Preoperative MRI of perianal fistula evaluation and its impact on surgical outcome

Abstract Background Perianal fistula (PAF) is an abnormal tract communicating an external cutaneous opening in the perianal region to the anal canal. PAF is one of the common anorectal disorders in surgical practice with high prevalence. The current study aimed to determine the ability of preoperative MRI for preoperative evaluation of perianal fistula. Results This is a retrospective evaluation of 65 patients with perianal fistula. MRI fistula imaging-related data were revised, and fistula severity was scored using criteria of both local extension of fistulas and active inflammation for a total maximum score of 22. Preoperative MRI could predict the severity of perianal disease with sensitivity, specificity, and accuracy rates of 75%, 92%, and 84.6%, respectively. Surgical findings concerning PAF severity correlated significantly with MRI findings. Diffusion-weighted magnetic resonance imaging (DW-MRI) provided high sensitivity and accuracy with 100% specificity for fistula visualization and highest sensitivity, specificity, and accuracy for detection of cavities > 3 mm in diameter. DW-MRI provided the highest specificity rate on ROC curve analysis among the three MRI pulse sequences (DW-MRI, short tau inversion recovery (STIR), and T1 post-contrast). Conclusion MRI is valuable and accurate for preoperative investigation for PAF evaluation and abscess localization. MRI allowed accurate detection of internal fistula opening and its relation to sphincters. DW-MRI is a valuable sequence with highest diagnostic yield, and its addition to STIR WI improves sensitivity and specificity for determination of fistula activity and extension.

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Identification of differentially methylated genes as diagnostic and prognostic biomarkers of breast cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02124-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Xiao-hong Mao ◽

Qiang Ye ◽

Guo-bing Zhang ◽

Jin-ying Jiang ◽

Hong-ying Zhao ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

High Sensitivity ◽

Breast Cancer Diagnosis ◽

Diagnostic Value ◽

Methylation Pattern ◽

Clinical Value ◽

Roc Curve Analysis ◽

Differentially Methylated Genes ◽

Sensitivity Specificity

Abstract Background Aberrant DNA methylation is significantly associated with breast cancer. Methods In this study, we aimed to determine novel methylation biomarkers using a bioinformatics analysis approach that could have clinical value for breast cancer diagnosis and prognosis. Firstly, differentially methylated DNA patterns were detected in breast cancer samples by comparing publicly available datasets (GSE72245 and GSE88883). Methylation levels in 7 selected methylation biomarkers were also estimated using the online tool UALCAN. Next, we evaluated the diagnostic value of these selected biomarkers in two independent cohorts, as well as in two mixed cohorts, through ROC curve analysis. Finally, prognostic value of the selected methylation biomarkers was evaluated breast cancer by the Kaplan-Meier plot analysis. Results In this study, a total of 23 significant differentially methylated sites, corresponding to 9 different genes, were identified in breast cancer datasets. Among the 9 identified genes, ADCY4, CPXM1, DNM3, GNG4, MAST1, mir129-2, PRDM14, and ZNF177 were hypermethylated. Importantly, individual value of each selected methylation gene was greater than 0.9, whereas predictive value for all genes combined was 0.9998. We also found the AUC for the combined signature of 7 genes (ADCY4, CPXM1, DNM3, GNG4, MAST1, PRDM14, ZNF177) was 0.9998 [95% CI 0.9994–1], and the AUC for the combined signature of 3 genes (MAST1, PRDM14, and ZNF177) was 0.9991 [95% CI 0.9976–1]. Results from additional validation analyses showed that MAST1, PRDM14, and ZNF177 had high sensitivity, specificity, and accuracy for breast cancer diagnosis. Lastly, patient survival analysis revealed that high expression of ADCY4, CPXM1, DNM3, PRDM14, PRKCB, and ZNF177 were significantly associated with better overall survival. Conclusions Methylation pattern of MAST1, PRDM14, and ZNF177 may represent new diagnostic biomarkers for breast cancer, while methylation of ADCY4, CPXM1, DNM3, PRDM14, PRKCB, and ZNF177 may hold prognostic potential for breast cancer.

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Diagnostic accuracy of magnetic resonance imaging in detection of intra-axial gliomas

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.1.2489 ◽

2020 ◽

Vol 37 (1) ◽

Author(s):

Sohbia Munir ◽

Sohail Ahmed Khan ◽

Hina Hanif ◽

Maria Khan

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Gold Standard ◽

High Sensitivity ◽

Cross Sectional Study ◽

Resonance Imaging ◽

Cross Sectional ◽

Post Contrast ◽

Sensitivity Specificity

Objective: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in detection of intra-axial gliomas in suspected cases keeping histopathology as gold standard. Methods: This cross-sectional study was conducted at Dow Institute of Radiology, DUHS from October 2017 - April 2018. Patients of either gender aged 30-70 years presenting with headache were included. Patients already diagnosed and referred for follow up were excluded. MRI was performed on 1.5T scanner by a trained MRI technician. T1, T2, FLAIR, diffusion weighted and T1 post contrast images were acquired and reviewed by two radiologists having more than five years post fellowship experience. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of MRI for intraaxial gliomas was calculated taking histopathology findings as gold standard. Results: Mean age of the patient`s was 51.71 ±10.85 years. Positive intraaxial gliomas on MRI were observed in 123 (79.90%) patients while on histopathology, positive intraaxial gliomas were observed in 131 (85.10%) patients. Diagnostic accuracy of MRI in detection of intra-axial gliomas taking histopathology findings as gold standard showed sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV) and overall diagnostic accuracy as 89.31%, 73.91%, 95.12%, 54.84% and 87.01%. Conclusions: MRI has high sensitivity, moderate specificity and high diagnostic accuracy in detection of intraaxial gliomas. doi: https://doi.org/10.12669/pjms.37.1.2489 How to cite this:Munir S, Khan SA, Hanif H, Khan M. Diagnostic accuracy of magnetic resonance imaging in detection of intra-axial gliomas. Pak J Med Sci. 2021;37(1):125-130. doi: https://doi.org/10.12669/pjms.37.1.2489 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The cone-beam breast computed tomography characteristics of breast non-mass enhancement lesions

Acta Radiologica ◽

10.1177/0284185120963923 ◽

2020 ◽

pp. 028418512096392

Author(s):

Wei Kang ◽

Wuning Zhong ◽

Danke Su

Keyword(s):

Computed Tomography ◽

Predictive Value ◽

Diagnostic Yield ◽

High Sensitivity ◽

High Specificity ◽

Cone Beam ◽

Diagnostic Model ◽

Benign Lesions ◽

Post Contrast ◽

Mass Enhancement

Background Cone-beam computed tomography (CBBCT) of the breast is emerging as a way of improving breast cancer diagnostic yield. Purpose To find characteristics of non-mass enhancement (NME) lesions on breast CBBCT and to identify the characteristics that distinguish malignant and benign lesions. Material and Methods Breast CBBCT images of 84 NME lesions were analyzed. Internal enhancement distribution and patterns, calcification distribution and suspicious morphology, and ΔHU enhancement values were compared between post-contrast and pre-contrast malignant and benign lesions. Univariate analyses were applied to find the strongest indicators of malignancy, and logistic regression analysis was used to develop a fitting equation for the combined diagnostic model. Results In the 84 NME lesions, the indicators of malignancy were as follows: segmental enhancement distribution ( P = 0.011, 53.62% sensitivity, 86.67% specificity, 94.87% positive predictive value [PPV], and 28.89% negative predictive value [NPV]), clumped internal enhancement patterns ( P = 0.017, 50.72% sensitivity, 86.67% specificity, 94.59% PPV, and 27.66% NPV), ΔHU ≥ 93.57 Hounsfield units (HU) ( P = 0.004, 66.67% sensitivity, 73.33% specificity, 92.00% PPV, and 32.35% NPV), and NME lesions with calcification ( P = 0.002, 36.23% sensitivity, 20.00% specificity, 82.14% PPV, and 67.57% NPV). The fitting equation for the combined diagnostic model was as follows: Logit (P) = –0.579 +1.318 × enhancement distribution + 1.000 × internal enhancement patterns + 1.539 × ΔHU value + 1.641 ×NME type. Conclusion Individual diagnostic criteria based on breast CBBCT characteristics (segmental enhancement distribution, clumped internal enhancement patterns, ΔHU values > 93.57 HU, and NME lesions with calcification) had high specificity and PPV; when combined, they had high sensitivity in predicting malignant NME lesions.

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Increased diagnostic confidence in the diagnosis of pituitary micro-lesions with the addition of three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions sequences

Acta Radiologica ◽

10.1177/0284185118774954 ◽

2018 ◽

Vol 60 (2) ◽

pp. 213-220

Author(s):

Ying Tang ◽

Yue Wu ◽

Hua Zhang ◽

Jing Wang ◽

ZhenWei Yao

Keyword(s):

Diagnostic Yield ◽

Three Dimensional ◽

Volume Effect ◽

Flip Angle ◽

Observer Agreement ◽

Kappa Statistics ◽

Diagnostic Confidence ◽

Mri Findings ◽

Post Contrast ◽

Contrast Enhanced

Background Conventional magnetic resonance imaging (MRI) is adversely affected by thick slices, small intersection gaps, and the partial volume effect, leading to the missed diagnosis or misdiagnosis of pituitary micro-lesions. Purpose To evaluate the diagnostic yield of three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-T2 SPACE) sequences compared with a standard MRI protocol for the diagnosis of pituitary micro-lesions. Material and Methods The MRI findings of 664 patients with clinically suspected pituitary lesions were retrospectively analyzed. All patients underwent coronal 3D-T2 SPACE sequences followed by T1-weighted (T1W) imaging. Conventional scanning sequences included coronal and sagittal T1W imaging and post-contrast enhanced coronal and sagittal T1 imaging. All images were independently evaluated by two experienced neuroradiologists. The inter-observer agreement was analyzed using kappa statistics. Results Compared with conventional sequences, there was an increase in diagnostic confidence of 60.3% for the diagnosis of pituitary micro-lesions with the addition of 3D-T2 SPACE sequences. The lesion conspicuity scores of combined conventional and 3D-T2 SPACE sequences were significantly higher than those of conventional imaging (z = −6.403, P < 0.01) and 3D-T2 SPACE sequences (z = −4.243, P < 0.01). In addition, the inter-observer agreement of 3D-T2 SPACE sequences was good (κ = 0.826). Conclusion Combined with routine sequences, post-contrast enhanced 3D-T2 SPACE sequences effectively improve diagnostic confidence in the diagnosis of pituitary micro-lesions. Post-contrast enhanced 3D-T2 SPACE is suitable for detecting pico-adenomas, micro-lesions adjacent to the cavernous sinuses or sellar floor, lesions between the anterior and posterior lobes, and lesions with early phase enhancement.

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TO FIND OUT AN APPROPRIATE CUT-OFF VALUE OF HUMAN b-HCG LEVELS IN CERVICOVAGINAL SECRETIONS FOR PREDICTION OF PRETERM DELIVERY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i2.945 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

B S Meena ◽

Alka Jilowa ◽

Purva . ◽

Anusha . ◽

Samta . ◽

...

Keyword(s):

Diagnostic Test ◽

Area Under The Curve ◽

Neonatal Morbidity ◽

High Sensitivity ◽

Roc Curve Analysis ◽

Neonatal Deaths ◽

Medical College ◽

Β Hcg ◽

Sensitivity Specificity

Background: Preterm birth is the leading cause of neonatal morbidity and mortality worldwide and account for 75% of neonatal deaths and 50% of long term morbidity, including respiratory disease and neurodevelopment impairment. Methods: Hospital based descriptive type of Observational study conducted at Department of Obstetrics and Gynaecology. SMS Medical College and Hospital, Jaipur (Raj.) Results: ROC curve analysis was performed to determine the optimal cut-off values of significant variables (b-hcg harmone) detected between the two groups. A 19.05 mIU/ml (Positive if greater Than or Equal To) area under the curve (AUC = 0.906) optimal cut- off value of b-hcg harmone, with a sensitivity of 86% and a specificity of 97.1%, was determined with SE 0.036. This level is good to use as a diagnostic test. Methods: β-HCG test is good and β-hcg has high sensitivity and specificity so can be used as a diagnostic test for preterm labor. Keywords: β-HCG, Sensitivity, Specificity, Diagnostic.

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Does Thrombocyte Size Give Us an Idea about Thrombocytosis Etiology?

The Scientific World JOURNAL ◽

10.1100/2012/598653 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Selami Kocak Toprak ◽

Betul Erismis ◽

Sema Karakus ◽

Nazmiye Kursun ◽

Aysegul Haberal ◽

...

Keyword(s):

Differential Diagnosis ◽

Blood Cell ◽

Predictive Value ◽

Surrogate Marker ◽

High Sensitivity ◽

Roc Curve Analysis ◽

Reactive Protein ◽

Red Blood Cell Indices ◽

Sensitivity Specificity ◽

Iron Profile

In the presence of a pathogenetic mutation in JAK2 or MPL, a differential diagnosis of essential thrombocythemia (ET) from reactive causes is relatively simple. However, in patients with suspected ET who lack JAK2 and MPL mutations, the exclusion of secondary causes is especially important. The study was aimed to explore the clinical application of particularly mean platelet volume (MPV), hemoglobin, red blood cell indices, white blood cell, serum iron profile, and C-reactive protein level in the differential diagnosis of thrombocytosis. Medical records of 49 patients, consisting of reactive thrombocytosis (RT) and ET were retrospectively reviewed. The mean MPV level in RT group was 7.49 fL, and in ET group was 8.80 fL (P<0.01). A cutoff point of <8.33 fL was found to have significant predictive value according to ROC curve analysis. This cutoff was associated with 83% positive predictive value (PPV) and 74% negative predictive value (NPV) in the diagnosis of ET and had a sensitivity of 65% and specificity of 89% for ET. Investigation of MPV is cheap, quick, and noninvasive, and may serve as a predictor of primary thrombocytosis. High sensitivity, specificity, PPV, and NPV enable this test an important tool and a possible surrogate marker in clinical practice.

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Confocal Laser Endomicroscopy in Gastrointestinal and Pancreatobiliary Diseases: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2016/4638683 ◽

2016 ◽

Vol 2016 ◽

pp. 1-31 ◽

Cited By ~ 30

Author(s):

Alessandro Fugazza ◽

Federica Gaiani ◽

Maria Clotilde Carra ◽

Francesco Brunetti ◽

Michaël Lévy ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Yield ◽

Meta Analysis ◽

High Sensitivity ◽

Gastric Neoplasms ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Pancreatic Cysts ◽

Specific Operator ◽

Sensitivity Specificity

Confocal laser endomicroscopy (CLE) is an endoscopic-assisted technique developed to obtain histopathological diagnoses of gastrointestinal and pancreatobiliary diseases in real time. The objective of this systematic review is to analyze the current literature on CLE and to evaluate the applicability and diagnostic yield of CLE in patients with gastrointestinal and pancreatobiliary diseases. A literature search was performed on MEDLINE, EMBASE, Scopus, and Cochrane Oral Health Group Specialized Register, using pertinent keywords without time limitations. Both prospective and retrospective clinical studies that evaluated the sensitivity, specificity, or accuracy of CLE were eligible for inclusion. Of 662 articles identified, 102 studies were included in the systematic review. The studies were conducted between 2004 and 2015 in 16 different countries. CLE demonstrated high sensitivity and specificity in the detection of dysplasia in Barrett’s esophagus, gastric neoplasms and polyps, colorectal cancers in inflammatory bowel disease, malignant pancreatobiliary strictures, and pancreatic cysts. Although CLE has several promising applications, its use has been limited by its low availability, high cost, and need of specific operator training. Further clinical trials with a particular focus on cost-effectiveness and medicoeconomic analyses, as well as standardized institutional training, are advocated to implement CLE in routine clinical practice.

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Serum SP-A and KL-6 levels can predict the improvement and deterioration of patients with interstitial pneumonia with autoimmune features

10.21203/rs.3.rs-35462/v1 ◽

2020 ◽

Author(s):

Jingxian Wang ◽

Peiyan Zheng ◽

Zhifeng Huang ◽

Huimin Huang ◽

Mingshan Xue ◽

...

Keyword(s):

Lung Function ◽

Interstitial Pneumonia ◽

Protein A ◽

Area Under The Curve ◽

High Sensitivity ◽

Serum Levels ◽

Surfactant Protein ◽

Roc Curve Analysis ◽

Group 13 ◽

Sensitivity Specificity

Abstract Background Some patients with Interstitial pneumonia with autoimmune features (IPAF) showed a progressive course despite therapy. Furthermore, it is difficult to predict poor patient outcomes. This study aimed to evaluate whether serial changes in serum levels of surfactant protein-A (SP-A) and Krebs von den Lungen-6 (KL-6) can predict disease progression. Methods 64 patients with IPAF and 50 healthy people served as normal controls. Based on long-term changes in lung function, 36 IPAF patients who were followed up for more than 3 months were divided into a progressive group (9), improvement group (13), and stable group (14). Serum KL-6 and SP-A levels were measured. The sensitivity, specificity, cut off value, and area under the curve (AUC) value for each of the indices were determined using the receiver operating characteristic (ROC) curve analysis. The expression differences of these biomarkers and their correlation with the severity of the disease were analyzed. Results Compared with healthy controls, serum SP-A and KL-6 levels in IPAF patients increased significantly [SP-A: (p < 0.001); KL-6: (p < 0.001)] and were negatively correlated with DLCO (SP-A: rS = -0.323, p = 0.018; KL-6: rS = -0.348, p = 0.0011). In the patients with progressive disease, the posttreatment serum SP-A and KL-6 levels increased significantly compared with pretreatment levels [SP-A: (p = 0.021); KL-6: (p = 0.008)]. In the patients showing improvement, the levels decreased significantly SP-A (p = 0.007) and KL-6 (p = 0.002). Changes in serum biomarkers (Delta SP-A and Delta KL-6) were significantly negatively correlated with changes in lung function (Delta FVC, Delta DLCO and Delta FEV1) (rS = 0.482, p < 0.05). A significant positive correlation was found between Delta SP-A and Delta KL-6 (rS = 0.482, p < 0.001).Conclusions Serum SP-A and KL-6 offers high sensitivity and specificity for the diagnosis of IPAF. The decrease of serum SP-A and / or KL-6 levels in patients with IPAF is related to the improvement of pulmonary function. SP-A and KL-6 may be important biomarkers to evaluate the prognosis of patients with IPAF.

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TO SEPARATELY ASSESS THE DIAGNOSTIC POTENTIAL OF TVS & MRI IN THE TERMS OF SENSITIVITY AND SPECIFICITY BY CORRELATING THE IMAGING FINDINGS WITH HISTOPATHOLOGY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i6.1209 ◽

2020 ◽

Vol 4 (6) ◽

Author(s):

Suraj Mathur

Keyword(s):

Transvaginal Ultrasound ◽

High Sensitivity ◽

Imaging Evaluation ◽

Medical College ◽

Conventional Mri ◽

Diagnostic Potential ◽

Adc Mapping ◽

Malignant Lesions ◽

Sensitivity Specificity

This prospective study was done in the Department of Radio diagnosis Govt. Medical College, Kozhikode. A total of 65 patients who were referred to our department with clinical suspicion of endometrial lesions and incidentally detected endometrial lesions on ultrasonography underwent transvaginal ultrasound and subsequent Imaging evaluation of pelvis MRI has very high sensitivity (95%) and specificity (98%) and is almost as accurate (97%) as histopathology in differentiating benign from malignant lesions. Addition of DWI with ADC mapping to conventional MRI increases its accuracy even more. However there is inherent limitation to MRI in detecting carcinoma in situ and micrometastasis. Keywords: TVS, MRI, Sensitivity, Specificity, Histopathology.

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Accuracy of Rotator Cuff Tears and Tendinosis Diagnoses on Shoulder Ultrasound Performed by a Short-experienced Operator

American Journal of Sonography ◽

10.25259/ajs-22-2018 ◽

2018 ◽

Vol 1 ◽

pp. 9

Author(s):

Harshad Arvind Vanjare ◽

Jyoti Panwar

Keyword(s):

Rotator Cuff ◽

Negative Predictive Value ◽

Rotator Cuff Tear ◽

Predictive Value ◽

Rotator Cuff Tears ◽

Mri Findings ◽

Cuff Tear ◽

Experienced Operator ◽

Magnetic Resonance Imaging Mri ◽

Sensitivity Specificity

Objective The objective of the study was to assess the accuracy of ultrasound examination for the diagnosis of rotator cuff tear and tendinosis performed by a short experienced operator, compared to magnetic resonance imaging (MRI) results. Method A total of 70 subjects suspected to have rotator cuff tear or tendinosis and planned for shoulder MRI were included in the study. Shoulder ultrasound was performed either before or after the MRI scan on the same day. Ultrasound operator had a short experience in performing an ultrasound of the shoulder. Ultrasound findings were correlated to MRI findings. Results Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of tendinosis were 58%, 84%, 63%, 80%, and 75%, respectively, and it was 68%, 91%, 73%, 88%, and 85%, respectively, for the diagnosis of rotator cuff tear. Conclusions Sensitivity for diagnosing rotator cuff tear or tendinosis was moderate but had a higher negative predictive value. Thus, the ultrasound operator with a short experience in performing shoulder ultrasound had moderate sensitivity in diagnosing tendinosis or tears; however, could exclude them with confidence.

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