The Diagnostic Accuracy/Efficacy of MRI in Differentiating Hepatic Hemangiomas from Metastatic Colorectal/Breast Carcinoma: A Multiple Reader ROC Analysis Using a Jackknife Technique

SummaryThe aim of our study was to evaluate the value of a pictorial atlas of 123I FP-CIT SPECT images for aid in the visual diagnosis. Patients, materials, methods: Sixty patients, of whom 20 were clinically diagnosed as ‘non-parkinsonian’ and 40 as having Parkinson's disease or any related disorder, were included in the study. An atlas consisting of 12 123I FP-CIT SPECT images was constructed first. Validity of the atlas was investigated by performing a receiver operating characteristic (ROC) analysis with the clinical diagnosis as the gold standard. The remaining 48 SPECT images were visually assessed twice by 5 observers, first with and secondly without consulting the atlas, or vice versa. The added value of the atlas was investigated by comparing the diagnostic accuracy and the interobserver variability for both methods. Results: ROC analysis performed on the atlas yielded an area under the curve of 1 for a threshold discriminating between clinically non-parkinsonian and parkinsonian patients that was situated between image 4 and 5 of the atlas. For the diagnostic accuracy, we found that the area under the ROC curve was systematically higher if observers had access to the atlas compared to when they had not (Wilcoxon's test, p<0.05). Also, the interobserver variability was significantly lower when observers used the atlas when compared to when they did not (p = 0.05). Conclusion: Diagnostic accuracy was significantly higher and interobserver variability significantly lower if observers had access to the atlas compared to when they had not. Hence, having a pictorial atlas available may facilitate the visual assessment of 123I FP-CIT SPECT scans.

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T1 and ECV mapping texture analysis distinguishing hypertrophic cardiomyopathy from athletes heart better than median values

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab090.085 ◽

2021 ◽

Vol 22 (Supplement_2) ◽

Author(s):

T Dresselaers ◽

P Rafouli-Stergiou ◽

R De Bosscher ◽

S Tilborghs ◽

C Dausin ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Texture Analysis ◽

Roc Analysis ◽

Left Ventricular ◽

Athlete’S Heart ◽

Support Vector ◽

Mapping Data ◽

Intensive Training ◽

Native T1 ◽

Athlete's Heart

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ph.D fellowship of the Research Foundation Flanders (FWO). The Master@Heart trial is funded by the FWO. Introduction Differentiating intensive training induced hypertrophy from hyperthropic cardiomyopathy (HCM) is important to identify those young athletes at risk of sudden cardiac death. Swoboda and colleagues demonstrated that T1 and ECV mapping can aid such a differentiation between athletic and pathological hypertrophy, particularly in subjects with indeterminate wall thickness (1). Recently texture analysis (TA) methods of CMR data have demonstrated improved diagnostic accuracy over conventional qualitative analysis in various heart diseases. Only few studies have applied TA to T1 and ECV mapping data (2-4). Here we aimed to demonstrate that a TA approach provides superior capacity to distinguish HCM from athlete’s heart over average native T1 and ECV values. Purpose It was our hypothesis that a texture analysis of T1 and ECV mapping images would identify features that could discriminate between a HCM and athlete’s heart with a higher classification accuracy (CA) than average T1 and ECV values. Methods This study included data from 97 subjects diagnosed with HCM (acc. to guidelines; 5) and 28 athletes that took part in the Master@Heart trial (an ongoing study assessing the beneficial effects of long-term endurance exercise for the prevention of coronary artery disease, 6). Long and short axis T1 mapping data was acquired on a 1.5T Philips Ingenia system using MOLLI (seconds scheme). After offline motion correction and T1 and ECV map calculation (7), the left ventricular myocardium was manually delineated (3D Slicer; 8). Texture analysis of the masked images resulted in 194 features (Pyradiomics, standard settings; 9). The dataset was then split (75/25%) for training and testing purposes keeping images from the same subject within the same set. A fast correlation based filter rank was applied to the training data to derive relevant features. A further reduction to only two features was based on the CA of a support vector machine (SVM) learning method (linear kernel; cost 0.9 regression loss epsilon 0.1; leave-one-out). Finally, ROC analysis on the test data was used to determine the diagnostic accuracy for the following predictors: (1) median T1 and ECV (2) two most relevant features (training) (3) combination of (1) and (2) (ROC AUC statistics (10)). Results The two most relevant features were the histogram feature ECV energy and the gray level size zone matrix (GLSZM) feature native T1 zone entropy, a measure of heterogeneity in the texture pattern. A model to distinguish HCM from athletes based on these features outperformed the model using only median T1 and ECV values with both higher sensitivity and specificity (table 1) and a significantly higher AUC in the ROC analysis (p < 0.05, figure 1). Combining these two features with median values did not improve the CA further. Conclusion Texture analysis of motion-corrected T1 and ECV mapping images out-performs classical analysis based on average values in distinguishing HCM from athlete"s heart.

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Evaluating the diagnostic accuracy of gene xpert analysis in pediatric pulmonary tuberculosis: a prospective clinical study in North-Western India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20211083 ◽

2021 ◽

Vol 8 (4) ◽

pp. 716

Author(s):

Venkatesh Karthik S. ◽

Jigisha Patadiya

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Roc Analysis ◽

Gastric Lavage ◽

Control Program ◽

Tuberculin Test ◽

Receiver Operating Curve ◽

Prospective Clinical Study ◽

Western India ◽

X Rays

Background: The diagnosis of tuberculosis (TB) by microbiological tests is a major challenge particularly in children. The use of Xpert analysis, a rapid genetic testing modality is not widely reported in our locality. The aim of the study to evaluate the diagnostic accuracy of Gene xpert analysis in diagnosis of pediatric Pulmonary TB.Methods: A prospective hospital-based study was conducted among 140 participants with symptomatology pertaining to pulmonary TB as per Revised national tuberculosis control program (RNTCP, India) criteria. The Xpert testing (GXT) was performed as per standards and was compared with erythrocyte sedimentation rate (ESR), tuberculin test (TT) and chest X-rays (CXR). The obtained results were reported in terms of Sensitivity %, Specificity %, Positive Predictive Value % (PPV) and Negative Predictive Value % (NPV) for comparisons. The receiver operating curve (ROC) analysis was employed to evaluate the accuracy of diagnosis.Results: The GXT was positive (10.71 %) in suspected TB patients. TT has significantly (10 %) with a73.33% sensitivity, 93.60% specificity and a PPV of 57.89 % when compared with xpert. The ESR showed a sensitivity of 53.33% and a specificity of 56%. The CXR showed sensitivity of 93.33%. The ROC analysis showed that TT had a higher confidence interval (0.699-0.970) t5`han other methods. The Rifampicin resistance was found 7.5% (n=2) of 15 GXT positive cases.Conclusions: The xpert based diagnosis of gastric lavage samples after a tuberculin test (TT) had high sensitivity and specificity, followed by chest X ray while the ESR had lower clinical accuracy. The ‘gene xpert analysis’ is highly useful rapid tool for diagnosis of children with TB.

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Clinical Utility of Striational Antibodies in Paraneoplastic and Myasthenia Gravis Paraneoplastic Panels

Neurology ◽

10.1212/wnl.0000000000012050 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012050

Author(s):

Shahar Shelly ◽

John R Mills ◽

Divyansu Dubey ◽

Andrew McKeon ◽

Anastasia Zekeridou ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Myasthenia Gravis ◽

Clinical Utility ◽

Roc Analysis ◽

Thymic Cancer ◽

Diagnostic Characteristics ◽

Data Platform ◽

Neurological Phenotype ◽

Antibody Positivity

Objective:To critically assess the clinical utility of striational antibodies (StrAbs) within paraneoplastic and myasthenia gravis serological evaluations.Methods:All Mayo Clinic patients tested for StrAbs from January 1st 2012-December 31st 2018 utilizing Mayo’s Unified Data Platform (UDP) were reviewed for neurological diagnosis and cancer.Results:38,502 unique paraneoplastic and 1,899 MG patients were tested. In paraneoplastic evaluations, the StrAbs positivity rate was higher in cancer vs without cancer (5% [321/6775] vs 4% [1154/31727]; p<0.0001; OR 1.35; CI=1.19-1.53) but ROC analysis indicated no diagnostic accuracy in cancer (AUC=0.505). No neurological phenotype was significantly associated with StrAbs in the paraneoplastic group. Positivity was more common in all MG cancers compared to paraneoplastic cancers (p<0.0001). In MG evaluations, the StrAbs positivity rate was higher in those with cancer vs without (46% [217/474] vs 26% [372/1425]; p<0.0001; OR 2.39, CI 1.9-2.96) with ROC analysis indicating poor diagnostic accuracy for thymic cancer (AUC 0.634, recommended cutoff=1:60, sensitivity=56%, specificity=71%), with worse accuracy for extrathymic cancers (AUC 0.543). In paraneoplastic or MG evaluations, the value of antibody positivity did not improve cancer predictions. Paraneoplastic evaluated patients were more likely with positive StrAbs to obtain computed tomography (CT) (p=0.0001) with 3% (12/468) cancer found.Conclusion:Despite a statistically significant association with cancer, an expansive review of performance in clinical service demonstrates that StrAbs are neither specific nor sensitive in predicting malignancy or neurological phenotypes. CT imaging is over utilized with positive StrAbs results. Removal of StrAbs from paraneoplastic or MG evaluations will improve the diagnostic characteristics of the current MG test.Classification of Evidence:This study provides Class II evidence that the presence of StrAbs do not accurately identify patients with malignancy or neurological phenotypes.

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Effects of polyclonal activators on cell differentiation and cytokine production of cultured invasive breast carcinoma of no special type, their association with tumour histopathological parameters and lymph node metastasis

International Journal of Immunopathology and Pharmacology ◽

10.1177/2058738420950580 ◽

2020 ◽

Vol 34 ◽

pp. 205873842095058

Author(s):

Alexander Autenshlyus ◽

Sergey Arkhipov ◽

Elena Mikhailova ◽

Igor Marinkin ◽

Nikolay Varaksin ◽

...

Keyword(s):

Lymph Node ◽

Cell Differentiation ◽

Breast Carcinoma ◽

Lymph Node Metastasis ◽

Roc Analysis ◽

Cytokine Production ◽

Stimulation Index ◽

Gm Csf ◽

Node Metastasis ◽

Tnf Α

Currently, a number of promising strategies and approaches to cancer treatment include differentiation therapy. However, theoretical and methodological foundations of this field are not yet well developed. The objective of this study was to determine the effects of a mixture of polyclonal activators (PAs; phytohaemagglutinin, concanavalin A and lipopolysaccharide) on cytokine production by biopsy samples of invasive breast carcinoma of no special type (IBC-NST) having various differentiation abilities and metastatic potentials as well as on differentiation status of the IBC-NST biopsy samples. We used ELISAs to investigate spontaneous and PA-stimulated cytokine production in the IBC-NST biopsy samples; from these data, we calculated a cytokine production stimulation index (SIPA). The effect of PAs on tumour cell differentiation was determined via a differentiation stimulation index (DSI). DSI was found to vary within the range 1.0–5.0. After treatment with PAs, in the IBC-NST biopsy samples of group I (DSI <1.25), the production of IL-2, IL-6, IL-8, IL-17, IL-18, IL-1β, IL-1Ra, TNF-α and GM-CSF increased; in the biopsy samples of group II (DSI >1.25), the production of IL-6, IL-1β, IL-1Ra, TNF-α, G-CSF and GM-CSF significantly increased, while the production of VEGF-A decreased. Receiver operating characteristic (ROC) analysis of SIPA revealed that increased production of IL-18 in the IBC-NST biopsy samples after exposure to PAs may block the PA-driven, cytokine-mediated differentiation of moderately differentiated into highly differentiated tumour cells. The ROC analysis also uncovered an association between the responses of tumour cells to PAs and lymph node metastasis observed in the patients. The findings suggest that there is a need for research aimed at finding new drugs for differentiating cancer therapy and at searching for targeted inducers of cytokine production or specific suppressors of their induction.

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ROC Analysis: Assessment of Diagnostic Accuracy in the Laboratory

Laboratory Medicine ◽

10.1093/labmed/22.10.708 ◽

1991 ◽

Vol 22 (10) ◽

pp. 708-711 ◽

Cited By ~ 1

Author(s):

Mark H. Zweig

Keyword(s):

Diagnostic Accuracy ◽

Roc Analysis

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Cut-off limits of the peak GH response to stimulation tests for the diagnosis of GH deficiency in children and adolescents: study in patients with organic GHD

Acta Endocrinologica ◽

10.1530/eje-16-0105 ◽

2016 ◽

Vol 175 (1) ◽

pp. 41-47 ◽

Cited By ~ 16

Author(s):

Chiara Guzzetti ◽

Anastasia Ibba ◽

Sabrina Pilia ◽

Nadia Beltrami ◽

Natascia Di Iorgi ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Children And Adolescents ◽

Roc Analysis ◽

Operating Characteristic ◽

Gh Deficiency ◽

Tolerance Test ◽

Gh Secretion ◽

Insulin Tolerance ◽

Igf I ◽

Stimulation Tests

ObjectiveThe diagnosis of GH deficiency (GHD) in children and adolescents is established when GH concentrations fail to reach an arbitrary cut-off level after at least two provocative tests. The objective of the study was to define the optimal GH cut-offs to provocative tests in children and adolescents.DesignRetrospective study in 372 subjects who underwent evaluation of GH secretion. GH and IGF-I were measured by chemiluminescence assay in all samples. Receiver operating characteristic (ROC) analysis was used to evaluate the optimal GH cut-offs and the diagnostic accuracy of provocative tests.MethodsSeventy four patients with organic GHD (GH peak <10μg/L after two provocative tests) and 298 control subjects (GH response >10μg/L to at least one test) were included in the study. The provocative tests used were arginine, insulin tolerance test (ITT) and clonidine. Diagnostic criteria based on cut-offs identified by ROC analysis (best pair of values for sensitivity and specificity) were evaluated for each test individually and for each test combined with IGF-I SDS.ResultsThe optimal GH cut-off for arginine resulted 6.5μg/L, 5.1μg/L for ITT and 6.8μg/L for clonidine. IGF-I SDS has low accuracy in diagnosing GHD (AUC=0.85). The combination of the results of provocative tests with IGF-I concentrations increased the specificity.ConclusionsThe results of the ROC analysis showed that the cut-off limits which discriminate between normal and GHD are lower than those commonly employed. IGF-I is characterized by low diagnostic accuracy.

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