TY  - JOUR
AB  - Background: Osteoporosis, a systemic skeletal disorder, is expected to affect 60% of women over 50. While dual-energy X-ray absorptiometry (DXA) scans are the current gold standard for diagnosis, they are typically used only after fractures occur, highlighting the need for early detection tools. Initial studies have shown panoramic radiographs (PRs) to be a potential medium, but these have methodological flaws. This study aims to address these shortcomings by developing a robust AI application for accurate osteoporosis identification in PRs. Methods: A total of 348 PRs were used for development, 58 PRs for validation, and 51 PRs for hold-out testing. Initially, the YOLOv8 object detection model was employed to predict the regions of interest. Subsequently, the predicted regions of interest were extracted from the PRs and processed by the EfficientNet classification model. Results: The model for osteoporosis detection on a PR achieved an overall sensitivity of 0.83 and an F1-score of 0.53. The area under the curve (AUC) was 0.76. The lowest detection sensitivity was for the cropped angulus region (0.66), while the highest sensitivity was for the cropped mental foramen region (0.80). Conclusion: This research presents a proof-of-concept algorithm showing the potential of deep learning to identify osteoporosis in dental radiographs. Furthermore, our thorough evaluation of existing algorithms revealed that many optimistic outcomes lack credibility when subjected to rigorous methodological scrutiny.
AU  - Gaudin, R.*
AU  - Vinayahalingam, S.*
AU  - van Nistelrooij, N.*
AU  - Ghanad, I.*
AU  - Otto, W.*
AU  - Kewenig, S.*
AU  - Rendenbach, C.*
AU  - Alevizakos, V.*
AU  - Grün, P.*
AU  - Kofler, F.
AU  - Heiland, M.*
AU  - von See, C.*
C1  - 72154
C2  - 56468
TI  - AI-powered identification of osteoporosis in dental panoramic radiographs: Addressing methodological flaws in current research.
JO  - Diagnostics
VL  - 14
IS  - 20
PY  - 2024
SN  - 2075-4418
ER  - 

TY  - JOUR
AB  - BACKGROUND: Economic restrictions and workforce cuts have continually challenged conventional autopsies. Recently, the COVID-19 pandemic has added tissue quality and safety requirements to the investigation of this disease, thereby launching efforts to upgrade autopsy strategies. METHODS: In this proof-of-concept study, we performed bedside ultrasound-guided minimally invasive autopsy (US-MIA) in the ICU of critically ill COVID-19 patients using a structured protocol to obtain non-autolyzed tissue. Biopsies were assessed for their quality (vitality) and length of biopsy (mm) and for diagnosis. The efficiency of the procedure was monitored in five cases by recording the time of each step and safety issues by swabbing personal protective equipment and devices for viral contamination. FINDINGS: Ultrasound examination and tissue procurement required a mean time period of 13 min and 54 min, respectively. A total of 318 multiorgan biopsies were obtained from five patients. Quality and vitality standards were fulfilled, which not only allowed for specific histopathological diagnosis but also the reliable detection of SARS-CoV-2 virions in unexpected organs using electronic microscopy and RNA-expressing techniques. INTERPRETATION: Bedside multidisciplinary US-MIA allows for the fast and efficient acquisition of autolytic-free tissue and offers unappreciated potential to overcome the limitations of research in postmortem studies.
AU  - Lahmer, T.*
AU  - Weirich, G.*
AU  - Porubsky, S.*
AU  - Rasch, S.*
AU  - Kammerstetter, F.A.*
AU  - Schustetter, C.*
AU  - Schüffler, P.*
AU  - Erber, J.*
AU  - Dibos, M.*
AU  - Delbridge, C.*
AU  - Kuhn, P.H.*
AU  - Jeske, S.
AU  - Steinhardt, M.*
AU  - Chaker, A.*
AU  - Heim, M.*
AU  - Heemann, U.*
AU  - Schmid, R.M.*
AU  - Weichert, W.*
AU  - Stock, K.F.*
AU  - Slotta-Huspenina, J.*
C1  - 69940
C2  - 55327
CY  - St Alban-anlage 66, Ch-4052 Basel, Switzerland
TI  - Postmortem minimally invasive autopsy in critically Ill COVID-19 patients at the bedside: A proof-of-concept study at the ICU.
JO  - Diagnostics
VL  - 14
IS  - 3
PB  - Mdpi
PY  - 2024
SN  - 2075-4418
ER  - 

TY  - JOUR
AB  - The currently prevailing variants of SARS-CoV-2 are subvariants of the Omicron variant. The aim of this study was to analyze the effect of mutations in the Spike protein of Omicron on the results Quan-T-Cell SARS-CoV-2 assays and Roche Elecsys anti-SARS-CoV-2 anti-S1. Omicron infected subjects ((n = 37), vaccinated (n = 20) and unvaccinated (n = 17)) were recruited approximately 3 weeks after a positive PCR test. The Quan-T-Cell SARS-CoV-2 assays (EUROIMMUN) using Wuhan and the Omicron adapted antigen assay and a serological test (Roche Elecsys anti-SARS-CoV-2 anti-S1) were performed. Using the original Wuhan SARS-CoV-2 IGRA TUBE, in 19 of 21 tested Omicron infected subjects, a positive IFNy response was detected, while 2 non-vaccinated but infected subjects did not respond. The Omicron adapted antigen tube resulted in comparable results. In contrast, the serological assay detected a factor 100-fold lower median Spike-specific RBD antibody concentration in non-vaccinated Omicron infected patients (n = 12) compared to patients from the pre Omicron era (n = 12) at matched time points, and eight individuals remained below the detection threshold for positivity. For vaccinated subjects, the Roche assay detected antibodies in all subjects and showed a 400 times higher median specific antibody concentration compared to non-vaccinated infected subjects in the pre-Omicron era. Our results suggest that Omicron antigen adapted IGRA stimulator tubes did not improve detection of SARS-CoV-2-specific T-cell responses in the Quant-T-Cell-SARS-CoV-2 assay. In non-vaccinated Omicron infected individuals, the Wuhan based Elecsys anti-SARS-CoV-2 anti-S1 serological assay results in many negative results at 3 weeks after diagnosis.
AU  - Ahmed, M.I.M.*
AU  - Plank, M.*
AU  - Castelletti, N.
AU  - Diepers, P.*
AU  - Eser, T.M.*
AU  - Rubio-Acero, R.*
AU  - Noreña, I.*
AU  - Reinkemeyer, C.*
AU  - Zapf, D.*
AU  - Hoelscher, M.*
AU  - Janke, C.*
AU  - Wieser, A.*
AU  - Geldmacher, C.*
C1  - 67655
C2  - 53962
CY  - St Alban-anlage 66, Ch-4052 Basel, Switzerland
TI  - Impact of Omicron variant infection on assessment of spike-specific Immune responses using EUROIMMUN Quan-T-Cell SARS-CoV-2 assay and Roche Elecsys anti-SARS-CoV-2-S.
JO  - Diagnostics
VL  - 13
IS  - 6
PB  - Mdpi
PY  - 2023
SN  - 2075-4418
ER  - 

TY  - JOUR
AB  - This study aimed to evaluate the diagnostic accuracy and false positivity rate of lymph node (LN) staging assessed by integrated 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG-PET/CT) in patients with operable lung cancer to the tumor histology. In total, 129 consecutive patients with non-small-cell lung cancer (NSCLC) undergoing anatomical lung resections were included. Preoperative LN staging was evaluated in the relationship to the histology of the resected specimens (group 1: lung adenocarcinoma/LUAD; group 2: squamous cell carcinoma/SQCA). Statistical analysis was performed by the Mann-Whitney U-test, the chi2 test, and binary logistic regression analysis. To establish an easy-to-use algorithm for the identification of LN false positivity, a decision tree including clinically meaningful parameters was generated. In total, 77 (59.7%) and 52 (40.3%) patients were included in the LUAD and SQCA groups, respectively. SQCA histology, non-G1 tumors, and tumor SUVmax > 12.65 were identified as independent predictors of LN false positivity in the preoperative staging. The corresponding ORs and their 95% CIs were 3.35 [1.10-10.22], p = 0.0339; 4.60 [1.06-19.94], p = 0.0412; and 2.76 [1.01-7.55], and p = 0.0483. The preoperative identification of false-positive LNs is an important aspect of the treatment regimen for patients with operable lung cancer; thus, these preliminary findings should be further evaluated in larger patient cohorts.
AU  - Damirov, F.*
AU  - Stoleriu, M.-G.
AU  - Manapov, F.
AU  - Büsing, K.*
AU  - Michels, J.D.*
AU  - Preissler, G.
AU  - Hatz, R.
AU  - Hohenberger, P.*
AU  - Roessner, E.D.*
C1  - 67833
C2  - 54311
CY  - St Alban-anlage 66, Ch-4052 Basel, Switzerland
TI  - Histology of the primary tumor correlates with false positivity of integrated 18F-FDG-PET/CT lymph node staging in resectable lung cancer patients.
JO  - Diagnostics
VL  - 13
IS  - 11
PB  - Mdpi
PY  - 2023
SN  - 2075-4418
ER  - 

TY  - JOUR
AB  - (1) Background and Purpose: In magnetic resonance imaging (MRI) of the spine, T2-weighted (T2-w) fat-saturated (fs) images improve the diagnostic assessment of pathologies. However, in the daily clinical setting, additional T2-w fs images are frequently missing due to time constraints or motion artifacts. Generative adversarial networks (GANs) can generate synthetic T2-w fs images in a clinically feasible time. Therefore, by simulating the radiological workflow with a heterogenous dataset, this study's purpose was to evaluate the diagnostic value of additional synthetic, GAN-based T2-w fs images in the clinical routine. (2) Methods: 174 patients with MRI of the spine were retrospectively identified. A GAN was trained to synthesize T2-w fs images from T1-w, and non-fs T2-w images of 73 patients scanned in our institution. Subsequently, the GAN was used to create synthetic T2-w fs images for the previously unseen 101 patients from multiple institutions. In this test dataset, the additional diagnostic value of synthetic T2-w fs images was assessed in six pathologies by two neuroradiologists. Pathologies were first graded on T1-w and non-fs T2-w images only, then synthetic T2-w fs images were added, and pathologies were graded again. Evaluation of the additional diagnostic value of the synthetic protocol was performed by calculation of Cohen's ĸ and accuracy in comparison to a ground truth (GT) grading based on real T2-w fs images, pre- or follow-up scans, other imaging modalities, and clinical information. (3) Results: The addition of the synthetic T2-w fs to the imaging protocol led to a more precise grading of abnormalities than when grading was based on T1-w and non-fs T2-w images only (mean ĸ GT versus synthetic protocol = 0.65; mean ĸ GT versus T1/T2 = 0.56; p = 0.043). (4) Conclusions: The implementation of synthetic T2-w fs images in the radiological workflow significantly improves the overall assessment of spine pathologies. Thereby, high-quality, synthetic T2-w fs images can be virtually generated by a GAN from heterogeneous, multicenter T1-w and non-fs T2-w contrasts in a clinically feasible time, which underlines the reproducibility and generalizability of our approach.
AU  - Schlaeger, S.*
AU  - Drummer, K.*
AU  - Husseini, M.E.*
AU  - Kofler, F.
AU  - Sollmann, N.*
AU  - Schramm, S.*
AU  - Zimmer, C.*
AU  - Kirschke, J.S.*
AU  - Wiestler, B.*
C1  - 67741
C2  - 54049
CY  - St Alban-anlage 66, Ch-4052 Basel, Switzerland
TI  - Implementation of GAN-based, synthetic T2-weighted fat saturated images in the routine radiological workflow improves spinal pathology detection.
JO  - Diagnostics
VL  - 13
IS  - 5
PB  - Mdpi
PY  - 2023
SN  - 2075-4418
ER  - 

TY  - JOUR
AB  - (1) Introduction: Near-infrared fluorescence (NIRF) combined with tumour-targeted tracers, such as bevacizumab-800CW, could aid surgical decision-making. This study explored the use of IRDye800CW, conjugated to bevacizumab, with four commercially available NIRF laparoscopes optimised for indocyanine green (ICG). (2) Methods: A (lymph node) phantom was made from a calibration device for NIRF and tissue-mimicking material. Serial dilutions of bevacizumab-800CW were made and ICG functioned as a reference. System settings, working distance, and thickness of tissue-mimicking material were varied to assess visibility of the fluorescence signal and tissue penetration. Tests were performed with four laparoscopes: VISERA ELITE II, Olympus; IMAGE1 S™ 4U Rubina, KARL STORZ; ENDOCAM Logic 4K platform, Richard Wolf; da Vinci Xi, Intuitive Surgical. (3) Results: The lowest visible bevacizumab-800CW concentration ranged between 13-850 nM (8-512 times diluted stock solution) for all laparoscopes, but the tracer was not visible through 0.8 cm of tissue in all systems. In contrast, ICG was still visible at a concentration of 0.4 nM (16,384 times diluted) and through 1.6-2.4 cm of tissue. Visibility and tissue penetration generally improved with a reduced working distance and manually adjusted system settings. (4) Conclusion: Depending on the application, bevacizumab-800CW might be sufficiently visible with current laparoscopes, but optimisation would widen applicability of tumour-targeted IRDye800CW tracers.
AU  - Sikkenk, D.J.*
AU  - Sterkenburg, A.J.*
AU  - Schmidt, I.*
AU  - Gorpas, D.
AU  - Nagengast, W.B.*
AU  - Consten, E.C.J.*
C1  - 67807
C2  - 54285
CY  - St Alban-anlage 66, Ch-4052 Basel, Switzerland
TI  - Detection of tumour-targeted IRDye800CW tracer with commercially available laparoscopic surgical systems.
JO  - Diagnostics
VL  - 13
IS  - 9
PB  - Mdpi
PY  - 2023
SN  - 2075-4418
ER  - 

TY  - JOUR
AB  - The differentiation between the atypical cartilaginous tumor (ACT) and the enchondromas is crucial as ACTs require a curettage and clinical as well as imaging follow-ups, whereas in the majority of cases enchondromas require neither a treatment nor follow-ups. Differentiating enchondromas from ACTs radiologically remains challenging. Therefore, this study evaluated imaging criteria in a combination of computed tomography (CT) and magnetic resonance (MR) imaging for the differentiation between enchondromas and ACTs in long bones. A total of 82 patients who presented consecutively at our institution with either an ACT (23, age 52.7 ±18.8 years; 14 women) or an enchondroma (59, age 46.0 ± 11.1 years; 37 women) over a period of 10 years, who had undergone preoperative MR and CT imaging and subsequent biopsy or/and surgical removal, were included in this study. A histopathological diagnosis was available in all cases. Two experienced radiologists evaluated several imaging criteria on CT and MR images. Likelihood of an ACT was significantly increased if either edema within the bone (p = 0.049), within the adjacent soft tissue (p = 0.006) or continuous growth pattern (p = 0.077) were present or if the fat entrapment (p = 0.027) was absent on MR images. Analyzing imaging features on CT, the likelihood of the diagnosis of an ACT was significantly increased if endosteal scalloping >2/3 (p < 0.001), cortical penetration (p < 0.001) and expansion of bone (p = 0.002) were present and if matrix calcifications were observed in less than 1/3 of the tumor (p = 0.013). All other imaging criteria evaluated showed no significant influence on likelihood of ACT or enchondroma (p > 0.05). In conclusion, both CT and MR imaging show suggestive signs which can help to adequately differentiate enchondromas from ACTs in long bones and therefore can improve diagnostics and consequently patient management. Nevertheless, these features are rare and a combination of CT and MR imaging features did not improve the diagnostic performance substantially.
AU  - Gassert, F.G.*
AU  - Breden, S.*
AU  - Neumann, J.*
AU  - Gassert, F.T.*
AU  - Bollwein, C.*
AU  - Knebel, C.*
AU  - Lenze, U.*
AU  - von Eisenhart-Rothe, R.*
AU  - Mogler, C.*
AU  - Makowski, M.R.*
AU  - Peeken, J.C.
AU  - Wörtler, K.*
AU  - Gersing, A.S.*
C1  - 66293
C2  - 53130
TI  - Differentiating enchondromas and atypical cartilaginous tumors in long Bones with computed tomography and magnetic resonance imaging.
JO  - Diagnostics
VL  - 12
IS  - 9
PY  - 2022
SN  - 2075-4418
ER  - 

TY  - JOUR
AB  - Management of radiological incidental findings (IF) is of rising importance; however, psychosocial implications of IF reporting remain unclear. We compared long-term psychosocial effects between individuals who underwent whole-body magnetic resonance imaging (MRI) with and without reported IF, and individuals who did not undergo imaging. We used a longitudinal population-based cohort from Western Europe. Longitudinal analysis included three examinations (exam 1, 6 years prior to MRI; exam 2, MRI; exam 3, 4 years after MRI). Psychosocial outcomes included PHQ-9 (Patient Health Questionnaire), DEEX (Depression and Exhaustion Scale), PSS-10 (Perceived Stress Scale) and a Somatization Scale. Univariate analyses and adjusted linear mixed models were calculated. Among 855 included individuals, 25% (n = 212) underwent MRI and 6% (n = 50) had at least one reported IF. Compared to MRI participants, non-participants had a higher psychosocial burden indicated by PHQ-9 in exam 1 (3.3 ± 3.3 vs. 2.5 ± 2.3) and DEEX (8.6 ± 4.7 vs. 7.7 ± 4.4), Somatization Scale (5.9 ± 4.3 vs. 4.8 ± 3.8) and PSS-10 (14.7 ± 5.7 vs. 13.7 ± 5.3, all p < 0.05) in exam 3. MRI participation without IF reporting was significantly associated with lower values of DEEX, PHQ-9 and Somatization Scale. There were no significant differences at the three timepoints between MRI participants with and without IF. In conclusion, individuals who voluntarily participated in whole-body MRI had less psychosocial burden and imaging and IF reporting were not associated with adverse long-term psychosocial consequences. However, due to the study design we cannot conclude that the MRI exam itself represented a beneficial intervention causing improvement in mental health scores.
AU  - Korbmacher-Boettcher, D.*
AU  - Bamberg, F.*
AU  - Peters, A.
AU  - Linkohr, B.
AU  - Ladwig, K.-H.
AU  - Schwettmann, L.
AU  - Weckbach, S.*
AU  - Schlett, C.L.*
AU  - Rospleszcz, S.
C1  - 66559
C2  - 52933
TI  - Long-term psychosocial consequences of whole-body magnetic resonance imaging and reporting of incidental findings in a population-based cohort study.
JO  - Diagnostics
VL  - 12
IS  - 10
PY  - 2022
SN  - 2075-4418
ER  - 

TY  - JOUR
AB  - The Framingham Risk Score to predict 30-year risk (FRS30y) of cardiovascular disease (CVD) constitutes an important tool for long-term risk prediction. However, due to its complex statistical properties and the paucity of large population-based cohorts with appropriate data, validation of the FRS30y is lacking. A population-based cohort from Southern Germany (N = 3110, 1516 (48.7%) women) was followed up for a median time of 29.5 [18.7, 31.2] years. Discrimination and calibration were assessed for the original, recalibrated and refitted FRS30y version. During follow up, 620 incident CVD events (214 in women) occurred. The FRS30y showed adequate discrimination (original and recalibrated version: Area under the curve (AUC): 78.4 for women and 74.9 for men) but overestimated actual CVD risk (original version: discordance 45.4% for women and 37.3% for men, recalibrated version: 37.6% and 28.6%, respectively). Refitting showed substantial improvement in neither discrimination nor calibration. The performance of FRS30y is adequate for long-term CVD risk prediction and could serve as an important tool in risk communication, especially for younger audiences.
AU  - Rospleszcz, S.
AU  - Starnecker, F.*
AU  - Linkohr, B.
AU  - von Scheidt, M.*
AU  - Gieger, C.
AU  - Schunkert, H.*
AU  - Peters, A.
AU  - DigiMed Bayern Consortium (Adam, J.)
AU  - DigiMed Bayern Consortium (Berutti, R.)
AU  - DigiMed Bayern Consortium (Brandmaier, S.)
C1  - 64878
C2  - 52011
TI  - Validation of the 30-year Framingham Risk Score in a German population-based cohort.
JO  - Diagnostics
VL  - 12
IS  - 4
PY  - 2022
SN  - 2075-4418
ER  - 

TY  - JOUR
AB  - Chronic antibody-mediated rejection (AMR) is a key limiting factor for the clinical outcome of a kidney transplantation (Ktx), where early diagnosis and therapeutic intervention is needed. This study describes the identification of the biomarker CXC-motif chemokine ligand (CXCL) 9 as an indicator for AMR and presents a new aptamer-antibody-hybrid lateral flow assay (hybrid-LFA) for detection in urine. Biomarker evaluation included two independent cohorts of kidney transplant recipients (KTRs) from a protocol biopsy program and used subgroup comparisons according to BANFF-classifications. Plasma, urine and biopsy lysate samples were analyzed with a Luminex-based multiplex assay. The CXCL9-specific hybrid-LFA was developed based upon a specific rat antibody immobilized on a nitrocellulose-membrane and the coupling of a CXCL9-binding aptamer to gold nanoparticles. LFA performance was assessed according to receiver operating characteristic (ROC) analysis. Among 15 high-scored biomarkers according to a neural network analysis, significantly higher levels of CXCL9 were found in plasma and urine and biopsy lysates of KTRs with biopsyproven AMR. The newly developed hybrid-LFA reached a sensitivity and specificity of 71% and an AUC of 0.79 for CXCL9. This point-of-care-test (POCT) improves early diagnosis-making in AMR after Ktx, especially in KTRs with undetermined status of donor-specific HLA-antibodies.
AU  - Seiler, L.K.*
AU  - Phung, N.L.*
AU  - Nikolin, C.*
AU  - Immenschuh, S.*
AU  - Erck, C.*
AU  - Kaufeld, J.*
AU  - Haller, H.*
AU  - Falk, C.S.*
AU  - Jonczyk, R.*
AU  - Lindner, P.*
AU  - Thoms, S.*
AU  - Siegl, J.*
AU  - Mayer, G.*
AU  - Feederle, R.
AU  - Blume, C.A.*
C1  - 64315
C2  - 52178
CY  - St Alban-anlage 66, Ch-4052 Basel, Switzerland
TI  - An antibody-aptamer-hybrid lateral flow assay for detection of CXCL9 in antibody-mediated rejection after kidney transplantation.
JO  - Diagnostics
VL  - 12
IS  - 2
PB  - Mdpi
PY  - 2022
SN  - 2075-4418
ER  -