scholarly journals OP0180 DIAGNOSTIC VALIDITY OF ULTRASOUND INCLUDING EXTRA-CRANIAL ARTERIES IN GIANT CELL ARTERITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 112.2-112
Author(s):  
I. Monjo ◽  
E. Fernández ◽  
D. Peiteado ◽  
A. Balsa ◽  
E. De Miguel
Keyword(s):  
Positive Predictive Value ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Ultrasound Examination ◽  
Axillary Artery ◽  
Imaging Modality ◽  
Large Vessel ◽  
Research Support

Background:Giant cell arteritis (GCA) is a chronic vasculitis of the medium and large arteries. The involvement of large vessel (LV) either isolated or associated with cranial artery is frequent, so it is necessary to use imaging techniques for diagnosis, because the biopsy in these cases is not useful. European League Against Rheumatism (EULAR) recommends an early imaging test in patients with suspected GCA, and ultrasound of temporal±axillary arteries is recommended as the first imaging modality in patients with suspected predominantly cranial GCA (1).Objectives:To assess the validity of Colour Doppler ultrasound (CDUS) of temporal superficial arteries (TA) and LV (axillary, subclavian and carotid) in the diagnosis of GCA, using as gold standard the patient’s definitive clinical diagnosis. Analyse if routine ultrasound examination of LV improves the diagnostic accuracy.Methods:This was an observational, descriptive and analytical study of 198 consecutive patients with GCA suspicion. A baseline CDUS of the TA and LV was performed. Ultrasound diagnosis was made according to the OMERACT (Outcome Measures in Rheumatology) definitions of halo sign and was established as a limit of average intimal thickness ≥ 0.34 mm for superficial temporal arteries and ≥ 1 mm for axillary, subclavian and carotid arteries. Statistical analysis was performed using SPSS version 25.Results:Eighty-seven patients (43.9%) were CDUS compatible with GCA, and 111 patients (56.1%) had a negative CDUS. Among the patients with positive CDUS three different patterns were detected: 45 patients (51.7%) had an exclusive cranial involvement, 31 (35.6%) had a mixed pattern with involvement of both TA and LV and 11 (12.6%) had an exclusive LV involvement. The validity (sensitivity and specificity) and security (positive predictive value and negative predictive value) of diagnostic are shown in table.When we analyse patients with LV involvement, 87.8% have axillary artery involvement, 77.4% subclavian involvement and 34.4% carotids involvement. If we only explored the axillary arteries, 12.2% of patients with LV involvement would not be diagnosed. However, if we explored axillary and subclavian arteries, 100% of patients with LV involvement would be diagnosed.Conclusion:Half of the patients with GCA have LV involvement and up to 12.8% exclusively LV affectation in our series. Adding CDUS exploration of LV arteries to TA increases both sensitivity and diagnostic specificity. The minimum ultrasound examination of LV should include both axillary and subclavian arteries.References:[1]Dejaco C, Ramiro S, Duftner C, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis. 2018;77(5):636–3SensitivitySpecificityPositive predictive valueNegative predictive valueCDUS TA and LV97,7%97,3%96,6%98,2%CDUS TA83,9%97,3%96,1%88,5%Disclosure of Interests:Irene Monjo: None declared, Elisa Fernández: None declared, Diana Peiteado: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi)

scholarly journals FRI0197 THE DIAGNOSTIC ACCURACY OF VASCULAR ULTRASOUND IN PATIENTS SUSPECTED OF GCA: A DANISH MULTICENTRE PROSPECTIVE COHORT STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 682.1-682
Author(s):  
S. Chrysidis ◽  
U. Møller Døhn ◽  
L. Terslev ◽  
U. Fredberg ◽  
T. Lorenzen ◽  
...  
Keyword(s):  
Multicentre Study ◽  
Diagnostic Accuracy ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Clinical Diagnosis ◽  
Axillary Artery ◽  
Laboratory Data ◽  
Temporal Artery ◽  
Large Vessel ◽  
The Us

Background:Giant Cell Arteritis (GCA) is one of the most common systemic vasculitis. Temporal artery biopsy (TAB) has been the standard test to confirm the diagnosis of GCA. However, TAB has a lower sensitivity than clinical diagnosis and up to 44% of biopsy-negative patients are clinically diagnosed as having GCA.In a recent meta-analysis of the diagnostic performance of ultrasound (US) in GCA the sensitivity was 77 % (1). The included studies were performed by expert groups in single centres. In the to date only multicentre study (TABUL) investigating the diagnostic accuracy of US compared to clinical diagnosis after 6 months the sensitivity was lower (54%) (2)Objectives:To evaluate the diagnostic accuracy of vascular US compared to TAB in a multicentre study.Methods:In three Danish centres patients suspected for GCA were included during a period of two years. At baseline, clinical and laboratory data were collected and vascular US of temporal, facial, common carotid and axillary artery were performed. The US examinations were performed with high frequency transducers (15-18 MHZ) and followed by a TAB. All ultrasongraphers had participated in the same standardized US educational program and were blinded to clinical and laboratory data. An external expert blinded to clinical and laboratory data evaluated all images and made the final US diagnosis.A positive sign for vasculitis in cranial arteries was defined as a hypoechoic intima media complex (IMC) thickening (halo sign) and a positive compression sign. A homogeneous IMC increased thickness in axillary artery of ≥1mm and in common carotid artery ≥1.5mm was defined as vasculitis.The consultant rheumatologist’s diagnosis at 6 months after initial presentation was considered as the reference standard for the diagnosis of GCA.Results:During the recruitment period, 112 patients were included, 59% females, mean (SD) age 72.4(7.9) years, among which 91(81.3%) fulfilled the ACR 1990 classification criteria for GCA. 92% of the patients reported a newly emerged localized headache, while 49 (43.8%) experienced polymyalgia rheumatic symptoms.TAB was positive in 46(41.1%) and inconclusive in 6 patients, who were excluded from the analysis. Mean (SD) duration of glucocorticoid therapy prior to US and TAB was 0.91(1.55) and 4.02(2.61) days, respectively. In 62 patients, the final diagnosis was GCA.In all patients with a positive TAB, the US of the temporal artery was also positive for GCA. Of 19 cases with positive US and negative TAB, 12 were clinically diagnosed with GCA of whom 6 had isolated large vessel involvement on US. Among 41 patients with both negative US and TAB, 4 were clinically diagnosed with GCA (Box 1)US had a sensitivity of 93% and specificity of 84% for the diagnosis of GCA, while the sensitivity for TAB was lower (74%) with a specificity of 100%. For the diagnosis of GCA, US had a PPV of 89.2 % and a NPV of 90.2%, while for TAB the PPV was 100% and the NPV 73.3%.Conclusion:US evaluation of the temporal, facial and selected supraaortic arteries performed by trained ultrasonographers can replace biopsy in the diagnosis of GCA.Box.1References:[1]Duftner C, Dejaco C, et al. Imaging in diagnosis, outcome prediction and monitoring of large vessel vasculitis: a systematic literature review and metaanalysis informing the EULAR recommendations. RMD Open 2018;4:e000612.[2]Luqmani R et al. The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study. Health Technol Assess 2016;20:1_238.Disclosure of Interests:stavros chrysidis: None declared, Uffe Møller Døhn: None declared, Lene Terslev Speakers bureau: LT declares speakers fees from Roche, MSD, BMS, Pfizer, AbbVie, Novartis, and Janssen., Ulrich Fredberg: None declared, Tove Lorenzen: None declared, Robin Christensen: None declared, Per Søndergaard: None declared, Jakob Matthisson: None declared, Knud Larsen: None declared, Andreas Diamandopoulos: None declared

scholarly journals Positive Predictive Value of the Giant Cell Arteritis Diagnosis in the Danish National Patient Registry: A Validation Study

2020 ◽  
Vol Volume 12 ◽  
pp. 731-736
Author(s):  
Peter Engholm Hjort ◽  
Philip Therkildsen ◽  
Berit Dalsgaard Nielsen ◽  
Ib Tønder Hansen ◽  
Mette Nørgaard ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Validation Study ◽  
Predictive Value ◽  
Patient Registry ◽  
National Patient Registry ◽  
Danish National Patient Registry ◽  
National Patient

Abstract T MP59: Texas Stroke Intervention Pre-Hospital Stroke Severity Scale (aka LEGS score): A Triaging Tool for Interventional Stroke Therapy

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Alexander Venizelos ◽  
Sherman Chen ◽  
Ryan Gianatasio ◽  
Stewart Coffman ◽  
Mark Gamber ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Good Predictor ◽  
Mr Angiography ◽  
Large Vessel ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Severity Scale ◽  
Vessel Occlusion

Introduction: A pre-hospital stroke severity scale that correlates well with an NIHSS of 10 or greater as well as with large vessel occlusions, but is easier and faster to perform than full NIHSS, would be a very useful triaging tool to emergency medical services (EMS). The LEGS score (Lower extremity strength, Eyes/visual fields, Gaze deviation, Speech difficulty) is a 16-point pre-hospital stroke severity scale that is a shortened NIHSS-5. Hypothesis: We assessed the hypothesis that the LEGS score was a useful pre-hospital stroke severity scoring system to identify large vessel acute ischemic strokes. Methods: The LEGS score (0-16) and NIHSS (0-42) were performed in the emergency department over a 6-month period. We retrospectively reviewed those charts for correlation to an NIHSS of 10 or greater and evidence of large-vessel occlusion on either CT or MR Angiography within 48 hours of last known normal. Results: A total of 181 consecutive ischemic stroke patients were evaluated. LEGS score 4 or greater was a good predictor of an NIHSS of 10 or greater (59/181; positive predictive value 92%; and specificity 95%) and false positives noted was 5/181. LEGS score of less than 4 was a good predictor of an NIHSS of less than 10 (108/181; negative predictive value 91%; and sensitivity 95%) and false negatives noted was 10/181. Of those patients 155 underwent intracranial vascular imaging. LEGS score of less than 4 was a good test to rule-out large vessel occlusion (negative predictive value of 86%; 89/103), but had modest sensitivity (69%; 31/45) and positive predictive value (60%; 31/52). The LEGS score of 4 or greater, however, was fairly specific for determining large-vessel occlusions at 81% (89/110). Conclusions: LEGS score of 4 or greater has good correlation with an NIHSS of 10 or greater as well as modest correlation with large vessel occlusion on CT or MR Angiography. This shortened NIHSS-5 may be a useful pre-hospital indicator of patients who may benefit from endovascular intervention.

Prenatal Sonographic Prediction of Twin Growth Discordance

2007 ◽  
Vol 10 (1) ◽  
pp. 198-201 ◽  
Author(s):  
Rita C. A. Machado ◽  
Maria L. Brizot ◽  
Adolfo W. Liao ◽  
Fábio R. Cabar ◽  
Marcelo Zugaib
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Fetal Growth ◽  
Predictive Value ◽  
Ultrasound Examination ◽  
Intraclass Correlation ◽  
Fetal Weight ◽  
Predictive Values ◽  
Twin Growth ◽  
Twin Pregnancies

AbstractOur aim was to evaluate the ability of prenatal ultrasound scans to predict fetal growth discordance, and to examine the correlation between fetal weight estimated by ultrasound with actual birthweight in twin pregnancies. The study consisted of 221 twin pregnancies with ultrasound fetal weight estimates based on Hadlock's 4 parameter formula. Prediction of intertwin birthweight discordance was examined at 4 different intervals between ultrasound examination and delivery (0–7 days, n = 96; 8–14 days, n = 66; 15–21 days, n = 58; 22–28 days, n = 59 pregnancies), with a total of 279 ultrasound examinations. Birthweight discordance was considered as a difference of 20% or greater. The correlation between fetal weight estimated between 0 and 7 days and actual birthweight was calculated by intraclass correlation coefficient. The predictive values for intertwin discordance of 20% or more in the 0 to 7 days group were: sensitivity = 93.6%, specificity = 79.4%, positive predictive value = 89.2%, negative predictive value = 87.1% and accuracy = 88.6%. In the groups with scans carried out between 8 and 14 days, 15 and 21 days, and 22 and 28 days, the sensitivity and accuracy values were 95.8% and 84.9%, 95.6% and 84.5%, 90.9% and 84.8%, respectively. Fetal growth discordance in twins can be accurately predicted by ultrasound examination performed up to 28 days before birth. There is a good correlation between fetal weight estimated between 0 and 7 days and actual birthweight.

scholarly journals Validity of clinical and ultrasound examination related to arthroscopy in acute injury of the medial meniscus of the knee

2008 ◽  
Vol 136 (1-2) ◽  
pp. 28-32 ◽  
Author(s):  
Sladjan Timotijevic ◽  
Zoran Vukasinovic ◽  
Zoran Bascarevic
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Medial Meniscus ◽  
Ultrasound Examination ◽  
Diagnostic Procedures ◽  
Acute Injury ◽  
Clinical Tests ◽  
Common Life ◽  
Chronic Injuries

INTRODUCTION Injuries of the medial meniscus of the knee are constantly present in sports, but also in common life activities. Diagnostic procedures which are available today in the diagnosis and estimation of the severity of intraarticular knee structures are numerous, but they are not available, plausible and valid at the same manner. OBJECTIVE The aim of this study was to compare the diagnostic validity of clinical and ultrasound examination related to arthroscopy in acute injury of the medial meniscus of the knee. METHOD This prospective study analyzed 198 hospitalized patients, treated from 2004 to 2006 at the Belgrade Institute for Orthopaedic Surgery ?Banjica" and Belgrade Special Orthopedic Surgery Hospital ?Decedra", who underwent arthroscopy. Before the arthroscopy, clinical and ultrasound examinations were performed. RESULTS The values of sensitivity (91.1%), specificity (80.0%), positive predictive value (83.6%) and negative predictive value (88.9%) of ultrasound examination of acute injury of the medial meniscus are proportionately lower as compared to the values of sensitivity (97.2%), specificity (90.2%), positive predictive value (86.0%) and negative predictive value (98.2%) of ultrasound examination in chronic injuries of the medial meniscus of the knee. CONCLUSION Ultrasound examination is a more useful method in the detection of lesions of the medial meniscus of the knee as related to clinical tests used in their detection in this study.

Abstract TMP62: Utility of the Los Angeles Motor Scale to Identify Emergency Large Vessel Occlusion in Acute Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Prasannna Tadi ◽  
Pranav Reddy ◽  
Sravanthi Pemmasani ◽  
Nasir Fakhri ◽  
Matthew Siket ◽  
...  
Keyword(s):  
Los Angeles ◽  
Positive Predictive Value ◽  
Acute Stroke ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Vessel Imaging ◽  
Los Angeles Motor Scale

Introduction: Stroke is a common medical emergency. The outcome depends upon access to stroke specialists, rapid scanning, assessment, and treatments. Identification of large vessel occlusion (LVO) is critical in the selection of patients for emergency embolectomy (clot removal) in patients with acute ischemic stroke. A pre-hospital stroke severity scale, such as the Los Angeles Motor Scale (LAMS) may have utility in selecting appropriate patients for CTA, while minimizing radiation exposure risk to the population as a whole. Methods: This was a retrospective analysis of 249 consecutive code stroke activations at a comprehensive stroke center during a 3.5 month period using a LAMS cutoff of ≥4 to trigger CTA acquisition. We determined the sensitivity, specificity, positive predictive value, and negative predictive value of using LAMS to detect large vessel occlusion (LVO). Gold standard was any vessel imaging within 24 hours. Inter-rater reliability of LAMS scoring was determined by blinded scoring of physical exam data from the chart by 3 neurovascular physicians. Results: There were 249 code stroke activations during the study period: 91 acute CTAs were recommended based on LAMS scoring. 20 large vessel occlusions were detected. 158 patients did not have a CTA acutely; none had a LVO during subsequent vessel imaging. The sensitivity is 100%, negative predictive value 100%, specificity 69%, positive predictive value 22% of the LAMS triage method. Inter-rater Reliability: Shrout-Fleiss pairwise weighted kappa coefficients between the three raters on LAMS scores were 0.67, 0.55, and 0.62. Kappa coefficients for pairs of raters when LAMS were dichotomized as <3 vs 4-5 were 0.64, 0.50, and 0.71. Clinically meaningful disagreements were evident. Conclusions: Accuracy and ease-of-use makes LAMS an ideal clinical tool to rapidly assess acute stroke patients for LVO and emergency mechanical thrombectomy. LAMS demonstrated excellent sensitivity in excluding patients who did not have a LVO. Appropriate training is required to ensure accuracy of LAMS scoring by providers.

scholarly journals Pattern of computerized tomography findings of the brain in cerebrovascular accidents

2020 ◽  
Vol 5 (1) ◽  
pp. 62-70
Author(s):  
Elina Shrestha ◽  
Narayan Bikram Thapa ◽  
SBS Rajbhandari
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Computerized Tomography ◽  
Predictive Value ◽  
Cerebrovascular Accident ◽  
Imaging Modality ◽  
P Value ◽  
Computerised Tomography ◽  
Female Ratio ◽  
Sensitivity Specificity

Introduction: Semi-industrialized countries  like Nepal have  high  mortality and disability rates due to cerebrovascular accident, representing  for more than 80% of all stroke deaths globally. Stroke is the most common neurological disorder requiring prolonged hospital stay. Aims of our study was to evaluate the role of computerized tomography in evaluation of cerebrovascular accident by differentiating ischemia from hemorrhage and proper identification of negative cases. Methods: A descriptive cross sectional  study of total 155  patients, clinically diagnosed as stroke,  referred to our department of radiology  for computerised tomography evaluation during six month period, were enrolled  into study. The clinical information, proper history, computerised tomography  findings  were properly documented and analysed in  SPSS version 20 software. Results: Out of total 155 patients, 85 cases (55 %)  were males and  70 cases (45 %) were  females with male: female  ratio of 1.2:1. The mean age of the patients was 63±15 years. There was significant  correlation between clinical with neuroradiological findings as evidenced  by p value of 0.000.  Sensitivity, specificity, positive predictive value, negative predictive value of clinical findings when correlated  to CT in diagnosing ischemic infarction were 84.3%, 67.3%, 82.6%, 70%. Similarly, sensitivity, specificity, positive predictive value, negative predictive value in diagnosing hemorrhagic infarction were 67.3%, 84.3%, 70%, 82.6% respectively. Conclusions: Computerised tomography is the first line reliable imaging modality for diagnosis, management of cerebrovascular accident and exclusion of stroke mimicker lesions. Education regarding prevention and control of  modifiable risk factors can minimize the incidence of  stroke.

Acute Appendicitis - Study of Role of Ultrasound and CT Scan in Decision Making for Surgery in a Tertiary Care Government Hospital in Eastern India

2021 ◽  
Vol 8 (33) ◽  
pp. 3048-3053
Author(s):  
Jainendra Kumar ◽  
Akriti Komal
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Imaging Modality ◽  
Tertiary Care ◽  
Accurate Diagnosis ◽  
Final Decision ◽  
Sensitivity Specificity

BACKGROUND Acute appendicitis (AA) is one of the commonest causes of acute abdominal emergencies. Accurate diagnosis and earlier surgery is imperative in such cases. Ultrasonography (US), and computed tomography (CT), are main stays accurate diagnosis of this disease. This study was conducted to compare the accuracy of US and CT in the diagnosis of AA and reduce number of negative appendectomies. METHODS This prospective study was done after approval from institutional ethical committee and obtaining written consent. 164 patients with clinical features suggestive of AA, were selected from emergency department of Patna Medical College, Patna India during the period from January 2019 to December 2020. 98 were males and 66 females, mean age being 18.08 years. 142 patents (86.58 %) underwent surgery, and 22 patients (13.41 %) were kept on clinical observation in hospital after imaging. After detailed clinical workup and laboratory investigations, all patients were subjected to both US and CT examination. Each patient was reevaluated clinically, and a clinical correlation was done between both sets of results. Based on these, final decision was made. Accuracy was decided based on intra-operative findings in appendectomy group and were correlated with imaging findings later with histopathologic findings. RESULTS Males outnumbered females, abdominal pain was present in 100%. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of US in diagnosis of AA in our study were 92.6 %, 76.4 %, 95.3%, 71.0% and 88.9 % respectively. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of CT in diagnosis of AA were 99.1 %, 90.5 %, 98.6%, 87.8% and 97.8 % respectively. CONCLUSIONS US should be the first-line imaging modality as it is free from radiation. CT is recommended as additional imaging tool to raise accuracy in diagnosis except in pregnancy and selected pediatric patients. KEYWORDS Acute Appendicitis, Computed Tomography, Ultrasound

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