Computed Tomography Enhances Diagnostic Accuracy in Challenging Medial Coronoid Disease Cases: An Imaging Study in Dog Breeding Appeal Cases

2020 ◽  
Vol 33 (05) ◽  
pp. 356-362
Author(s):  
Jan Wennemuth ◽  
Bernd Tellhelm ◽  
Nele Eley ◽  
Kerstin von Pückler
Keyword(s):  
Computed Tomography ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Working Group ◽  
False Negative ◽  
Imaging Study ◽  
Second Opinion ◽  
Substantial Agreement ◽  
Hounsfield Units ◽  
The Mean

Abstract Objectives The aim of this study was to determine the radiographic sensitivity in detecting medial coronoid disease (MCD), using computed tomography (CT) as reference in dogs presented for an official second opinion, and to compare the medial coronoid process (MCP) in fragmented and fissured MCP as well as those unaffected by MCD. Materials and Methods The data of dogs, presented for official second opinion radiographs and CT, were reviewed by three board-certified observers and in accordance with the International Elbow Working Group guidelines regarding MCD. Radiographic delineation, radiopacity and Hounsfield Units (HU) of the MCP were recorded additionally and the correlation between radiography and CT was investigated. Results Sensitivity and specificity of radiography compared with CT yielded values of 83.6% for the former and 83.5% for the latter. False-negative grading in radiography correlated significantly (p = 0.0001) with a present fissure line in CT. The mean delineation (p = 0.03) and mean HU of fragmented MCP (p = 0.0045) were significantly reduced compared with fissured MCP and no significant differences in measured HU for fissured MCP were detected in comparison to elbows unaffected by MCD. Conclusion The results of the present study show substantial agreement between radiography and CT in second opinion cases. However, sensitivity is reduced compared with not preselected cases. A present fissure line in CT was significantly associated with a false-negative grading in radiography. Therefore, CT imaging of the elbows is strongly recommended in cases of appeal.

Pearls and Pitfalls of Interpretation in CT Colonography

2020 ◽  
Vol 71 (2) ◽  
pp. 140-148
Author(s):  
Michael Schonberger ◽  
Philippe Lefere ◽  
Abraham H. Dachman
Keyword(s):  
Computed Tomography ◽  
Sensitivity And Specificity ◽  
False Positive ◽  
Ct Colonography ◽  
False Negative ◽  
High Sensitivity ◽  
Negative Results ◽  
False Negative Results ◽  
The Common

The accuracy of computed tomography (CT) colonography (CTC) requires that the radiologist be well trained in the recognition of pitfalls of interpretation. In order to achieve a high sensitivity and specificity, the interpreting radiologist must be well versed in the causes of both false-positive and false-negative results. In this article, we review the common and uncommon pitfalls of interpretation in CTC.

Usefulness of Nasal Endoscopy for Diagnosing Patients With Chronic Rhinosinusitis: A Meta-Analysis

2019 ◽  
Vol 34 (2) ◽  
pp. 306-314
Author(s):  
Do Hyun Kim ◽  
Youngjun Seo ◽  
Kyung Min Kim ◽  
Seoungmin Lee ◽  
Se Hwan Hwang
Keyword(s):  
Diagnostic Accuracy ◽  
Chronic Rhinosinusitis ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
False Negative ◽  
Nasal Endoscopy ◽  
Summary Receiver Operating Characteristic ◽  
True Negative ◽  
Endoscopic Score

Background We evaluated the accuracy of nasal endoscopy in diagnosing chronic rhinosinusitis (CRS) compared with paranasal sinus computed tomography (CT). Methods Two authors independently searched the 5 databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) up to March 2019. For all included studies, we calculated correlation coefficients between the endoscopic and CT scores. We extracted data on true-positive and false-positive and true-negative and false-negative results. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool (version 2). Results We included 16 observational or retrospective studies. A high correlation ( r = .8543; 95% confidence interval [CI] [0.7685–0.9401], P < .0001, I2 = 76.58%) between endoscopy and CT in terms of the diagnostic accuracy for CRS was apparent. The odds ratio (Lund–Kennedy endoscopic score ≥1) was 7.915 (95% CI [4.435–14.124]; I2 = 28.361%). The area under the summary receiver operating characteristic curve was 0.765. The sensitivity and specificity were 0.726 (95% CI [0.584–0.834]) and 0.767 (95% CI [0.685–0.849]), respectively. However, high interstudy heterogeneity was evident given the different endoscopic score thresholds used (Lund–Kennedy endoscopic score ≥1 vs 2). In a subgroup analysis of studies using a Lund–Kennedy endoscopic score threshold ≥2, the area under the summary curve was 0.881, and the sensitivity and specificity were 0.874 (95% CI [0.783–0.930]) and 0.793 (95% CI [0.366–0.962]), respectively. Conclusion Nasal endoscopy is a useful diagnostic tool; the Lund–Kennedy score was comparable with that of CT.

scholarly journals Subspecialty Second-Opinion in Multiple Myeloma CT: Emphasis on Clinically Significant Lytic Lesions

Medicina ◽  
2020 ◽  
Vol 56 (4) ◽  
pp. 195
Author(s):  
Alberto Stefano Tagliafico ◽  
Liliana Belgioia ◽  
Alessandro Bonsignore ◽  
Federica Rossi ◽  
Giulia Succio ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multiple Myeloma ◽  
Lesion Detection ◽  
Second Opinion ◽  
Lytic Lesion ◽  
Focal Lesion ◽  
Years Of Experience ◽  
Focal Lesions ◽  
Lytic Lesions ◽  
The Mean

Background and objectives: In order to increase the accuracy of lytic lesion detection in multiple myeloma, a dedicated second-opinion interpretation of medical images performed by subspecialty musculoskeletal radiologists could increase accuracy. Therefore, the purpose of this study is to evaluate the added value (increased accuracy) of subspecialty second-opinion (SSO) consultations for Computed Tomography (CT) examinations in Multiple Myeloma (MM) patients undergoing stem cell transplantation on standard computed tomography with a focus on focal lesion detection. Materials and Methods: Approval from the institutional review board was obtained. This retrospective study included 70 MM consecutive patients (mean age, 62 years ± 11.3 (standard deviation); range, 35–88 years) admitted in the last six years. Pre-transplant total-body CT (reported by general radiologists) was the only inclusion criteria. Each of these CT examinations had a second-opinion interpretation by two experienced subspecialty musculoskeletal (MSK) radiologists (13 years of experience and 6 years of experience, mean: 9.5 years), experts in musculoskeletal radiology and bone image interpretation with a focus on lytic lesions. Results: Per lesion intra- and inter-observer agreement between the two radiologists was calculated with K statistics and the results were good (K = 0.67: Confidence Inteval (CI) 95%: 0.61–0.78). When the initial CT reports were compared with the re-interpretation reports, 46 (65%) of the 70 cases (95% CI: 37–75%) had no discrepancy. There was a discrepancy in detecting a clinically unimportant abnormality in 10/70 (14%) patients (95% CI: 7–25%) unlikely to alter patient care or irrelevant to further clinical management. A discrepancy in interpreting a clinically important abnormality was registered in 14/70 (21%) patients for focal lesions. The mean diameter of focal lesions was: 23 mm (95% CI: 5–57 mm). The mean number of focal lesions per patient was 3.4 (95% CI). Conclusions: subspecialty second-opinion consultations in multiple myeloma CT is more accurate to identify lesions, especially lytic lesions, amenable to influence patients’ care.

scholarly journals Application of Computed Tomography (CT) Attenuation Values in Diagnosis of Transudate and Exudate in Patients with Pleural Effusion

2018 ◽  
Vol 11 (02) ◽  
pp. 19-25
Author(s):  
Keshab Sharma ◽  
PS Lamichhane ◽  
BK Sharma
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Ct Scan ◽  
Pleural Fluid ◽  
Pleural Effusions ◽  
Hounsfield Units ◽  
Fluid Analysis ◽  
Ct Attenuation ◽  
The Mean ◽  
Attenuation Values

Background: Pleural effusion is the pathologic accumulation of fluid in the pleural space. The fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. Analysis of pleural fluid by thoracentesis with imaging guidance helps to determine the cause of pleural effusion. The purpose of this study was to assess the accuracy of computed tomography (CT) in characterizing pleural fluid based on attenuation values and CT appearance. Materials and Methods: This prospective study included 100 patients admitted to Gandaki Medical College and Teaching Hospital, Pokhara, Nepal between January 1, 2017 and February 28, 2018. Patients who were diagnosed with pleural effusion and had a chest CT followed by diagnostic thoracentesis within 48 hours were included in the study. Effusions were classified as exudates or transudates using laboratory biochemistry markers on the basis of Light’s criteria. The mean attenuation values of the pleural effusions were measured in Hounsfield units in all patients using a region of interest with the greatest quantity of fluid. Each CT scan was also reviewed for the presence of additional pleural features. Results: According to Light’s criteria, 26 of 100 patients with pleural effusions had transudates, and the remaining patients had exudates. The mean attenuation of the exudates (16.5 ±1.7 HU; 95% CI, range, -33.4 – 44 HU) was significantly higher than the mean attenuation of the transudates (11.6 ±0.57 HU; 95% CI, range, 5 - 16 HU), (P = 0.0001). None of the additional CT features accurately differentiated exudates from transudates (P = 0.70). Fluid loculation was found in 35.13% of exudates and in 19.23% of transudates. Pleural thickening was found in 29.7% of exudates and in 15.3% of transudates. Pleural nodule was found in 10.8% of exudates which all were related to the malignancy. Conclusion: CT attenuation values may be useful in differentiating exudates from transudates. Exudates had significantly higher Hounsfield units in CT scan. Additional signs, such as fluid loculation, pleural thickness, and pleural nodules were more commonly found in patients with exudative effusions and could be considered and may provide further information for the differentiation.

scholarly journals Comparison of the diagnostic accuracy of cone beam computed tomography and three intraoral radiographic systems in the diagnosis of carious lesions in vitro.

2020 ◽  
Vol 9 (6) ◽  
pp. 466-473
Author(s):  
Jorge A. Beltrán ◽  
◽  
Roberto A. León-Manco ◽  
Maria Eugenia Guerrero ◽  
◽  
...  
Keyword(s):  
Computed Tomography ◽  
Dental Caries ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Cone Beam Computed Tomography ◽  
Area Under The Curve ◽  
Cone Beam ◽  
Occlusal Surfaces ◽  
Caries Lesions

Objective: The objective of the study was to compare the diagnostic accuracy of cone beam computed tomography and three intraoral radiographic systems in the detection of in vitro caries lesions. Material and Methods: One hundred teeth (46 molars and 54 premolars) were evaluated, including 176 proximal surfaces and 90 occlusal surfaces, with or without dental caries lesions. Digital images of all teeth were obtained using specific intraoral radiographs, VistaScan DürrDental®phosphor-plate radiography, XIOS XG Sirona® digital sensor radiography, and CBCT I-CATTM. Observers evaluated the images for the detection of caries lesions. The teeth were clinically sectioned and stereomicroscopy served as a validation tool. The relationship of sensitivity and specificity between all systems was determined through the ROC curve using Az values. Results: The values of the area under the curve (Az) selected for the CBCT I-CATTM system were 0.89 (0.84-0.93), for conventional radiography 0.71 (0.66-0.76), digital sensor radiography 0.74 (0.70-0.78) and digital radiography with phosphor-plates 0.73 (0.69-0.77). Statistically significant differences were found between the CBCT I-CATTM system and intraoral radiographic systems (p<0.01). The sensitivity and specificity values for the CBCT I-CATTM were 0.84 and 0.93 respectively. Conclusion: CBCT has a high sensitivity and specificity compared to intraoral radiographic systems for the diagnosis of dental caries lesions in vitro.

scholarly journals ASSESSMENT OF JAW BONE DENSITY IN TERMS OF HOUNSFIELD UNITS USING CONE BEAM COMPUTED TOMOGRAPHY FOR DENTAL IMPLANT TREATMENT PLANNING

2021 ◽  
Vol 71 (1) ◽  
pp. 221-27
Author(s):  
Myra Ahmad ◽  
Yasir Ikram Ahmed ◽  
Farheen Qureshi ◽  
Muhammad Sharjeel Ashraf ◽  
Zubair Ahmed Khan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Density ◽  
Treatment Planning ◽  
Cone Beam Computed Tomography ◽  
Cone Beam ◽  
Hounsfield Units ◽  
Implant Placement ◽  
The Mean ◽  
Anterior Mandible ◽  
Implant Treatment

Objective: To assess jawbone density in terms of Hounsfield units using cone beam computed tomography fordental implant treatment planning in patients reporting to a local tertiary care dental hospital Study Design: Cross sectional study. Place and Duration of Study: Department of Periodontology and Oral Implantology, Fatima Memorial Hospital, Lahore, from Mar to Sep 2018. Methodology: A total of 100 patients who fulfilled the inclusion criteria and underwent implant placement wereincluded in the study. After ethical approval, informed and written consent, brief history was taken and a singleradiographer exposed and took cone beam computed tomography scan of all the subjects using PLANMECAmachine. A single investigator using PLANMECA software recorded jawbone density in terms of Hounsfieldunits. All data were presented as mean, SD and one way ANOVA was used. Multiple comparisons of the fourregions in the maxilla and mandible were performed with a Tukey test. An independent t-test was also used tocompare gender with age groups and bone density. Results: Total of 100 patients who underwent implant placement were included, 48 (48%) were males & 52 (52%) were females with the mean age of 28.53 ± 5.33 years. The mean jawbone density in terms of Hounsfield units using cone beam computed tomography in anterior maxilla was 709.75 ± 122.63 Hounsfield units, posterior maxilla was 299.66 ± 73.09 Hounsfield units, anterior mandible was 1093.34 ± 109.42 Hounsfield units and posterior mandible was 599.45 ± 135.55 Hounsfield units (p<.001). Conclusion: The anterior mandible and anterior...........

scholarly journals Diagnostic performance of a wearing dynamic ECG recorder for Atrial Fibrillation screening: The HUAMI heart study

2021 ◽  
Author(s):  
Fu Wenxia ◽  
Li Ruogu
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Normal Sinus Rhythm ◽  
False Negative ◽  
Upright Position ◽  
Normal Sinus ◽  
Heart Study ◽  
User Friendly

Abstract Background: Atrial fibrillation (AF) is the most prevalent cardiac dysrhythmia with a significant morbidity and mortality rate. Notably, one out of three patients with AF is asymptomatic. Given the asymptomatic and paroxysmal nature of AF, AF's timely detection with traditional instruments is somewhat unsatisfactory and delayed. Thus, wearing a dynamic electrocardiogram (ECG) recorder can help analyze, interpret, and distinguish AF from normal sinus rhythm accurately and safely, even in an upright position and after exercises, using an artificial intelligence (AI) algorithm.Methods: A total of 114 participants in the outpatient registry of our institution from June 24, 2020 to July 24, 2020, were enrolled. Participants were tested with a wearable dynamic ECG recorder and 12-lead ECG in a supine, an upright position and after exercises for 60seconds. Results: A total of 114 subjects (sixty-one with normal sinus rhythm, fifty-three with AF) were enrolled in the study. The number of cases unable to be determined by the dynamic ECG recorder wristband was two, one in each group. Case results not clinically objective were defined as false-negative or false-positive. The diagnostic accuracy, sensitivity and specificity using wearable dynamic ECG recorders in a supine position were 94.74% (95% CI% 88.76%-97.80%), 88.68% (95% CI 77.06%-95.07%) and100% (95% CI 92.91%-100%), respectively. Meanwhile, the diagnostic accuracy, sensitivity and specificity in an upright position were 97.37% (95% CI% 92.21%-99.44%), 94.34% (95% CI 84.03%-98.65%), and 100% (95% CI 92.91%-100%), respectively. The result after exercise was the same as the result of the upright position.Conclusion: AF can be detected using the widely accessible wearable dynamic ECG recorder with an AI algorithm after different postures and exercises. It may provide a useful and user-friendly screening tool, diagnosing AF early in at-risk individuals.

scholarly journals Diagnostic Accuracy of PCR Alone and Compared to Urinary Antigen Testing for Detection of Legionella spp.: a Systematic Review

2015 ◽  
Vol 54 (2) ◽  
pp. 401-411 ◽  
Author(s):  
Tomer Avni ◽  
Amir Bieber ◽  
Hefziba Green ◽  
Tali Steinmetz ◽  
Leonard Leibovici ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Diagnostic Performance ◽  
False Negative ◽  
Clinical Samples ◽  
Direct Immunofluorescence ◽  
Urinary Antigen ◽  
True Negative ◽  
Consensus Definition

The diagnosis of Legionnaires' disease (LD) is based on the isolation ofLegionellaspp., a 4-fold rise in antibodies, a positive urinary antigen (UA), or direct immunofluorescence tests. PCR is not accepted as a diagnostic tool for LD. This systematic review assesses the diagnostic accuracy of PCR in various clinical samples with a direct comparison versus UA. We included prospective or retrospective cohort and case-control studies. Studies were included if they used the Centers for Disease Control and Prevention consensus definition criteria of LD or a similar one, assessed only patients with clinical pneumonia, and reported data for all true-positive, false-positive, true-negative, and false-negative results. Two reviewers abstracted data independently. Risk of bias was assessed using Quadas-2. Summary sensitivity and specificity values were estimated using a bivariate model and reported with a 95% confidence interval (CI). Thirty-eight studies were included. A total of 653 patients had confirmed LD, and 3,593 patients had pneumonia due to other pathogens. The methodological quality of the studies as assessed by the Quadas-2 tool was poor to fair. The summary sensitivity and specificity values for diagnosis of LD in respiratory samples were 97.4% (95% CI, 91.1% to 99.2%) and 98.6% (95% CI, 97.4% to 99.3%), respectively. These results were mainly unchanged by any covariates tested and subgroup analysis. The diagnostic performance of PCR in respiratory samples was much better than that of UA. Compared to UA, PCR in respiratory samples (especially in sputum samples or swabs) revealed a significant advantage in sensitivity and an additional diagnosis of 18% to 30% of LD cases. The diagnostic performance of PCR in respiratory samples was excellent and preferable to that of the UA. Results were independent on the covariate tested. PCR in respiratory samples should be regarded as a valid tool for the diagnosis of LD.

Foreign body ingestion: comparison of diagnostic accuracy of computed tomography versus endoscopy

2008 ◽  
Vol 123 (5) ◽  
pp. 535-540 ◽  
Author(s):  
W-H Luk ◽  
W C Fan ◽  
R Y Y Chan ◽  
S W W Chan ◽  
K H Tse ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Clinical Findings ◽  
Foreign Body Ingestion ◽  
Persistent Symptoms ◽  
Computed Tomography Images

AbstractPurpose:To investigate and compare the sensitivity and specificity of computed tomography and of endoscopy, as diagnostic tests for foreign body ingestion.Materials and methods:Over a two-year period, Asian patients with suspected foreign body ingestion were studied. The clinical findings, computed tomography images, endoscopic results, treatment and outcomes were prospectively analysed.Results:Over the study period, 193 patients were admitted for foreign body ingestion, complaining of a persistent foreign body sensation in the neck. The sensitivity and specificity of computed tomography were 78 and 96 per cent, respectively; the positive predictive value was 75 per cent and the negative predictive value 97 per cent. The diagnostic accuracy of computed tomography was 94 per cent.Conclusion:Our study showed that computed tomography had high negative predictive value and accuracy in the diagnosis of foreign body ingestion. It was useful if endoscopy showed negative findings but the patient still had persistent symptoms of foreign body ingestion.

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