scholarly journals Diagnostic power of chest CT for COVID-19: to screen or not to screen

2020 ◽  
Author(s):  
K. De Smet ◽  
D. De Smet ◽  
I. Demedts ◽  
B. Bouckaert ◽  
T. Ryckaert ◽  
...  
Keyword(s):  
High Sensitivity ◽  
High Specificity ◽  
Diagnostic Value ◽  
Chest Ct ◽  
Respiratory Pathogens ◽  
Likelihood Ratios ◽  
Asymptomatic Patients ◽  
Diagnostic Power ◽  
Low Sensitivity ◽  
A Prospective Study

Structured abstractBackgroundchest CT is increasingly used for COVID-19 screening in healthcare systems with limited SARS-CoV-2 PCR capacity. Its diagnostic value was supported by studies with methodological concerns and its use is controversial. Here we investigated its potential to diagnose COVID-19 in symptomatic patients and to screen asymptomatic patients in a prospective study with minimal selection bias.MethodsFrom March 19, 2020 to April 20, 2020 we performed parallel SARS-CoV-2 PCR and CT with categorization of COVID-19 suspicion by CO-RADS, in 859 patients with COVID-19 symptoms and 1138 controls admitted to the hospital for COVID-19 unrelated medical urgencies. CT-CORADS was categorized on a 5-point scale from 1 (very low suspicion) to 5 (very high suspicion). AUC under ROC curve were calculated in symptomatic versus asymptomatic patients to predict positive SARS-CoV-2 positive PCR and likelihood ratios for each CO-RADS score were used for rational selection of diagnostic thresholds.FindingsCT-CORADS had significant (P<0.0001) diagnostic power in both symptomatic (AUC=0.891) and asymptomatic (AUC=0.700) patients hospitalized during SARS-CoV-2 peak prevalence. In symptomatic patients (41.7% PCR+), CO-RADS ≥ 3 detected positive PCR with high sensitivity (89.1%) and 72.5% specificity. In asymptomatic patients (5.3% PCR+), a CO-RADS score ≥ 3 detected SARS-CoV-2 infection with low sensitivity (45.0%) but high specificity (88.8%).InterpretationCT-CORADS has meaningful diagnostic power in symptomatic patients, supporting its application for time-sensitive triage. Sensitivity in asymptomatic patients is insufficient to justify its use as screening approach. Incidental detection of CO-RADS ≥ 3 in asymptomatic patients should trigger reflex testing for respiratory pathogens.

scholarly journals Early chest computed tomography to diagnose COVID-19 from suspected patients: A multicenter retrospective study

2020 ◽  
Author(s):  
Congliang Miao ◽  
Mengdi Jin ◽  
Li Miao ◽  
Xinying Yang ◽  
Peng Huang ◽  
...  
Keyword(s):  
Ground Glass Opacity ◽  
High Specificity ◽  
Diagnostic Value ◽  
Chest Ct ◽  
Imaging Features ◽  
Rt Pcr ◽  
Polymerase Chain ◽  
Low Sensitivity ◽  
Chest Ct Scan ◽  
Ct Features

AbstractObjectiveThe purpose of this study is to distinguish the imaging features of COVID-19 with other chest infectious diseases and evaluate diagnostic value of chest CT for suspected patients.MethodsAdult suspected patients aged>18 years within 14 days who underwent chest CT scan and reverse-transcription polymerase-chain-reaction (RT-PCR) tests were enrolled. The enrolled patients were confirmed and grouped according to results of RT-PCR tests. The data of basic demographics, single chest CT features, and combined chest CT features were analyzed for confirmed and non-confirmed groups.ResultsA total of 130 patients were enrolled with 54 cases positive and 76 cases negative. The typical CT imaging features of positive group were ground glass opacity (GGO), crazy-paving pattern and air bronchogram. The lesions were mostly distributed bilaterally, close to the lower lungs or the pleura. When features combined, GGO with bilateral pulmonary distribution and GGO with pleural distribution were more common, of which were 31 cases (57.4%) and 30 cases (55.6%) respectively. The combinations were almost presented statistically significant (P<0.05) except for the combination of GGO with consolidation. Most combinations presented relatively low sensitivity but extremely high specificity. The average specificity of these combinations is around 90%.ConclusionsThe combinations of GGO could be useful in the identification and differential diagnosis of COVID-19, which alerts clinicians to isolate patients for treatment promptly and repeat RT-PCR tests until incubation ends.

scholarly journals Interest of Ultrasound in the Exploration of Rotator Cuff Lesions - Confrontation of Clinical Examination and Ultrasound Finding

2018 ◽  
Vol 5 ◽  
Author(s):  
Nessrine Akasbi ◽  
Asmae El Aissaoui ◽  
Ikrame Yazghich ◽  
Samira El Fakir ◽  
Taoufik Harzy
Keyword(s):  
Rotator Cuff ◽  
Physical Examination ◽  
Clinical Examination ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Ultrasound Finding ◽  
X Ray ◽  
Rotator Cuff Lesion ◽  
Rotator Cuff Lesions ◽  
A Prospective Study

Introduction: The aim of our study was to evaluate the interest of ultrasound in the exploration of painful shoulders evoking rotator cuff lesions and to determine the diagnostic value of the different tendon tests through a confrontation physical examination versus shoulder ultrasound. Materials and methods: A prospective study was conducted including patients consulting for shoulder pain that suggests a rotator cuff lesion. All patients underwent a clinical examination, an x ray and shoulder ultrasound.Results: The confrontation physical examination versus shoulder ultrasound showed that Jobe's test is very sensitive (100%) but less specific (27%), the Patte test, has a high sensitivity (100%) but an average specificity (51%), the Palm-Up test was fairly sensitive (91%) but not very specific (43%) and the Gerber test was more specific (95.7%) and less sensitive (38%). The comparison between x ray and ultrasound showed that ultrasound of shoulder is more efficient in the detection of calcifications and erosions of humeral head.Conclusion: Ultrasound of shoulder is more performant than physical examination and x ray in exploring the rotator cuff lesions.

scholarly journals The Rule of Histology in the Diagnosis of Periprosthetic Infection: Specific Granulocyte Counting Methods and New Immunohistologic Staining Techniques may Increase the Diagnostic Value

2016 ◽  
Vol 10 (1) ◽  
pp. 457-465 ◽  
Author(s):  
Friedrich Boettner ◽  
Gabriele Koehler ◽  
Alexander Wegner ◽  
Tom Schmidt-Braekling ◽  
Georg Gosheger ◽  
...  
Keyword(s):  
Periprosthetic Infection ◽  
High Specificity ◽  
Diagnostic Value ◽  
Lower Sensitivity ◽  
Specific Staining ◽  
Tissue Samples ◽  
Hip And Knee Arthroplasty ◽  
Staining Techniques ◽  
Low Sensitivity ◽  
Intraoperative Test

Objective: The current study investigates the diagnostic accuracy of the criteria described for frozen sections and whether modern leukocyte specific staining techniques including leukocyte peroxidase and Naphtol-AS-D-chloroacetate-esterase will improve the accuracy of the intra-operative histology. Method: 77 patients undergoing revision total hip and knee arthroplasty were included in this retrospective study. Patients were grouped into septic and aseptic based on intraoperative cultures. Tissue samples were analyzed utilizing the Mirra, Feldman, Lonner, Banit and Athanasou criteria. Results: An experienced pathologist had a high specificity (96%), but rather low sensitivity (57%) diagnosing infection. By using the Banit-, Mirra-, or Athanasou-criteria the sensitivity is increased to 0.90. The Feldman- and Lonner-criteria have a lower sensitivity (0.48 and 0.38), however, an increased specificity of 0.96 and 0.98, respectively. The Banit cut off has the highest accuracy (86%). MPOX and NACE staining increased the sensitivity and accuracy up to 100% and 92% respectively. Conclusion: Banit’s cut off is the most accurate histologic criteria to diagnose infection. Modern leukocyte specific staining techniques slightly improve the accuracy. The synovial fluid white blood cell count appears to be the most accurate intraoperative test.

Epstein-Barr Virus (EBV)-Encoded RNA: Automated In-Situ Hybridization (ISH) Compared with Manual ISH and Immunohistochemistry for Detection of EBV in Pediatric Lymphoproliferative Disorders

2009 ◽  
Vol 12 (3) ◽  
pp. 195-199 ◽  
Author(s):  
Naim K. Fanaian ◽  
Cynthia Cohen ◽  
Sandra Waldrop ◽  
Jennifer Wang ◽  
Bahig M. Shehata
Keyword(s):  
In Situ Hybridization ◽  
Predictive Value ◽  
Epstein Barr Virus ◽  
High Sensitivity ◽  
High Specificity ◽  
Lymphoproliferative Disorders ◽  
Barr Virus ◽  
Epstein Barr ◽  
Low Sensitivity

Detection of Epstein-Barr virus (EBV) may be achieved by various methods, including EBV-encoded RNA (EBER) in-situ hybridization (ISH) and immunohistochemistry (IHC) for latent membrane protein (LMP-1). We compared novel automated ISH and IHC techniques in pediatric lymphoproliferative disorders with results obtained by manual ISH. Thirty-seven pediatric cases previously studied by manual EBER ISH (including 18 EBER-positive, 15 EBER-negative, and 4 EBER-equivocal cases) were used for the study. Automated EBER ISH and automated LMP-1 IHC were performed using the BondMax autostainer and prediluted EBER probe and EBV cell surface 1 to 4 at 1:50 dilution, respectively. Results of each of the automated techniques for EBV detection were compared with results by manual EBER ISH. Compared with manual EBER ISH as the gold standard, automated ISH had a sensitivity and specificity of 94% and 69%, respectively, accuracy of 83%, positive predictive value (PPV) of 79%, and negative predictive value (NPV) of 90%. Automated IHC had a sensitivity of 44%, specificity of 93%, accuracy of 67%, PPV of 88%, and NPV of 59%. Automated ISH and IHC correlated significantly ( P < 0.045). Automated ISH is useful for diagnosis of EBV-related pediatric neoplasms, being easy to perform and interpret and requiring only the technologist's time to set up and having a high sensitivity and NPV. The automated IHC protocol is of too low sensitivity for routine use, although results show high specificity and PPV.

scholarly journals Validation of the French version of the McLean Screening Instrument for Adolescent Borderline Personality Disorder (MSI-BPD)

2020 ◽  
Author(s):  
Bojan Mirkovic ◽  
Mario Speranza ◽  
Lionel Cailhol ◽  
Julien-Daniel Guelfi ◽  
Fernando Perez-Diaz ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychometric Properties ◽  
High Sensitivity ◽  
High Specificity ◽  
Structured Interview ◽  
Screening Instrument ◽  
Borderline Personality ◽  
French Version ◽  
Low Sensitivity

Abstract Background: The study examines the psychometric properties of the French version of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) created by M. Zanarini to screen borderline personality disorder in clinical and non-clinical populations.Method: In this multicentric longitudinal study from the European Network on Borderline Personality Disorder, a sample of 84 adolescent patients from five psychiatric centres and 85 matched controls without psychiatric comorbidity completed the MSI-BPD, French version, and were interviewed with the Structured Interview for DSM-IV Personality (SIDP-IV), in order to assess the presence or absence of borderline personality disorder.Results: The MSI-BPD showed excellent internal consistency (α = 0.87 [0.84;0.90]). Compared to the semi-structured reference interview (SIDP-IV), the MSI-BPD showed substantial congruent validity (AUC = 0.93, CI 95%: 0.90 - 0.97). The optimal cut-off point in the present study was 5 or more, as it had relatively high sensitivity (0.87) and specificity (0.85). In our sample, the cut-off point (7 or more) proposed by the original developers of the MSI-BPD showed high specificity (0.95) but low sensitivity (0.63).Conclusions: The French version of the MSI-BPD is now available, and its psychometric properties are satisfactory. The French version of the MSI-PBD can be used as a screening tool for borderline personality disorder, for clinical purposes or in research studies.

scholarly journals CD10 and Das1: A Biomarker Study Using Immunohistochemistry to Subtype Gastric Intestinal Metaplasia

2021 ◽  
Author(s):  
Athanasios Koulis ◽  
Natasha Costanzo ◽  
Catherine Mitchell ◽  
Stephen Lade ◽  
David Goode ◽  
...  
Keyword(s):  
Intestinal Metaplasia ◽  
High Sensitivity ◽  
High Specificity ◽  
Expression Data ◽  
Gastric Intestinal Metaplasia ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Risk Of Progression ◽  
Low Sensitivity ◽  
Digital Quantification

Abstract Background: Intestinal metaplasia (IM) is considered a key pivot point in the Correa model of gastric cancer (GC). It is histologically subtyped into the complete and incomplete subtypes, the latter being associated with a greater risk of progression. However, the clinical utility of IM subtyping remains unclear, partially due to the absence of reliable defining biomarkers.Methods: Based on gene expression data and existing literature, we selected CD10 and Das1 as candidate biomarkers to distinguish complete and incomplete IM glands in tissues from patients without GC (IM-GC) and patients with GC (IM+GC). Immunohistochemical staining of individually subtyped IM glands was scored after blinding by two researchers using tissue belonging to both IM-GC and IM+GC patients. Whole tissue Das1 staining was further assessed using digital image quantification (cellSens Dimension, Olympus).Results: Across both cohorts CD10 stained the IM brush border and was shown to have a high sensitivity (87.5% and 94.9% in IM-GC and IM+GC patients respectively) and specificity (100.0% and 96.7% respectively) with an overall AUROC of 0.944 for complete IM glands. By contrast Das1 stained mainly goblet cells and the apical membrane of epithelial cells, mostly of incomplete IM glands with a low sensitivity (28.6% and 29.3% in IM-GC and IM+GC patients respectively) but high specificity (98.3% and 85.1% respectively) and an overall AUROC of 0.603 for incomplete IM glands. A combined logistic regression model showed a significant increase in AUROC for detecting complete IM glands (0.955 vs 0.970). Whole tissue digital quantification of Das1 staining showed a significant association with incomplete IM compared to complete IM, both in IM-GC and in IM+GC patients (p=0.016 and p=0.009 respectively, Mann-Whitney test and unpaired t test used). Additionally, complete IM in IM+GC patients exhibited significantly more Das1 staining than in IM-GC patients (p=0.019, Mann-Whitney test). Conclusions: These findings suggest that CD10 is an outstanding biomarker for complete IM and Das1 may be useful as a secondary biomarker for IM glands at greater risk of progression irrespective of IM subtype. Overall, the clinical use of these biomarkers could lead to improved patient stratification and targeted surveillance.

scholarly journals Engineered CRISPR/Cas12a Enables Rapid SARS-CoV-2 Detection

2020 ◽  
Author(s):  
Long T. Nguyen ◽  
Santosh R. Rananaware ◽  
Brianna L.M. Pizzano ◽  
Brandon T. Stone ◽  
Piyush K. Jain
Keyword(s):  
High Sensitivity ◽  
High Specificity ◽  
Single Copy ◽  
Lateral Flow ◽  
Lateral Flow Assay ◽  
Magnesium Concentration ◽  
Clinical Validation ◽  
Respiratory Pathogens ◽  
Reporter Assay ◽  
Wide Range

ABSTRACTThe coronavirus disease (COVID-19) caused by SARS-CoV-2 has swept through the globe at an unprecedented rate. CRISPR-based detection technologies such as DETECTR, SHERLOCK, and STOPCovid have emerged as a rapid and affordable platform that can shape the future of diagnostics. Recently, we reported engineered crRNAs for Cas12a, called ENHANCE, that enables enhanced detection of nucleic acids. Here we report development, clinical validation, and advancement of ENHANCE platform for detecting SARS-CoV-2. With an RT-LAMP pre-amplification step, ENHANCE detects samples down to a single copy with 95% accuracy and shows high specificity towards various isolates of SARS-CoV-2 against 31 highly similar and common respiratory pathogens. Utilizing LbCas12a-mediated trans-cleavage activity, ENHANCE works robustly in a wide range of magnesium concentration (3 mM-13 mM), allowing for further assay optimization. Additionally, ENHANCEv2 is developed to further improve the previously reported ENHANCE. ENHANCEv2 employs mutated LbCas12aD156R, engineered chimeric DNA-extended crRNA, and a dual reporter for both fluorescence-based reporter assay and lateral flow assay. Both ENHANCE and ENHANCEv2 are validated in 62 clinical nasopharyngeal swabs, showing 60/62 (96.7%) agreement with RT-qPCR results, and using only 5 μL of sample and 20 minutes of CRISPR reaction. Lateral flow assay on paper strips displays 100% agreement with fluorescence-based reporter assay in the clinical validation. Following a 30-minute pre-amplification RT-LAMP step, the lyophilized ENHANCEv2 is shown to achieve high sensitivity and specificity while reducing CRISPR reaction time to as low as 3 minutes and maintaining its detection capability upon storage at room temperature for several weeks.

scholarly journals Role of endoscopy in suspicion of atrophic gastritis with and without intestinal metaplasia in comparison to histopathology

2021 ◽  
Vol 84 (1) ◽  
pp. 9-17
Author(s):  
H Ibrahim ◽  
A Shams El-Deen ◽  
ZA Kasemy ◽  
M Saad ◽  
AA Sakr
Keyword(s):  
Atrophic Gastritis ◽  
Intestinal Metaplasia ◽  
Sensitivity And Specificity ◽  
Chronic Gastritis ◽  
Gastrointestinal Symptoms ◽  
High Sensitivity ◽  
High Specificity ◽  
Poor Correlation ◽  
Gastric Lesions ◽  
Low Sensitivity

Background and study aims : Atrophic gastritis (AG) and intestinal metaplasia (IM) are established premalignant gastric lesions. Many studies documented a poor correlation between esophagogastroduodenoscopy (EGD) and histopathological (HP) findings of precancerous gastric lesions. The aim was to bridge the gap between endoscopy and HP in detection of chronic gastritis, AG and IM. Patients and methods : a prospective single-center study involved 150 patients with endoscopic criteria of gastric lesions with upper gastrointestinal symptoms referred for upper GI endoscopy met the endoscopic criteria and classified according to HP of biopsies from targeted gastric lesions into chronic gastritis (GI), AG(GII) or IM(GIII). We correlated the endoscopic criteria of the 3 groups with the HP results. Results : (73males & 75 females) with ages ranged17-75 years and mean± SD was 41.96 ± 15.95. GI, GII &GIII were [42 patients (28%),82 patients (54.7%) and 26 patients (17.3%)], respectively. Diffuse gastric mottling was more common in GI (74.3%, P<0.001), visible submucosal vessels, gastric atrophy predominated in GII (75.6, 82.3 & 73.1% (P 0.005,0.4 & <0.01)), respectively. Whitish raised lesions were more specific in GIII (85.7%) (P<0.001). The sensitivity and specificity of endoscopic suspicion of chronic gastritis were (86&88% in GI), (87&85% in GII) and (54% &100% in GIII) (p-0.001). The logistic regression model for risk factors was χ2= 25.74 and 49.32, p < 0.001. Conclusion : Conventional endoscopy has high sensitivity and specificity for suspicion of chronic gastritis and AG, but low sensitivity and very high specificity for IM. Targeted biopsies may be valuable with image enhanced techniques.

scholarly journals Cardiac troponins: current information on the main analytical characteristics of determination methods and new diagnostic possibilities

Medwave ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. e002132-e002132
Author(s):  
Aleksey M. Chaulin
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Cross Reactivity ◽  
Current Data ◽  
Myocardial Infarctions ◽  
Low Sensitivity ◽  
Muscle Lesions ◽  
Cardiac Troponins

The methods used to diagnose cardiovascular diseases are constantly being improved, leading to an expanded perception of the diagnostic value of biomarkers and their new diagnostic possibilities. One striking example are the main biomarkers used to diagnose acute myocardial infarction: cardiac troponins. The first methods for determining cardiac troponins (proposed 30 years ago) were characterized by extremely low sensitivity. Therefore, they could only detect large acute myocardial infarctions. These methods were also characterized by low specificity, expressed as a high probability of cross-reactivity with skeletal troponin isoforms, which generated false-positive results in the presence of skeletal myopathies and skeletal muscle lesions. With the introduction of high-sensitivity cardiac troponins into clinical practice, the possibility of early diagnosis and exclusion of acute myocardial infarction by assessing troponin concentrations in the first few hours (from admission to the first hour, second hour, or third hour) has become more specific. Our knowledge about cardiac troponins has changed over the years and promising new medical uses have emerged. This paper reviews current data on the diagnostic value of cardiac troponins, the main methods used for their determination, and their analytical characteristics from historical and modern insights.

scholarly journals Diagnostic value of HRCT-Thorax for pandemic COVID-19 pneumonia in Pakistan

2020 ◽  
Vol 24 (Supp-1) ◽  
pp. 77-84
Author(s):  
Abdul Rasheed Qureshi ◽  
Zaheer Akhtar ◽  
Muhammad Irfan ◽  
Muhammad Sajid ◽  
Zeeshan Ashraf
Keyword(s):  
High Sensitivity ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Sudden Onset ◽  
High Resolution Computed Tomography ◽  
Diagnostic Efficacy ◽  
Cross Sectional ◽  
Experienced Radiologist ◽  
Variable Extent ◽  
Low Sensitivity

Background: In the scenario of, inadequate testing, the low sensitivity of the COVID-19-PCR test, limited availability of testing kits, and low detection rate, we aimed to investigate the usefulness of high-resolution computed tomography of chest (HRCT) for diagnosing pandemic coronavirus (COVID-19) pneumonia. Objective: To determine the diagnostic efficacy of HRCT thorax in Covid-19 pandemic pneumonia. Materials and Methods: This prospective, cross-sectional study was conducted in the Pulmonology–OPD of Gulab Devi Teaching Hospital, Lahore-Pakistan from 01-04-2020 to 15-07-2020.   121 patients with dry cough, fever, and dyspnea of sudden onset were included while patients with Bronchial Asthma, ILD, Tuberculosis, Bronchiectasis, COPD, and overt heart failure were excluded. Patients were investigated with chest x-ray, HRCT, COVID-PCR, and hematological tests. HRCT films were evaluated by a qualified and experienced radiologist. Findings were summarized, organized and statistical analysis was done by using SPSS-26 software to make an inference. Results: Five patients were diagnosed as non-covid. Out of 116-diagnosed covid-19 patients, 38(32.75%) showed sub-pleural consolidation, 19(16.37%) consolidation with air-bronchogram, 29(25.0%) crazy paving sign, one pleural effusion (0.86%) and 18 cases (15.51%) displayed reticulations. 11cases(9.48%) had isolated ground glass appearances, while all categories showed it to variable extent. 65 patients (56.03%) were PCR-positive while  51(43.96) patients with positive-HRCT findings for COVID-19 pneumonia had negative nasopharyngeal-PCR. HRCT-Thorax revealed sensitivity: 97.41 %, specificity: 80%, PPV: 99.12%, NPV: 57.14%, and diagnostic accuracy of 96.69% for COVID-19 pneumonia. Conclusion: HRCT-Thorax, having high sensitivity and adequate specificity, can provide foundations for evidence-based early diagnosis and quantification of coronavirus pneumonia.  It can be tremendously useful for decision making in   PCR-negative patients and anticipating respiratory improvement or decline by serial scans.

Sign in / Sign up

Export Citation Format

Share Document