Diagnostic Performance of Galactomannan Antigen Testing in Cerebrospinal Fluid

Testing cerebrospinal fluid (CSF) for the presence of galactomannan (GM) antigen may help in diagnosing cerebral aspergillosis (CA). However, the use of the CSF GM test as a diagnostic test has been little studied. We evaluated its diagnostic performance by comparing the CSF GM optical density indexes (ODI) at different cutoffs in patients with probable and proven CA to those in patients without CA. Patients from 2 tertiary referral hospitals with suspected CA between 2004 and 2014 and in whom CSF GM ODI had been determined were selected. European Organization for Research and Treatment of Cancer/Invasive Infectious Diseases Study Mycoses Group (EORTC/MSG) definitions of invasive aspergillosis and CA were used, but with the exclusion of the test to be validated (i.e., the CSF GM test) as a microbiological EORTC/MSG criterion. The study population consisted of 44 patients (4 with proven CA, 13 with probable CA, and 27 with no CA). Of the 17 patients with CA, 15 had a CSF GM ODI of ≥2.0. Of 27 patients without CA, 26 had a CSF GM ODI of <0.5 and 1 had a CSF GM ODI of 8.2. When a GM CSF ODI cutoff of 1.0 was used, the sensitivity, specificity, and positive and negative predictive values were 88.2%, 96.3%, 93.8%, and 92.9%, respectively. The same results were found when a CSF GM ODI cutoff of 0.5 or 2.0 was used. Testing GM in CSF has a high diagnostic performance for diagnosing CA and may be useful to diagnose or virtually rule out the infection without the need for a cerebral biopsy.

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Simultaneous determination of cerebrospinal fluid oligoclonal bands and the "gamma-protein index" by agarose electrophoresis and densitometry.

Clinical Chemistry ◽

10.1093/clinchem/32.1.84 ◽

1986 ◽

Vol 32 (1) ◽

pp. 84-87 ◽

Cited By ~ 1

Author(s):

C A French ◽

R P Tracy ◽

R A Rudick ◽

A M Kraemer ◽

D A Arvan

Keyword(s):

Cerebrospinal Fluid ◽

Gamma Globulin ◽

Oligoclonal Bands ◽

Laboratory Procedure ◽

Predictive Values ◽

Qualitative And Quantitative ◽

Agarose Electrophoresis ◽

Sensitivity Specificity ◽

Single Laboratory

Abstract Oligoclonal bands were identified in electropherograms of cerebrospinal fluid, and the "gamma-protein index" was concurrently calculated from the same strip. For the index, an upper limit of normal of 0.66 was established. We compared results with the clinical diagnosis in 69 patients with multiple sclerosis and 48 control patients with other diseases. Sensitivity, specificity, and positive predictive values of 73%, 96%, and 96%, respectively, were obtained from the index. An abnormal index and the presence of oligoclonal bands combined increased the positive predictive value to 100%. This approach may allow adequate qualitative and quantitative assessment of gamma-globulin abnormalities in cerebrospinal fluid after a single laboratory procedure.

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Accuracy of MRCP compared to ERCP in the diagnosis of bile duct disorders

South African Journal of Radiology ◽

10.4102/sajr.v12i1.580 ◽

2008 ◽

Vol 12 (1) ◽

pp. 14 ◽

Cited By ~ 4

Author(s):

Delmé Hurter ◽

Coert De Vries ◽

Pierre Potgieter ◽

Renald Barry ◽

Frikkie Botha ◽

...

Keyword(s):

Bile Duct ◽

Prospective Observational Study ◽

Magnetic Resonance Cholangiopancreatography ◽

Endoscopic Retrograde ◽

Predictive Values ◽

Biliary Pathology ◽

Study Population ◽

Small Study Population ◽

Bile Duct Calculi ◽

Sensitivity Specificity

AIM: To determine the accuracy of Magnetic Resonance Cholangiopancreatography compared to the gold standard Endoscopic Retrograde Cholangiopancreatography in the diagnosis of bile duct disorders at our institution. PATIENTS AND METHODS: 52 patients with suspected pancreatobiliary pathology were included in this prospective observational study. MRCP was performed in the 24-hour period prior to the ERCP. RESULTS: MRCP had sensitivity, specificity, positive and negative predictive values of 87%, 80%, 83.3% and 84.2% respectively for choledocholitiasis which correlates well with results obtained in other parts of the world. CONCLUSION: At our institution, MRCP has high diagnostic accuracy for bile duct calculi. Due to a small study population, results for other biliary pathology were inconclusive

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Evaluation of endometrial carcinoma on magnetic resonance imaging

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.00805.x ◽

2007 ◽

Vol 17 (1) ◽

pp. 188-196 ◽

Cited By ~ 105

Author(s):

A. G. Rockall ◽

R. Meroni ◽

S. A. Sohaib ◽

K. Reynolds ◽

F. Alexander-Sefre ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Endometrial Carcinoma ◽

Diagnostic Performance ◽

Myometrial Invasion ◽

Imaging Features ◽

Nodal Metastases ◽

Resonance Imaging ◽

Predictive Values ◽

Sensitivity Specificity

Our aims were to assess diagnostic performance of T2-weighted (T2W) and dynamic gadolinium-enhanced T1-weighted (T1W) magnetic resonance imaging (MRI) in the preoperative assessment of myometrial and cervical invasion by endometrial carcinoma and to identify imaging features that predict nodal metastases. Two radiologists retrospectively reviewed MR images of 96 patients with endometrial carcinoma. Tumor size, depth of myometrial and cervical invasion, and nodal enlargement were recorded and then correlated with histology. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the identification of any myometrial invasion (superficial or deep) were 0.94, 0.50, 0.93, 0.55 on T2W and 0.92, 0.50, 0.92, 0.50 on dynamic T1W, and for deep myometrial invasion were 0.84, 0.78, 0.65, 0.91 on T2W and 0.72, 0.88, 0.72, 0.88 on dynamic T1W. The sensitivity, specificity, PPV and NPV for any cervical invasion (endocervical or stromal) were 0.65, 0.87, 0.57, 0.90 on T2W and 0.50, 0.90, 0.46, 0.92 on dynamic T1W, and for cervical stromal involvement were 0.69, 0.95, 0.69, 0.95 on T2W and 0.50, 0.96, 0.57, 0.95 on dynamic T1W. Leiomyoma or adenomyosis were seen in 73% of misdiagnosed cases. Sensitivity and specificity for the detection of nodal metastases was 66% and 73%, respectively. Fifty percent of patients with cervical invasion on MRI had nodal metastases. In conclusion, MRI has a high sensitivity for detecting myometrial invasion and a high NPV for deep invasion. MRI has a high specificity and NPV for detecting cervical invasion. Dynamic enhancement did not improve diagnostic performance. MRI may allow accurate categorization of cases into low- or high-risk groups ensuring suitable extent of surgery and adjuvant therapy

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Evaluating the clinical usefulness of platelet function testing: Considerations for the proper application and interpretation of performance measures

Thrombosis and Haemostasis ◽

10.1160/th12-08-0608 ◽

2013 ◽

Vol 109 (05) ◽

pp. 808-816 ◽

Cited By ~ 25

Author(s):

Matthew J. Price ◽

Helen Parise ◽

Paul A. Gurbel ◽

Jeffrey R. Dahlen

Keyword(s):

Performance Measures ◽

Platelet Function ◽

Diagnostic Performance ◽

Clinical Usefulness ◽

Pharmacodynamic Effect ◽

Predictive Values ◽

Prognostic Performance ◽

Platelet Function Testing ◽

Sensitivity Specificity ◽

Function Testing

SummaryVarious diagnostic and prognostic performance measures have been used to describe the clinical usefulness of platelet function testing in the evaluation and management of patients taking P2Y12 inhibitors, which reduce the risk for thrombosis due to their action on the platelet P2Y12 receptor. Platelet function tests are used to confirm the presence of an antiplatelet effect of a P2Y12 inhibitor, and confirmation that the pharmacodynamic effect is associated with a reduction in the rate of thrombosis. Despite this clear association, enthusiasm for the clinical usefulness of platelet function testing has been tempered based on observed sensitivity, specificity, and positive predictive value for the detection of future thrombotic events. However, evaluating the prognostic utility of a test based on diagnostic performance indicators is not appropriate because prognostic tests are not used to diagnose which patients will have events; instead, they are used to assist in risk stratification. Therefore, when evaluating the usefulness of platelet function testing, diagnostic performance measures such as sensitivity, specificity, and predictive values should focus on diagnostic performance in identifying a pharmacodynamic effect, and prognostic performance should be evaluated using prognostic performance measures such as hazard ratios and net reclassification improvement, which are comparable to other well-established risk factors for cardiovascular events.

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Scanned versus Fused-Reconstructed Oblique MR-Images for Assessment of the Tibiofibular Syndesmosis—Diagnostic PerFormance and Reader Agreement

Diagnostics ◽

10.3390/diagnostics11020197 ◽

2021 ◽

Vol 11 (2) ◽

pp. 197

Author(s):

Hannes Seuss ◽

Matthias Hammon ◽

Frank Roemer ◽

Rafael Heiss ◽

Rolf Janka ◽

...

Keyword(s):

Diagnostic Performance ◽

False Negative ◽

Ankle Sprains ◽

Tibiofibular Syndesmosis ◽

Mr Images ◽

Predictive Values ◽

Tibiofibular Ligament ◽

Ligament Rupture ◽

Sensitivity Specificity ◽

Oblique Images

To evaluate the diagnostic performance and reader agreement of a novel MRI image fusion method enabling the reconstruction of oblique images for the assessment of the tibiofibular syndesmosis. We evaluated 40 magnetic resonance imaging examinations of patients with ankle sprains (16 with ruptures and 24 without) for the presence of anteroinferior tibiofibular ligament rupture. For all patients, we performed a fusion of standard two-dimensional transversal and coronal 3 mm PDw TSE images into an oblique-fusion reconstruction (OFR) and compared these against conventionally scanned oblique sequence for the evaluation of the tibiofibular syndesmosis. To evaluate diagnostic performance, two expert readers independently read the OFR images twice. We analyzed sensitivity, specificity, negative and positive predictive values, accuracy, and agreement. Reader 1 misinterpreted one OFR as a false negative, demonstrating a sensitivity of 0.94 and specificity of 1.00, reader 2 demonstrated perfect accuracy. Intrareader agreement was almost perfect for reader 1 (α = 0.95) and was perfect for reader 2 (α = 1.00). Additionally, interreader agreement between all fusion sequence reads was almost perfect (α = 0.97). The proposed OFR enables reliable detection of anteroinferior tibiofibular ligament rupture with excellent inter- and intrareader agreement, making conventional scanning of oblique images redundant and supplies a method to retroactively create oblique images, e.g., from external examinations.

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Noninvasive Methods, including Transient Elastography, for the Detection of Liver Disease in Adults with Cystic Fibrosis

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2015/138530 ◽

2015 ◽

Vol 29 (3) ◽

pp. 139-144 ◽

Cited By ~ 18

Author(s):

Matthew D Sadler ◽

Pam Crotty ◽

Linda Fatovich ◽

Stephanie Wilson ◽

Harvey R Rabin ◽

...

Keyword(s):

Cystic Fibrosis ◽

Liver Disease ◽

Diagnostic Performance ◽

Transient Elastography ◽

Liver Stiffness ◽

Roc Curves ◽

Noninvasive Methods ◽

Predictive Values ◽

Area Under Roc Curve ◽

Sensitivity Specificity

BACKGROUND: Liver disease is the third leading cause of mortality in patients with cystic fibrosis (CF). However, detection of CF-associated liver disease (CFLD) is challenging.OBJECTIVE: To evaluate the diagnostic performance of noninvasive methods for the detection of CFLD with a focus on transient elastography (TE).METHODS: Patients at the Adult CF Clinic of Calgary and Southern Alberta (n=127) underwent liver stiffness measurement (LSM) by TE using the FibroScan (FS, Ecosens, France) M probe; aspartate amino-transferase to platelet ratio index (APRI) and FibroTest (FT) scores were also calculated. The diagnostic performance of these tools for the detection of CFLD (defined as two or more the following criteria: abnormal liver biochemistry, hepatomegaly or sonographic abnormalities other than steatosis) were compared using the area under ROC curves.RESULTS: Forty-seven percent of the cohort was male. The median age was 27 years (interquartile range [IQR] 22 to 37 years) and body mass index 21 kg/m2(IQR 19 kg/m2to 23 kg/m2); 25% of patients were on ursodeoxycholic acid and 12% had undergone lung transplantation. The prevalence of CFLD was 14% (n=18). FS was successful in all patients; one (0.8%) patient had poorly reliable results (IQR/M >30% and LSM ≥7.1kPa). Compared with patients without CFLD (n=109), individuals with CFLD had higher median LSM according to FS (3.9 kPa [IQR 3.4 to 4.9 kPa] versus 6.4 kPa [IQR 4.4 to 8.0 kPa]), APRI (0.24 [IQR 0.17 to 0.31] versus 0.50 [IQR 0.22 to 1.18]) and FT scores (0.08 [IQR 0.05 to 1.5] versus 0.18 [IQR 0.11 to 0.35]; all P<0.05). Area under ROC curve for FS, APRI and FT for the detection of CFLD were 0.78 (95% CI 0.65 to 0.92), 0.72 (95% CI 0.56 to 0.87) and 0.76 (95% CI 0.62 to 0.90) (P not significant). At a threshold of >5.2 kPa, the sensitivity, specificity, positive and negative predictive values of LSM according to FS for detecting CFLD were 67%, 83%, 40% and 94%, respectively.CONCLUSIONS: FS, APRI and FT were useful noninvasive methods for detecting CFLD in adults.

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Diagnostic accuracy and validity of the O-RADS MRI score based on a simplified MRI protocol: a single tertiary center retrospective study

Acta Radiologica ◽

10.1177/02841851211060413 ◽

2021 ◽

pp. 028418512110604

Author(s):

Serdar Aslan ◽

Sebnem Alanya Tosun

Keyword(s):

Area Under The Curve ◽

Imaging Method ◽

Predictive Values ◽

Experienced Radiologist ◽

Tertiary Center ◽

Mri Protocol ◽

Study Population ◽

Magnetic Resonance Imaging Mri ◽

Sensitivity Specificity ◽

Mri Score

Background Adnexal masses (AM) are a common gynecological problem. It is important to use a reliable imaging method in the differentiation of benign and malignant AMs. Purpose To assess the accuracy and validity of the O-RADS magnetic resonance imaging (MRI) score for characterizing AM using a simplified MRI protocol. Material and Methods The study population comprised 332 women who underwent MRI due to the detection of indeterminate AM on ultrasonography between January 2018 and June 2020. An experienced radiologist calculated the O-RADS MRI score into five categories, using an MRI protocol with a simplified dynamic study. Sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) were calculated (cutoff for malignancy, score ≥ 4). The reference standard was histopathologic diagnosis or imaging findings during >24 months of follow-up. Results Of 237 AMs, 28 (11.9%) were malignant. The malignancy rates of AMs with scores of 1, 2, 3, 4, and 5 were 0% (0/12), 0% (0/111), 1.2% (1/77), 50% (10/20), and 100% (17/17), respectively. The O-RADS MRI score showed 96.3% sensitivity, 95.2% specificity, and 95.3% accuracy in malignancy prediction. The AUC for the differentiation of benign and malignant masses were 0.983. False positivity rate was high in cases with an O-RADS MRI score of 4 (50%). Conclusion The O-RADS MRI score, based on a simplified MRI protocol, has high accuracy and validity in distinguishing benign from malignant sonographically indeterminate AMs. Its use in clinical practice can classify the malignancy risks of masses and prevent unnecessary surgery in benign lesions.

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Cerebrospinal Fluid (1,3)-Beta-d-Glucan Testing Is Useful in Diagnosis of Coccidioidal Meningitis

Journal of Clinical Microbiology ◽

10.1128/jcm.01224-16 ◽

2016 ◽

Vol 54 (11) ◽

pp. 2707-2710 ◽

Cited By ~ 10

Author(s):

David A. Stevens ◽

Yonglong Zhang ◽

Malcolm A. Finkelman ◽

Demosthenes Pappagianis ◽

Karl V. Clemons ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Diagnostic Performance ◽

Operating Characteristic ◽

Characteristic Curve ◽

False Negative ◽

Beta Glucan ◽

Predictive Values ◽

Serial Samples ◽

The One ◽

Commercial Kit

Diagnosing coccidioidal meningitis (CM) can be problematic owing to its infrequency and/or a delay in the positivity of a cerebrospinal fluid (CSF) culture or CSF antibody, particularly if the primary coccidioidal infection is unrecognized. We tested 37 CSF specimens, 26 from patients with confirmed CM and 11 from patients with suspected microbial meningitis without fungal diagnosis, for (1,3)-beta-glucan (BG). BG in CM CSF specimens ranged from 18 to 3,300 pg/ml and in controls ranged from <3.9 to 103 pg/ml. Diagnostic performance was determined using a 31-pg/ml cutoff (the bottom of the serum range according to the directions for the commercial kit, although further serial dilutions of the standard indicated linearity to 3.9). Sensitivity was 96%, specificity was 82%, positive and negative predictive values were 93% and 90%, and the area under the receiver operating characteristic curve was 0.937. Fifteen of 15 samples of >103 pg/ml were CM. The one false-negative specimen was from a patient with a pseudosyrinx, without inflammatory evidence of meningitis activity. Serial samples from some patients were positive at ≤8 years, indicating no loss of positivity with chronicity. Samples stored frozen since 2000 included those with 2 of the 3 highest values, indicating that fresh samples not required. A previous study indicated serum sensitivities of 53% in acute, 50% in resolved, and 83% in disseminated and meningeal coccidioidomycosis. Three studies of other fungal meningitides ranged from 86 to 1,524 pg/ml CSF, with 37 controls of <4 to 115 pg/ml CSF. CSF BG analysis had good diagnostic performance in CM. CSF BG testing can be useful in CM, and a commercial kit is available. It will be of interest to correlate this with course, treatment, outcome, inflammation, and antigen. The only mycoses with common central nervous system (CNS) involvement are cryptococcal and coccidioidal, so CSF BG screening can be useful in meningitis diagnosis.

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Diagnostic reliability of a simplified epidemiologic tool to detect high-risk overjet for dental trauma.

Brazilian Dental Science ◽

10.14295/bds.2015.v18i4.1167 ◽

2015 ◽

Vol 18 (4) ◽

pp. 68

Author(s):

Andressa Reisen ◽

Alessandra Ramos Parpaiola ◽

Arlete Maria Gomes Oliveira ◽

Luciane Zanin ◽

Flávia Martão Flório

Keyword(s):

High Risk ◽

Dental Trauma ◽

Diagnostic Reliability ◽

Gold Standard Method ◽

Predictive Values ◽

Simplified Method ◽

External Examiner ◽

Study Population ◽

Sensitivity Specificity

Objective: To evaluate the diagnostic reliability of a simplified tool to detect high-risk overjet for dental trauma. Material and Methods: The study population was composed of 131 volunteers divided into two groups according to the overjet measurement in terms of risk for traumatic dental injury (GRAB: risk absent and GRPR: risk present). The distance between the most prominent labial surface and its corresponding counterpart was measured using both the conventional (WHO, 1997) and the simplified tool. The measurements were taken independently and on separate occasions by two previously calibrated dental surgeons (Kappa=0.86). The gold standard method, as recommended by the WHO (1997), was performed by an external examiner. The simplified method, based on pencil-marked wooden tongue depressors was carried out in a blind manner by the other examiner. Sensitivity, specificity, positive and negative predictive values were calculated for the classification of risk for dental trauma in terms of overjet using the simplified method and compared to the conventional method. Results: The results revealed high values for sensitivity (S=1), specificity (E=0.93), positive (PPV=0.95) and negative predictive value (NPV=1). Conclusion: The examination using the simplified tool was reliable in identifying high-risk overjet, thus offering an alternative to the conventional examination.

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Diagnostic accuracy of serum lipase and amylase as biomarkers for acute pancreatitis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20181766 ◽

2018 ◽

Vol 6 (5) ◽

pp. 1721

Author(s):

Anil Kumar ◽

Sangeeta Kapoor

Keyword(s):

Acute Pancreatitis ◽

Diagnostic Accuracy ◽

Serum Amylase ◽

Health Care Facilities ◽

Likelihood Ratios ◽

Serum Lipase ◽

Predictive Values ◽

Single Marker ◽

Study Population ◽

Sensitivity Specificity

Background: Currently, majority of clinicians ask for both amylase and lipase for diagnosis of acute pancreatitis but a large number of health care facilities in India still have facility for only amylase. Aim was to find which single marker to be used in for diagnosis of acute pancreatitis.Methods: Patients seeking care at emergency department for acute abdominal pain during the period from July 2016 to June 2017 formed the study population. The serum lipase and amylase were taken from 1725 patients. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were calculated.Results: Sixteen patients had amylase above 3-fold elevation, while there were 26 such patients in the lipase group. The sensitivity and specificity of amylase at 3-fold above normal limit were 62.8% and 99.2% while those of lipase were 96.1% and 99.1% respectively. Both amylase and lipase had high accuracy index in the area under the ROC curve (0.990 and 0.997 respectively).Conclusions: In this study, serum lipase had better diagnostic accuracy as compared to serum amylase. In resource-constrained settings with limited lab and radiological facilities, serum lipase should be preferred over serum amylase for diagnosis of acute pancreatitis.

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