Value of antigranulocyte scintigraphy with Tc-99m-sulesomab in diagnosing combat-related infections of the musculoskeletal system

AimCombat-related extremity injuries are regularly associated with long-term complications such as chronic infection, especially osteomyelitis. Clinical examination and laboratory parameters do not usually allow reliable diagnosis. In contrast, imaging techniques enable constructive assertions to be made about the location and extent of an infection of the peripheral musculoskeletal system. The aim of this study was therefore to determine the diagnostic reliability of three-phase bone scanning and antigranulocyte scintigraphy using Tc-99m-sulesomab (Leukoscan) in the diagnostic clarification of infections associated with combat-related extremity injuries.MethodsTwenty-seven male patients (mean age 33.9 years) with suspected combat-associated infections of the extremities were included in this retrospective analysis. All patients underwent three-phase bone scanning using Tc-99m-HDP followed by antigranulocyte scintigraphy with Tc-99m-sulesomab. In 26 of the 27 patients, a CT scan of affected limb was obtained, where the secondary fusion with single photon emission CT data set was possible. The diagnostic reliability of imaging techniques was validated against microbiological samples obtained during surgery and used as gold standard.ResultsThree-phase bone scanning yielded a positive result in all patients, with 18 scans classified as true positive (TP) and nine scans as false positive (FP). This produced a sensitivity of 100%, a specificity of 0% and a positive predictive value (PPV) of 67%. Antigranulocyte scintigraphy recognised 13 patients as TP, 1 patient as FP, 8 patients as true negative (TN) and 5 patients as false negative (FN), which gave a sensitivity of 72%, a specificity of 88%, a PPV of 93%, a negative predictive value (NPV) of 62% and an accuracy of 78%. CT recognised in 7 cases a TP result, in 3 cases an FP, in 5 cases a TN and in 11 cases an FN result. This produced a sensitivity of 39%, a specificity of 63%, a PPV of 70%, an NPV of 31% and an accuracy of 46%.ConclusionsThree-phase bone scanning did not deliver any diagnostic benefit, since no result was able to differentiate unequivocally between infection-related and reactive changes. Antigranulocyte scintigraphy using Tc-99m-sulesomab represented a highly suitable technique for diagnostically clarifying combat-related infections of the extremities. It is superior to CT in sensitivity, specificity, PPV, NPV and accuracy.

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Asbestos-related diseases in mineworkers: a clinicopathological study

ERJ Open Research ◽

10.1183/23120541.00022-2017 ◽

2017 ◽

Vol 3 (3) ◽

pp. 00022-2017 ◽

Cited By ~ 2

Author(s):

Ntombizodwa Ndlovu ◽

David Rees ◽

Jill Murray ◽

Naseema Vorajee ◽

Guy Richards ◽

...

Keyword(s):

Lung Cancer ◽

Predictive Value ◽

Imaging Techniques ◽

False Negative ◽

Accurate Diagnosis ◽

Reference Standard ◽

Disease Manifestation ◽

Clinical Diagnoses ◽

Low Sensitivity ◽

Sensitivity Specificity

The accurate diagnosis of asbestos-related diseases is important because of past and current asbestos exposures. This study evaluated the reliability of clinical diagnoses of asbestos-related diseases in former mineworkers using autopsies as the reference standard.Sensitivity, specificity, positive predictive value and negative predictive value were calculated.The 149 cases identified had clinical examinations 0.3–7.4 years before death. More asbestos-related diseases were diagnosed at autopsy rather than clinically: 77 versus 52 for asbestosis, 27 versus 14 for mesothelioma and 22 versus 3 for lung cancer. Sensitivity and specificity values for clinical diagnoses were 50.6% and 81.9% for asbestosis, 40.7% and 97.5% for mesothelioma, and 13.6% and 100.0% for lung cancer. False-negative diagnoses of asbestosis were more likely using radiographs of acceptable (versus good) quality and in cases with pulmonary tuberculosis at autopsy.The low sensitivity values are indicative of the high proportion of false-negative diagnoses. It is unlikely that these were the result of disease manifestation between the last clinical assessment and autopsy. Where clinical features suggest asbestos-related diseases but the chest radiograph is negative, more sophisticated imaging techniques or immunohistochemistry for asbestos-related cancers should be used. Autopsies are useful for the detection of previously undiagnosed and misdiagnosed asbestos-related diseases, and for monitoring clinical practice and delivery of compensation.

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Clinico-Radiological and Pathological Correlation of Breast Lesions in Patients Presenting to a Tertiary Hospital in Western Nepal

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v5i2.19164 ◽

2018 ◽

Vol 5 (2) ◽

pp. 40-44

Author(s):

Prakash Sharma ◽

Elina Shrestha ◽

Prabhat Kumar Tiwari

Keyword(s):

Predictive Value ◽

Imaging Techniques ◽

False Negative ◽

Age Groups ◽

Breast Disease ◽

Needle Aspiration ◽

Tertiary Hospital ◽

Radiology Department ◽

Breast Lump ◽

Breast Masses

INTRODUCTION: Breast masses are frequently encountered problem, especially in females. Mammography and ultrasound are considered the standard imaging techniques for detection and evaluation of breast disease. The study was done to discuss the role of mammography and ultrasound in evaluation of breast mases with cytological correlation and to compare the sensitivity, specificity, positive predictive value and negative predictive value of ultrasonography6 with mammography in breast masses in different age groups and in patients with different breast density.MATERIALS AND METHODS: It was a non randomized prospective study carried out in Manipal teaching hospital Pokhara. The data for study was collected from patients with breast lump who attended the department of Radiology during the period from October 2013 to October 2014. Mammography and ultrasonography were performed on all cases presented with breast lump. A Fine needle aspiration cytology correlation was then performed with formed the basis for definitive judgement.RESULTS: The study analyzed 50 total numbers of patients presented to Radiology department who had breast lumps. Patients were aged between 20 and 75 years. Maximum numbe3r of patients were between 40 and 49 yrs constituting 40%. The mean age was 39.8 years ± 12.85 yrs. Ultrasound was significantly more sensitive than mammography in age less than 40 years. Mammogram had a significantly higher sensitivity than ultrasound in age group of more than 40 yrs. By using combined modalities (ultrasonography combined with mammogram), all benign cases were diagnosed correctly. For malignant breast masses, 10% were diagnosed as false negative but no cases were diagnosed false positive by combined modalities. Ultrasound was more sensitive than mammography in dense and heterogeneously dense breast whereas mammography was more sensitive than ultrasound in predominantly fatty breast.CONCLUSION: Combination of ultrasound and mammogram is more sensitive than other modality alone.Journal of Universal College of Medical Sciences, Vol. 5, No. 2, 2017, Page: 40-44

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Decisive Diagnosis of Infected Mandibular Osteoradionecrosis with a Tc-99m-labelled Anti-granulocyte Fab′-fragment

Nuklearmedizin ◽

10.1055/s-0038-1632227 ◽

1999 ◽

Vol 38 (07) ◽

pp. 309-311 ◽

Cited By ~ 3

Author(s):

W. Brenner ◽

H. Terheyden ◽

K. H. Bohuslavizki ◽

E. Henze ◽

W. U. Kampen

Keyword(s):

Blood Pool ◽

Bone Scanning ◽

Acute Osteomyelitis ◽

Elevated Blood ◽

Fab Fragment ◽

Postoperative Changes ◽

Three Phase ◽

Golden Standard ◽

Blood Pool Activity ◽

Bone Inflammation

SummaryThe accepted golden standard for detection of inflammatory bone disease is conventional three-phase bone scanning. Hyperperfusion, a high blood-pool activity and elevated bone metabolism are typical signs for an acute osteomyelitis. However, in case of subacute, chronic inflammation, neither elevated blood flow nor high blood-pool activity may be seen. This may cause difficulties in differentiating such cases from neoplastic or postoperative changes. This case report verifies the possible advantage of immunoscintigraphy with Tc-99m-labelled antigranulocyte Fab′-fragments (LeukoScan®) in a patient with infected mandibular osteoradionecrosis, who had equivocal clinical symptomes and questionable radiographic results. LeukoScan® is shown to be more sensitive in case of subacute bone inflammation compared with three-phase bone scanning. However, acquisition of delayed images after 24 hours including SPECT is inevitable in case of negative scans during the first hours of investigation.

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Diagnostic Value of Real-Time Shear Wave Elastography in Diagnosing Thyroid Cancer

Revista de Chimie ◽

10.37358/rc.17.12.5985 ◽

2018 ◽

Vol 68 (12) ◽

pp. 2818-2822

Author(s):

Maria Cristina Oprea ◽

Mihaela Vlad ◽

Ioana Golu ◽

Ioan Sporea ◽

Lazar Fulger

Keyword(s):

Shear Wave ◽

Predictive Value ◽

Thyroid Nodules ◽

Imaging Techniques ◽

Area Under The Curve ◽

Thyroid Volume ◽

Shear Wave Elastography ◽

Maximum Diameter ◽

Diagnostic Tools ◽

Tissue Elasticity

Thyroid nodules are a common pathology found in 50 to 60% of otherwise healthy people. Diagnostic imaging techniques are help discriminating between benign and malignant nodules, while fine needle aspiration is still a gold standard. Shear wave elastography, a recent imaging technique, holds the promise to become reliable diagnostic tools and is currently used in combination with ultrasound. We here report data obtained in a series of 52 thyroid nodules analysed by means of elastography, as well as conventional and Doppler ultrasound. We found no differences in age, nodule and thyroid volume, length, width, thickness and maximum diameter between benign and malignant lesions. Several sonographic patterns are considered to be predictive of malignancy, out of which we only found the intranodular blood flow to be statistically significant. By the means of shear wave elastography we have first assessed tissue elasticities, which are shown in a range of colours, depending on tissue elasticity/stiffness. Then, we have measured and recorded four parameters automatically displayed by the system, namely SWE-mean, SWE-max, SWE-SD and SWE-ratio. Data analysis showed all these quantitative parameters had good sensitivity, specificity, positive predictive value, negative predictive value and area under the curve, as calculated by the ROC curve. As with these parameters, the cut-off points were lower than in literature, still able to indicate reliable diagnoses, which were confirmed by histopathological exam. Our conclusion is that shear wave elastography has great potential for reliably and accurately diagnosing thyroid malignancies.

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NESTROFT—A Cost-Effective Mass Screening Tool for the Detection of β-Thalassemia Carrier Status in Anemic Pregnant Women: A Step Toward Reducing the National Disease Burden

Journal of Laboratory Physicians ◽

10.1055/s-0041-1732493 ◽

2021 ◽

Author(s):

Manasi Gosavi ◽

Ramesh Chavan ◽

M. B. Bellad

Keyword(s):

Pregnant Women ◽

Effective Mass ◽

Mass Screening ◽

Predictive Value ◽

Screening Tool ◽

Hematological Parameters ◽

False Negative ◽

Cost Effective ◽

Mean Corpuscular Hemoglobin ◽

Carrier Status

Abstract Introduction β-Thalassemias are inherited hemoglobinopathies commonly encountered in practice. With chances of a promising cure being rare, the prevention of births with this disorder should assume priority, especially in low-resource countries. This can be achieved by the implementation of a mass screening program that is reliable and, at the same time, cost-effective. Objectives This study focuses on the utility of Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) as a mass screening tool to detect thalassemia carriers. Hematological parameters that may predict carrier status were also evaluated. Materials and Methods Hemoglobin estimation was performed on all consented pregnant women. If the patient was found to have hemoglobin < 11 g/dL, the blood sample was subjected to other routine hematological tests along with peripheral smear examination. NESTROFT was performed using 0.36% saline solution. Confirmation was done using high-performance liquid chromatography (HPLC). Statistical Analysis Data obtained were tabulated using version 21 of the Statistical Package for Social Sciences. Means, standard deviations, and percentages were used to describe the sample. Chi-square test and Students’ “t” test were used to identify differences between the groups. Results Of 441 pregnant women enrolled, 206 were found to be anemic. Nineteen (9.2%) of the anemic pregnant women were detected to be carriers of hemoglobinopathies. Among the hematological parameters, mean red blood cell count and reticulocyte count were higher, while mean corpuscular hemoglobin concentration was lower in carriers. Also, carriers were more likely to present with microcytic hypochromic anemia. NESTROFT showed a sensitivity of 84.21%, specificity of 96.25%, a positive predictive value of 69.56%, and a negative predictive value of 98.36%. A false-positive result was seen in 3.74% of the tests, while a false negative result was seen in 15.78% of the tests. Conclusions NESTROFT (0.36%) can be used as a simple and cost-effective mass screening tool for the detection of carrier status. This should be followed by confirmation using HPLC or hemoglobin electrophoresis.

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Evaluating Presence/Absence of Target Microbes in Microbiological Tests

Journal of AOAC International ◽

10.1093/jaoac/83.6.1429 ◽

2000 ◽

Vol 83 (6) ◽

pp. 1429-1434

Author(s):

Robert J Blodgett ◽

Anthony D Hitchins

Keyword(s):

Performance Studies ◽

Collaborative Study ◽

False Negative ◽

The Other ◽

Test Results ◽

Logistic Curve ◽

Microbiological Method ◽

Test Portion ◽

Method Performance ◽

Data Set

Abstract A typical qualitative microbiological method performance (collaborative) study gathers a data set of responses about a test for the presence or absence of a target microbe. We developed 2 models that estimate false-positive and false-negative rates. One model assumes a constant probability that the tests will indicate the target microbe is present for any positive concentration in the test portion. The other model assumes that this probability follows a logistic curve. Test results from several method performance studies illustrate these estimates.

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Exercise induced reduction in myocardial work predicts significant coronary artery disease in patients with false negative stress echocardiography

European Heart Journal ◽

10.1093/ehjci/ehaa946.0131 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A.L Chilingaryan ◽

L.G Tunyan ◽

K.G Adamyan ◽

P.H Zelveyan ◽

L.R Tumasyan ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Predictive Value ◽

Stress Echocardiography ◽

False Negative ◽

Funding Source ◽

Concentric Hypertrophy ◽

Constructive Work ◽

Artery Disease ◽

Isovolumic Relaxation

Abstract Stress echocardiography (SE) is a reliable technique for the diagnosis of coronary artery disease (CAD) with high sensitivity and specificity. However in patients with small left ventricular (LV) cavity caused by marked concentric hypertrophy the sensitivity of SE is low. We assumed that in patients with false negative SE evaluation of global myocardial work (GW) might detect significant CAD. Methods 238 patents with chest pain (98 female, mean age 61±5 years) without history of CAD were referred to SE for CAD confirmation. 94 (39.5%) patients had negative SE and were enrolled in our study for re-examination. Age and gender matched 50 healthy subjects served as controls. GW index (GWI) was obtained from pressure-strain loops composed from speckle tracking analysis indexed to brachial systolic blood pressure. Global constructive work (GCW) as the sum of positive work due to myocardial shortening during systole and negative work due to lengthening during isovolumic relaxation, global wasted work (GWW) as energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation, and GW efficiency (GWE) as the percentage ratio of constructive work to the sum of constructive work and wasted work were measured after submaximal treadmill SE at the heart rate of 100–110 beats per minute (109±11 s after SE) using EchoPac software by blinded experienced echocardiographer. All patients were referred to coronary angiography after re-examination. Results 42 (44.7%) patients had lower GWI values than the lowest limit of GWI value in controls. These patients had significant reduction in GWI, compared with remaining 52 patients in whom GWI did not differ from those of controls (GWI 1897±112 mmHg% vs 2518±243 mmHg%, p<0.01). GCW, GWE and GWW were comparable between patients with or without reduced GWI (GCW 2283±107mmHg% vs 2321±110 mmHg%, p=NS; GWE 96.9±1.1% vs 97.4±1.2%, p=NS; GWW 57±3 mmHg% vs 53±4 mmHg%, p=NS). 28 (66.7%) of 42 patients with GWI reduction and 8 (15.0%) of 52 patients without GWI reduction had at least one vessel significant CAD. GWI had sensitivity, specificity, and accuracy in detection of CAD 78%, 76%, 77% respectively with 67% positive predictive value, and 85% negative predictive value. 29 (80.5%) patients out of 36 with significant CAD had concentric increase in LVMi compared with true negative SE patients (83±6 g/m2 vs 71±4 g/m2, p<0.01). GWI was the predictor of significant CAD (area under the curve 0.793). Conclusion GWI extends diagnostic power of conventional SE in detection of CAD, especially in patients with smaller LV cavity due to concentric hypertrophy when sensitivity of conventional SE is low. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Committee of Sience at Ministry of Education of Republic of Armenia

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Validity of ultrasound arterial wall vascularization for assessment of vascular inflammation

European Heart Journal ◽

10.1093/ehjci/ehaa946.2403 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

W Sato ◽

Y Kobayashi ◽

M Otaka ◽

M Unuma ◽

T Yamanaka ◽

...

Keyword(s):

Carotid Stenosis ◽

Predictive Value ◽

Arterial Wall ◽

Carotid Arteries ◽

Vascular Inflammation ◽

False Negative ◽

Intraplaque Hemorrhage ◽

Funding Source ◽

Negative Finding ◽

18F Fdg

Abstract Background Vascular inflammation plays a fundamental role in most vascular diseases including atherosclerosis and vasculitis syndrome, in which arterial wall vascularization (AWV) frequently develops. Visualization of AWV is informative in detecting the vascular inflammation but is challenging. A new ultrasound technique (superb micro-vascular imaging [SMI]) allows the detection of extremely low-velocity flows. We examined an availability of SMI for assessment of the instability of atherosclerotic plaques and the activity of Takayasu arteritis (TA). Methods and results The study consists of two independent and consecutive parts A and B, examined in carotid stenosis (A) and TA (B), respectively. In part A, 12 patients with symptomatic severe carotid stenosis (CS group) scheduled for carotid endarterectomy were enrolled. In six of 12 patients, preoperative ultrasonography with SMI showed intraplaque neovascularization at the plaque shoulder. Postoperatively, histopathology confirmed the neovessels at the corresponding sites of visualized AWV. SMI had a sensitivity of 67%, specificity of 90% for detection of AWV in CS group. In SMI analysis, false positive findings were caused by motion artifact and arterial wall calcification, and a false negative finding is attributed by intraplaque hemorrhage. In part B, 10 patients with TA were enrolled. All patients underwent 18F-FDG-PET/CT, and its vascular uptake were compared with AWV detected by SMI. Bilateral common carotid arteries (CCA), internal carotid arteries and common iliac arteries were examined by SMI. Active vascular 18F-FDG uptake (max SUV >2.1) were found at five sites in three patients, which were not significantly correlated with the prevalence of macaroni sign, increase in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Of note, SMI revealed AWV at five sites corresponding to uptake of 18F-FDG, with a sensitivity/specificity of 100% and 98%, positive predictive value 71%, and a negative predictive value 100%. Conclusion SMI enables visualization of AWV at vulnerable plaque in CS patients and at 18F-FDG positive sites in TA patients. SMI has potential as a modality to detect the vascular inflammation. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research, Japan

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Diagnostic Accuracy of a New d-Dimer Assay (Sclavo Auto d-Dimer) for Exclusion of Deep Vein Thrombosis in Symptomatic Outpatients

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029616649436 ◽

2016 ◽

Vol 23 (3) ◽

pp. 221-228 ◽

Cited By ~ 1

Author(s):

Cristina Legnani ◽

Michela Cini ◽

Mirella Frascaro ◽

Giuseppina Rodorigo ◽

Michelangelo Sartori ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Imaging Techniques ◽

False Negative ◽

High Specificity ◽

Predictive Values ◽

Cutoff Value ◽

Vein Thrombosis ◽

Number Of Patients ◽

Deep Vein ◽

D Dimer

In patients presenting non-high clinical pretest probability (PTP), a negative d-dimer can exclude venous thromboembolism without imaging tests. However, each d-dimer assay should be validated in prospective studies. We evaluated an automated d-dimer immunoassay using the Sclavo Auto d-dimer (Sclavo Diagnostics Int, Sovicille, Italy) provided by Dasit Diagnostica (Cornaredo, Milan, Italy). Three hundred two consecutive outpatients suspected of leg deep vein thrombosis (DVT) with non-high PTP were included. The Sclavo Auto d-dimer assay was evaluated on 2 analyzers (Sysmex CA-7000 and Sysmex CS-2100; Sysmex Corporation, Kobe, Japan, provided by Dasit). The cutoff value (200 ng/mL) was established a priori. Prevalence of DVT was 11.9%. Since no false-negative patients were detected, the sensitivity and negative predictive values (NPVs) were 100% (sensitivity = CA-7000: 100% [95% confidence interval, CI: 93.3-100], CS-2100: 100% [95% CI: 93.3-100]; NPV = CA-7000: 100% [95% CI: 97.9-100], CS-2100: 100% [95% CI: 98.0-100]). Specificity was 65.4% (95% CI: 59.4-71.1) and 69.2% (95% CI: 63.3-74.7) for CA-7000 and CS-2100, respectively. Specificity increased when a higher cutoff value (234 ng/mL) was used for patients aged ≥60 years without compromising the safety. Assay reproducibility was satisfactory at concentrations near the cutoff value (total coefficient of variations <10%). In conclusion, the Sclavo Auto d-dimer assay was accurate when used for DVT diagnostic workup in outpatients with non-high PTP. Based on its high sensitivity and NPV, it can be used as a stand-alone test in outpatients with non-high PTP. Given its high specificity, the number of patients in whom further imaging techniques can be avoided increased, improving the yield of the test.

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Evaluation of the Carba NP Test for Rapid Detection of Carbapenemase-Producing Enterobacteriaceae and Pseudomonas aeruginosa

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00878-13 ◽

2013 ◽

Vol 57 (9) ◽

pp. 4578-4580 ◽

Cited By ~ 147

Author(s):

Nathalie Tijet ◽

David Boyd ◽

Samir N. Patel ◽

Michael R. Mulvey ◽

Roberto G. Melano

Keyword(s):

Pseudomonas Aeruginosa ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Rapid Detection ◽

False Negative ◽

Bacterial Extract ◽

Content Type ◽

Negative Results ◽

False Negative Results

ABSTRACTThe Carba NP test was evaluated against a panel of 244 carbapenemase- and non-carbapenemase-producingEnterobacteriaceaeandPseudomonas aeruginosaisolates. We confirmed the 100% specificity and positive predictive value of the test, but the sensitivity and negative predictive value were 72.5% and 69.2%, respectively, and increased to 80% and 77.3%, respectively, using a more concentrated bacterial extract. False-negative results were associated with mucoid strains or linked to enzymes with low carbapenemase activity, particularly OXA-48-like, which has emerged globally in enterobacteria.

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