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Insights into Imaging

Table 1 Examples of integrative diagnostics

From: Integrative diagnostics: the time is now—a report from the International Society for Strategic Studies in Radiology

Disease

Clinical Findings

In Vivo Dx (Imaging)

In Vitro Dx (Laboratory Medicine)

In Vitro Dx (Pathology)

References

Cancer

Prostate

DRE, osseous lesion

Transrectal ultrasound, MRI, PET

PSA, acid phosphatase

 

[40, 41]

Colorectal

Occult blood, ileus

CT, MRI, PET

CEA, CA 19–9, blood count

Histopathology, MSI assessment

[42]

Pancreatic

Jaundice

MRI

CA 19–9, bilirubin, GGT

Histopathology

[43]

Breast

Clinical examination

CT

CA 15–3

Histopathology, ER and PR status, HER2neu

[44]

Brain

Neurologic deficit

CT, MRI

S100β

 

[45]

Lung

  

CEA, SCC, NSE, CYFRA 21–1

 

[46]

Plasmocytoma

Spontaneous fractures

Whole-body MRI

Blood count, serum electrophoresis, IEF

 

[47, 48]

Cardiovascular

Chest pain

 

Triple-rule-out ECG-gated CT

TnI/TnT, NT-proBNP, BNP, D-dimer

 

[49]

Dyspnea

 

Thorax

NT-proBNP, BNP, differential blood count, creatinine, GFR, CRP, PCT

 

[50]

Neurological

     

Stroke

Hemiparesis

CT angiography, MRI

GFAP, S100β

 

[51]

Meningitis

Neurologic deficit, meningitis sign (eg, Kernig sign)

 

CSF cell count, albumin, IgG, IgA, IgM, glucose, lactate, bacteria, CRP, PCT, sepsis parameter, bacterial culture

 

[52]

Multiple sclerosis

Specific neurologic deficit

 

CSF cell count, albumin, IgG, IgA, IgM, glucose, CRP, oligoclonal bands

 

[53]

Encephalitis

     

Inflammation

     

Sepsis

 

Focus search

CRP, PCT, cytokine profiles IL-6, IL-8, differential blood count, blood culture

 

[54]

Rheumatoid arthritis

 

Bone imaging

CRP, sedimentation rate

 

[55, 56]

Endocrinology

Addison or Conn syndrome

Hypertension/hypotension, cardiovascular symptoms, stress

MRI, selective adrenal venous sampling

Adrenal hormones, orthostasis test, salt exposure test

 

[57, 58]

Hypophysitis

Headache, altered vision, diabetes insipidus, signs of adrenal insufficiency

CT, MRI

Adrenal hormones, TSH, CRH, CRP, drugs and therapeutic medications

 

[59]

Multiple endocrine neoplasia syndromes

   

Mutation status: MEN, Ret, VHL1

 

Diabetes

Polyuria, polydipsia, fatigue, weight change, CKD, retinopathy

 

Glucose, HbA1c, C-peptide, urine-Stix, blood gases and blood pH, lactate, ADH, copeptin, GADD45 antibodies, islet cell antibodies, IA-2 antibodies, insulin

 

[60, 61]

Hypothyroidism

Fatigue, weight gain, low activity, depression, blood pressure, HR

Thyroid ultrasound

TSH, FT4, FT3, Tg, TRAK and TPO antibodies

 

[62]

Congenital adrenal hyperplasia

Virilization, salt loss

Ultrasound

Cortisol, aldosterone, electrolytes

Karyotyping, mutation status: 21-OHase, 17a-OHase

[63]

  1. ADH antidiuretic hormone, BNP B-type natriuretic peptide, CA 15–3 cancer antigen, CA 19–9 carbohydrate antigen, CEA carcinoembryonic antigen, CKD chronic kidney disease, CRH corticotropin-releasing hormone, CRP C-reactive protein, CSF cerebrospinal fluid, CYFRA 21–1 cytokeratin fragment, DRE digital rectal examination, Dx diagnosis, ECG electrocardiography, ER estrogen receptor, FT3 free T3, FT4 free T4, GADD45 growth arrest and DNA damage, GFAP glial fibrillary acidic protein, GFR glomerular filtration rate, GGT gamma-glutamyl transferase, HbA1c glycated hemoglobin, HER2neu human epidermal growth factor receptor 2, HR heart rate, IA-2 islet antigen, IEF isoelectric focusing, Ig immunoglobulin, IL interleukin, MEN multiple endocrine neoplasm, MSI multisatellite instability, NSE neuron-specific enolase, NT-proBNP N-terminal pro–B-type natriuretic peptide, OHase hydroxyvitamin hydroxylase, PCT procalcitonin, PR progesterone receptor, PSA prostate-specific antigen, Ret rearranged during transfection, SCC squamous cell carcinoma, Tg thyroglobulin, TnI troponin I, TnT troponin T, TPO thyroid peroxidase; TRAK thyrotropin receptor antibodies, TSH thyroid-stimulating hormone, VHL Von Hippel Lindau
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