scholarly journals Utility of Apical Lung Assessment on Computed Tomography Angiography as a COVID-19 Screen in Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3765-3769
Author(s):  
Charles Esenwa ◽  
Ji-Ae Lee ◽  
Taha Nisar ◽  
Anna Shmukler ◽  
Inessa Goldman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Computed Tomography Angiography ◽  
Predictive Value ◽  
Screening Tool ◽  
Clinical Symptoms ◽  
Shortness Of Breath ◽  
Patient Reported

Background and Purpose: Evaluation of the lung apices using computed tomography angiography of the head and neck during acute ischemic stroke (AIS) can provide the first objective opportunity to screen for coronavirus disease 2019 (COVID-19). Methods: We performed an analysis assessing the utility of apical lung exam on computed tomography angiography for COVID-19–specific lung findings in 57 patients presenting with AIS. We measured the diagnostic accuracy of apical lung assessment alone and in combination with patient-reported symptoms and incorporate both to propose a COVID-19 era AIS algorithm. Results: Apical lung assessment when used in isolation, yielded a sensitivity of 0.67, specificity of 0.93, positive predictive value of 0.19, negative predictive value of 0.99, and accuracy of 0.92 for the diagnosis of COVID-19, in patients presenting to the hospital for AIS. When combined with self-reported clinical symptoms of cough or shortness of breath, sensitivity of apical lung assessment improved to 0.83. Conclusions: Apical lung assessment on computed tomography angiography is an accurate screening tool for COVID-19 and can serve as part of a combined screening approach in AIS.

Preoperative computed tomography assessment for a deep inferior epigastric perforator (DIEP) flap: a new easy technique from the Bologna experience

2020 ◽  
pp. 028418512096389
Author(s):  
Matteo Renzulli ◽  
Alfredo Clemente ◽  
Stefano Brocchi ◽  
Chiara Gelati ◽  
Simone Zanotti ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Diep Flap ◽  
Reconstruction Method ◽  
Branching Pattern ◽  
Flap Reconstruction ◽  
3D Reconstructions ◽  
Deep Inferior Epigastric Perforator

Background Deep inferior epigastric perforator (DIEP) flap reconstruction is the gold standard reconstructive technique for women undergoing breast cancer surgery. A preoperative computed tomography angiography (CTA)-dedicated protocol and 3D reconstructions are mandatory for correct surgical planning. Purpose To evaluate the diagnostic performance of a new preoperative CTA protocol and a new reconstruction method in the assessment of DIEP technique. Material and Methods A total of 263 women (median age 49 years, age range 26–73 years) underwent preoperative CTA examination before DIEP flap breast reconstruction. A CTA-dedicated protocol followed by 3D-reconstructions were performed. Identification, branching pattern, and caliber at origin were assessed for each perforator. Intraoperative findings were the standard of reference. The sensitivity, positive predictive value, and diagnostic accuracy of the preoperative CTA protocol were calculated. Results In 255/263 (97%) patients, the dominant perforators assessed by CTA resulted adequate for surgical reconstruction. In 260/263 (99%) cases, the imaging localization of the dominant perforators corresponded with those seen intraoperatively (mean errors ≤1 cm). The preoperative CTA imaging sensitivity, positive predictive value, and diagnostic accuracy in determining the localization of perforators were 99% (95% CI 98–100), 100% and 99% (95% CI 98–100), respectively. No statistically significant differences were found between the CTA findings and the surgical findings for the assessment of branching pattern and caliber of the dominant perforators ( P < 0.001). Conclusion The present protocol has demonstrated high accuracy in the CTA imaging assessment of the perforators before DIEP flap reconstruction with high reproducibility between CT and surgical findings.

scholarly journals Comparison of Clinical Diagnosis of Stroke with Computed Tomographic Scan of the Brain

2013 ◽  
Vol 28 (2) ◽  
pp. 96-101
Author(s):  
Sirajee Shafiqul Islam ◽  
Aminur Rahman ◽  
Md Manzur Alahi ◽  
Md Ahmed Ali ◽  
Md Kafiluddin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Positive Predictive Value ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Clinical Diagnosis ◽  
Predictive Value ◽  
Hemorrhagic Stroke ◽  
Sensitivity Specificity ◽  
The Brain

Background and purpose: Stroke is a leading cause of mortality and morbidity in both developed as well as developing countries. The clinical presentation of stroke depending on the site and extent of lesions. For the management purpose it is important to know whether we are dealing with a bleed or an infarct. Methodology: Computed Tomography (CT scan) is available most of the tertiary level hospitals in Bangladesh. This study was carried out to compare clinical diagnosis of stroke with Computed tomography (CT) scan findings in ascertaining the type of stroke (hemorrhagic or ischemic). Materials and methods: This cross-sectional comparative study was conducted in the Department of Neurology, Rajshahi Medical College Hospital during the period of January 2010 to December 2010. Total 200 stroke patients were selected by purposive sampling technique on the basis of inclusion and exclusion criteria as the study sample. . CT brain scan was done for all the patients. The clinical diagnosis was compared with the results of CT scan and performance test was done. Results: Clinically 67 patients were diagnosed as hemorrhagic stroke and 133 patients were diagnosed as ischemic stroke. Out of these 67 hemorrhagic patients CT scan revealed that 56 patients had intracerebral hemorrhage, 5 had infarct, 4 had subarachnoid hemorrhage and 2 had space occupying lesions in the brain. Out of these 133 ischemic patients CT scan revealed that 119 patients had infarction, 6 had intracerebral hemorrhage and 8 had space occupying lesions in the brain. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical diagnosis of hemorrhagic stroke were 90.32%, 92.03%, 83.58%, 92.02% and 91.5% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical diagnosis of ischemic stroke were 95.96%, 81.58%, 89.47%, 92.53% and 90.5% respectively. Conclusion: The diagnosis of stroke in clinically with high accuracy, but perform a CT scan will help to confirm and differentiate to type stroke. Thus CT scan should be done in all cases stroke to specify the diagnosis. DOI: http://dx.doi.org/10.3329/bjn.v28i2.17179 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 96-101

scholarly journals Computed Tomography-Aortography Versus Color-Duplex Ultrasound for Surveillance of Endovascular Abdominal Aortic Aneurysm Repair

2020 ◽  
Vol 13 (6) ◽  
Author(s):  
Elixène Jean-Baptiste ◽  
Patrick Feugier ◽  
Coralie Cruzel ◽  
Gabrielle Sarlon-Bartoli ◽  
Thierry Reix ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Endovascular Aneurysm Repair ◽  
Positive Likelihood Ratio ◽  
Morphological Abnormality ◽  
Aneurysm Repair

Background Color-duplex ultrasonography (DUS) could be an alternative to computed tomography-aortography (CTA) in the lifelong surveillance of patients after endovascular aneurysm repair (EVAR), but there is currently no level 1 evidence. The aim of this study was to assess the diagnostic accuracy of DUS as an alternative to CTA for the follow-up of post-EVAR patients. Methods Between December 16, 2010, and June 12, 2015, we conducted a prospective, blinded, diagnostic-accuracy study, in 15 French university hospitals where EVAR was commonly performed. Participants were followed up using both DUS and CTA in a mutually blinded setup until the end of the study or until any major aneurysm-related morphological abnormality requiring reintervention or an amendment to the follow-up policy was revealed by CTA. Database was locked on October 2, 2017. Our main outcome measures were sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios of DUS against reference standard CTA. CIs are binomial 95% CI. Results This study recruited prospectively 659 post-EVAR patients of whom 539 (82%) were eligible for further analysis. Following the baseline inclusion visit, 940 additional follow-up visits were performed in the 539 patients. Major aneurysm-related morphological abnormalities were revealed by CTA in 103 patients (17.2/100 person-years [95% CI, 13.9–20.5]). DUS accurately identified 40 patients where a major aneurysm-related morphological abnormality was present (sensitivity, 39% [95% CI, 29–48]) and 403 of 436 patients with negative CTA (specificity, 92% [95% CI, 90–95]). The negative predictive value and positive predictive value of DUS were 92% (95% CI, 90–95) and 39% (95% CI, 27–50), respectively. The positive likelihood ratio was 4.87 (95% CI, 2.9–9.6). DUS sensitivity reached 73% (95% CI, 51–96) in patients requiring an effective reintervention. Conclusions DUS had an overall low sensitivity in the follow-up of patients after EVAR, but its performance improved meaningfully when the subset of patients requiring effective reinterventions was considered. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01230203.

Diagnostic Accuracy of BISAP Score for Detecting Acute Pancreatitis Keeping Computed Tomography Severity Index as GS

2021 ◽  
Vol 15 (11) ◽  
pp. 3164-3165
Author(s):  
Mohammad Iltaf ◽  
Sana Akhtar ◽  
Dilaram Khan
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Severe Acute Pancreatitis ◽  
Predictive Value ◽  
Gold Standard ◽  
Severity Index ◽  
Cross Sectional

Objective: To establish the diagnostic accuracy of BISAP in detecting the severe acute pancreatitis keeping computed tomography severity index as gold standard. Study Design: Cross-sectional study Place and Duration of Study: Department of Gastroenterology, Hayatabad Medical Complex, Peshawar from April 16th 2018 to 16th October 2018. Methodology: One hundred and twenty nine patients of age range of 18-60, of either gender having severe acute pancreatitis were included. While patients already diagnosed as severe acute pancreatitis and having known history of chronic pancreatitis were excluded. Patients were subjected to CT scan to confirm whether the severe acute pancreatitis is present or not. All CT scans were reported by single experiences radiologist. Results: There were 30.3% were males and 69.7% were females with mean age 42±11.03 years. BISAP had sensitivity 92.74%, specificity 80%, positive predictive value 99.13%, negative predictive value 20.76% and the overall diagnostic accuracy was 92.24%. Conclusion: BISAP had sensitivity 93.61%, specificity 100%, positive predictive value 100%, negative predictive value 40% and the overall diagnostic accuracy was 93.87% in severe acute pancreatitis keeping CT severity index as gold standard. Keywords: Accuracy, Severe acute pancreatitis, Computed tomography

scholarly journals Diagnostic Accuracy of Ultrasound and Plain X-Ray KUB (Kidney, Ureter, Bladder) Compared to Non-Contrast CT (Computed Tomography) in Patients of Ureteric Calculi

2020 ◽  
Vol 7 (47) ◽  
pp. 2762-2766
Author(s):  
N. Imdad Ali ◽  
Noor Elahi Pasha ◽  
Ravishankar T.H.S
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
X Ray ◽  
Ureteric Calculus ◽  
Ureteric Calculi ◽  
Ureteric Colic ◽  
Contrast Ct

BACKGROUND Imaging plays a major role in the diagnosis and management of patients with urolithiasis. Non-Contrast Computed Tomography (NCCT) is generally accepted as the gold standard, but there are concerns over higher radiation exposure from NCCT to the patient population. Our prospective study compared the diagnostic accuracy of plain X-ray KUB (Kidney, Ureter, Bladder) and USG (Ultrasonography) with NCCT in the evaluation of patients with ureteric colic. METHODS This study conducted from December 2018 to January 2020 in the Department of Urology, Vijayanagar Institute of Medical Sciences, and attached Hospital. 230 patients with ureteric colic were evaluated for ureteric calculi with x-ray KUB, USG (Ultrasonography) abdomen and pelvis and NCCT (Non-Contrast Computed Tomography) KUB region. RESULTS Out of 230 patients, 168 (73 %) were males and 62 (26.9 %) were females. Ages of the study population ranged from 18 to 55 yrs. 198 of the 230 patients were confirmed to have ureteric calculus, with lower ureteric calculus 97 (48.9 %), upper ureteric 65 (32.8 %), middle ureteric 29 (14.6 %), and multiple 7 (3.5 %). X-ray and USG (Ultrasonography) group yielded a sensitivity of 86.3 %, a specificity of 87.5 %, positive predictive value 97 %, and negative predictive value 51 %. While On NCCT (Non-Contrast Computed Tomography), a total of 192 patients (96 %) demonstrated ureterolithiasis of the 198 patients confirmed to have ureteric calculi (Table 2). X-ray and USG group yielded a sensitivity of 96.9 %, specificity of 93.6 %, positive predictive value 98.9 %, and negative predictive value 83 %. CONCLUSIONS Combination of x-ray KUB and USG, and NCCT were found to be excellent imaging modalities for the detection of ureteric calculi. X-ray KUB and USG can be used as the first investigation of choice for patients with ureteric colic and for follow up of patients after treatment. KEYWORDS Ureteric Colic, Ureterolithiasis, Ultrasonography

scholarly journals Diagnostic accuracy of coronary computed tomography angiography-derived fractional flow reserve

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Wenbing Jiang ◽  
Yibin Pan ◽  
Yumeng Hu ◽  
Xiaochang Leng ◽  
Jun Jiang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diagnostic Accuracy ◽  
Fractional Flow Reserve ◽  
Computed Tomography Angiography ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Coronary Computed Tomography Angiography ◽  
Fractional Flow ◽  
Non Invasive ◽  
Flow Reserve

Abstract Background Fractional flow reserve (FFR) is a widely used gold standard to evaluate ischemia-causing lesions. A new method of non-invasive approach, termed as AccuFFRct, for calculating FFR based on coronary computed tomography angiography (CCTA) and computational fluid dynamics (CFD) has been proposed. However, its diagnostic accuracy has not been validated. Objectives This study sought to present a novel approach for non-invasive computation of FFR and evaluate its diagnostic performance in patients with coronary stenosis. Methods A total of 54 consecutive patients with 78 vessels from a single center who underwent CCTA and invasive FFR measurement were retrospectively analyzed. The CT-derived FFR values were computed using a novel CFD-based model (AccuFFRct, ArteryFlow Technology Co., Ltd., Hangzhou, China). Diagnostic performance of AccuFFRct and CCTA in detecting hemodynamically significant coronary artery disease (CAD) was evaluated using the invasive FFR as a reference standard. Results Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for AccuFFRct in detecting FFR ≤ 0.8 on per-patient basis were 90.7, 89.5, 91.4, 85.0 and 94.1%, respectively, while those of CCTA were 38.9, 100.0, 5.71, 36.5 and 100.0%, respectively. The correlation between AccuFFRct and FFR was good (r = 0.76 and r = 0.65 on per-patient and per-vessel basis, respectively, both p < 0.0001). Area under the curve (AUC) values of AccuFFRct for identifying ischemia per-patient and per-vessel basis were 0.945 and 0.925, respectively. There was much higher accuracy, specificity and AUC for AccuFFRct compared with CCTA. Conclusions AccuFFRct computed from CCTA images alone demonstrated high diagnostic performance for detecting lesion-specific ischemia, it showed superior diagnostic power than CCTA and eliminated the risk of invasive tests, which could be an accurate and time-efficient computational tool for diagnosing ischemia and assisting clinical decision-making.

Noninvasive Evaluation of Coronary Artery Bypass Grafts with 16-Slice Multidetector Computed Tomography

2012 ◽  
Vol 15 (1) ◽  
pp. 12 ◽  
Author(s):  
Levent Sahiner ◽  
Ali Oto ◽  
Kudret Aytemir ◽  
Tuncay Hazirolan ◽  
Musturay Karcaaltincaba ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Multidetector Computed Tomography ◽  
Coronary Artery Bypass ◽  
Predictive Value ◽  
Artery Bypass ◽  
Time Interval ◽  
Mdct Angiography ◽  
Sensitivity Specificity

<p><b>Background:</b> The aim of this study was to investigate the diagnostic accuracy of 16-slice multislice, multidetector computed tomography (MDCT) angiography for the evaluation of grafts in patients with coronary artery bypass grafting (CABG).</p><p><b>Methods:</b> Fifty-eight consecutive patients with CABG who underwent both MDCT and conventional invasive coronary angiography were included. The median time interval between the 2 procedures was 10 days (range, 1-32 days). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT for the detection of occluded grafts were calculated. The accuracy of MDCT angiography for detecting significant stenoses in patent grafts and the evaluability of proximal and distal anastomoses were also investigated.</p><p><b>Results:</b> Optimal diagnostic images could not be obtained for only 3 (2%) of 153 grafts. Evaluation of the remaining 150 grafts revealed values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the MDCT angiography procedure for the diagnosis of occluded grafts of 87%, 97%, 94%, 93%, and 92%, respectively. All of the proximal anastomoses were optimally visualized. In 4 (8%) of 50 patent arterial grafts, however, the distal anastomotic region could not be evaluated because of motion and surgical-clip artifacts. The accuracy of MDCT angiography for the detection of significant stenotic lesions was relatively low (the sensitivity, specificity, PPV, and NPV were 67%, 98%, 50%, and 99%, respectively). The number of significant lesions was insufficient to reach a reliable conclusion, however.</p><p><b>Conclusion:</b> Our study showed that MDCT angiography with 16-slice systems has acceptable diagnostic performance for the evaluation of coronary artery bypass graft patency.</p>

Diagnosis of cerebral hemorrhage before the era of computed tomography

2013 ◽  
Vol 154 (44) ◽  
pp. 1743-1746
Author(s):  
Gergely Hofgárt ◽  
Rita Szepesi ◽  
Bertalan Vámosi ◽  
László Csiba
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Hemorrhagic Stroke ◽  
Cranial Computed Tomography ◽  
Cerebral Stroke ◽  
Daily Routine ◽  
Stroke Patients ◽  
The Difference

Introduction: During the past decades there has been a great progress in neuroimaging methods. Cranial computed tomography is part of the daily routine now and its use allows a fast diagnosis of parenchymal hemorrhage. However, before the availability of computed tomography the differentiation between ischemic and hemorrhagic stroke was based on patient history, physical examination, percutan angiography and cerebrospinal fluid sampling, and the clinical utility could be evaluated by autopsy of deceased patients. Aim: The authors explored the diagnostic performance of cerebrospinal fluid examination for the diagnosis of ischemic and hemorrhagic stroke. Method: Data of 200 deceased stroke patients were retrospectively evaluated. All patients had liquor sampling at admission and all of them had brain autopsy. Results: Bloody or yellowish cerebrospinal fluid at admission had a positive predictive value of 87.5% for hemorrhagic stroke confirmed by autopsy, while clear cerebrospinal fluid had positive predictive value of 90.7% for ischemic stroke. Patients who had clear liquor, but autopsy revealed hemorrhagic stroke had higher protein level in the cerebrospinal fluid, but the difference was not statistically significant (p = 0.09). Conclusions: The results confirm the importance of pathological evaluation of the brain in cases deceased from cerebral stroke. With this article the authors wanted to salute for those who contributed to the development of the Hungarian neuropathology. In this year we remember the 110th anniversary of the birth, and the 60th anniversary of the death of professor Kálmán Sántha. Professor László Molnár would be 90 years old in 2013. Orv. Hetil., 154 (44), 1743–1746.

VALUE OF COMBINATION OF HAP SCORE AND BISAP SCORE IN PREDICTING SEVERITY IN PATIENTS OF ACUTE PANCREATITIS

2019 ◽  
pp. 96-100
Author(s):  
Thi Ngoc Suong Le ◽  
Pham Chi Tran ◽  
Van Huy Tran
Keyword(s):  
Acute Pancreatitis ◽  
Positive Predictive Value ◽  
Roc Curve ◽  
Predictive Value ◽  
Prognostic Value ◽  
Acute Inflammation ◽  
Clinical Symptoms ◽  
Mortality Rates ◽  
Multiple Organ ◽  
Central Hospital

Acute pancreatitis (AP) is an acute inflammation of the pancreas, usually occurs suddenly with a variety of clinical symptoms, complications of multiple organ failure and high mortality rates. Objectives: To determine the value of combination of HAP score and BISAP score in predicting the severity of acute pancreatitis of the Atlanta 2012 Classification. Patients and Methods: 75 patients of acute pancreatitis hospitalized at Hue Central Hospital between March 2017 and July 2018; HAP and BISHAP score is calculated within the first 24 hours. The severity of AP was classified by the revised Atlanta criteria 2012. Results: When combining the HAP and BISAP scores in predicting the severity of acute pancreatitis, the area under the ROC curve was 0,923 with sensitivity value was 66.7%, specificity value was 97.1%; positive predictive value was 66.7%, negative predictive value was 97.1%. Conclusion: The combination of HAP and BISAP scores increased the sensitivity, predictive value, and prognostic value in predicting the severity of acute pancreatitis of the revised Atlanta 2012 classification in compare to each single scores. Key words: HAPscore, BiSAP score, acute pancreatitis, predicting severity

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