Diagnostic value of virtual autopsy using pm-MRI at 3T on malformed second trimester fetuses vs classic autopsy

Objective To determine the diagnostic value of virtual autopsy using post mortem-MRI (pm-MRI) at 3Tesla (T) compared to classic autopsy for the confirmation of fetal structural anomalies and secondly to establish which cases of termination of pregnancy would benefit mostly from a virtual autopsy. Methods In each of 32 fetuses included in the study, 32 anatomical structures were assessed, after termination of pregnancy in the second trimester. All cases were evaluated by prenatal ultrasonography, virtual autopsy and classic autopsy, and then divided into four groups: Cerebral Group, Cardiac Group, Renal Group and Other Group (miscellaneous group). The concordance of virtual autopsy with classic autopsy was calculated overall and for each group and each structural item. Also, the concordance between the two methods was assessed using a diagnostic error score (DgE_score), calculated as the absolute value of the difference between the number of malformations detected by classic autopsy per case (CA score) and the number of malformations detected at virtual autopsy per case (VA score). Results Overall virtual autopsy demonstrated a diagnostic sensitivity (Se) compared to classic autopsy of 67.33% [95% CI 57.28–76.33], with a specificity (Sp) of 98.37% [95% CI 97.33–99.09], a positive predictive value (PPV) of 81.93% [95% CI 71.95–89.52], a negative predictive value (NPV) of 96.49% [95% CI 95.11–97.57] achieving a diagnostic accuracy of 95.31% [95% CI 93.83–96.52]. Overall, no statistic significant correlation was demonstrated between DgE_score and the gestational age of the fetuses or between DgE_score and the weight of the fetuses, but a significant correlation was revealed between the virtual autopsy and classic autopsy score. The diagnostic utility of virtual autopsy using pm-MRI at 3 T as compared to classic autopsy for each category of termination of pregnancy revealed in the Cerebral Group a Se of 80.00% [95% CI 28.36–99.49], with a 96.30% [95% CI 81.03–99.91], a PPV of 80.00% [95% CI 35.75–96.64] a NPV of 96.30% [95% CI 81.81–99.34], with a diagnostic accuracy of 93.75% [95% CI 79.19% to 99.23] and a Cohen’s Kappa coefficient of 0.76 [95% CI 0.4494–1.0765]; in the Renal Group a Se and Sp of 100%, but in the Cardiac Group the Se was only 60.00% [95% CI 26.24–87.84], Sp 75% [95% CI 34.91–96.81], the PPV 75.00% [95% CI 44.92–91.69], NPV 60% [95% CI 38.87–77.96], with a diagnostic accuracy of 66.67% [95% CI 40.99–86.66] and a Cohen’s Kappa coefficient of 0.32 [95% CI -0.07–0.76]. Conclusions The results support virtual autopsy using pm-MRI at 3T as a reliable alternative to classic autopsy for the non-forensic analysis of second trimester fetuses. Analyzing the diagnostic utility of virtual autopsy using pm-MRI at 3 T for the confirmation of prenatal ultrasound findings in second trimester fetuses as compared to classic autopsy, the best results were obtained in the Cerebral and Renal Group. Reserved results were found in the Cardiac Group. Therefore, for the pregnancies with termination of pregnancy for cerebral or renal abnormalities, virtual autopsy by pm-MRI at 3T can be taken into consideration as a first-line investigation to confirm the prenatal findings.

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A comparative study of sublingual versus oral misoprostol following oral mifepristone for second trimester termination of pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190274 ◽

2019 ◽

Vol 8 (2) ◽

pp. 498

Author(s):

Ruchi Gupta ◽

Krishna Priya Banerjee ◽

Reena Pant

Keyword(s):

Success Rate ◽

Medical Abortion ◽

Oral Route ◽

Termination Of Pregnancy ◽

Second Trimester ◽

Oral Misoprostol ◽

Sublingual Misoprostol ◽

Group A ◽

The Mean ◽

Group B

Background: The objective of this study is to assess the effectualness and safety of sublingual versus oral misoprostol following oral mifepristone for second trimester termination of pregnancy.Methods: This institution based contingent study was conducted on 220 women requesting for mid-trimester termination of pregnancy between 12-20 weeks with legal indication as per Govt. MTP act. After excluding the women as per exclusion criteria, they were randomly allocated into two groups (Group A Sublingual, Group B Oral), the women received 200 mg oral mifepristone followed by sublingual or oral misoprostol 400µg three hourly for a maximum of 5 doses 48 hours later. The course of misoprostol was reiterated if women failed to abort in 24 hours.Results: The mean induction-abortion interval of Group-A and Group -B was 4.02±1.39 hours and 6.44±1.79 hours respectively. The mean dose of misoprostol in Group–A and Group-B was 680±220.4µg and 1003.6±274.9µg. Hence mean Induction-abortion interval and dose were shortened in Group-A as compare to Group-B (p <0.05). There was 100% success rate noticed via both routes. Evacuation was done in 4 (3.64%) women in Group-B as compare to only 1 (0.91%) in Group-A . The acceptability was significantly more in Group-B (100%) as compare Group-A (52.73%), probably because of unpleasant taste of sublingual misoprostol. All side effects (Nausea, pain, headache, and diarrhea) were common in both the Groups, only fever was significantly more common in sublingual group as compare to oral group (p<0.05).Conclusions: From present study authors conclude that, sublingual misoprostol when combined with mifepristone is effective for medical abortion in second trimester in terms of effectualness, endurability and success rate than oral route.

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Role of misoprostol 4 hourly versus 6 hourly in medical termination of pregnancy in 2nd trimester.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.11.6285 ◽

2021 ◽

Vol 28 (11) ◽

pp. 1645-1649

Author(s):

Komal Devi ◽

Shazia Aftab ◽

Reena ◽

Huma Baloch ◽

Devi Kumari ◽

...

Keyword(s):

Cross Sectional Study ◽

Termination Of Pregnancy ◽

Ethical Review ◽

Second Trimester ◽

Cross Sectional ◽

Medical Termination Of Pregnancy ◽

Medical Termination ◽

Ethical Approval ◽

Group A ◽

Group B

Objective: To determine efficacy of misoprostol given in 4 hourly versus 6 hourly intervals in second trimester for termination of pregnancy. Study Design: Cross sectional study. Setting: Study was conducted at the department of Obstetrics and Gynecology of Jinnah Medical and Dental College Karachi Allied Hospital. Period: March to August 2020. Material & Methods: Pregnant ladies in second trimester, requiring abortion due to medical reasons, were planned for termination of pregnancy. Two groups were made. Patients in Group-A were given misoprostol 4 hourly and those in Group-B were given misoprostol 6 hourly. Similar dose of drug (200ug) was given in both groups and monitoring was done. If abortion done in 48 hours, it was considered effective abortion and if not happened in 48 hours, it was considered a failed abortion. Consent was taken from all ladies in study group. Ethical approval was taken from ethical review committee. Results: Total 140 cases were studied, 70 cases in each group, A & B. Age range of cases was 16-40 years with mean age of 26.4±3.5 years. Most of the cases were having age between 20-30 years (63.5%). Group-A (N=70) was given misoprostol 4 hourly, where abortion was done in 94.3% cases while abortion failed in 5.7% cases. In Group-B (N=70) misoprostol was given 6 hourly, induced abortion in 82.8% and failed in 17.1% cases. Conclusion: Misoprostol dose of 20ug given via vaginal route is much effective drug for medical termination of pregnancy when given 4 hourly instead 6 hourly, with low failure rate.

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Diagnostic Accuracy of Contrast Transthoracic Echocardiography, Contrast Transcranial Doppler and Transesophageal Echocardiography in Patients Undergoing Patent Foramen Ovale Closure

10.21203/rs.3.rs-440132/v1 ◽

2021 ◽

Author(s):

Kaijing Wang ◽

Xianda Ni ◽

Yuxin Wu ◽

Chen Chen

Keyword(s):

Diagnostic Accuracy ◽

Cardiac Catheterization ◽

Patent Foramen Ovale ◽

Clinical Decision Making ◽

Clinical Decision ◽

Diagnostic Value ◽

Foramen Ovale ◽

Group A ◽

Group B ◽

Pfo Closure

Abstract Purpose: To compare diagnostic accuracy of cTTE, cTCD and TEE in patients undergoing patent foramen ovale closure (PFO) so as to provide evidence for clinical decision-making.Methods: The clinical data of 140 patients with cerebral infarction or migraine who successfully underwent PFO closure or whose right cardiac catheterization results showed no PFO in our hospital were analyzed retrospectively, including clinical baseline, data of cTTE, cTCD and TEE.Results: Patients who successfully underwent PFO closure or whose right cardiac catheterization results showed no PFO were divided into group A and group B, respectively. The differences of the shunt in cTTE and cTCD, the diameter of PFO in TEE and the appearance of bubbles in cTTE were compared. The results showed that the proportion of medium-large shunt in group A was significantly higher than group B in resting cTCD, post-Valsalva cTCD and total cTCD respectively (67.35% VS 42.86%，P=0.004；100% VS 71.42%，P=0.0003；81.63% VS 51.43%，P=0.002). The proportion of medium-large shunt in group A was higher than group B in cTCD (75.90% VS 19.35%，P＜0.001). The diameters of PFO of group A were larger than group B in TEE (2.18±0.78 VS 1.19±0.78，P＜0.001). Take the successful PFO closure as the state variable. The ROC curves of cTTE, cTCD and TEE were made, and the results showed that cTCD and TEE had better sensitivity and specificity. The proportion of appearance of bubbles within 5 cardiac cycles in cTTE in group A was significantly higher than group B (73.47% VS 42.86%，P=0.005).Conclusions: For the patients with PFO to be occluded, the success rate of operation could be improved by selecting patients with larger shunt, larger diameter of foramen ovale and shorter interval in the appearance of bubbles. Otherwise, there was perhaps no PFO. cTCD and TEE had better diagnostic value for PFO closure than that of cTTE.

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The diagnostic accuracy of wrist cineradiography in diagnosing scapholunate dissociation

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413489056 ◽

2013 ◽

Vol 39 (3) ◽

pp. 263-271 ◽

Cited By ~ 20

Author(s):

G. S. I. Sulkers ◽

N. W. L. Schep ◽

M. Maas ◽

C. M. A. M. van der Horst ◽

J. C. Goslings ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Diagnostic Value ◽

Inclusion Criteria ◽

Scapholunate Ligament ◽

Scapholunate Dissociation ◽

Post Test ◽

Sensitivity Specificity ◽

Post Test Probability ◽

Test Probability

Ruptures of the scapholunate ligament (SLL) may cause carpal instability, also known as scapholunate dissociation (SLD). SLD may lead to osteoarthritis of the radiocarpal and midcarpal joints. The aim of this retrospective study was to determine the diagnostic value of wrist cineradiography in detecting SLD. All cineradiographic studies made during a 24 year period were retrieved. All patients who underwent the confirmation method (arthroscopy and/or arthrotomy) and cineradiography were included. In total, 84 patients met the inclusion criteria. Sensitivity, specificity, likelihood ratio, positive predictive value, negative predictive value, and diagnostic accuracy for detecting SLD were calculated for radiography and cineradiography. Cineradiography had a sensitivity of 90%, a specificity of 97%, and a diagnostic accuracy of 0.93 in detecting SLD. Radiography had a sensitivity of 81%, a specificity of 80%, and a diagnostic accuracy of 0.81. Cineradiography has a high diagnostic value for diagnosing SLDs. A positive cineradiography markedly increases the post-test probability of SLD.

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The value of S-Detect in improving the diagnostic performance of radiologists for the differential diagnosis of thyroid nodules

Medical Ultrasonography ◽

10.11152/mu-2501 ◽

2020 ◽

Vol 22 (4) ◽

pp. 415

Author(s):

Qi Wei ◽

Shu-E Zeng ◽

Li-Ping Wang ◽

Yu-Jing Yan ◽

Ting Wang ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Diagnostic Performance ◽

Thyroid Nodules ◽

Characteristic Curve ◽

Diagnostic Value ◽

Ultrasound Images ◽

Experienced Radiologist ◽

Before And After ◽

Sensitivity Specificity

Aims: To compare the diagnostic value of S-Detect (a computer aided diagnosis system using deep learning) in differentiating thyroid nodules in radiologists with different experience and to assess if S-Detect can improve the diagnostic performance of radiologists.Materials and methods: Between February 2018 and October 2019, 204 thyroid nodules in 181 patients were included. An experienced radiologist performed ultrasound for thyroid nodules and obtained the result of S-Detect. Four radiologists with different experience on thyroid ultrasound (Radiologist 1, 2, 3, 4 with 1, 4, 9, 20 years, respectively) analyzed the conventional ultrasound images of each thyroid nodule and made a diagnosis of “benign” or “malignant” based on the TI-RADS category. After referring to S-Detect results, they re-evaluated the diagnoses. The diagnostic performance of radiologists was analyzed before and after referring to the results of S-Detect.Results: The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of S-Detect were 77.0, 91.3, 65.2, 68.3 and 90.1%, respectively. In comparison with the less experienced radiologists (radiologist 1 and 2), S-Detect had a higher area under receiver operating characteristic curve (AUC), accuracy and specificity (p <0.05). In comparison with the most experienced radiologist, the diagnostic accuracy and AUC were lower (p<0.05). In the less experienced radiologists, the diagnostic accuracy, specificity and AUC were significantly improved when combined with S-Detect (p<0.05), but not for experienced radiologists (radiologist 3 and 4) (p>0.05).Conclusions: S-Detect may become an additional diagnostic method for the diagnosis of thyroid nodules and improve the diagnostic performance of less experienced radiologists.

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Comparison of efficacy of Misoprostol 4 hourly with Misoprostol 6 hour for Medical termination of pregnancy in second trimester.

The Professional Medical Journal ◽

10.29309/tpmj/2019.27.01.3169 ◽

2020 ◽

Vol 27 (01) ◽

pp. 46-51

Author(s):

Shamas un Nisa ◽

Farzana Razaq ◽

Sadaf un Nisa

Keyword(s):

Side Effects ◽

Controlled Trial ◽

Fetal Loss ◽

Termination Of Pregnancy ◽

Second Trimester ◽

Medical Termination Of Pregnancy ◽

Medical Termination ◽

Group A ◽

Vaginal Misoprostol ◽

Group B

Termination of Pregnancy (TOP), in our country is carried out only when considerable danger to a fetus due to congenital abnormalities, intrauterine fetal loss or when maternal life is under threat. The principle concerns in providing second trimester termination include safety, efficacy, simplicity, low-cost, and fast acting with minimal side effects. Objectives: To compare the efficacy in term of complete abortion within 48 hours between protocol-I (200 µg misoprostol 4 hourly) versus protocol-II (200 µg misoprostol 6 hourly) for second trimester (14-24 weeks) medical termination of pregnancy. Study Design: Randomized controlled trial. Settings: Gynecology & obstetrics unit-II, Bahawal Victoria Hospital (BVH) Bahawalpur. Period: From 1st July 2017 to 30th June 2018. Material & Method: A total of 182 patients meeting the inclusion criteria were included in study. Ninety one patients were included in group-A and 91 patients were included in group-B. Women allocated to group-A was given misoprostol 200µg every 4 hour. Similar drug and dose were administered to women of group-B intra-vaginally, 6 hourly. Patients in both groups were monitored up to 48. If abortion occurred within 48 hours of induction, it was labeled as effective abortion otherwise it was regarded as failed abortion. Results: The mean age in group-A was 26.71 years 25.49 years in Group-B. In group-A, 89 (97.8%) patients showed efficacy (abortion within 48 hours) and in group-B, 74 (81.32%) patients showed efficacy to misoprostol. Conclusion: The regimen of using 200μg of vaginal misoprostol 4 hourly is more efficacious and quick for 2nd trimester TOP with fewer side effects when compared to 200μg of vaginal misoprostol 6 hourly.

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Diagnostic Value of Stress Radiography in Lesions of the Lateral Ligaments of the Ankle

Acta Radiologica ◽

10.1177/028418518802900620 ◽

1988 ◽

Vol 29 (6) ◽

pp. 711-714 ◽

Cited By ~ 18

Author(s):

J. Ahovuo ◽

E. Kaartinen ◽

P. Slätis

Keyword(s):

Diagnostic Accuracy ◽

Ankle Joint ◽

Predictive Value ◽

Diagnostic Value ◽

Positive Test ◽

Lateral Ligament ◽

Stress Radiography ◽

Anterior Displacement ◽

Lateral Ligaments ◽

Talar Tilt

The diagnostic accuracy of inversion and anterior stress radiography in rupture of the lateral ligaments of the ankle joint was assessed in 56 patients undergoing surgery. In inversion stress radiography, 58 per cent of the patients with confirmed rupture of the lateral ligaments of the ankle had a talar tilt of 10 degrees or more, allowing a predictive value of a positive test of 94 per cent. In anterior stress radiography, 53 per cent of the patients had a posterior tibiotalar distance of 9 mm or more, allowing a predictive value of a positive test of 81 per cent. In measurements of talar tilt and anterior displacement of the talus values higher than normal in the injured ankle may be a sign of a rupture of the lateral ligament.

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Diagnostic Accuracy of Magnetic Resonance Images and Weight-Bearing Radiographs in Patients With Arthroscopic-Proven Medial Osteoarthritis of the Knee

Clinical Medicine Insights Arthritis and Musculoskeletal Disorders ◽

10.1177/1179544120938369 ◽

2020 ◽

Vol 13 ◽

pp. 117954412093836

Author(s):

Nuria Muñoz-García ◽

José Cordero-Ampuero ◽

Rosario Madero-Jarabo

Keyword(s):

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Weight Bearing ◽

Diagnostic Value ◽

Magnetic Resonance Images ◽

Osteoarthritis Of The Knee ◽

Predictive Values ◽

Arthroscopic Findings ◽

Sensitivity Specificity

Aims: The aim of this study is to analyze the diagnostic value of weight-bearing radiographs, magnetic resonance images (MRI), and the combination of both in osteoarthritic knees when using arthroscopic findings as the “gold standard” to compare with. Methods: A total of 59 patients were studied because of chronic pain in 1 of their knees. Radiographs were classified according to Kellgren-Lawrence scale. Magnetic resonance images were classified according to Vallotton, and arthroscopic findings according to Outerbridge criteria. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were, respectively, 75.0%, 60.0%, 56.2%, 77.8%, and 66.1% for weight-bearing radiographs, and 70.8%, 88.6%, 81.0%, 81.6%, and 81.4% for MRI. Logistic regression analysis showed that a weight-bearing radiograph added to MRI offered no additional diagnostic value compared with MRI alone ( P < .001). Conclusions: Magnetic resonance images presented higher specificity, positive and negative predictive values, and accuracy than weight-bearing radiographs for knee osteoarthritis. The combination of radiographs and MRI did not improve the diagnostic accuracy, compared with MRI alone.

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FAST and abnormal urinalysis: the effective screening tools in pediatric abdominal trauma

Journal of Emergency Practice and Trauma ◽

10.15171/jept.2018.05 ◽

2018 ◽

Vol 5 (1) ◽

pp. 14-18

Author(s):

Majid Zamani ◽

Farhad Heydari ◽

Mehrdad Esmailian

Keyword(s):

Diagnostic Accuracy ◽

Ct Scan ◽

Abdominal Trauma ◽

Predictive Value ◽

Radiation Risk ◽

Diagnostic Value ◽

Screening Tools ◽

Accuracy Evaluation ◽

Abdominal Ultrasonography ◽

Predictive Values

Objective: The present study examines the diagnostic accuracy of abdominal ultrasonography and urinalysis test in children with blunt abdominal trauma, compared with CT scan. The aim of this study was to compare the diagnostic value of ultrasound and urinalysis test with CT scan as a golden standard diagnostic method in predicting abdominal peritoneal injury in these patients. Methods: This prospective study, based on diagnostic accuracy evaluation, was performed on children with blunt abdominal traumas less than 12 years of age who were referred to the emergency department from 2017-2018 and for whom abdominal ultrasonography, urinalysis and abdominal CT scans were requested. Demographic data, mechanism of trauma, the results of urine tests, ultrasound and CT scan of the abdomen were recorded. Sensitivity, specificity, positive and negative predictive values were used to measure the diagnostic power of the tests. Results: In this study, 100 children with multiple traumas were included. The mean age of these patients was 5.75 ± 3 years with a range of 1-12 years. In terms of sexual distribution, 69 (69%) were boys and 31 (31%) were girls. According to the results, ultrasound with an abnormal urinalysis test had sensitivity of 85.7%, specificity of 91.9%, positive predictive value of 63.2% and negative predictive value of 97.5%. The accuracy was 91%. Conclusion: According to the results of this study, the combination of ultrasonography and urinalysis resulted in a significant increase in diagnostic value (P <0.001). Pediatric patients with a negative ultrasonography and urinalysis test should be observed rather than subjected to the radiation risk of CT

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Improved Diagnostic Accuracy of Bone Metastasis Detection by Water-HAP Associated to Non-Contrast CT

Diagnostics ◽

10.3390/diagnostics10100853 ◽

2020 ◽

Vol 10 (10) ◽

pp. 853

Author(s):

Yoshinobu Ishiwata ◽

Yojiro Hieda ◽

Soichiro Kaki ◽

Shinjiro Aso ◽

Keiichi Horie ◽

...

Keyword(s):

Bone Metastasis ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Ct Images ◽

Kappa Coefficient ◽

Characteristic Analysis ◽

Predictive Values ◽

Contrast Ct ◽

Sensitivity Specificity ◽

Conventional Ct

We examined whether water-hydroxyapatite (HAP) images improve the diagnostic accuracy of bone metastasis compared with non-contrast CT alone. We retrospectively evaluated dual-energy computed tomography (DECT) images of 83 cancer patients (bone metastasis, 31; without bone metastasis, 52) from May 2018 to June 2019. Initially, two evaluators examined for bone metastasis on conventional CT images. In the second session, both CT and CT images plus water-HAP images on DECT. The confidence of bone metastasis was scored from 1 (benign) to 5 (malignant). The sensitivity, specificity, positive predictive values, and negative predictive values for both modalities were calculated based on true positive and negative findings. The intra-observer area under curve (AUC) for detecting bone metastasis was compared by receiver operating characteristic analysis. Kappa coefficient calculated the inter-observer agreement. In conventional CT images, sensitivity, specificity, positive predictive value, and negative predictive value of raters 1 and 2 for the identification of bone metastases were 0.742 and 0.710, 0.981 and 0.981, 0.958 and 0.957, and 0.864 and 0.850, respectively. In water-HAP, they were 1.00 and 1.00, 0.981 and 1.00, 0.969 and 1.00, and 1.00 and 1.00, respectively. In CT, AUCs were 0.861 and 0.845 in each observer. On water-HAP images, AUCs were 0.990 and 1.00. Kappa coefficient was 0.964 for CT and 0.976 for water-HAP images. The combination of CT and water-HAP images significantly increased diagnostic accuracy for detecting bone metastasis. Water-HAP images on DECT may enable accurate initial staging, reduced radiation exposure, and cost.

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