A Comparison of Sinus Computed Tomography (CT) Staging Systems for Outcomes Research

1994 ◽  
Vol 8 (6) ◽  
pp. 291-298 ◽  
Author(s):  
Richard E. Gliklich ◽  
Ralph Metson
Keyword(s):  
Computed Tomography ◽  
Outcomes Research ◽  
Staging System ◽  
Classification Systems ◽  
Rater Agreement ◽  
Sinus Disease ◽  
Staging Systems ◽  
Preoperative Ct ◽  
Definition Of ◽  
Ct Classification

The success of outcomes research for sinus disease will depend in part on the utilization of a computed tomography (CT) staging system that meets rigorous statistical criteria. Such a staging system must demonstrate an even distribution of population by scale, a high inter-rater and intra-rater agreement, and a low percentage of unclassifiable scans. Four proposed sinus CT classification systems were evaluated for these parameters. Each system was used by four masked raters to rate 42 consecutive preoperative CT scans on two separate occasions. One of these systems is based on the site of disease rather than the degree of sinus opacification and gives a clear definition of sinus disease (2 mm or greater of mucosal thickening). This system had the highest inter-rater agreement (κ = 0.61, range = 0.38 to 0.61) and the lowest percentage of unclassifiable scans (0.6%, range = 0.6 to 14.2%). The statistical attributes of this particular sinus CT staging system support its use for outcomes research in sinus disease.

Definitions, classification, epidemiology, and risk factors of acute kidney injury

2018 ◽  
Author(s):  
Eric A. J. Hoste ◽  
John A. Kellum ◽  
Norbert Lameire
Keyword(s):  
Acute Kidney Injury ◽  
Medical Literature ◽  
Kidney Injury ◽  
Staging System ◽  
Acute Kidney Injury Network ◽  
Classification Systems ◽  
Clinical Settings ◽  
Binary Descriptor ◽  
Staging Systems ◽  
Definition Of

The lack of a precise biochemical definition of acute kidney injury (AKI) resulted in at least 35 definitions in the medical literature, which gave rise to a wide variation in reported incidence and clinical significance of AKI, impeded a meaningful comparison of studies.The first part of this chapter describes and discusses different definitions and classification systems of AKI. Patient outcome and the need for renal replacement therapy are directly related to the severity of AKI, an observation that supports the use of a categorical staging system rather than a simple binary descriptor. The severity of AKI is commonly characterized using the relative changes in serum creatinine and urine output. Recently introduced staging systems including the RIFLE classification and the Acute Kidney Injury Network (AKIN) use these relatively simple and readily available parameters allowing the assignment of individual patients to different AKI stages. More recently, a Kidney Disease: Improving Global Outcomes (KDIGO) workgroup developed a consensus-based AKI staging system drawing elements of both RIFLE and AKIN. The potential pitfalls and limitations of the proposed definitions and classifications are briefly described.The second part of the chapter describes the epidemiology of AKI in different clinical settings; the intensive care unit (ICU), the hospitalized population, and the community. The different spectrum of AKI in the emerging countries is discussed and the most important causes and aetiologies of the major clinical types of AKI, prerenal, renal, and post-renal are summarized in table form. Finally the patient survival and renal functional outcome of AKI are briefly discussed

A comparison of four staging systems for localized and regional neuroblastoma: a report from the Childrens Cancer Study Group.

1990 ◽  
Vol 8 (4) ◽  
pp. 678-688 ◽  
Author(s):  
A E Evans ◽  
G J D'Angio ◽  
H N Sather ◽  
A A de Lorimier ◽  
A Dalton ◽  
...  
Keyword(s):  
Survival Rates ◽  
Staging System ◽  
Tumor Stage ◽  
Good Prognosis ◽  
Study Group ◽  
Tnm System ◽  
Cancer Study ◽  
Cancer Study Group ◽  
Staging Systems ◽  
Definition Of

Four major staging systems have been used to estimate the prognosis for children with local and regional neuroblastoma (NBL). Data obtained at diagnosis for 251 neuroblastoma patients from two Childrens Cancer Study Group (CCSG) studies were analyzed according to staging systems of the CCSG, St Jude Children's Research Hospital, the Pediatric Oncology Group (POG), and the Union Internationale Contre le Cancer (UICC) tumor-nodes-metastasis (TNM) system. The most significant variables were found to be age, tumor stage, extent of tumor removal, transgression of the midline by tumor infiltration, and site of primary tumor. Involvement of lymph nodes per se was not a bad prognostic sign unless associated with extension beyond the midline, the latter being the single most important prognostic variable. All four staging systems had value for prognostication and all identified with accuracy the low stage patient (stage I, stage A) who fares well (greater than or equal to 87% survival). The CCSG definition of stages II and III disease discriminated prognostic groups best among the remaining patients, and was able to identify the child with local-regional NBL with poor survival. The estimated 5-year survival rates for children with regional tumor (stage III, IIIA[N]), according to the four systems were 44%, 74%, 74%, and 74% for the CCSG, St Jude, POG, and UICC methods, respectively. We conclude that all four staging systems effectively define good-prognosis patients with localized disease but that the CCSG staging system most accurately identifies patients with regional tumor who have a poor outcome.

scholarly journals Predicting epiphyseal stability of slipped capital femoral epiphysis with preoperative CT imaging

2020 ◽  
Vol 14 (1) ◽  
pp. 68-75
Author(s):  
Megan E. Fischer-Colbrie ◽  
Craig R. Louer ◽  
James D. Bomar ◽  
Peter Hahn ◽  
Eric W. Edmonds ◽  
...  
Keyword(s):  
Classification System ◽  
Evaluation Method ◽  
Interobserver Reliability ◽  
Slipped Capital Femoral Epiphysis ◽  
Ct Imaging ◽  
Classification Systems ◽  
Level Of Evidence ◽  
Ct Evaluation ◽  
Preoperative Ct ◽  
Ct Classification

Background We analyzed preoperative CT scans of hips with slipped capital femoral epiphysis (SCFE) for characteristics that could be predictive of intraoperative epiphyseal stability and developed a set of imaging criteria for stable and unstable SCFE. We then compared this grading system with the Loder classification. Methods We reviewed preoperative CT imaging to develop a SCFE stability classification system. Three orthopaedic surgeons used the classification system to grade stability on a series of SCFE hips. Kappa was used to evaluate intra- and interobserver reliability among the observers. A series of SCFE hips treated with open procedures in which intraoperative stability was determined under direct visualization was evaluated. Intraoperative stability was compared with stability ratings as determined by the CT classification system and the Loder classification system. Results Interobserver reliability among our three observers was κ = 0.823 (95% confidence interval (CI) 0.414 to 1.0; p < 0.001). Intraobserver reliability was κ = 0.901 (95% CI 0.492 to 1.31; p < 0.001). In all, 27 hips were used in the comparison of intraoperative stability with the Loder and CT classification systems. CT-predicted stability exhibited 78% concordance with intraoperative stability. The sensitivity and specificity of CT-predicted stability was 75% and 82%, respectively, versus Loder sensitivity of 69% and specificity of 91%. Conclusion The CT evaluation method provided is easy to use and can help to improve the accuracy in determining preoperative epiphyseal stability, which may lead to improved treatment outcomes for this population. Level of Evidence III

Comparison of Sinus Computed Tomography Staging Systems

1997 ◽  
Vol 117 (4) ◽  
pp. 372-379 ◽  
Author(s):  
Ralph Metson ◽  
Richard E. Gliklich ◽  
James A. Stankiewicz ◽  
David W. Kennedy ◽  
James A. Duncavage ◽  
...  
Keyword(s):  
Neck Surgery ◽  
Skewed Distribution ◽  
Rating System ◽  
Ct Scans ◽  
Rater Agreement ◽  
Rating Systems ◽  
Disease States ◽  
Staging Systems ◽  
Definition Of ◽  
Paranasal Sinus Disease

In an attempt to establish a standardized rating system for CT of the paranasal sinuses, the Committee on Rhinology and Paranasal Sinus Disease of the American Academy of Otolaryngology-Head and Neck Surgery instituted a protocol for the review of sinus CT scans at six international sites. Fifty identical scans were rated by four otolaryngologists at each site according to five established sinus CT staging systems. Twenty of 24 reviewers repeated the rating session at least 1 week later to determine intrarater variability. The number of CT scans that could not be classified by a particular rating system ranged from 1.3% to 5.5%. The range of intrarater agreement (κ = 0.39 to 0.74) exceeded that of inter-rater agreement (κ = 0.18 to 0.49). A skewed distribution of CT scans resulted in a system with high rater agreement but poor ability to differentiate among disease states. The use of a numeric rating system to assign a score to each scan produced a comprehensive and disease-sensitive system, but one with low rater agreement. A precise definition of mucosal thickening in terms of millimeters appeared to enhance the raters' ability to assign stage and improve a system's comprehensiveness and reproducibility. On the basis of these findings, recommendations are made for the use of CT rating systems to study clinical outcomes in patients with chronic sinusitis.

scholarly journals Correlations Between Symptoms, Nasal Endoscopy Computed Tomography and Surgical Findings in Patients with Chronic Rhinosinusitis

2015 ◽  
Vol 11 (3) ◽  
pp. 201-205 ◽  
Author(s):  
M Pokharel ◽  
S Karki ◽  
BL Shrestha ◽  
I Shrestha ◽  
RCM Amatya
Keyword(s):  
Computed Tomography ◽  
Chronic Rhinosinusitis ◽  
Task Force ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Staging System ◽  
Nasal Endoscopy ◽  
Sinus Disease ◽  
Radiological Score ◽  
Symptom Criteria

Background Although Chronic rhinosinusitis (CRS) is increasing in prevalence and incidence, its diagnosis and treatment still pose a challenge. The Task Force on rhinosinusitis (TFR) advocates the use of symptom based criteria. However, many otorhinolaryngologists depend on diagnostic nasal endoscopy and computed tomography(CT) of paranasal sinuses for diagnosis of CRS. Computed tomography has been extensively relied upon in confirming the presence of CRS, in assessing severity of disease, surgical planning and management decisions. Despite its widespread use, several studies have failed to correlate findings on CT with symptom severity. Objective To determine the correlations between symptoms described at presentation, radiological findings, endoscopy and extensiveness of surgery. Methods Longitudinal, prospective, analytical study conducted from August 2011 to August 2012 among 87 patients diagnosed as CRS according to the TFR criteria. Symptom, endoscopic, radiological and surgical scoring was done by using Lund and Mackay staging system. Pearson correlation coefficients between scores for symptoms, endoscopy, sinus CT and surgery was determined. Results When overall symptom score was correlated with radiological score and endoscopy score, it was found to be statistically significant (p= <0.01). However, no significant relationship was found between Lund and Mackay symptom and surgery score. Conclusion The symptom criteria used by TFR for CRS diagnosis are not very specific for sinus disease. A detail assessment of the subjective and objective criteria (CT and endoscopy) is necessary for tailoring surgical plan but should not be relied upon for determining the extensiveness of surgical intervention. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12504 Kathmandu Univ Med J 2013; 43(3):201-205

scholarly journals Image defined risk factors in patients with neuroblastoma. Literature review

2019 ◽  
Vol 6 (3) ◽  
pp. 31-43
Author(s):  
E. S. Ternovaya ◽  
D. Yu. Kachanov ◽  
T. V. Shamanskaya ◽  
A. P. Shcherbakov ◽  
S. R. Varfolomeeva ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Risk Group ◽  
Staging System ◽  
Preoperative Imaging ◽  
Review Of The Literature ◽  
Resonance Imaging ◽  
Staging Systems ◽  
Definition Of ◽  
Radiological Studies

Currently, two staging systems are used: the International Neuroblastoma Staging System (INSS), which relies on surgical staging, and the International Neroblastoma Risk Group Stading System (INRGSS), which relies on preoperative imaging for staging and image-defined risk. The article presents a review of the literature on image defined risk factors (IDRF) determined during radiological studies (computed tomography and magnetic resonance imaging) in patients with neuroblastoma. The article focuses on the definition of IDRFs, their prevalence and their influence on surgical outcomes and prognosis of patients with neuroblastoma.

Correlation of Clinical Examination with Computer Tomography in Paranasal Sinus Disease

1997 ◽  
Vol 11 (3) ◽  
pp. 193-196 ◽  
Author(s):  
Roy R. Casiano
Keyword(s):  
Computed Tomography ◽  
Paranasal Sinus ◽  
Clinical Examination ◽  
Middle Turbinate ◽  
Staging System ◽  
Sinus Surgery ◽  
Clinical Staging ◽  
Sinus Disease ◽  
Ostiomeatal Complex ◽  
Paranasal Sinus Disease

The accuracy of clinical examination in predicting radiologic paranasal sinus disease was investigated. Two hundred forty-seven patients who underwent endoscopic sinus surgery over a 4-year period were clinically and radiologically staged prior to surgery. A clinical staging system was developed utilizing fiberoptic intranasal examination to adequately visualize the anterior and posterior ostiomeatal complex structures with special attention to the mucosal status. The degree to which the clinical staging was able to predict and correlate with radiologic staging and predict the degree of sinus opacification was determined. Clinical and radiological presence of middle turbinate anomalies, septal deviation, and other structural anomalies were also evaluated. Clinical examination correlated well with radiologic examination: 74% sensitivity and 84% specificity). More than 94% of the patients with frank polyp disease had pansinus opacification involving the sphenoid. In the presence of normal mucous membranes, the absence of middle turbinate anomalies correlated with a normal computed tomography. However, with the exception of middle turbinate hypertrophy, the ability to clinically predict concha bullosa or paradoxical curvature was low and did not influence the overall computed tomography result.

scholarly journals Both Magnetic Resonance Imaging and Computed Tomography Are Reliable and Valid in Evaluating Cystic Osteochondral Lesions of the Talus

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712094669
Author(s):  
En Deng ◽  
Lixiang Gao ◽  
Weili Shi ◽  
Xing Xie ◽  
Yanfang Jiang ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Measurement Method ◽  
Intraclass Correlation ◽  
Classification Systems ◽  
Osteochondral Lesions ◽  
Accurate Information ◽  
Resonance Imaging ◽  
Ct Classification

Background: Compared with computed tomography (CT), magnetic resonance imaging (MRI) might overestimate the condition of osteochondral lesions of the talus (OLTs) owing to subchondral bone marrow edema and the overlying cartilage defect. However, no study has compared MRI and CT directly in evaluating OLTs with subchondral cysts. Purpose: To compare the reliability and validity of MRI and CT in evaluating OLTs with subchondral cysts. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: An institutional radiology database was queried for inpatients diagnosed with OLTs with subchondral cysts who had undergone surgical treatment between May 2015 and October 2019. A total of 48 patients met the inclusion criteria. Based on our measurement method, 2 experienced observers who were blinded to the study independently measured the length, width, and depth of the cysts using MRI and CT. The classification of cystic lesions was also performed based on MRI and CT findings. Results: Interobserver reliability was almost perfect, with intraclass correlation coefficients (ICCs) ranging from 0.935 to 0.999. ICCs for intraobserver reliability ranged from 0.944 to 0.976. The mean size of cysts measured on MRI (length, 13.38 ± 4.23 mm; width, 9.28 ± 2.28 mm; depth, 11.54 ± 3.69 mm) was not significantly different to that evaluated on CT (length, 13.40 ± 4.08 mm; width, 9.25 ± 2.34 mm; depth, 11.32 ± 3.54 mm). The size of subchondral cysts was precisely estimated on both MRI and CT. The MRI classification and CT classification revealed almost perfect agreement (kappa = 0.831). Conclusion: With our measurement method, both MRI and CT were deemed to be reliable and valid in evaluating the size of subchondral cysts of OLTs, and the MRI classification was well-correlated with the CT classification. The presented measurement method and classification systems could provide more accurate information before surgery.

Quantification for Staging Sinusitis

1995 ◽  
Vol 104 (10_suppl) ◽  
pp. 17-21 ◽  
Author(s):  
Valerie J. Lund ◽  
David W. Kennedy
Keyword(s):  
Computed Tomography ◽  
Chronic Sinusitis ◽  
Staging System ◽  
Acute Sinusitis ◽  
Endoscopic Appearance ◽  
Sinus Disease ◽  
Endoscopic Findings ◽  
Severity Of Disease ◽  
Surgical History

A method of quantifying the symptoms, radiologic data, and endoscopic findings in extensive sinus disease is proposed. It is intended to enable clinicians to classify patients with extensive sinus disease according to severity of disease and prognostic category. The rubric of extensive sinus disease, for scoring and staging, comprises recurrent acute sinusitis and chronic sinusitis, but not an isolated episode of acute sinusitis. The method assigns simple numeric scores to specific computed tomography findings, elements of surgical history, presence of defining symptoms of sinusitis, and endoscopic appearance. This quantitative system may be rationalized into a staging system.

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