RESUMEN
BACKGROUND: Carotid plaque volume (CPV) can be measured by 3D ultrasound and may be a better predictor of stroke than stenosis, but analysis time limits clinical utility. This study tested the accuracy, reproducibility, and time saved of using an artificial intelligence (AI) derived semiautomatic software to measure CPV ("auto-CPV"). METHODS: Three-dimensional (3D) ultrasound images for 121 individuals were analyzed by 2 blinded operators to measure auto-CPV. Corresponding endarterectomy specimen volumes were calculated by the validated saline suspension technique. Inter-rater and intrarater agreement plus accuracy compared with the volume of the endarterectomized plaque were calculated. Measurement times were compared with previous manual CPV measurement. RESULTS: The mean difference between auto-CPV and surgical volume was small at (±s.d.) [95% confidence interval [CI]] 0.06 (0.24) [-0.41 to 0.54] cm3. The intraclass correlation (ICC) was strong at 0.91; 95% CI 0.86-0.94. Interobserver and intraobserver error was low with mean difference (±s.d.) [95%CI] 0.01 (0.26) [-0.5 to 0.5] cm3 and 0.03 (0.19) [-0.35 to 0.40] cm3 respectively. Both showed excellent ICC with narrow confidence intervals, ICC = 0.90; 95% CI (0.85-0.94) and ICC = 0.95; 95% CI (0.92-0.96). Auto-CPV measurement took 43% the time of manual planimetry; median (IQR) 05:39 (01:58) minutes compared to 13:05 (04:15) minutes, Wilcoxon rank-sum test, P < 0.01. CONCLUSIONS: Auto-CPV assessment is accurate, reproducible, and significantly faster than manual planimetry. Improved feasibility means that the utility of CPV can be assessed in large population studies to stratify risk in asymptomatic carotid disease or assess response to medical treatment.
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Inteligencia Artificial , Placa Aterosclerótica , Humanos , Reproducibilidad de los Resultados , Resultado del Tratamiento , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/cirugía , Ultrasonografía , Imagenología Tridimensional , Variaciones Dependientes del ObservadorRESUMEN
Diabetic autonomic neuropathy is probably the most undiagnosed but serious complication of diabetes. The main objectives were to assess the prevalence of peripheral and autonomic neuropathy in a population of diabetic patients, analyze it in a real-life outpatient unit scenario and determine the feasibility of performing SUDOSCAN tests together with widely used tests for neuropathy. A total of 33 patients were included in the study. Different scoring systems (the Toronto Clinical Neuropathy Score-TCNS; the Neuropathy Disability Score-NDS; and the Neuropathy Symptom Score-NSS) were applied to record diabetic neuropathy (DN), while the SUDOSCAN medical device was used to assess sudomotor function, detect diabetic autonomic neuropathy and screen for cardiac autonomic neuropathy (CAN). Fifteen (45.5%) patients had sudomotor dysfunction. The SUDOSCAN CAN risk score was positively correlated with the hands' electrochemical sweat conductance (ESC), diastolic blood pressure (DBP), the level of the glycated hemoglobin, as well as with the TCNS, NDS and NSS. Performing SUDOSCAN tests together with other tests for DN proved to be a feasible approach that could be used in daily clinical practice in order to screen for DN, as well as for the early screening of CAN, before more complex and time-consuming tests.
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Neuropatías Diabéticas , Humanos , Sistema Nervioso Autónomo , Neuropatías Diabéticas/diagnóstico , Respuesta Galvánica de la Piel , Hemoglobina GlucadaRESUMEN
Chronic wounds such as venous leg ulcers invariably heal slowly and recur. In the case of venous leg ulcers, poor healing of chronic wounds is variously attributed to ambulatory hypertension, impaired perfusion and diffusion, presence of chronic inflammation at wound sites, lipodermatosclerosis, and senescence. The aim of this study was to investigate whether a new technique, optical coherence tomography (OCT), which permits imaging of blood capillaries in the peri-wound skin, can provide new insights into the pathology. OCT and its recent variant, dynamic OCT, permit rapid noninvasive depth-resolved imaging of the capillaries in the superficial dermis via a handheld probe, showing the morphology and density of vessels down to 20 µm in diameter. We used dynamic OCT to investigate 15 chronic wounds and assess characteristics of the vessels at the 4 poles around the wounds, the wound bed, adjacent dermatosclerosis, and unaffected skin. The results of the study show that both vessel morphology and density in the wound edges are dramatically different from that in healthy skin, showing clusters of glomuleri-like vessels (knot-like forms or clumps) and an absence of linear branching vessels, and also greater blood perfusion. Such vessel shapes are reported to be associated with tissue growth. The OCT imaging procedure was rapid and well tolerated by patients and provided new information not available from other devices. Thus, OCT appears to have great promise as a tool for the evaluation and study of chronic ulcers.
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Úlcera del Pie/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Úlcera Varicosa/diagnóstico por imagen , Cicatrización de Heridas/fisiología , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Diagnóstico Diferencial , Femenino , Úlcera del Pie/patología , Úlcera del Pie/fisiopatología , Humanos , Úlcera de la Pierna/diagnóstico por imagen , Úlcera de la Pierna/patología , Úlcera de la Pierna/fisiopatología , Masculino , Microcirculación/fisiología , Persona de Mediana Edad , Flujo Sanguíneo Regional/fisiología , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Úlcera Varicosa/patología , Úlcera Varicosa/fisiopatologíaRESUMEN
A significant arising complication in the care of patients with diabetes is increased susceptibility to chronic wounds, including diabetic foot ulcers and pressure sores. This is driven by, e.g., neuropathy and peripheral arterial disease. It is well recognized that best practice in wound care requires wound assessment, including measurement, on presentation and regularly throughout the treatment program. Proper assessment is necessary to ensure that the most appropriate and cost-effective therapy is used at all times, with quantitative measurement necessary to track the efficacy of the chosen approach. A documented assessment can also assist patient-clinician dialog and discussion within the multidisciplinary team. Remote evaluation and assessment of the wound is also of increasing importance and practicality through the use of a telemedicine approach. There has been considerable progress in the space of imaging for wounds, including systems that include three-dimensional measurement and telemedicine features. This literature review examines the available options and reviews the clinical evidence for measurement accuracy, scope for remote assessment, and published user feedback on the systems.