S216 – Is Oculomotor Testing Useful in the Modern Era?

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P148-P148
Author(s):  
Zameel Dewji ◽  
Brian W Blakley
Keyword(s):  
Diagnostic Odds Ratio ◽  
Likelihood Ratios ◽  
Level Of Evidence ◽  
Predictive Values ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity ◽  
The Cost ◽  
Modern Era

Objectives To understand the role of oculomotor testing in the era of advanced imaging with MRI. Methods First, the literature was evaluated systematically to determine the level of evidence that oculomotor testing is sensitive in central nervous system lesions. Next, the sensitivity and specificity of saccade, pursuit, and gaze testing in detection of brain abnormalities were assessed using a database of 561 patients who underwent ENG using magnetic resonance imaging (MRI) as the “gold standard.” Among the abnormal MRI scans, oculomotor testing was abnormal in 1 and normal in 37. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (PLR and NLR), and the diagnostic odds ratio (OR) with 95% confidence interval (± CI) were calculated. Results For oculomotor testing, our data which concur with the literature indicate: Sensitivity 2.6%, (± 0.005–1.1); Specificity 96%, ± (0.89–0.98); Diagnostic OR 0.71 ± (0.065–5.6); PPV 20% ± (0.043, −0.64); NPV 71% ±(0.62, 0.78). Conclusions Our data suggest that oculomotor testing adds little diagnostic information. The cost and benefit of oculomotor testing are low.

Efficacy of MRI Versus Arthroscopy for Evaluation of Sinus Tarsi Syndrome

2008 ◽  
Vol 29 (11) ◽  
pp. 1111-1116 ◽  
Author(s):  
Keun-Bae Lee ◽  
Long-Bin Bai ◽  
Jin-Gyoon Park ◽  
Eun-Kyoo Song ◽  
Jae-Jun Lee
Keyword(s):  
Diagnostic Efficiency ◽  
Full Agreement ◽  
Level Of Evidence ◽  
Predictive Values ◽  
Sinus Tarsi ◽  
Arthroscopic Findings ◽  
Sinus Tarsi Syndrome ◽  
Prospective Comparative Study ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

Background: Magnetic resonance imaging (MRI) has been used to diagnose sinus tarsi syndrome (STS) because of its non-invasiveness and accuracy. The purpose of the present study was to evaluate the diagnostic efficiency of MRI compared with subtalar arthroscopy for STS. Materials and Methods: Twenty-eight patients (30 feet) who had undergone both MRI and subtalar arthroscopy for STS were evaluated. MRI results were compared with arthroscopic findings, which were considered the standard. Sensitivity, specificity, and positive and negative predictive values were calculated, and correlations between MRI and arthroscopic findings were investigated. Results: MRI was found to detect interosseous talocalcaneal ligament (ITCL) tears, cervical ligament (CL) tears, sinus tarsi fat alterations, and synovial thickening, with sensitivities, specificities, positive and negative predictive accuracies of: 44%, 60%, 85%, 18% (ITCL tears); 73%, 89%, 80%, 86% (CL tears); 71%, 92%, 93%, 71% (sinus tarsi fat alterations); and 86%, 87%, 67%, 95% (synovial thickening). Correlations between MRI and arthroscopic findings showed full agreement in 10%, partial agreement in 50%, and no agreement in 40%. Conclusion: MRI is useful for detecting CL tears, sinus tarsi fat alterations, and synovial thickening, but is inadequate for correctly detecting ITCL tears. Level of Evidence: II, Prospective Comparative Study

scholarly journals Intraoperative neurophysiological mapping and monitoring in spinal tumor surgery: sirens or indispensable tools?

2016 ◽  
Vol 41 (2) ◽  
pp. E18 ◽  
Author(s):  
Antonino Scibilia ◽  
Carmen Terranova ◽  
Vincenzo Rizzo ◽  
Giovanni Raffa ◽  
Adolfo Morelli ◽  
...  
Keyword(s):  
Complex Function ◽  
Spinal Tumor ◽  
Neurological Deficits ◽  
Neurological Injury ◽  
Neurophysiological Monitoring ◽  
Predictive Values ◽  
Effective Role ◽  
Mapping Techniques ◽  
Sensitivity Specificity

Spinal tumor (ST) surgery carries the risk of new neurological deficits in the postoperative period. Intraoperative neurophysiological monitoring and mapping (IONM) represents an effective method of identifying and monitoring in real time the functional integrity of both the spinal cord (SC) and the nerve roots (NRs). Despite consensus favoring the use of IONM in ST surgery, in this era of evidence-based medicine, there is still a need to demonstrate the effective role of IONM in ST surgery in achieving an oncological cure, optimizing patient safety, and considering medicolegal aspects. Thus, neurosurgeons are asked to establish which techniques are considered indispensable. In the present study, the authors focused on the rationale for and the accuracy (sensitivity, specificity, and positive and negative predictive values) of IONM in ST surgery in light of more recent evidence in the literature, with specific emphasis on the role of IONM in reducing the incidence of postoperative neurological deficits. This review confirms the role of IONM as a useful tool in the workup for ST surgery. Individual monitoring and mapping techniques are clearly not sufficient to account for the complex function of the SC and NRs. Conversely, multimodal IONM is highly sensitive and specific for anticipating neurological injury during ST surgery and represents an important tool for preserving neuronal structures and achieving an optimal postoperative functional outcome.

scholarly journals Value and Diagnostic Efficacy of Fetal Morphology Assessment Using Ultrasound in A Poor-Resource Setting

Diagnostics ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 109 ◽  
Author(s):  
Ukweh ◽  
Ugbem ◽  
Okeke ◽  
Ekpo
Keyword(s):  
Predictive Value ◽  
Performance Metrics ◽  
Area Under The Curve ◽  
Youden Index ◽  
Likelihood Ratios ◽  
Diagnostic Efficacy ◽  
Predictive Values ◽  
Resource Setting ◽  
Post Test ◽  
Sensitivity Specificity

Background: Ultrasound is operator-dependent, and its value and efficacy in fetal morphology assessment in a low-resource setting is poorly understood. We assessed the value and efficacy of fetal morphology ultrasound assessment in a Nigerian setting. Materials and Methods: We surveyed fetal morphology ultrasound performed across five facilities and followed-up each fetus to ascertain the outcome. Fetuses were surveyed in the second trimester (18th–22nd weeks) using the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. Clinical and surgical reports were used as references to assess the diagnostic efficacy of ultrasound in livebirths, and autopsy reports to confirm anomalies in terminated pregnancies, spontaneous abortions, intrauterine fetal deaths, and still births. We calculated sensitivity, specificity, positive and negative predictive values, Area under the curve (AUC), Youden index, likelihood ratios, and post-test probabilities. Results: In total, 6520 fetuses of women aged 15–46 years (mean = 31.7 years) were surveyed. The overall sensitivity, specificity, and AUC were 77.1 (95% CI: 68–84.6), 99.5 (95% CI: 99.3–99.7), and 88.3 (95% CI: 83.7–92.2), respectively. Other performance metrics were: positive predictive value, 72.4 (95% CI: 64.7–79.0), negative predictive value, 99.6 (95% CI: 99.5–99.7), and Youden index (77.1%). Abnormality prevalence was 1.67% (95% CI: 1.37–2.01), and the positive and negative likelihood ratios were 254 (95% CI: 107.7–221.4) and 0.23 (95% CI: 0.16–0.33), respectively. The post-test probability for positive test was 72% (95% CI: 65–79). Conclusion: Fetal morphology assessment is valuable in a poor economics setting, however, the variation in the diagnostic efficacy across facilities and the limitations associated with the detection of circulatory system anomalies need to be addressed.

Symptoms are the Most Effective Child SCAT5 Component for Recognizing Concussion on the Day of Injury

2021 ◽  
Author(s):  
Nicholas Kevin Erdman ◽  
Patricia M. Kelshaw ◽  
Samantha L. Hacherl ◽  
Shane V. Caswell
Keyword(s):  
Middle School ◽  
Diagnostic Accuracy ◽  
School Children ◽  
Assessment Tool ◽  
Diagnostic Odds Ratio ◽  
Likelihood Ratios ◽  
Middle School Children ◽  
Predictive Values ◽  
Symptom Evaluation ◽  
Diagnostic Properties

Abstract Background: The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) was developed to evaluate children between 5-12 years of age for a suspected concussion. However, limited empirical evidence exists demonstrating the value of the Child SCAT5 for acute concussion assessment. Therefore, the purpose of our study was to examine differences and assess the diagnostic properties of Child SCAT5 scores among concussed and non-concussed middle school children on the same day as a suspected concussion.Methods: Our participants included 34 concussed (21 boys, 13 girls; age=12.8±0.86 years) and 44 non-concussed (31 boys, 13 girls; age=12.4±0.76 years) middle school children who were administered the Child SCAT5 upon suspicion of a concussion. Child SCAT5 scores were calculated from the symptom evaluation (total symptoms, total severity), child version of the Standardized Assessment of Concussion (SAC-C), and modified Balance Error Scoring System (mBESS). The Child SCAT5 scores were compared between the concussed and non-concussed groups. Non-parametric effect sizes (r=z/√n) were calculated to assess the magnitude of difference for each comparison. The diagnostic properties (sensitivity, specificity, diagnostic accuracy, predictive values, likelihood ratios, and diagnostic odds ratio) of each Child SCAT5 score were also calculated.Results: Concussed children endorsed more symptoms (p<0.001, r=0.45), higher symptom severity (p<0.001, r=0.44), and had higher double leg (p=0.046, r=0.23), single leg (p=0.035, r=0.24), and total scores (p=0.022, r=0.26) for the mBESS than non-concussed children. No significant differences were observed for the SAC-C scores (p’s≥0.542). The quantity and severity of endorsed symptoms had the best diagnostic accuracy (AUC=0.76–0.77), negative predictive values (NPV=0.84–0.88), and negative likelihood ratios (-LR=0.22–0.31) of the Child SCAT5 scores.Conclusions: The symptom evaluation was the most effective component of the Child SCAT5 for differentiating between concussed and non-concussed middle school children on the same day as a suspected concussion.

Role of contrast-enhanced spectral mammography in the post biopsy management of B3 lesions: Preliminary results

2018 ◽  
Vol 105 (5) ◽  
pp. 378-387 ◽  
Author(s):  
Giulia Bicchierai ◽  
Jacopo Nori ◽  
Diego De Benedetto ◽  
Cecilia Boeri ◽  
Ermanno Vanzi ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Surgical Excision ◽  
Surgical Biopsy ◽  
Predictive Values ◽  
Contrast Enhanced ◽  
B3 Lesions ◽  
Malignant Lesions ◽  
Sensitivity Specificity

PurposeTo evaluate the role of contrast-enhanced spectral mammography (CESM) in the post biopsy management of breast lesions classified as lesions of uncertain malignant potential (B3) by core needle biopsy and vacuum-assisted biopsy (VAB).MethodsThe local ethics committee approved this retrospective study and for this type of study formal consent is not required. A total of 42 B3 lesions in 40 women aged 41–77 years were included in our study. All patients underwent CESM 2–3 weeks after the biopsy procedure and surgical excision was subsequently performed within 60 days of the CESM procedure. Three radiologists reviewed the images independently. The results were then compared with histologic findings.ResultsThe sensitivity, specificity, and positive and negative predictive values for confirmed demonstration of malignancy at CESM were 33.3%, 87.2%, 16.7%, and 94.4% for reader 1; 66.7%, 76.9%, 18.2%, and 96.7% for reader 2; 66.7%, 74.4%, 16.7%, and 96.7% for reader 3. Overall agreement on detection of malignant lesions using CESM among readers ranged from moderate to substantial (κ = .451–.696), for categorization of BPE from moderate to substantial (κ = .562–.711), and for evaluation of lesion intensity enhancement from fair to moderate (κ = .346–.459).ConclusionIn cases of Breast Imaging Reporting and Data System (BI-RADS) 1, BI-RADS 2, or BI-RADS 3 results at CESM, follow-up or VAB rather than surgical biopsy might be performed.

scholarly journals Evaluation of brain lesion distribution criteria at disease onset in differentiating MS from NMOSD and MOG-IgG-associated encephalomyelitis

2018 ◽  
Vol 25 (4) ◽  
pp. 585-590 ◽  
Author(s):  
Jae-Won Hyun ◽  
So-Young Huh ◽  
Hyun-June Shin ◽  
Mark Woodhall ◽  
Su-Hyun Kim ◽  
...  
Keyword(s):  
Immunoglobulin G ◽  
Brain Lesion ◽  
Disease Onset ◽  
Brain Magnetic Resonance Imaging ◽  
Asian Population ◽  
The Body ◽  
Predictive Values ◽  
Mri Scans ◽  
Sensitivity Specificity ◽  
The Brain

Objectives: We aimed to evaluate the utility of the recently described brain lesion distribution criteria to differentiate multiple sclerosis (MS) from aquaporin-4 immunoglobulin G-positive neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein immunoglobulin G-associated encephalomyelitis (MOG-EM) at disease onset in an Asian cohort. Methods: A total of 214 patients who fulfilled the published criteria for MS, NMOSD, or MOG-EM and underwent brain magnetic resonance imaging (MRI) within 3 months of disease onset were enrolled. The brain lesion distribution criteria were defined as the presence of a lesion adjacent to the body of the lateral ventricle and in the inferior temporal lobe, or an S-shaped U-fiber lesion, or a Dawson’s finger-type lesion. Results: Brain lesions were identified in the initial MRI scans of 166/214 patients. The distribution criteria were applied to these scans (MS ( n = 94), NMOSD ( n = 64), and MOG-EM ( n = 8)). The sensitivity, specificity, and positive and negative predictive values of the criteria for MS versus NMOSD were 79.8%, 87.5%, 90.4%, and 74.7%, and for MS versus MOG-EM these were 79.8%, 100%, 100%, and 29.6%, respectively. Conclusion: These findings suggest that the brain lesion distribution criteria are helpful in distinguishing MS from NMOSD and MOG-EM in an Asian population, even at disease onset.

scholarly journals 0579 Non Intrusive and Unattended Sleep Analyzer Effectively Screens Patients Suspected of Sleep Apnea: A Comparison With Polysomnography

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A222-A222
Author(s):  
P Edouard ◽  
D Campo ◽  
P Bartet ◽  
L Marais ◽  
M Petitjean ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Absolute Error ◽  
Sleep Time ◽  
Apnea Hypopnea Index ◽  
Good Precision ◽  
Likelihood Ratios ◽  
Sensitivity Specificity ◽  
The Cost ◽  
Screening Device

Abstract Introduction Sleep Apnea Syndrome (SAS) is largely underdiagnosed due to the cost and availability of Polysomnography (PSG). We aimed at evaluating the diagnosis of SAS with the WITHINGS Sleep Apnea Detector (SAD), a non-intrusive pressure and sound sensor placed under the mattress. Methods 118 patients (67 F, 49 years, BMI 33kg/m²) suspected of SAS had an in-laboratory PSG together with Sleep Apnea Detector. From the pressure signal, Sleep Apnea Detector derives respiratory and cardiac signals and movements. From the microphone, snoring and snorting are detected. These features are used to detect sleep periods with a Random Forest classifier and apnea and hypopnea events with a Convolutional Neural Network. The Total Sleep Time (TST) and Apnea Hypopnea Index (AHI) deduced (TSTsad, AHIsad) are compared with the PSG results scored according to AASM rules (TSTpsg, AHIpsg). AHI and TST were compared using bias and Mean Absolute Error (MAE). Sensitivity, specificity, likelihood ratios (LR) and AUROC were calculated for AHI thresholds of 15 and 30/hr. Results The average (SD) TSTpsg was 367 (61) minutes. Sleep Apnea Detector overestimated TST by 25 minutes, 7.0% of the average duration in the sample. The precision is acceptable, with a MAE=53 minutes. Average AHIpsg was 32.5 (30.1) and AHIsad 32.8 (29.9). The bias was 0.3 (95% CI [-2.7, 3.3]), MAE=10.3. The sensitivity (Se15) and specificity (Sp15) and their 95% confidence intervals were Se15=88.0% [79.0, 94.1] and Sp15=88.6% [73.3, 96.8]. Positive and negative LR were respectively LR+15=7.70 and LR-15=0.136. AUROC15=0.926. At the 30 threshold, Se30=86.0% [73.3, 94.2] and Sp30=91.2% [81.8, 96.7]. Positive and negative LR were LR+30=9.75 and LR-30=0.153. AUROC30=0.954. Conclusion Sleep Apnea Detector has excellent sensitivity and specificity, low bias and good precision. Thus it can be used as an unattended SAS screening device in patients likely to suffer from SAS. Support WITHINGS

Neutrophil CD64 Index as a superior biomarker for early diagnosis of infection in febrile patients in the hematology department

2017 ◽  
Vol 55 (1) ◽  
pp. 82-90 ◽  
Author(s):  
Shu-Dao Xiong ◽  
Lian-Fang Pu ◽  
Hui-Ping Wang ◽  
Lin-Hui Hu ◽  
Yang-Yang Ding ◽  
...  
Keyword(s):  
High Specificity ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Combined Analysis ◽  
Reactive Protein ◽  
Neutrophil Cd64 ◽  
Special Value ◽  
Diagnostic Values ◽  
Neutropenic Patients ◽  
Sensitivity Specificity

Abstract Background: In the hematology department, the availability of biomarkers for early detection of infection is difficult to obtain. The present study aimed to compare the diagnostic values of neutrophil CD64 Index, procalcitonin (PCT), interleukin-6 (IL-6) and C-reactive protein (CRP) and to determine whether the combined analysis of these biomarkers offer stronger predictive power in the diagnosis for the infection of febrile patients. Methods: Neutrophil CD64 Index, PCT, IL-6 and CRP levels were determined in 356 febrile patients in the hematology ward from May 2013 to May 2015. Sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values, receiver operating characteristic (ROC) areas under the curve (AUC), and logistic regression analysis were determined to evaluate the diagnostic values of these biomarkers. Results: The levels of the four biomarkers were higher in the infection patients (p<0.001), and the PCT and IL-6 were higher in the patients with positive microbial blood culture (p<0.01). The neutrophil CD64 Index, PCT, IL-6, CRP had AUCs of 0.95, 0.83, 0.75 and 0.73, respectively. The best cut-off value of the neutrophil CD64 Index to detect infections was 5.06, with high specificity (87.5%) and sensitivity (88.4%). Furthermore, neutrophil CD64 Index, PCT and IL-6 offered the best combination of diagnosis with sensitivity of 93.9% and an AUC of 0.95. In addition, the neutrophil CD64 Index may have a special value to assist the physician to diagnose infection in the neutropenic patients with fever. Conclusions: The neutrophil CD64 Index is useful for early identification of infections in febrile patients in the hematology department. The combined analysis of the CD64 Index, PCT and IL-6 could further improve its sensitivity.

Magnetic Resonance Imaging in the Diagnosis of Glomus Tumours of the Hand

2005 ◽  
Vol 30 (5) ◽  
pp. 535-540 ◽  
Author(s):  
M. M. AL-QATTAN ◽  
A. AL-NAMLA ◽  
A. AL-THUNAYAN ◽  
F. AL-SUBHI ◽  
A. F. EL-SHAYEB
Keyword(s):  
Predictive Value ◽  
Final Diagnosis ◽  
Senior Author ◽  
Glomus Tumour ◽  
Resonance Imaging ◽  
Predictive Values ◽  
Final Histological Diagnosis ◽  
Sensitivity Specificity ◽  
The Cost ◽  
Negative Imaging

This paper studies the sensitivity, specificity and predictive values of MRI in the diagnosis of glomus tumours of the hand and investigates the final diagnosis and outcome in cases with false positive or negative imaging tests. A total of 42 cases with the clinical diagnosis of a glomus tumour were included in the study. All patients underwent MRI and the results of MRI were correlated with the final histological diagnosis of the excised lesion. MRI had a sensitivity of 90%, a specificity of 50%, a positive predictive value of 97% and a negative predictive value of 20%. The four cases in which the MRI was negative all proved histologically to be glomus tumours. All four tumours were small (2–3 mm in diameter) and the lack of delineation of the lesions by MRI was attributed to their small size. Despite negative MRIs, surgical exploration identified the glomus tumours. Based on the results of the current study and the cost of MRI, the senior author has stopped ordering pre-operative MRIs in patients clinically diagnosed with a glomus tumour.

A unique antiphospholipid assay recognizing phospholipid mixture compared with criteria antiphospholipid immunoassays in lupus patients

Lupus ◽  
2016 ◽  
Vol 26 (6) ◽  
pp. 606-615 ◽  
Author(s):  
Y Zuo ◽  
R Willis ◽  
E Papalardo ◽  
M Petri ◽  
E N Harris ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Clinical Manifestations ◽  
Case Series ◽  
Likelihood Ratios ◽  
Serum Samples ◽  
Predictive Values ◽  
Pregnancy Morbidity ◽  
Commercial Kits ◽  
Sensitivity Specificity

Background While essential for the classification of antiphospholipid syndrome (APS), anticardiolipin (aCL) assays lack specificity and anti-β2glycoproteinI (anti-β2GPI) assays lack sensitivity in this regard. Our aim was to perform a comparative analysis of the APhL ELISA assay (IgG/IgM) and criteria antiphospholipid (aPL) immunoassays in identifying APS-related clinical manifestations in a large group of patients with systemic lupus erythematosus (SLE). Methods Serum samples from 1178 patients from the Hopkins ( n = 543), LUMINA ( n = 588) and Jamaican SLE cohorts ( n = 47) were examined for IgG/IgM positivity in aCL (in-house), anti-β2GPI (two commercial kits) and APhL (Louisville APL) ELISA assays. Correlation of assay positivity with clinical manifestations and sensitivity, specificity, positive and negative predictive values and likelihood ratios were evaluated. A case series analysis was also performed in patients for whom there was isolated positivity in the specific aPL assays. Results The prevalence of aCL positivity was 34.9%, anti-β2GPI kit A was 22.6%, APhL was 11.5% and anti-β2GPI kit B was 7.6% in the study population. Anti-β2GPI kit B, aCL and APhL assays were correlated with venous thrombosis, while only APhL was significantly correlated with arterial thrombosis and consistently correlated with pregnancy-related morbidity. No significant correlations were noted for anti-β2GPI kit A. Sensitivity was greatest for aCL assays followed by anti-β2GPI kit A, APhL and anti-β2GPI kit B, while specificity was greatest and equal for anti-β2GPI kit B and APhL assays. Conclusions Overall, APhL antibodies, especially IgG, represent a promising biomarker for the classification of APS patients in the context of autoimmunity and in risk assessment with regards to pregnancy morbidity and thrombotic manifestations.

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