scholarly journals Diagnostic Performance of Dual-Energy Subtraction Radiography for the Detection of Pulmonary Emphysema: An Intra-Individual Comparison

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1849
Author(s):  
Julia A. Mueller ◽  
Katharina Martini ◽  
Matthias Eberhard ◽  
Mathias A. Mueller ◽  
Alessandra A. De Silvestro ◽  
...  
Keyword(s):  
Pulmonary Emphysema ◽  
Diagnostic Performance ◽  
Conventional Radiography ◽  
Dual Energy ◽  
P Value ◽  
X Rays ◽  
Reference Standard ◽  
Significant Difference ◽  
Energy Subtraction ◽  
Interreader Agreement

Purpose/Objectives: To compare the diagnostic performance of dual-energy subtraction (DE) and conventional radiography (CR) for detecting pulmonary emphysema using computed tomography (CT) as a reference standard. Methods and Materials: Sixty-six patients (24 female, median age 73) were retrospectively included after obtaining lateral and posteroanterior chest X-rays with a dual-shot DE technique and chest CT within ±3 months. Two experienced radiologists first evaluated the standard CR images and, second, the bone-/soft tissue weighted DE images for the presence (yes/no), degree (1–4), and quadrant-based distribution of emphysema. CT was used as a reference standard. Inter-reader agreement was calculated. Sensitivity and specificity for the correct detection and localization of emphysema was calculated. Further degree of emphysema on CR and DE was correlated with results from CT. A p-value < 0.05 was considered as statistically significant. Results: The mean interreader agreement was substantial for CR and moderate for DE (kCR = 0.611 vs. kDE = 0.433; respectively). Sensitivity, as well as specificity for the detection of emphysema, was comparable between CR and DE (sensitivityCR 96% and specificityCR 75% vs. sensitivityDE 91% and specificityDE 83%; p = 0.157). Similarly, there was no significant difference in the sensitivity or specificity for emphysema localization between CR and DE (sensitivityCR 50% and specificityCR 100% vs. sensitivityDE 57% and specificityDE 100%; p = 0.157). There was a slightly better correlation with CT of emphysema grading in DE compared to CR (rDE = 0.75 vs. rCR = 0.68; p = 0.108); these differences were not statistically significant, however. Conclusion: Diagnostic accuracy for the detection, quantification, and localization of emphysema between CR and DE is comparable. Interreader agreement, however, is better with CR compared to DE

Serum Concentrations of DKK-1 Correlate with the Extent of Bone Disease in Multiple Myeloma.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3518-3518
Author(s):  
Martin Kaiser ◽  
Maren Mieth ◽  
Peter Liebisch ◽  
Susanne Rötzer ◽  
Christian Jakob ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Disease ◽  
Serum Levels ◽  
Conventional Radiography ◽  
Bone Lesions ◽  
X Rays ◽  
Myeloma Bone Disease ◽  
Lytic Lesions ◽  
Significant Difference ◽  
First Time

Abstract Objectives: Lytic bone disease is a hallmark of multiple myeloma (MM) and is caused by osteoclast activation and osteoblast inhibition. Secretion of Dickkopf (DKK)-1 by myeloma cells was reported to cause inhibition of osteoblast precursors. DKK-1 is an inhibitor of the Wnt/β-catenin signaling, which is a critical signaling pathway for the differentiation of mesenchymal stem cells into osteoblasts. So far there is no study showing a significant difference in serum DKK-1 levels in MM patients with or without lytic bone lesions. Methods: DKK-1 serum levels were quantified in 184 previously untreated MM patients and 33 MGUS patients by ELISA, using a monoclonal anti-DKK-1 antibody. For the evaluation of bone disease, skeletal X-rays were performed. Results: Serum DKK-1 was elevated in MM as compared to MGUS (mean 11,963 pg/mL versus 1993 pg/mL, P < 0.05). Serum DKK-1 levels significantly correlated with myeloma stage according to Durie and Salmon (mean 2223 pg/mL versus 15,209 pg/mL in stage I and II/III, respectively; P = 0.005). Importantly, myeloma patients without lytic lesions in conventional radiography had significantly lower DKK-1 levels than patients with lytic bone disease (mean 3114 pg/mL versus 17,915 pg/mL; P = 0.003). Of interest, serum DKK-1 correlated with the number of bone lesions (0 vs. 1–3 vs. >3 lesions: mean 3114 pg/mL vs. 3559 pg/mL vs. 24,068 pg/mL; P = 0.002). Conclusion: This is the largest study of DKK-1 serum levels in multiple myeloma patients and data show for the first time a correlation between DKK-1 serum concentration and the amount of lytic bone disease, suggesting that DKK1 is an important factor for the extent of bone disease and supporting the hypothesis of DKK-1 as a therapeutic target in myeloma bone disease.

A PHANTOM TEST OF PROTON-INDUCED DUAL-ENERGY X-RAY ANGIOGRAPHY USING IODINATED CONTRAST MEDIA

2007 ◽  
Vol 17 (01n02) ◽  
pp. 11-21 ◽  
Author(s):  
Y. OGURI ◽  
J. HASEGAWA ◽  
M. OGAWA ◽  
J. KANEKO ◽  
K. SASA
Keyword(s):  
Contrast Media ◽  
Dual Energy ◽  
Characteristic Line ◽  
X Rays ◽  
Iodinated Contrast Media ◽  
X Ray ◽  
Cdte Detector ◽  
Iodinated Contrast ◽  
Subtraction Procedure ◽  
Energy Subtraction

Characteristic-line radiation from heavy metal targets bombarded by MeV proton beams has been tested as an X-ray source for dual-energy K-edge subtraction imaging for human angiography (blood vessel imaging) based on iodinated contrast media. To utilize the strong absorption by iodine (Z = 53) at its K-absorption edge (33.2 keV), we used K α-line of La (lanthanum, Z = 57) at 33.4 keV. As a reference, also K α X emission of Sn (tin, Z = 50) at 25.2 keV was employed. Metallic plates of La and Sn were irradiated by 7-MeV protons to produce these characteristic X-rays. Energy-subtraction method was tested using Lucite phantoms which contain aqueous solutions of KI (potassium iodide) with different concentrations. Also Ca ( H 2 PO 4)2 powder was stuffed in these phantoms to simulate bones. The transmission images of the phantoms were recorded on imaging plates. During the exposure, the energy spectra of the X-rays were monitored by a CdTe detector. We found that the contrast of images of iodide solutions taken with La X-rays was higher than that with Sn X-rays. Also the energy subtraction procedure was successfully applied to reduce the graphical noise due to the bones and inhomogeneity of the soft tissue. However, to apply the present method to actual clinical use, the X-ray intensity must be increased by several orders of magnitude. Also the transmission of the “lower-energy” photons has to be a few orders higher for imaging of objects as thick as human chest.

Ready for the Frontline: Is Early Thoracoscopic Decortication the New Standard of Care for Advanced Pneumonia with Empyema?

2006 ◽  
Vol 72 (8) ◽  
pp. 688-693 ◽  
Author(s):  
Adam M. Suchar ◽  
Amer H. Zureikat ◽  
Loretto Glynn ◽  
Mindy B. Statter ◽  
Jongin Lee ◽  
...  
Keyword(s):  
Pleural Fluid ◽  
Surgical Outcome ◽  
Standard Of Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
P Value ◽  
X Rays ◽  
Necrotizing Pneumonia ◽  
Significant Difference ◽  
Student’S T

Video-assisted thoracoscopic decortication (VATD) has been established as an effective and potentially less morbid alternative to open thoracotomy for the management of empyema. However, the timing and role of VATD for advanced pneumonia with empyema is still controversial. In assessing surgical outcome, the authors reviewed their VATD experience in children with empyema or empyema with necrotizing pneumonia. The charts of 42 children who underwent VATD at our institution between July 2001 and July 2005 were retrospectively reviewed for surgical outcome. For purposes of analysis, patients were cohorted into four classes with increasing severity of pneumonia: 1 (-) intraoperative pleural fluid cultures, (-) necrotizing pneumonia, 18 (43%); 2 (+) pleural fluid cultures, (-) necrotizing pneumonia, 10 (24%); 3 (-) pleural fluid cultures, (+) necrotizing pneumonia, 6 (14%); 4 (+) pleural fluid cultures, (+) necrotizing pneumonia, 8 (19%). A P value of <0.05 via Student's t test or Fischer's exact analysis was considered an indicator of significant difference in the comparison of group outcomes. VATD was successfully completed in all 42 patients with no mortality and without significant morbidity (82% had less than 20 cc blood loss). There was found to be no significant difference (p = NS) in time to surgical discharge (removal of chest tube) among all groups. Hospital length of stay postsurgery was found to be significantly increased between 1 and 4 (6 days vs 9 days; P = 0.038). 14/14 (100%) of children with necrotizing pneumonia were found to have evidence of lung parenchymal preservation with improved aeration on follow-up CT scan and/or chest x-rays. The authors conclude that early VATD in children with advanced pneumonia with empyema is indicated to avoid unnecessarily lengthy hospitalization and prolonged intravenous antibiotic therapy. Furthermore, early VATD can be safely performed in various stages of advanced pneumonia with empyema, promoting lung salvage, and accelerating clinical recovery.

scholarly journals Epiphyseal Fusion of Iliac Crests in Male and Female Adolescents: An Age Estimation Criterion

2021 ◽  
Vol 2 (1) ◽  
pp. 11-21
Author(s):  
Muhammad Maqsood ◽  
Muhammad Zahid Bashir Muhammad Zahid Bashir ◽  
Muhammad Kashif Butt Muhammad Kashif Butt ◽  
Faizan Maqsood Faizan Maqsood
Keyword(s):  
Bone Growth ◽  
Iliac Crest ◽  
Skeletal Maturity ◽  
Age Groups ◽  
Radiological Examination ◽  
P Value ◽  
Complete Fusion ◽  
X Rays ◽  
Significant Difference ◽  
The Mean

Background: Determination of age depends upon physical examination, dental assessment, and skeletal evaluation. The radiological examination of bone for appearance and fusion of ossification centers helps in the assessment of skeletal maturity as the process occurs in a particular sequence which is almost constant for that particular bone. Objectives: The objective of this study was to determine the age of fusion of iliac crest by radiological examination of subjects of age bracket 17-25 years coming to Shalamar Hospital Lahore Methods: In this cross-sectional study, radiological examinations (Digital X-Rays) were performed to evaluate the fusion of Iliac Crest in 200 subjects of both genders of 17 – 25 years. Data analysis was done using SPSS Version 23. Conclusions were drawn and compared with available results of previous work done in this field. Results: Out of 200 subjects, there were 132 males (66 %) and 68 females (34%). The mean ± SD age of both genders was 20.41± 2.55. There were 93 cases (70.45%) of complete fusion among males, showing 100 % union in the age groups of 21-25 years, while 40 cases (58.83%) of complete union among females were observed during 20-25 year of age groups. The mean ± SD age of complete union for males was 20.67± 2.61 years and for females 19.90 ± 2.38 years, with a significant p value of <0.05. Similarly, a statistically significant difference was observed among people of different socio-economic statuses. No difference was observed among different ethnic groups. Conclusions: The fusion of the iliac crest is not affected by ethnicity. Factors like diet and nutrition directly affect bone growth and hence bone age. More studies should be conducted across the country to formulate a standard in setting up a uniform criterion for assessing the age of adolescents

scholarly journals Diagnostic Performance of Extracellular Volume Quantified by Dual-Layer Dual-Energy CT for Detection of Acute Myocarditis

2021 ◽  
Vol 10 (15) ◽  
pp. 3286
Author(s):  
Salim Aymeric Si-Mohamed ◽  
Lauria Marie Restier ◽  
Arthur Branchu ◽  
Sara Boccalini ◽  
Anaelle Congi ◽  
...  
Keyword(s):  
Predictive Value ◽  
Diagnostic Performance ◽  
Acute Myocarditis ◽  
Extracellular Volume ◽  
Population Based ◽  
Dual Energy ◽  
Arterial Phase ◽  
Dual Energy Ct ◽  
P Value ◽  
Iodinated Contrast

Background: Myocardial extracellular volume (ECV) is a marker of the myocarditis inflammation burden and can be used for acute myocarditis diagnosis. Dual-energy computed tomography (DECT) enables its quantification with high concordance with cardiac magnetic resonance (CMR). Purpose: To investigate the diagnostic performance of myocardial ECV quantified on a cardiac dual-layer DECT in a population of patients with suspected myocarditis, in comparison to CMR. Methods: 78 patients were included in this retrospective monocenter study, 60 were diagnosed with acute myocarditis and 18 patients were considered as a control population, based on the 2009 Lake and Louise criteria. All subjects underwent a cardiac DECT in acute phase consisted in an arterial phase followed by a late iodine enhancement phase at 10 min after injection (1.2 mL/kg, iodinated contrast agent). ECV was calculated using the hematocrit level measured the day of DECT examinations. Non-parametric analyses have been used to test the differences between groups and the correlations between the variables. A ROC curve has been used to identify the optimal ECV cut-off discriminating value allowing the detection of acute myocarditis cases. A p value < 0.05 has been considered as significant. Results: The mean ECV was significantly higher (p < 0.001) for the myocarditis group compared to the control (34.18 ± 0.43 vs. 30.04 ± 0.53%). A cut-off value of ECV = 31.60% (ROC AUC = 0.835, p < 0.001) allows to discriminate the myocarditis with a sensitivity of 80% and a specificity of 78% (positive predictive value = 92.3%, negative predictive value = 53.8% and accuracy = 79.5%). Conclusion: Myocardial ECV enabled by DECT allows to diagnose the acute myocarditis with a cut-off at 31.60% for a sensitivity of 80% and specificity of 78%.

scholarly journals Performance evaluation of Baermann techniques: The quest for developing a microscopy reference standard for the diagnosis of Strongyloides stercoralis

2021 ◽  
Vol 15 (2) ◽  
pp. e0009076
Author(s):  
Woyneshet Gelaye ◽  
Nana Aba Williams ◽  
Stella Kepha ◽  
Augusto Messa Junior ◽  
Pedro Emanuel Fleitas ◽  
...  
Keyword(s):  
Control Strategies ◽  
Strongyloides Stercoralis ◽  
Molecular Techniques ◽  
Diagnostic Methods ◽  
Superior Performance ◽  
P Value ◽  
Reference Standard ◽  
Significant Difference ◽  
Stool Samples ◽  
Composite Reference Standard

Background Soil-transmitted helminths (STH) are common in low and middle income countries where there is lack of access to clean water and sanitation. Effective diagnosis and treatment are essential for the control of STH infections. However, among STH parasites, Strongyloides stercoralis is the most neglected species, both in diagnostics and control strategies. Diagnostic methods cover different approaches, each with different sensitivities and specificities, such as serology, molecular techniques and microscopy based techniques. Of the later, the Baermann technique is the most commonly used procedure. In the literature, several ways have been described to perform the Baermann method, which illustrates the overall lack of a ‘(gold) reference standard’ method for the diagnosis of S. stercoralis infection. In this study we have evaluated the performance of three Baermann techniques in order to improve the reference standard for the microscopic diagnosis of S. stercoralis infection thereby facilitating individual case detection, mapping of the disease and proper evaluation of treatment responses. Methods/Principal findings A community based cross sectional study was conducted at Zenzelima, Bahir Dar Zuria Ethiopia. A total of 437 stool samples were collected and analyzed by the following procedures: conventional Baermann (CB), modified Baermann (MB), and modified Baermann with charcoal pre-incubation (MBCI). The diagnostic sensitivity and Negative Predictive Value (NPV) of each technique was calculated using the combination of all the three techniques as a composite reference standard. Our result indicated that larvae of S. stercoralis were detected in 151 (34.6%) stool samples. The prevalence of S. stercoralis infection based on the three diagnostic methods was 9.6%, 8.0%, and 31.3% by CB, MB, and MBCI respectively. The sensitivity and NPV for CB, MB, and MBCI were 26.7% and 70.8%, 22.1% and 69.6%, and 87.0% and 93.2%, respectively. The MBCI showed significant difference (P- value = <0.001) in the sensitivity and NPV values when compared with CB and MB values. The agreement between CB, MB, and MBCI with the composite reference standard was 31.8%, 26.7%, 89.6%, respectively. Conclusion/Significance Our results suggest the superior performance of MBCI. It is relatively easy to implement, simple to perform and comparatively cheaper. The CB is by far the commonly used method in routine diagnostic although this technique significantly underestimates the true burden of the disease and thereby contributing to the exclusion of S. stercoralis from the control strategies. Therefore, MBCI is recommended as a routine microscopy-based diagnostic test for S. stercoralis infection, particularly in settings where molecular procedures are not available.

scholarly journals Contrast-Enhanced Mammographic Features of In Situ and Invasive Ductal Carcinoma Manifesting Microcalcifications Only: Help to Predict Underestimation?

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4371
Author(s):  
Yun-Chung Cheung ◽  
Kueian Chen ◽  
Chi-Chang Yu ◽  
Shir-Hwa Ueng ◽  
Chia-Wei Li ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Invasive Ductal Carcinoma ◽  
Carcinoma In Situ ◽  
Diagnostic Performance ◽  
Ductal Carcinoma ◽  
Ground Glass ◽  
P Value ◽  
Contrast Enhanced ◽  
Significant Difference

Background: The contrast-enhanced mammographic features of ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) manifesting microcalcifications only on mammograms were evaluated to determine whether they could predict IDC underestimation. Methods: We reviewed patients who underwent mammography-guided biopsy on suspicious breast microcalcifications only and received contrast-enhanced spectral mammography (CESM) within 2 weeks before the biopsy. Those patients who were proven to have cancers (DCIS or IDC) by biopsy and subsequently had surgical treatment in our hospital were included for analysis. The presence or absence, size, morphology and texture of enhancement on contrast-enhanced spectral mammography were reviewed by consensus of two radiologists. Results: A total of 49 patients were included for analysis. Forty patients (81.6%) showed enhancement, including 18 (45%) DCIS and 22 (55%) IDC patients. All nine unenhanced cancers were pure DCIS. Pure DCIS showed 72.22% nonmass enhancement and 83.33% pure ground glass enhancement. IDC showed more mass (72.2% vs. 27.8%) and solid enhancements (83.33% vs. 16.67%). The cancer and texture of enhancement were significantly different between pure DCIS and IDC, with moderate diagnostic performance for the former (p-value < 0.01, AUC = 0.66, sensitivity = 93%, specificity = 39%) and the latter (p-value < 0.01, AUC = 0.74, sensitivity = 65%, specificity = 83%). Otherwise, pure DCIS showed a significant difference in enhanced texture compared with upgraded IDC and IDC (p = 0.0226 and 0.0018, respectively). Conclusions: Nonmass and pure ground glass enhancements were closely related to pure DCIS, and cases showing mass and unpurified solid enhancements should be suspected as IDC. Unenhanced DCIS with microcalcifications only has a low DCIS upgrade rate. The CESM-enhanced features could feasibly predict IDC underestimation.

scholarly journals A Comparative Evaluation of Antigen-Specific Sandwich Immunoassay and Indirect Immunofluorescence Assay (IIF) in Detecting Antineutrophil Cytoplasmic Antibodies: Are We Ready to Replace IIF with ELISA as the Primary Screening Method?

2021 ◽  
Author(s):  
Sangeeta Deka ◽  
Deepjyoti Kalita ◽  
Ravi Shankar ◽  
U. Sasi Rekha ◽  
Girish Sindhwani
Keyword(s):  
Indirect Immunofluorescence ◽  
Diagnostic Performance ◽  
Screening Method ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
Enzyme Linked Immunosorbent Assay ◽  
P Value ◽  
K Value ◽  
Primary Screening ◽  
Significant Difference ◽  
Positive Results

Abstract Background Antineutrophil cytoplasmic antibodies (ANCA) are important biomarkers in the diagnosis of ANCA-associated vasculitis, and indirect immunofluorescence (IIF) had been the method of choice for its detection from the very beginning. However, international consensus on ANCA testing (2017) advocates the use of high-quality immunoassays as the primary screening method. The purpose of this study was to evaluate the diagnostic performance of enzyme-linked immunosorbent assay (ELISA) compared to IIF in detecting ANCA. Methods One-hundred eighty-nine serum samples of suspected or known cases of systemic vasculitis were screened for ANCA by IIF and proteinase-3- and myeloperoxidase-ELISA. In IIF, positive results were further divided into cytoplasmic pattern of ANCA and perinuclear pattern of ANCA, depending upon the pattern of fluorescence. McNemar’s chi-squared test was applied to check the equality of proportions of positive results, and Kappa statistics was used to measure the agreement between the two methods. Diagnostic performance of ELISA was evaluated taking IIF as reference. Results IIF detected ANCA in 17.5% cases and ELISA detected it in 11.6% cases. A good agreement between the overall performance of ELISA and IIF was observed (K-value: 6.8, p-value: < 001). However, a significant difference in the proportion of positive results by the two methods was observed in McNemar’s test (two-sided p-value: 0.007). Taking IIF as standard, ELISA showed 60.6% sensitivity, 98.7% specificity, and predictive value of positive and negative results of 90.9 and 92.2%, respectively. Conclusion The new generation antigen-specific ELISAs had high specificity but the chances of missing cases in primary screening due to the low sensitivity and high false negativity (39.4%) need to be dealt with.

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