Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group

2016 ◽  
Vol 75 (11) ◽  
pp. 1958-1963 ◽  
Author(s):  
Robert G W Lambert ◽  
Pauline A C Bakker ◽  
Désirée van der Heijde ◽  
Ulrich Weber ◽  
Martin Rudwaleit ◽  
...  
Keyword(s):  
Working Group ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Imaging Features ◽  
Mri Features ◽  
Asas Classification Criteria ◽  
Diagnosis And Classification ◽  
Active Sacroiliitis ◽  
Definition Of

ObjectivesTo review and update the existing definition of a positive MRI for classification of axial spondyloarthritis (SpA).MethodsThe Assessment in SpondyloArthritis International Society (ASAS) MRI working group conducted a consensus exercise to review the definition of a positive MRI for inclusion in the ASAS classification criteria of axial SpA. Existing definitions and new data relevant to the MRI diagnosis and classification of sacroiliitis and spondylitis in axial SpA, published since the ASAS definition first appeared in print in 2009, were reviewed and discussed. The precise wording of the existing definition was examined in detail and the data and a draft proposal were presented to and voted on by the ASAS membership.ResultsThe clear presence of bone marrow oedema on MRI in subchondral bone is still considered to be the defining observation that determines the presence of active sacroiliitis. Structural damage lesions seen on MRI may contribute to a decision by the observer that inflammatory lesions are genuinely due to SpA but are not required to meet the definition. The existing definition was clarified adding guidelines and images to assist in the application of the definition.ConclusionThe definition of a positive MRI for classification of axial SpA should continue to primarily depend on the imaging features of ‘active sacroiliitis’ until more data are available regarding MRI features of structural damage in the sacroiliac joint and MRI features in the spine and their utility when used for classification purposes.

scholarly journals The Banff Working Group Classification of Definitive Polyomavirus Nephropathy: Morphologic Definitions and Clinical Correlations

2017 ◽  
Vol 29 (2) ◽  
pp. 680-693 ◽  
Author(s):  
Volker Nickeleit ◽  
Harsharan K. Singh ◽  
Parmjeet Randhawa ◽  
Cinthia B. Drachenberg ◽  
Ramneesh Bhatnagar ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Working Group ◽  
Classification Scheme ◽  
Clinical Presentation ◽  
Interstitial Fibrosis ◽  
The United States ◽  
Systematic Analysis ◽  
Definition Of ◽  
Morphologic Classification

Polyomavirus nephropathy (PVN) is a common viral infection of renal allografts, with biopsy-proven incidence of approximately 5%. A generally accepted morphologic classification of definitive PVN that groups histologic changes, reflects clinical presentation, and facilitates comparative outcome analyses is lacking. Here, we report a morphologic classification scheme for definitive PVN from the Banff Working Group on Polyomavirus Nephropathy, comprising nine transplant centers in the United States and Europe. This study represents the largest systematic analysis of definitive PVN undertaken thus far. In a retrospective fashion, clinical data were collected from 192 patients and correlated with morphologic findings from index biopsies at the time of initial PVN diagnosis. Histologic features were centrally scored according to Banff guidelines, including additional semiquantitative histologic assessment of intrarenal polyomavirus replication/load levels. In-depth statistical analyses, including mixed effects repeated measures models and logistic regression, revealed two independent histologic variables to be most significantly associated with clinical presentation: intrarenal polyomavirus load levels and Banff interstitial fibrosis ci scores. These two statistically determined histologic variables formed the basis for the definition of three PVN classes that correlated strongest with three clinical parameters: presentation at time of index biopsy, serum creatinine levels/renal function over 24 months of follow-up, and graft failure. The PVN classes 1–3 as described here can easily be recognized in routine renal biopsy specimens. We recommend using this morphologic PVN classification scheme for diagnostic communication, especially at the time of index diagnosis, and in scientific studies to improve comparative data analysis.

Considering Context: An Integrative Concept for Promoting Outcomes in the Intellectual Disability Field

2013 ◽  
Vol 51 (2) ◽  
pp. 132-137 ◽  
Author(s):  
Karrie A. Shogren
Keyword(s):  
Intellectual Disability ◽  
Research Policy ◽  
Rapid Evolution ◽  
Policy And Practice ◽  
Consensus Definition ◽  
Individuals With Disabilities ◽  
Diagnosis And Classification ◽  
Integrative Concept ◽  
Definition Of

Abstract In light of the rapid evolution of research, policy, and practice in the intellectual disability (ID) field resulting from shifts in our conceptualization of disability and in frameworks for the diagnosis and classification of ID, systematic consideration of the multiple, interrelated contextual factors that impact research, policy, and practice are necessary to achieve valued outcomes for individuals with disabilities, their families, and society. The purpose of this article is to introduce a recently developed consensus definition of context and elaborate on application of this definition to research, practice, and policy in the ID field, with a specific focus on how context may be able to serve as an integrative concept to support the attainment of valued outcomes in the disability field for individuals with disabilities, their families, and society.

Diagnosis and classification of axial spondyloarthritis

2016 ◽  
Author(s):  
Floris van Gaalen ◽  
Désirée van der Heijde ◽  
Maxime Dougados
Keyword(s):  
Chronic Back Pain ◽  
Axial Spondyloarthritis ◽  
Chronic Inflammatory Disease ◽  
Disease Classification ◽  
Laboratory Features ◽  
Bone Changes ◽  
Diagnosis And Classification ◽  
The Difference ◽  
Magnetic Resonance Imaging Mri

Axial spondyloarthritis (axSpA) is a potentially disabling chronic inflammatory disease affecting the spine and sacroiliac (SI) joints. Lead symptoms are chronic back pain and stiffness. The disease is called radiographic axSpA or ankylosing spondylitis (AS) when, on plain radiographs, bone changes consistent with sacroiliitis are present. When no evidence of sacroiliitis is seen on radiographs, it is called non-radiographic axSpA. In such cases, diagnosis is made based on evidence of active inflammation of SI joints on magnetic resonance imaging (MRI) and clinical and laboratory features, or a combination of clinical and laboratory features only. Apart from affecting the spine and SI joints, axSpA may involve peripheral joints (e.g. knee, ankle) and manifest in extra-articular manifestations, for example uveitis, psoriasis, and inflammatory bowel disease. In this chapter, diagnosis and classification of axSpA is discussed, including use of MRI in detecting sacroiliitis and the difference between clinical diagnosis and disease classification.

scholarly journals Diffuse midline gliomas, H3 K27M-mutant are associated with less peritumoral edema and contrast enhancement in comparison to glioblastomas, H3 K27M-wildtype of midline structures

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0249647
Author(s):  
Rouzbeh Banan ◽  
Arash Akbarian ◽  
Majid Samii ◽  
Amir Samii ◽  
Helmut Bertalanffy ◽  
...  
Keyword(s):  
Contrast Enhancement ◽  
Lower Probability ◽  
Imaging Features ◽  
Peritumoral Edema ◽  
Mri Features ◽  
Histological Criteria ◽  
Magnetic Resonance Imaging Mri ◽  
Lower Contrast ◽  
Diffuse Midline Glioma

Purpose The entity ‘diffuse midline glioma, H3 K27M-mutant (DMG)’ was introduced in the revised 4th edition of the 2016 WHO classification of brain tumors. However, there are only a few reports on magnetic resonance imaging (MRI) of these tumors. Thus, we conducted a retrospective survey focused on MRI features of DMG compared to midline glioblastomas H3 K27M-wildtype (mGBM-H3wt). Methods We identified 24 DMG cases and 19 mGBM-H3wt patients as controls. After being retrospectively evaluated for microscopic evidence of microvascular proliferations (MVP) and tumor necrosis by two experienced neuropathologists to identify the defining histological criteria of mGBM-H3wt, the samples were further analyzed by two experienced readers regarding imaging features such as shape, peritumoral edema and contrast enhancement. Results The DMG were found in the thalamus in 37.5% of cases (controls 63%), in the brainstem in 50% (vs. 32%) and spinal cord in 12.5% (vs. 5%). In MRI and considering MVP, DMG were found to be by far less likely to develop peritumoral edema (OR: 0.13; 95%-CL: 0.02–0.62) (p = 0.010). They, similarly, were associated with a significantly lower probability of developing strong contrast enhancement compared to mGBM-H3wt (OR: 0.10; 95%-CL: 0.02–0.47) (P = 0.003). Conclusion Despite having highly variable imaging features, DMG exhibited markedly less edema and lower contrast enhancement in MRI compared to mGBM-H3wt. Of these features, the enhancement level was associated with evidence of MVP.

scholarly journals Assessing interobserver variability and accuracy in the histological diagnosis and classification of cutaneous neurofibromass

2019 ◽  
Vol 2 (Supplement_1) ◽  
pp. i117-i123 ◽  
Author(s):  
Nicolas Ortonne ◽  
Steven L Carroll ◽  
Fausto J Rodriguez ◽  
Douglas C Miller ◽  
Rosalynn M Nazarian ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Neurofibromatosis Type ◽  
Free Text ◽  
Diagnosis And Classification ◽  
Definition Of ◽  
Cutaneous Neurofibromas ◽  
Strong Agreement

Abstract Background Cutaneous neurofibromas (cNFs) are the most common tumors in people with neurofibromatosis type 1 (NF1) and are associated with reduced quality of life. There is currently no widely accepted standardized language for describing cNFs clinically or histopathologically. The objective of this study was to evaluate interobserver agreement across pathologists in describing and reporting of neurofibromas involving the skin. Methods Twenty-eight (H&E)-stained slides of cNF were scanned using an Aperio XT scanner. The digital images were reviewed by 6 pathologists, who entered free text of up to a 200 word description for each case into a REDcap database. Responses were analyzed for the most commonly used terms based on frequency, as well as agreement (reported as concordance) between reviewers. Results A set of the terms most commonly used by pathologists for the histological classification of cNF along with areas of agreement and disagreement have been identified. The study shows that there was strong agreement across reviewers that not all neurofibromas involving the skin are cutaneous neurofibromas and regarding the presence or absence of atypical features and heterologous elements. Areas of less concordance were identified and include cNF subtypes, definition of extension and pattern of growth, as well as the distinction of a cNF from a plexiform without an intraneural component involving skin. Conclusions This work is the first step towards development of a robust classification system and devising “gold standard” histopathologic diagnostic criteria for cutaneous neurofibromas.

scholarly journals Deep learning for detection of radiographic sacroiliitis: achieving expert-level performance

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Keno K. Bressem ◽  
Janis L. Vahldiek ◽  
Lisa Adams ◽  
Stefan Markus Niehues ◽  
Hildrun Haibel ◽  
...  
Keyword(s):  
Neural Network ◽  
Sensitivity And Specificity ◽  
Axial Spondyloarthritis ◽  
Sacroiliac Joints ◽  
Cohen's Kappa ◽  
The Neural Network ◽  
Diagnosis And Classification ◽  
Absolute Agreement ◽  
Artificial Neural

Abstract Background Radiographs of the sacroiliac joints are commonly used for the diagnosis and classification of axial spondyloarthritis. The aim of this study was to develop and validate an artificial neural network for the detection of definite radiographic sacroiliitis as a manifestation of axial spondyloarthritis (axSpA). Methods Conventional radiographs of the sacroiliac joints obtained in two independent studies of patients with axSpA were used. The first cohort comprised 1553 radiographs and was split into training (n = 1324) and validation (n = 229) sets. The second cohort comprised 458 radiographs and was used as an independent test dataset. All radiographs were assessed in a central reading session, and the final decision on the presence or absence of definite radiographic sacroiliitis was used as a reference. The performance of the neural network was evaluated by calculating areas under the receiver operating characteristic curves (AUCs) as well as sensitivity and specificity. Cohen’s kappa and the absolute agreement were used to assess the agreement between the neural network and the human readers. Results The neural network achieved an excellent performance in the detection of definite radiographic sacroiliitis with an AUC of 0.97 and 0.94 for the validation and test datasets, respectively. Sensitivity and specificity for the cut-off weighting both measurements equally were 88% and 95% for the validation and 92% and 81% for the test set. The Cohen’s kappa between the neural network and the reference judgements were 0.79 and 0.72 for the validation and test sets with an absolute agreement of 90% and 88%, respectively. Conclusion Deep artificial neural networks enable the accurate detection of definite radiographic sacroiliitis relevant for the diagnosis and classification of axSpA.

scholarly journals Terminology for describing normally sited and ectopic pregnancies on ultrasound: ESHRE recommendations for good practice

2020 ◽  
Vol 2020 (4) ◽  
Author(s):  
◽  
Emma Kirk ◽  
Pim Ankum ◽  
Attila Jakab ◽  
Nathalie Le Clef ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Ectopic Pregnancy ◽  
Working Group ◽  
Good Practice ◽  
Clear Definition ◽  
Different Types ◽  
Ectopic Pregnancies ◽  
Definition Of ◽  
Comprehensive Classification

Abstract STUDY QUESTION What recommendations can be provided to improve terminology for normal and ectopic pregnancy description on ultrasound? SUMMARY ANSWER The present ESHRE document provides 17 consensus recommendations on how to describe normally sited and different types of ectopic pregnancies on ultrasound. WHAT IS KNOWN ALREADY Current diagnostic criteria stipulate that each type of ectopic pregnancy can be defined by clear anatomical landmarks which facilitates reaching a correct diagnosis. However, a clear definition of normally sited pregnancies and a comprehensive classification of ectopic pregnancies are still lacking. STUDY DESIGN, SIZE, DURATION A working group of members of the ESHRE Special Interest Group in Implantation and Early Pregnancy (SIG-IEP) and selected experts in ultrasound was formed in order to write recommendations on the classification of ectopic pregnancies. PARTICIPANTS/MATERIALS, SETTING, METHODS The working group included nine members of different nationalities with internationally recognised experience in ultrasound and diagnosis of ectopic pregnancies on ultrasound. This document is developed according to the manual for development of ESHRE recommendations for good practice. The recommendations were discussed until consensus by the working group, supported by a survey among the members of the ESHRE SIG-IEP. MAIN RESULTS AND THE ROLE OF CHANCE A clear definition of normally sited pregnancy on ultrasound scan is important to avoid misdiagnosis of uterine ectopic pregnancies. A comprehensive classification of ectopic pregnancy must include definitions and descriptions of each type of ectopic pregnancy. Only a classification which provides descriptions and diagnostic criteria for all possible locations of ectopic pregnancy would be fit for use in routine clinical practice. The working group formulated 17 recommendations on the diagnosis of the different types of ectopic pregnancies on ultrasound. In addition, for each of the types of ectopic pregnancy, a schematic representation and examples on 2D and 3D ultrasound are provided. LIMITATIONS, REASONS FOR CAUTION Owing to the limited evidence available, recommendations are mostly based on clinical and technical expertise. WIDER IMPLICATIONS OF THE FINDINGS This document is expected to have a significant impact on clinical practice in ultrasound for early pregnancy. The development of this terminology will help to reduce the risk of misdiagnosis and inappropriate treatment. STUDY FUNDING/COMPETING INTEREST(S) The meetings of the working group were funded by ESHRE. T.T. declares speakers’ fees from GE Healthcare. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A DISCLAIMER This Good Practice Recommendations (GPR) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation. ESHRE’s GPRs should be used for informational and educational purposes. They should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. Furthermore, ESHRE’s GPRs do not constitute or imply the endorsement, recommendation or favouring of any of the included technologies by ESHRE.

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