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A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Biomedical Engineering and Materials".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 7085

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Dr. Giulio Distefano

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Institute of Nephrology and Dialysis—Nephrological, Vascular and Internal Medicine Diagnostic Ultrasound Service, Maggiore Hospital of Modica, ASP Ragusa, 97015 Modica, Italy
Interests: ultrasound; vascular access; EcoColorDoppler; vascular; interventional radiology
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Prof. Dr. Antonio Granata

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Nephrology and Dialysis Unit, “Cannizzaro” Emergency Hospital, 95126 Catania, Italy
Interests: doppler ultrasound; contrast enhanced ultrasound; vascular access; renovascular hypertension; chronic kidney disease; nutcracker syndrome; kidney transplantation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue is dedicated to the innovative applications of biomedical imaging techniques in the diagnosis and treatment of human diseases. It aims to celebrate the progress made in this field, which has led to the development of increasingly precise and reliable imaging-based diagnostic and therapeutic tools, in line with the evolution of diagnostics toward minimally invasive and non-invasive approaches.

From advanced radiological techniques to parametric ultrasonography and molecular imaging techniques, diagnostic imaging allows for the precise identification of the causes of a disease, monitoring its progression and evaluating the efficacy of treatment.

In this Special Issue, readers will find the following content:

Review articles that illustrate the latest innovations in biomedical imaging, focusing on applications in various medical areas;
Original research presenting new clinical and preclinical studies on the use of innovative imaging techniques for diagnosis, monitoring and treatment in various application areas.

This Special Issue aims to pay tribute to the important role that biomedical imaging techniques play in modern medicine, contributing to improving the health and quality of life of patients.

Dr. Giulio Distefano
Prof. Dr. Antonio Granata
Guest Editors

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Keywords

medical imaging
advanced radiological techniques
artificial intelligence
molecular imaging
computed tomography (CT)
magnetic resonance imaging (MRI)
ultrasound
fluoroscopy
optical imaging
liquid biopsy

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Published Papers (8 papers)

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Research

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15 pages, 1617 KiB

Open AccessArticle

Methodology Development for Investigating Pathophysiological [¹⁸F]-FDG Muscle Uptake in Patients with Rheumatic Musculoskeletal Diseases

by Maia Sobejana, Mustafa Al Beiramani, Gerben J. C. Zwezerijnen, Anneke van der Kooi, Joost Raaphorst, Carel G. M. Meskers, Martin van der Esch, Conny J. van der Laken and Maarten M. Steinz

Biomedicines 2025, 13(2), 465; https://doi.org/10.3390/biomedicines13020465 - 14 Feb 2025

Abstract

Objectives: This retrospective study explored the qualitative and quantitative assessment of F18-fluordeoxyglucose ([¹⁸F]-FDG) positron emission tomography and computed tomography (PET/CT) scans to assess pathophysiological muscle glucose uptake in patients with a rheumatic musculoskeletal disease (RMD). [¹⁸F]-FDG PET/CT detects metabolic activity via glucose uptake in tissues. This study aimed to determine the feasibility of quantitative assessment of [¹⁸F]-FDG uptake in muscles across three different RMDs compared to controls. Methods: In this study we analysed whole-body [¹⁸F]-FDG PET/CT scans from patients with rheumatoid arthritis (RA; n = 11), osteoarthritis (OA; n = 10), and idiopathic inflammatory myositis (IIM; n = 10), and non-RMD controls (n = 11), focusing on muscle-tracer uptake in specific muscle groups. Qualitative assessment visually identified regions with high [¹⁸F]-FDG uptake, followed by quantitative assessment using two methods: fixed volume-of-interest (VOI) and hotspot VOI. In the fixed VOI method, a VOI was placed in the respective muscle at a fixed position (50% height from proximal to distal end) on PET/CT images. In the hotspot VOI method, the VOI was placed at the site of the highest [¹⁸F]-FDG uptake observed during qualitative assessment. Standardised uptake values (SUVs) were determined for different muscle groups between RMDs and controls. Results: Qualitative assessment revealed a heterogenous uptake pattern of [¹⁸F]-FDG that was found in 93% of quadriceps and hamstring muscles, while other muscles displayed either heterogenous or homogenous patterns. A Bland–Altman analysis showed that the hotspot VOI method had a higher sensitivity in detecting differential [¹⁸F]-FDG uptake in muscles. Across all muscle groups, patients with IIM had the highest [¹⁸F]-FDG uptake, followed by patients with OA and RA, respectively. Conclusions: [¹⁸F]-FDG PET/CT enables qualitative and quantitative differentiation of muscle glucose uptake in patients with RA, OA, and IIM, at both individual muscle and patient group levels. The hotspot method and SUV_peak are recommended for quantitative assessment. High [¹⁸F]-FDG uptake in multiple muscle groups suggests pathophysiological glucose metabolism in RMD-affected muscles. Full article

(This article belongs to the Special Issue Applications of Imaging Technology in Human Diseases)

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15 pages, 1942 KiB

Open AccessArticle

Reproducibility of Thermography for Measuring Skin Temperature of Upper Limbs in Breast Cancer Survivors

by Vanessa Maria da Silva Alves Gomes, Naiany Tenório, Ana Rafaela Cardozo da Silva, Laura Raynelle Patriota Oliveira, Ana Claúdia Souza da Silva, Juliana Netto Maia, Marcos Leal Brioschi and Diego Dantas

Biomedicines 2024, 12(11), 2465; https://doi.org/10.3390/biomedicines12112465 - 27 Oct 2024

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Abstract

Background/Objectives: Breast cancer-related lymphedema (BCRL) is a chronic condition that has early diagnosis as a critical component for proper treatment. Thermography, a non-invasive imaging method, is considered a promising complementary tool for the diagnosis and monitoring of BCRL, especially in subclinical stages. The present study aimed to evaluate the intra- and inter-examiner reproducibility of thermography for measuring the skin temperature of the upper limbs (UL) of women with and without BCRL. Methods: This study, conducted with women who underwent a unilateral mastectomy, assessed BCRL using indirect volumetry. Maximum, minimum, and mean skin temperatures were measured in five regions of interest (ROI) of each UL (C1, C2, C3, C4, and Cup) in four different postures. Reproducibility measures were assessed using an intraclass correlation coefficient, 95% confidence interval, and coefficient of variation. Results: The sample comprised 30 women; 14 were diagnosed with BCRL. A total of 120 thermograms were recorded in different postures, and 3600 ROI were analyzed in the UL with and without BRCL. The intraclass correlation coefficient of the analyses indicated intra- and inter-examiner reproducibility from good to excellent (0.82 to 1.00) for all skin temperatures evaluated (maximum, minimum, and mean). The coefficient of variation for all measures was below 10%, indicating low variability. Conclusions: Our findings demonstrate that thermography shows good-to-excellent reproducibility across multiple postures and regions of interest, reinforcing its potential as a non-invasive and reliable method for assessing lymphedema in breast cancer survivors. This study establishes a foundation for incorporating thermography into clinical practice for early BCRL detection, particularly in subclinical stages, thus improving patient management and outcomes. Full article

(This article belongs to the Special Issue Applications of Imaging Technology in Human Diseases)

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13 pages, 1874 KiB

Open AccessArticle

Ultrasound-Guided Venous Puncture Reduces Groin Complications in Electrophysiological Procedures

by Yannick Teumer, Daniel Eckart, Lyuboslav Katov, Markus Graf, Carlo Bothner, Wolfgang Rottbauer and Karolina Weinmann-Emhardt

Biomedicines 2024, 12(10), 2375; https://doi.org/10.3390/biomedicines12102375 - 17 Oct 2024

Cited by 2 | Viewed by 1113

Abstract

Background: In electrophysiological procedures, multiple punctures on the femoral vein can be necessary depending on the number of catheters required. The femoral vein is typically located indirectly by using its anatomical relationship to the artery as a reference. However, this conventional approach can lead to significant complications, including bleeding, peri-interventional transfusion, pseudoaneurysms, or arteriovenous fistulas. Despite these risks, there is limited evidence comparing the safety of ultrasound-guided venipuncture versus the conventional technique in electrophysiological procedures. Objective: This study aimed to evaluate the impact of ultrasound-guided venipuncture on vascular access complications in electrophysiological procedures and to identify associated risk factors. Methods: In this single-center trial, patients scheduled for electrophysiological procedures at Ulm University Heart Center, Germany, were enrolled between November 2021 and October 2023. Venipuncture in the groin was performed using either the conventional or an ultrasound-guided approach. The primary composite endpoint was defined as peri-interventional major vascular access complications (Bleeding Academic Research Consortium (BARC) ≥2 bleeding, pseudoaneurysms, arteriovenous fistulas, and peri-interventional transfusion) and minor complications (BARC 1). Results: A total of 1370 patients were included: 749 in the conventional group and 621 in the ultrasound group. The primary endpoint was achieved in 19.2% of the conventional group and 12.1% of the ultrasound group (p < 0.001). An increased sheath diameter and a higher number of venous accesses were identified as risk factors for the primary endpoint. Conclusions: Ultrasound guidance for venous groin puncture in electrophysiological procedures reduces access-related complications, supporting its use with careful attention to sheath size and number. Full article

(This article belongs to the Special Issue Applications of Imaging Technology in Human Diseases)

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16 pages, 2819 KiB

Open AccessArticle

Segmentation-Free Estimation of Left Ventricular Ejection Fraction Using 3D CNN Is Reliable and Improves as Multiple Cardiac MRI Cine Orientations Are Combined

by Philippe Germain, Aissam Labani, Armine Vardazaryan, Nicolas Padoy, Catherine Roy and Soraya El Ghannudi

Biomedicines 2024, 12(10), 2324; https://doi.org/10.3390/biomedicines12102324 - 12 Oct 2024

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Abstract

Objectives: We aimed to study classical, publicly available convolutional neural networks (3D-CNNs) using a combination of several cine-MR orientation planes for the estimation of left ventricular ejection fraction (LVEF) without contour tracing. Methods: Cine-MR examinations carried out on 1082 patients from our institution were analysed by comparing the LVEF provided by the CVI42 software (V5.9.3) with the estimation resulting from different 3D-CNN models and various combinations of long- and short-axis orientation planes. Results: The 3D-Resnet18 architecture appeared to be the most favourable, and the results gradually and significantly improved as several long-axis and short-axis planes were combined. Simply pasting multiple orientation views into composite frames increased performance. Optimal results were obtained by pasting two long-axis views and six short-axis views. The best configuration provided an R² = 0.83, a mean absolute error (MAE) = 4.97, and a root mean square error (RMSE) = 6.29; the area under the ROC curve (AUC) for the classification of LVEF < 40% was 0.99, and for the classification of LVEF > 60%, the AUC was 0.97. Internal validation performed on 149 additional patients after model training provided very similar results (MAE 4.98). External validation carried out on 62 patients from another institution showed an MAE of 6.59. Our results in this area are among the most promising obtained to date using CNNs with cardiac magnetic resonance. Conclusion: (1) The use of traditional 3D-CNNs and a combination of multiple orientation planes is capable of estimating LVEF from cine-MRI data without segmenting ventricular contours, with a reliability similar to that of traditional methods. (2) Performance significantly improves as the number of orientation planes increases, providing a more complete view of the left ventricle. Full article

(This article belongs to the Special Issue Applications of Imaging Technology in Human Diseases)

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Review

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21 pages, 351 KiB

Open AccessReview

Beyond the Surface: Nutritional Interventions Integrated with Diagnostic Imaging Tools to Target and Preserve Cartilage Integrity: A Narrative Review

by Salvatore Lavalle, Rosa Scapaticci, Edoardo Masiello, Valerio Mario Salerno, Renato Cuocolo, Roberto Cannella, Matteo Botteghi, Alessandro Orro, Raoul Saggini, Sabrina Donati Zeppa, Alessia Bartolacci, Vilberto Stocchi, Giovanni Piccoli and Francesco Pegreffi

Biomedicines 2025, 13(3), 570; https://doi.org/10.3390/biomedicines13030570 - 24 Feb 2025

Abstract

This narrative review provides an overview of the various diagnostic tools used to assess cartilage health, with a focus on early detection, nutrition intervention, and management of osteoarthritis. Early detection of cartilage damage is crucial for effective patient management. Traditional diagnostic tools like radiography and conventional magnetic resonance imaging (MRI) sequences are more suited to detecting late-stage structural changes. This paper highlights advanced imaging techniques, including sodium MRI, T2 mapping, T1ρ imaging, and delayed gadolinium-enhanced MRI of cartilage, which provide valuable biochemical information about cartilage composition, particularly the glycosaminoglycan content and its potential links to nutrition-related factors influencing cartilage health. Cartilage degradation is often linked with inflammation and measurable via markers like CRP and IL-6 which, although not specific to cartilage breakdown, offer insights into the inflammation affecting cartilage. In addition to imaging techniques, biochemical markers, such as collagen breakdown products and aggrecan fragments, which reflect metabolic changes in cartilage, are discussed. Emerging tools like optical coherence tomography and hybrid positron emission tomography–magnetic resonance imaging (PET-MRI) are also explored, offering high-resolution imaging and combined metabolic and structural insights, respectively. Finally, wearable technology and biosensors for real-time monitoring of osteoarthritis progression, as well as the role of artificial intelligence in enhancing diagnostic accuracy through pattern recognition in imaging data are addressed. While these advanced diagnostic tools hold great potential for early detection and monitoring of osteoarthritis, challenges remain in clinical translation, including validation in larger populations and integration into existing clinical workflows and personalized treatment strategies for cartilage-related diseases. Full article

(This article belongs to the Special Issue Applications of Imaging Technology in Human Diseases)

13 pages, 241 KiB

Open AccessReview

PET-Assessed Metabolic Tumor Volume Across the Spectrum of Solid-Organ Malignancies: A Review of the Literature

by Anusha Agarwal, Chase J. Wehrle, Sangeeta Satish, Paresh Mahajan, Suneel Kamath, Shlomo Koyfman, Wen Wee Ma, Maureen Linganna, Jamak Modaresi Esfeh, Charles Miller, David C. H. Kwon, Andrea Schlegel and Federico Aucejo

Biomedicines 2025, 13(1), 123; https://doi.org/10.3390/biomedicines13010123 - 7 Jan 2025

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Abstract

Solid-organ malignancies represent a significant disease burden and remain one of the leading causes of death globally. In the past few decades, the rapid evolution of imaging modalities has shifted the paradigm towards image-based precision medicine, especially in the care of patients with solid-organ malignancies. Metabolic tumor volume (MTV) is one such semi-quantitative parameter obtained from positron emission tomography (PET) imaging with ¹⁸F-fluorodeoxyglucose (FDG) that has been shown to have significant implications in the clinical oncology setting. Across various solid tumor malignancies, including lung cancer, head and neck cancer, breast cancer, esophageal cancer, and colorectal cancer, the current literature has demonstrated an association between MTV and various clinical outcomes. MTV may be used in conjunction with several existing and established clinical parameters to help inform risk stratification and treatment strategies and predict outcomes in cancer. Optimizing such volumetric parameters is paramount for advancing efforts to advance cancer care for our patients. While such advancements are made, it is important to investigate and address the limitations of MTV, including variability in terms of measurement methods, a lack of standardized cut-off values, and the impact of inherent tumor heterogeneity. Despite these limitations, which can precipitate challenges in standardization, MTV as a prognostic factor has great potential and opens an avenue for the future integration of technology into an image-based precision medicine model of care for cancer patients. This article serves as a narrative review and explores the utility and limitations of PET-MTV in various settings of solid-organ malignancy. Full article

(This article belongs to the Special Issue Applications of Imaging Technology in Human Diseases)

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12 pages, 8949 KiB

Open AccessReview

Advancements in Elastography for Evaluating Fibrosis in Renal Transplants: Current Perspectives

by Giulio Distefano, Salvatore Granata, Walter Morale and Antonio Granata

Biomedicines 2024, 12(12), 2671; https://doi.org/10.3390/biomedicines12122671 - 23 Nov 2024

Viewed by 489

Abstract

Renal fibrosis is a leading cause of chronic allograft nephropathy. While renal biopsy remains the gold standard for diagnosing fibrosis, it is an invasive procedure with potential for severe complications. Elastography, an emerging ultrasound imaging technique, appears to be a valuable tool for quantifying tissue stiffness, which correlates with fibrosis. Indeed, numerous studies have demonstrated a strong correlation between increased tissue stiffness, measured by elastography, and the degree of fibrosis detected in biopsy. Over the past few years, various elastography techniques have been evaluated, including strain elastography, shear wave elastography, and acoustic radiation force impulse. However, challenges such as operator dependence, tissue heterogeneity, and the lack of standardized protocols persist. Despite these limitations, elastography presents itself as a valuable tool for the non-invasive monitoring of renal transplant function and could facilitate the early detection of fibrosis, allowing for timely interventions. Future research should focus on standardizing acquisition protocols, establishing robust reference values, and exploring the clinical utility of elastography in guiding therapeutic decisions. The aim of this review is to explore the current state of elastography in the assessment of fibrosis in renal transplantation. Full article

(This article belongs to the Special Issue Applications of Imaging Technology in Human Diseases)

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Other

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10 pages, 2562 KiB

Open AccessCase Report

PET CT Imaging with FDG in the Therapeutical Management of Locally Advanced Cervical Cancer Diagnosed in a 43-Year-Old Patient: Case Report and Review of the Literature

by Ottó Molnar, Simona Mihuțiu, Oreste Mihai Straciuc, Alexandra Vesa and Liviu Lazar

Biomedicines 2025, 13(1), 83; https://doi.org/10.3390/biomedicines13010083 - 1 Jan 2025

Viewed by 615

Abstract

Background: Cervical cancer is the most important cancer type found in women throughout the world. Numerous research studies are being performed to investigate the effectiveness of different strategies for the imaging and treatment of locally advanced cervical cancer, which are showing favorable outcomes. Brachytherapy is characterized by the application of very high radiation doses to target tumor cells with the least exposure to normal tissues. Methods: In the present case study, we report a 43-year-old female patient suffering from cervical cancer belonging to urban origin, with no personal pathological history, who presented herself to the gynecology department of the Bihor County Emergency Clinical hospital with vaginal bleeding. The histopathological examination of the cervix showed squamous cell carcinoma. The treatment was performed with neoadjuvant chemotherapy and concurrent chemoradiotherapy. Results: According to the clinical and histopathological examination, a diagnosis of non-keratinizing squamous carcinoma of the uterine cervix at FIGO stage III C1 was established. Radio-chemotherapy was performed, as well as periodic imaging assessments with a CT of the chest, pelvis, and abdomen, without local and distant relapse. FDG PET imaging was performed for the management and follow-up of cervical cancer by retrieving the SUVmax value. Conclusions: The post-therapeutic complications are represented by the vaginal stenosis installed 6 months after the end of the radiotherapeutic treatment. Full article

(This article belongs to the Special Issue Applications of Imaging Technology in Human Diseases)

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