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14 pages, 3146 KiB

Open AccessArticle

The Effect of Primary Aldosteronism on Carotid Artery Texture in Ultrasound Images

by Sumit Kaushik, Bohumil Majtan, Robert Holaj, Denis Baručić, Barbora Kološová, Jiří Widimský, Jr. and Jan Kybic

Diagnostics 2022, 12(12), 3206; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12123206 - 17 Dec 2022

Viewed by 1348

Abstract

Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. Early diagnoses of PA are essential to avoid the long-term negative effects of elevated aldosterone concentration on the cardiovascular and renal system. In this work, we study the texture of the carotid [...] Read more.

Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. Early diagnoses of PA are essential to avoid the long-term negative effects of elevated aldosterone concentration on the cardiovascular and renal system. In this work, we study the texture of the carotid artery vessel wall from longitudinal ultrasound images in order to automatically distinguish between PA and essential hypertension (EH). The texture is characterized using 140 Haralick and 10 wavelet features evaluated in a region of interest in the vessel wall, followed by the XGBoost classifier. Carotid ultrasound studies were carried out on 33 patients aged 42–72 years with PA, 52 patients with EH, and 33 normotensive controls. For the most clinically relevant task of distinguishing PA and EH classes, we achieved a classification accuracy of 73% as assessed by a leave-one-out procedure. This result is promising even compared to the 57% prediction accuracy using clinical characteristics alone or 63% accuracy using a combination of clinical characteristics and intima-media thickness (IMT) parameters. If the accuracy is improved and the method incorporated into standard clinical procedures, this could eventually lead to an improvement in the early diagnosis of PA and consequently improve the clinical outcome for these patients in future. Full article

(This article belongs to the Special Issue Advances in Vascular Imaging)

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15 pages, 1570 KiB

Open AccessArticle

Validation of Existing Clinical Prediction Tools for Primary Aldosteronism Subtyping

by Barbora Kološová, Petr Waldauf, Dan Wichterle, Jan Kvasnička, Tomáš Zelinka, Ondřej Petrák, Zuzana Krátká, Lubomíra Forejtová, Jan Kaván, Jiří Widimský, Jr. and Robert Holaj

Diagnostics 2022, 12(11), 2806; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12112806 - 15 Nov 2022

Cited by 3 | Viewed by 1296

Abstract

The new clinical prediction score (SCORE) has been recently proposed for primary aldosteronism (PA) subtyping prior to adrenal vein sampling (AVS). This study aimed to compare that SCORE with previously published scores and their validation using a cohort of patients at our center [...] Read more.

The new clinical prediction score (SCORE) has been recently proposed for primary aldosteronism (PA) subtyping prior to adrenal vein sampling (AVS). This study aimed to compare that SCORE with previously published scores and their validation using a cohort of patients at our center who had had positive SIT confirming PA and had been diagnosed with either bilateral PA according to AVS or unilateral PA if biochemically cured after an adrenalectomy. Final diagnoses were used to evaluate the diagnostic performance of the proposed clinical prediction tools. Only Kamemura’s model (with a maximum score of 4 points) and Kobayashi’s score (with a maximum score of 12 points) reached 100% reliability for prediction of bilateral PA; however, with sensitivity of only 3%. On the other hand, the values of SCORE = 3 (with sensitivity of 48%), the SPACE score ≥18 (with sensitivity of 35%), the Kobayashi’s score ≤2 (with sensitivity of 28%), and the Kocjan’s score = 3 (with sensitivity of 28%) were able to predict unilateral PA with 100% probability. Furthermore, Umakoshi’s and Young’s models both reached 100% reliability for a unilateral PA with score = 4 and both predictive factors together respectively; however, the sensitivity was lower compared with previous models; 4% and 14%, respectively. None of the clinical prediction tools applied to our cohort predicted unilateral and bilateral subtypes together with the expected high diagnostic performance, and therefore can only be used for precisely defined cases. Full article

(This article belongs to the Special Issue Advances in Vascular Imaging)

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10 pages, 1499 KiB

Open AccessArticle

CT Brain Perfusion in the Prediction of Final Infarct Volume: A Prospective Study of Different Software Settings for Acute Ischemic Core Calculation

by Karin Kremenova, Jiri Lukavsky, Michal Holesta, Tomas Peisker, David Lauer, Jiri Weichet and Hana Malikova

Diagnostics 2022, 12(10), 2290; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12102290 - 22 Sep 2022

Cited by 4 | Viewed by 1788

Abstract

CT perfusion (CTP) is used for the evaluation of brain tissue viability in patients with acute ischemic stroke (AIS). We studied the accuracy of three different syngo.via software (SW) settings for acute ischemic core estimation in predicting the final infarct volume (FIV). The [...] Read more.

CT perfusion (CTP) is used for the evaluation of brain tissue viability in patients with acute ischemic stroke (AIS). We studied the accuracy of three different syngo.via software (SW) settings for acute ischemic core estimation in predicting the final infarct volume (FIV). The ischemic core was defined as follows: Setting A: an area with cerebral blood flow (CBF) < 30% compared to the contralateral healthy hemisphere. Setting B: CBF < 20% compared to contralateral hemisphere. Setting C: area of cerebral blood volume (CBV) < 1.2 mL/100 mL. We studied 47 AIS patients (aged 68 ± 11.2 years) with large vessel occlusion in the anterior circulation, treated in the early time window (up to 6 h), who underwent technically successful endovascular thrombectomy (EVT). FIV was measured on MRI performed 24 ± 2 h after EVT. In general, all three settings correlated with each other; however, the absolute agreement between acute ischemic core volume on CTP and FIV on MRI was poor; intraclass correlation for all three settings was between 0.64 and 0.69, root mean square error of the individual observations was between 58.9 and 66.0. Our results suggest that using CTP syngo.via SW for prediction of FIV in AIS patients in the early time window is not appropriate. Full article

(This article belongs to the Special Issue Advances in Vascular Imaging)

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14 pages, 2167 KiB

Open AccessArticle

Adrenal Venous Sampling Could Be Omitted before Surgery in Patients with Conn’s Adenoma Confirmed by Computed Tomography and Higher Normal Aldosterone Concentration after Saline Infusion Test

by Robert Holaj, Petr Waldauf, Dan Wichterle, Jan Kvasnička, Tomáš Zelinka, Ondřej Petrák, Zuzana Krátká, Lubomíra Forejtová, Jan Kaván and Jiří Widimský, Jr.

Diagnostics 2022, 12(7), 1718; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12071718 - 15 Jul 2022

Cited by 5 | Viewed by 1504

Abstract

Purpose: Adrenal venous sampling (AVS) performed to distinguish unilateral and bilateral primary aldosteronism (PA) is invasive and poorly standardized. This study aimed to identify non-invasive characteristics that can select the patients with unilateral PA who could bypass AVS before surgery. Methods: A single-center [...] Read more.

Purpose: Adrenal venous sampling (AVS) performed to distinguish unilateral and bilateral primary aldosteronism (PA) is invasive and poorly standardized. This study aimed to identify non-invasive characteristics that can select the patients with unilateral PA who could bypass AVS before surgery. Methods: A single-center study collected a total of 450 patients with PA. Development and validation cohorts included 242 and 208 patients. The AVS was successful in 150 and 138 patients from the cohorts, and the unilateral PA was found in 96 and 94 patients, respectively. Clinical factors independently associated with lateralized AVS in multivariable logistic regression were used to construct a unilateral PA prediction score (SCORE). Results: The proposed SCORE was calculated as a sum of the prevalence of adrenal nodule on computed tomography (2 points) and plasma/serum aldosterone concentration ≥ 165 ng/L after the saline infusion test (SIT) (1 point). Importantly, the SCORE = 3 points identified 48% of unilateral PA patients with a specificity of 100% in the development cohort. The zero rate of false-positive classifications was preserved with the same cut-off value in the validation cohort. Conclusions: AVS could be omitted before surgery in patients with typical Conn´s adenoma provided the aldosterone concentration ≥ 165 ng/L after the SIT. Full article

(This article belongs to the Special Issue Advances in Vascular Imaging)

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13 pages, 669 KiB

Open AccessArticle

Prospective Study of Low-Radiation and Low-Iodine Dose Aortic CT Angiography in Obese and Non-Obese Patients: Image Quality and Impact of Patient Characteristics

by Matthias A. Fink, Sibylle Stoll, Claudius Melzig, Andrea Steuwe, Sasan Partovi, Dittmar Böckler, Hans-Ulrich Kauczor and Fabian Rengier

Diagnostics 2022, 12(3), 675; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12030675 - 10 Mar 2022

Cited by 5 | Viewed by 1838

Abstract

The purpose of this study was to prospectively analyse image quality and radiation dose of body mass index (BMI)-adapted low-radiation and low-iodine dose CTA of the thoracoabdominal aorta in obese and non-obese patients. This prospective, single-centre study included patients scheduled for aortic CTA [...] Read more.

The purpose of this study was to prospectively analyse image quality and radiation dose of body mass index (BMI)-adapted low-radiation and low-iodine dose CTA of the thoracoabdominal aorta in obese and non-obese patients. This prospective, single-centre study included patients scheduled for aortic CTA between November 2017 and August 2020 without symptoms of high-grade heart failure. A BMI-adapted protocol was used: Group A/Group B, BMI < 30/≥ 30 kg/m², tube potential 80/100 kVp, total iodine dose 14.5/17.4 g. Intraindividual comparison with the institutional clinical routine aortic CTA protocol was performed. The final study cohort comprised 161 patients (mean 71.1 ± 9.4 years, 32 women), thereof 126 patients in Group A (mean BMI 25.4 ± 2.8 kg/m²) and 35 patients in Group B (34.0 ± 3.4 kg/m²). Mean attenuation over five aortoiliac measurement positions for Group A/B was 354.9 ± 78.2/262.1 ± 73.0 HU. Mean effective dose for Group A/B was 3.05 ± 0.46/6.02 ± 1.14 mSv. Intraindividual comparison in 50 patients demonstrated effective dose savings for Group A/B of 34.4 ± 14.5/25.4 ± 14.1% (both p < 0.001), and iodine dose savings for Group A/B of 54/44.8%. Regression analysis showed that female sex and increasing age were independently associated with higher vascular attenuation. In conclusion, BMI-adapted, low-radiation and low-iodine dose CTA of the thoracoabdominal aorta delivers diagnostic image quality in non-obese and obese patients without symptoms of high-grade heart failure, with superior image quality in females and the elderly. Full article

(This article belongs to the Special Issue Advances in Vascular Imaging)

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Review

Jump to: Research

11 pages, 2905 KiB

Open AccessReview

Endovascular Arteriovenous Fistula Creation—Review of Current Experience

by Alexandros Mallios, Jan Malik and William C. Jennings

Diagnostics 2022, 12(10), 2447; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12102447 - 10 Oct 2022

Cited by 3 | Viewed by 2023

Abstract

Functioning vascular access is an essential element for life-saving hemodialysis therapy. A surgically-created arteriovenous fistula has been considered the best option for many years. Recently, two manufacturers developed systems for percutaneous/endovascular creation of an arteriovenous fistula (WavelinQ and Ellipsys). We provide a review [...] Read more.

Functioning vascular access is an essential element for life-saving hemodialysis therapy. A surgically-created arteriovenous fistula has been considered the best option for many years. Recently, two manufacturers developed systems for percutaneous/endovascular creation of an arteriovenous fistula (WavelinQ and Ellipsys). We provide a review of the available experience with these systems and discuss advantages and disadvantages. Full article

(This article belongs to the Special Issue Advances in Vascular Imaging)

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13 pages, 2167 KiB

Open AccessReview

Arteriovenous Hemodialysis Access Stenosis Diagnosed by Duplex Doppler Ultrasonography: A Review

by Jan Malik, Cora de Bont, Anna Valerianova, Zdislava Krupickova and Ludmila Novakova

Diagnostics 2022, 12(8), 1979; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12081979 - 16 Aug 2022

Cited by 5 | Viewed by 3667

Abstract

Arteriovenous fistula (AVF) is currently the hemodialysis access with the longest life expectations for the patients. However, even the AVF is at risk for many complications, especially the development of stenosis. The latter can not only lead to inadequate hemodialysis but also lead [...] Read more.

Arteriovenous fistula (AVF) is currently the hemodialysis access with the longest life expectations for the patients. However, even the AVF is at risk for many complications, especially the development of stenosis. The latter can not only lead to inadequate hemodialysis but also lead to AVF thrombosis. Duplex Doppler ultrasonography is a very precise method, in the hands of experienced professionals, for the diagnosis of AVF complications. In this review, we summarize the ultrasound diagnostic criteria of significant stenoses and their indication for procedural therapy. Full article

(This article belongs to the Special Issue Advances in Vascular Imaging)

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14 pages, 5232 KiB

Open AccessReview

Diagnosis of Ischemic Stroke: As Simple as Possible

by Hana Malikova and Jiri Weichet

Diagnostics 2022, 12(6), 1452; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12061452 - 13 Jun 2022

Cited by 3 | Viewed by 10385

Abstract

The absolute majority of strokes in high-income countries, roughly 91%, are of ischemic origin. This review is focused on acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation, which is considered the most devastating subtype of AIS. Moreover, stroke [...] Read more.

The absolute majority of strokes in high-income countries, roughly 91%, are of ischemic origin. This review is focused on acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation, which is considered the most devastating subtype of AIS. Moreover, stroke survivors impose substantial direct and indirect costs of care as well as costs due to productivity loss. We review of diagnostic possibilities of individual imaging methods such as computed tomography and magnetic resonance imaging, and discuss their pros and cons in the imaging of AIS. The goals of non-invasive imaging in AIS are as follows: (a) to rule out intracranial hemorrhage and to quickly exclude hemorrhagic stroke and contraindications for intravenous thrombolysis; (b) to identify potential LVO and its localization and to quickly provide guidance for endovascular treatment; (c) to assess/estimate the volume or size of the ischemic core. We suggest fast diagnostic management, which is able to quickly satisfy the above-mentioned diagnostic goals in AIS with LVO. Full article

(This article belongs to the Special Issue Advances in Vascular Imaging)

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