High diagnostic accuracy of NT-proBNP for cardiac origin of pleural effusions

ABSTRACT Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard. Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis. Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each. Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.

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Detection of Degenerative Changes on MR Images of the Lumbar Spine with a Convolutional Neural Network: A Feasibility Study

Diagnostics ◽

10.3390/diagnostics11050902 ◽

2021 ◽

Vol 11 (5) ◽

pp. 902

Author(s):

Nils Christian Lehnen ◽

Robert Haase ◽

Jennifer Faber ◽

Theodor Rüber ◽

Hartmut Vatter ◽

...

Keyword(s):

Neural Network ◽

Lumbar Spine ◽

Diagnostic Accuracy ◽

Nerve Root ◽

Spinal Canal ◽

Spinal Canal Stenosis ◽

Degenerative Changes ◽

High Diagnostic Accuracy ◽

Canal Stenosis ◽

Disc Herniations

Our objective was to evaluate the diagnostic performance of a convolutional neural network (CNN) trained on multiple MR imaging features of the lumbar spine, to detect a variety of different degenerative changes of the lumbar spine. One hundred and forty-six consecutive patients underwent routine clinical MRI of the lumbar spine including T2-weighted imaging and were retrospectively analyzed using a CNN for detection and labeling of vertebrae, disc segments, as well as presence of disc herniation, disc bulging, spinal canal stenosis, nerve root compression, and spondylolisthesis. The assessment of a radiologist served as the diagnostic reference standard. We assessed the CNN’s diagnostic accuracy and consistency using confusion matrices and McNemar’s test. In our data, 77 disc herniations (thereof 46 further classified as extrusions), 133 disc bulgings, 35 spinal canal stenoses, 59 nerve root compressions, and 20 segments with spondylolisthesis were present in a total of 888 lumbar spine segments. The CNN yielded a perfect accuracy score for intervertebral disc detection and labeling (100%), and moderate to high diagnostic accuracy for the detection of disc herniations (87%; 95% CI: 0.84, 0.89), extrusions (86%; 95% CI: 0.84, 0.89), bulgings (76%; 95% CI: 0.73, 0.78), spinal canal stenoses (98%; 95% CI: 0.97, 0.99), nerve root compressions (91%; 95% CI: 0.89, 0.92), and spondylolisthesis (87.61%; 95% CI: 85.26, 89.21), respectively. Our data suggest that automatic diagnosis of multiple different degenerative changes of the lumbar spine is feasible using a single comprehensive CNN. The CNN provides high diagnostic accuracy for intervertebral disc labeling and detection of clinically relevant degenerative changes such as spinal canal stenosis and disc extrusion of the lumbar spine.

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Validity of different copeptin assays in the differential diagnosis of the polyuria-polydipsia syndrome

Scientific Reports ◽

10.1038/s41598-021-89505-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Clara Odilia Sailer ◽

Julie Refardt ◽

Claudine Angela Blum ◽

Ingeborg Schnyder ◽

Jose Alberto Molina-Tijeras ◽

...

Keyword(s):

Differential Diagnosis ◽

Diagnostic Accuracy ◽

Healthy Volunteers ◽

Primary Outcome ◽

The Other ◽

Poor Correlation ◽

Elisa Assay ◽

Moderate Correlation ◽

High Diagnostic Accuracy ◽

Osmotic Stimulation

AbstractThe aim of this study was to correlate three commercially available copeptin assays and their diagnostic accuracy in the differential diagnosis of the polyuria-polydipsia syndrome. Analyzed data include repeated copeptin measures of 8 healthy volunteers and 40 patients with polyuria-polydipsia syndrome undergoing osmotic stimulation and of 40 patients hospitalized with pneumonia. Copeptin was measured using the automated Brahms KRYPTOR, the manual Brahms LIA and the manual Cloud Clone ELISA assay. Primary outcome was the interrater correlation coefficient (ICC) and diagnostic accuracy in the polyuria-polydipsia syndrome of the three assays. In healthy volunteers, there was a moderate correlation for the KRYPTOR and LIA (ICC 0.74; 95% CI 0.07 to 0.91), and a poor correlation for the KRYPTOR and ELISA (ICC 0.07; 95% CI − 0.06 to 0.29), as for the LIA and ELISA (ICC 0.04; 95% CI − 0.04 to 0.17). The KRYPTOR had the highest diagnostic accuracy (98% (95% CI 83 to100)), comparable to the LIA (88% (95% CI 74 to 100)), while the ELISA had a poor diagnostic accuracy (55% (95% CI 34 to 68)) in the differential diagnosis of the polyuria-polydipsia syndrome. The KRYPTOR and LIA yield comparable copeptin concentrations and high diagnostic accuracy, while the ELISA correlates poorly with the other two assays and shows a poor diagnostic accuracy for polyuria-polydipsia patients. The current copeptin cut-off is valid for the KRYPTOR and LIA assay. Our results indicate that interpretation with other assays should be performed with caution and separate validation studies are required before their use in differentiating patients with polyuria-polydipsia syndrome.Trial registration: NCT02647736 January 6, 2016/NCT01940614 September 12, 2013/NCT00973154 September 9, 2009.

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Image-guided Biopsy of Mesenteric, Omental, and Peritoneal Disease

Digestive Disease Interventions ◽

10.1055/s-0038-1660499 ◽

2018 ◽

Vol 02 (02) ◽

pp. 106-115

Author(s):

Joshua Cornman-Homonoff ◽

David Madoff

Keyword(s):

Diagnostic Accuracy ◽

Patient Care ◽

Clinical History ◽

Peritoneal Disease ◽

Image Guided ◽

High Diagnostic Accuracy ◽

Guided Biopsy ◽

Imaging Characteristics ◽

Procedural Evaluation ◽

Technical Considerations

AbstractThe peritoneum, omenta, and mesenteries can be affected by a myriad of disease processes, but many common pathologies cannot be definitively distinguished based on clinical history and imaging characteristics alone. Percutaneous image-guided biopsy is a safe, well-tolerated procedure with high diagnostic accuracy, which has supplanted more invasive means of obtaining tissue and is increasingly essential in directing patient care. An understanding of the indications, pre-procedural evaluation, technical considerations, and potential complications is essential for the radiologist who performs these procedures, and more broadly for any clinician who may request them.

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Diagnostic Accuracy of Sonographic Septations in Tuberculous and Malignant Pleural Effusions

Journal of Islamabad Medical & Dental College ◽

10.35787/jimdc.v9i2.339 ◽

2020 ◽

Vol 9 (2) ◽

pp. 95-102

Author(s):

Abdul Rasheed Qureshi ◽

Muhammad Irfan ◽

Zeeshan Ashraf

Keyword(s):

Pleural Effusion ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Tertiary Care ◽

Positive Likelihood Ratio ◽

Fisher Exact Test ◽

Care Hospital ◽

Pleural Effusions ◽

Malignant Pleural Effusions ◽

Malignant Group

Background: Discrimination between tuberculous (TB) and malignant pleural effusions is a real practical challenge because both exist as exudative lymphocytic type. Transthoracic ultrasonography not only identifies and quantifies pleural effusion but also displays sonographic septations, which are frequently seen in TB pleural effusions and can help in differentiation between tuberculosis and malignancy successfully, without any invasive procedure. We designed this study to determine the diagnostic usefulness of these septations for tuberculous and malignant pleural effusions. Material and Methods: This prospective study was conducted in the OPD of Gulab Devi Chest Hospital Lahore, Pakistan, a 1500 bedded tertiary care hospital, from November 2016 to February 2018. Total of 339 consecutive cases, aged 14-83 years with radiological evidence of pleural effusion were included in the study. After detailed history, thorough physical examination, radiological, haematological and biochemical findings were recorded. Pleural fluid macroscopic, cytological, microbiologic and biochemical analysis results were also recorded. Ultrasonography was done, septated and non-septated pleural effusions identified and findings were noted. SPSS-16 was used for statistical evaluation. Fisher Exact test was utilized for comparison between TB and malignant cases with P-value < 0.05 taken as significant. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and positive likelihood ratio were calculated. Results: Out of total 339 cases, 49 (14.45%) were malignant and 290 (85.55%) were non-malignant. In the malignant group, only 03 cases (6.12%) showed sonographic septations. In the non-malignant group, 259/290 (89.31%) cases showed tuberculous etiology and 187/259 (72.20%) of these cases displayed sonographic septations. By considering septations as predictor of TB, statistical analysis revealed a sensitivity of 79.23%, specificity of 92.85%, PPV of 98.42%, NPV of 44.31% and diagnostic accuracy of 81.29%, respectively. Conclusions: Sonographic septations can be a valuable predictor of tuberculosis, in a population with high prevalence of the disease. We found it to be a useful feature in differentiating between a malignant and tuberculous etiology, in exudative lymphocytic pleural effusions. It can be used with confidence in patients who are unfit for interventional procedures.

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Robotic Colonoscopy: Comparative Analysis of Costs Compared to Painless Conventional Colonoscopy

10.21203/rs.3.rs-104356/v1 ◽

2020 ◽

Author(s):

Rosi Sicuro ◽

Emanuele Tumino ◽

Christian Lambiase ◽

Domenica Mamone

Keyword(s):

Colorectal Cancer ◽

Diagnostic Accuracy ◽

Impact Analysis ◽

Early Stage ◽

Health Technology ◽

University Hospital ◽

Time Interval ◽

Diagnostic Colonoscopy ◽

High Diagnostic Accuracy ◽

The University

Abstract BackgroundAmong the various causes of death, colorectal carcinoma represents the second highest cause in frequency both in men and in women. A colorectal cancer is diagnosed every 3.5 minutes and a person dies of colorectal cancer every 9 minutes. In 2018, in Italy were recorded around 51.000 new cases, with a mortality rate of over 18.000 deaths. There is clear evidence demonstrating that the identification and treatment of cancer at an early stage positively influence the reduction in mortality. Colonoscopy is the most effective technique used to identify and remove polyps, thus avoiding the costs related to surgical treatment and hospitalization.The purpose of this study is to evaluate the costs of the system Endotics for robotic colonoscopy as an alternative to conventional diagnostic colonoscopy performed under anaesthesia at the University Hospital of Pisa.MethodsThe cost analysis was developed according to the Budget Impact Analysis method application, an essential and complementary part of the Health Technology Assessment evaluation, which has the main purpose of assessing the financial sustainability of new health technology, estimating the consequences of its use and diffusion in a specific context characterized by the limited availability of resources. The observation period covered a time interval of 3 months, during which an average of 43 colonoscopic procedures per day was performed and mapped and a total of 23 colonoscopes were used. ResultsOverall, the work done has allowed identifying the cost of a conventional painless diagnostic colonoscopy performed in our institution which amounts to € 426.25. The valuation of the costs of the robotic colonoscopy amounted overall to € 441.25.ConclusionsThe ideal procedure to diagnose a colon disease should be safe, well-tolerated, possibly non-invasive, with high diagnostic accuracy and, not least, cost-effectiveness. The results of this study suggest that in the University Hospital of Pisa the costs related to robotic colonoscopy performed with the Endotics system are superimposable to those of conventional painless colonoscopy, reducing the overall risk associated with the colonoscopic procedure maintaining a high diagnostic accuracy with a greater tolerability by the patient, thus pushing the colonoscopy towards “the ideal procedure”.

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Pleuraerguss: Vereinfachte Kriterien zur Unterscheidung zwischen Exsudat und Transsudat

Karger Kompass Pneumologie ◽

10.1159/000504151 ◽

2019 ◽

Vol 7 (6) ◽

pp. 331-332

Author(s):

Franz Stanzel

Keyword(s):

Lactate Dehydrogenase ◽

Diagnostic Accuracy ◽

Pleural Fluid ◽

Likelihood Ratio ◽

Validation Cohort ◽

Characteristic Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Serum Lactate Dehydrogenase ◽

Pleural Effusions

Background: An important part of the investigation of pleural effusion is the identification of markers that help separate exudate from transudate. Objectives: The purposes of this study were to compare the accuracy of published and new sets of criteria to distinguish between exudative and transudative pleural effusions, and to determine whether serum biochemical analysis is necessary. Methods: An externally validated cohort study was performed. Pleural effusions were determined to be transudative or exudative on the basis of an assessment of the medical record by two clinicians blinded to biochemical results. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating characteristic curve were determined for each proposed combination of criteria. Results: Pleural fluid analysis was available for 311 thoracenteses in the main cohort and for 112 thoracenteses in the validation cohort. The best sensitivity (97% [95% CI 94-99]) and negative likelihood ratio (0.04 [95% CI 0.02-0.08]) for identifying exudative effusions were observed with criteria combining pleural fluid lactate dehydrogenase greater than 0.6 the upper limit of normal serum lactate dehydrogenase and pleural fluid cholesterol greater than 1.04 mmol/L (40 mg/dL). The overall diagnostic accuracy was similar to Light's criteria. Findings were similar in the validation cohort. Conclusions: Our proposed criteria using simultaneously pleural fluid lactate dehydrogenase and pleural fluid cholesterol can identify an exudate with a sensitivity and an overall diagnostic accuracy similar to Light's criteria. It avoids simultaneous blood sampling, thus reducing patient discomfort and potential costs.

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Diagnostic accuracy of deep-learning with anomaly detection for a small amount of imbalanced data: discriminating malignant parotid tumors in MRI

Scientific Reports ◽

10.1038/s41598-020-76389-4 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Hidetoshi Matsuo ◽

Mizuho Nishio ◽

Tomonori Kanda ◽

Yasuyuki Kojita ◽

Atsushi K. Kono ◽

...

Keyword(s):

Anomaly Detection ◽

Diagnostic Accuracy ◽

Area Under The Curve ◽

Imbalanced Data ◽

Classification Models ◽

Mr Images ◽

High Diagnostic Accuracy ◽

Parotid Tumors ◽

Malignant Parotid Tumors ◽

Local Outlier

Abstract We hypothesized that, in discrimination between benign and malignant parotid gland tumors, high diagnostic accuracy could be obtained with a small amount of imbalanced data when anomaly detection (AD) was combined with deep leaning (DL) model and the L2-constrained softmax loss. The purpose of this study was to evaluate whether the proposed method was more accurate than other commonly used DL or AD methods. Magnetic resonance (MR) images of 245 parotid tumors (22.5% malignant) were retrospectively collected. We evaluated the diagnostic accuracy of the proposed method (VGG16-based DL and AD) and that of classification models using conventional DL and AD methods. A radiologist also evaluated the MR images. ROC and precision-recall (PR) analyses were performed, and the area under the curve (AUC) was calculated. In terms of diagnostic performance, the VGG16-based model with the L2-constrained softmax loss and AD (local outlier factor) outperformed conventional DL and AD methods and a radiologist (ROC-AUC = 0.86 and PR-ROC = 0.77). The proposed method could discriminate between benign and malignant parotid tumors in MR images even when only a small amount of data with imbalanced distribution is available.

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