Infection Manager System (IMS) as a new hemocytometry-based bacteremia detection tool: A diagnostic accuracy study in a malaria-endemic area of Burkina Faso

Background New hemocytometric parameters can be used to differentiate causes of acute febrile illness (AFI). We evaluated a software algorithm–Infection Manager System (IMS)—which uses hemocytometric data generated by Sysmex hematology analyzers, for its accuracy to detect bacteremia in AFI patients with and without malaria in Burkina Faso. Secondary aims included comparing the accuracy of IMS with C-reactive protein (CRP) and procalcitonin (PCT). Methods In a prospective observational study, patients of ≥ three-month-old (range 3 months– 90 years) presenting with AFI were enrolled. IMS, blood culture and malaria diagnostics were done upon inclusion and additional diagnostics on clinical indication. CRP, PCT, viral multiplex PCR on nasopharyngeal swabs and bacterial- and malaria PCR were batch-tested retrospectively. Diagnostic classification was done retrospectively using all available data except IMS, CRP and PCT results. Findings A diagnosis was affirmed in 549/914 (60.1%) patients and included malaria (n = 191) bacteremia (n = 69), viral infections (n = 145), and malaria-bacteremia co-infections (n = 47). The overall sensitivity, specificity, and negative predictive value (NPV) of IMS for detection of bacteremia in patients of ≥ 5 years were 97.0% (95% CI: 89.8–99.6), 68.2% (95% CI: 55.6–79.1) and 95.7% (95% CI: 85.5–99.5) respectively, compared to 93.9% (95% CI: 85.2–98.3), 39.4% (95% CI: 27.6–52.2), and 86.7% (95% CI: 69.3–96.2) for CRP at ≥20mg/L. The sensitivity, specificity and NPV of PCT at 0.5 ng/ml were lower at respectively 72.7% (95% CI: 60.4–83.0), 50.0% (95% CI: 37.4–62.6) and 64.7% (95% CI: 50.1–77.6) The diagnostic accuracy of IMS was lower among malaria cases and patients <5 years but remained equal to- or higher than the accuracy of CRP. Interpretation IMS is a new diagnostic tool to differentiate causes of AFI. Its high NPV for bacteremia has the potential to improve antibiotic dispensing practices in healthcare facilities with hematology analyzers. Future studies are needed to evaluate whether IMS, combined with malaria diagnostics, may be used to rationalize antimicrobial prescription in malaria endemic areas. Trial registration ClinicalTrials.gov (NCT02669823) https://clinicaltrials.gov/ct2/show/NCT02669823

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Periappendiceal fat-stranding models for discriminating between complicated and uncomplicated acute appendicitis: a diagnostic and validation study

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00398-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Hui-An Lin ◽

Hung-Wei Tsai ◽

Chun-Chieh Chao ◽

Sheng-Feng Lin

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Perforated Appendicitis ◽

Scoring Systems ◽

Cutoff Score ◽

C Reactive Protein ◽

Reactive Protein ◽

Link Type ◽

Fat Stranding ◽

Complicated Acute Appendicitis

Abstract Background Recent studies have reported promising outcomes of non-operative treatment for uncomplicated appendicitis; however, the preoperative prediction of complicated appendicitis is challenging. We developed models by incorporating fat stranding (FS), which is commonly observed in perforated appendicitis. Material and methods We reviewed the data of 402 consecutive patients with confirmed acute appendicitis from our prospective registry. Multivariate logistic regression was performed to select clinical and radiographic factors predicting complicated acute appendicitis in our model 1 (involving backward elimination) and model 2 (involving stepwise selection). We compared c statistics among scoring systems developed by Bröker et al. (in J Surg Res 176(1):79–83. https://doi.org/10.1016/j.jss.2011.09.049, 2012), Imaoka et al. (in World J Emerg Surg 11(1):1–5, 2016), Khan et al. (in Cureus. https://doi.org/1010.7759/cureus.4765, 2019), Kim et al. (in Ann Coloproctol 31(5):192, 2015), Kang et al. (in Medicine 98(23): e15768, 2019), Atema et al. (in Br J Surg 102(8):979–990. https://doi.org/10.1002/bjs.9835, 2015), Avanesov et al. (in Eur Radiol 28(9):3601–3610, 2018), and Kim et al. (in Abdom Radiol 46:1–12, 2020). Finally, we examined our models by performing the integrated discrimination improvement (IDI) test. Results Among enrolled patients, 64 (15.9%) had complicated acute appendicitis. We developed new 10-point scoring models by including the following variables: C-reactive protein, neutrophil to lymphocyte ratio, and computed tomography features of FS, ascites, and appendicolith. A cutoff score of ≥ 6 exhibited a high sensitivity of 82.8% and a specificity of 82.8% for model 1 and 81.3% and 82.3% for model 2, respectively, with c statistics of 0.878 (model 1) and 0.879 (model 2). Compared with the model developed by Bröker et al. which included C-reactive protein and the abdominal pain duration (c statistic: 0.778), the models developed by Atema et al. (c statistic: 0.826, IDI: 5.92%, P = 0.0248), H.Y Kim et al. (c statistics: 0.838, IDI: 13.82%, P = 0.0248), and our two models (IDI: 18.29%, P < 0.0001) demonstrated a significantly higher diagnostic accuracy. Conclusion Our models and the scoring systems developed by Atema et al. and Kim et al. were validated to have a high diagnostic accuracy; moreover, our models included the lowest number of variables.

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Elevated C-reactive protein increases diagnostic accuracy of algorithm-defined stroke-associated pneumonia in afebrile patients

International Journal of Stroke ◽

10.1177/1747493018798527 ◽

2018 ◽

Vol 14 (2) ◽

pp. 167-173 ◽

Cited By ~ 3

Author(s):

Lalit Kalra ◽

Craig J Smith ◽

John Hodsoll ◽

Andy Vail ◽

Saddif Irshad ◽

...

Keyword(s):

Diagnostic Accuracy ◽

C Reactive Protein ◽

Stroke Patients ◽

Laboratory Findings ◽

Stroke Units ◽

Reactive Protein ◽

Control And Prevention ◽

Sensitivity Specificity ◽

Clinical Algorithms ◽

Pneumonia Diagnosis

Background and aim Pyrexia-dependent clinical algorithms may under or overdiagnose stroke-associated pneumonia. This study investigates whether inclusion of elevated C-reactive protein as a criterion improves diagnosis. Methods The contribution of C-reactive protein ≥30 mg/l as an additional criterion to a Centers for Disease Control and Prevention-based algorithm incorporating pyrexia with chest signs and leukocytosis and/or chest infiltrates to diagnose stroke-associated pneumonia was assessed in 1088 acute stroke patients from 37 UK stroke units. The sensitivity, specificity, and positive predictive value of different approaches were assessed using adjudicated stroke-associated pneumonia as the reference standard. Results Adding elevated C-reactive protein to all algorithm criteria did not increase diagnostic accuracy compared with the algorithm alone against adjudicated stroke-associated pneumonia (sensitivity 0.74 (95% CI 0.65–0.81) versus 0.72 (95% CI 0.64–0.80), specificity 0.97 (95% CI 0.96–0.98) for both; kappa 0.70 (95% CI 0.63–0.77) for both). In afebrile patients (n = 965), elevated C-reactive protein with chest and laboratory findings had sensitivity of 0.84 (95% CI 0.67–0.93), specificity of 0.99 (95% CI 0.98–1.00), and kappa 0.80 (95% CI 0.70–0.90). The modified algorithm of pyrexia or elevated C-reactive protein and chest signs with infiltrates or leukocytosis had sensitivity of 0.94 (95% CI 0.87–0.97), specificity of 0.96 (95% CI 0.94–0.97), and kappa of 0.88 (95% CI 0.84–0.93) against adjudicated stroke-associated pneumonia. Conclusions An algorithm consisting of pyrexia or C-reactive protein ≥30 mg/l, positive chest signs, leukocytosis, and/or chest infiltrates has high accuracy and can be used to standardize stroke-associated pneumonia diagnosis in clinical or research settings. Trial Registration http://www.isrctn.com/ISRCTN37118456

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Diagnostic Accuracy of C-Reactive Protein in Neonatal Sepsis

Journal of Bioresource Management ◽

10.35691/jbm.4102.0001 ◽

2014 ◽

Vol 1 (1) ◽

Cited By ~ 1

Author(s):

Sidra Younis ◽

Muhammad Ali Sheikh ◽

Amjad Ali Raza

Keyword(s):

Blood Culture ◽

Diagnostic Accuracy ◽

Neonatal Sepsis ◽

High Sensitivity ◽

Operational Definition ◽

C Reactive Protein ◽

Capillary Refill ◽

Neonatal Deaths ◽

Reactive Protein ◽

Sensitivity Specificity

Sepsis is the most common cause of neonatal mortality and is responsible for 30-50% of total neonatal deaths each year in developing countries. The objective of the study was to determine the diagnostic accuracy of Creactive protein (CRP) in neonatal sepsis. Fifty nine consecutive patients with risk factors and clinical features suggestive of CRP sepsis were selected as per operational definition and fulfilling the inclusion and exclusion criteria. Detailed physical examination was carried out. Blood sample for culture and CRP was taken from all the patients. Results of blood culture and CRP were noted down in the performa. Statistical analysis was performed by SPSS software version 16. Among selected patients 31/59 (52.5%) were male whereas 28/59 (47.5%) were female. Mean age of all patients was 15.47+7.26 days and mean weight was 2.94+0.63Kg. Temperature instability was present in 79.7%, Tachypnea in 69.5%, Tachycardia in 66.1%, delayed capillary refill in 64.4% and oliguria in 55.9%. Blood cultures were positive in 64.4% and raised CRP was found in 64.5%. Sensitivity, specificity, positive predictive value and negative predictive of raised CRP was found to be 97.3%, 95.2%, 97.3% and 95.2% respectively. In conclusion this study show that C-reactive protein has high sensitivity and specificity for establishing the diagnosis of neonatal sepsis which is comparable to that of blood culture results.

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Diagnostic Role of C- Reactive protein in Acute Appendicitis

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v16i4.31107 ◽

2020 ◽

Vol 16 (4) ◽

pp. 246-251

Author(s):

Ashis Pun ◽

Amit Dhungana ◽

Ramjee Bastola

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

White Blood Count ◽

Negative Appendectomy ◽

C Reactive Protein ◽

Accuracy Rate ◽

Reactive Protein ◽

Diagnostic Role ◽

Sensitivity Specificity

Introduction: Acute appendicitis is the common surgical disease however, accurate diagnosis and exclusion of acute appendicitis always remains challenge to the surgeons. Although diagnoses rely mostly on clinical examination but C- reactive protein (CRP) can be of valuable armamentarium. Hence, this study was conducted to find the diagnostic role of C-reactive protein in Acute Appendicitis Methods: A retrospective cross sectional study was conducted among 100 respondents in the Department of Surgery, Bharatpur Hospital from September 2019 to August 2020. Ethical approval was taken from the Institutional Review Committee (IRC) Bharatpur Hospital. Statistical analysis was done by using SPSS version 16 using descriptive statistics. Results: Total of 100 patients was included in study with mean age 31 years old.Out of which 60% were male and 40% were female. CRP value was raised (>6) in 87 (87%) cases and normal in 13(13%) cases. Among those with raised CRP, three patients had normal appendix histopathologically and 57 had uncomplicated appendicitis and 27 had complicated appendicitis histopathologically with sensitivity, specificity, positive predictive value and diagnostic accuracy rate of 95.45 %, 75 %, 96.55 % and 93% respectively. When white blood count (WBC) and CRP level were combined with HPE findings, its sensitivity, specificity and diagnostic accuracy rate were 100%, 80% and 93.83 % respectively. Conclusions: CRP improves the diagnostic accuracy of Acute appendicitis. The adjunct use of CRP and leucocyte count can effectively reduce the negative appendectomy rate.

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Post-operative serum procalcitonin vs C reactive Protein as a marker of post-operative infectious complications in pancreatic surgery – A systemic review and meta-analysis

10.1101/2020.10.06.20208181 ◽

2020 ◽

Author(s):

Bhavin Vasavada ◽

Hardik Patel

Keyword(s):

Diagnostic Accuracy ◽

Odds Ratio ◽

Area Under Curve ◽

Pancreatic Surgery ◽

Meta Analysis ◽

Diagnostic Odds Ratio ◽

Infectious Complications ◽

C Reactive Protein ◽

Reactive Protein ◽

Sensitivity Specificity

AbstractAim of StudyAim of this meta-analysis was to compare diagnostic accuracy of C reactive Protein and Procalcitonin between postoperative day 3 to 5 in predicting infectious complications post pancreatic surgery.MethodsSystemic literature search was performed using MEDLINE, EMBASE and SCOPUS to identify studies evaluating the diagnostic accuracy of Procalcitonin (PCT) and C-Reactive Protein (CRP) as a predictor for detecting infectious complications between postoperative days (POD) 3 to 5 following pancreatic surgery. A meta-analysis was performed using random effect model and pooled predictive parameters. Geometric means were calculated for PCT cut offs. The work has been reported in line with PRISMA guidelines.ResultsAfter applying inclusion and exclusion criteria 15 studies consisting of 2212 patients were included in the final analysis according to PRISMA guidelines. Pooled sensitivity, specificity, Area under curve and diagnostic odds ratio (DOR)for day 3 C-reactive protein was respectively 62%,67% 0.772 and 6.54. Pooled sensitivity, specificity, Area under curve and diagnostic odds ratio (DOR)for day 3 procalcitonin was respectively 74%,79%,0.8453 and 11.03. Sensitivity, specificity, Area under curve, and Diagnostic odds ratio for day 4 C-reactive protein was respectively 60%,68%, 0.8022 and 11.90. Pooled Sensitivity, specificity and Diagnostic odds ratio of post-operative day 5 procalcitonin level in predicting infectious complications were respectively 83%,70% and 12.9. Pooled Sensitivity, specificity, AUROC and diagnostic odds ratio were respectively 50%,70%, 0.777 and 10.19.ConclusionPost-operative procalcitonin is better marker to predict post-operative infectious complications after pancreatic surgeries and post-operative day 3 procalcitonin has highest diagnostic accuracy.

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P41 C-REACTIVE PROTEIN AS A PREDICTOR FOR ANASTOMOTIC LEAKAGE AFTER ESOPHAGEAL SURGERY

Diseases of the Esophagus ◽

10.1093/dote/doz092.41 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

E R C Hagens ◽

W C Lam MSc ◽

W J Eshuis ◽

W Lameris ◽

M I van Berge Henegouwen ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Anastomotic Leakage ◽

Prospective Observational Study ◽

Gastrointestinal Surgery ◽

Infectious Complications ◽

Oral Contrast ◽

Reactive Protein ◽

Sensitivity Specificity ◽

Youden’S Index ◽

Operator Curve

Abstract Aim To determine the accuracy and optimal cut-off values of CRP to predict anastomotic leakage. Background and methods CRP is commonly used by surgeons to raise suspicion of anastomotic leakage and other infectious complications in gastrointestinal surgery, but optimal cut-off values and diagnostic accuracy are undetermined. A prospective observational study was conducted including consecutive patients with an esophageal carcinoma scheduled for an esophagectomy with gastric tube reconstruction between April 2016 and October 2018 in the Amsterdam UMC, location AMC, The Netherlands. CRP was measured routinely on post-operative day (POD) 3, 5 and 7. Anastomotic leakage was confirmed if a defect or leakage of oral contrast was seen on a CT-scan or by endoscopy or if saliva was draining form the neck incision in clinical suspicion of leakage. The diagnostic accuracy of CRP was assessed by receiver operator curve (ROC) analysis. Youden’s index was adopted to determine the cut-off value. Results 200 patients were included. POD 5 showed the highest area under the ROC to predict anastomotic leakage with a cut-off value of 120 mg/L. The optimal cut-off value for CRP to predict anastomotic leakage or any complication is shown in table 1 with the corresponding area under the ROC, sensitivity, specificity, positive predicting value and negative prediction value. Conclusion CRP on postoperative day 5 is a feasible marker to predict anastomotic leakage, using a cut-off value of 120 mg/L, resulting in a negative predicting value of 96% and a specificity of 92%. When CRP exceeds 120 mg/L on postoperative day 5 additional investigations should be considered.

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Diagnosis of Dengue Virus Infection in Oral Fluid using Immunochromatographic Tests.

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v11i1.51944 ◽

2017 ◽

Vol 11 (1) ◽

pp. 6-9

Author(s):

Tahmina Akther ◽

Biswajit Paul ◽

Saif Ullah Munshi ◽

Shahina Tabassum

Keyword(s):

Diagnostic Accuracy ◽

Oral Fluid ◽

Viral Infections ◽

Dengue Infection ◽

High Sensitivity ◽

Epidemiological Survey ◽

Igg Antibody ◽

Serological Tests ◽

Ns1 Antigen ◽

Sensitivity Specificity

Dengue viral infections are diagnosed by detecting dengue NS1 antigen and dengue specific IgM/IgG antibody by traditional serological tests using patient's blood. Recently saliva is being used employed for diagnosis of different infectious diseases including dengue. In the present study, dengue NS1 antigen and anti-dengue IgM/IgG antibody were detected using rapid immunochromatographic (ICT) kits for diagnosis of dengue and compared with the results of serum ICT results performed on corresponding sera collected from the same individuals. A total of 215 suspected dengue patients were tested and dengue infection was found in 176 (81.9%) sera and 161 (74.9 %) oral fluid samples. Among the 30 dengue NS1 antigen positive sera, 28 were also positive for NS1 in oral fluid indicating high sensitivity (93.3%), specificity (100%), diagnostic accuracy (99.1%), PPV (100%) and NPV (98.9 %) of testing dengue NS1 antigen in oral fluid. Similarly oral fluid assay for anti-dengue IgM showed sensitivity, specificity, diagnostic accuracy, PPV and NPV of 87.3%, 100.0%, 95.8%, 100.0% and 94.1% respectively. Test for anti-dengue IgM/IgG in oral fluid showed sensitivity, specificity, diagnostic accuracy, PPV and NPV of 89.7%, 100.0%, 98.1%, 100.0% and 97.7% respectively. All these parameters for detection of anti-dengue IgG by ICT showed 100%in oral fluid. Thus, results from this study indicates that detection of dengue NS1 antigen or anti-dengue IgM/IgG in oral fluid is an alternative tool for dengue diagnosis. It may benefits dengue diagnosis especially in infants and children since it is easy to collect and require no additional sample processing. It also has the potential to use for epidemiological survey. Bangladesh J Med Microbiol 2017; 11 (1): 6-9

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THE VALIDITY OF HEMATOLOGIC MARKERS FOR DIAGNOSIS OF NEONATAL SEPSIS

Annals of King Edward Medical University ◽

10.21649/akemu.v21i4.765 ◽

2016 ◽

Vol 21 (4) ◽

pp. 240

Author(s):

Aqeela Ayub ◽

Akmal Laeeq Chishti ◽

Khwaja Amjad Hassen

Keyword(s):

Diagnostic Accuracy ◽

Neonatal Sepsis ◽

Cross Sectional ◽

Term Neonates ◽

Clinical Sepsis ◽

Reactive Protein ◽

Sepsis Screen ◽

One Year ◽

Sensitivity Specificity ◽

Written Informed Consent

AbstractObjective:To determine the validity of haematologic markers for sepsis screen (absolute neutrophil count (ANC), immature/total leukocytes ratio (I:T), platelets count (PC), C-reactive protein (CRP) and serum ferri-tin), both individually and in combination for early diagnosis of neonatal sepsis.Methodology:This cross sectional analytical study was conducted in Neonatal Section of Paediatric Medicine Unit II, Mayo Hospital Lahore for one year. One hundred neonates presenting with clinical sepsis were included through non-probability, purposive sampling after written informed consent. Blood sample was collected for full hematologic screening as mentioned above along with blood cultures. Data was entered and analyzed using SPSS Version 17.Results: There were 68 male and 32 females including 31 preterm and 69 term neonates. 45 neonates were <1 day age, 40 neonates 1 10 days age, 15 neonates 11 30 days age. Mean weight of study cases was 2.35 0.69 Kg. Sensitivity, specificity and diagnostic accuracy of ANC were 77.3%, 100% and 90%, for I/T ratio were 81.8%, 81.4% and 81%, for CRP were 75%, 83.9% and 80%, for platelet count were 84.1%, 71.4% and 77%, for serum ferritin were 88.6%, 69.6% and 78% respectively. Sensitivity, specificity and diagnostic accuracy of combination of SF + I:T was 81.8%, 82.1% and 82%, for combination of SF + ANC + I:T were 93.2%, 71.4% and 81% for combination of SF + CRP + I:T were 93.2%, 67.9% and 79%, for combination of SF + I:T + PC were 90.9%, 58.9% and 73%, for combination of SF + CRP + ANC were 95.5%, 69.6% and 81%. Sensitivity, specificity and diagnostic accuracy of combination of all markers were 90.9%, 76.8% and 83% respectively.Conclusion:Results of our study showed that we can safely rely on hematologic markers for confirmation of neonatal sepsis both singly and in combination. We suggest that these tests may help to diagnose neonatal sepsis earlier.Key Words:Neonatal Sepsis, Diagnostic accuracy, Lethargy, Prolong rupture of membrane, Temperature instability, Hematologic markers.

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Clausal Density Between Ages 4 and 9 Years for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties

Language Speech and Hearing Services in Schools ◽

10.1044/2020_lshss-20-00043 ◽

2020 ◽

pp. 1-15

Author(s):

Ling-Yu Guo ◽

Phyllis Schneider ◽

William Harrison

Keyword(s):

Diagnostic Accuracy ◽

Psychometric Properties ◽

Language Impairment ◽

Reference Data ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Criterion Validity ◽

Likelihood Ratios ◽

Generation Task ◽

Sensitivity Specificity

Purpose This study provided reference data and examined psychometric properties for clausal density (CD; i.e., number of clauses per utterance) in children between ages 4 and 9 years from the database of the Edmonton Narrative Norms Instrument (ENNI). Method Participants in the ENNI database included 300 children with typical language (TL) and 77 children with language impairment (LI) between the ages of 4;0 (years;months) and 9;11. Narrative samples were collected using a story generation task, in which children were asked to tell stories based on six picture sequences. CD was computed from the narrative samples. The split-half reliability, concurrent criterion validity, and diagnostic accuracy were evaluated for CD by age. Results CD scores increased significantly between ages 4 and 9 years in children with TL and those with LI. Children with TL produced higher CD scores than those with LI at each age level. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of CD scores were all significant at each age level, with the magnitude ranging from small to large. The diagnostic accuracy of CD scores, as revealed by sensitivity, specificity, and likelihood ratios, was poor. Conclusions The finding on diagnostic accuracy did not support the use of CD for identifying children with LI between ages 4 and 9 years. However, given the attested reliability and validity for CD, reference data of CD from the ENNI database can be used for evaluating children's difficulties with complex syntax and monitoring their change over time. Supplemental Material https://doi.org/10.23641/asha.13172129

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Noninvasive Evaluation of Coronary Artery Bypass Grafts with 16-Slice Multidetector Computed Tomography

The Heart Surgery Forum ◽

10.1532/hsf98.20111075 ◽

2012 ◽

Vol 15 (1) ◽

pp. 12 ◽

Cited By ~ 1

Author(s):

Levent Sahiner ◽

Ali Oto ◽

Kudret Aytemir ◽

Tuncay Hazirolan ◽

Musturay Karcaaltincaba ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Diagnostic Accuracy ◽

Multidetector Computed Tomography ◽

Coronary Artery Bypass ◽

Predictive Value ◽

Artery Bypass ◽

Time Interval ◽

Mdct Angiography ◽

Sensitivity Specificity

Background: The aim of this study was to investigate the diagnostic accuracy of 16-slice multislice, multidetector computed tomography (MDCT) angiography for the evaluation of grafts in patients with coronary artery bypass grafting (CABG).Methods: Fifty-eight consecutive patients with CABG who underwent both MDCT and conventional invasive coronary angiography were included. The median time interval between the 2 procedures was 10 days (range, 1-32 days). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT for the detection of occluded grafts were calculated. The accuracy of MDCT angiography for detecting significant stenoses in patent grafts and the evaluability of proximal and distal anastomoses were also investigated.Results: Optimal diagnostic images could not be obtained for only 3 (2%) of 153 grafts. Evaluation of the remaining 150 grafts revealed values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the MDCT angiography procedure for the diagnosis of occluded grafts of 87%, 97%, 94%, 93%, and 92%, respectively. All of the proximal anastomoses were optimally visualized. In 4 (8%) of 50 patent arterial grafts, however, the distal anastomotic region could not be evaluated because of motion and surgical-clip artifacts. The accuracy of MDCT angiography for the detection of significant stenotic lesions was relatively low (the sensitivity, specificity, PPV, and NPV were 67%, 98%, 50%, and 99%, respectively). The number of significant lesions was insufficient to reach a reliable conclusion, however.Conclusion: Our study showed that MDCT angiography with 16-slice systems has acceptable diagnostic performance for the evaluation of coronary artery bypass graft patency.

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