scholarly journals Detectability on Plain CT is an Effective Discriminator between Carcinoma and Benign Disorder for a Polyp >10 mm in the Gallbladder

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 388
Author(s):  
Tatsunori Satoh ◽  
Masataka Kikuyama ◽  
Keiko Sasaki ◽  
Hirotoshi Ishiwatari ◽  
Shinya Kawaguchi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multivariate Analysis ◽  
Odds Ratio ◽  
Patient Characteristics ◽  
Polyp Size ◽  
Predictive Values ◽  
Lesion Detectability ◽  
Contrast Enhanced ◽  
Cell Densities ◽  
Sensitivity Specificity

An appropriate diagnosis is required to avoid unnecessary surgery for gallbladder cholesterol polyps (GChPs) and to appropriately treat pedunculated gallbladder carcinomas (GCs). Generally, polyps >10 mm are regarded as surgical candidates. We retrospectively evaluated plain and contrast-enhanced (CE) computed tomography (CT) findings and histopathological features of 11 early GCs and 10 GChPs sized 10–30 mm to differentiate between GC and GChP >10 mm and determine their histopathological background. Patient characteristics, including polyp size, did not significantly differ between groups. All GCs and GChPs were detected on CE-CT; GCs were detected more often than GChPs on plain CT (73% vs 9%; p < 0.01). Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for GCs were 73%, 90%, 89%, 75%, and 81%, respectively. On multivariate analysis, lesion detectability on plain CT was independently associated with GCs (odds ratio, 27.1; p = 0.044). Histopathologically, GChPs consisted of adipose tissue. Although larger vessel areas in GCs than in GChPs was not significant (52,737 μm2 vs 31,906 μm2; p = 0.51), cell densities were significantly greater in GCs (0.015/μm2 vs 0.0080/μm2; p < 0.01). Among GPs larger than 10 mm, plain CT could contribute to differentiating GCs from GChPs.

scholarly journals Contrast-Enhanced EUS for Differential Diagnosis of Pancreatic Masses: A Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Sibin Mei ◽  
Mengyu Wang ◽  
Leimin Sun
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Likelihood Ratio ◽  
Endoscopic Ultrasonography ◽  
Odds Ratio ◽  
Area Under The Curve ◽  
Diagnostic Odds Ratio ◽  
Contrast Enhanced ◽  
Pancreatic Masses ◽  
Sensitivity Specificity

Background. Though methods for the diagnosis of pancreatic masses are various, such as ultrasonography (US), computed tomography (CT), endoscopic ultrasonography (EUS), and contrast-enhanced computed tomography (CE-CT), their sensitivity, specificity, and accuracy are not quite satisfying. Contrast-enhanced endoscopic ultrasonography (CE-EUS), as a new technique, has its own unique advantages in diagnosing pancreatic disease. However, its sensitivity, specificity, and accuracy are still controversial. Objective. To evaluate the accuracy of CE-EUS for differential diagnosis between benign and malignant pancreatic mass lesions. Design. Eighteen relevant articles systemically searched from PubMed, Web of Science, Ovid, Scopus, and MEDLINE were selected. The pooled results were calculated in a fixed effects model. Main Outcome Measurement. The pooled sensitivity, specificity, positive likelihood ratio (LR), negative likelihood ratio, diagnostic odds ratio (OR), and summary receiver operating characteristic (SROC) curve. Results. The pooled sensitivity, specificity, and diagnostic odds ratio of CE-EUS for the differential diagnosis of pancreatic adenocarcinomas were 0.91 (95% confidence interval (CI), 0.89-0.93), 0.86 (95% CI, 0.83-0.89), and 69.50 (95% CI, 48.89-98.80), respectively. The SROC area under the curve was 0.9545. The subgroup analysis based on excluding the outliers showed that the heterogeneity was eliminated and the pooled sensitivity and specificity were 0.92 (95% CI, 0.90-0.93) and 0.87 (95% CI, 0.84-0.89), respectively. The SROC area under the curve was 0.9569. Conclusion. CE-EUS is a useful method to distinguish pancreatic adenocarcinoma from other pancreatic diseases. Compared with EUS elastography, it has higher specificity. However, it is still not superior to pathological diagnosis for the identification of pancreatic carcinomas.

scholarly journals Accuracy of the fluorescence-aided identification technique (FIT) for detecting tooth-colored restorations utilizing different fluorescence-inducing devices: an ex vivo comparative study

2021 ◽  
Author(s):  
W. Leontiev ◽  
E. Magni ◽  
C. Dettwiler ◽  
C. Meller ◽  
R. Weiger ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ex Vivo ◽  
Predictive Values ◽  
Composite Restorations ◽  
Significant Difference ◽  
Identification Technique ◽  
Illumination Method ◽  
Sensitivity Specificity ◽  
Entire Procedure ◽  
Higher Sensitivity

Abstract Objectives The aim of the present study was to compare the accuracy of the conventional illumination method (CONV) and the fluorescence-aided identification technique (FIT) for distinguishing between composite restorations and intact teeth using different fluorescence-inducing devices commonly used for FIT. Materials and methods Six groups of six dentists equipped with one of six different FIT systems each independently attempted to identify composite restorations and intact teeth on a full-mouth model with 22 composite restorations using CONV and, 1 h later, FIT. The entire procedure was repeated 1 week later. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values, including 95% confidence intervals (CI), were calculated for CONV and FIT overall and for each device. The influence of examiner age, method, and device on each parameter was assessed by multivariate analysis of variance. Results The sensitivity (84%, CI 81–86%), specificity (94%, CI 93–96%), PPV (92%, CI 90–94%), and NPV (90%, CI 88–91%) of FIT was significantly higher than that of CONV (47%, CI 44–50%; 82%, CI 79–84%; 66%, CI 62–69%, and 69%, CI 68–71%, respectively; p<0.001). The differences between CONV and FIT were significant for all parameters and FIT systems except VistaCam, which achieved no significant difference in specificity. Examiners younger than 40 years attained significantly higher sensitivity and negative predictive values than older examiners. Conclusions FIT is more reliable for detecting composite restorations than the conventional illumination method. Clinical relevance FIT can be considered an additional or alternative tool for improving the detection of composite restorations.

Role of contrast-enhanced spectral mammography in the post biopsy management of B3 lesions: Preliminary results

2018 ◽  
Vol 105 (5) ◽  
pp. 378-387 ◽  
Author(s):  
Giulia Bicchierai ◽  
Jacopo Nori ◽  
Diego De Benedetto ◽  
Cecilia Boeri ◽  
Ermanno Vanzi ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Surgical Excision ◽  
Surgical Biopsy ◽  
Predictive Values ◽  
Contrast Enhanced ◽  
B3 Lesions ◽  
Malignant Lesions ◽  
Sensitivity Specificity

PurposeTo evaluate the role of contrast-enhanced spectral mammography (CESM) in the post biopsy management of breast lesions classified as lesions of uncertain malignant potential (B3) by core needle biopsy and vacuum-assisted biopsy (VAB).MethodsThe local ethics committee approved this retrospective study and for this type of study formal consent is not required. A total of 42 B3 lesions in 40 women aged 41–77 years were included in our study. All patients underwent CESM 2–3 weeks after the biopsy procedure and surgical excision was subsequently performed within 60 days of the CESM procedure. Three radiologists reviewed the images independently. The results were then compared with histologic findings.ResultsThe sensitivity, specificity, and positive and negative predictive values for confirmed demonstration of malignancy at CESM were 33.3%, 87.2%, 16.7%, and 94.4% for reader 1; 66.7%, 76.9%, 18.2%, and 96.7% for reader 2; 66.7%, 74.4%, 16.7%, and 96.7% for reader 3. Overall agreement on detection of malignant lesions using CESM among readers ranged from moderate to substantial (κ = .451–.696), for categorization of BPE from moderate to substantial (κ = .562–.711), and for evaluation of lesion intensity enhancement from fair to moderate (κ = .346–.459).ConclusionIn cases of Breast Imaging Reporting and Data System (BI-RADS) 1, BI-RADS 2, or BI-RADS 3 results at CESM, follow-up or VAB rather than surgical biopsy might be performed.

scholarly journals Small Subcutaneous Soft Tissue Tumors (<5 cm) Can Be Sarcomas and Contrast-Enhanced Ultrasound (CEUS) Is Useful to Identify Potentially Malignant Masses

2020 ◽  
Vol 17 (23) ◽  
pp. 8868
Author(s):  
Armanda De Marchi ◽  
Simona Pozza ◽  
Lorena Charrier ◽  
Filadelfo Cannone ◽  
Franco Cavallo ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Malignant Tumors ◽  
Univariate Analysis ◽  
Soft Tissue Tumors ◽  
Deep Fascia ◽  
Contrast Enhanced Ultrasound ◽  
Predictive Values ◽  
Contrast Enhanced ◽  
Potentially Malignant ◽  
Sensitivity Specificity

Subcutaneous masses smaller than 5 cm can be malignant, in contrast with the international guidelines. Ultrasound (US) and magnetic resonance imaging (MRI) are useful to distinguish a potentially malignant mass from the numerous benign soft tissue (ST) lesions. Contrast-enhanced ultrasound (CEUS) was applied in ST tumors, without distinguishing the subcutaneous from the deep lesions. We evaluated CEUS and MRI accuracy in comparison to histology in differentiating malignant from nonmalignant superficial ST masses, 50% smaller than 5 cm. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) with their 95% confidence intervals (CI) were calculated. Of malignant cases, 44.4% measured ≤5 cm. At univariate analysis, no statistically significant differences emerged between benign and malignant tumors in relation with clinical characteristics, except for relationship with the deep fascia (p = 0.048). MRI accuracy: sensitivity 52.8% (CI 37.0, 68.0), specificity 74.1% (CI 55.3, 86.8), PPV 73.1% (CI 53.9, 86.3), and NPV 54.1% (CI 38.4, 69.0). CEUS accuracy: sensitivity 75% (CI 58.9, 86.3), specificity 37% (CI 21.5, 55.8), PPV 61.4% (CI 46.6, 74.3), and NPV 52.6% (CI 31.7, 72.7). CEUS showed a sensitivity higher than MRI, whereas PPV and NPV were comparable. Also, masses measuring less than 5 cm can be malignant and referral criteria for centralization could be revised.

scholarly journals Prediction of Extrathyroidal Extension Using Ultrasonography and Computed Tomography

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Doh Young Lee ◽  
Tack-Kyun Kwon ◽  
Myung-Whun Sung ◽  
Kwang Hyun Kim ◽  
J. Hun Hah
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Extrathyroidal Extension ◽  
Ct Scans ◽  
Imaging Features ◽  
Predictive Values ◽  
Preoperative Prediction ◽  
Ct Findings ◽  
Sensitivity Specificity ◽  
Thyroid Capsule

Objectives. The aim of the present study was to evaluate the value of high-resolution ultrasound (US) and computed tomography (CT) scan for preoperative prediction of the extrathyroidal extension (ETE).Methods. We analyzed the medical records of 377 patients with papillary thyroid carcinoma (PTC) with preoperative US and CT scan to calculate the sensitivity, specificity, and positive and negative predictive values of characteristics imaging features (such as contact and disruption of thyroid capsule) for the presence of ETE in postoperative pathologic examination. We also evaluated the diagnostic power for several combinations of US and CT findings.Results. ETE was present in 174 (46.2%) based on pathologic reports. The frequency of ETE was greater in the patients with greater degrees of tumor contact and disruption of capsule, as revealed by both US and CT scans (positive predictive value of 72.2% and 81.8%, resp.). Considering positive predictive values and AUC of US and CT categories, separately or combined, a combination of US and CT findings was most accurate for predicting ETE (83.0%, 0.744).Conclusions. This study suggests that ETE can be predicted most accurately by a combination of categories based on the findings of US and CT scans.

scholarly journals In vivo detection of external apical root resorption induced by apical periodontitis using periapical radiography and cone-beam computed tomography

2021 ◽  
Author(s):  
Stephanie Diaz Huamán ◽  
Maya Fernanda Manfrin Arnez ◽  
Fernanda Maria Machado Pereira Cabral de Oliveira ◽  
Andiara De Rossi ◽  
Léa Assed Bezerra Silva ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Predictive Value ◽  
Root Resorption ◽  
Calculated Data ◽  
Cone Beam ◽  
Predictive Values ◽  
Apical Root Resorption ◽  
External Apical Root Resorption ◽  
Sensitivity Specificity

Abstract Objectives: To investigate sensitivity, specificity, predictive values and accuracy of periapical radiography (PR) and Cone beam computed tomography (CBCT) for detection of external apical root resorption (EARR).Materials and Methods: Dog’s teeth with experimentally induced root resorption underwent or not root canal treatment (n = 62 roots). True positives (TP), false positives (FP), true negatives (TN) and false negatives (FN) in PR and CBCT diagnoses were determined using histopathologic findings as gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (TP + TN) in the diagnosis of EARR were calculated. Data was compared using chi-squared test (⍺= 0.05).Results: We found that PR detected EARR in 35% of roots and CBCT, in 47%. EARR was microscopically diagnosed in 50% (p = 0.03 comparison between PR and microscopy; p = 0.67 comparison between CBCT and microscopy). Overall, CBCT produced more accurate diagnoses than PR (0.93 for CBCT versus 0.70 for PR; p = 0.008). Interestingly, when data was stratified into small and large resorptions, PR and CBCT allowed identification of large resorption in 100% of the cases and showed the same accuracy. However, for small resorptions, PR showed an accuracy of 0.83, whereas CBCT showed an accuracy of 0.96 (p = 0.003).Conclusions: We demonstrated that CBCT showed higher accuracy to detect EARR. These findings shed light on the use of CBCT for detection of initial root resorption.Clinical relevance: Early identification of resorption allows a prompt treatment and reduces the risk of dental structure loss.

Risk Factors for Prolonged Opioid Use After Ankle Fracture Surgery

2021 ◽  
pp. 193864002110291
Author(s):  
Matthew S. Broggi ◽  
Philip O. Oladeji ◽  
Corey Spenser ◽  
Rishin J. Kadakia ◽  
Jason T. Bariteau
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Odds Ratio ◽  
Ankle Fracture ◽  
Significant Risk ◽  
Patient Characteristics ◽  
Low Back ◽  
Opioid Use ◽  
Increased Risk ◽  
Fracture Surgery

Background The incidence of ankle fractures is increasing, and risk factors for prolonged opioid use after ankle fracture fixation are unknown. Accordingly, the purpose of this study was to investigate risk factors that lead to prolonged opioid use after surgery. Methods The Truven MarketScan database was used to identify patients who underwent ankle fracture surgery from January 2009 to December 2018 based on CPT codes. Patient characteristics were collected, and patients separated into 3 cohorts based on postoperative opioid use (no refills, refills within 6 months postoperative, and refills within 1 year postoperatively). The χ2 test and multivariate analysis were performed to assess the association between risk factors and prolonged use. Results In total, 34 691 patients were analyzed. Comorbidities most highly associated with prolonged opioid use include 2+ preoperative opioid prescriptions (odds ratio [OR] = 11.92; P < .001), tobacco use (OR = 2.03; P < .001), low back pain (OR = 1.81; P < .001), depression (OR = 1.48; P < .001), diabetes (OR = 1.34; P < .001), and alcohol abuse (OR = 1.32; P < .001). Conclusion Opioid use after ankle fracture surgery is common and may be necessary; however, prolonged opioid use and development of dependence carries significant risk. Identifying those patients at an increased risk for prolonged opioid use can aid providers in tailoring their postoperative pain regimen. Levels of Evidence Prognostic, Level III

scholarly journals Comparison of Three-Dimensional Fluoroscopy versus Postoperative Computed Tomography for the Assessment of Accurate Screw Placement after Instrumented Spine Surgery

2012 ◽  
Vol 2 (2) ◽  
pp. 095-098 ◽  
Author(s):  
Sarah T. Garber ◽  
Erica F. Bisson ◽  
Meic H. Schmidt
Keyword(s):  
Computed Tomography ◽  
Three Dimensional ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Predictive Values ◽  
Frequent Use ◽  
Number Of Patients ◽  
Kappa Value ◽  
Instrumented Spine Surgery ◽  
Sensitivity Specificity

While intraoperative three-dimensional fluoroscopy does not possess the resolution and image quality of computed tomography (CT), it may provide adequate information about screw placement to guide intra- and postoperative decision making. We compared the accuracy of intraoperative three-dimensional fluoroscopy visualization of proper screw placement with that of postoperative CT. We retrospectively reviewed spinal instrumentation procedures done using the O-arm (Medtronic, Minneapolis, MN, USA) that also had postoperative CT. All screws were assessed for placement accuracy on O-arm and CT images on a 4-point scale. In this study, 20 cases met the inclusion criteria. Thirteen breaches (11 grade 1 and 2 grade 2) were identified on O-arm images, and 14 breaches (10 grade 1, 3 grade 2, and 1 grade 3) were identified on CT. Sensitivity, specificity, and positive and negative predictive values were 93, 99, 99, and 98%, respectively. The Kappa value (0.96) suggested a very high degree of agreement between three-dimensional fluoroscopy and CT in determining accuracy of screw placement. These findings may allow less frequent use of postoperative CT scans, improving cost effectiveness in patients who require spinal instrumentation procedures and potentially decreasing the number of patients who require replacement of an inappropriately positioned screw.

scholarly journals e-ASPECTS software is non-inferior to neuroradiologists in applying the ASPECT score to computed tomography scans of acute ischemic stroke patients

2016 ◽  
Vol 12 (6) ◽  
pp. 615-622 ◽  
Author(s):  
Simon Nagel ◽  
Devesh Sinha ◽  
Diana Day ◽  
Wolfgang Reith ◽  
René Chapot ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Correlation Coefficients ◽  
Ground Truth ◽  
Stroke Patients ◽  
Computed Tomography Images ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Sensitivity Specificity ◽  
Contrast Enhanced Computed Tomography

Background The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is an established 10-point quantitative topographic computed tomography scan score to assess early ischemic changes. We performed a non-inferiority trial between the e-ASPECTS software and neuroradiologists in scoring ASPECTS on non-contrast enhanced computed tomography images of acute ischemic stroke patients. Methods In this multicenter study, e-ASPECTS and three independent neuroradiologists retrospectively and blindly assessed baseline non-contrast enhanced computed tomography images of 132 patients with acute anterior circulation ischemic stroke. Follow-up scans served as ground truth to determine the definite area of infarction. Sensitivity, specificity, and accuracy for region- and score-based analysis, receiver-operating characteristic curves, Bland-Altman plots and Matthews correlation coefficients relative to the ground truth were calculated and comparisons were made between neuroradiologists and different pre-specified e-ASPECTS operating points. The non-inferiority margin was set to 10% for both sensitivity and specificity on region-based analysis. Results In total 2640 (132 patients × 20 regions per patient) ASPECTS regions were scored. Mean time from onset to baseline computed tomography was 146 ± 124 min and median NIH Stroke Scale (NIHSS) was 11 (6–17, interquartile range). Median ASPECTS for ground truth on follow-up imaging was 8 (6.5–9, interquartile range). In the region-based analysis, two e-ASPECTS operating points (sensitivity, specificity, and accuracy of 44%, 93%, 87% and 44%, 91%, 85%) were statistically non-inferior to all three neuroradiologists (all p-values <0.003). Both Matthews correlation coefficients for e-ASPECTS were higher (0.36 and 0.34) than those of all neuroradiologists (0.32, 0.31, and 0.3). Conclusions e-ASPECTS was non-inferior to three neuroradiologists in scoring ASPECTS on non-contrast enhanced computed tomography images of acute stroke patients.

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