Abstract 18795: Resting Patient- and Vessel-Specific Myocardial Perfusion Attenuation Patterns Improves Diagnostic Performance of Coronary Computed Tomographic Angiography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Guanglei Xiong ◽  
Iksung Cho ◽  
Heidi Gransar ◽  
Deeksha Kola ◽  
Kimberly Elmore ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Diagnostic Accuracy ◽  
Coronary Stenosis ◽  
Diagnostic Performance ◽  
Ct Perfusion ◽  
Quantitative Coronary Angiography ◽  
High Grade ◽  
Operating Characteristics ◽  
Luminal Diameter ◽  
Coronary Stenoses

Introduction: Coronary CT angiography (CCTA) demonstrates improved performance for diagnosis of high-grade coronary stenoses, but may be affected by artifacts and overestimation of stenosis severity. Whether the addition of resting myocardial perfusion attenuation patterns subtended by stenosis seen on CCTA improves diagnostic performance has not been examined to date. Methods: We evaluated 127 patients (mean age 53.0, 54.3% male) who underwent CCTA and ICA. Percentage of coronary stenosis was assessed by quantitative coronary angiography (QCA), which served as the reference comparator to CCTA. CCTA stenosis was categorized as 0%, 1-24%, 25-49%, 50-69%, 70-99%, and 100% luminal diameter reduction. Automated software (SmartHeart, Redwood City, CA) was used to measure resting CT perfusion attenuation patterns in myocardial segments by AHA 17-segment model. Segmental CT attenuation values were assigned to territories subtended by left anterior descending (LAD), left circumflex (LCX), and right coronary arteries (RCA). Per-patient and per-vessel analyses were based on highest severity (maximal stenosis, minimal attenuation). On both per-patient and per-vessel basis, logistic regression was devised for CCTA stenosis alone and for CCTA plus resting myocardial attenuation. Diagnostic accuracy and area under the receiver operating characteristics curve (AUC) were determined. Results: Diagnostic accuracy of CCTA alone was 84.0%, 85.5%, 90.4%, and 88.6%, at per-patient, per-LAD, per-LCX and per-RCA level, respectively. In comparison, the accuracy of CCTA plus myocardial attenuation were 89.6%, 91.9%, 95.2%, and 92.7%. The AUCs using CCTA alone to discriminate QCA-confirmed coronary stenoses >70% were 0.823 (95% CI: 0.737-0.909), 0.782 (95% CI: 0.667-0.898), 0.690 (95% CI: 0.503-0.878), and 0.793 (95% CI: 0.640-0.945) for per-patient, per-LAD, per-LCX, and per-RCA analysis, respectively. The AUCs using CCTA plus myocardial attenuation improved to 0.864 (95% CI: 0.765-0.962), 0.881 (95% CI: 0.793-0.968), 0.772 (95% CI: 0.535-1.000), and 0.820 (95% CI: 0.685-0.954). Conclusions: The addition of resting CT myocardial perfusion attenuation patterns improves identification and discrimination of high-grade coronary stenosis by CCTA.

scholarly journals HPV E6/E7 mRNA test for the detection of high grade cervical intraepithelial neoplasia (CIN2+): A systematic review

2019 ◽  
Author(s):  
Awoke Derbie ◽  
Daniel Mekonnen ◽  
Yimtubeznash Woldeamanuel ◽  
Xaveer Van Ostade ◽  
Tamrat Abebe
Keyword(s):  
Systematic Review ◽  
Coming Out ◽  
Gold Standard ◽  
Diagnostic Performance ◽  
Grey Literature ◽  
High Grade ◽  
Operating Characteristics ◽  
Cervical Lesions ◽  
Predictive Values ◽  
Hpv E6

Abstract Background: Genital infection with certain types of Human papillomavirus (HPV) is a major cause of cervical cancer globally. For early detection of premalignant dysplasia, evidences are coming out on the usefulness of HPV E6/E7 mRNA test as a potential tool compared with cytology and HPV DNA testing. Taking into account shortage of compiled data on this field, the aim of this systematic review was to describe the latest diagnostic performance of HPV E6/E7 mRNA testing to detect high grade cervical lesions (CIN2+) where by histology as was taken as a ‘gold standard’. Methods: Articles published in English were systematically searched using key words from PubMed/Medline and SCOPUS. In addition, Google Scholar and the Google database were searched manually for grey literature. Two reviewers independently assessed study eligibility, risk of bias and extracted the data. We performed a descriptive presentation of the performance of E6/E7 mRNA testings (interims of sensitivity, specificity, negative and positive predictive values) for the detection of CIN2+. Results: Out of 231 applicable citations, we have included 29 articles with a total of 23,576 study participants (age range, 15-84) who had different cervical pathologies. Among the participants who had cervical histology, the proportion of CIN2+ was between 10.6% and 90.6%. Using histology as a gold standard, 11 studies evaluated the PreTect HPV Proofer, 7 studies evaluated the APTIMA HPV assay (Gen-Probe) and 6 studies evaluated the Quantivirus® HPV assay. The diagnostic performance of those three most common mRNA testing tools to detect CIN2+ was; 1) PreTect Proofer; median sensitivity 83%, median specificity 73%, median PPV 70 and median NPV 88.9%. 2) APTIMA assay; median sensitivity 91.4%, median specificity 46.2%, median PPV 34.3% and median NPV 96.3%. 3) Quantivirus®: median sensitivity 86.1%, median specificity 54.6%, median PPV 54.3%, median NPV 89.3%. Further, the area under the receiver operating characteristics (AU-ROC) curve varied between 63.8% and 90.9%. Conclusions: The reported diagnostic accuracy implies that mRNA tests possess diagnostic relevance to detect CIN2+ and could potentially be considered in areas where there is no histology facility. Further studies including its cost should be considered.

Abstract 2334: Head-to-head Comparison of Whole-Heart Coronary MR and 40/64 slice Multidetector-CT Angiography for Detection of Coronary Artery Stenosis.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Anne-Catherine Pouleur ◽  
Jean-Benoit le Polain de Waroux ◽  
Joelle Kefer ◽  
Céline Goffinet ◽  
Jean-Louis Vanoverschelde ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Cardiac Catheterization ◽  
Multidetector Ct ◽  
Reference Method ◽  
Free Breathing ◽  
Luminal Diameter ◽  
3 Dimensional ◽  
Coronary Imaging ◽  
Coronary Stenoses ◽  
Whole Heart

Purpose . Whole-heart magnetic resonance coronary angiography (WH-MRCA) has been recently proposed for non-invasive coronary imaging. Early studies have suggested that WH-MRCA might have similarly high diagnostic accuracy for detection of coronary disease as multidetector CT (MDCT). Yet, no direct comparison between both techniques has been performed. The aim of the present study was therefore to perform a head-to-head comparison of both techniques for detection of significant coronary stenoses using invasive cardiac catheterization as reference standard. Methods. Seventy-seven consecutive patients (56 M, 61±14 years) prospectively underwent free-breathing 3-dimensional WH-MRCA and 40/64-slice MDCT before cardiac catheterization. WH-MRCA and MDCT images were visually graded by 2 blinded observers and the diagnostic accuracy of both methods for detecting >50% luminal diameter stenoses (DS) in segments and vessels >1.5 mm size was compared using quantitative angiography (QCA) as reference method. Results. MDCT was successfully completed in all 77 patients in < 5 minutes. By contrast, WH-MRCA failed in 9 patients (12%) because of poor navigator performance and lasted 20±4 minutes (p<.01 vs MDCT). According to QCA, out of 992 segments > 1.5 mm diameter, 49 presented >50% DS. If all segments including non interpretable segments were considered, WH-MRCA had lower sensibility (35/49 or 71% vs. 45/49 or 92%, p<0.001), lower specificity (644/943 or 68% vs. 863/943 or 92%, p<0.001) and accuracy (679/992 or 68% vs. 908/992 or 92%, p<0.001) for detection of coronary stenosis than MDCT. However if only interpretable segments were considered, the sensitivity (35/37 or 95% vs. 45/46 or 98%, p=0.58), specificity (644/689 or 93% vs. 863/917 or 94%, p=0.67) and diagnostic accuracy (679/726 or 94%, vs. 908/963 or 94%, p=0.58) of WH-MRCA and MDCT for detection of >50% DS was similar. This was also the case on per-vessel basis. Conclusion. In the present study, MDCT had higher success rate than WH-MRCA. Therefore on an intention to diagnose basis, MDCT was superior to WH-MRCA. However, the diagnostic accuracy of WH-MRCA on per-segment and per-vessel basis was not statistically different from MDCT if only interpretable segments were considered.

Evaluation of myocardial scarring and perfusion

2019 ◽  
pp. 271-284
Keyword(s):  
Clinical Practice ◽  
Myocardial Perfusion ◽  
Myocardial Ischaemia ◽  
Coronary Stenosis ◽  
Ct Perfusion ◽  
Image Interpretation ◽  
Routine Clinical Practice ◽  
Functional Evaluation ◽  
Myocardial Scarring ◽  
Myocardial Ct Perfusion

Myocardial CT perfusion (CTP) imaging is increasingly being used in routine clinical practice as a technique for detecting myocardial ischaemia. CTP offers the advantage of combining anatomical and functional evaluation of coronary stenosis in the same examination and enhances the accuracy of CTA in both patients with suspected and known CAD. This chapter covers contrast pharmacokinetics, scan acquisition, image interpretation, delayed CCT, and evaluation of myocardial perfusion.

scholarly journals Arterial spin labeling MR imaging for differentiation between high- and low-grade glioma—a meta-analysis

2018 ◽  
Vol 20 (11) ◽  
pp. 1450-1461 ◽  
Author(s):  
Alberto Falk Delgado ◽  
Francesca De Luca ◽  
Danielle van Westen ◽  
Anna Falk Delgado
Keyword(s):  
Mr Imaging ◽  
Arterial Spin Labeling ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Spin Labeling ◽  
Low Grade Glioma ◽  
Cochrane Library ◽  
Low Grade ◽  
High Grade ◽  
Operating Characteristics

Abstract Background Arterial spin labeling is an MR imaging technique that measures cerebral blood flow (CBF) non-invasively. The aim of the study is to assess the diagnostic performance of arterial spin labeling (ASL) MR imaging for differentiation between high-grade glioma and low-grade glioma. Methods Cochrane Library, Embase, Medline, and Web of Science Core Collection were searched. Study selection ended November 2017. This study was prospectively registered in PROSPERO (CRD42017080885). Two authors screened all titles and abstracts for possible inclusion. Data were extracted independently by 2 authors. Bivariate random effects meta-analysis was used to describe summary receiver operating characteristics. Trial sequential analysis (TSA) was performed. Results In total, 15 studies with 505 patients were included. The diagnostic performance of ASL CBF for glioma grading was 0.90 with summary sensitivity 0.89 (0.79–0.90) and specificity 0.80 (0.72–0.89). The diagnostic performance was similar between pulsed ASL (AUC 0.90) with a sensitivity 0.85 (0.71–0.91) and specificity 0.83 (0.69–0.92) and pseudocontinuous ASL (AUC 0.88) with a sensitivity 0.86 (0.79–0.91) and specificity 0.80 (0.65–0.87). In astrocytomas, the diagnostic performance was 0.89 with sensitivity 0.86 (0.79 to 0.91) and specificity 0.79 (0.63 to 0.89). Sensitivity analysis confirmed the robustness of the findings. TSA revealed that the meta-analysis was adequately powered. Conclusion Arterial spin labeling MR imaging had an excellent diagnostic accuracy for differentiation between high-grade and low-grade glioma. Given its low cost, non-invasiveness, and efficacy, ASL MR imaging should be considered for implementation in the routine workup of patients with glioma.

scholarly journals Comparison of myocardial contrast stress-echocardiography and standard stress-echocardiography in detecting myocardial ischemia in patients with different severity of coronary artery stenoses

2020 ◽  
Vol 92 (4) ◽  
pp. 45-50
Author(s):  
L. S. Atabaeva ◽  
M. A. Saidova ◽  
V. N. Shitov ◽  
I. I. Staroverov
Keyword(s):  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Myocardial Ischemia ◽  
Diagnostic Accuracy ◽  
Stress Echocardiography ◽  
Diagnostic Value ◽  
Contrast Enhanced ◽  
Coronary Artery Stenoses ◽  
Coronary Stenoses ◽  
Sensitivity Specificity

Aim. To compare diagnostic value between standard stress-echocardiography and myocardial contrast stress echocardiography in detection of myocardial ischemia in patients with different severity of coronary artery stenoses. Materials and methods. Myocardial contrast stress-echocardiography and standard stress-echocardiography were performed in 38 patients with coronary artery stenoses over 50% by angiography. Of all lesions 39 were intermediate (5075%) and 33 over 75% stenoses. Fractional flow reserve (FFR) was measured in 12 coronary arteries. During myocardial contrast stress-echocardiography wall motion and myocardial perfusion was assessed. Results. Adequate visualisation increased from 81.6% in unenhanced segments to 96.1% in contrast-enhanced segments. The sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography in intermediate (5075%) coronary stenoses were 44%, 83%, 56% and 56%, 94% и 64% respectively compare to angiography. Taking into account the 12 arteries with evaluated FFR, these parameters increased to 52%, 93% и 65% in standard stress-echocardiography and to 68%, 100% and 75% in myocardial contrast stress-echocardiography. In coronary stenoses over 75% the sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography were 78%, 88%, 80% and 86%, 100%, 92% respectively Conclusion. Use of contrast-enhanced stress-echorardiography significantly increased the diagnostic value of this method by improving endocardial border visualization and possibilities of myocardial perfusion assessment.

scholarly journals Diagnostic accuracy of perfusion-CT using Peak Enhancement Intensity (PEI) in detecting high grade pancreatic ductal adenocarcinoma keeping histopathology as gold standard.

2019 ◽  
Vol 26 (11) ◽  
pp. 1829-1834
Author(s):  
Abdul Raouf ◽  
Adeela Abid Bukhari ◽  
Natasha Arshad ◽  
Muhammad Ahsan
Keyword(s):  
Diagnostic Accuracy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Predictive Value ◽  
Gold Standard ◽  
Ct Perfusion ◽  
Perfusion Ct ◽  
Ductal Adenocarcinoma ◽  
Correct Identification ◽  
High Grade ◽  
Ct Guided

Pancreatic ductal carcinoma is the most common primary malignancy of the pancreas and is associated with a very poor prognosis, being worldwide one of the leading cause of cancer related death. The pre-operative correct identification of this group of patients is very important to minimize unnecessary resections but remains difficult owing to the post-operative assessment of some factors such as tumor resection margins and grading. Perfusion CT (P-CT) is a new imaging technique able to provide qualitative and quantitative information on perfusion parameters of tissues, which have been demonstrated to be correlated with histological markers of angiogenesis. Objectives: To estimate the diagnostic accuracy of CT perfusion using PEI in detecting high grade pancreatic ductal adenocarcinoma keeping histopathology as gold standard. Study Design: Cross sectional study. Setting: Radiology department of Allied Hospital Faisalabad. Period: 6 months after approval from June, 2016 to Nov, 2016. Material and Methods: Permission for research was sought from hospital ethical committee. Patients were collected from OPD & indoor of Radiology and surgical department of Allied Hospital Faisalabad. Confounding variables were controlled by restriction (by excluding the subjects with history of metastatic disease or chemotherapy). CT-Perfusion examination was performed with the patient in supine position on a 128 slice Optima Multi detector CT scanner. Image guided (CT guided) biopsy was done on all patients and specimen was sent to the hospital pathology lab and histopathology was done by senior pathologist, who kept blinded to perfusion-CT analysis. Results: In this study, out of 100 cases, the diagnostic accuracy of CT perfusion using PEI in detecting high grade pancreatic ductal adenocarcinoma keeping histopathology as gold standard was recorded as 90.59%, 91.49%, 92.31%, 89.58% and 91% for sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate. Conclusion: We concluded that diagnostic accuracy of CT perfusion using PEI is higher in detection of high grade pancreatic ductal adenocarcinoma keeping histopathology as gold standard. 

Sign in / Sign up

Export Citation Format

Share Document