Unenhanced breast MRI: could it replace dynamic breast MRI in detecting and characterizing breast lesions?

Abstract Background We aimed to evaluate the unenhanced MRI of the breast (UE-MRI) as an effective substitute for dynamic contrast-enhanced breast MRI (DCE-MRI) in both detecting and characterizing breast lesions. We enrolled in our retrospective study 125 females (232 breasts, as 18 patients had unilateral mastectomy) with breast mass at MRI of variable pathologies. Routine DCE-MRI protocol of the breast was conducted. We compared the conventional unenhanced images including STIR, T2, and DWIs to the DCE-MRI by two blinded radiologists, to detect and characterize breast lesions, and then we compared their results with the final reference diagnoses supplied by the histopathology or serial negative follow-ups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for UE-MRI and DCE-MRI were calculated. UE-MRI results of each observer were also compared with DCE- MRI. Results The calculated UE-MRI sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the first observer were 95%, 80%, 83%, 94%, and 89% respectively, and for the second observer, they were 94%, 79%, 81%, 93%, and 86%. On the other hand, those for the DCE-MRI by the first observer were 98%, 82%, 84%, 98%, and 90% and were 97%, 81%, 84%, 97%, and 89% by the second observer. The intraobserver agreement between the UE-MRI and DCE-MRI results of each observer was 94% and 95%, while the interobserver agreement for each section was 97.4% for UE-MRI and 98.3% for DCE-MRI. Conclusion UE-MRI of the breast can be a reliable and effective substitute for breast DCE-MRI. It can be used with comparable accuracy to DCE-MRI whenever contrast administration is not feasible or contraindicated.

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Diagnostic Accuracy of Ultrasound in Palpable Breast Lesions

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i3.33697 ◽

2020 ◽

Vol 5 (3) ◽

pp. 1196-1200

Author(s):

Manish Raj Pathak ◽

Mahesh Gautam ◽

Rashmita Bhandari

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Diagnostic Tool ◽

Predictive Value ◽

Breast Lesions ◽

Non Invasive ◽

Malignant Lesions ◽

Palpable Breast ◽

Sensitivity Specificity

Introduction: Breast carcinoma is the second leading cause of cancer related mortality in females around the world. Ultrasound plays a key role in differentiating cystic and solid lesions and is a convenient and non-invasive diagnostic tool to differentiate between benign and malignant lesions. Objectives: The aim of this study is to evaluate the diagnostic accuracy of ultrasound in palpable breast lesions. Methodology: A prospective cross-sectional study was carried out in patients with palpable breast lesions who presented in Department of radio diagnosis and imaging of Nobel Medical collegefor a period of one-year from February 2019- January 2020 using ultrasound. A total of 60 patientswereevaluated in the study. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. Results: Out of 60 patients evaluated, ultrasound showed 46 (76.7%) cases to be benign and 14 (23.3%) cases to be malignant. FNAC revealed benign disease in 47 (78.3%) patients and malignant disease in 13 (21.7%) patients. The most common benign lesion was fibroadenoma. We found nearly 91.7% of the malignant lesions had spiculated margins and microcalcification. The sensitivity of ultrasound was 95.74% and specificity 92.3% with diagnostic accuracy 95%. Conclusion: Ultrasound is a convenient and non-invasive diagnostic tool with good sensitivity, specificity, positive predictive value, negative predictive value and accuracy in palpable breast lesions.

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Diagnostic accuracy of monofilament test to detect diabetic neuropathy

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v10i1.37086 ◽

2021 ◽

Vol 10 (1) ◽

pp. 20-25

Author(s):

Sujan Shrestha ◽

Mamen Prasad Gorhaly ◽

Manil Ratna Bajracharya

Keyword(s):

Peripheral Neuropathy ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Diabetic Peripheral Neuropathy ◽

Perception Threshold ◽

Sensitivity Specificity ◽

Vibration Perception ◽

Monofilament Test

Background Diabetic peripheral neuropathy (DPN) is a significant independent risk factor for diabetic foot, and an effective screening instrument is required to diagnose DPN early to prevent future ulceration and amputation. This study aims to determine the diagnostic accuracy of monofilament test to detect diabetic peripheral neuropathy. Methods This cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital, Mahabouddha, Kathmandu from February 2016 to January 2017. A total of 96 diabetic patients attending inpatient and outpatient Department were selected. Diabetic peripheral neuropathy was assessed by measurement of loss of protective sensation (LOPS) by monofilament test and compared with vibration perception threshold by standard biothesiometer. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were calculated. Results The prevalence of diabetic peripheral neuropathy was 26%. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were found to be 92.0%, 95.8%, 88.5% and 97.1% respectively. There was strong association between LOPS by monofilament and vibration perception threshold by biothesiometer. Conclusion This study showed a strong diagnostic accuracy of monofilament test to detect DPN when compared with biothesiometer. As monofilament test is a cheap, easily available, and portable, it can be used in the periphery where biothesiometer is not available.

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DIAGNOSTIC ACCURACY OF GRAY SCALE ULTRASONOGRAPHY VERSUS COLOR DOPPLER IN SUSPECTED CASES OF ACUTE APPENDICITIS

The International Journal of Frontier Sciences ◽

10.37978/tijfs.v5i1.319 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Tahir Iqbal ◽

Muhammad Usman Shahid ◽

Ishfaq Ahmad Shad ◽

Shahzad Karim Bhatti ◽

Syed Amir Gilani ◽

...

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Color Doppler ◽

Diagnostic Tools ◽

Gray Scale ◽

Versus Color ◽

Sensitivity Specificity

ABSTRACT: BACKGROUND: A common surgical emergency is acute appendicitis. Various diagnostic tools are available to diagnosis acute appendicitis. Radiological investigations play an important role in making accurate and early diagnosis and thus preventing morbidity associated with the disease. OBJECTIVE: To determine the diagnostic accuracy of gray scale ultrasonography versus color Doppler in suspected cases of acute appendicitis. MATERIALS AND METHODS: The study was carried in the department of Radiology of Mayo Hospital, Lahore. A total of 75 patients were enrolled of age 18-40 years, both genders who were suspected cases of acute appendicitis. All patients underwent baseline investigations along with gray scale ultrasonography and color Doppler. All patients were subjected to surgery to confirm the diagnosis and findings were subjected to statistical analysis. RESULTS: The mean age of the patients was 23.25 ±10.55 and mean transverse diameter of appendix was 8.37 ±3.39. There were 62.7% males and 37.3%females. Findings of gray scale ultrasonography and color Doppler were then correlated with surgical findings to calculate the diagnostic accuracy of these modalities. The results revealed that gray scale ultrasonography sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 92.7%, 94.32%, 95%, 91.4% and 93.3% respectively, whereas color Doppler had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 97.7%, 93.9%, 95.3%, 97% and 96% respectively. Diagnostic accuracy of both modalities together was 98.6%. CONCLUSION: Color Doppler has better diagnostic accuracy than gray scale ultrasonography for diagnosis of acute appendicitis and the combination of both modalities yields diagnostic accuracy that is similar to gold standard.

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Validation of the Dutch leakage score as a predictor of anastomotic leakage in intestinal surgery in a third level hospital

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20214406 ◽

2021 ◽

Vol 9 (11) ◽

pp. 3251

Author(s):

Alan Barker-Antonio ◽

Arturo Jarquin-Arremilla ◽

Elias Hernandez Cruz ◽

Roberto Armando Garcia-Manzano ◽

Ediel Osvaldo Davila-Ruiz

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Anastomotic Leakage ◽

Negative Predictive Value ◽

Predictive Value ◽

Intestinal Anastomosis ◽

Intestinal Surgery ◽

Patient Death ◽

Versatile Tool ◽

Sensitivity Specificity

Background: Intestinal surgery can present multiple complications that can lead to patient death; therefore, it is important to design early detection strategies to reduce complications in patients with intestinal anastomosis and thus avoid patient death. The aim of this work is to evaluate the diagnostic performance of the Dutch leakage score in 125 patients with intestinal anastomosis as a predictor of anastomotic leakage.Methods: In a sample of 125 patients undergoing intestinal anastomosis, demographic variables were identified and the Dutch leakage score was applied. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were obtained using a 2×2 table.Results: The Dutch leakage score was positive in 23.2% (29 patients) of whom 24 had anastomotic leakage and 5 had no anastomotic leakage. It presents a sensitivity in the test of 100%, a specificity of 95%, a positive predictive value of 82.7%, a negative predictive value of 100%. The diagnostic accuracy is 96%.Conclusions: The Dutch leakage score is a versatile tool, inexpensive, easy to apply and available in any hospital center. It is capable of early diagnosis of anastomotic leakage. It favors early re-intervention, improves prognosis and survival, decreases hospital stay and health care costs.

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A Comparative Analysis Between RIPASA and Alvarado Scoring Systems for the Diagnosis of Acute Appendicitis- A Nepalese Perspective

Journal of Lumbini Medical College ◽

10.22502/jlmc.v6i2.264 ◽

2018 ◽

Vol 6 (2) ◽

Author(s):

Suman Baral ◽

Neeraj Thapa ◽

Raj Kumar Chhetri ◽

Rupesh Sharma

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Scoring Systems ◽

Negative Appendectomy ◽

Alvarado Score ◽

Sensitivity Specificity

Introduction: Various diagnostic criteria have been described for acute appendicitis. For decades the most commonly used one has been Alvarado score. RIPASA scoring system has also been developed for Asian population which has shown highest sensitivity and diagnostic accuracy. This study aimed to compare these two diagnostic criteria in Nepalese population attending a tertiary center. Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination was taken as the gold standard for diagnosis. Statistical analysis was done using McNemar's test as applicable. Results: Ninety nine (90 %) patients had histologically confirmed appendicitis. With the cut-off value greater than 7.5 for RIPASA score; sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 94.5%, 27.27 %, 92.16 %, 37.5 %, 88.18% and 7.84% respectively. With the cut-off value greater than 7 for Alvarado score, sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 71.72%, 72.73 %, 95.95 %, 22.22%, 71.82 %, and 4.05 % respectively. 94.5% of patients were correctly stratified by RIPASA under higher probability group while only 71.8 % were classified by Alvarado (p value= 0.0001). Conclusion: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, this method can be applied in Nepalese setting for the diagnosis of acute appendicitis.

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The Value of Contrast-Enhanced Ultrasound versus Doppler Ultrasound in Grading Renal Artery Stenosis

BioMed Research International ◽

10.1155/2020/7145728 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Yanhua Cui ◽

Quanbin Zhang ◽

Jiping Yan ◽

Ji Wu

Keyword(s):

Positive Predictive Value ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Negative Predictive Value ◽

Doppler Ultrasound ◽

Predictive Value ◽

Artery Stenosis ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced ◽

Sensitivity Specificity

Objective. This study is aimed at exploring the accuracy of contrast-enhanced ultrasound (CEUS) in grading renal artery stenosis. Methods. 122 renal arteries with suspected renal artery stenosis were selected. DSA, DUS, and CEUS were performed for all patients with suspected renal artery stenosis in the research. DSA was selected as the gold standard. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of CEUS or Doppler ultrasound (DUS) in the diagnosis of renal artery stenosis were analyzed. The consistency between CEUS and digital subtraction angiography (DSA) was compared. The accuracy of DUS or CEUS in grading renal artery stenosis was assessed by the area under the receiver operating characteristic (ROC) curves and compared between groups. Results. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CEUS in the diagnosis of renal artery stenosis were 88.9%, 87.8%, 88.5%, 93.5%, and 80.0%, respectively. There was no significant difference in grading renal artery stenosis between CEUS and DSA (X2=0.643, P=0.424). 77 of the 122 renal arteries were diagnosed with the stenosis rate more than 30% by CEUS. Compared with the results of DSA, the kappa value of CEUS was 0.749 (P<0.05). Conclusion. CEUS is accurate in grading renal artery stenosis, and it may represent the method of choice in diagnosing renal artery stenosis.

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Qualitative analysis of contrast-enhanced ultrasound in the diagnosis of small, TR3–5 benign and malignant thyroid nodules measuring ≤1 cm

British Journal of Radiology ◽

10.1259/bjr.20190923 ◽

2020 ◽

Vol 93 (1111) ◽

pp. 20190923

Author(s):

Xin Li ◽

Feng Gao ◽

Fan Li ◽

Xiao-xia Han ◽

Si-hui Shao ◽

...

Keyword(s):

Positive Predictive Value ◽

Qualitative Analysis ◽

Negative Predictive Value ◽

Predictive Value ◽

Diagnostic Performance ◽

Thyroid Nodules ◽

Area Under The Curve ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced ◽

Sensitivity Specificity

Objective: To evaluate the performance of contrast-enhanced ultrasound in the diagnosis of small, solid, TR3–5 benign and malignant thyroid nodules (≤1 cm). Methods: From January 2016 to March 2018, 185 thyroid nodules from 154 patients who underwent contrast enhanced ultrasound (CEUS) and fine-needle aspiration or thyroidectomy in Shanghai General Hospital were included. The χ2 test was used to compare the CEUS characteristics of benign and malignant thyroid nodules, and the CEUS features of malignant nodules assigned scores. The total score of the CEUS features and the scores of the above nodules were evaluated according to the latest 2017 version of the Thyroid Imaging Reporting and Data System (TI-RADS). The diagnostic performance of the two were compared based on the receiver operating characteristic curves generated for benign and malignant thyroid nodules. Results: The degree, enhancement patterns, boundary, shape, and homogeneity of enhancement in thyroid small solid nodules were significantly different (p＜0.05). No significant differences were seen between benign and malignant thyroid nodules regarding completeness of enhancement and size of enhanced lesions (p＞0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the TI-RADS classification TR5 in diagnosis of malignant nodules were 90.10%, 55.95%, 74.59%, 72.22%, and 82.46%, respectively (area under the curve [AUC]=0.738; 95% confidence interval[CI], 0.663–0.813). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the total score of CEUS qualitative analysis indicators were 86.13%, 89.29%, 87.57%, 90.63%, and 84.27% respectively (AUC = 0.916; 95% CI, 0.871–0.961). Conclusion: CEUS qualitative analysis is superior to TI-RADS in evaluating the diagnostic performance of small, solid thyroid nodules. Qualitative analysis of CEUS has a significantly higher specificity for diagnosis of malignant thyroid nodules than TI-RADS. Advances in knowledge: The 2017 version of TI-RADS has recently suggested the malignant stratification of thyroid nodules by ultrasound. In this paper we applied this system and CEUS to evaluate 185 nodules and compare the results with pathological findings to access the diagnostic performance.

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ROLE OF DOPPLER INDICES IN THE PREDICTION OF ADVERSE PERINATAL OUTCOME IN PREECLAMPSIA

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i4.4567 ◽

2021 ◽

Vol 71 (4) ◽

pp. 1209-1213

Author(s):

Shakra Tabasam ◽

Zaib Malik ◽

Asifa Siraj ◽

Sadaf Afroz

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Perinatal Outcome ◽

Military Hospital ◽

Reference Standard ◽

Adverse Perinatal Outcome ◽

Doppler Study ◽

Sensitivity Specificity

Objective: To determine diagnostic accuracy of systolic/diastolic ratio and cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Pak Emirates Military Hospital, Rawalpindi, from Jun to Dec 2017. Methodology: A total of 191 patients with preeclampsia were included. Doppler ultrasound (including doppler wave forms obtained from free floating portion of umbilical artery and doppler waveform from middle cerebral artery at the level of circle of Willis) examination was done after gestational age 30 weeks and Doppler study repeated at 2-4 weeks interval depending on severity of preeclampsia and abnormalities of waveform. Cases were followed and results of last Doppler examination within 10 days of delivery were considered and perinatal outcome noted. Results: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of systolic/diastolic ratio in predicting adverse perinatal outcome among patients in preeclampsia, keeping actual adverse perinatal outcome as reference standard was 82.35%, 86.52%, 87.50%, 81.05% and 84.29% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia, keeping actual adverse perinatal outcome as reference standard was 78.67%, 92.24%, 86.76%, 86.99% and 86.91% respectively. Conclusion: The diagnostic accuracy of systolic/diastolic ratio, cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia is quite high.

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Diagnosis of Congenital Anomalies of Kidney and Ureter by Ultrasonography

Journal of Paediatric Surgeons of Bangladesh ◽

10.3329/jpsb.v5i1.23882 ◽

2015 ◽

Vol 5 (1) ◽

pp. 8-11

Author(s):

Fathima Nusrath Halim ◽

Mohammad Ali Sarker ◽

Farah Nazlee ◽

Md Nazrul Islam

Keyword(s):

Kidney Disease ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Congenital Anomalies ◽

Transabdominal Ultrasonography ◽

Imaging Tool ◽

Congenital Kidney Anomalies ◽

Sensitivity Specificity

Present study was conducted to investigate the diagnostic accuracy of transabdominal ultrasonography in correlation with IVU in suspected patients of Congenital anomalies of kidney and Ureter. In study, ultrasonography and IVU was done in 50 clinically suspected patients of congenital anomalies of kidney that was admitted in BSMMU, BIRDEM & DMCH during the period of July 2008 to May 2009. Patients of all ages and both sexes were included. Findings of USG and IVU were correlated. Sonographically abnormalities were diagnosed in 46 (92%) cases, out of which 45 (95.7%) also diagnosed by IVU and 1 (33.3) was normal in IVU. Out of 4 (8%) Sonographically demonstrated normal cases, 2 (4.3%) were proved normal by IVU and 2 (66.7%) cases which missed by sonography were diagnosed by IVU. Sensitivity of ultrasonography in diagnosing congenital kidney disease was 95.7% and specificity was 66.7%, positive predictive value was 97.8%, negative predictive value was 50.0% and accuracy was 94.0%. So, we conclude that ultrasonography has significant sensitivity, specificity, positive predictive value, and accuracy in diagnosis of congenital kidney anomalies correlating with IVU. As such, USG can be considered as an appropriate imaging tool for diagnosis of congenital anomalies of kidney.J. Paediatr. Surg. Bangladesh 5(1): 8-11, 2014 (January)

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A comparative study of RIPASA score and modified Alvarado score in diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20195099 ◽

2019 ◽

Vol 6 (11) ◽

pp. 3937

Author(s):

Waleed Yusif El Sherpiny

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Negative Appendectomy ◽

Alvarado Score ◽

Sensitivity Specificity ◽

Ripasa Score

Background: Various diagnostic criteria have been described for diagnosing acute appendicitis. Of these, Alvarado score has been the most commonly used. The RIPASA score is a new diagnostic scoring system developed for the diagnosis of acute appendicitis and showed higher sensitivity, specificity and diagnostic accuracy as compared to Alvarado score. we want to compare prospectively Alvarado and RIPASA score by applying them to patients attending emergency department complaining of right iliac fossa pain that could probably be acute appendicitis.Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination of the removed appendix was taken as the gold standard for diagnosis of acute appendicitis.Results: Among (90%) patients had histologically confirmed appendicitis. With the cut-off value greater than 7.5 for RIPASA score; sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy were 88.2%, 14.5%, 73.1%, 32%,and 68% respectively. With the cut-off value greater than 7 for Alvarado score, sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 51.2%, 80 %, 91 %, 29%, and 57%, respectively. 87.5% of patients were correctly stratified by RIPASA under higher probability group while only 45% were classified by Alvarado as high probability.Conclusions: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, it can be applied for the diagnosis of acute appendicitis.

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