The association between serum ferritin levels and malignant intraductal papillary mucinous neoplasms

Background Serum ferritin levels are elevated in many malignancies. In this study, we showed the performance of serum ferritin in identifying malignant intraductal papillary mucinous neoplasms (IPMNs). Methods A total of 151 patients with pathologically confirmed IPMNs were enrolled. Serum tumor biomarker (carbohydrate antigen 19–9 (CA19–9) and carcinoembryonic antigen (CEA)) levels and serum ferritin levels were recorded. Lesion location, tumor size, diameter of the main pancreatic duct (MPD), mural nodule, and IPMN type, were collected from imaging examinations. IPMNs with high grade dysplasia and associated invasive carcinoma were considered malignant IPMNs. Results Serum ferritin levels in patients with malignant IPMNs were higher than those in patients with nonmalignant IPMNs (p < 0.05). Serum ferritin was an independent factor for the occurrence of malignant IPMNs (odds ratio (OR) = 1.18, 95% confidence interval (CI):1.01–1.39). A similar trend was found between high serum ferritin (> 149 ng/ml) and malignant IPMNs (OR = 5.64, 95% CI:1.78–17.92). The area under the curve (AUC) of serum ferritin was higher than that of CEA and CA19–9 in identifying malignant IPMNs (AUC = 0.67 vs. AUC = 0.58, 0.65). The combination of serum ferritin with IPMN type showed a similar performance to MPD diameter and the combination of serum CA19–9 with IPMN types in identifying malignant IPMNs (AUC = 0.78 vs. AUC = 0.79, 0.77) and invasive carcinoma (AUC = 0.77 vs. AUC = 0.79, 0.79). Conclusions Elevated serum ferritin is a factor associated with malignant IPMNs. Serum ferritin may be a useful marker for identifying malignancy in IPMNs.

Effect of lesion characteristics on diagnostic performance of CT-derived fractional flow reserve: exploring the indications for application based on CT-FFR CHINA trial (Preprint)

BACKGROUND High diagnostic performance of coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR; CT-FFR) in identifying flow-limiting stenosis has been confirmed. CT-FFR is recommended to assess the hemodynamic significance of coronary lesions. However, the optimal indications of CT-FFR relies on its ability to discriminating ischemia in situations of different types of lesions. And the effect of lesion-dependent factors on determining the diagnostic accuracy of CT-FFR have not been comprehensively evaluated yet. OBJECTIVE We aimed to investigate the effect of lesion-related factors on the diagnostic performance of CT-FFR with computational fluid dynamics algorithm, to promote the clinical application of it. METHODS This multicenter prospective clinical trial enrolled 317 patients with 30%–90% stenosis undergoing CCTA and invasive FFR from 5 centers across China. All target lesions were assigned into different lesion characteristics (target vessels, lesion location, lesion length, bifurcation lesions, and coronary calcification) subgroups. Diagnostic performance (accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under receiver operating characteristics curve (AUC)) of CT-FFR identifying ischemia were calculated and compared in all sub-groups. RESULTS Three hundred and sixty-six target vessels from 317 patients (mean age: 59.3 ± 9.6 years) were analyzed. The overall vessel-based diagnostic accuracy, sensitivity, specificity, PPV, NPV, and AUC of CT-FFR were 87.2%, 86.4%, 88.8%, 86.9%, 88.4%, and 0.90. Absence of bifurcation lesion group possessed the higher NPV of CT-FFR than presence of bifurcation lesion group (92.8% vs. 78.9%, p = 0.006). Whereas there was no statistically significant difference in diagnostic performance of CT-FFR among different target vessels, lesion location, lesion length, and coronary calcification sub-groups (all p > 0.05). CONCLUSIONS This study supported CT-FFR as a powerful noninvasive functional assessment tool for coronary lesions with different lesion characteristics, involving target vessel, lesion location, lesion length, and coronary calcification. While the diagnostic performance of CT-FFR was negatively affected by the presence of bifurcation lesions. CLINICALTRIAL https://clinicaltrials.gov; Unique identifier: NCT03692936.

Imaging of the medial collateral ligament of the knee: a systematic review

Introduction The primary aim of this investigation was to systematically review relevant literature of various imaging modalities (magnetic resonance imaging (MRI), stress radiography and ultrasonography) in the assessment of patients with a medial collateral ligament (MCL) injury. Materials and methods A systematic literature review of articles indexed in PubMed and Cochrane library was performed. Original research reporting data associated with medial gapping, surgical, and clinical findings associated with MCL injuries were considered for inclusion. The methodological quality of each inclusion was also assessed using a verified tool. Results Twenty-three imaging studies (magnetic resonance imaging (MRI) n = 14; ultrasonography n = 6; radiography n = 3) were ultimately included into the review. A total of 808 injured, and 294 control, knees were assessed. Interobserver reliabilities were reported in radiographic and ultrasonographic investigations with almost perfect agreement. MRI studies demonstrated agreement ranging between substantial to almost perfect. Intraobserver reliability was only reported in radiographic studies pertinent to medial gapping and was found to be almost perfect. Correlation of MRI with clinical findings was moderate to strong (65–92%). Additionally, MRI imaging was more sensitive in the detection of MCL lesions when compared to clinical examination. However, when compared to surgical findings, MRI underestimated the grade of instability in up to 21% of cases. Furthermore, MRI showed relatively inferior performance in the identification of the exact MCL-lesion location when compared to surgical findings. Interestingly, preoperative clinical examination was slightly inferior to stress radiography in the detection of MCL lesions. However, clinical testing under general anaesthesia performed similar to stress radiography. The methodological quality analysis showed a low risk of bias regarding patient selection and index testing in each imaging modality. Conclusion MRI can reliably diagnose an MCL lesion but demonstrates limitations in its ability to predict the specific lesion location or grade of MCL instability. Ultrasonography is a widely available, radiation free modality, but is rarely used in clinical practice for detecting MCL lesions and clinical or surgical correlates are scarce. Stress radiography findings correlate with surgical findings but clinical correlations are missing in the literature. Level of evidence IV.

Predicting Aphasia from Strokes

Strokes can occur when someone’s blood vessels get blocked and the nutrients and oxygen being transported will not reach the brain. When a stroke happens, the brain cells don’t get the nutrients they need and start to die [3]. This could cause different side effects after stroke. In this study, we try to predict the possibility of one type of after-stroke side effect, aphasia, using Machine Learning (ML) techniques. Using the data of a study about brain lesion damage after a stroke and what effects the patients were experiencing afterward, we trained a model to predict whether a person may have aphasia based on where their lesion was, how big the lesion was, how long ago their stroke was, and some other factors. We evaluated several classification methods and found that using linear discriminant analysis was the most accurately predicting when we used age, sex, lesion location, lesion volume, and many more. By linear discriminant analysis, we were able to have a 91% overall predictive rate of patients having aphasia or not after experiencing a stroke.

Discordant resting and hyperaemic coronary physiology among unselected patients referred for coronary angiography: a single centre experience

Background Physiological assessment of intermediate coronary artery lesions to guide therapy is well established. Recently, the use of non-hyperaemic pressure ratios (NHPRs) has been suggested as a reliable alternative to hyperaemic assessment, such as fractional flow reserve (FFR). However certain patient / lesion subsets, including proximal lesion location, young patient age and assessment of non-LAD vessels, have been associated with discordance of resting and hyperaemic measurements which has led to some confusion over their interpretation and integration into routine clinical practice. Purpose To evaluate the frequency of discordant resting and hyperaemic measurements among patients undergoing assessment of intermediate coronary artery stenoses, and to identify common lesion-specific features within patients with discordant data. Methods From our coronary physiology database, we identified consecutive lesions which had been assessed between October 2020 and March 2021 with both resting (resting full-cycle ratio; RFR) and hyperaemic (wire-based FFR with peripheral adenosine) indices. Positive RFR defined as &lt;0.89 (negative RFR &gt;0.93, grey zone RFR 0.89–0.93). Positive FFR defined as &lt;0.80 (negative FFR ≥0.80). Concordance between measurements was assessed: Group 1 (RFR -ve, FFR +ve: positive discordance); Group 2 (RFR -ve, FFR -ve: normal concordance), Group 3 (RFR +ve, FFR +ve: abnormal concordance) and Group 4 (RFR +ve, FFR -ve: negative discordance). Results 100 lesions were identified as being assessed with both RFR and FFR, in 83 patients (67% male), mean age 67 (±12) years, vessel assessed; LAD 66, RCA 19, LCx 13, LMCA 1 and radial graft 1; with 45 being proximal lesions. 30 RFR measurements were in the grey zone. Of the remaining 70 lesions, 55 results (79%) were concordant (Group 2 = 31, Group 3 = 24), with 15 results (21%) being discordant (Group 1 = 3, Group 4 = 12). Negative predictive value (NPV) of RFR (for FFR &lt;0.80) was 91%, when grey zone RFR measurements were excluded. Discordance was not related to age (69 vs 68 years, p=0.75), lesion location (proximal lesion with discordance (6/15) vs proximal lesion with concordance (27/55), p=0.91, figure 1) or non-LAD vessel (non-LAD with discordance (9/15) vs non-LAD lesion with concordance (20/55), p=0.77, figure 2). Conclusion Overall within our patient group, there appeared to be a good association of RFR to FFR. In particular, RFR had a high NPV for an FFR &lt;0.80. The clinical relevance of discordant measurements requires further investigation. However, our data suggest that a positive RFR (&lt;0.89) measurement may not always correlate with a significant FFR measurement (&lt;0.80), and the mechanism for this is unclear. Consequently, caution should be applied when including these measures in every day practice, in particular within patients with a positive RFR measurement. FUNDunding Acknowledgement Type of funding sources: None.

A Novel Approach for Detection of Optic Disc and Lesion Location for Screening Diabetic Retinopathy

Diabetic Retinopathy is not typically perceivable in diabetic patients at the initial stage. Their first signs, like micro-aneurysms, often go unnoticed in preliminary testing by specialists. Additionally, its presence is difficult to detect as there are other pathologies that may also lead to induce similar signs and symptoms. Until the detection of the presence of exudates, a specialist cannot simply deduce the presence of diabetic retinopathy. This paper presents a method to assist in the identification and differentiation of exudates on colour retinal images based on a variety of k-nearest neighbour filters. The proposed method proved to be a rational approach to detect bright lesions with sufficient certainty, yielding a possible injury with a specificity of 99%.

Lesion site and therapy time predict responses to a therapy for anomia after stroke: a prognostic model development study

Stroke is a leading cause of disability, and language impairments (aphasia) after stroke are both common and particularly feared. Most stroke survivors with aphasia exhibit anomia (difficulties with naming common objects), but while many therapeutic interventions for anomia have been proposed, treatment effects are typically much larger in some patients than others. Here, we asked whether that variation might be more systematic, and even predictable, than previously thought. 18 patients, each at least 6 months after left hemisphere stroke, engaged in a computerised treatment for their anomia over a 6-week period. Using only: (a) the patients’ initial accuracy when naming (to-be) trained items; (b) the hours of therapy that they devoted to the therapy; and (c) whole-brain lesion location data, derived from structural MRI; we developed Partial Least Squares regression models to predict the patients’ improvements on treated items, and tested them in cross-validation. Somewhat surprisingly, the best model included only lesion location data and the hours of therapy undertaken. In cross-validation, this model significantly out-performed the null model, in which the prediction for each patient was simply the mean treatment effect of the group. This model also made promisingly accurate predictions in absolute terms: the correlation between empirical and predicted treatment response was 0.62 (95% CI 0.27, 0.95). Our results indicate that individuals’ variation in response to anomia treatment are, at least somewhat, systematic and predictable, from the interaction between where and how much lesion damage they have suffered, and the time they devoted to the therapy.