Особенности функции внешнего дыхания у детей с внебольничной пневмонией

Outcome prediction by serum calprotectin in patients with COVID-19 in the emergency department

Restriction spectrum imaging (RSI), as an advanced quantitative diffusion-weighted magnetic resonance imaging technique, has the potential to distinguish primary benign and malignant lung lesions. To explore how well the tri-compartmental RSIperforms in distinguishing primary benign from malignant lung lesions compared with diffusion-weighted imaging (DWI), and to further explore whether positron emission tomography/magnetic resonance imaging (PET/MRI) can improve diagnostic efficacy. Prospective. 137 patients, including 108 malignant and 29 benign lesions (85 males, 52 females; average age = 60.0 ± 10.0 years). T2WI, T1WI, multi-b value DWI, MR-based attenuation correction, and PET imaging on a 3.0 T whole-body PET/MR system. The apparent diffusion coefficient (ADC), RSI-derived parameters (restricted diffusion , hindered diffusion , and free diffusion ) and the maximum standardized uptake value (SUVmax) were calculated and analyzed for diagnostic efficacy individually or in combination. Student's t-test, Mann-Whitney U test, receiver operating characteristic (ROC) curves, Delong test, Spearman's correlation analysis. P < 0.05 was considered statistically significant. The , SUVmax were significantly higher, and , ADC were significantly lower in the malignant group [0.717 ± 0.131, 9.125 (5.753, 13.058), 0.194 ± 0.099, 1.240 (0.972, 1.407)] compared to the benign group [0.504 ± 0.236, 3.390 (1.673, 6.030), 0.398 ± 0.195, 1.485 ± 0.382]. The area under the ROC curve (AUC) values ranked from highest to lowest as follows: AUC (SUVmax) > AUC ( ) > AUC ( ) > AUC (ADC) > AUC ( ) (AUC = 0.819, 0.811, 0.770, 0.745, 0549). The AUC (AUC = 0.900) of the combined model of RSI with PET was significantly higher than that of either single-modality imaging. RSI-derived parameters ( , ) might help to distinguish primary benign and malignant lung lesions and the discriminatory utility of was not observed. The RSI exhibits comparable or potentially enhanced performance compared with DWI, and the combined RSI and PET model might improve diagnostic efficacy. Stage 2.

BackgroundThermal imaging (TI) is a portable, low cost imaging tool with high feasibility for use. Clinical joint assessment.Is routinely performed in rheumatoid arthritis (RA) patient care.ObjectivesTo assess a combined TI...

Ratio of visceral fat area to body fat mass (VBR) is a superior predictor of coronary heart disease.

To determine the diagnostic value of preoperative inflammatory biomarkers and CA199, alone or in combination, in diagnosing pancreatic cancer (PCC). This retrospective study was comprised of 75 PCC patients and 83 healthy controls (HC). The participant's medical data was mined from the electronic records of the First Affiliated Hospital of Guangxi Medical University. The data included the preoperative circulating albumin/fibrinogen ratio (AFR), the platelet/lymphocyte ratio (PLR), the lymphocyte/monocyte ratio (LMR), the neutrophil/lymphocyte ratio (NLR), and the derived NLR (dNLR). The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUROC) were used to evaluate the diagnostic efficacy of these candidate biomarkers for PCC. A single AFR significantly distinguished PCC from the healthy controls (AUROC: 0.903, 95% CI: 0.846 - 0.945) and had a significantly higher sensitivity and larger AUROC than CA199 (AUROC: 0.814, 95% CI: 0.774 - 0.871). The combinations of AFR with CA199 (AUROC: 0.932, 95% CI: 0.881 - 0.966), RDW with CA199 (AUROC: 0.905, 95% CI: 0.849 - 0.946), Alb with CA199 (AUROC: 0.869, 95% CI: 0.806 - 0.917), and Fib with CA199 (AUROC: 0.921, 95% CI: 0.868 - 0.958) also yielded higher sensitivities and larger AUROCs than CA199 alone. Circulating AFR was an effective biomarker in diagnosing PCC. Combining AFR, RDW, Alb, and Fib with CA199 could improve the diagnostic efficacy for PCC.

To determine whether baseline ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) radiomic markers of thoracic tumor burden and metabolic heterogeneity predict early progression and overall survival (OS) in patients with small cell lung cancer (SCLC) receiving first-line platinum-etoposide chemotherapy. We retrospectively analyzed 45 patients with SCLC who underwent baseline ¹⁸F-FDG PET/CT before chemotherapy. Radiomic features were extracted from thoracic tumor volumes, including metabolic tumor volume (MTV), total lesion glycolysis (TLG), standardized uptake value (SUV) histogram parameters, and gray-level co-occurrence matrix (GLCM) metrics. Univariable and multivariable Cox regression assessed associations with progression-free survival (PFS) and OS. Receiver operating characteristic (ROC) analysis, with area under the ROC curve (AUC), assessed discriminatory ability for early progression (PFS < 6 months) and short-term mortality (OS < 12 months). Higher log-transformed TLG (logTLG) was correlated with shorter PFS and OS in univariable analysis. In multivariable models, logTLG independently predicted PFS (hazard ratio [HR] 2.20, 95% confidence interval [CI] 1.12-4.30; p = 0.021) and OS (HR 2.54, 95% CI 1.24-5.20; p = 0.011). Age (HR 1.07 per year; 95% CI 1.02-1.12, p = 0.007) and stage IV vs. III (HR 2.46, 95% CI 1.06-5.71; p = 0.037) were additional OS predictors. GLCM texture features were not significant. ROC analysis showed MTV (AUC 0.88) and serum lactate dehydrogenase (LDH) (AUC 0.74) best predicted early progression, while age (AUC 0.79), stage (AUC 0.73), and SUV entropy (AUC 0.75) predicted short-term mortality. Kaplan-Meier curves confirmed poorer survival with high logTLG, advanced stage, and older age. Baseline thoracic PET/CT radiomics, particularly logTLG, independently predict survival in SCLC. MTV and LDH identify early progression, while age, stage, and SUV entropy predict short-term mortality, supporting integrated imaging-clinical risk stratification.

Objective To explore the value of quantitative T2 weighted magnetic resonance imaging (T2WI) and diffusion tensor imaging (DTI) parameters for predicting functional outcomes after surgery for cervical spondylotic myelopathy (CSM). Methods One hundred and forty CSM patients received T2WI and DTI before surgery at Tianjin Hospital between April 2014 and April 2016. They were then given systematic rehabilitation treatment after the surgery. The Japanese Orthopaedics Association (JOA) scoring system was applied to evaluate their neurological function before and after the surgery. According to the JOA recovery rate at 1-year follow-up, the patients were divided into a good recovery group (recovery rate≥50%) and a poor recovery group (recovery rate <50%). Maximum spinal cord compression (MSCC), signal change ratio (SCR), transverse area (TA), apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were compared between the two groups. Receiver operating characteristics (ROC) curves were used to measure the prognostic ability and determine the best cut-off value for each variable. The independent predictors of a poor recovery were estimated using univariate and multivariate analysis. Results ROC analysis showed that the area under the ROC curve (AUC) of MSCC was 0.593. For SCR it was 0.682. For the TA it was 0.706. For the ADC it was 0.719 and for FA it was 0.749. The respective cut-off values were 44% compression, 1.561, 0.46 cm2, 1.339×10-3 mm2/s and 0.386. FA had the largest AUC, followed by ADC, TA, SCR and MSCC. MSCC and SCR had low discrimination power (AUC<0.7) in predicting a poor recovery, whereas TA, ADC and FA had moderate discrimination power (AUC 0.7-0.9). Logistic multivariate regression showed that a low JOA score, TA≤0.46 cm2 or FA≤0.386 were independent risk factors for a poor recovery. A predicting model built according to the results of the logistic regression analysis gave an AUC of 0.87, significantly better than that of the JOA score. With a cut-off value of 0.36, the sensitivity and specificity were 80% and 77% respectively. Conclusions Combining T2WI and DTI parameters with the JOA score may better predict the recovery of patients with CSM. The values can also provide references for making up rehabilitation plans. Key words: T2 weighted magnetic resonance imaging; Diffusion tensor imaging; Cervical vertebrae; Spinal cord compression; Prognosis

BackgroundMycoplasma pneumoniae pneumonia (MPP) is a major cause of community-acquired pneumonia (CAP) in children, with some cases progressing to refractory MPP (RMPP). RMPP is associated with a hypercoagulable state and pulmonary embolism. This study aimed to investigate pulmonary microvascular changes in RMPP and evaluate the predictive value of pulmonary blood volume (PBV) parameters.MethodsA retrospective study using UV-Net-based pulmonary vascular analysis included 512 pediatric MPP patients in a cross-validation cohort and 124 pediatric MPP patients in an external testing cohort. Pulmonary blood vessels were segmented and classified by cross-sectional area into three blood-volume fractions: BV5%, representing the percentage of PBV contained in vessels with a cross-sectional area less than 5 mm2; BV5–10%, representing the percentage of PBV contained in vessels with a cross-sectional area between 5 and 10 mm2; and BV10%, representing the percentage of PBV contained in vessels with a cross-sectional area greater than 10 mm2. Logistic regression and extreme gradient boosting were used to analyze associations and predict RMPP. Model performance was assessed via receiver operating characteristic (ROC) curve analysis.ResultsPatients with RMPP, compared to patients with non-RMPP, had a significantly lower BV5% (median: 58.50% vs. 60.63%, P=0.007) and higher BV10% (median: 20.90% vs. 19.39%, P=0.004). Multivariate analysis revealed BV5% as a protective predictor [odds ratio (OR) =0.70, P=0.005] and BV10% as a risk factor for RMPP (OR =1.49, P=0.002). Compared with the clinical-only model, the model incorporating these computed tomography (CT)-derived parameters significantly improved performance in the cross-validation cohort, demonstrating superiority in terms of area under the ROC curve (AUC) and other metrics (combined model: AUC =0.91, 95% CI: 0.89–0.94; clinical-only model: AUC =0.88, 95% CI: 0.86–0.91; P<0.001). In the external testing cohort, the combined model consistently outperformed the clinical-only model in accuracy, precision, specificity, and F1 score.ConclusionsQuantitative analysis revealed microvascular alterations in patients with RMPP. Integrating CT-derived biomarkers can enhance RMPP prediction and facilitate early intervention.

Category:Basic Sciences/Biologics; DiabetesIntroduction/Purpose:Staphylococcus aureus is the major pathogen foot and ankle infections and osteomyelitis (>50%). There are currently no sensitive and specific diagnostic tools for monitoring a pathogen’s ongoing infection or providing prognostic measures. We have developed a novel immunoassay for S. aureus, and have applied this to diagnose and monitor its infectivity. We hypothesize that: 1) the species-specific immunoassay can serve as a reliable diagnostic tool for S. aureus foot and ankle infections and 2) the immunoassay provides a measure of treatment response and prognosis of clinical outcome to antibiotics therapy for S. aureus foot and ankle infections.Methods:From July 2015 to July 2019, 83 infected diabetic foot ulcer (DFU) patients undertaking surgical treatment were recruited. Blood were drawn from subjects at initial, 4-week, 8-week, and 12-week after surgery. Clinical wound healing status was determined by a fellowship-trained orthopaedic foot and ankle surgeon. Serum antibodies and plasmablast cultured antibodies (newly synthesized antibodies: NSA) were harvested. Eight unique S. aureusantigens from distinct functional classes were used for the immunoassay. All serum and NSA samples were run on a flow cytometer (Bio-Plex 200; Bio-Rad, Life Sciences Research) in duplicates and assessed for predictive ability in discriminating infection status and healing status using receiver operating characteristic (ROC) curve analysis, with accuracy summarized by the area under the ROC curve (AUC). Nonparametric estimates and 95% confidence intervals for the AUC were computed for each predictor along with p-values for testing the significance of each AUC.Results:Analysis of serum immunoassay showed significant difference in three anti-S. aureus antigens titers (IsdH (p = 0.037; AUC = 0.638), ClfB (p = 0.025; AUC = 0.644), and SCIN (p = 0.005; AUC = 0.677)) between S. aureus infected versus non- S. aureus infected DFU patients at initial presentation. NSA immunoassay showed elevation of two different S. aureus specific antigens, IsdH and LukS-PV, for S. aureus infected versus non- S. aureus infected DFU patients in ratios of approximately five and four, respectively. Changes of NSA based anti-S. aureus antibody titers over 12 weeks period, as single antigen or in combination, significantly correlated with clinical resolution of infection and wound healing status. Four anti-S. aureus antigen combinations achieved the highest AUC (Figure 1).Conclusion:Our results demonstrate that both the serum and NSA immunoassay can diagnose S. aureus infected DFUs. Furthermore, changes in NSA titers over a period of time against various S. aureus specific antigens significantly correlated with clinical representation of infection and wound healing status. The novel species-specific immunoassay can serve as a promising diagnostic system, tracking tool and prognostic potential in management of S. aureus associated foot and ankle infection.

Objective To compare the diagnostic performances of real time of shear wave elastography (SWE) and strain ratio (SR) in differentiating benign and malignant liver tumors. Methods From March 2017 to August 2017, 68 patients with 70 lesions were examined with SR and SWE respectively, the parameters of SWE were maximum real-time shear wave velocity (Vmax), average real-time shear wave velocity (Vmean) and real-time shear wave velocity elasticity ratio of lesion/peripheral liver tissue (Vratio). The receiver operating characteristic (ROC) curve of SWE and SR parameters were plotted to assess the value in distinguishing benign and malignant liver tumors. The results were compared using the area under the ROC curve (AUC). The sensitivity, specificity, accuracy of SWE and SR were calculated, The accuracy of the parameters with the largest AUC were compared between SWE and SR by McNemar test in differentiating focal liver lesions. Results The AUC of SR, Vmax, Vmean and Vratio were 0.948, 0.868, 0.918 and 0.956 respectively. The comparison of AUC reveals no significant difference between them. The sensitivity, specificity, accuracy of SR in differentiating benign and malignant liver tumors were 92.73%, 93.33%, 92.86% respectively (P>0.05). The SWE parameter with the largest AUC was Vratio. The sensitivity, specificity, accuracy of Vratio was 94.56%, 100.00%, 95.71%, respectively. The accuracy of Vratio and SR in differentiating benign and malignant liver tumors showed no significant difference (P>0.05). Conclusions The application of SWE and SR in the differential diagnosis of benign and malignant liver tumors is of high diagnostic value. They provide a new method for the differential diagnosis of liver tumor lesions, and the diagnostic value of both of them is equivalent. Key words: Liver neoplasms/US; Elasticity imaging techniques; Diagnosis, differential

Introduction: Expression of Osteopontin (OPN) and Matrix Metalloproteinase 2 (MMP 2) are elevated in CRC. OPN is an integrin binding phosphorylated glycoprotein implicated in cell-mediated immunity, inflammation, tumor progression, and cell viability. OPN is secreted by macrophages and leukocytes. OPN activity is associated with the PI3K/AKT and ERK pathways and VEGF mediated tumor angiogenesis. MMP-2 degrades type IV collagen and facilitates tumor cell invasion and metastasis. MMP-2 also promotes tumor angiogenesis. This study’s first purpose was to compare preoperative (PreOp) plasma OPN and MMP2 levels in CRC and benign pathology (BP) patients (pts); the 2nd purpose was to assess the combination of these proteins for diagnosis. Method: PreOp plasma samples obtained from consenting CRC and BP pts undergoing surgery were used for this study. Prospectively gathered demographic, clinical and pathologic data were analyzed. Plasma levels of OPN and MMP2 (ng/ml) were measured via ELISA and reported as median + 95% CI. The receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) were used to evaluate the diagnostic value of each protein alone and in combination. Expression levels of OPN and MMP2 were determined in tumor and normal tissue for a subset of pts by QRT-PCR. The Mann-Whitney test was used for analysis. Results: Plasma from 156 CRC (73% colon, 27% rectal) and 102 BP (polyp 32%, diverticulitis 56%, other 12%) pts was studied. CRC stage breakdown was: 1, 26%; 2, 33%, 3, 29%, 4, 12%. CRC median preop plasma levels were significantly higher vs. the BP group for both proteins [OPN; 82.4,CI:75.4, 89.5 vs 59.2, CI:53.8,63.3;MMP2; 203.6,CI:195.0,214.5 vs 160.2,CI:151.9,172.2; P&amp;lt;0.0001). Higher OPN levels were noted in stg 3(p=0.04) and Stg 4(p=0.01) vs stg 1 pts. The AUC value for the ROC curve for OPN and MMP2 were 0.73 and 0.73 respectively with 61% and 70% specificity. The AUC for the 2 protein combination was 0.80 with 65% sensitivity and 80% specificity. OPN and MMP2 expression was elevated in 75% and 50% of CRC tumors tested, respectively (n=12). Conclusion: Median CRC OPN and MMP2 levels were significantly higher (39% and 27%) than BP levels. OPN and MMP2 expression was confirmed in a subset of pts. This 2 protein combination improved the AUC and specificity for CRC diagnosis. Further study with more protein combinations is warranted. Citation Format: Chandana S. k. Herath Mudiyanselage, Hiromichi Miyagaki, Neil Mitra, Yanni Hedjar, Xiaohong Yan, Vesna Cekic, Joseph Martz, Jennifer Agnew, Richard L. Whelan. Osteopontin and matrix metalloproteinase 2 plasma levels are elevated in colorectal cancer (CRC) vs benign disease; The 2 protein combination improves specificity as regards CRC diagnosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1415.

BackgroundSince the triglyceride glucose (TyG) index can reflect insulin resistance, it has been proven to be an efficient predictor of glycolipid-metabolism-related diseases. Therefore, this study aimed to investigate the predictive value of the TyG index for visceral obesity (VO) and body fat distribution in patients with type 2 diabetes mellitus (T2DM).MethodsAbdominal adipose tissue characteristics in patients with T2DM, including visceral adipose area (VAA), subcutaneous adipose area (SAA), VAA-to-SAA ratio (VSR), visceral adipose density (VAD), and subcutaneous adipose density (SAD), were obtained through analyses of computed tomography images at the lumbar 2/3 level. VO was diagnosed according to the VAA (> 142 cm2 for males and > 115 cm2 for females). Logistic regression was performed to identify independent factors of VO, and receiver operating characteristic (ROC) curves were used to compare the diagnostic performance according to the area under the ROC curve (AUC).ResultsA total of 976 patients were included in this study. VO patients showed significantly higher TyG values than non-VO patients in males (9.74 vs. 8.88) and females (9.59 vs. 9.01). The TyG index showed significant positive correlations with VAA, SAA, and VSR and negative correlations with VAD and SAD. The TyG index was an independent factor for VO in both males (odds ratio [OR] = 2.997) and females (OR = 2.233). The TyG index ranked second to body mass index (BMI) for predicting VO in male (AUC = 0.770) and female patients (AUC = 0.720). Patients with higher BMI and TyG index values showed a significantly higher risk of VO than the other patients. TyG-BMI, the combination index of TyG and BMI, showed significantly higher predictive power than BMI for VO in male patients (AUC = 0.879 and 0.835, respectively) but showed no significance when compared with BMI in female patients (AUC = 0.865 and 0.835, respectively).Conclusions. TyG is a comprehensive indicator of adipose volume, density, and distribution in patients with T2DM and is a valuable predictor for VO in combination with anthropometric indices, such as BMI.

The aims of this study were to assess the diagnostic value of the weight-to-height ratio (WHtR) for the detection of obesity and metabolic syndrome (MS) in Korean children and adolescents, and to determine the advantages of WHtR as a population-based screening tool in comparison with other obesity indicators, such as body mass index (BMI) and waist circumference (WC). We performed a cross-sectional analysis of data from 3057 children and adolescents (1625 boys, 1332 girls) aged 10–19 years who were included in the fifth Korean National Health and Nutrition Examination Survey (KNHANES, 2010–2012) up to the second year of the sixth KNHANES (2013–2014). Receiver operation characteristic (ROC) curves were generated to determine the optimal cutoff value and accuracy of WHtR for predicting individual obesity indicators or more than two non-WC components of MS. The area under the ROC curve (AUC) is a measure of the diagnostic power of a test. A perfect test will have an AUC of 1.0, and an AUC equal to 0.5 means that the test performs no better than chance. The optimal WHtR cutoff for the evaluation of general obesity and central obesity was 0.50 in boys and 0.47–0.48 in girls, and the AUC was 0.9. Regarding the assessment of each MS risk factor, the optimal WHtR cutoff was 0.43–0.50 in boys and 0.43–0.49 in girls, and these cutoffs were statistically significant only for the detection of high triglyceride and low High-density lipoprotein (HDL) cholesterol levels. When a pairwise comparison of the AUCs was conducted between WHtR and BMI/WC percentiles to quantify the differences in power for MS screening, the WHtR AUC values (boys, 0.691; girls, 0.684) were higher than those of other indices; however, these differences were not statistically significant (boys, p = 0.467; girls, p = 0.51). The WHtR cutoff value was 0.44 (sensitivity, 67.7%; specificity, 64.6%) for boys and 0.43 (sensitivity, 66.4%; specificity, 66.9%) for girls. There was no significant difference between the diagnostic power of WHtR and that of BMI/WC when screening for MS. Although the use of WHtR was not superior, WHtR is still useful as a screening tool for metabolic problems related to obesity because of its convenience.

<b>Background:</b> The contribution of and the validities of cut-offs for individual quick Sequential Organ Failure Assessment (qSOFA) elements, and the discriminatory capacity of qSOFA vs IDSA/ATS minor criteria for predicting mortality in patients with community-acquired pneumonia (CAP) remain unknown. <b>Methods:</b> A prospective cohort study of 2116 CAP patients was performed. The primary outcome was in-hospital mortality. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC) and net reclassification improvement (NRI). <b>Results:</b> Overall mortality was 6.43%: 3.05% for patients with qSOFA &lt;2 vs 25.96% for those with qSOFA ≥2. The predictive validities of respiratory rate ≥22 breaths/min, altered mentation, and systolic blood pressure ≤100 mm Hg were good, adequate, and poor for mortality (AUROC, 0.833, 0.717, 0.668), respectively. Respiratory rate ≥22 breaths/min best predicted mortality among the three cut-offs (&gt;20 breaths/min and ≥30 breaths/min). The discrimination of mortality using systolic arterial pressure ≤100 mm Hg was greater compared with hypotension. qSOFA had a sensitivity of 59.6%, specificity of 88.3%, and positive likelihood ratio of 5.105 for predicting mortality. The predictive validity of qSOFA was good for mortality (AUROC = 0.868), was statistically greater than minor criteria, was equal to PSI, and was inferior compared with CURB-65 (AUROC, 0.824, 0.902, 0.919; NRI, 0.088, -0.068, -0.103; respectively). <b>Conclusions:</b> The parsimonious qSOFA as a bedside prompt might be positioned as a proxy for IDSA/ATS minor criteria.

Background: Beyond prostate-specific antigen (PSA), other biomarkers for prostate cancer (PCa) detection are available and need to be evaluated for clinical routine. Objective: The aim of the study was to evaluate the Prostate Health Index (PHI) density (PHID) in comparison with PHI in a large Caucasian group >1,000 men. Methods: PHID values were used from available patient data with PSA, free PSA, and [−2]pro­PSA and prostate volume from 3 former surveys from 2002 to 2014. Those 1,446 patients from a single-center cohort included 701 men with PCa and 745 with no PCa. All patients received initial or repeat biopsies. The diagnostic accuracy was evaluated by receiver operating characteristic (ROC) curves comparing area under the ROC curves (AUCs), precision-recall approach, and decision curve analysis (DCA). Results: PHID medians differed almost 2-fold between PCa (1.12) and no PCa (0.62) in comparison to PHI (48.6 vs. 33; p always <0.0001). However, PHID and PHI were equal regarding the AUC (0.737 vs. 0.749; p = 0.226), and the curves of the precision-recall analysis also overlapped in the sensitivity range between 70 and 100%. DCA had a maximum net benefit of only ∼5% for PHID versus PHI between 45 and 55% threshold probability. Contrary, in the 689 men with a prostate volume ≤40 cm³, PHI (AUC 0.732) showed a significant larger AUC than PHID (AUC 0.69, p = 0.014). Conclusions: Based on DCA, PHID had only a small advantage in comparison with PHI alone, while ROC analysis and precision-recall analysis showed similar results. In smaller prostates, PHI even outperformed PHID. The increment for PHID in this large Caucasian cohort is too small to justify a routine clinical use.