FDG-PET for Staging and Follow-up of HIV-Infected Patients with Non Hodgkin Lymphoma and Hodgkin Lymphoma: A Single Center Experience.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 5014-5014
Author(s):  
Silvia Cantoni ◽  
Erika Ravelli ◽  
Maria Cristina Moioli ◽  
Chiara Rusconi ◽  
Vittorio Ruggero Zilioli ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Ct Scan ◽  
Hodgkin Lymphoma ◽  
False Positive ◽  
Fdg Pet ◽  
False Negative ◽  
Hiv Positive ◽  
Number Of Patients ◽  
Positive Results

Abstract Abstract 5014 Introduction Risk of developing non Hodgkin lymphomas (NHL) is known to be increased among patients (pts) infected by HIV-1 and sporadic non-HIV related cases of Hodgking lymphomas (HL) are also described. HIV-positive pts also feature a virus-related systemic lymphoadenopathy which makes nodal involvement by lymphoma difficult to evaluate using conventional imaging. The role of positron-emission tomography using 18F-fluorodeoxyglucose (FDG-PET) in the staging and evaluation of response to treatment of pts with NHL and HL is well established in immunocompetent pts, while only limited information is available on lymphomas arising in the setting of HIV infection. We report on a retrospective analysis of FDG-PET results in a group of HIV pts with lymphoma, both NHL and HL, followed-up at our hospital. Patients and methods Twelve HIV-positive male pts with a diagnosis of lymphoma (7 high grade and 1 follicular NHL, 4 HL) underwent a total of 22 PET scans. PET results were compared with those obtained by computed tomography (CT). Nine PET were performed at staging, 7 at restaging following chemotherapy, and 6 at follow-up. At diagnosis of lymphoma: median CD4 count was 200 cells/mcL (range 98-451); HIV genome was undetectable in 5/9 pts, in the remaining 4 pts for whom the data was available viral loads ranged from 103 to 1,452,720 copies/mL; 10/12 pts were already receiving HAART, while the remaining 2 pts started treatment upon diagnosis of lymphoma. Results In the majority of cases (17/22 = 77%) results of PET, CT scan and clinical status were concordant, being diagnostic of either lymphoma presence (11/17) or absence (6/17). No false positive results were recorded at follow-up. In 5/22 cases (23%) PET and CT scan were discordant. In 4 cases PET yielded a false negative result; in 2 cases at diagnosis (2 pts with HL) and in 2 cases at follow-up (both in the pt with follicular lymphoma). In the remaining case, a PET-negative CT-positive adenopathy was demonstrated which proved to be reactive in nature at biopsy. Discussion Our results suggest that FDG-PET is useful in the evaluation of lymphoma in the setting of HIV infection, similarly to what has been observed among immunocompetent pts. Although the number of patients is limited, in our experience PET proved to be able to discriminate between reactive and lymphomatous involvement of lymphoid tissue as demonstrated by absence of false positive results in pts evaluated at follow-up. These results need to be confirmed by larger clinical trials. Disclosures No relevant conflicts of interest to declare.

Prognostic value of FDG-PET in Hodgkin lymphoma for posttreatment evaluation. Long-term follow-up results

2009 ◽  
Vol 150 (47) ◽  
pp. 2133-2138
Author(s):  
Zsuzsa Molnár ◽  
Zsófia Simon ◽  
Zita Borbényi ◽  
Beáta Deák ◽  
LászLÓ Galuska ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Predictive Value ◽  
False Positive ◽  
Fdg Pet ◽  
Clinical Stage ◽  
False Negative ◽  
True Negative ◽  
Significant Difference ◽  
The Difference

In the past few decades Hodgkin lymphoma (HL) has become a highly curable malignant disease, as a result of using modern polychemotherapy and irradiation. Differentiation of active tumor from fibrosis or necrosis within residual radiographic masses represents a problem of interpretation. Aims: The aim of this retrospective study is to assess the value of FDG-PET for prediction of remission or relapse in HL. Patients and methods: Data of 128 patients, who had residual masses on CT after completion of their planned treatment, have been analyzed. FDG-PET was performed between January 1995 and February 2005. Results: The median duration of the follow-up from PET was 75.5 months (range: 20–180 months). 89 (70%) patients had negative and 39 (30%) patients had positive FDG-PET results. The numbers of true-positive, true-negative, false-positive and false-negative subjects were 29, 83, 10 and 6, respectively. Sensitivity of post-treatment FDG-PET was 83%, specificity 93%, positive predictive value 74%, negative predictive value 93%, and accuracy 88%. The difference between the event free survival of PET positive and negative cases is highly significant (p = 0.0000), according to the Mantel-Cox test. Conclusion: Our results, in accordance with literature, clearly indicate that patients with negative FDG-PET results are unlikely to progress or relapse during a long follow-up. However, false positive uptake is a problem. We have investigated the effect of age, histological subtype, clinical stage and the type of treatment on the accuracy, but on the basis of these facts we could not find any significant difference. However, the date of the investigation influenced the results: before 2000 the number of false results was significantly higher than after that time, which shows the importance of investigators’ experience.

False-Negative and False-Positive Results in FDG-PET and PET/CT in Breast Cancer

PET Clinics ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 289-298 ◽  
Author(s):  
Rakesh Kumar ◽  
Neerja Rani ◽  
Chetan Patel ◽  
Sandip Basu ◽  
Abass Alavi
Keyword(s):  
Breast Cancer ◽  
False Positive ◽  
Fdg Pet ◽  
False Negative ◽  
Pet Ct ◽  
Positive Results

Assessment of the total cost of FNAC as a diagnostic tool in patients with thyroid nodules

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6628-6628
Author(s):  
I. Borget ◽  
P. Vielh ◽  
M. Allyn ◽  
M. Schlumberger ◽  
G. De Pouvourville
Keyword(s):  
False Positive ◽  
Thyroid Nodules ◽  
Unit Cost ◽  
False Negative ◽  
Final Diagnosis ◽  
Sensitivity Analyses ◽  
Markov Modelling ◽  
Total Cost ◽  
Number Of Patients

6628 Background: The prevalence of thyroid nodules in the general population ranges from 4 to 7% and fine-needle aspiration cytology (FNAC) is a widely used diagnostic procedure. As the final diagnosis is based on post-surgical pathology of the lesion, a number of patients with nodules classified as benign or indeterminate by cytology may have a postponed final diagnosis, impacting the procedure cost. This study aims to determine the total cost of FNAC, by taking into account of diagnostic mistakes (false-positive and false-negative), failures of FNAC (indeterminate results) and the follow-up of non operated patients. Methods: A Markov model was built to describe the management of patients through time, from the first FNA-t. We derived estimates for diagnostic accuracy values and follow-up from a retrospective study, including all patients who had their first FNAC from 2003 to 2005 at Institut Gustave Roussy. Costs were computed from the viewpoint of the hospital. A microcosting study was performed to determine the unit cost of FNAC. Sensitivity analyses were performed. Results: Out of the 624 patients who had FNAC, 15 were cytologically classified as malignant, 57 as suspicious and 171 as indeterminate. Surgical excision was carried on in 155 cases. The unit cost of FNAC was 121 €. Markov modelling showed that the mean total cost of a true diagnosis including unnecessary surgeries, repeat FNAC and follow-up was 1,145 Euros. The number of false negative and false positive cases had little impact on total cost, whereas it was significantly affected by the percentage (27%) of unsatisfactory specimens. The absence of such specimens would reduce the total cost to 738 Euros (35%). Conclusions: The cost of FNAC exceeds its unit production cost. It depends on the performance of the cytologist and on the rate of indeterminate results that might be reduced by routine ultrasound-guidance. No significant financial relationships to disclose.

Clinical Symptom Or Sign-Directed Surveillance Can Be More Useful In Detecting Relapse Compared To Routine Imaging In Patients With Diffuse Large B-Cell Lymphoma In Remission

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2914-2914
Author(s):  
Junshik Hong ◽  
Ji Hyun Kim ◽  
Jinny Park ◽  
Jae Hoon Lee
Keyword(s):  
Ct Scan ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Disease Relapse ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Positive Results

Abstract Background For patients with aggressive lymphoma in complete remission (CR) after primary therapy, efficient detection of relapse with maintenance of performance status is important because there is the second chance for cure by salvage therapy. Contrary to initial staging workup, treatment, and its response evaluation, there is ambiguity in the field of surveillance of patients with lymphoma in CR: intervals of outpatient department (OPD) follow-up, lists of required laboratory tests, and especially routing imaging by computed tomography (CT) scan or 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), have not been firmly standardized according to experts and guidelines. Despite a lack of evidence, routine imaging (RI) with CT or FDG-PET/CT has been widely adopted. The aim of the current study was to analyze the patterns and outcomes of OPD surveillance and to evaluate the role of RI and unplanned early OPD visits in patients with diffuse large B-cell lymphoma (DLBCL) in remission. Methods Patients 1) diagnosed as DLBCL according to 2008 WHO criteria, 2) age °Ã 20 years, 3) achieved CR according to 2007 Revised Criteria after receiving R-CHOP immunochemotherapy with or without following radiotherapy or high dose therapy, and 4) had °Ã 1 OPD visit for the surveillance of relapse, were included. The institutional policy of OPD visits in patients with DLBCL in CR was as follows: OPD visit every 2 to 3 months for the first 2 years, then every 4 to 6 months for the next 3 years, and annually thereafter. History taking, physical examination, and checking complete blood cell count were performed routinely during each visit. Every single OPD visit was reviewed and classified with regard to whether or not it was planned. If an OPD visit was scheduled during the last OPD visit for purpose of surveillance of asymptomatic patients, the visit was classified as a 'planned OPD visit'. An 'unplanned early visit' was defined as any OPD visit earlier than the appointed next visit decided by the patient because of any abnormal symptom or sign. RI was defined as a CT or FDG-PET/CT scheduled by a physician at least 2 months prior to actual scanning for routine surveillance of lymphoma, i.e., without any symptom or sign of relapse. There was no specific institutional policy of RI, and three physicians (Hong J, Park J, and Lee JH) decided whether or not to perform RI during the next visit with consideration of the patient's opinion. Result One hundred and six patients diagnosed between May 2004 and February 2012, satisfied the inclusion criteria. During a median follow-up duration of 38.1 months, 15 patients (14.2%) experienced disease relapse. A total of 856 OPD visits (median 6, range 1-25) were analyzed from the 106 patients; 501 visits were planned OPD visits with RI, 322 visits were planned visits without RI, and 33 visits (33/856 = 3.9%) were unplanned early visits (Fig. 1). RI showed a perfect sensitivity and negative predictive value but low positive predictive value due to frequent false-positive results (Fig. 2). Six of seven patients who underwent routine CT scan and 17 of 21 patients who underwent a surveillance FDG-PET/CT received unnecessary further evaluations, even including biopsy with general anesthesia. Compared to enhanced CT scan, FDG-PET/CT showed a higher rate of false positive results [7/407 (13.7%) for CT vs. 23/165 (13.7%) for FDG-PET/CT]. Unplanned early visits of patients showed a strong association with disease relapse compared to planned OPD visits; one third of the unplanned early visits were due to disease relapse (Fig 3). Due to the small number of patients, it was impossible to determine whether RI can prolong the survival of relapsed patients with DLBCL, although there appeared to be no significant difference between the groups. Conclusions Considering limited diagnostic values in addition to the risk of radiation exposure, financial cost, and anxiety of the patients, RI appears not to be an ideal strategy for surveillance in patients with DLBCL who achieved a CR in the rituximab era. Clinical symptom or sign-directed surveillance can be more useful in detecting relapse compared to RI, at least in patients with DLBCL in remission. It should be emphasized that patients should be encouraged to visit the hospital earlier if they experience any discomfort. Disclosures: Off Label Use: lenalidomide in newly diagnosed myeloma.

Abstract TP59: To Estimate the Time of Stroke Onset by Using Ct Scan and Stroke Severity Scale

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Saadat Kamran ◽  
Zain Bhutta ◽  
Naveed Akhtar ◽  
Vernice Bates ◽  
Abdul Salam ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Scan ◽  
False Positive ◽  
False Negative ◽  
Stroke Onset ◽  
Ct Scans ◽  
Time Range ◽  
Stroke Patients ◽  
Area Of Interest ◽  
Number Of Patients

Purpose: Thrombolysis in acute stroke is time limited. Onset time is unknown in a large number of patients. We wanted to classify acute stroke patients with unknown time of onset into less than or more than 4.5 hours onset, using CT scan and National Institute of Health Stroke Scale(NIHSS). Methods: Acute stroke patients with NIHSS ≥8 and CT within 24 hours of onset were included. The control group included 100 normal CT. Two reviewers blinded to clinical information independently reviewed all images. CT was graded as 0-normal, grade-I poorly-demarcated hypodensity and grade-II well-demarcated hypodensity. Hounsfield unit (HU) calculated in the area of interest using 0.5-1 cm area and compared with the contralateral side (n=44). The diagnosis was confirmed from follow-up scans. Results: A total 120 CT-scans were reviewed. There were 65% males, age ranged from 39-90 years. < 4.5 hour group : Sixty-nine CT were graded as <4.5-hours, 87%(n=60) were correctly graded (p<0.0001) and 13%(n=9), false negative) were incorrectly assigned to > 4.5 hours category. Both observers were incorrect on same eight CT-scans. Five of the false negative (assigned to >4.5-hours) were in 2.30-3.0 hours range with average NIHSS of 13. Four patients under two hours developed hypodensity, assigned to >4.5 hour category with average NIHSS of 21. Average NIHSS of the group was 15. > 4.5 hours group: Fifty-one CT were over 4.5 hours. Forty-four (86%) were correctly graded as >4.5-hours (p<0.0001) and seven (14%) patients were incorrectly assigned to <4.5 hour category (false positive). Six false positive patients were in 3.30-4.10 time range, average NIHSS of 15. Average NIHSS of >4.5-hour group was 14. Eleven incorrectly categorized scans [false negative (n=5) and positive (n=6)] tend to fall in the 2.45-4.10 hours range. Twenty-five (21%) CT scans were normal, all under three hours except one with NIHSS ≥8 at seven hours. HU were measured in 44 patients. Average HU of patients in <4.5 hour category (n=20) was 3.5 and >4.5 hour category (n=24) was 7.5. Conclusion: Acute stroke with unknown time of onset, NIHSS >8 and CT scan changes of grade 0-I indicate <4.5 hours stroke onset. Higher NIHSS patients can develop early hypodensity, incorrectly suggesting >4.5 hours onset (false negative).

High False Positive Rate with the Use of CT and FDG-PET in Post-Remission Surveillance for Hodgkin Lymphoma.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2327-2327 ◽  
Author(s):  
Dan Zuckerman ◽  
Ann Lacasce ◽  
Eric Jacobsen ◽  
Tak Takvorian ◽  
Ephraim Hochberg
Keyword(s):  
Hodgkin Lymphoma ◽  
False Positive ◽  
Fdg Pet ◽  
Lung Lesion ◽  
False Positives ◽  
Ct Scans ◽  
Second Malignancy ◽  
Pet Ct ◽  
Relapsed Disease

Abstract The role of radiologic surveillance in the follow-up of patients with Hodgkin lymphoma is poorly defined. There is no consensus in the NCCN guidelines regarding the use of CT scans. The use of FDG-PET is discouraged given anecdotal experience with false positives. We have retrospectively analyzed 45 cases of classical Hodgkin lymphoma treated with curative intent at our institutions between 2003 and 2005. All patients received ABVD and had a negative FDG-PET within 6 weeks of completing therapy. Follow-up with surveillance CT scans and PET/CT scans were obtained at the discretion of the treating clinician at 3–6 month intervals for the first 2–3 years of follow-up and then every 6–12 months for the next 2–3 years (median every 6 months). A false positive was defined as a radiologic finding on CT or PET/CT that resulted in either increased frequency of surveillance or medical intervention that was subsequently proven by pathology to be benign or resolved spontaneously on further imaging within 12 months. Of the 45 patients, 29 were women and 16 were men. The median age was 34 (18–71) and the median duration of follow-up was 41 months (12–57 months). Sixteen patients had advanced stage (III or IV) disease. Forty-one (91%) patients are alive and without disease, three patients (7%) are alive with relapsed disease, and one patient (2%) has died from disease. There were 25 patients (56%) for whom scans did not change management; 6 patients (13%) for whom scans revealed relapsed disease (4) or second malignancy (2); and 14 patients (31%) for whom scans proved to be false positives. All 4 relapses were asymptomatic, occurred within 3 to 9 months of completing therapy, and were identified on both CT and PET(3) or CT alone (1). All 4 patients proceeded to salvage chemotherapy and autologous or allogeneic transplantation; one patient died of disease and three have relapsed following transplantation. The 2 second malignancies, which were high-grade sarcomas, were asymptomatic and identified on both CT and PET. Both patients had received XRT and one sarcoma was within the radiation field. There were 17 false positive results identifed in 14 patients during follow-up. Of the 17 false positives, 8 were identified on CT with a normal PET (5 lung lesions, 1 ovarian cyst, 1 retractile testicle and 1 renal cyst), 6 were identified on PET with a normal CT (2 parotid uptakes, 2 thymic “rebounds,” 1 nodal uptake, and 1 splenic uptake), and 3 were identified on CT and PET (1 lung lesion, 1 splenic and hilar adenopathy, and 1 small bowel lesion). The patient with the FDG-avid lung lesion underwent CT-guided FNA of the lesion and bronchoscopy with BAL, both of which were negative. The patient with FDG-avid splenic and hilar nodal lesions underwent splenectomy and was found to have sarcoidosis, from which she has been asymptomatic. In conclusion, there is a high rate of false positives when using CT and/or PET as post-remission surveillance. There were no instances in which PET identified early relapsed disease or second malignancy without corresponding CT findings. In our series, PET had no clinical utility in the surveillance of patients with Hodgkin’s lymphoma in remission.

Selective Use of Intraoperative Touch Prep Analysis of Sentinel Nodes in Breast Cancer

2005 ◽  
Vol 71 (11) ◽  
pp. 955-962 ◽  
Author(s):  
Rachel C. Forbes ◽  
Clovis Pitchford ◽  
Jean F. Simpson ◽  
Glen C. Balch ◽  
Mark C. Kelley
Keyword(s):  
Breast Cancer ◽  
Predictive Value ◽  
False Positive ◽  
False Negative ◽  
Nodal Metastasis ◽  
Axillary Lymph ◽  
Sentinel Nodes ◽  
Number Of Patients ◽  
The Impact ◽  
Positive Results

Imprint cytology (touch prep) is often used for intraoperative examination of sentinel nodes in breast cancer. This allows axillary lymph node dissection (ALND) to be performed immediately for tumor-positive nodes. We evaluated the accuracy of touch prep examination of sentinel nodes and its role in the surgical treatment of breast cancer. We analyzed 169 breast cancer patients who underwent 170 lymphatic mapping procedures with intraoperative touch prep examination. Results from the touch prep were correlated with histopathology and clinical variables. There were 115 true-negative, 35 true-positive, 15 false-negative, and 5 false-positive results. Touch prep had a sensitivity of 70 per cent and specificity of 96 per cent. Positive predictive value, negative predictive value, and diagnostic accuracy were all 88 per cent. The false-negative rate was 30 per cent and correlated with the size of the nodal metastasis and number of involved nodes, but not other patient factors. Touch prep is useful for the evaluation of sentinel nodes in breast cancer, but it has a lower sensitivity than initially reported, particularly in patients with micrometastases. False positive results occur, although they may be reduced after experience with the technique. We recommend that suspicious findings on touch prep should be confirmed by frozen section and that ALND only be performed for histologically documented metastases. We currently perform touch prep only in patients who are at high risk of nodal metastasis or will undergo mastectomy. This improves operative efficiency and limits the impact of false positive and negative results without dramatically increasing the number of patients who require a second surgical procedure.

HIV Status Does Not Impact on Outcome in Patients with Hodgkin Lymphoma Treated with ABVD Chemotherapy in the HAART Era,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3646-3646
Author(s):  
Silvia Montoto ◽  
Kate Shaw ◽  
Jessica Okosun ◽  
Shreyans Gandhi ◽  
Paul Fields ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Hodgkin Lymphoma ◽  
Prognostic Score ◽  
Hiv Positive ◽  
Hiv Status ◽  
University Hospitals ◽  
Hiv Viral Load ◽  
Hiv Patients ◽  
Abvd Chemotherapy

Abstract Abstract 3646 Background: The prognosis of patients with HIV and non-Hodgkin lymphoma (NHL) has improved considerably since the advent of HAART, approaching that of patients with NHL in the general population when treated with the same chemotherapy regimens. However, it is not clear whether the same holds true for patients with Hodgkin lymphoma (HL). Aim: To analyze the outcome of patients diagnosed with HL treated with ABVD in the HAART era according to HIV status. Patients: From 1997 to 2010, 237 patients (92 with HIV infection) were newly diagnosed with HL at 5 university hospitals in London and consecutively treated with ABVD chemotherapy. Patients with HIV were older (median age: 41 years vs 31, p<0.001) and more were men (88% vs 59%, p<0.001). The histology subtype was more frequently mixed cellularity in HIV patients (54%) than in non-HIV (19%, p<0.001). In addition, HIV positive patients had more advanced stage at diagnosis (stage III-IV: 80% vs 33%, p<0.001), B-symptoms (81% vs 36%, p<0.001), lower Hb level (<10.5g/dL: 46% vs 20%, p<0.001) and lower albumin level (<4g/dL: 76% vs 35%, p<0.001). Patients with HIV infection had more frequently high risk disease according to the International Prognostic Score than HIV negative patients (IPS>3: 71% vs 22%, p<0.001). Amongst HIV patients, the HIV viral load (VL) was undetectable at the time of HL diagnosis in 52 of 86 patients with available data. The median VL for the remainder was 4,563 (range: 3,060–6,066). Forty-seven patients (53%) had a CD4 count <200/mL. All patients were treated with 4–6 cycles of ABVD chemotherapy with or without radiotherapy to residual/bulky areas according to local policies. Ninety patients with HIV infection received HAART concomitantly during chemotherapy. Results: The complete response (CR) rate in HIV positive and negative patients was 74% and 81%, respectively (p=NS). Fifty-one patients (21%) received consolidation radiotherapy. After a median follow-up of 59 months (range: 8–172 months), 40 patients relapsed at a median time of 7 months (range: 1–106). The median duration of response for HIV positive and negative patients was 33 months and 48 months, respectively (p=NS). Thirty-three patients have died: in 25 cases of HL; 2 patients due to toxicity and 5 patients due to other causes. Five-year event-free survival (EFS) was 59% (95%CI: 46–69) for HIV patients and 65% (95%CI: 56–72) for the remainder (p=NS). Five-year overall survival (OS) was 79% (95%CI: 67–87) and 88% (95%CI: 80–92) for HIV positive and negative patients respectively (p=0.06). HIV status did not predict OS or EFS on multivariate analysis including all variables comprising the IPS and HIV status. Conclusions: This long follow-up study demonstrates that patients diagnosed with HL in the setting of HIV infection have a more extensive disease with adverse prognostic factors. However, when treated with ABVD chemotherapy HIV positive status does not adversely affect OS or EFS. Disclosures: Montoto: Roche: Honoraria; Genentech: Research Funding. Orkin:Janssen: Honoraria; Gilead: Honoraria; BMS: Honoraria; BI: Honoraria; MSD: Honoraria; GSK: Honoraria; Viiv: Honoraria. Gribben:Roche: Honoraria; Celgene: Honoraria; GSK: Honoraria; Mundipharma: Honoraria; Gilead: Honoraria; Pharmacyclics: Honoraria.

scholarly journals USE OF MIDDLE-FIELD MRIWITH SPECIFIC SEQUENCIES COMPENSATING THE MOVEMENT ARTEFACTS FOR BRAIN STUDIES IN PATIENTS WITH HIV INFECTION

2018 ◽  
pp. 43-49
Author(s):  
E. V. Fedorenko ◽  
P. E. Lutsenko ◽  
V. A. Arkhangelsky ◽  
E. M. Kazakova ◽  
T. A. Shelkovnikova ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Brain Mri ◽  
False Negative ◽  
Main Group ◽  
Control Group ◽  
Number Of Patients ◽  
Follow Up Studies ◽  
Movement Artifacts ◽  
The Brain

Nowadays of great importance is not only the issue of early diagnosis of HIV infection, but of early detection and effective treatment of AIDS complications. The annual increase in the incidence of HIV infection amounts to 4%. Unfortunately, a great number of patients ask for hospital care when their disease has the stage of secondary complications. Such situation requires a fast and affordable diagnostics together with verification of the nature of the affection. Purpose. To evaluate the diagnosis effectiveness of the secondary infectious cerebral affection in patients with HIV infection using the method of non-contrast MRI including the usage of the specially developed software. One hundred thirty three patients were recruited for the study, the main group of 108 persons (as old as 36,8±8,3), all referred to the brain MRI with suggestion of neurologic complications of HIV. The control group comprised 25 patients of the same age with focal damage of vascular nature. In everybody the MRI has been carried out using open middle-field scanner (Az-360, by AZ plc company, Moscow) with field induction 0,4 T, supplied with wireless four-channel quadratur coil for head studies, without contrast enhancement, but using in everybody the specially designed protocols for compensation of movement artifacts. All patients were re-examined in 2, 4 and 6 weeks. MRI images both in first admission and in follow-up studies were reported first qualitatively by type of contour of pathologic focus, by presence of multiple pattern of focal damage, by ultrastructure of foci, extent of perifocal oedema, interhaemispheric dislocation; also the dimensions of lateral ventriculi, of external subarachnoidal spaces and thickness of cortex in various regions were measured. Focal cerebral damage verified later as toxoplasmosis was revealed in the main group in 80% (86 of 108) of patients. False-negative and false-positive conclusions of MRI studies were not revealed also in prospective follow-up studies. Of these in 69 (80,2%) the pathologic foci were multiple and did localize periventricularly in particular in putamen, nucleus caudatus, equally frequent for both haemispherae, single foci were detected in thalami, concomitant with tendency to extensive cortical dystrophy. The putamen region was involved more frequently as compared to other basal ganglii (р=0,003). No significant differences were revealed between various cortical regions as regard to frequency of detection of pathologic foci. Four weeks period was detected as being the most effective time for the dynamic control in the course of treatment. Conclusion. Middle-field MRI of the brain with compensation of movement artifacts is a proper technique for both the diagnosis and follow-up control of treatment of cerebral toxoplasmosis in patients with HIV infection.

Critical Evaluation of Impedance Phlebography for the Diagnosis of Deep Vein Thrombosis

1974 ◽  
Vol 31 (02) ◽  
pp. 273-278
Author(s):  
Kenneth K Wu ◽  
John C Hoak ◽  
Robert W Barnes ◽  
Stuart L Frankel
Keyword(s):  
Deep Vein Thrombosis ◽  
False Positive ◽  
False Negative ◽  
Critical Evaluation ◽  
Original Method ◽  
Vein Thrombosis ◽  
Negative Results ◽  
False Negative Results ◽  
Deep Vein ◽  
Positive Results

SummaryIn order to evaluate its daily variability and reliability, impedance phlebography was performed daily or on alternate days on 61 patients with deep vein thrombosis, of whom 47 also had 125I-fibrinogen uptake tests and 22 had radiographic venography. The results showed that impedance phlebography was highly variable and poorly reliable. False positive results were noted in 8 limbs (18%) and false negative results in 3 limbs (7%). Despite its being simple, rapid and noninvasive, its clinical usefulness is doubtful when performed according to the original method.

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