scholarly journals Pattern of computerized tomography findings of the brain in cerebrovascular accidents

2020 ◽  
Vol 5 (1) ◽  
pp. 62-70
Author(s):  
Elina Shrestha ◽  
Narayan Bikram Thapa ◽  
SBS Rajbhandari

Introduction: Semi-industrialized countries  like Nepal have  high  mortality and disability rates due to cerebrovascular accident, representing  for more than 80% of all stroke deaths globally. Stroke is the most common neurological disorder requiring prolonged hospital stay. Aims of our study was to evaluate the role of computerized tomography in evaluation of cerebrovascular accident by differentiating ischemia from hemorrhage and proper identification of negative cases. Methods: A descriptive cross sectional  study of total 155  patients, clinically diagnosed as stroke,  referred to our department of radiology  for computerised tomography evaluation during six month period, were enrolled  into study. The clinical information, proper history, computerised tomography  findings  were properly documented and analysed in  SPSS version 20 software. Results: Out of total 155 patients, 85 cases (55 %)  were males and  70 cases (45 %) were  females with male: female  ratio of 1.2:1. The mean age of the patients was 63±15 years. There was significant  correlation between clinical with neuroradiological findings as evidenced  by p value of 0.000.  Sensitivity, specificity, positive predictive value, negative predictive value of clinical findings when correlated  to CT in diagnosing ischemic infarction were 84.3%, 67.3%, 82.6%, 70%. Similarly, sensitivity, specificity, positive predictive value, negative predictive value in diagnosing hemorrhagic infarction were 67.3%, 84.3%, 70%, 82.6% respectively. Conclusions: Computerised tomography is the first line reliable imaging modality for diagnosis, management of cerebrovascular accident and exclusion of stroke mimicker lesions. Education regarding prevention and control of  modifiable risk factors can minimize the incidence of  stroke.

2019 ◽  
Vol 26 (08) ◽  
pp. 1229-1232
Author(s):  
Khadija Kiran ◽  
Amtul Huda ◽  
Zuhair Bhatti

To investigate the role of IL-21 as diagnostic marker in diagnosis of rheumatoid arthritis. Study Design: Cross sectional study. Setting: Department of Physiology and Orthopedic Gujranwala Medical College, Gujranwala. Period: October 2017 to October 2018 in one year duration. Materials and Methods: A total of 150 patients were included in the study, main variables assessed in this study were positive predictive value negative predictive value, sensitivity, specificity and accuracy of IL-21 in diagnosis of rheumatoid arthritis. SPSS version 23 was used to analyze the data. P value less than or equal to 0.05 was taken as significant. Study was started after permission from hospital ethical committee and patients were informed in detail about disease and procedure to be done. Non probability consecutive sampling was used. Results: The estimated sensitivity was 93.6%. The estimated specificity was 50%. Positive predictive value was 96.3% and negative predictive value was 35.7%. The overall accuracy was 90.6% for diagnosing rheumatoid arthritis. Conclusion: IL-21 induces MMP3 in rheumatoid arthritis patients, identification of IL-21 from synovium of patients indicates the presence of rheumatoid arthritis. We observed 90.6% diagnostic accuracy of IL-21 for rheumatoid patients taking RA factor as gold standard of diagnostic tool.


2021 ◽  
Vol 8 (33) ◽  
pp. 3048-3053
Author(s):  
Jainendra Kumar ◽  
Akriti Komal

BACKGROUND Acute appendicitis (AA) is one of the commonest causes of acute abdominal emergencies. Accurate diagnosis and earlier surgery is imperative in such cases. Ultrasonography (US), and computed tomography (CT), are main stays accurate diagnosis of this disease. This study was conducted to compare the accuracy of US and CT in the diagnosis of AA and reduce number of negative appendectomies. METHODS This prospective study was done after approval from institutional ethical committee and obtaining written consent. 164 patients with clinical features suggestive of AA, were selected from emergency department of Patna Medical College, Patna India during the period from January 2019 to December 2020. 98 were males and 66 females, mean age being 18.08 years. 142 patents (86.58 %) underwent surgery, and 22 patients (13.41 %) were kept on clinical observation in hospital after imaging. After detailed clinical workup and laboratory investigations, all patients were subjected to both US and CT examination. Each patient was reevaluated clinically, and a clinical correlation was done between both sets of results. Based on these, final decision was made. Accuracy was decided based on intra-operative findings in appendectomy group and were correlated with imaging findings later with histopathologic findings. RESULTS Males outnumbered females, abdominal pain was present in 100%. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of US in diagnosis of AA in our study were 92.6 %, 76.4 %, 95.3%, 71.0% and 88.9 % respectively. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of CT in diagnosis of AA were 99.1 %, 90.5 %, 98.6%, 87.8% and 97.8 % respectively. CONCLUSIONS US should be the first-line imaging modality as it is free from radiation. CT is recommended as additional imaging tool to raise accuracy in diagnosis except in pregnancy and selected pediatric patients. KEYWORDS Acute Appendicitis, Computed Tomography, Ultrasound


Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 503
Author(s):  
Thomas F. Monaghan ◽  
Syed N. Rahman ◽  
Christina W. Agudelo ◽  
Alan J. Wein ◽  
Jason M. Lazar ◽  
...  

Sensitivity, which denotes the proportion of subjects correctly given a positive assignment out of all subjects who are actually positive for the outcome, indicates how well a test can classify subjects who truly have the outcome of interest. Specificity, which denotes the proportion of subjects correctly given a negative assignment out of all subjects who are actually negative for the outcome, indicates how well a test can classify subjects who truly do not have the outcome of interest. Positive predictive value reflects the proportion of subjects with a positive test result who truly have the outcome of interest. Negative predictive value reflects the proportion of subjects with a negative test result who truly do not have the outcome of interest. Sensitivity and specificity are inversely related, wherein one increases as the other decreases, but are generally considered stable for a given test, whereas positive and negative predictive values do inherently vary with pre-test probability (e.g., changes in population disease prevalence). This article will further detail the concepts of sensitivity, specificity, and predictive values using a recent real-world example from the medical literature.


2021 ◽  
Vol 10 (1) ◽  
pp. 20-25
Author(s):  
Sujan Shrestha ◽  
Mamen Prasad Gorhaly ◽  
Manil Ratna Bajracharya

Background Diabetic peripheral neuropathy (DPN) is a significant independent risk factor for diabetic foot, and an effective screening instrument is required to diagnose DPN early to prevent future ulceration and amputation. This study aims to determine the diagnostic accuracy of monofilament test to detect diabetic peripheral neuropathy. Methods This cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital, Mahabouddha, Kathmandu from February 2016 to January 2017. A total of 96 diabetic patients attending inpatient and outpatient Department were selected. Diabetic peripheral neuropathy was assessed by measurement of loss of protective sensation (LOPS) by monofilament test and compared with vibration perception threshold by standard biothesiometer. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were calculated. Results The prevalence of diabetic peripheral neuropathy was 26%. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were found to be 92.0%, 95.8%, 88.5% and 97.1% respectively. There was strong association between LOPS by monofilament and vibration perception threshold by biothesiometer. Conclusion This study showed a strong diagnostic accuracy of monofilament test to detect DPN when compared with biothesiometer. As monofilament test is a cheap, easily available, and portable, it can be used in the periphery where biothesiometer is not available.  


2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Tahir Iqbal ◽  
Muhammad Usman Shahid ◽  
Ishfaq Ahmad Shad ◽  
Shahzad Karim Bhatti ◽  
Syed Amir Gilani ◽  
...  

ABSTRACT: BACKGROUND: A common surgical emergency is acute appendicitis. Various diagnostic tools are available to diagnosis acute appendicitis. Radiological investigations play an important role in making accurate and early diagnosis and thus preventing morbidity associated with the disease. OBJECTIVE: To determine the diagnostic accuracy of gray scale ultrasonography versus color Doppler in suspected cases of acute appendicitis. MATERIALS AND METHODS: The study was carried in the department of Radiology of Mayo Hospital, Lahore. A total of 75 patients were enrolled of age 18-40 years, both genders who were suspected cases of acute appendicitis. All patients underwent baseline investigations along with gray scale ultrasonography and color Doppler. All patients were subjected to surgery to confirm the diagnosis and findings were subjected to statistical analysis. RESULTS: The mean age of the patients was 23.25 ±10.55 and mean transverse diameter of appendix was 8.37 ±3.39. There were 62.7% males and 37.3%females. Findings of gray scale ultrasonography and color Doppler were then correlated with surgical findings to calculate the diagnostic accuracy of these modalities. The results revealed that gray scale ultrasonography sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 92.7%, 94.32%, 95%, 91.4% and 93.3% respectively, whereas color Doppler had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 97.7%, 93.9%, 95.3%, 97% and 96% respectively. Diagnostic accuracy of both modalities together was 98.6%. CONCLUSION: Color Doppler has better diagnostic accuracy than gray scale ultrasonography for diagnosis of acute appendicitis and the combination of both modalities yields diagnostic accuracy that is similar to gold standard.


2020 ◽  
Vol 7 (50) ◽  
pp. 3027-3032
Author(s):  
Ruby Elizabeth Elias ◽  
Bindiya Gisuthan ◽  
Sreeganesh A.S

BACKGROUND Helicobacter pylori associated chronic gastritis plays a vital role in the development of majority of gastric adenocarcinomas and most gastric MALT (Mucosa Associated Lymphoid Tissue) lymphomas. Many diagnostic methods are available for the identification of this organism. However, in gastroenterology practice, histopathological examination of biopsy samples provides visual identification of the pathogen and the associated mucosal changes with special stains like Giemsa. The aim of this study was to evaluate the efficacy of three stains H & E- (Haematoxylin and Eosin), Giemsa and IHC (Immunohistochemistry) in the identification of H. pylori. Associated histologic changes were noted and the relationship between the degree of colonisation and the activity and chronicity of gastritis were analysed. METHODS 585 gastric biopsies taken from dyspeptic patients were evaluated for gastritis, based on updated Sydney System. In 250 randomly selected cases, three staining methods were used. RESULTS Out of 585 cases, 413 (70.60 %) had features of chronic gastritis. Mild chronic gastritis was the commonest finding and is seen in most cases of mild H. pylori colonisation. When activity was monitored, mild activity was the most frequent finding [225 (38.46 %)]. Majority of the severe activity cases showed severe H. pylori colonisation. 13.16 %, 4.79 % and 7.35 % showed intestinal metaplasia, atrophy and dysplastic changes respectively. Out of 250 cases, H & E and Giemsa stains showed 45.6 % and 57.2 % positivity while IHC demonstrated maximum number of positivity (156 cases - 62.4 %). Sensitivity and specificity of H & E was found to be 77.90 % and 98.95 %, positive predictive value was 99.13 % and negative predictive value was 69.18 %. For Giemsa stain, sensitivity was 91.67 %, specificity was 100 %, positive predictive value was 100 % and negative predictive value was 87.85 %. DISCUSSION H. pylori gastritis was a frequent finding in dyspeptic patients in southern part of India. When chi-square test was done, a significant statistical relationship between the severity of H. pylori colonisation, activity and chronicity of gastritis was noted. P value was < 0.001. With the use of special stain, Giemsa and ancillary techniques like IHC, the detection rate of H. pylori was enhanced considerably. CONCLUSIONS With increasing number of H. pylori in the mucosa, there was increase in the chronicity and activity of gastritis. Although immunohistochemistry revealed more cases of H. pylori, Giemsa can be a cost-effective substitute, because of its high specificity and positive predictive value. KEYWORDS H. pylori Gastritis, Giemsa, Haematoxylin and Eosin Stain, Immunohistochemistry


Author(s):  
Badugu Rao Bahadur ◽  
Gangadhara Rao Koneru ◽  
Prabha Devi Kodey ◽  
Jyothi Melam

Background: To differentiate ovarian mass as benign or malignant could change clinical approach. Finding a screening and diagnostic method for ovarian cancer is challenging due to high mortality and insidious symptoms. Risk malignancy index (RMI) has the advantage of rapid and exact triage of patients with ovarian mass.Methods: Prospective study carried for 2 years at NRI Medical College and General Hospital, Chinakakani, Mangalagiri, Andhra Pradesh, India. 79 patients with ovarian mass were investigated and risk malignancy index (RMI-3 and RMI-4) calculated. Final confirmation was done based on histopathological report. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for RMI 3 and RMI 4 taking histopathology as control and comparison was done.Results: (n=79); 50 (63.29%) cases were benign and 29 (36.70%) were malignant based on histopathology. RMI 4 is more sensitive (68.96%) than RMI 3 (62.06%), but RMI 3 is more specific (94%) than RMI 4 (92%).The positive predictive value of RMI-3 and RMI-4 were 85.71%  and 83.33% respectively. The negative predictive value for RMI-4 and RMI-3 were 83.63% and 81.03% respectively.Conclusions: With increasing age, chance of malignancy increases. RMI 4 was more sensitive than RMI-3, however less specific than RMI 3 in differentiating benign and malignant tumors. The positive predictive value is slightly more for RMI 3, than RMI 4. Negative predictive value is slightly more for RMI 4, than RMI 3. 


2017 ◽  
Author(s):  
Ευστάθιος Δράμπαλος

Σκοπός: H εφαρμογή για πρώτη φορά διεθνώς της μορφομετρίας της σπονδυλικής στήλης με χρήση απορροφησιομετρίας (VFA) σε ασθενείς με κυφοπλαστική. Αναλύονται τα πλεονεκτήματα και μειονεκτήματα της μεθόδου, ελέγχεται η αξιοπιστία της και συγκρίνεται με την μορφομετρία κατά τον κλασσικό ακτινολογικό έλεγχο (ΜRΧ) στην εκτίμηση των σπονδυλικών παραμορφώσεων στους συγκεκριμένους ασθενείς.Υλικά και Μέθοδος: Πραγματοποιήθηκαν μετρήσεις σε 42 ασθενείς με κυφοπλαστική λόγω οστεοπορωτικών σπονδυλικών καταγμάτων και αναλύθηκαν οι σπόνδυλοι από τον T4 μέχρι τον L4 με την VFA και την MRX. Μετρήθηκαν το πρόσθιο (ha), μέσο (hm) και οπίσθιο (hp) ύψος του σπονδυλικού σώματος και προσδιορίσθηκαν οι λόγοι ha/hp και hm/hp. Αναλύθηκαν για την VFA η συμφωνία αποτελεσμάτων του ίδιου παρατηρητή (IOA) και η συμφωνία αποτελεσμάτων μεταξύ ανεξάρτητων παρατηρητών (INA) για τους λόγους ha/hp και hm/hp καθώς και για την μέθοδο Genant σε επίπεδο σπονδύλου, ‘περιοχής της σπονδυλικής στήλης (θωρακική/ΘΜΣΣ ή οσφυϊκή/ΟΜΣΣ), σε επίπεδο ‘γειτονικών προς την κυφοπλαστική σπονδύλων’, και σε επίπεδο ‘σπονδύλων με κυφοπλαστική’. Σε κάθε επίπεδο χρησιμοποιήθηκε η μέση τιμή ha/hp και hm/hp. Στη συνέχεια, αναλύσαμε την συμφωνία μεταξύ VFA και MRX στον καθορισμό των λόγων ha/hp και hm/hp καθώς και μετά την διχοτόμηση των λόγων ha/hp περί της τιμής όριο που συνήθως χρησιμοποιείται για τον καθορισμό ενός κατάγματος. Αποτελέσματα: Οι IOA και INA για τους λόγους ha/hp και hm/hp στην VFA ήταν ‘σχεδόν τέλεια’ σε όλα τα επίπεδα (ICC 0.94-0.98). Η εφαρμογή της μεθόδου Genant κατά την VFA ανέδειξε επίσης ‘σχεδόν τέλεια’ INA (ICC=0.833). Η ανάλυση σε επίπεδο σπονδύλου έδειξε ‘σχεδόν τέλεια’ συμφωνία μεταξύ VFA και MRX για τον λόγο ha/hp [intraclass correlation coefficient, ICC=0.85], και ‘ισχυρή συμφωνία’ για τον λόγο hm/hp (ICC=0.78). Για τον λόγο ha/hp η συμφωνία ήταν ‘σχεδόν τέλεια’ τόσο στην ΘΜΣΣ (ICC=0.82) όσο και στην ΟΜΣΣ (ICC=0.87), ενώ για τον λόγο hm/hp η συμφωνία ήταν ‘ισχυρή’ στην ΘΜΣΣ (ICC=0.75) και ‘σχεδόν τέλεια’ στην ΟΜΣΣ (ICC=0.80). Η συμφωνία ήταν εξίσου ‘σχεδόν τέλεια’ σε επίπεδο ‘σπονδύλων με κυφοπλαστική’ (ICC=0.83) όσο και σε επίπεδο ‘γειτονικών προς την κυφοπλαστική σπονδύλων’ (ICC=0.80) για τον λόγο ha/hp. Όταν οι λόγοι ha/hp μετατράπηκαν σε κατάγματα (ναι ή όχι κάταγμα) χρησιμοποιώντας διαφορετικές τιμές κατώφλι για την διάγνωση κατάγματος (λόγοι ha/hp 0.75, 0.80 και 0.85) η συμφωνία μεταξύ των μεθόδων ήταν λιγότερο καλή, από μέτρια έως ουσιώδης (κ 0.52-0.63 στην ΟΜΣΣ και 0.53-0.66 στην ΘΜΣΣ). Χρησιμοποιώντας την κατάταξη Genant οι διαφορές στην ταξινόμηση των σπονδύλων ήταν περισσότερο προς την κατεύθυνση της MRX με 32 αναγνωρισμένα κατάγματα μόνο από την MRX και μόνο 5 μόνο από την VFA. Στη μελέτη αυτή, με επιπολασμό σφηνοειδών σπονδυλικών καταγμάτων 9.3%, οι δείκτες ακρίβειας sensitivity, specificity, positive predictive value (PPV) και negative predictive value (NPV) υπολογίστηκαν σε 0.522, 0.97, 0.87 και 0.92 αντίστοιχα. Συμπεράσματα: Η εφαρμογή της VFA σε ασθενείς με κυφοπλαστική έχει υψηλή επαναληψιμότητα και αναπαραγωγιμότητα. Η συμφωνία μεταξύ VFA και MRX στην εκτίμηση των λόγων ha/hp και hm/hm ήταν από ‘ισχυρή’ έως ‘σχεδόν τέλεια’ ανάλογα με το επίπεδο εξέτασης. Η συμφωνία στην αναγνώριση των σπονδυλικών καταγμάτων ήταν μέτρια. Οι διαφορές ήταν περισσότερο προς την κατεύθυνση της MRX. Η υψηλή τιμή του δείκτη NPV της VFA στους ασθενείς με κυφοπλαστική, δείχνει ότι η μέθοδος θα μπορούσε να χρησιμοποιηθεί για τον εντοπισμό αυτών που χρήζουν περαιτέρω ακτινολογικού ελέγχου.


2020 ◽  
Author(s):  
Bei Zhang ◽  
Li Zhang ◽  
Bingyang Bian ◽  
Fang Lin ◽  
Zining Zhu ◽  
...  

Abstract BACKGROUND Whole body diffusion weighted imaging (WB-DWI) is commonly used for the detection of multiple myeloma (MM). Comparative data on the efficiency of WB-DWI compared with 18 F positron emission tomography computed tomography ( 18 F-FDG PET/CT) to detect MM are lacking. METHODS This was a retrospective, single-center study of twenty-two patients with MM enrolled from January 2019 to December 2019. All patients underwent WB-DWI and 18 F-FDG PET/CT. Pathological and clinical manifestations as well as radiologic follow-up were used for diagnosis. The overall accuracy, sensitivity, specificity, positive predictive value and negative predictive value of both methods were compared. The appearance diffusion coefficient (ADC) values of MM lesions and false-positive lesions were estimated. RESULTS A total of 214 MM bone lesions were evaluated. WB-DWI showed a higher overall accuracy than PET/CT (75.7% and 55.6%, respectively; < 0.05). However, for sensitivity, specificity, positive predictive value and negative predictive value, there were no significant differences for WB-DWI vs PET/CT (99.3% and 83.9%, 64.9% and 94.8%, 63.6% and 54.2%, 98.1% and 65.3%, respectively). The ADC value for MM lesions was significantly lower than that for false-positive lesions (p < 0.001). Receiver operating curve (ROC) curve analysis showed that the AUC was 0.846, and when the cut-off value was 0.745×10 -3 mm 2 /s, the sensitivity and specificity were 86.0% and 82.4%, respectively, which distinguished MM lesions from non-MM lesions. CONCLUSION WB-DWI may be a useful tool for the diagnosis of MM bone disease due to to higher overall accuracy and measurements of ADC values compared with PET/CT.


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