46026 Valencia, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, 08908 L’Hospitalet de Llobregat, Spain (S.B.)
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50
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Loh TP, Cooke BR, Tran TCM, Markus C, Zakaria R, Ho CS, Theodorsson E, Greaves RF. The LEAP checklist for laboratory evaluation and analytical performance characteristics reporting of clinical measurement procedures. Clin Chem Lab Med 2023:cclm-2023-0933. [PMID: 37838925 DOI: 10.1515/cclm-2023-0933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 10/16/2023]
Abstract
Reporting a measurement procedure and its analytical performance following method evaluation in a peer-reviewed journal is an important means for clinical laboratory practitioners to share their findings. It also represents an important source of evidence base to help others make informed decisions about their practice. At present, there are significant variations in the information reported in laboratory medicine journal publications describing the analytical performance of measurement procedures. These variations also challenge authors, readers, reviewers, and editors in deciding the quality of a submitted manuscript. The International Federation of Clinical Chemistry and Laboratory Medicine Working Group on Method Evaluation Protocols (IFCC WG-MEP) developed a checklist and recommends its adoption to enable a consistent approach to reporting method evaluation and analytical performance characteristics of measurement procedures in laboratory medicine journals. It is envisioned that the LEAP checklist will improve the standardisation of journal publications describing method evaluation and analytical performance characteristics, improving the quality of the evidence base that is relied upon by practitioners.
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Affiliation(s)
- Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Brian R Cooke
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Thi Chi Mai Tran
- Faculty of Medical Technology, Hanoi Medical University, Hanoi, Vietnam
- Department of Clinical Biochemistry, National Children's Hospital, Hanoi, Vietnam
| | - Corey Markus
- Flinders University International Centre for Point-of-Care Testing, Flinders Health and Medical Research Institute, Adelaide, Australia
| | - Rosita Zakaria
- RMIT University, School of Health and Biomedical Sciences, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Chung Shun Ho
- Biomedical Mass Spectrometry Unit, Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Elvar Theodorsson
- Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, Linkoping University, Linkoping, Sweden
| | - Ronda F Greaves
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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