Diagnostic value of imaging in infective endocarditis: a systematic literature review and a proposal of an updated diagnostic work-up

2016 ◽  
Author(s):  
Anna Gomes
Keyword(s):  
Infective Endocarditis ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Diagnostic Value ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

2018 ◽  
Vol 22 (7) ◽  
pp. 1-114 ◽  
Author(s):  
Paula Ghaneh ◽  
Robert Hanson ◽  
Andrew Titman ◽  
Gill Lancaster ◽  
Catrin Plumpton ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pancreatic Cancer ◽  
Chronic Pancreatitis ◽  
Diagnostic Accuracy ◽  
Cost Effective ◽  
Diagnostic Value ◽  
Pet Ct ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Background Pancreatic cancer diagnosis and staging can be difficult in 10–20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. Objective To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. Design A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. Participants Patients with suspected pancreatic malignancy. Interventions All patients to undergo PET/CT following standard diagnostic work-up. Main outcome measures The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients’ diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. Results Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUVmax.) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity (p = 0.01) and specificity (p = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios (p < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients (p = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval –0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. Conclusion PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. Study registration Current Controlled Trials ISRCTN73852054 and UKCRN 8166. Funding The National Institute for Health Research Health Technology Assessment programme.

scholarly journals Uveitis: Diagnostic work-up. A literature review and recommendations from an expert committee

2017 ◽  
Vol 16 (12) ◽  
pp. 1254-1264 ◽  
Author(s):  
Pascal Sève ◽  
Patrice Cacoub ◽  
Bahram Bodaghi ◽  
Salim Trad ◽  
Jérémie Sellam ◽  
...  
Keyword(s):  
Literature Review ◽  
Expert Committee ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals Abdominal ultrasound in the diagnostic work-up of visceral leishmaniasis and for detection of complications of spleen aspiration

2021 ◽  
Vol 15 (2) ◽  
pp. e0009107
Author(s):  
Rezika Mohammed ◽  
Yonathan Gebrewold ◽  
Angela Schuster ◽  
Helina Fikre ◽  
Tigist Mekonnen ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Splenic Injury ◽  
Abdominal Ultrasound ◽  
Diagnostic Value ◽  
Treatment Center ◽  
Diagnostic Tools ◽  
Us Findings ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Introduction Abdominal ultrasound (US) is increasingly used in the diagnostic work-up of infectious diseases, but studies on its diagnostic value in visceral leishmaniasis (VL) are lacking. US could help to identify complications of spleen aspiration (SA). We aimed to assess the diagnostic value of US and the evolution of findings after VL treatment; the incidence and degree of splenic injury; and the pain perceived during SA. Methodology/result We conducted a cross-sectional prospective study at the Leishmaniasis Research and Treatment Center, Gondar, Ethiopia between Oct 2017 and Dec 2018. We enrolled VL suspects undergoing tissue aspiration; US were conducted before and after SA, and at the end of VL treatment. Splenic injury was graded using the American association of surgery trauma injury scale (grade 1–4). The pain perceived during SA was graded using a visual analogue scale. Out of 392 VL suspects, 192 (49%) were confirmed VL cases. The median age was 25 years (IQR 21–30). Massive splenomegaly and hepatomegaly were the most common US findings. Splenic nodules were seen in 3.7% of the 190 VL cases and 1.5% of the 197 non-VL cases. Ascites was more common in VL (16.4%) than in non-VL cases (9.1%). The frequency of US abnormalities decreased with treatment. None of the US findings had sufficient sensitivity and specificity to justify its use as a diagnostic test. US detected splenic injury in four of the 318 patients who had post-SA US. All four patients remained clinically stable. Pain was perceived as moderate or severe in 51% of patients. Conclusion The diagnostic value of abdominal US for VL was low but found useful to detect subclinical splenic injury. SA caries a risk of splenic injury and was perceived painful by most. Further research on less invasive diagnostic tools is needed.

scholarly journals Diagnostic value of lymphopaenia and elevated serum ACE in patients with uveitis

2020 ◽  
pp. bjophthalmol-2020-316563
Author(s):  
Philippine Cotte ◽  
Pierre Pradat ◽  
Laurent Kodjikian ◽  
Yvan Jamilloux ◽  
Pascal Seve
Keyword(s):  
Retrospective Study ◽  
Predictive Value ◽  
Elevated Serum ◽  
Diagnostic Value ◽  
Granulomatous Uveitis ◽  
Registration Number ◽  
The Mean ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

AimTo evaluate the diagnostic worth of elevated serum ACE (sACE) and lymphopaenia, singly or combined, in diagnosing sarcoid uveitis.MethodsMonocentric retrospective study, on a cohort of 996 adult patients referred to our department between March 2001 and December 2018 for a diagnostic work-up of uveitis. The sensitivity (SE), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the two biomarkers were calculated in different contexts.ResultsEight hundred and sixty-eight patient cases were reviewed. The mean age at uveitis onset was 49.4 (±18.6) years. Of them, 144 patients had a diagnosis of sarcoid uveitis. An elevated sACE had SE of 45.8%, Sp of 88.8%, PPV of 44.9% and NPV of 89.2% in diagnosing sarcoid uveitis. For lymphopaenia, SE was 15.3%, Sp was 96.7%, PPV was 47.8% and NPV was 85.2%. For the combination of elevated sACE and lymphopaenia, SE was 18.9%, Sp was 99.0%, PPV was 73.9% and NPV was 89.5%. The value of this combination varied according to patient age at diagnosis plus anatomoclinical entities: for patients aged ≤50 years, SE was 31.3%, Sp was 99.7%, PPV was 90.9% and NPV was 94.3%. For granulomatous uveitis, SE was 26.2%, Sp was 97.3%, PPV was 73.3% and NPV was 82.5%.ConclusionA combination of elevated serum ACE and lymphopaenia more convincingly suggests sarcoid uveitis than these investigational tests used alone, especially in patients with granulomatous uveitis, while a lack of these markers corresponds to a high NPV.Trial registration numberNCT03863782.

scholarly journals Diagnostic Work-Up and Treatment of Traumatic Spondylolisthesis of the Axis: Case Series and Literature Review

2016 ◽  
Vol 6 (1_suppl) ◽  
pp. s-0036-1582943-s-0036-1582943
Author(s):  
Ratko Yurac ◽  
Juán José Zamorano ◽  
Manuel Valencia ◽  
Bartolomé Marré ◽  
Guillermo Izquierdo ◽  
...  
Keyword(s):  
Literature Review ◽  
Case Series ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Traumatic Spondylolisthesis

scholarly journals Diagnostic value of a panel of tumor markers as a part of a diagnostic work-up for ascites of unknown etiology

2012 ◽  
Vol 02 (03) ◽  
pp. 93-100
Author(s):  
Soha Saoud Abdelmoniem ◽  
Eman Mosad Zaki ◽  
Hala Mostafa Imam ◽  
Hosny Badrawy ◽  
Sanaa Ali ◽  
...  
Keyword(s):  
Tumor Markers ◽  
Diagnostic Value ◽  
Unknown Etiology ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals Stroke masquerading as cardiac arrest: the artery of Percheron

2021 ◽  
Vol 14 (1) ◽  
pp. e238681
Author(s):  
Megan Quetsch ◽  
Sureshkumar Nagiah ◽  
Stephen Hedger
Keyword(s):  
Cardiac Arrest ◽  
Clinical Assessment ◽  
Altered Consciousness ◽  
Cognitive Changes ◽  
Consciousness Level ◽  
Artery Of Percheron ◽  
Conscious Level ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

The artery of Percheron (AOP) is a rare arterial variant of the thalamic blood supply. Due to the densely packed collection of nuclei it supplies, an infarction of the AOP can be devastating. Here we highlight a patient who had an AOP stroke in the community, which was initially managed as cardiac arrest. AOP strokes most often present with vague symptoms such as reduced conscious level, cognitive changes and confusion without obvious focal neurology, and therefore are often missed at the initial clinical assessment. This case highlights the importance of recognising an AOP stroke as a cause of otherwise unexplained altered consciousness level and the use of MRI early in the diagnostic work-up.

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