Diagnostic Methods in Osteomyelitis

1988 ◽  
Vol 97 (2_suppl) ◽  
pp. 25-25
Author(s):  
Carl W. Norden
Keyword(s):  
Chronic Osteomyelitis ◽  
Clinical Suspicion ◽  
Diagnostic Methods ◽  
Ct Scans ◽  
Radiographic Examination ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Bone Scans ◽  
Sensitivity Specificity ◽  
Microbiologic Diagnosis

The mainstays of diagnosis of acute and chronic osteomyelitis remain clinical suspicion and radiographic examination, respectively. For both diseases, accurate microbiologic diagnosis is critical and can usually be obtained by aspiration of bone or pus. Imaging studies such as bone scans, CT scans, and magnetic resonance imaging have not been systematically evaluated for sensitivity, specificity, and predictive value in the diagnosis of this disease. Thus, they generally remain expensive and unproven adjuncts in the workup of patients with osteomyelitis. Both the incidence and the outcome of osteomyelitis have been dramatically altered by antibiotics. The disease, however, still continues to pose difficulties in diagnosis. The purpose of this report is to review and update approaches to the problem.

Detecting Asymptomatic Recurrence in Early-Stage Endometrial Cancer: The Value of Vaginal Cytology, Imaging Studies, and CA-125

2016 ◽  
Vol 26 (8) ◽  
pp. 1434-1439 ◽  
Author(s):  
Jung-Yun Lee ◽  
Ji Hee Kim ◽  
Jung Won Seo ◽  
Hee Seung Kim ◽  
Jae-Weon Kim ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Imaging Modalities ◽  
Ct Scans ◽  
Ca 125 ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Positron Emission ◽  
Vaginal Cytology ◽  
Early Stage Endometrial Cancer

ObjectiveThe aim of this study was to evaluate the value of vaginal cytology, imaging modalities, and serum CA-125 in detecting asymptomatic recurrence during posttreatment surveillance for early-stage endometrial cancer.MethodsA retrospective analysis was conducted on patients with stage I to II endometrial cancer who received primary surgical treatment at Seoul National University Hospital between 2000 and 2011. Clinicopathologic characteristics and surveillance test data were obtained from medical records. The total numbers of vaginal cytologies, imaging studies, and serum CA-125 levels performed during surveillance or until recurrence were evaluated, and the number of tests needed to detect each asymptomatic recurrence was calculated.ResultsA total of 389 patients were identified, together with a total of 3323 vaginal cytologies, 1025 chest x-rays, 1177 abdominal computed tomography (CT) scans, 98 magnetic resonance imaging scans, 163 positron emission tomography/CT scans, 298 ultrasonographies, and 3335 serum CA-125 results obtained during the surveillance period. Recurrence was detected in 14 patients (3.6%). Ten of these cases were asymptomatic, of which six were identified through CT scans and four were identified through elevated serum CA-125 levels. Most of the patients (7/10) with asymptomatic recurrences had localized recurrence patterns, five of whom underwent curative-intent resection and survived. The number of CA-125 tests needed to identify 1 asymptomatic recurrence was 839, whereas the number of CT scans needed to achieve the same result was 196. Other imaging modalities and vaginal cytology did not detect asymptomatic recurrence.ConclusionsFor posttreatment surveillance in early-stage endometrial cancer, vaginal cytology and imaging modalities such as chest x-ray, magnetic resonance imaging, positron emission tomography/CT, and ultrasonography have low utility. Routine CT scans and serum CA-125 testing may be useful for detecting asymptomatic recurrence.

scholarly journals Cardiac amyloidosis: non-invasive diagnosis

2020 ◽  
Vol 66 (3) ◽  
pp. 345-352
Author(s):  
Viviane Tiemi Hotta ◽  
Maria Clementina Pinto Giorgi ◽  
Fábio Fernandes ◽  
Maria Cristina Donadio Abduch ◽  
Andréa Maria Gomes Marinho Falcão ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Multimodality Imaging ◽  
Clinical Suspicion ◽  
Diagnostic Methods ◽  
Cardiac Biomarkers ◽  
Resonance Imaging ◽  
Non Invasive ◽  
Definition Of ◽  
High Degree

SUMMARY Cardiac amyloidosis is an infiltrative disease which requires a high degree of clinical suspicion for appropriate diagnosis. Early diagnosis and the definition of the type of amyloidosis play a key role in the early treatment and prognosis of this disease. In this context, the use of cardiac biomarkers such as troponins and NT-proBNT associated with analysis by multimodality imaging methods like echocardiographic techniques such as strain, nuclear medicine, and cardiovascular resonance imaging have an increasing role in patients with cardiac amyloidosis. This article details the role of non-invasive diagnostic methods in patients with cardiac amyloidosis.

Сauses of Dizziness in Patients with Suspected Stroke

2018 ◽  
Vol 7 (3) ◽  
pp. 217-221
Author(s):  
E. V. Shevchenko ◽  
G. R. Ramazanov ◽  
S. S. Petrikov
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Demyelinating Disease ◽  
Heart Rhythm ◽  
Diagnostic Methods ◽  
Deficiency Anemia ◽  
Resonance Imaging ◽  
Peripheral Vestibulopathy ◽  
Suspected Stroke ◽  
The Brain

Background Acute dizziness may be the only symptom of stroke. Prevalence of this disease among patients with isolated dizziness differs significantly and depends on study design, inclusion criteria and diagnostic methods. In available investigations, we did not find any prospective studies where magnetic resonance imaging, positional maneuvers, and Halmagyi-Curthoys test had been used to clarify a pattern of diseases with isolated acute dizziness and suspected stroke.Aim of study To clarify the pattern of the causes of dizziness in patients with suspected acute stroke.Material and methods We examined 160 patients admitted to N.V. Sklifosovsky Research Institute for Emergency Medicine with suspected stroke and single or underlying complaint of dizziness. All patients were examined with assessment of neurological status, Dix-Hollpike and Pagnini-McClure maneuvers, HalmagyiCurthoys test, triplex scans of brachiocephalic arteries, transthoracic echocardiography, computed tomography (CT) and magnetic resonance imaging (MRI) of the brain with magnetic field strength 1.5 T. MRI of the brain was performed in patients without evidence of stroke by CT and in patients with stroke of undetermined etiology according to the TOAST classification.Results In 16 patients (10%), the cause of dizziness was a disease of the brain: ischemic stroke (n=14 (88%)), hemorrhage (n=1 (6%)), transient ischemic attack (TIA) of posterior circulation (n=1 (6%)). In 70.6% patients (n=113), the dizziness was associated with peripheral vestibulopathy: benign paroxysmal positional vertigo (n=85 (75%)), vestibular neuritis (n=19 (17%)), Meniere’s disease (n=7 (6%)), labyrinthitis (n=2 (1,3%)). In 6.9% patients (n=11), the cause of dizziness was hypertensive encephalopathy, 1.9% of patients (n=3) had heart rhythm disturbance, 9.4% of patients (n=15) had psychogenic dizziness, 0.6% of patients (n=1) had demyelinating disease, and 0.6% of patients (n=1) had hemic hypoxia associated with iron deficiency anemia.Conclusion In 70.6% patients with acute dizziness, admitted to hospital with a suspected stroke, peripheral vestibulopathy was revealed. Only 10% of patients had a stroke as a cause of dizziness.

scholarly journals Whiplash Injuries Can be Visible by Functional Magnetic Resonance Imaging

2006 ◽  
Vol 11 (3) ◽  
pp. 197-199 ◽  
Author(s):  
Bengt H Johansson
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Functional Magnetic Resonance Imaging ◽  
Medical Condition ◽  
Diagnostic Methods ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Eye Problems ◽  
Concentration Sensitivity ◽  
Whiplash Trauma

Whiplash trauma can result in injuries that are difficult to diagnose. Diagnosis is particularly difficult in injuries to the upper segments of the cervical spine (craniocervical joint [CCJ] complex). Studies indicate that injuries in that region may be responsible for the cervicoencephalic syndrome, as evidenced by headache, balance problems, vertigo, dizziness, eye problems, tinnitus, poor concentration, sensitivity to light and pronounced fatigue. Consequently, diagnosis of lesions in the CCJ region is important. Functional magnetic resonance imaging is a radiological technique that can visualize injuries of the ligaments and the joint capsules, and accompanying pathological movement patterns.Three severely injured patients that had been extensively examined without any findings of structural lesions were diagnosed by functional magnetic resonance imaging to have injuries in the CCJ region.These injuries were confirmed at surgery, and after surgical stabilization the medical condition was highly improved.It is important to draw attention to the urgent need to diagnose lesions and dysfunction in the CCJ complex and also improve diagnostic methods.

scholarly journals Advantages of 18F-FDG PET/CT Imaging over Modified Duke Criteria and Clinical Presumption in Patients with Challenging Suspicion of Infective Endocarditis

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 720
Author(s):  
Valentin Pretet ◽  
Cyrille Blondet ◽  
Yvon Ruch ◽  
Matias Martinez ◽  
Soraya El Ghannudi ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Predictive Value ◽  
Fdg Pet ◽  
Clinical Suspicion ◽  
Duke Criteria ◽  
High Clinical Suspicion ◽  
Pet Ct ◽  
18F Fdg ◽  
Sensitivity Specificity ◽  
Fdg Pet Ct

According to European Society of Cardiology guidelines (ESC2015) for infective endocarditis (IE) management, modified Duke criteria (mDC) are implemented with a degree of clinical suspicion degree, leading to grades such as “possible” or “rejected” IE despite a persisting high level of clinical suspicion. Herein, we evaluate the 18F-FDG PET/CT diagnostic and therapeutic impact in IE suspicion, with emphasis on possible/rejected IE with a high clinical suspicion. Excluding cases of definite IE diagnosis, 53 patients who underwent 18F-FDG PET/CT for IE suspicion were selected and afterwards classified according to both mDC (possible IE/Duke 1, rejected IE/Duke 0) and clinical suspicion degree (high and low IE suspicion). The final status regarding IE diagnosis (gold standard) was based on the multidisciplinary decision of the Endocarditis Team, including the ‘imaging specialist’. PET/CT images of the cardiac area were qualitatively interpreted and the intensity of each focus of extra-physiologic 18F-FDG uptake was evaluated by a maximum standardized uptake value (SUVmax) measurement. Extra-cardiac 18F-FDG PET/CT pathological findings were considered to be a possible embolic event, a possible source of IE, or even a concomitant infection. Based on the Endocarditis Team consensus, final diagnosis of IE was retained in 19 (36%) patients and excluded in 34 (64%). With a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and global accuracy of 79%, 100%, 100%, 89%, and 92%, respectively, PET/CT performed significantly better than mDC (p = 0.003), clinical suspicion degree (p = 0.001), and a combination of both (p = 0.001) for IE diagnosis. In 41 patients with possible/rejected IE but high clinical suspicion, sensitivity, specificity, PPV, NPV, and global accuracies were 78%, 100%, 100%, 85%, and 90%, respectively. Moreover, PET/CT contributed to patient management in 24 out of 53 (45%) cases. 18F-FDG PET/CT represents a valuable diagnostic tool that could be proposed for challenging IE cases with significant differences between mDC and clinical suspicion degree. 18F-FDG PET/CT allows a binary diagnosis (definite or rejected IE) by removing uncertain diagnostic situations, thus improving patient therapeutic management.

scholarly journals Diagnostic tools for neurosyphilis: a systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gustavo Henrique Pereira Boog ◽  
João Vitor Ziroldo Lopes ◽  
João Vitor Mahler ◽  
Marina Solti ◽  
Lucas Tokio Kawahara ◽  
...  
Keyword(s):  
New Technologies ◽  
Clinical Suspicion ◽  
Risk Of Bias ◽  
Diagnostic Methods ◽  
Diagnostic Tools ◽  
Test Accuracy ◽  
Cerebrospinal Fluid Analysis ◽  
Evaluation Methodologies ◽  
Fluid Analysis ◽  
Criteria For Diagnosis

Abstract Purpose Increasing incidences of syphilis highlight the preoccupation with the occurrence of neurosyphilis. This study aimed to understand the current diagnostic tools and their performance to detect neurosyphilis, including new technologies and the variety of existing methods. Methods We searched databases to select articles that reported neurosyphilis diagnostic methods and assessed their accuracy, presenting sensitivity and specificity values. Information was synthesized in tables. The risk of bias was examined using the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy recommendations. Results Fourteen studies were included. The main finding was a remarkable diversity of tests, which had varied purposes, techniques, and evaluation methodologies. There was no uniform criterion or gold standard to define neurosyphilis. The current basis for its diagnosis is clinical suspicion and cerebrospinal fluid analysis. There are new promising tests such as PCR tests and chemokine measurement assays. Conclusions The diagnosis of neurosyphilis is still a challenge, despite the variety of existing and developing tests. We believe that the multiplicity of reference standards adopted as criteria for diagnosis reveals the imprecision of the current definitions of neurosyphilis. An important next step for the scientific community is to create a universally accepted diagnostic definition for this disease.

381 Role of CT scans of abdomen and pelvis in management of patients with immunotherapy-induced colitis

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A406-A406
Author(s):  
Juan Ibarra Rovira ◽  
Raghunandan Vikram ◽  
Selvi Thirumurthi ◽  
Bulent Yilmaz ◽  
Heather Lin ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Clinical Diagnosis ◽  
Predictive Value ◽  
Clinical Symptoms ◽  
Cytotoxic T Lymphocyte ◽  
Checkpoint Inhibitors ◽  
Ct Scans ◽  
Wall Thickening ◽  
Low Sensitivity ◽  
Sensitivity Specificity

BackgroundColitis is one of the most common immune-related adverse event in patients who receive immune checkpoint inhibitors targeting cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death-1 (PD-1). Although radiographic changes are reported on computed tomography such as mild diffuse bowel thickening or segmental colitis, the utility of CT in diagnosis of patients with suspected immune-related colitis is not well studied.MethodsCT scans of the abdomen and pelvis of 34 patients on immunotherapy with a clinical diagnosis of immunotherapy induced colitis and 19 patients receiving immunotherapy without clinical symptoms of colitis (control) were enrolled in this retrospective study. Segments of the colon (rectum, sigmoid, descending, transverse, ascending and cecum) were assessed independently by two fellowship trained abdominal imaging specialists with 7 and 13 years‘ experience who were blinded to the clinical diagnosis. Each segment was assessed for mucosal enhancement, wall thickening, distension, peri-serosal fat stranding. Any disagreements were resolved in consensus. The degree of distension and the spurious assignment of wall thickening were the most common causes for disagreement. The presence of any of the signs was considered as radiographic evidence of colitis.ResultsCT evidence of colitis was seen in 16 of 34 patients with symptoms of colitis. 7 of 19 patients who did not have symptoms of colitis showed signs of colitis on CT. The sensitivity, specificity, Positive Predictive Value and Negative Predictive Value for colitis on CT is 47%, 63.2%, 69.5% and 40%, respectively.ConclusionsCT has a low sensitivity, specificity and negative predictive value for the diagnosis of immunotherapy-induced colitis. CT has no role in the diagnosis of patients suspected of having uncomplicated immune-related colitis and should not be used routinely for management.Trial RegistrationThis protocol is not registered on clinicaltrials.gov.Ethics ApprovalThis protocol was IRB approved on: 11/16/2015 - IRB 4 Chair Designee FWA #: 00000363 OHRP IRB Registration Number: IRB 4 IRB00005015ConsentThis protocol utilizes an IRB approved waiver of consent.

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