scholarly journals Synovial Sarcoma on Magnetic Resonance Imaging: a Retrospective Study on Tumor Configuration and Postoperative Surveillance

2020 ◽  
Author(s):  
Sam Sedaghat ◽  
Frederick Schmitz ◽  
Johannes Berek ◽  
Charlotte Borchers ◽  
Maya Sedaghat
Keyword(s):  
Contrast Enhancement ◽  
Synovial Sarcoma ◽  
False Positive ◽  
Diagnostic Performance ◽  
False Negative ◽  
Post Treatment ◽  
Marked Contrast ◽  
Postoperative Surveillance ◽  
Synovial Sarcomas ◽  
Treatment Changes

Abstract Background: To assess the configuration of primary and recurrent synovial sarcoma on MRI. Additionally, to evaluate postoperative MRI regarding diagnostic performance and locoregional post-treatment changes.Methods: Twenty-five patients with histologically proven synovial sarcomas underwent 1.5-T MRI follow-up between 2012 and 2018. In all, 258 pre- and postoperative MRIs with available radiological and pathological were screened for primary/recurrent synovial sarcoma, diagnostic performance (false-positive/-negative and true-positive/-negative values) and post-treatment changes.Results: The median age of the patients was 40±15.2 years. The median volumes of primary and recurrent synovial sarcomas were 603 cm3 and 806 cm3, respectively. Of the patients 24% presented recurrences (n=6). In two patients false-positive diagnosis was made . There was one false-negative diagnosis of synovial sarcoma. Primary synovial sarcomas were significantly most often polycyclic/multilobulated (p=0.01) and heterogeneous in appearance with marked contrast enhancement. Recurrent synovial sarcomas showed two appearances: ovoid/nodular/homogeneous and polycyclic/multilobulated/heterogeneous, both with marked contrast enhancement. The most common post-treatment changes were subcutaneous (92%; p<0.001) and muscular edema (72%; p<0.001-0.003). Conclusion: While the configuration of primary synovial sarcomas was mainly polycyclic/multilobulated/heterogeneous, recurrent synovial sarcomas showed two shapes: ovoid/homogeneous and polycyclic/multilobulated/heterogeneous. MRI is still a highly valuable imaging modality for the postoperative surveillance of synovial sarcomas. Subcutaneous and muscular edema are common post-treatment changes.

Magnetic resonance imaging in the investigation of sensorineural hearing loss: is contrast enhancement still necessary?

2001 ◽  
Vol 115 (1) ◽  
pp. 14-21 ◽  
Author(s):  
D. J. Annesley-Williams ◽  
R. D. Laitt ◽  
J. P. R. Jenkins ◽  
R. T. Ramsden ◽  
J. E. Gillespie
Keyword(s):  
Magnetic Resonance ◽  
Contrast Enhancement ◽  
False Positive ◽  
Spin Echo ◽  
False Negative ◽  
Turbo Spin Echo ◽  
Turbo Spin ◽  
Contrast Enhanced ◽  
Negative Case ◽  
T2 Weighted Images

High resolution T2-weighted magnetic resonance (MR) imaging has been proposed as a rapid, inexpensive means of investigating patients with sensorineural deafness, particularly to exclude vestibular schwannomas. Whether the accepted ‘gold standard’ of contrast-enhanced T1-weighted images can be omitted, however, remains controversial. Over a 22-month period the use of axial turbo-spin echo T2-weighted images (T2W) were prospectively compared with contrast-enhanced T1-weighted spin echo scans in the evaluation of 513 patients presenting with audiovestibular symptoms. A 2-D T2W turbo spin echo (TSE) sequence with 3 mm slices was used in 340 patients while a 3-D sequence with overlapping 1 mm slices was used in 173 patients. The T2-weighted image findings were documented and subsequently compared with contrast-enhanced images. With the 2-D sequence 24 patients (25 lesions) had internal auditory meatus (IAM)/cerebello-pontine angle (CPA) masses identified by contrast-enhanced T1-weighted images, all of which were seen on the T2-weighted TSE sequence; there was one false positive ‘mass’ on the T2-weighted scans and one false negative case of IAM dural enhancement on T1-weighted imaging; six were considered normal initially on the T2-weighted images although three were subtly abnormal in retrospect. With the 3-D sequence three acoustic neuromas were all identified correctly with no false positive and only one false negative result (labyrinthitis). The 2-D and 3-D images were judged technically inadequate for clinical assessment in 15 and nine per cent respectively. We conclude that mass lesions of the IAM/CPA can be reliably identified on T2W TSE imaging but labyrinthine lesions may be missed without contrast enhancement. This is of particular importance in planning the management of neurofibromatosis type 2. Non-neoplastic disorders of the inner ear are also likely to be missed.

Diagnostic Performance of Contrast-enhanced Mammography: Comparison With MRI and Mammography

2021 ◽  
Author(s):  
Sabahattin Yüzkan ◽  
Duygu Cengiz ◽  
İlhan Hekimsoy ◽  
Özlem Sezgin Okçu ◽  
Ayşenur Oktay
Keyword(s):  
Predictive Value ◽  
False Positive ◽  
Diagnostic Performance ◽  
False Positive Rate ◽  
False Negative ◽  
False Negative Rate ◽  
Performance Characteristics ◽  
Histopathological Analysis ◽  
Contrast Enhanced ◽  
Improved Performance

Abstract Objective To compare the diagnostic performance of contrast-enhanced mammography (CEM) with MRI and mammography (MG) based on histopathological results. Methods In this IRB-approved study, written informed consent was obtained from all patients. Images from 40 patients (62 lesions) with suspicious findings on US between March 2018 and August 2018 were evaluated. Sensitivity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CEM, MRI, and MG were evaluated and compared within a 95% confidence interval. Maximum dimensions of lesions were measured and correlations of results were evaluated with Spearman’s Rho test. Results In the histopathological analysis, 66% (41/62) of lesions were malignant and 34% (21/62) lesions were benign. Contrast-enhanced mammography, MRI, and MG had sensitivities of 100% (41/41), 100% (41/41), and 80% (33/41), respectively. The sensitivity of CEM and MRI was significantly better than that of MG (P = 0.03). The NPVs of CEM (100%, 7/7) and MRI (100%, 14/14) were statistically higher than the NPV of MG (60%, 12/20) (P = 0.03). The false-positive rates for CEM, MRI, and MG were 33% (7/21), 66% (14/21), and 42% (9/21), respectively. Contrast-enhanced mammography had a significantly lower false-positive rate than MRI (P &lt; 0.001). Mammography had the highest false-negative rate, missing 19% (8/41) of malignant lesions. Conclusion Contrast-enhanced mammography has similar performance characteristics to MRI and improved performance characteristics relative to MG. In particular, CEM and MRI have similar sensitivity and NPVs and both are superior in each of these metrics to MG.

scholarly journals Evaluation of Serum Cryptococcal Antigen Testing Using Two Novel Semiquantitative Lateral Flow Assays in Persons with Cryptococcal Antigenemia

2020 ◽  
Vol 58 (4) ◽  
Author(s):  
Caleb Skipper ◽  
Kiiza Tadeo ◽  
Emily Martyn ◽  
Elizabeth Nalintya ◽  
Radha Rajasingham ◽  
...  
Keyword(s):  
False Positive ◽  
Diagnostic Performance ◽  
False Negative ◽  
Lateral Flow ◽  
Reference Standard ◽  
Serum Samples ◽  
Cryptococcal Antigen ◽  
Negative Results ◽  
Lateral Flow Assays ◽  
Positive Results

ABSTRACT Early cryptococcal disease can be detected via circulating antigen in blood before fulminant meningitis develops, when early antifungal therapy improves survival. Two semiquantitative cryptococcal antigen (CrAg) lateral flow assays (LFAs) have been developed, but their diagnostic performance has not been defined. Cryopreserved serum samples from HIV-infected Ugandans obtained as part of a prospective CrAg-screening cohort were tested in duplicate for CrAg by the CrAgSQ (IMMY) and CryptoPS (Biosynex) lateral flow assays. Case-controlled diagnostic performance was measured using the FDA-approved CrAg LFA (IMMY) as a reference standard via McNemar’s test. Of 99 serum samples tested, 57 were CrAg positive (CrAg+) by the CrAg LFA reference standard. By CrAgSQ, 57 were read as positive, with 98% sensitivity (56/57; 95% confidence interval [CI], 0.91 to 0.99) and 98% specificity (41/42; 95% CI, 0.88 to 0.99) (McNemar’s, P = 0.99). The sample with a false-negative result by CrAgSQ (n = 1) had a titer of <1:5, while the sample with a false-positive result (n = 1) yielded a 1+ result. By CryptoPS, 52 samples were read as positive, with 88% sensitivity (50/57; 95% CI, 0.76 to 0.95) and 95% specificity (40/42; 95% CI, 0.84 to 0.99) (McNemar’s, P = 0.18). The CryptoPS false-negative results included samples with titers of <1:5 (n = 1), 1:5 (n = 5), and 1:20 (n = 1), while samples with false-positive results by CryptoPS (n = 2) yielded Positive results. The CryptoPS assay missed 35% (7/20) of samples with CrAg LFA titers of ≤1:20. The new semiquantitative CrAg LFAs allow rapid estimation of titer levels in easy-to-perform platforms. The CrAgSQ demonstrated better qualitative sensitivity and specificity than the CryptoPS compared to the reference standard. The exact grading of the CrAgSQ results has some subjectivity, with interreader variability; however, qualitative reads were generally concordant for both assays.

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

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

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

scholarly journals Preliminary Results of MyCog, a Brief Assessment for the Detection of Cognitive Impairment in Primary Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 259-260
Author(s):  
Laura Curtis ◽  
Lauren Opsasnick ◽  
Julia Yoshino Benavente ◽  
Cindy Nowinski ◽  
Rachel O’Conor ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Cognitive Aging ◽  
False Positive ◽  
False Positive Rate ◽  
False Negative ◽  
False Negative Rate ◽  
Self Report ◽  
Card Sorting ◽  
Primary Care Settings

Abstract Early detection of Cognitive impairment (CI) is imperative to identify potentially treatable underlying conditions or provide supportive services when due to progressive conditions such as Alzheimer’s Disease. While primary care settings are ideal for identifying CI, it frequently goes undetected. We developed ‘MyCog’, a brief technology-enabled, 2-step assessment to detect CI and dementia in primary care settings. We piloted MyCog in 80 participants 65 and older recruited from an ongoing cognitive aging study. Cases were identified either by a documented diagnosis of dementia or mild cognitive impairment (MCI) or based on a comprehensive cognitive battery. Administered via an iPad, Step 1 consists of a single self-report item indicating concern about memory or other thinking problems and Step 2 includes two cognitive assessments from the NIH Toolbox: Picture Sequence Memory (PSM) and Dimensional Change Card Sorting (DCCS). 39%(31/80) participants were considered cognitively impaired. Those who expressed concern in Step 1 (n=52, 66%) resulted in a 37% false positive and 3% false negative rate. With the addition of the PSM and DCCS assessments in Step 2, the paradigm demonstrated 91% sensitivity, 75% specificity and an area under the ROC curve (AUC)=0.82. Steps 1 and 2 had an average administration time of &lt;7 minutes. We continue to optimize MyCog by 1) examining additional items for Step 1 to reduce the false positive rate and 2) creating a self-administered version to optimize use in clinical settings. With further validation, MyCog offers a practical, scalable paradigm for the routine detection of cognitive impairment and dementia.

Primary renal synovial sarcoma presenting with a retroperitoneal bleed

2021 ◽  
Vol 14 (3) ◽  
pp. e237099
Author(s):  
Daanesh Huned ◽  
Juinn Huar Kam ◽  
Lui Shiong Lee ◽  
Raj Vikesh Tiwari
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Synovial Sarcoma ◽  
Soft Tissue Mass ◽  
Renal Angiomyolipoma ◽  
Right Hepatectomy ◽  
Tissue Mass ◽  
Biopsy Confirmation ◽  
Synovial Sarcomas ◽  
Neo Adjuvant Chemotherapy

Synovial sarcomas are most commonly localised in extremities, especially in the lower thigh and knee areas. Comprising less than 1% of all malignancies, retroperitoneal synovial sarcoma is very rare with primary synovial sarcoma of the kidney being even more infrequent and difficult to diagnose. We describe a case report of a renal synovial sarcoma in a young adult who was initially managed as a case of Wunderlich’s syndrome secondary to what was believed to be a ruptured renal angiomyolipoma. After biopsy confirmation, the patient was eventually managed with neo-adjuvant chemotherapy followed by a right radical nephrectomy and right hepatectomy. Despite its rarity, synovial sarcoma should be considered as differential diagnosis of a bleeding retroperitoneal soft tissue mass detected in young adults.

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