scholarly journals Limited usefulness of routine head and neck CT angiogram in the imaging assessment of dizziness in the emergency department

2021 ◽  
pp. 197140092098866
Author(s):  
Angela Guarnizo ◽  
Kevin Farah ◽  
Daniel A Lelli ◽  
Darren Tse ◽  
Nader Zakhari
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Positive Predictive Value ◽  
Head And Neck ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Posterior Circulation ◽  
Emergency Department Presentation ◽  
Ct Angiogram ◽  
Computed Tomography Angiogram

Objective To assess the usefulness of head and neck computed tomography angiogram for the investigation of isolated dizziness in the emergency department in detecting significant acute findings leading to a change in management in comparison to non-contrast computed tomography scan of the head. Methods Patients presenting with isolated dizziness in the emergency department investigated with non-contrast computed tomography and computed tomography angiogram over the span of 36 months were included. Findings on non-contrast computed tomography were classified as related to the emergency department presentation versus unrelated/no significant abnormality. Similarly, computed tomography angiogram scans were classified as positive or negative posterior circulation findings. Results One hundred and fifty-three patients were imaged as a result of emergency department presentation with isolated dizziness. Fourteen cases were diagnosed clinically as of central aetiology. Non-contrast computed tomography was positive in three patients, all with central causes with sensitivity 21.4%, specificity 100%, positive predictive value 100%, negative predictive value 92.6% and accuracy 92.8%. Computed tomography angiogram was positive for angiographic posterior circulation abnormalities in five cases, and only two of them had a central cause of dizziness, with sensitivity 14.3%, specificity 97.7%, positive predictive value 40%, negative predictive value 91.46% and accuracy 92.1%. Conclusion Both non-contrast computed tomography and computed tomography angiogram of the head and neck have low diagnostic yield for the detection of central causes of dizziness, However, non-contrast computed tomography has higher sensitivity and positive predictive value than computed tomography angiogram, implying a lack of diagnostic advantage from the routine use of computed tomography angiogram in the emergency department for the investigation of isolated dizziness. Further studies are required to determine the role of computed tomography angiogram in the work-up of isolated dizziness in the emergency department.

scholarly journals DIAGNOSTIC ACCURACY OF ULTRASOUND IN THE DETECTION OF PNEUMOTHORAX IN CHEST TRAUMA PATIENTS WITH CT AS THE GOLD STANDARD

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Danquale Vance Kynshikhar ◽  
Chaman Lal Kaushal ◽  
Ashwani Tomar ◽  
Neeti Aggarwal
Keyword(s):  
Emergency Department ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Chest Trauma ◽  
Accurate Diagnosis ◽  
Trauma Patients ◽  
Chest Ultrasound

Background: To study the diagnostic accuracy of ultrasound in the detection of pneumothorax in chest trauma patients with CT as the Gold Standard Methods: The present study was conducted from 31th July 2018 to 30th July 2019. A total of 36 patients were enrolled in the study. Results: By chest ultrasound, pneumothorax was detected in 15 of 24 patients. The sensitivity of chest ultrasound for the diagnosis of pneumothorax was 62.5%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 54.14% and accuracy was 75%. Conclusion: Chest ultrasound can play an important role in the emergency department aiding a physician for bedside rapid and accurate diagnosis of pneumothorax without interruption in the resuscitation process and without transferring the patient to the radiology section. Keywords: Ultrasound, CT, Pneumothorax

Detection of local failures after management of nasopharyngeal carcinoma: a prospective, controlled trial

2008 ◽  
Vol 122 (11) ◽  
pp. 1230-1234 ◽  
Author(s):  
S M Ragab ◽  
F A Erfan ◽  
M A Khalifa ◽  
E M Korayem ◽  
H A Tawfik
Keyword(s):  
Computed Tomography ◽  
Nasopharyngeal Carcinoma ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
External Beam Radiotherapy ◽  
Reliability Coefficient ◽  
Histological Findings ◽  
Significant Agreement ◽  
Sensitivity Specificity

AbstractObjectives:To conduct a prospective study (1) to evaluate and compare the efficacies of nasopharyngeal endoscopy and computed tomography in the diagnosis of local failure of external beam radiotherapy for nasopharyngeal carcinoma, and (2) to assess whether multiple endoscopic nasopharyngeal biopsies are superior to a single, targeted biopsy, for the same purpose.Methods:Forty-six patients who had been treated with external beam radiotherapy for primary nasopharyngeal carcinoma were enrolled in the study. For every patient recruited, computed tomography, rigid nasopharyngeal endoscopy and nasopharyngeal biopsies were performed 12 weeks after radiotherapy.Results:Twelve weeks after treatment, six patients (13 per cent) had evident disease on histological examination of biopsies. Nasopharyngeal endoscopy showed a sensitivity, specificity, positive predictive value and negative predictive value of 66.6, 95, 66.6 and 95 per cent, respectively. There was statistically significant agreement between the endoscopic findings and the histological findings (Kappa reliability coefficient = 0.617, p < 0.01). Computed tomography showed a sensitivity, specificity, positive predictive value and negative predictive value of 50, 45, 12 and 85.7 per cent, respectively. There was no statistically significant agreement between the computed tomography findings and the histological findings (Kappa reliability coefficient = 0.021, p > 0.05). A targeted, single biopsy performed under endoscopic control demonstrated excellent sensitivity, specificity, positive predictive value and negative predictive value, being 83.3, 100, 100 and 97.5 per cent, respectively. The Kappa test showed a very statistically significant agreement between the histological findings for the single and the multiple endoscopic biopsies (Kappa reliability coefficient = 0.897, p < 0.001).Conclusions:Rigid nasopharyngeal endoscopy should be considered the primary follow-up tool after radiotherapy treatment of nasopharyngeal carcinoma, with computed tomography being reserved for patients with histological or symptomatic indications. Routine postnasal biopsies are not necessary, given the excellent specificity and negative predictive value of rigid nasopharyngeal endoscopy. Single, targeted endoscopic biopsy provides an excellent alternative to the usual multiple biopsies. In addition, it reduces cost, time, morbidity and patient discomfort.

scholarly journals Local behavior and lymph node metastases of Wilms' tumor: accuracy of computed tomography

2014 ◽  
Vol 47 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Eduardo Just da Costa e Silva ◽  
Giselia Alves Pontes da Silva
Keyword(s):  
Computed Tomography ◽  
Lymph Node ◽  
Positive Predictive Value ◽  
Lymph Nodes ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Wilms Tumor ◽  
Local Behavior ◽  
Adjacent Organ Invasion ◽  
Organ Invasion

Objective To evaluate the accuracy of computed tomography for local and lymph node staging of Wilms' tumor. Materials and Methods Each case of Wilms' tumor was evaluated for the presence of abdominal lymph nodes by a radiologist. Signs of capsule and adjacent organ invasion were analyzed. Surgical and histopathological results were taken as the gold standard. Results Sensitivity was 100% for both mesenteric and retroperitoneal lymph nodes detection, and specificity was, respectively, 12% and 33%, with positive predictive value of 8% and 11% and negative predictive value of 100%. Signs of capsular invasion presented sensitivity of 87%, specificity of 77%, positive predictive value of 63% and negative predictive value of 93%. Signs of adjacent organ invasion presented sensitivity of 100%, specificity of 78%, positive predictive value of 37% and negative predictive value of 100%. Conclusion Computed tomography tumor showed low specificity and low positive predictive value in the detection of lymph node dissemination. The absence of detectable lymph nodes makes their presence unlikely, and likewise regarding the evaluation of local behavior of tumors.

scholarly journals Computed tomography versus ureteroscopy in identification of renal tract stone with ureteral stent in situ

2011 ◽  
Vol 93 (8) ◽  
pp. 639-641 ◽  
Author(s):  
VCY Tang ◽  
A Attwell-Heap
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Ureteral Stent ◽  
The Difference ◽  
Contrast Ct ◽  
Sensitivity Specificity

INTRODUCTION The aim of this study was to validate the use of non-contrast computed tomography (CT) with a ureteral stent in situ instead of ureteroscopy for identification of renal tract stones. METHODS All patients who had stents inserted for renal tract stones and underwent non-contrast CT with the stent in situ followed by ureteroscopy between May 2008 and October 2009 at The Canberra Hospital, Australia, were analysed retrospectively. Statistical analysis was performed to compare any differences between CT and ureteroscopy in the identification of stones. RESULTS Overall, 57 patients were included in the study. The difference between CT and ureteroscopy findings was statistically significant. CT identification of stones with a stent in situ had a sensitivity of 86%, a specificity of 46%, a positive predictive value of 63%, a negative predictive value of 76% and an accuracy of 67%. CONCLUSIONS Our study suggests that non-contrast CT is inferior to the ‘gold standard’ of ureteroscopy. It lacks sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Therefore, we cannot recommend using non-contrast CT to replace ureteroscopy.

Pre-operative prediction of cholesteatomas from radiology: retrospective cohort study of 106 cases

2019 ◽  
Vol 133 (06) ◽  
pp. 477-481 ◽  
Author(s):  
D Selwyn ◽  
J Howard ◽  
P Cuddihy
Keyword(s):  
Computed Tomography ◽  
Cohort Study ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Retrospective Cohort Study ◽  
Predictive Value ◽  
Retrospective Cohort ◽  
Anatomical Variation ◽  
Predictive Values ◽  
Mastoid Surgery

AbstractObjectivePre-operative imaging is often used to predict the extent of a cholesteatoma and anatomical variation to plan for surgery. This study aimed to measure the predictive accuracy of computed tomography findings.MethodsA retrospective cohort study was conducted of all patients in a district general hospital undergoing mastoid surgery within a consecutive 12-month period, in whom computed tomography had been performed prior to operative intervention. The study measured the key findings of pre-operative computed tomography imaging and compared them to the intra-operative findings.ResultsA total of 106 patients were included. The sensitivity and specificity for predicting cholesteatoma were 79 per cent and 81 per cent respectively. The positive predictive value was 90 per cent and the negative predictive value was 65 per cent. In predicting complications of cholesteatomas, the sensitivity was 70 per cent, whereas the specificity was 91 per cent. The positive predictive value was 88 per cent and the negative predictive value was 76 per cent.ConclusionPre-operative computed tomography conducted prior to mastoid surgery has high positive predictive values for both predicting cholesteatomas and complications (90 per cent and 88 per cent respectively).

scholarly journals Pewarnaan Toluidin blue sebagai petanda ketepatan biopsi pasca terapi karsinoma sel skuamosa kepala-leher

2012 ◽  
Vol 42 (1) ◽  
Author(s):  
Bambang Hariwiyanto ◽  
Camelia Herdini ◽  
Inawati Bobot
Keyword(s):  
Squamous Cell Carcinoma ◽  
Positive Predictive Value ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Frozen Section ◽  
Post Treatment ◽  
Malignant Cells ◽  
Specificity Test

Background: Squamous cell carcinoma (SCC) is the most frequent malignancy in the head and neck. The treatment modalities of SCC are surgery followed by chemotherapy and/or radiotherapy, could also chemotherapy and/or radiotherapy without surgery. The gold standard of assessing success  in SCC treatment is if there no malignant cells found not only in frozen section tissues, but also in  post chemotherapy and/or radiotherapy tissues. Determining the spot of biopsy tissue for malignancy assessment after treatment is not easy. Toluidin Blue (TB) is a staining material, absorbed by intercellular space in epithelial dysplasia, included SCC.   To determine the validity of Toluidin Blue as sign of accuracy for biopsy site in SCC post treatment malignancy, which not only for surgically treated cases, but also after chemotherapy and/or radiotherapy without surgical treatment. Method: Diagnostic test study to determine sensitivity test, specificity test, positive predictive value and negative predictive value of TB to detect malignant cells in post treatment head and neck SCC patients. Result: There were 30 samples biopsy material from 30 post treatment SCC patients. Sensitivity test was 83,3%, specificity  test: 66,7%, positive predictive value: 79.0%, negative predictive value: 72,7%. Conclusion: TB staining is accurate for determining biopsy spot in post treatment head and neck SCC. Keyword : Validity, toluidin blue, squamous cell carcinoma, post treatment.  Abstrak :  Latar belakang: Karsinoma sel skuamosa (KSS) merupakan jenis keganasan kepala dan leher yang paling sering dijumpai dibanding keganasan yang lain. KSS kepala leher dapat dilakukan terapi pembedahan diikuti kemoterapi dan/atau radioterapi maupun kemoterapi dan/atau radioterapi tanpa pembedahan. Penentuan keberhasilan radikalitas pengobatan ditandai dengan tidak adanya sisa tumor secara mikroskopis yang diambil pada jaringan pasca kemoradiasi tanpa pembedahan, atau pemeriksaan jaringan secara frozen section. Untuk menentukan apakah pada jaringan masih ada sisa tumor atau sudah bebas tumor secara makroskopis terkadang sulit. Toluidin Blue (TB) adalah zat pewarna yang dapat terserap pada ruang interseluler epitel yang mengalami displasia seperti yang terjadi pada KSS. Tujuan: Menilai validitas pewarnaan TB sebagai petanda ketepatan lokasi biopsi KSS pasca terapi, baik pasca pembedahan, maupun yang diterapi dengan kemoterapi dan/atau radioterapi tanpa pembedahan. Metode: Uji diagnostik untuk menentukan sensitifitas dan spesifitas pewarnaan, nilai duga positif dan nilai duga negatif TB sebagai salah satu petanda ketepatan biopsi KSS pasca terapi KSS kepala-leher. Hasil: Didapatkan 30 sampel penelitian yang berasal dari 26 penderita KSS yang telah dilakukan terapi baik bedah maupun kemoradiasi tanpa bedah. Sensitifitas pewarnaan TB terhadap hasil biopsi pasca terapi 83,3%, spesifitas 66,7%, nilai duga positif 79,0% dan nilai duga negatif 72,7%. Kesimpulan: Pewarnaan TB valid untuk menentukan ketepatan biopsi keganasan KSS kepala dan leher pasca terapi. Kata kunci: Validitas, toluidin blue, karsinoma sel skuamosa, pasca terapi

Paramedic Interpretation of Prehospital Lead-II ST-Segments

1997 ◽  
Vol 12 (2) ◽  
pp. 70-73 ◽  
Author(s):  
Robert Hill ◽  
Michael Heller ◽  
Alexander Rosenau ◽  
Scott Melanson ◽  
David Pronchik ◽  
...  
Keyword(s):  
Emergency Department ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Prehospital Setting ◽  
Emergency Medical Technician ◽  
Emergency Physicians ◽  
Emergency Medical ◽  
St Segment ◽  
St Segments

AbstractObjective:To determine the reliability of ST-segment interpretation by paramedics from lead-II rhythm strips obtained in the prehospital setting.Design:Prospective, blinded study of 127 patients transported by an urban/rural emergency medical services system with complaints consistent with ischemic heart disease.Methods:Emergency department physicians asked emergency medical technician-paramedics (EMT-P) via radio to evaluate ST-segments for elevation or depression and grade it as “mild,” “moderate,” or “severe.” Then, this rhythm strip was interpreted blindly by emergency physicians who also interpreted the lead-II obtained from a 12-lead electrocardiogram (ECG) obtained in the emergency department (ED). The field interpretation was compared with the subsequent readings and the final in-patient diagnosis using positive predictive value (PPV), negative predictive value (NPV), and the Kappa statistic. Markedly discrepant interpretations were analyzed separately.Results:Using physician interpretation as the reference standard, paramedic interpretation of the lead-II ST-segments obtained in the prehospital setting was correct (within ±1 gradation) in 113 out of 127 total cases (89%). Of 105 patients for whom final hospital diagnosis was available, the ST-segment on the rhythm strip obtained in the prehospital setting, had a positive predictive value of 74% and a negative predictive value of 85% for myocardial ischemia or myocardial infarction (MI) (p <0.001, Kappa = 0.59). Discordant interpretations between the paramedics and emergency physicians often were related to a basic misunderstanding of rhythm strip morphology.Conclusion:Field interpretation of ST-segments by paramedics is fairly accurate as judged both by emergency physicians and correlation with final patient outcome, but its clinical utility is unproved. A small but clinically significant number of outliers, consisting of markedly discrepant false positives, reflects paramedic uncertainty in identifying the deviations of the ST-segment.

scholarly journals Deep Learning Based Software to Identify Large Vessel Occlusion on Noncontrast Computed Tomography

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 3133-3137
Author(s):  
Marta Olive-Gadea ◽  
Carlos Crespo ◽  
Cristina Granes ◽  
Maria Hernandez-Perez ◽  
Natalia Pérez de la Ossa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Deep Learning ◽  
Positive Predictive Value ◽  
Acute Stroke ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Learning Algorithm ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Noncontrast Computed Tomography

Background and Purpose: Reliable recognition of large vessel occlusion (LVO) on noncontrast computed tomography (NCCT) may accelerate identification of endovascular treatment candidates. We aim to validate a machine learning algorithm (MethinksLVO) to identify LVO on NCCT. Methods: Patients with suspected acute stroke who underwent NCCT and computed tomography angiography (CTA) were included. Software detection of LVO (MethinksLVO) on NCCT was tested against the CTA readings of 2 experienced radiologists (NR-CTA). We used a deep learning algorithm to identify clot signs on NCCT. The software image output trained a binary classifier to determine LVO on NCCT. We studied software accuracy when adding National Institutes of Health Stroke Scale and time from onset to the model (MethinksLVO+). Results: From 1453 patients, 823 (57%) had LVO by NR-CTA. The area under the curve for the identification of LVO with MethinksLVO was 0.87 (sensitivity: 83%, specificity: 71%, positive predictive value: 79%, negative predictive value: 76%) and improved to 0.91 with MethinksLVO+ (sensitivity: 83%, specificity: 85%, positive predictive value: 88%, negative predictive value: 79%). Conclusions: In patients with suspected acute stroke, MethinksLVO software can rapidly and reliably predict LVO. MethinksLVO could reduce the need to perform CTA, generate alarms, and increase the efficiency of patient transfers in stroke networks.

scholarly journals Accuracy of Ultrasound Scanning in Diagnosing Acute Appendicitis in Patients Admitted at Vicente Sotto Memorial Medical Center

2020 ◽  
Vol 3 (2) ◽  
pp. 134-139
Author(s):  
Uma Gurung ◽  
Dhiraj Gurung
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Medical Center ◽  
Diagnostic Tools ◽  
Advantages And Disadvantages ◽  
Sensitivity Specificity ◽  
Suspected Acute Appendicitis

Introduction: Acute appendicitis is the most common abdominal surgical emergency. Both abdominal ultrasonography and computed tomography are common diagnostic tools in its diagnosis with each having its own advantages and disadvantages. Methods: Patients of suspected acute appendicitis were evaluated with an ultrasound to see the sensitivity, specificity, positive and negative predictive value of ultrasound for intraoperative appendicitis diagnosis. The study included 113 patients of suspected acute appendicitis presenting in the emergency during a one year duration. Sensitivity, specificity, positive predictive value and negative predictive value was calculated from their respective formulae. Results: The majority of the patients were male patients between the age group of 18 to 30. The sensitivity of ultrasound for diagnosis of acute appendicitis was 96% and specificity was 33%. The positive predictive value was 98% and the negative predictive value was 20% Conclusion: Ultrasound has good sensitivity and the low cost along with no radiation exposure makes this an acceptable screening investigative modality though due to low specificity, it would be recommended to go for a computed tomography scan if ultrasound shows negative result for appendicitis.  

scholarly journals Pitfall of Positron Emission Tomography-Computed Tomography in assessing Metastasis in a Recurrent Head and Neck Cancer

2015 ◽  
Vol 6 (1) ◽  
pp. 14-16
Author(s):  
Jai Prakash Agarwal ◽  
Poonam Joshi ◽  
Shubhada Kane
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Head And Neck Cancer ◽  
Positive Predictive Value ◽  
Head And Neck ◽  
Distant Metastasis ◽  
Predictive Value ◽  
Emission Tomography ◽  
Positron Emission ◽  
Recurrent Head

ABSTRACT Advanced and recurrent head and neck cancers often present with distant metastasis. The most common sites include lung, liver and bones. The propensity for metastasis depends upon the site of the primary disease as well. Cancers of hypopharynx and nasopharynx both have high propensity for distant meta stasis. Positron emission tomographycomputed tomography is done in many of these situations to assess distant metastasis, especially in locally advanced and recurrent cases. The positive predictive value of PET-CT in predicting distant metastasis in recurrent head and neck cancers is 60%. This low positive predictive value is attributed to inflammation, infections, and post RT changes. The present case report highlights that PET positive lesions should be interpreted with caution as they can be false positive and can be mistaken for metastasis and, hence, a potentially curative patient can be treated as one with palliative intent. How to cite this article Joshi P, Chaturvedi P, Agarwal JP, Kane S. Pitfall of Positron Emission Tomography-Computed Tomography in assessing Metastasis in a Recurrent Head and Neck Cancer. Int J Head Neck Surg 2015;6(1):14-16.

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