Category: Lab Tests and Imaging

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Deepfake X-Rays Fool Radiologists and AI

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Findings raise concerns about cybersecurity and diagnostic trust

Anatomy-matched real and GPT-4o-generated radiographs: (A) real and (B) GPT-4o-generated posteroanterior chest radiographs, (C) real and (D) GPT-4ogenerated lateral cervical spine radiographs, (E) real and (F) GPT-4o-generated posteroanterior hand radiographs, and (G) real and (H) GPT-4o-generated lateral lumbar spine radiographs. The pairs demonstrate that GPT-4o can produce radiographically plausible images across different anatomic regions.
https://doi.org/10.1148/radiol.252094 ©RSNA 2026

Neither radiologists nor multimodal large language models (LLMs) are able to easily distinguish AI-generated “deepfake” X-ray images from authentic ones, according to a study published in Radiology. The findings highlight the potential risks associated with AI-generated X-ray images, along with the need for tools and training to protect the integrity of medical images and prepare health care professionals to detect deepfakes.

The term “deepfake” refers to a video, photo, image or audio recording that appears real but has been created or manipulated using AI.

“Our study demonstrates that these deepfake X-rays are realistic enough to deceive radiologists, the most highly trained medical image specialists, even when they were aware that AI-generated images were present,” said lead study author Mickael Tordjman, MD, post-doctoral fellow, Icahn School of Medicine at Mount Sinai, New York. “This creates a high-stakes vulnerability for fraudulent litigation if, for example, a fabricated fracture could be indistinguishable from a real one. There is also a significant cybersecurity risk if hackers were to gain access to a hospital’s network and inject synthetic images to manipulate patient diagnoses or cause widespread clinical chaos by undermining the fundamental reliability of the digital medical record.”

Seventeen radiologists from 12 different centers in six countries (United States, France, Germany, Turkey, United Kingdom and United Arab Emirates) participated in the retrospective study. Their professional experience ranged from 0 to 40 years. Half of the 264 X-ray images in the study were authentic, and the other half were generated by AI. Radiologists were evaluated on two distinct image sets, with no overlapping between the datasets. The first dataset included real and ChatGPT-generated images of multiple anatomical regions. The second dataset included chest X-ray images—half authentic and the other half created by RoentGen, an open-source generative AI diffusion model developed by Stanford Medicine researchers.

When radiologist readers were unaware of the study’s true purpose, yet asked after ranking the technical quality of each ChatGPT image if they noticed anything unusual, only 41% spontaneously identified AI-generated images. After being informed that the dataset contained synthetic images, the radiologists’ mean accuracy in differentiating the real and synthetic X-rays was 75%.

Individual radiologist performance in accurately detecting the ChatGPT-generated images ranged from 58% to 92%. Similarly, the accuracy of four multimodal LLMs—GPT-4o (OpenAI), GPT-5 (OpenAI), Gemini 2.5 Pro (Google), and Llama 4 Maverick (Meta)—ranged from 57% to 85%. Even ChatGPT-4o, the model used to create the deepfakes, was unable to accurately detect all of them, though it identified the most by a considerable margin compared to Google and Meta LLMs.

Radiologist accuracy in detecting the RoentGen synthetic chest X-Rays ranged from 62% to 78% and the LLM models’ performance ranged from 52% to 89%.

There was no correlation between a radiologist’s years of experience and their accuracy in detecting synthetic X-ray images. However, musculoskeletal radiologists demonstrated significantly higher accuracy than other radiology subspecialists.

Spotting the Risks in Synthetic Imaging

“Deepfake medical images often look too perfect,” Dr. Tordjman said. “Bones are overly smooth, spines unnaturally straight, lungs overly symmetrical, blood vessel patterns excessively uniform, and fractures appear unusually clean and consistent, often limited to one side of the bone.”

Recommended solutions to clearly distinguish real and fake images and help prevent tampering include implementing advanced digital safeguards, such as invisible watermarks that embed ownership or identity data directly into the images and automatically attaching technologist-linked cryptographic signatures when the images are captured.

“We are potentially only seeing the tip of the iceberg,” Dr. Tordjman said. “The logical next step in this evolution is AI-generation of synthetic 3D images, such as CT and MRI. Establishing educational datasets and detection tools now is critical.”

The study’s authors have published a curated deepfake dataset with interactive quizzes for educational purposes.

For More Information

Access the Radiology study, “The Rise of Deepfake Medical Imaging: Radiologists’ Diagnostic Accuracy in Detecting ChatGPT-generated Radiographs,” and the related editorial, “The Democratization of Deceit: Seeing Is No Longer Believing.”

Source: Radiological Society of North America

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UP Researchers Innovate Handheld Detection Device that Could Transform TB Screening

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The new MARTI TB screening device

With their innovation of a small but powerful handheld device, researchers at the University of Pretoria (UP) are on course to redefine the tuberculosis (TB) screening process, which could ultimately help to combat the TB pandemic more effectively. TB is one of the deadliest infectious diseases worldwide, claiming more than 1.25 million lives each year, of which about 50 000 deaths occur in South Africa. It is the leading cause of death among people with HIV.

MARTI (mycolate antibody real-time immunoassay) is the name of the handheld device that can provide very high certainty that a person at risk does not have TB. Using just one drop of blood – and no laboratory – it is set to change the way TB is detected. It may even be adapted for use in both human and veterinary healthcare. The diagnostic is fast, accurate, affordable and – the intellectual part of it – proudly South African.

An internal validation trial was recently completed to confirm the accuracy of the test. These trial results show remarkable promise in terms of the specificity, sensitivity and accuracy of the diagnostic test, coming close to the range of targets set by the World Health Organization for the “perfect” test, making MARTI an ideal screening and diagnostic tool. An earlier trial demonstrated great potential in using this test to monitor TB treatment; these results were published in the journal Biomarkers in Medicine.

“Many people aren’t aware that TB doesn’t always sit in the lungs – it can be present in bones, joints and the brain,” says Professor Jan Verschoor, former research leader of UP’s Tuberculosis Research Group in the Department of Biochemistry, Genetics and Microbiology and now an emeritus professor of biochemistry who has been leading this discovery. “The ‘gold standard’ TB test that involves growing cultures from lung sputum can take about six weeks, by which time, many more people could have been infected by the patient or the patient’s health could have deteriorated beyond the prospect of cure. From a simple finger-prick blood sample, the MARTI test gives us a result in 30 minutes. This has profound cost and public health implications in a country like South Africa, where we conduct three to five million TB tests a year.

Tuberculosis bacteria. Credit: CDC

Caused by Mycobacterium tuberculosis, this resilient bacterium has long evaded simple detection methods, particularly in regions where healthcare infrastructure is limited. But now, an unexpected hero has emerged in the war on TB: a molecule in the bacterium’s waxy coat – specifically its mycolic acid (MA) – holds the key. These wax-like substances form a nearly impenetrable barrier, making the bacterium both drug-resistant and difficult to detect.

But while other scientists focused on breaking through this barrier, Prof Verschoor took a different approach: what if the wax itself could be used to detect the disease? He was the first to demonstrate that antibodies to the waxes are reliable indicators of active TB, irrespective of whether someone had been vaccinated or was coinfected with HIV.

A key aspect of the innovation came from Carl Baumeister, a PhD candidate under Prof Verschoor. He made the leap from slow laboratory-based biosensing to a handheld device that detects anti-MA antibodies accurately and affordably in less than 30 minutes. The result is a test that’s as clever as it is simple and cost-effective.

Detecting these anti-MA antibodies requires sophisticated sensing technology: the surface of a screen-printed carbon electrode is pre-coated with a thin layer of MA. MARTI works by flowing a drop of blood over this electrode. If a patient has TB, the sensor detects these antibodies in the blood sample; if a patient does not have TB, no signal would be generated since there are no anti-MA antibodies in the blood sample.

“The device fits in the palm of your hand and requires only a single drop of blood – no sputum, no needles, no laboratory,” says Carl Baumeister, Head of Operations of the UP spin-off company MARTI TB Diagnostics. “This may become a game-changer to diagnose TB in paediatric and HIV-positive patients, where obtaining sputum samples is often neither feasible nor safe. The same could apply to the 20% of all extra-pulmonary cases.”

“If MARTI says you don’t have TB, you can trust it,” Baumeister says. “That’s a critical trait when trying to rule out cases during an outbreak or in mass screening campaigns, much like what was needed during the COVID-19 pandemic.

Unlike other TB diagnostics, MARTI offers something rare and powerful: near-perfect negative predictive value in typical screening applications.

The internal validation trial across six healthcare facilities in Tshwane was led by Prof Veronica Ueckermann, Head of Infectious Diseases at Steve Biko Academic Hospital and UP’s Faculty of Health Sciences.

“Collecting, transporting, processing and analysing the samples from the various sites within the temperature and time constraints of the validation trial protocol posed a significant logistical challenge – but we succeeded,” says Mosa Molatseli, a senior research scientist who heads up the MARTI laboratory.

Recognising its potential, UP established the start-up company MARTI TB Diagnostics (Pty) Ltd to develop and eventually commercialise MARTI.

“This is designed to ensure that the technology remains in South African hands while attracting investment and serving global needs,” says Gerrie Mostert, interim CEO of the company. “The next steps are to get investors, funding and partner organisations on board, obtain regulatory approval and start manufacturing the kit. Ultimately, MARTI should be rolled out to clinics worldwide.”

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Beyond Diagnosis: The Treatment Power of Modern Radiology

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Diagnostic selective angiogram (DSA) to visualise the blood vessels of the small bowel, performed to localise internal bleeding.

When you think about radiology, you probably think of an X-ray, MRI or a CT scan to help radiologists and doctors see what is happening inside the body. This is the ‘medical detective’ part of radiology.  But it has become so much more than that… Interventional Radiology can offer patients an effective alternative to open surgery, with a much shorter recovery time.

Dr Siviwe Mpateni, an Interventional Radiologist (IR) at SCP Radiology, provides insights and answers questions about Interventional Radiology. Why it has become such an important part of modern healthcare and how these highly targeted procedures are helping to improve outcomes for patients across a wide range of conditions.

Dr Siviwe Mpateni – Interventional Radiologist with SCP Radiology

Can you explain IR in simple terms?

In a nutshell, it bridges the gap between diagnosis and treatment. Radiologists use imaging technologies, not only to see inside the body but also to treat disease with extraordinary precision. What is even more remarkable, is that it’s usually through tiny incisions, often no larger than a pinhole.  IR guides miniature instruments, through blood vessels or tissues to stop bleeding, open blocked arteries, treat tumours, relieve pain or for a biopsy.

For patients, this means shorter hospital stays, less pain and a quicker return to normal life. The impact of these procedures can be extraordinary.

You say the impact can be extraordinary – can you give us an example?

One particularly memorable case was a young man who suffered an acute stroke and had lost his ability to speak. Imaging showed a major vessel blockage in his brain, our team performed an urgent thrombectomy (removing blood clots from arteries or veins), successfully restoring blood flow. Seeing him and so many others recover, together with the positive impact of what we do, daily, reinforces my passion for the field.

It is obviously a passion of yours, can you explain what it is that draws you to IR?

It is the problem-solving aspect, the innovative approach to patient care and the impact we can have on patients who often have very few options left. It’s a truly special field.

Many patients referred to us have exhausted conventional therapies, particularly for pain management. A number of these are oncology patients, who may have limited time left. Using targeted, image-guided pain blocks, we can relieve their suffering in a precise and minimally invasive manner. This is the part of IR that I am truly passionate about. Knowing that, without these options, patients could spend their final days in severe pain, drives my commitment to this field. It’s the ability to preserve patient’s dignity and relieve pain at their most vulnerable moment. With our interventions, they can spend that time with their loved ones –  awake and alert, rather than heavily sedated on pain medication.

What IR advancements have there been in the last 10 or 15 years?

IR has progressed rapidly since the 1950s when Charles Dotter pioneered the idea of using imaging. His first major success was opening a blocked leg artery in a patient facing amputation. He saved her limb and launched a new field of medicine.

Since then, there have been remarkable advancements. We have smaller and more versatile devices, while the number of conditions we can treat has expanded significantly.

In collaboration with oncologists, surgeons and other clinical specialists, IR has become invaluable in the patient journey.

Are there any specific areas of medicine that IR have been particularly successful in or made a major impact?

There are several areas, most notably in oncology where IR has developed a powerful and expanding role. Interventional radiologists are now integral partners in the management of solid organ tumours, offering image-guided therapies such as ablation, embolisation and targeted drug delivery. Beyond tumour control, IR plays a crucial role in palliative care – managing cancer-related pain and complications, often significantly improving quality of life for patients who may have previously had limited or no treatment options

These advances reflect how IR has evolved into a central therapeutic specialty, working collaboratively within multidisciplinary teams to improve both progression-free survival and quality of life.

When you think of the trauma of surgery, being under anaesthetic and the recovery, IR is quite revolutionary.

It certainly is but, it is important to remember that IR is not a substitute for surgery. Rather, it complements surgical care and offers alternative or adjunctive options for patients who may benefit from less invasive approaches.

And, because IR spans the entire body, from head to toe, our scope is broad. This can be confusing for patients or referrers, unlike specialties confined to a single organ system. But it’s what makes the work exciting. No two days are ever the same, and there’s always a new challenge to tackle.

‘Radiology is advancing in leaps and bounds’, says Dr Mpateni. ‘IR is a fine tune medicine that has an enormous place in healthcare, where people are being more conservative about having major surgery.’

Dr Mpateni will soon take up an Interventional Radiology Fellowship at the University of Toronto, where he will gain further experience in complex procedures, particularly in interventional oncology and pain management.

‘Training alongside global leaders is an invaluable opportunity,’ he says. ‘My goal is to bring that knowledge and expertise back to South Africa so that we can continue expanding access to advanced, minimally invasive treatments that improve outcomes and quality of life for our patients.’

As IR continues to grow, specialists like Dr Mpateni are helping ensure that South African patients have access to some of the most advanced, targeted and patient-centred treatments available in modern medicine.

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New Antenna Upgrade Boosts MRI Image Quality

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Magnetic resonance imaging (MRI) is one of medicine’s most powerful diagnostic tools. But certain tissues deep inside the body – including brain regions and delicate structures of the eye and orbit that are of particular relevance for ophthalmology – are difficult to image clearly. The problem is not the scanner itself, but the hardware that sends and receives radio signals. 

Now, researchers at the Max Delbrück Center have developed an advanced materials-based MRI antenna that overcomes these limitations – delivering enhanced images more quickly and that can be used in existing MRI machines. The research, led by Nandita Saha, a doctoral student in the Experimental Ultrahigh Field Magnetic Resonance lab of Professor Thoralf Niendorf, was published in Advanced Materials.

Niendorf and his team worked closely with researchers at Rostock University Medical Center, combining expertise in MRI physics with clinical ophthalmology and translational imaging. The Rostock team is also supporting clinical validation of the technology.

“By using concepts from metamaterials, we were able to guide radiofrequency fields more efficiently and demonstrate how advanced physics can directly improve medical imaging,” says Niendorf, senior author of the paper. “This work shows a pathway toward faster, clearer MRI scans that could benefit patients in many clinical areas.” 

Rethinking MRI hardware with metamaterials

MRI works by sending radiofrequency (RF) signals into the body and detecting how tissues respond inside a strong magnetic field. The stronger the signal response, the better the image. Conventional MRI antennas – also called RF coils – often struggle to collect enough signal from deep or anatomically complex regions. This leads to images that lack detail and prolongs scan times.

The research team addressed this bottleneck by integrating metamaterials directly into the MRI antenna. Metamaterials are engineered structures that interact with electromagnetic waves in ways not found in natural materials. The engineered RF antenna increases signal strength from targeted tissues, improves spatial resolution and image sharpness and enables faster data acquisition. Crucially, the antenna fits into existing MRI systems, avoiding the need for new infrastructure. The team validated the technology by imaging the eye and orbit region in a group of volunteers at 7.0 Tesla.

MRI image of an eye, the eye socket and the brain.
© AG Niendorf, Max Delbrück Center

“Our research demonstrates clear relevance for ophthalmological applications as it can facilitate anatomically detailed, high-spatial resolution MRI of the eye,” says Professor Oliver Stachs, a co-author of the paper at University Medicine Rostock. “It offers the potential to open a window into the eye and into (patho)physiological processes that in the past have been largely inaccessible.” 

“Our goal was to rethink MRI hardware from the modern physics of antenna design,” adds Saha. This technology can also be tuned to protect sensitive areas of the body during MRI, for example, to reduce unwanted heating around medical implants, she adds. It could also be used to focus RF energy more effectively for MRI guided therapies for various cancer treatments, such as gentle heating of tumors (hyperthermia) or thermal ablation of tissue. 

Better diagnostics

For patients, MRI scans can be uncomfortable and time-consuming – even more so when images need to be repeated because important details are hard to see. Faster scans mean patients spend less time inside scanners. Clearer images mean doctors can make diagnoses with greater confidence. And because the new antenna is lightweight and compact, it can also be designed to better fit specific parts of the body, improving comfort even further.

The technology could also be adapted to support MRI systems running at magnetic field strengths lower or higher than 7.0T, to image target anatomy other than the eye, orbit or the brain or to track metabolism or drug movement inside the body, says Niendorf. Special MRI scans that use other atoms, such as sodium or fluorine, could also benefit from this technology by producing clearer signals and better images, he adds. 

“Innovations in imaging hardware have the potential to transform diagnostics, and this study is an important step toward next-generation MRI technology,” says Dr Ebba Beller, a co-author of the paper at Rostock University Medical Center.

The researchers are already planning larger studies at multiple hospitals and adapting the design for other organs, such as the heart and kidneys. The collaboration will continue to be strengthened by long-standing reciprocal visiting scientist appointments of Stachs and Niendorf. 

Source: Max Delbrück Center for Molecular Medicine

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Study Shows Low-Field MRI Is Feasible for Breast Screening

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Mass General Brigham’s evaluation of low-field MRI performance lays potential groundwork for this technology to be a lower-cost, accessible option for breast imaging

Photo by National Cancer Institute on Unsplash

Researchers at Mass General Brigham have demonstrated the technical feasibility of using ultra-low field (ULF) magnetic resonance imaging (MRI) for breast imaging. With further refinement and evaluation, the technology could offer an alternative to existing breast cancer screening methods and may reduce barriers to screening. Results are published in Scientific Reports.

“These results are a very encouraging proof of principle, though larger studies are needed to establish diagnostic performance,” said project principal investigator and co-senior author Matthew Rosen, PhD, an associate professor of Radiology and director of the Low Field MRI laboratory in the Athinoula A. Martinos Center for Biomedical Imaging in the Mass General Brigham Department of Radiology. “They motivate our continued pursuit of safe, comfortable, lower-cost screening approaches that can expand access for patients.”

Current U.S. guidelines recommend screening mammography for women aged 40 to 74 years. Unlike mammography, ULF MRI doesn’t require breast compression, which many patients find uncomfortable. Another benefit of ULF MRI is that it doesn’t use ionizing radiation.

While higher risk patients may receive MRI screening for breast cancer, standard MRI machines are not used in routine breast cancer screening because they are expensive and not widely available. ULF MRI systems cost less than 5% of the price of standard MRI systems and have lower long-term operating costs.

In this study, ULF MRI scans were performed on 14 participants, including 11 women with no history of breast cancer, two women with a prior breast cancer diagnosis, and one woman with a benign mass.

When interpreting the ULF MRI scans, three radiologists could reliably identify essential breast features and distinguish fibroglandular tissue from adipose tissue. The authors note that discrepancies were likely related to the novelty of ULF MRI and may be reduced with additional training and experience.

“This early evidence suggests that ULF MRI can detect essential breast features and some abnormalities without radiation or injected contrast,” said co-first author Neha Koonjoo, PhD, an investigator at the Martinos Center. “These findings point to the potential for ULF MRI as an option that could complement existing screening tools in the future.”

“Even at very low magnetic field, the radiology team was able to make observations about the breast,” said co-principal investigator and co-senior author Kathryn E. Keenan, PhD, from the US National Institute of Standards and Technology. “We attempted this study in hopes that the breast features would be visible, but you don’t always have success. We’re very motivated by this study to continue our work on ultra-low-field MRI for breast screening.”

The researchers note that further study is needed to determine the diagnostic accuracy of ULF MRI for breast cancer screening, including studies in larger cohorts that include patients with benign and malignant lesions. They also emphasize that further refinements in ULF MRI technology are needed to meet clinical resolution standards for breast cancer screening.

“These results will guide the next engineering steps to improve image quality and enable a more comfortable exam and help bring screening to more settings and more patients,” said co-first author Sheng Shen, PhD, of the Martinos Center for Biomedical Imaging.

Source: Mass General Brigham

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Point-of-care Rapid Tests can Improve Screening for Latent Tuberculosis

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Photo by National Cancer Institute on Unsplash

A new test shows promising results for detecting latent tuberculosis infection in resource-limited settings. This is according to a study from Karolinska Institutet, published in the journal Clinical Infectious Diseases.

“This test can help more people with latent tuberculosis to be detected and receive preventive treatment, especially in rural areas in countries with limited resources,” says last author Lina Davies Forsman, a researcher at the Department of Medicine, Solna, Karolinska Institutet.

Tuberculosis remains one of the world’s deadliest infectious diseases. To reduce the number of new cases, infected individuals with latent infection must be detected and offered preventive treatment to avoid active tuberculosis, which can spread the disease to others.

Currently, latent tuberculosis is often diagnosed using a laboratory test called QuantiFERON-TB Gold Plus. This test involves several steps and can take one to two days before the results are available, as well as requiring advanced laboratory infrastructure and trained personnel. This makes it difficult to carry out tests in areas with a high prevalence of tuberculosis where access to laboratories and trained personnel is limited.

Results within 15 minutes

In the new study, researchers from Karolinska Institutet, together with colleagues in Vietnam, have therefore compared this test with another test, TB-Feron. This is a point-of-care test that provides results within 15 minutes and does not require an advanced laboratory or trained personnel.

The study included 345 adult participants in Hanoi, Vietnam, divided into three groups: people with confirmed tuberculosis, people in the same household as people with infectious tuberculosis, and people with no known exposure to tuberculosis. All were tested with both TB-Feron and the established laboratory test QuantiFERON-TB Gold Plus.

The results show that TB-Feron has high sensitivity – 88 percent of individuals with expected positive results were correctly identified. The corresponding figure for QuantiFERON-TB Gold Plus was 92 percent.

However, the specificity, i.e. TB-Feron’s ability to rule out tuberculosis infection in healthy individuals, was moderate at 70 percent. The corresponding figure for QuantiFERON-TB Gold Plus was 96 percent.

Among household contacts, the concordance between TB-Feron and the established test was good, with 92 percent concordance for positive samples.

“It is promising that TB-Feron works so well in an environment with a high disease burden. The test is patient-friendly and easy to use, with rapid same-day results, making it useful in primary care,” says Han Thi Nguyen, pulmonologist and doctoral student at the same department and first author of the study.

The researchers also investigated the reliability of TB-Feron by comparing results from two different groups with laboratory staff. No systematic differences were observed, indicating good reproducibility.

Source: Karolinska Institutet

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Simple Method for Early Detection of Chronic Kidney Disease

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Chronic kidney disease (CKD). Credit: Scientific Animations CC4.0

Subtle abnormalities in kidney function – even within the range considered normal – may help identify people at risk of developing chronic kidney disease. This is shown in a new study from Karolinska Institutet, published in Kidney International. The researchers have therefore developed a web-based tool that could aid in early detection and thus primary prevention.

Chronic kidney disease is a growing global health concern afflicting 10−15% of adults worldwide, and is projected to become one of the top five leading causes of years of life lost by 2040. In the absence of effective screening programmes, patients are often diagnosed late, when more than half of their kidney function has already been lost. 

To address this gap, researchers at Karolinska Institutet have constructed population-based distributions for estimated glomerular filtration rate (eGFR), the most widely used measure of kidney function. The aim is to help doctors identify people at risk, thus enabling early preventive action.

“We were inspired by the growth and weight charts used in paediatrics, which intuitively help clinicians identify children at risk of obesity or undergrowth,” says the first author of the study, Yuanhang Yang, Postdoctoral Researcher at the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet.

A web-based calculator

The researchers have made their eGFR distribution charts openly available to healthcare professionals and developed a web-based calculator, developed by PhD student Antoine Creon, that can help assess how a patient’s eGFR compares with population norms for their age.

The study included over 1.1 million adults in the region of Stockholm, covering roughly 80 per cent of the population aged between 40 and 100 years. Nearly seven million eGFR tests collected between 2006 and 2021 were used to construct age- and sex-specific distributions. 

The findings show that departures from the median eGFR for one’s age and sex are associated with worse outcomes. Individuals with an eGFR below the 25th percentile had a markedly higher risk of developing kidney failure requiring dialysis or transplantation. Mortality also displayed a U-shaped relationship; both low and high percentile extremes were linked to increased risk of death. 

Ability to act earlier 

The study also illustrates this lack of awareness in healthcare, according to the researchers. Among those with a seemingly normal eGFR above 60 ml/min/1.73 m², but below the 25th percentile, only one fourth had received additional testing for urinary albumin, which is important for detecting early kidney damage.

“For example, consider a 55-year-old woman with an eGFR of 80. Most clinicians would not react to such a seemingly normal value. However, our charts show that this corresponds to the 10th percentile for women of that age – and that she has a three-fold higher risk of starting dialysis in the future. This signals an opportunity to act earlier,” says Juan Jesús Carrero, Professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.

Source: Karolinska Institutet

Categories : Gastrointestinal Lab Tests and ImagingTags :

New Optical Tool Lights up IBD Biomarkers

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A test that rapidly detects signs of inflammatory bowel disease (IBD) in stool samples could improve future diagnosis and monitoring of the condition, a study suggests.

Microscopy images of colon tissue samples from IBD patients under remission (left) and with active disease (right). Granzyme A, indicated by green fluorescence, is elevated in the intestinal tract of IBD patients with active disease. Credit: Emily Thompson.

Scientists have developed a tool to measure the activity of a molecule linked to gut inflammation within faecal samples. The optical tool, known as a luminescent reporter, lights up when it detects the molecule, with higher readouts indicating increased activity and inflammation.

The new technique could boost the accuracy of stool sample tests for IBD, reducing the need for invasive, expensive procedures, experts say.

Gut inflammation

IBD is a chronic illness where the body’s immune system mistakenly attacks the digestive tract, leading to long-lasting inflammation. Diagnosis and monitoring of the condition often rely on colonoscopies, where a small camera is used to examine the gut.

Current IBD stool tests measure general markers of inflammation, such as the protein calprotectin, so a positive result requires further investigation to confirm the source. 

University of Edinburgh researchers studied gut tissue from IBD patients and identified high levels of an enzyme – a molecule that speeds up chemical reactions in cells – called granzyme A (GzmA) in inflamed gut tissue compared with non-inflamed tissues. 

Enzyme activity

GzmA is released by T cells; in IBD, T cells mistakenly see the gut as a threat and become overactive, which can lead to tissue damage and inflammation.

The research team developed a luminescent reporter to measure the activity of GzmA in stool samples. The reporter tool was tested on 150 samples from both IBD and healthy patients. 

Combining the new reporting tool with the current common testing of faecal calprotectin levels was more successful in identifying IBD in patients than using faecal calprotectin scores alone.

Researchers say the ability to identify gut-specific inflammation is a step forward for IBD diagnosis, but caution further research is needed before it can be used in a clinical setting.

Spin-out company

The tool will form part of the assets of a new company in the process of spinning out of the University of Edinburgh, called IDXSense, supported by Edinburgh Innovations, the University’s commercialisation service. 

The technique could also support the development of personalised IBD treatments in the future, with the ability to rapidly and accurately monitor gut inflammation levels in response to different therapies, experts say.

Source: The University of Edinburgh

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Diagnostic Breast MRI may be Unnecessary for Some Patients with Early-stage Breast Cancer

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Adding breast magnetic resonance imaging (MRI) to a diagnostic mammogram did not reduce five-year cancer recurrence rates for patients with stage I/II hormone receptor (HR)-negative breast cancer, according to researchers at The University of Texas MD Anderson Cancer Center. 

The Phase III Alliance A011104/ACRIN6694 trial found that five-year locoregional recurrence rates were 6.8% in patients who received an MRI as part of a diagnostic work-up and 4.3% in those who did not. These data were presented today at the San Antonio Breast Cancer Symposium (SABCS) by principal investigator Isabelle Bedrosian, MD, professor of Breast Surgical Oncology (Abstract GS2-07).

“We have long assumed that finding more breast cancer on an MRI and removing it with surgery would help lower the chance of a patient’s cancer coming back,” Bedrosian said. “When you look at our findings alongside earlier trials, the message is clear: adding MRI before surgery doesn’t improve results for patients – and may not have to be used as a standard part of the diagnostic process.”

No additional MRI benefit in this group

The trial enrolled 319 patients between 2014 and 2018 with newly diagnosed stage I or II HR-negative breast cancer. These patients were eligible for lumpectomy and did not have germline BRCA1/2 mutations, bilateral breast cancer or a history of prior breast cancer. All patients had undergone diagnostic mammography with or without ultrasound prior to trial enrolment.  Patients were randomly assigned to undergo additional imaging by breast MRI (161 patients) or to receive no further imaging (158 patients).

Not only did breast MRI not impact five-year recurrence rates, but there were also not significant differences between groups for five-year distant recurrence-free survival nor overall survival. 

A small subset of patients with tumour subtypes (HR- HER2+ and HR-HER2-) and those over the age of 50 at diagnosis also showed no benefit to MRI.

Pre-op MRI not finding anything important

Breast MRI is a common part of the diagnostic evaluation because it can reveal cancer that mammography might not detect. However, the evidence that it improves surgical outcomes for patients has been limited.

“We believe the reason MRI did not reduce recurrence rates may be twofold,” Bedrosian said. “It is possible that MRI didn’t uncover many lesions that mammography hadn’t already found, or perhaps identifying and surgically removing those additional lesions was not important to reducing risk of the cancer coming back. It’s possible that in the group that did not receive MRI, radiation and chemotherapy effectively treated the occult areas of disease”. 

Experts are now analysing how often breast MRI identified additional lesions in the trial population to better understand why breast MRI did not impact oncologic outcomes.

Study limitations 

Limitations included that most patients involved in the trial had breast cancer that hadn’t spread to their lymph nodes, which may partly explain why recurrence rates were low overall. Despite being open to women of all ages, the study enrolled mostly older women who may have been less likely to benefit from breast MRI. 

Categories : Cardiovascular Disease Lab Tests and ImagingTags :

New Scan Could Help Millions with Hard-to-treat High Blood Pressure

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A speedy new scan could improve how millions of people with hypertension are treated, suggests a new study

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About a quarter of people with high blood pressure have been estimated to have primary aldosteronism, a problem with their adrenal glands producing too much of the hormone aldosterone, which regulates levels of salt in the body.

This problem is often missed, as the path to diagnosis is complex, involving multiple tests and, to guide treatment, an invasive procedure that is not always reliable.

The new 10-minute scan, developed at University College London and described in a research letter in the New England Journal of Medicine (NEJM), reveals overactivity in adrenal glands that was invisible with conventional tests, showing exactly where too much aldosterone is being made.

This, the researchers say, will make it easier to decide on the best treatment approach – either removal of an adrenal gland that is producing too much aldosterone, or the use of new medications that block aldosterone production, targeting the cause of high blood pressure in many patients.

Professor Bryan Williams, Chair of Medicine at UCL and clinical lead for the study, said: “We have been waiting for a test like this for many decades. This British innovation is going to transform the diagnosis of aldosterone excess as an important and previously hidden cause of hypertension in many of our patients. It offers huge potential to completely change the way we make this diagnosis and enable us to provide better targeted treatment for our patients.”

The over-production of aldosterone, which raises high blood pressure by causing the body to retain too much salt, can result in a condition called primary aldosteronism, which increases the risk of heart disease, stroke and kidney disease. However, many people who do not meet the threshold for this condition are thought to have excess aldosterone raising their blood pressure.

Currently the condition is screened with a blood test and confirmed with a second test*. To decide on treatment, two catheters are inserted in veins on either side of the groin to measure levels of aldosterone on each side of the body. This helps clinicians determine if the problem is only located in one adrenal gland or both – but the test is not always accurate and not often offered as few hospitals have the expertise to perform this complex procedure.

To better detect the condition, researchers at UCL used a PET-CT scan, which creates detailed 3D images of parts of the inside of the body and maps the accumulation of a tiny amount of radioactive tracer injected into a person’s vein.

They built a new tracer compound designed to bind to the aldosterone-producing enzyme, aldosterone synthase. The tracer was highly selectively taken up by the parts of the adrenal gland that were over-producing aldosterone, lighting up these areas on the scan.

In their NEJM research letter, the researchers described how 17 patients were scanned in the world’s first use of this technique at UCLH. The team found the source of over-production of aldosterone in every patient and did not see any side effects.

Professor Williams added: “This is the first time we have been able to visualise this disease. We can see it light up on the scan. The intensity of the signal reflects the level of aldosterone over-production. This might allow us, in future, to more precisely target these over-producing areas.” 

The achievement builds on more than a decade’s work by Professor Erik Arstad (UCL Division of Medicine and UCL Chemistry) and colleagues, who pioneered and patented a new method to make radioactive tracers.

Using this method, they were able to repurpose a drug-like molecule that bound to the aldosterone-producing enzyme for use as a tracer, replacing a single atom with a radioactive version of that atom – meaning this molecule would light up on a PET-CT scan.

Professor Arstad said: “It is very rewarding to be able to bring laboratory innovation into the clinic for the benefit of patients with hard-to-treat hypertension.”

The study was conducted at UCL and UCLH and was funded by the MRC and the NIHR University College London Hospitals Biomedical Research Centre.

The team is now embarking on a phase 2 clinical trial to gather sufficient data for the test to be approved for routine clinical use in the NHS.

In the UK, more than 14 million people are estimated to have high blood pressure (about one in three adults).

*For instance, a salt loading test, where a person increases their intake of salt (sodium), which would be expected to suppress aldosterone levels. If aldosterone levels are still high despite this increase, that confirms a primary hyperaldosteronism diagnosis.

Source: University College London