scholarly journals Role of Computed Tomography Perfusion in Identification of Acute Lacunar Stroke Syndromes

Stroke ◽  
2021 ◽  
Vol 52 (1) ◽  
pp. 339-343
Author(s):  
Carlos Garcia-Esperon ◽  
Milanka Visser ◽  
Leonid Churilov ◽  
Ferdinand Miteff ◽  
Andrew Bivard ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Posterior Fossa ◽  
Delay Time ◽  
Imaging Modality ◽  
Lacunar Stroke ◽  
Transient Time ◽  
Predictive Values ◽  
Computed Tomography Perfusion ◽  
Noncontrast Computed Tomography ◽  
Sensitivity Specificity

Background and Purpose: Lacunar syndromes correlate with a lacunar stroke on imaging in 50% to 60% of cases. Computed tomography perfusion (CTP) is becoming the preferred imaging modality for acute stroke triage. We aimed to estimate the sensitivity, specificity, and predictive values for noncontrast computed tomography and CTP in lacunar syndromes, and for cortical, subcortical, and posterior fossa regions. Methods: A retrospective analysis of confirmed ischemic stroke patients who underwent acute CTP and follow-up magnetic resonance imaging between 2010 and 2018 was performed. Brain noncontrast computed tomography and CTP were assessed independently by 2 stroke neurologists. Receiver operating characteristic curve analysis was performed to estimate sensitivity, specificity, and area under the curve (AUC) for the detection of strokes in patients with lacunar syndromes using different CTP maps. Results: We found 106 clinical lacunar syndromes, but on diffusion-weighted imaging, these consisted of 59 lacunar, 33 cortical, and 14 posterior fossa strokes. The discrimination of ischemia identification was very poor using noncontrast computed tomography in all 3 regions, but good for cortical (AUC, 0.82) and poor for subcortical and posterior regions (AUCs, 0.55 and 0.66) using automated core-penumbra maps. The addition of delay time and mean transient time maps substantially increased subcortical (AUC, 0.80) and slightly posterior stroke detection (AUC, 0.69). Conclusions: Analysis of mean transient time and delay time maps in combination with core-penumbra maps improves detection of subcortical and posterior strokes.

scholarly journals Detectability on Plain CT is an Effective Discriminator between Carcinoma and Benign Disorder for a Polyp >10 mm in the Gallbladder

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 388
Author(s):  
Tatsunori Satoh ◽  
Masataka Kikuyama ◽  
Keiko Sasaki ◽  
Hirotoshi Ishiwatari ◽  
Shinya Kawaguchi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multivariate Analysis ◽  
Odds Ratio ◽  
Patient Characteristics ◽  
Polyp Size ◽  
Predictive Values ◽  
Lesion Detectability ◽  
Contrast Enhanced ◽  
Cell Densities ◽  
Sensitivity Specificity

An appropriate diagnosis is required to avoid unnecessary surgery for gallbladder cholesterol polyps (GChPs) and to appropriately treat pedunculated gallbladder carcinomas (GCs). Generally, polyps >10 mm are regarded as surgical candidates. We retrospectively evaluated plain and contrast-enhanced (CE) computed tomography (CT) findings and histopathological features of 11 early GCs and 10 GChPs sized 10–30 mm to differentiate between GC and GChP >10 mm and determine their histopathological background. Patient characteristics, including polyp size, did not significantly differ between groups. All GCs and GChPs were detected on CE-CT; GCs were detected more often than GChPs on plain CT (73% vs 9%; p < 0.01). Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for GCs were 73%, 90%, 89%, 75%, and 81%, respectively. On multivariate analysis, lesion detectability on plain CT was independently associated with GCs (odds ratio, 27.1; p = 0.044). Histopathologically, GChPs consisted of adipose tissue. Although larger vessel areas in GCs than in GChPs was not significant (52,737 μm2 vs 31,906 μm2; p = 0.51), cell densities were significantly greater in GCs (0.015/μm2 vs 0.0080/μm2; p < 0.01). Among GPs larger than 10 mm, plain CT could contribute to differentiating GCs from GChPs.

scholarly journals Inter-observer agreement on the evaluation of automated breast volume scanner for breast masses

2022 ◽  
pp. 1-11
Author(s):  
Yingchun Liu ◽  
Lin Chen ◽  
Jia Zhan ◽  
Xuehong Diao ◽  
Yun Pang ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Observer Agreement ◽  
Breast Volume ◽  
Imaging Data ◽  
Predictive Values ◽  
Breast Masses ◽  
Cutoff Value ◽  
Automated Breast Volume Scanner ◽  
The Masses ◽  
Sensitivity Specificity

Objective: To explore inter-observer agreement on the evaluation of automated breast volume scanner (ABVS) for breast masses. Methods: A total of 846 breast masses in 630 patients underwent ABVS examinations. The imaging data were independently interpreted by senior and junior radiologists regarding the mass size ([Formula: see text][Formula: see text]cm, [Formula: see text][Formula: see text]cm and total). We assessed inter-observer agreement of BI-RADS lexicons, unique descriptors of ABVS coronal planes. Using BI-RADS 3 or 4a as a cutoff value, the diagnostic performances for 331 masses with pathological results in 253 patients were assessed. Results: The overall agreements were substantial for BI-RADS lexicons ([Formula: see text]–0.779) and the characteristics on the coronal plane of ABVS ([Formula: see text]), except for associated features ([Formula: see text]). However, the overall agreement was moderate for orientation ([Formula: see text]) for the masses [Formula: see text][Formula: see text]cm. The agreements were substantial to be perfect for categories 2, 3, 4, 5 and overall ([Formula: see text]–0.918). However, the agreements were moderate to substantial for categories 4a ([Formula: see text]), 4b ([Formula: see text]), and 4c ([Formula: see text]), except for category 4b of the masses [Formula: see text][Formula: see text]cm ([Formula: see text]). Moreover, for radiologists 1 and 2, there were no significant differences in sensitivity, specificity, accuracy, positive and negative predictive values with BI-RADS 3 or 4a as a cutoff value ([Formula: see text] for all). Conclusion: ABVS is a reliable imaging modality for the assessment of breast masses with good inter-observer agreement.

scholarly journals Prediction of Extrathyroidal Extension Using Ultrasonography and Computed Tomography

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Doh Young Lee ◽  
Tack-Kyun Kwon ◽  
Myung-Whun Sung ◽  
Kwang Hyun Kim ◽  
J. Hun Hah
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Extrathyroidal Extension ◽  
Ct Scans ◽  
Imaging Features ◽  
Predictive Values ◽  
Preoperative Prediction ◽  
Ct Findings ◽  
Sensitivity Specificity ◽  
Thyroid Capsule

Objectives. The aim of the present study was to evaluate the value of high-resolution ultrasound (US) and computed tomography (CT) scan for preoperative prediction of the extrathyroidal extension (ETE).Methods. We analyzed the medical records of 377 patients with papillary thyroid carcinoma (PTC) with preoperative US and CT scan to calculate the sensitivity, specificity, and positive and negative predictive values of characteristics imaging features (such as contact and disruption of thyroid capsule) for the presence of ETE in postoperative pathologic examination. We also evaluated the diagnostic power for several combinations of US and CT findings.Results. ETE was present in 174 (46.2%) based on pathologic reports. The frequency of ETE was greater in the patients with greater degrees of tumor contact and disruption of capsule, as revealed by both US and CT scans (positive predictive value of 72.2% and 81.8%, resp.). Considering positive predictive values and AUC of US and CT categories, separately or combined, a combination of US and CT findings was most accurate for predicting ETE (83.0%, 0.744).Conclusions. This study suggests that ETE can be predicted most accurately by a combination of categories based on the findings of US and CT scans.

Radiographically negative stress-related bone injury

1998 ◽  
Vol 39 (4) ◽  
pp. 416-420 ◽  
Author(s):  
J. Hodler ◽  
H. Steinert ◽  
M. Zanetti ◽  
U. Frölicher ◽  
J. Rogala ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Bone Scintigraphy ◽  
Imaging Modality ◽  
Diagnostic Value ◽  
Bone Diseases ◽  
Two Phase ◽  
Predictive Values ◽  
Bone Injury ◽  
Initial Imaging ◽  
Sensitivity Specificity

Purpose: To assess the diagnostic value of MR imaging relative to two-phase bone scintigraphy in radiographically negative stress-related injuries. Material and Methods: Sixteen consecutive patients presenting with stressrelated bone injuries and normal standard radiographs were examined with two-phase bone scans and MR imaging. MR imaging protocols varied according to the region to be examined. The MR and scintigraphic images were evaluated blindly and separately by respectively two radiologists and two nuclear medicine physicians. The standard of reference was represented by a combination of clinical and scintigraphic findings as well as clinical follow-up. Results: For MR imaging, sensitivity, specificity, and positive and negative predictive values for the presence of stress-related injuries for the two readers were 69/63%, 100/80%, 100/91%, and 50/40%, respectively. Interobserver agreement was good (kappa=0.62). For scintigraphy, all abnormal and normal findings were correctly identified. Conclusion: For patients with clinically suspected stress-related injuries and a low probability of other active bone diseases (such as infection or neoplasm), bone scintigraphy should be the initial imaging modality.

scholarly journals In vivo detection of external apical root resorption induced by apical periodontitis using periapical radiography and cone-beam computed tomography

2021 ◽  
Author(s):  
Stephanie Diaz Huamán ◽  
Maya Fernanda Manfrin Arnez ◽  
Fernanda Maria Machado Pereira Cabral de Oliveira ◽  
Andiara De Rossi ◽  
Léa Assed Bezerra Silva ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Predictive Value ◽  
Root Resorption ◽  
Calculated Data ◽  
Cone Beam ◽  
Predictive Values ◽  
Apical Root Resorption ◽  
External Apical Root Resorption ◽  
Sensitivity Specificity

Abstract Objectives: To investigate sensitivity, specificity, predictive values and accuracy of periapical radiography (PR) and Cone beam computed tomography (CBCT) for detection of external apical root resorption (EARR).Materials and Methods: Dog’s teeth with experimentally induced root resorption underwent or not root canal treatment (n = 62 roots). True positives (TP), false positives (FP), true negatives (TN) and false negatives (FN) in PR and CBCT diagnoses were determined using histopathologic findings as gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (TP + TN) in the diagnosis of EARR were calculated. Data was compared using chi-squared test (⍺= 0.05).Results: We found that PR detected EARR in 35% of roots and CBCT, in 47%. EARR was microscopically diagnosed in 50% (p = 0.03 comparison between PR and microscopy; p = 0.67 comparison between CBCT and microscopy). Overall, CBCT produced more accurate diagnoses than PR (0.93 for CBCT versus 0.70 for PR; p = 0.008). Interestingly, when data was stratified into small and large resorptions, PR and CBCT allowed identification of large resorption in 100% of the cases and showed the same accuracy. However, for small resorptions, PR showed an accuracy of 0.83, whereas CBCT showed an accuracy of 0.96 (p = 0.003).Conclusions: We demonstrated that CBCT showed higher accuracy to detect EARR. These findings shed light on the use of CBCT for detection of initial root resorption.Clinical relevance: Early identification of resorption allows a prompt treatment and reduces the risk of dental structure loss.

scholarly journals Noncontrast Computed Tomography e-Stroke Infarct Volume Is Similar to RAPID Computed Tomography Perfusion in Estimating Postreperfusion Infarct Volumes

Stroke ◽  
2021 ◽  
Vol 52 (2) ◽  
pp. 634-641 ◽  
Author(s):  
Mehdi Bouslama ◽  
Krishnan Ravindran ◽  
George Harston ◽  
Gabriel M. Rodrigues ◽  
Leonardo Pisani ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Odds Ratio ◽  
Functional Outcomes ◽  
Adjusted Odds Ratio ◽  
Infarct Volume ◽  
Tertiary Care ◽  
Computed Tomography Perfusion ◽  
Ischemic Core ◽  
Noncontrast Computed Tomography ◽  
Core Volume

Background and Purpose: The e-Stroke Suite software (Brainomix, Oxford, United Kingdom) is a tool designed for the automated quantification of The Alberta Stroke Program Early CT Score and ischemic core volumes on noncontrast computed tomography (NCCT). We sought to compare the prediction of postreperfusion infarct volumes and the clinical outcomes across NCCT e-Stroke software versus RAPID (IschemaView, Menlo Park, CA) computed tomography perfusion measurements. Methods: All consecutive patients with anterior circulation large vessel occlusion stroke presenting at a tertiary care center between September 2010 and November 2018 who had available baseline infarct volumes on both NCCT e-Stroke Suite software and RAPID CTP as well as final infarct volume (FIV) measurements and achieved complete reperfusion (modified Thrombolysis in Cerebral Infarction scale 2c-3) post-thrombectomy were included. The associations between estimated baseline ischemic core volumes and FIV as well as 90-day functional outcomes were assessed. Results: Four hundred seventy-nine patients met inclusion criteria. Median age was 64 years (55–75), median e-Stroke and computed tomography perfusion ischemic core volumes were 38.4 (21.8–58) and 5 (0–17.7) mL, respectively, whereas median FIV was 22.2 (9.1–56.2) mL. The correlation between e-Stroke and CTP ischemic core volumes was moderate (R=0.44; P <0.001). Similarly, moderate correlations were observed between e-Stroke software ischemic core and FIV (R=0.52; P <0.001) and CTP core and FIV (R=0.43; P <0.001). Subgroup analysis showed that e-Stroke software and CTP performance was similar in the early and late (>6 hours) treatment windows. Multivariate analysis showed that both e-Stroke software NCCT baseline ischemic core volume (adjusted odds ratio, 0.98 [95% CI, 0.97–0.99]) and RAPID CTP ischemic core volume (adjusted odds ratio, 0.98 [95% CI, 0.97–0.99]) were independently and comparably associated with good outcome (modified Rankin Scale score of 0–2) at 90 days. Conclusions: NCCT e-Stroke Suite software performed similarly to RAPID CTP in assessing postreperfusion FIV and functional outcomes for both early- and late-presenting patients. NCCT e-Stroke volumes seems to represent a viable alternative in centers where access to advanced imaging is limited. Moreover, the future development of fusion maps of NCCT and CTP ischemic core estimates may improve upon the current performance of these tools as applied in isolation.

Usefulness of Grey Scale and Doppler transvaginal sonography in diagnosis of ovarian torsion

2020 ◽  
Vol 14 (2) ◽  
pp. 97-102
Author(s):  
Khalid Rehman `Yousaf ◽  
Shahzad Saeed ◽  
Saman Chaudhry ◽  
Rabia Bashrat ◽  
Abadullah Khalid ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Ovarian Function ◽  
Imaging Modality ◽  
Ovarian Torsion ◽  
Transvaginal Sonography ◽  
Predictive Values ◽  
Grey Scale ◽  
Sensitivity Specificity

Background: Ovarian torsion diagnosis is a great challenge as delay in diagnosis can cause severe morbidity. Early accurate diagnosis is crucial to preserve ovarian function. Ultrasonography being the primary imaging modality plays a vital role in the evaluation of suspected ovarian torsion by helping surgeons reach the correct diagnosis, thus avoiding unnecessary intervention. This study aims to determine the diagnostic accuracy of isolated and combined sonographic features of ovarian torsion on grey scale and Doppler transvaginal ultrasonography. Patients and methods: From radiology database, from January 2016 till December 2019, sonographic signs of ovarian torsion in 113 women with suspected ovarian torsion on ultrasonography and subsequent surgical diagnosis were evaluated. Ultrasound findings were compared with surgical findings to determine the accuracy, sensitivity, specificity, and positive and negative predictive values of individual and combined ultrasound signs. Results: Diagnostic accuracy of ultrasound for ovarian torsion was 85.8%. Abnormal ovarian Doppler flow was the most accurate individual sonographic sign with accuracy, sensitivity, specificity and positive predictive value of 85.8%, 83.5%, 100% and 100% respectively followed by ovarian enlargement and ovarian edema. Combined ultrasound signs resulted in higher sensitivity and positive predictive values, and lower specificity and negative predictive values for ovarian torsion. Increasing the number of sonographic parameters increased the specificity but decreased sensitivity. High accuracy, sensitivity, positive predictive value, specificity and negative predictive value was seen when combination of three or two sonographic parameters was used as diagnostic criteria. Conclusion: Transvaginal sonography is a convenient, reliable and extremely useful imaging modality for preoperative diagnosis of ovarian torsion with high specificity, sensitivity, positive predictive value and diagnostic accuracy helping treating physicians to take prompt decisions regarding timely surgical intervention. However, due to low negative predictive values, absence of sonographic signs does not rule out ovarian torsion and high index of clinical suspicion remains of utmost importance.

scholarly journals Comparison of Three-Dimensional Fluoroscopy versus Postoperative Computed Tomography for the Assessment of Accurate Screw Placement after Instrumented Spine Surgery

2012 ◽  
Vol 2 (2) ◽  
pp. 095-098 ◽  
Author(s):  
Sarah T. Garber ◽  
Erica F. Bisson ◽  
Meic H. Schmidt
Keyword(s):  
Computed Tomography ◽  
Three Dimensional ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Predictive Values ◽  
Frequent Use ◽  
Number Of Patients ◽  
Kappa Value ◽  
Instrumented Spine Surgery ◽  
Sensitivity Specificity

While intraoperative three-dimensional fluoroscopy does not possess the resolution and image quality of computed tomography (CT), it may provide adequate information about screw placement to guide intra- and postoperative decision making. We compared the accuracy of intraoperative three-dimensional fluoroscopy visualization of proper screw placement with that of postoperative CT. We retrospectively reviewed spinal instrumentation procedures done using the O-arm (Medtronic, Minneapolis, MN, USA) that also had postoperative CT. All screws were assessed for placement accuracy on O-arm and CT images on a 4-point scale. In this study, 20 cases met the inclusion criteria. Thirteen breaches (11 grade 1 and 2 grade 2) were identified on O-arm images, and 14 breaches (10 grade 1, 3 grade 2, and 1 grade 3) were identified on CT. Sensitivity, specificity, and positive and negative predictive values were 93, 99, 99, and 98%, respectively. The Kappa value (0.96) suggested a very high degree of agreement between three-dimensional fluoroscopy and CT in determining accuracy of screw placement. These findings may allow less frequent use of postoperative CT scans, improving cost effectiveness in patients who require spinal instrumentation procedures and potentially decreasing the number of patients who require replacement of an inappropriately positioned screw.

scholarly journals Computed Tomography Angiography is the Definitive Vascular Imaging Modality for Penetrating Neck Injury: A South African Experience

2017 ◽  
Vol 107 (1) ◽  
pp. 23-30 ◽  
Author(s):  
A. S. Madsen ◽  
V. Y. Kong ◽  
G. V. Oosthuizen ◽  
J. L. Bruce ◽  
G. L. Laing ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Vascular Injury ◽  
Computed Tomography Angiography ◽  
Imaging Modality ◽  
Arterial Injury ◽  
Vascular Trauma ◽  
Neck Injury ◽  
Predictive Values ◽  
Venous Injury ◽  
Penetrating Neck Injury

Background and Aims: Computed tomography angiography has become central to the diagnostic algorithm for penetrating neck injury, but despite its widespread use the literature to support this adoption is limited. We reviewed our experience with computed tomography angiography for the identification of vascular trauma in hemodynamically stable patients with penetrating neck injury at a major trauma center in South Africa. Materials and Methods: A prospectively kept trauma registry capturing data in real time was retrospectively reviewed. All patients with penetrating neck injury investigated with computed tomography angiography as the initial vascular investigation during a 47-month period were included. Results: A total of 380 patients were included. Indications for computed tomography angiography were as follows: hard signs (13), soft signs (201), no signs but proximity/zone I or III wounds (141), and undefined signs of vascular injury (25). Of the 380 scans, 7 (1.8%) were indeterminate, 299 (78.7%) negative, and 74 (19.5%) positive for a vascular injury (54 arterial and 20 isolated venous injury). Eight were false positive and 4 false negative. The sensitivity, specificity, positive, and negative predictive values for detecting arterial injury were 93.9%, 97.5%, 85.2%, and 99.1%, respectively. Overall, the yield for demonstrating “true arterial injury” was 12.1% (46/380); hard signs: 76.9% (10/13), soft signs: 16.4% (33/201), and no signs: 2.1% (3/141) which all were secondary to gunshot wounds). Only 8.4% (32/380) required intervention for arterial injury and none for isolated venous injury (hard signs: 62.0%, soft signs: 11.4%, and no signs: 0.7%). No serious complications resulted from computed tomography angiography. Conclusion: Computed tomography angiography is a safe and effective imaging modality for the investigation of vascular trauma post penetrating neck injury. Asymptomatic patients with stab wounds do not need to be imaged regardless of proximity concerns. Symptomatic stable patients including a subgroup with hard signs should be imaged rather than explored. Computed tomography angiography provides an interventional road map and can identify injuries amenable to endovascular or conservative management.

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