Purpose To determine whether the characteristics of brain arteriovenous malformations (BAVMs) are associated with the coexistence of intracranial aneurysms (IAs). Material and methods The analysis included imaging data of 89 patients who were diagnosed with the BAVM through digital subtraction angiography. Morphological characteristics of BAVMs and aneurysms, arterial supply and venous drainage of the BAVM, and the presence of intracranial hemorrhage (ICH) were retrospectively evaluated. A comparative analysis of the characteristics of the BAVMs was performed between the group with BAVMs alone and the group with BAVMs with aneurysms. The assessment of BAVMs was based on the Spetzler-Martin scale, while the classification of IAs was based on BAVM vascularity. Results BAVMs associated with IAs (n = 28), compared to BAVMs alone (n = 61), showed no significant differences in BAVM nidus size (27.32 vs. 26.10 mm) or number of arterial supply sources (64.29% vs. 54.10% for a single source). BAVM patients with aneurysms experienced significantly more ICH (57.14% vs. 34.43%; p < 0.05). A total of 42 IAs with an average size of 4.92 mm were described, of which 42.86% were multiple. Flow-related aneurysms were the most common type (n = 26, 61.90%). The type of aneurysm had no statistically significant effect on the incidence of bleeding. Conclusions The coexistence of BAVMs and IAs was observed in 31.46% of patients in this study. The presence of IAs, regardless of their type, increased the risk of intracerebral bleeding in patients with BAVM.
Purpose Acute stroke from non-terminal internal carotid artery (non-T ICA) occlusions presents with variable symptoms. Although collaterals influence stroke severity, their role in non-T ICA occlusions remains unclear. This study evaluated the safety and efficacy of endovascular therapy (EVT) for isolated non-T ICA occlusions and examined the impact of collateral status. Material and methods Patients treated with EVT for acute isolated non-T ICA occlusion between August 2015 and February 2023 were retrospectively analyzed. Demographic, clinical, imaging, and interventional data were collected. Regression models assessed associations between collateral status and clinical outcomes, symptomatic intracranial hemorrhage (sICH), and in-hospital mortality. Results Fifty-eight patients were included. Median Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and National Institutes of Health Stroke Scale (NIHSS) were 10 (interquartile range [IQR] 8-10) and 13 (IQR 7-18). Successful (modified Thrombolysis in Cerebral Infarction [mTICI] 2b-3) and complete (mTICI 3) reperfusion was achieved in 91% and 85%, respectively. sICH occurred in 5%, and in-hospital mortality was 21%. Excluding patients with pre-stroke disability, 42% achieved modified Rankin Scale (mRS) ≤ 2 at discharge. Good collaterals were associated with higher ASPECTS at discharge (9 vs. 7, p = 0.035) and numerically lower mortality (17% vs. 28%). Complete reperfusion (mTICI 3) was associated with favorable outcomes, with 100% reaching mRS ≤ 2 and ≤ 3 at discharge and 90 days, compared to poorer outcomes after incomplete reperfusion (mTICI 2b/c). Stroke etiology showed no association with collateral status. Conclusions EVT for isolated non-T ICA occlusions is technically effective and appears to be reasonably safe, although clinical outcomes remain modest. Collateral quality was associated with imaging outcomes, while complete reperfusion after distal embolization was associated with better clinical recovery. Collateral assessment and careful management of distal emboli may aid treatment decision-making. The clinical effectiveness of EVT in this setting requires confirmation in controlled trials.
Purpose The aim of this study was to research shear wave elastography (SWE) and diffusion-weighted magnetic resonance imaging (DWI) for oral carcinoma and benign lesions in buccal, sublingual, and submandibular spaces. Material and methods Eighteen patients with lesions in buccal, sublingual, and submandibular spaces were evaluated using SWE and DWI. Maximum shear elastic modulus data were analysed using a SWE software. Mean apparent diffusion coefficient (ADC) values were analysed using ADC maps with DWI. The shear elastic modulus and ADC value for oral carcinoma and benign lesions were compared using the Mann-Whitney U test. The relationship between shear elastic modulus and ADC value was assessed by Pearson’s correlation coefficient. Results The shear elastic modulus of the oral carcinoma (116.6 kPa) was higher than those of the benign lesions (47.0 kPa). The ADC value of oral carcinoma (1.14 × 10–3 mm2s–1) was lower than those of benign lesions (1.62 × 10–3 mm2s–1). The ADC value was significantly correlated with shear elastic modulus (Y = –88.8X + 207.2, R2 = 0.408, p = 0.004). Conclusions The SWE and ADC with DWI can be useful in the quantitative evaluation of oral carcinoma and benign lesions.
Purpose:This study aimed to investigate whether body composition and thoracic morphology parameters could serve as predictors of pneumothorax risk in patients undergoing computed tomography (CT)-guided lung biopsies. Material and methods:We retrospectively analyzed 147 percutaneous CT-guided lung biopsies performed between January 2019 and December 2023, categorizing patients into groups with and without pneumothorax. Indirect assessment methods for body composition, including body mass index (BMI) and thoracic morphology parameters, were evaluated alongside confounding factors such as access route (AR) through dependent lung areas (DA), patient demographics, lesion characteristics, and procedural details. Statistical analyses included chi-square, Fisher's exact, and Mann-Whitney U tests, while univariate and binomial logistic regression models were used to examine the impact of these factors on pneumothorax occurrence. Results:BMI ≥ 27.5 (p < 0.01), pectus excavatum at the level of the target lesion (PEL) (p = 0.028), transverse asymmetry at the anatomical reference level, defined as the level of the inferior pulmonary vein (TAA) (p < 0.01), and AR through DA (p < 0.01) were significantly associated with a reduced incidence of peri-interventional pneumothorax. Binary logistic regression confirmed BMI ≥ 27.5, AR through DA, TAA, and PEL as significant protective factors (R² = 0.497, p < 0.001). Conclusions:Constitutional factors such as higher BMI or the identification of subclinical chest deformities on pre-procedural imaging may facilitate stratification into lower-risk categories, facilitating more precise and confident procedural planning. Especially in the absence of these protective factors, ensuring that the AR traverses the DA becomes particularly important for minimizing the risk of pneumothorax during CT-guided lung biopsies.
Purpose To develop and validate the value of different radiomics models based on diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) images for preoperative discrimination of parotid gland tumors (PGTs). Material and methods A total of 158 patients with pathologically confirmed PGTs (123 benign and 35 malignant PGTs) were divided into training (n = 110) and test (n = 48) cohorts. A total of 963 radiomics features were extracted from DWI and DCE-MRI images. After dimensionality reduction and feature selection, three radiomics models based on DWI, DCE-MRI, and DWI + DCE-MRI were constructed by several machine learning algorithms. The optimal radiomics model was selected using receiver operating characteristic (ROC) curve analysis. The performance of the models was evaluated using ROC curve and area under the curve (AUC) analysis, and decision curve analysis (DCA) was conducted to estimate the clinical values. Results Logistic regression (LR) was selected as the optimal classifier for distinguishing benign and malignant PGTs. The radiomics model based on DWI + DCE-MRI achieved the highest AUC values in the training and test cohorts (AUC = 0.915 and 0.861), outperforming the DCE-only model (AUC = 0.903 and 0.847) and the DWI-only model (AUC = 0.839 and 0.769). The DCA based on the DWI + DCE-MRI radiomics model demonstrated high clinical usefulness. Conclusions Radiomics is a useful tool for distinguishing malignant from benign PGTs. The radiomics predictive model that combines DWI and DCE-MRI yielded outstanding performance for improving clinical decision-making regarding the treatment of PGTs.
Purpose Accurate detection of residual disease following breast-conserving surgery or neoadjuvant chemotherapy is essential for appropriate treatment planning in breast cancer. This retrospective pilot study aimed to evaluate the utility of the signal enhancement ratio (SER), a quantitative parameter derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), in detecting residual malignancy. Material and methods Fourteen women who underwent 3T bilateral breast DCE-MRI at a tertiary care centre in central India were included. SER maps were generated using voxel-wise calculations, and regions of interest were placed on areas of maximum enhancement. Residual disease was confirmed histologically in 4 patients and excluded in 10 patients (8 by histopathology, 2 by long-term follow-up). Results Median SER was significantly higher in residual disease (136.2) compared to non-residual cases (44.0, p < 0.05). Morphological features showed high sensitivity (100%) but low specificity (50%). An SER cut-off of 90 improved specificity to 90% without loss of sensitivity. Conclusions SER mapping may enhance diagnostic accuracy in post-treatment breast MRI, supporting its use as a quantitative adjunct.
Purpose:To determine the intra- and interrater reliability of the anterior cruciate ligament (ACL) graft signal-to-noise quotient (SNQ) assessed on magnetic resonance imaging (MRI) using a standardized coronal-oblique plane and region-of-interest (ROI) measurement protocol. Material and methods:Twelve adults following ACL reconstruction underwent MRI graft assessment. Five ROIs were placed along the intra-articular portion of the ACL graft. Posterior cruciate ligament (PCL) and background ROIs were used for SNQ normalization (SNQ = [ACL signal - PCL signal]/background signal). Two radiologists independently performed two blinded measurement sessions, 1 week apart. Reliability included intraclass correlation coefficients (ICCs), 95% confidence intervals (CIs), standard error of measurement (SEM), and smallest detectable difference (SDD). Results:Intrarater ICCs for individual ROIs ranged from 0.67 to 0.90, with the highest reliability at R2 (ICC = 0.90; 95% CI: 0.70-0.97) and the lowest at R5 (ICC = 0.67; 95% CI: 0.20-0.89). Corresponding SEM values ranged from 0.31 to 1.01 and SDD from 0.87 to 2.79. Interrater ICCs ranged from 0.52 to 0.83, again highest at R2 (ICC = 0.83; 95% CI: 0.65-0.92) and lowest at R5 (ICC = 0.52; 95% CI: 0.15-0.76). Interrater SEM values ranged from 0.51 to 1.23 and SDD from 1.43 to 3.43. Averaging SNQ across all five ROIs improved reliability, yielding excellent intrarater agreement (ICC = 0.90; 95% CI: 0.67-0.97; SEM = 0.28; SDD = 0.76) and good interrater agreement (ICC = 0.85; 95% CI: 0.67-0.93; SEM = 0.34; SDD = 0.96). Conclusions:The proposed MRI-based SNQ protocol demonstrates excellent intrarater and good interrater reliability over a 1-week interval. ROI averaging meaningfully enhances reproducibility and provides actionable SDD thresholds for detecting ACL graft signal change.
Breast cancer heterogeneity is crucial for treatment decision-making and prognosis prediction. Magnetic resonance imaging (MRI) is a key tool in breast imaging, providing a non-invasive assessment of morphological characteristics, cell density, hemodynamics, and vascular proliferation. Integrating MRI with advanced techniques such as radiomics, habitat imaging, and artificial intelligence enables a deeper understanding of tumor morphology and biological behavior through analysis of imaging features, thereby characterizing the heterogeneity inherent in breast cancer. This review explores MRI’s role as an imaging biomarker for evaluating breast cancer molecular subtypes, aiming to support personalized treatment strategies and improve therapeutic outcomes.
Contrast-enhanced ultrasound has evolved into a precision supportive tool in managing liver oncology, particularly for hepatocellular carcinoma. It has moved beyond simple visual impressions to objective, quantitative data using dynamic contrast-enhanced ultrasound, perfusion curve analysis, and 3D-volumetric assessments. Furthermore, the integration of fusion imaging and artificial intelligence-driven pipelines has made ultrasound indispensable for guiding complex interventional procedures in real-time. In parallel, emerging technologies like targeted microbubbles and ultrasound-targeted microbubble destruction are pushing the field toward molecular imaging and theranostics, turning ultrasound into an active participant in therapy. This review examines these clinical applications, takes a critical look at persistent hurdles, and identifies current research directions.
Purpose: The study aims to assess whether: 1) shear wave elastography (2D-SWE) and attenuation imaging (ATI) can confirm or dispute ultrasonographic (USG) diagnosis of liver steatosis, 2) there is a correlation between 2D-SWE and ATI results, and 3) which blood tests and liver condition indices are most related to a higher F index among participants. Material and methods: A group of 117 participants (hepatitis B and hepatitis C negative) with B-mode USG-diagnosed fatty liver was examined using ATI and 2D-SWE. Blood tests were performed, and data were analysed for normality, model fitting, and the identification of predictors for a higher F index. The likelihood ratio test assessed variables and their odds ratio in relation to the fibrosis-4 index (FIB-4), followed by interaction analysis with reference patients. Results: ATI and 2D-SWE provided more accurate liver diagnostics than USG. F2-F3 stages correlated with older age, higher glucose, aspartate aminotransferase (AST), FIB-4, De Ritis, AST to platelet ratio index (APRI), and g-glutamyl transpeptidase (GGTP). The model showed that AST was a strong indicator of higher F index. Univariate analysis revealed that higher odds for F2-F3 stages were associated with elevated glucose, FIB-4, De Ritis, ATI, AST, and APRI. Compared to S0, values greater than S1 were linked to a higher F index. Interaction analysis showed that only FIB-4-GGTP was significant, with higher GGTP reducing the impact of FIB-4. Conclusions: ATI and 2D-SWE may complement USG in assessing liver condition. Key predictors for a higher F index include S index, AST, glucose, De Ritis, and FIB-4, with APRI being moderately relevant.
It is still hard to diagnose Parkinson’s disease (PD) early and correctly, since the motor symptoms are often relatively mild and there are no unique diagnostic tools. The goal of this project was to create and test a hybrid deep learning model that can accurately classify PD by using hand-drawn spiral and waveform pictures. A novel two-channel hybrid model was created, where the input representation combines normalised greyscale features and Canny edge features to capture both spatial and structural stroke patterns from patient drawings. The model combines a convolutional neural network (CNN) with hand-crafted grey-level co-occurrence matrix (GLCM) features to enhance its performance and make it easier to understand. We trained and evaluated three different models: a baseline CNN, a fusion CNN + GLCM, and a fine-tuned ResNet-50. We did this on both the original and pre-processed datasets. The hybrid CNN + GLCM model that used pre-processing had the best classification accuracy at 97.02% and worked well on datasets that were not used to train it. Statistical studies validated the importance of enhancements in performance relative to baseline models. The suggested technique provides a straightforward, comprehensible, and efficient approach for PD screening using easily administered drawing exercises. Its great precision and low equipment needs make it a good candidate for use in real-world clinical settings.
Purpose: This study aimed to provide a descriptive analysis of anterior horn of the lateral meniscus (AHLM) tears on magnetic resonance imaging (MRI), including demographics, tear morphology, additional meniscal findings, ligamentous injury, and surgical management. Material and methods: Radiology database search identified AHLM tears. Inclusion criteria: Presence of AHLM tear and age 12-70 years old. Exclusion criteria: No tear, incorrect/incomplete MRI protocol, knee surgery, advanced cartilage loss, and non-AHLM predominant tear. Tear morphology, associated features, and ligamentous injury were recorded. Chart review included age, biologic gender, and surgical management. Statistical analyses evaluated differences across tear morphology groups with adjustment for multiple comparisons. Results: Fifty-five patients were included (28 females, 27 males; median age 54.0 years). Tear morphologies included horizontal (41.8%), complex/macerated (21.8%), radial (21.8%), and vertical (14.6%). Meniscal flap was present in 14.6% and intrameniscal/parameniscal cyst formation in 32.7%. Concurrent ligamentous injury was identified in 27.3%. Thirteen patients (23.6%) underwent operative management, of whom eight (14.6%) underwent AHLM surgery. Radial tears demonstrated the highest proportion of surgical management (58.3%) and ligamentous injury (41.7%). Significant differences were observed across tear morphology groups for age and gender distribution, with radial tears occurring more frequently in younger male patients and complex/macerated tears occurring more frequently in older patients (adjusted p < 0.05). Conclusions: Radial tears were more frequently observed in younger male patients and were more often managed surgically. Complex/macerated tears were more frequently observed in older patients. Prospective studies with arthroscopic correlation are required to better define the clinical significance of AHLM tear subtypes.
Purpose:Tubal patency examination is an essential part of the infertility workup; hysterosalpingo-foam sonography (HyFoSy) is a recommended substitute for the standard hysterosalpingography (HSG). This study aimed to determine the diagnostic concordance of HyFoSy and HSG, as well as the impact of uterus position on test performance. Material and methods:The prospective observational cohort study enrolled 80 infertile women referred for assessing tubal patency at Al Yarmouk Hospital. Recorded parameters included demographics (age, parity, uterus position) and the results of tubal patency testing (patent, unilateral, or bilateral blocked tubes). HyFoSy was performed first, followed by HSG. Results:Age and parity were insignificant. HyFoSy showed a high degree of diagnostic concordance with HSG (85%), with a Cohen's k coefficient of 0.3 (95% confidence interval, CI: 0.05-0.55). Gwet's agreement coefficient 1 was 0.84 (95%, CI: 0.74-0.94), indicating strong agreement. McNemar's test revealed significant systematic bias between the methods (p < 0.001), suggesting that HyFoSy and HSG are not interchangeable, which was further confirmed by Bland-Altman analysis showing a mean bias of +0.25 in favor of HyFoSy. The latter has a tendency to overestimate tubal patency among women with a retroverted uterus. Conclusions:HyFoSy is a promising tool for use as a complementary infertility test, showing high concordance with HSG. However, it should not be used as a stand-in for HSG without clinical judgment, especially in women with a retroverted uterus. The best of both approaches may be provided by a hybrid strategy that uses HyFoSy as a first-line test and saves HSG for cases that are unclear or high-risk.
Purpose: Allogeneic hematopoietic cell transplantation (alloHCT) is a treatment for several otherwise incurable conditions, which carries a risk of numerous complications. This study evaluated the associations of ultrasound modalities - renal resistive index (rRI) and renal shear wave elastography (rSWE) - with the risk of kidney dysfunction, sepsis, and graft versus host disease (GvHD). Material and methods: We enrolled 33 patients scheduled for alloHCT who underwent renal ultrasonography including rRI and rSWE at three time points: before conditioning, at discharge, and 100 days after alloHCT. The results were analyzed for correlations with demographic and laboratory data. Baseline rRI and rSWE values were compared between patients and the control group, consisting of 30 patients without hematological diseases. Patterns of fluctuations of the measurements and influencing factors were investigated. Results: Baseline values of rRI and rSWE were higher in alloHCT patients than in the control group (p = 0.005 and 0.013, respectively). Baseline rRI in alloHCT recipients correlated negatively with estimated glomerular filtration rate (eGFR) after 100 days from alloHCT (r = -0.560, p = 0.0013). Neither rRI nor rSWE correlated with eGFR or calcineurin inhibitor concentrations. Discharge rSWE was significantly elevated in cases complicated by hypotension requiring vasopressor treatment (p = 0.008). No significant differences in rRI or rSWE were noted according to acute kidney injury, sepsis, or acute GvHD, but rSWE after day +100 was significantly lower in patients with chronic GvHD (p = 0.012). Conclusions: Baseline rRI and rSWE were higher in alloHCT patients than in the control group. Hypotension and chronic GvHD potentially influence rSWE. Further studies are necessary to evaluate the associations and influencing factors of this noninvasive modality.
Purpose: In this study, we quantitatively assessed the involvement of the mandibular condyle in patients with medication-related osteonecrosis of the jaw (MRONJ) based on computed tomography (CT) texture analysis. Material and methods: We analyzed CT scans obtained between April 2020 and March 2023, from 31 patients (7 males and 24 females) with MRONJ. We extracted 279 radiomic features from regions of interest defined on the affected and control sides. These features were analyzed using MaZda version 4.6.2.0. Using Fisher's coefficient, 10 of these features were selected for analysis. The selected features were compared between the affected and control sides using the paired t-test and the Wilcoxon signed-rank test. Significance was set at p < 0.05. Results: All selected radiomics features, which were texture features of the mandibular condylar bone marrow, showed significant differences between the affected and control sides in patients with MRONJ (p < 0.05). Conclusions: These findings suggested that microstructural changes, not easily detected on visual inspection, may occur in the trabecular structure of the affected mandibular condyle in patients with MRONJ. Therefore, the impact of the disease on the temporomandibular joint should be considered in MRONJ.
Purpose: This study aimed to quantitatively assess thoracic morphometry using thoracic computed tomography (CT) in patients with nonspecific interstitial pneumonia (NSIP), usual interstitial pneumonia (UIP), and healthy controls, and to determine whether morphometric parameters can differentiate between interstitial lung disease (ILD) subtypes. Material and methods: A retrospective, cross-sectional study was conducted involving 180 participants (60 NSIP, 60 UIP, and 60 healthy controls). Standardised thoracic CT scans were analysed at 3 thoracic levels (T3, T6, and T9). The anteroposterior (AP) and transverse (T) thoracic diameters were measured, and their ratios (AP/T) were calculated. Results: Significant intergroup differences were observed in thoracic dimensions, mainly at the upper thoracic level (T3). UIP patients showed smaller AP and transverse diameters than NSIP and controls (p = 0.028 and p = 0.003). At T6, the transverse diameter was also reduced in UIP compared with controls (p = 0.029). The AP/T ratio did not differ significantly (p > 0.05), suggesting preserved thoracic geometry despite dimensional reduction. NSIP values were intermediate between UIP and controls. Conclusions: Quantitative CT-based thoracic morphometry reveals distinct structural differences among ILD subtypes. Patients with UIP show reduced upper thoracic dimensions consistent with restrictive remodeling, whereas NSIP demonstrates relatively preserved thoracic configuration. CT-derived thoracic diameters represent simple, reproducible, and cost-effective imaging biomarkers that may complement conventional pattern analysis and support objective disease assessment.
Purpose: Anomalous aortic origin of a coronary artery (AAOCA) is a congenital cardiac anomaly in which a coronary artery arises from an abnormal location on the aorta. In this article, we refer to the classification by Cheezum et al. [1], which distinguishes anomalies according to the point of origin and the course of the abnormal artery. The study aimed to determine the frequency of occurrence of anomalies and to assess types associated with an increased risk of sudden cardiac death. Methods: We retrospectively analyzed 16,680 electrocardiography-gated cardiac computed tomography (CT) scans from years 2015-2022. Anomalies were found in 102 patients. Inclusion criteria were: scan description allowing for identification of coronary anomalies or images available, and patient age over 18 years. This resulted in a sample of 96 patients with anomalies. Results: The study group consisted of 42 women and 54 men; median age at the time of diagnosis was 61 years. The most common anomalies were: right anomalous origin of the left circumflex artery (R-LCx) (48 cases-50%), right coronary artery from the left sinus (17 cases-18%), left main coronary artery from the right sinus (7 cases-7%), and left anterior descending artery from the right sinus (12 cases-13%). The courses were as follows: retroaortic (47 cases-48%), interarterial (27 cases-29%), retrocardiac (2 cases-2%), and prepulmonic (2 cases-2%). Conclusions: AAOCAs were found in 0.58% of CT scans performed. R-LCx was the most prevalent type, and the most prevalent course was retroaortic (47). Anomalies were mostly benign in their clinical manifestations.
Coronary artery disease (CAD) remains a leading cause of disability and death worldwide. Noninvasive tests are crucial to ensure early diagnosis and risk stratification. The coronary artery calcium scoring (CACS), a non-invasive measure obtained using non-contrast computed tomography, reflects the calcific plaque burden, and may provide important diagnostic and prognostic information. This study aimed to systematically review and meta-analyze the recent literature to ascertain the diagnostic and prognostic usefulness of CACS in patients with suspected or established CAD. A literature search was conducted in PubMed, Scopus, and Web of Science for studies published between 2008 and 2024. The studies were included if they evaluated the prognostic and diagnostic value of CACS, either alone or with computed tomography angiography (CTA). Data extraction was performed for pooled sensitivities and specificities, hazard ratios (HRs), and event-free survival. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) criteria were used to assess methodological quality. Fourteen high-quality studies with a total of more than 80,000 patients were meta-analyzed. Subjects with CAC ≥ 100 were at a significantly increased risk of developing major adverse cardiac events (HR 2.7; 95% confidence interval: 2.1-3.6). CACS is highly beneficial in diagnostic discrimination (pooled sensitivity 88%, specificity 77%) in those presenting with chest pain but no prior history of CAD. It is essential to emphasize that CAC score of zero correlates with the best prognosis and very low rates of clinical events across various populations, including patients with diabetes and asymptomatic individuals. The CACS fills a special niche as a very strong predictor and non-invasive marker in the diagnosis and prognosis of CAD. Combining calcium scoring with CTA benefits clinical decision-making, particularly for patients categorized as low to intermediate risk.
