The Role of 3D Reconstruction of the Skull in Patients with Suspected Shunt Malfunction

2021 ◽  
Vol 56 (2) ◽  
pp. 110-115
Author(s):  
Jonathan Roth ◽  
Tali Jonas Kimchi ◽  
Ben Shofty ◽  
Ariel Agur ◽  
Liat Ben-Sira ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Clinical Course ◽  
High Sensitivity ◽  
Shunt Malfunction ◽  
X Rays ◽  
Radiological Findings ◽  
Sensitivity Specificity ◽  
Shunt Tubing ◽  
Shunt Series

Background: Mechanical shunt malfunction may lead to significant morbidity and mortality. Shunt series assessments help evaluate shunt integrity; however, they are of limited value in the area of the skull due to skull curvature, thickness, and air sinuses. We describe the role of 3D bone reconstruction CT (3DCT) in demonstrating the shunt integrity over the skull, comparing this technique to skull X-rays (SXR). Methods: Data were collected retrospectively for shunted patients with concurrent SXR and 3DCT and for patients presenting with shunt failures at the region of the skull, including clinical course and radiological findings. We compared the SXR and 3DCT findings. The 3DCT was reconstructed from standard diagnostic CT protocols performed during evaluation of suspected shunt malfunction and not thin-slice CT protocols. Results: Forty-eight patients with 57 shunts underwent SXR and 3DCT. Interobserver agreement was high for most variables. Both SXR and 3DCT had a high sensitivity, specificity, and accuracy identifying tubing disconnections (between 0.83 and 1). Full valve type and setting were significantly more accurate based on SXR versus 3DCT (>90 vs. <20%), and valve integrity was significantly more readily verified on 3DCT versus SXR (100 vs. 52%). Conclusions: 3DCT and SXR complement each other in diagnosing mechanical shunt malfunctions over the skull. The main limitation of 3DCT is identification of valve type and settings, which are clearer on SXR, while the main limitation of SXR is a less ability to evaluate valve integrity. 3DCT also enables an intuitive 3D understanding of the shunt tubing over the skull.

scholarly journals 367. Role of Conventional Biomarker for Prediction of Chest CT-confirmed COVID-19 Pneumonia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S286-S286
Author(s):  
Monprach Harnphadungkit ◽  
Taweegrit Siripongboonsitti
Keyword(s):  
Roc Curve ◽  
Potential Role ◽  
Univariate Analysis ◽  
High Sensitivity ◽  
Chest Ct ◽  
Inflammatory Biomarkers ◽  
X Rays ◽  
Wide Range ◽  
Sensitivity Specificity

Abstract Background The coronavirus disease 2019 (COVID-19) has a wide range of severity. Chest computed tomography (CT) had high sensitivity and specificity to identify COVID-19 pneumonia. However, chest CT was not available in almost all hospitals in pandemic settings, including developed countries. This study is to evaluate the potential role of conventional inflammatory biomarkers to predict COVID-19 pneumonia. Methods All 155 RT-PCR-confirmed COVID-19 patients were evaluated for pneumonia by chest CT from April 10, 2021 to May 3, 2021 in the outpatient unit, a Thai university hospital. The inflammatory biomarkers were evaluated the sensitivity, specificity, LR+, LR-, and ROC to predict COVID-19 pneumonia. Results Of all 155 patients, pneumonia was diagnosed by chest CT in 117 patients. The pneumonia patients had a median (IQR) age of 38 (30, 55) years old. The BMI was higher in pneumonia than mild illness in 25.5 (22.0, 29.5) and 22.9 (19.4, 26.9) kg/m2, respectively (p=0.031). In univariate analysis, serum high-sensitivity C-reactive protein (hsCRP), lactate dehydrogenase (LDH), ferritin, total lymphocyte count (TLC), and albumin were associated with pneumonia, but the only hsCRP demonstrated association by multivariate analysis. The area under the ROC curves (AUC) was 0.82, 0.74, 0.68, 0.38, and 0.37 in hsCRP, LDH, ferritin, TLC, and albumin, respectively. The optimal cut-off level for CRP to diagnose COVID-19 pneumonia was 2.00 mg/L given sensitivity, specificity, LR+, LR- of 81.9%, 70.3%, 2.75, and 0.26 respectively (Figure 1 and Table 1). ROC Curve of hsCRP to Diagnose of COVID-19 Pneumonia This figure shows ROC curve for hsCRP to diagnose of chest CT-confirmed COVID-19 pneumonia. The area under the ROC curve is 0.82. The optimal cut-off value for hsCRP is 2.00 given sensitivity of 81.9% and specificity of 70.3%. Conclusion The hsCRP was the conventional biomarker that had an excellent performance in predicting COVID-19 pneumonia lead to early anti-SARS-CoV-2 treatment. This study demonstrated the potential role of hsCRP combined with clinical assessment in negative chest X-rays to replace chest CT in a high burden COVID-19 country during pandemic situations. Disclosures All Authors: No reported disclosures

scholarly journals Artificial Intelligence Applied to Chest X-ray for Differential Diagnosis of COVID-19 Pneumonia

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 530
Author(s):  
Christian Salvatore ◽  
Matteo Interlenghi ◽  
Caterina B. Monti ◽  
Davide Ippolito ◽  
Davide Capra ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Differential Diagnosis ◽  
Area Under The Curve ◽  
Community Acquired Pneumonia ◽  
Validation Dataset ◽  
X Rays ◽  
Different Types ◽  
Chest X Ray ◽  
Sensitivity Specificity

We assessed the role of artificial intelligence applied to chest X-rays (CXRs) in supporting the diagnosis of COVID-19. We trained and cross-validated a model with an ensemble of 10 convolutional neural networks with CXRs of 98 COVID-19 patients, 88 community-acquired pneumonia (CAP) patients, and 98 subjects without either COVID-19 or CAP, collected in two Italian hospitals. The system was tested on two independent cohorts, namely, 148 patients (COVID-19, CAP, or negative) collected by one of the two hospitals (independent testing I) and 820 COVID-19 patients collected by a multicenter study (independent testing II). On the training and cross-validation dataset, sensitivity, specificity, and area under the curve (AUC) were 0.91, 0.87, and 0.93 for COVID-19 versus negative subjects, 0.85, 0.82, and 0.94 for COVID-19 versus CAP. On the independent testing I, sensitivity, specificity, and AUC were 0.98, 0.88, and 0.98 for COVID-19 versus negative subjects, 0.97, 0.96, and 0.98 for COVID-19 versus CAP. On the independent testing II, the system correctly diagnosed 652 COVID-19 patients versus negative subjects (0.80 sensitivity) and correctly differentiated 674 COVID-19 versus CAP patients (0.82 sensitivity). This system appears promising for the diagnosis and differential diagnosis of COVID-19, showing its potential as a second opinion tool in conditions of the variable prevalence of different types of infectious pneumonia.

scholarly journals ULTRASONOGRAPHY

2008 ◽  
Vol 15 (01) ◽  
pp. 26-32
Author(s):  
TAHIR MALIK ◽  
ZAFAR AMIN ◽  
TAHIR MALIK
Keyword(s):  
Acute Abdomen ◽  
Imaging Modality ◽  
Tertiary Care ◽  
High Sensitivity ◽  
Cost Effective ◽  
Military Hospital ◽  
Care Hospital ◽  
Radiation Hazards ◽  
Sensitivity Specificity

) To determine the role of ultrasonography as the primaryimaging modality in patients of acute abdomen. (2) To evaluate the sensitivity, specificity, positive and negativepredictive value of ultrasonography in acute abdomen. Design: A hospital based descriptive study. Setting: InCombined Military Hospital Lahore which is a tertiary care hospital. Period: From 1 Jan 2003 to 30 Dec 2003. stSubjects: A total of 100 consecutive patients of acute abdomen were selected for the study. There were 61 malepatients and 39 female patients. The patients’ age ranged from 02 years to 70 years. Ultrasonography was done usingALOKA SSD-5500 machine with high resolution probes. Results: During my study of patients of acute abdomen mostcommon conditions encountered were renal colic due to renal and ureteric stones followed by gut perforation,cholecystitis, appendicitis and cholelithiasis. My study revealed a sensitivity of 79.7% and specificity of 88.4% ofultrasonography in patients with acute abdomen. The positive predictive value was 95.1% and a negative predictivevalue was 60.5%. Conclusion: Ultrasonography helped in prompt decision making in most of the cases of acuteabdomen with a high sensitivity and specificity in skilled and experienced hands, as well as high positive predictivevalue. Hence, in our setup it can be used as a primary imaging modality for patients presenting with acute abdomenin any age group, as it is readily available, cost effective and free of any radiation hazards. Ultrasonography not onlyhelps in diagnosing the cause of pain but also ruling out other possibilities.

scholarly journals Predictive Value of Pleural Cytology in the Diagnosis of Complicated Parapneumonic Effusions and Empyema Thoracis

2020 ◽  
Vol 2020 ◽  
pp. 1-5 ◽  
Author(s):  
John Ferguson ◽  
Michal Kazimir ◽  
Michael Gailey ◽  
Frank Moore ◽  
Earl Schott
Keyword(s):  
Logistic Regression ◽  
Pleural Fluid ◽  
Predictive Value ◽  
Interobserver Agreement ◽  
Empyema Thoracis ◽  
Cytologic Diagnosis ◽  
Wilcoxon Rank Sum Test ◽  
Sensitivity Specificity ◽  
Fluid Cytology

Introduction. Complicated parapneumonic effusions (CPE) are distinguished from uncomplicated parapneumonic effusions (UPE) by the ability to resolve without drainage. Determinants include pleural pH, pleural glucose, and pleural LDH, along with microbiologic cultures. Inflammation mediated by neutrophil chemotactic cytokines leads to fibrinous loculation of an effusion, and the degree of this inflammation may lead to a CPE. One role of the pathologist is to evaluate for the presence of malignancy in a pleural effusion; however, the ability of the pathologist to distinguish a CPE from UPE has not been evaluated. Materials and Methods. A single-center retrospective study was performed on pleural cytology specimens from 137 patients diagnosed with a parapneumonic effusion or empyema over a five-year interval. Pleural cytology was characterized as either uncomplicated or complicated by two pathologists based on cellular composition and the presence or absence of fibrinous exudate in the fluid. Cohen’s kappa was calculated for interobserver agreement. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of cytologic diagnoses were calculated. Determinants of cytologic accuracy were assessed using Wilcoxon rank sum test, unpaired t-test, and logistic regression. Results. Kappa interobserver agreement between pathologists was 0.753. Pleural fluid cytology sensitivity, specificity, PPV, and NPV for CPE/empyema were 76.0%, 95% CI [65.0, 84.9]; 50%, 95% CI [29.1, 70.9]; 83.3%, 95% CI [76.7, 88.4]; and 38.7%, 95% CI [26.5, 52.5], respectively. The presence of pleural bacteria, elevated pleural LDH, and reduced pleural pH were nonsignificant determinants of cytologic accuracy. Logistic regression was significant for the presence of pleural bacteria (p=0.03) in determining a successful cytologic diagnosis. Conclusion. Pleural cytology adds little value to traditional markers of distinguishing a UPE from CPE. Inflammation on pleural fluid cytology is suggestive of empyema or the presence of pleural fluid bacteria.

scholarly journals Diagnostic performance of chest computed tomography during the epidemic wave of COVID-19 varied as a function of time since the beginning of the confinement in France

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242840
Author(s):  
Samia Boussouar ◽  
Mathilde Wagner ◽  
Victoria Donciu ◽  
Nicoletta Pasi ◽  
Joe Elie Salem ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Diagnostic Performance ◽  
High Sensitivity ◽  
Chest Ct ◽  
Rt Pcr ◽  
First Line ◽  
Chest Computed Tomography ◽  
Sensitivity Specificity ◽  
Epidemic Wave

Objective To evaluate the diagnostic performance of the initial chest CT to diagnose COVID-19 related pneumonia in a French population of patients with respiratory symptoms according to the time from the onset of country-wide confinement to better understand what could be the role of the chest CT in the different phases of the epidemic. Material and method Initial chest CT of 1064 patients with respiratory symptoms suspect of COVID-19 referred between March 18th, and May 12th 2020, were read according to a standardized procedure. The results of chest CTs were compared to the results of the RT-PCR. Results 546 (51%) patients were found to be positive for SARS-CoV2 at RT-PCR. The highest rate of positive RT-PCR was during the second week of confinement reaching 71.9%. After six weeks of confinement, the positive RT-PCR rate dropped significantly to 10.5% (p<0.001) and even 2.2% during the two last weeks. Overall, CT revealed patterns suggestive of COVID-19 in 603 patients (57%), whereas an alternative diagnosis was found in 246 patients (23%). CT was considered normal in 215 patients (20%) and inconclusive in 1 patient. The overall sensitivity of CT was 88%, specificity 76%, PPV 79%, and NPV 85%. At week-2, the same figures were 89%, 69%, 88% and 71% respectively and 60%, 84%, 30% and 95% respectively at week-6. At the end of confinement when the rate of positive PCR became extremely low the sensitivity, specificity, PPV and NPV of CT were 50%, 82%, 6% and 99% respectively. Conclusion At the peak of the epidemic, chest CT had sufficiently high sensitivity and PPV to serve as a first-line positive diagnostic tool but at the end of the epidemic wave CT is more useful to exclude COVID-19 pneumonia.

scholarly journals The role of grey-scale ultrasound in the diagnosis of adhesive capsulitis of the shoulder: a systematic review and meta-analysis

2020 ◽  
Vol 22 (3) ◽  
pp. 305
Author(s):  
Huaiyu Wu ◽  
Hongtian Tian ◽  
Fajin Dong ◽  
Weiyu Liang ◽  
Di Song ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Adhesive Capsulitis ◽  
High Sensitivity ◽  
Cochrane Library ◽  
Summary Receiver Operating Characteristic ◽  
Grey Scale ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

Aims: In this systematic review and meta-analysis, we discuss the value of grey-scale ultrasonography (US) in diagnosing adhesive capsulitis of the shoulder (ACS).Material and methods: We retrieved relevant studies from PubMed, Cochrane Library, and Embase before 8 April 2019. We selected 7 studies concerning 446 patients (490 shoulders) that used grey-scale US to diagnose ACS and magnetic resonance imaging (MRI) or arthroscopy as the reference standard. We assessed the diagnostic accuracy of US on the basis of combined sensitivity, specificity, likelihood ratio (LR), and the area under the summary receiver operating characteristic (SROC) curve (AUC).Results: The combined sensitivity, specificity, positive LR and negative LR were found to be 88% (95%CI: 74–95), 96% (95%CI: 88–99), 23.89 (95%CI: 6.31–90.51) and 0.12 (95%CI: 0.05–0.29), respectively. The AUC was 0.97 (95%CI: 0.96–0.98). ACS was diagnosed on the basis of four US features: coracohumeral ligament thickening, inferior capsule/axillary recess capsule thickening, rotator interval abnormality, and restriction of the range of motion. The corresponding sensitivities were 64.4 (95%CI: 48.8–78.1), 82.1 (95%CI: 73.8–88.7), 82.6 (95%CI: 74.1–89.2) and 94.3 (95%CI: 84.3–98.8), respectively, and specificities were 88.9 (95%CI: 76.0–96.3), 95.7 (95%CI: 90.3–98.6), 93.9 (95%CI: 89.8–96.7), and 90.9 (95%CI: 75.7–98.1), respectively.Conclusions: Our meta-analysis showed that grey-scale US plays a significant role in the diagnosis of ACS. Because of its high sensitivity and specificity, US can be added to the existing clinical diagnosis program.

scholarly journals Role of Magnetic Resonance Cholangiopancreatography in Cases of Obstructive Jaundice in Correlation with Ultrasonography

2016 ◽  
Vol 02 (02) ◽  
pp. 070-084
Author(s):  
Mohammadali Jiwani ◽  
Pankaj Banode ◽  
Ashutosh Kharche ◽  
Atieya Jiwani ◽  
S Vaidhya
Keyword(s):  
Obstructive Jaundice ◽  
Magnetic Resonance Cholangiopancreatography ◽  
High Sensitivity ◽  
Final Diagnosis ◽  
High Morbidity ◽  
Diagnostic Purpose ◽  
Determine Role ◽  
Sensitivity Specificity ◽  
Relationship Of

AbstractJaundice is a common problem in society, it is important to discriminate between obstructive and non obstructive cause due to high morbidity in cases of obstructive jaundice, also non obstructive jaundice requires medical management while obstructive jaundice requires surgical intervention. Our study was done with aims to determine role of MRCP in cases of obstructive jaundice in correlation with ultrasonography keeping post surgical follow ups/ ERCP/ histopathology as gold standard for final diagnosis. All patients in our study undergone USG followed by MRCP. We had included total 100 patients out of which 58 females and 42 males. Out of all patients we have observed 56 malignant causes and 44 benign causes. We have observed benign conditions are seen more frequently in adults while increase in frequency of malignancy with increase in age thus there found to have direct relationship of malignant etiology with increase in age. Most common benign cause observed in our study was choledocholithiasis while most common malignancy was carcinoma head of pancreas. In our study we have concluded that MRCP is better modality with high sensitivity, specificity and diagnostic accuracy as compared to USG also with use of MRCP invasive procedures like ERCP can be avoided just for diagnostic purpose. We have also noticed few limitations of both USG and MRCP in process of diagnosis.

scholarly journals MRI versus Ultrasonography in detection of suspected placental invasion

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
R H Abdallah ◽  
L A Habib ◽  
Y A Abdallah ◽  
M S Seweed ◽  
N M Youssry
Keyword(s):  
Tissue Characterization ◽  
Surgical Intervention ◽  
High Sensitivity ◽  
Depth Of Invasion ◽  
Mri Imaging ◽  
Promising Tool ◽  
Placental Invasion ◽  
Sensitivity Specificity ◽  
Better Than

Abstract Purpose of this study is to highlight the role of MRI and U/S in suspected placental invasion. Methods 40 patients were included in our study. All clinically suspected patients with previous CS or surgical intervention were subjected to US and MRI. Results Our study demonstrated that MRI has a significant promising tool factor for detection of placental invasion degree with high sensitivity, specificity and accuracy and superior to ultrasound in detection of degree of invasion. Conclusion MRI imaging of the placenta is of high sensitivity the diagnosis of degree of invasion better than US which couldn’t accurately detect the depth of invasion. Another advantage of MRI is that it’s not operator dependent and gives better tissue characterization.

Digital x-ray mapping of nanometer-size supported bimetallic catalysts

1988 ◽  
Vol 46 ◽  
pp. 530-531
Author(s):  
L. T. Germinario
Keyword(s):  
Background Radiation ◽  
Metal Cluster ◽  
Single Element ◽  
Beam Diameter ◽  
X Rays ◽  
X Ray ◽  
Major Interest ◽  
Induced Changes

Understanding the role of metal cluster composition in determining catalytic selectivity and activity is of major interest in heterogeneous catalysis. The electron microscope is well established as a powerful tool for ultrastructural and compositional characterization of support and catalyst. Because the spatial resolution of x-ray microanalysis is defined by the smallest beam diameter into which the required number of electrons can be focused, the dedicated STEM with FEG is the instrument of choice. The main sources of errors in energy dispersive x-ray analysis (EDS) are: (1) beam-induced changes in specimen composition, (2) specimen drift, (3) instrumental factors which produce background radiation, and (4) basic statistical limitations which result in the detection of a finite number of x-ray photons. Digital beam techniques have been described for supported single-element metal clusters with spatial resolutions of about 10 nm. However, the detection of spurious characteristic x-rays away from catalyst particles produced images requiring several image processing steps.

An x-ray microprobe based upon a close-coupled focal-spot / glass capillary arrangement

1992 ◽  
Vol 50 (2) ◽  
pp. 1758-1759
Author(s):  
D. A. Carpenter ◽  
M. A. Taylor
Keyword(s):  
Imaging Techniques ◽  
Fluorescence Analysis ◽  
High Sensitivity ◽  
Specimen Preparation ◽  
X Rays ◽  
Glass Capillary ◽  
Close Coupling ◽  
X Ray ◽  
Point To Point ◽  
Beam Damage

The development of intense sources of x rays has led to renewed interest in the use of microbeams of x rays in x-ray fluorescence analysis. Sparks pointed out that the use of x rays as a probe offered the advantages of high sensitivity, low detection limits, low beam damage, and large penetration depths with minimal specimen preparation or perturbation. In addition, the option of air operation provided special advantages for examination of hydrated systems or for nondestructive microanalysis of large specimens.The disadvantages of synchrotron sources prompted the development of laboratory-based instrumentation with various schemes to maximize the beam flux while maintaining small point-to-point resolution. Nichols and Ryon developed a microprobe using a rotating anode source and a modified microdiffractometer. Cross and Wherry showed that by close-coupling the x-ray source, specimen, and detector, good intensities could be obtained for beam sizes between 30 and 100μm. More importantly, both groups combined specimen scanning with modern imaging techniques for rapid element mapping.

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