The Role of Native T1 Mapping in the Diagnosis of Myocarditis in a Real-World Setting

Background: This prospective single-center study sought to investigate the impact of cardiovascular magnetic resonance (CMR) on the diagnosis of myocarditis, with special attention given to absolute T1 values and defined cutoff values. Methods: All patients referred to our center with the suspicion of an inflammatory myocardial disease were diagnosed by a consensus expert consortium blinded to CMR findings. Classical Lake Louise criteria were then used to confirm or change the diagnosis. Results: Of a total of 149 patients, 15 were diagnosed with acute myocarditis without taking CMR findings into account. Acute myocarditis was excluded in 91 patients, whereas 42 cases were unclear. Using classical Lake Louise criteria, an additional 35 clear diagnoses were made, either confirming or excluding myocarditis. In the remaining patients, there was no further increase in definitive diagnoses using T1 measurements. The diagnostic performance of T1 mapping in distinguishing acute myocarditis patients from healthy controls was good (area under the curve (AUC) 0.835, cutoff value 1019 ms, sensitivity 73.7%, specificity 72.4%). In the group of patients with suspected and then excluded myocarditis, the cutoff value had a false-positive rate of 56.6%. Conclusions: Acute myocarditis should be diagnosed on the basis of clinical and imaging factors, whereas T1 mapping could be helpful, especially for excluding acute myocarditis.

Download Full-text

Ascertaining an efficient eligibility cut-off for extended Medicare items for eating disorders

Australasian Psychiatry ◽

10.1177/10398562211028632 ◽

2021 ◽

pp. 103985622110286

Author(s):

Tracey Wade ◽

Jamie-Lee Pennesi ◽

Yuan Zhou

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

False Positive Rate ◽

Area Under The Curve ◽

Rate Sensitivity ◽

True Positive Rate ◽

Eating Disorder Examination Questionnaire ◽

Eating Disorder Examination ◽

Positive Rate ◽

The Relationship

Objective: Currently eligibility for expanded Medicare items for eating disorders (excluding anorexia nervosa) require a score ⩾ 3 on the 22-item Eating Disorder Examination-Questionnaire (EDE-Q). We compared these EDE-Q “cases” with continuous scores on a validated 7-item version of the EDE-Q (EDE-Q7) to identify an EDE-Q7 cut-off commensurate to 3 on the EDE-Q. Methods: We utilised EDE-Q scores of female university students ( N = 337) at risk of developing an eating disorder. We used a receiver operating characteristic (ROC) curve to assess the relationship between the true-positive rate (sensitivity) and the false-positive rate (1-specificity) of cases ⩾ 3. Results: The area under the curve showed outstanding discrimination of 0.94 (95% CI: .92–.97). We examined two specific cut-off points on the EDE-Q7, which included 100% and 87% of true cases, respectively. Conclusion: Given the EDE-Q cut-off for Medicare is used in conjunction with other criteria, we suggest using the more permissive EDE-Q7 cut-off (⩾2.5) to replace use of the EDE-Q cut-off (⩾3) in eligibility assessments.

Download Full-text

Considerations on the region of interest in the ROC space

Statistical Methods in Medical Research ◽

10.1177/09622802211060515 ◽

2021 ◽

pp. 096228022110605

Author(s):

Luigi Lavazza ◽

Sandro Morasca

Keyword(s):

Receiver Operating Characteristic ◽

Operating Characteristic ◽

False Positive Rate ◽

Area Under The Curve ◽

Region Of Interest ◽

True Positive Rate ◽

True Positive ◽

Receiver Operating Characteristic Curves ◽

Positive Rate ◽

Receiver Operating

Receiver Operating Characteristic curves have been widely used to represent the performance of diagnostic tests. The corresponding area under the curve, widely used to evaluate their performance quantitatively, has been criticized in several respects. Several proposals have been introduced to improve area under the curve by taking into account only specific regions of the Receiver Operating Characteristic space, that is, the plane to which Receiver Operating Characteristic curves belong. For instance, a region of interest can be delimited by setting specific thresholds for the true positive rate or the false positive rate. Different ways of setting the borders of the region of interest may result in completely different, even opposing, evaluations. In this paper, we present a method to define a region of interest in a rigorous and objective way, and compute a partial area under the curve that can be used to evaluate the performance of diagnostic tests. The method was originally conceived in the Software Engineering domain to evaluate the performance of methods that estimate the defectiveness of software modules. We compare this method with previous proposals. Our method allows the definition of regions of interest by setting acceptability thresholds on any kind of performance metric, and not just false positive rate and true positive rate: for instance, the region of interest can be determined by imposing that [Formula: see text] (also known as the Matthews Correlation Coefficient) is above a given threshold. We also show how to delimit the region of interest corresponding to acceptable costs, whenever the individual cost of false positives and false negatives is known. Finally, we demonstrate the effectiveness of the method by applying it to the Wisconsin Breast Cancer Data. We provide Python and R packages supporting the presented method.

Download Full-text

Vitamin D assessment in perioperative medicine and critical care

Wiener klinische Wochenschrift ◽

10.1007/s00508-019-01584-x ◽

2019 ◽

Cited By ~ 1

Author(s):

Paul Zajic ◽

Stefan Heschl ◽

Michael Schörghuber ◽

Petra Srekl-Filzmaier ◽

Tatjana Stojakovic ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

False Positive Rate ◽

Fluid Loading ◽

Vitamin D Levels ◽

Positive Rate ◽

25 Hydroxy Vitamin D ◽

The Mean ◽

Clinical Trials Registry ◽

The Impact

Summary Background There is controversy about the impact of acute illness on vitamin D levels. This study was carried out to assess the influence of perioperative fluid loading on 25-hydroxy-vitamin D [25(OH)D] levels. The study evaluated the clinical utility of a commonly available chemiluminescence assay (ECLIA, IDS-iSYS) and liquid chromatography/mass spectrometry (LC-MS/MS) in the diagnosis of vitamin D deficiency in this setting. Methods In this prospective observational pilot study in adult patients undergoing cardiovascular surgery on cardiopulmonary bypass (CPB), blood samples drawn at preoperative baseline (t1), after weaning from CPB (t2), on intensive care unit (ICU) admission (t3) and on the first (t4) and second (t5) postoperative days were analyzed. Results A total of 26 patients (130 samples) were included in this study. Fluid loading by CPB led to a median reduction of 25(OH)D by −22.6% (range −54.5% to −19.5%) between t1 and t2. Cohen’s kappa (κ) for method agreement for vitamin D deficiency (tested cut-off values 20 ng/ml and 12 ng/ml), was κ = 0.291 (p < 0.001) and κ = 0.469 (p < 0.001), respectively. The mean difference between measurements by ECLIA and LC-MS/MS was 4.8 ng/ml (±5.7), Pearson’s r for correlation was 0.73 (p < 0.001). The biologically inactive C3-epimer did not contribute to 25(OH)D levels assessed by LC-MS/MS. Conclusion The 25(OH)D measurements by chemiluminescence assays can noticeably deviate from those measured by LC-MS/MS, which can be considered the unequivocal gold standard. These assays may still be acceptably reliable in the screening for vitamin D deficiency, especially in the setting of low vitamin D levels. Stricter definitions, e.g. serum 25(OH)D levels lower than 12 ng/ml, may be used to diagnose deficiency with low false positive rate. Trial Registration DRKS00009216, German Clinical Trials Registry (www.drks.de)

Download Full-text

Applying the Paris System for Reporting Urine Cytology Increases the Rate of Atypical Urothelial Cells in Benign Cases: A Need for Patient Management Recommendations

Acta Cytologica ◽

10.1159/000452092 ◽

2016 ◽

Vol 61 (1) ◽

pp. 71-76 ◽

Cited By ~ 30

Author(s):

Rosario Granados ◽

Joanny A. Duarte ◽

Teresa Corrales ◽

Encarnación Camarmo ◽

Paloma Bajo

Keyword(s):

False Positive Rate ◽

Urine Cytology ◽

Urinary Cytology ◽

Low Grade ◽

High Grade ◽

Abnormal Cytology ◽

Positive Rate ◽

High Grade Carcinoma ◽

Management Recommendations ◽

The Impact

The Paris System (TPS) for reporting urinary cytology attempts to unify the terminology in this field. Objectives: To analyze the impact of adopting TPS by measuring nomenclature agreement and cytohistological correlation. Materials and Methods: Voided urine liquid-based cytology samples corresponding to 149 biopsy-proven cases (76 high-grade carcinomas, 40 low-grade carcinomas, and 33 benign lesions), were reclassified by the same pathologist using TPS. Diagnostic agreement and sensitivity for both nomenclature systems was measured. Results: When using TPS, the rate of atypical samples increased 8 times (from 3 to 24.2%) in benign cases, 10 times (from 2.5 to 25%) in low-grade carcinomas, and 2.4 times (from 6.6 to 15.8%) in high-grade carcinomas. The false-positive rate (abnormal cytology in negative or low-grade carcinoma cases) increased from 11 to 34.2%. Sensitivity was higher (63 vs. 49%) with TPS at the expense of a lower specificity (73 vs. 91%). The agreement between both nomenclatures was moderate for negative and high-grade carcinoma cases (k = 0.42 and 0.56, respectively) and weak for low-grade tumors (k = 0.35). Conclusions: Adopting TPS for reporting urine cytology results in a considerable increase in atypical diagnoses, improving sensitivity but lowering specificity. Appropriate management recommendations for patients with an atypical cytological diagnosis are required.

Download Full-text

Does Inflation Reduce Air Pollution? Evidence from Indonesia

E3S Web of Conferences ◽

10.1051/e3sconf/202131701068 ◽

2021 ◽

Vol 317 ◽

pp. 01068

Author(s):

Andryan Setyadharma ◽

Shanty Oktavilia ◽

Indah Fajarini Sri Wahyuningrum ◽

Sri Indah Nikensari ◽

Arumawan Mei Saputra

Keyword(s):

Air Pollution ◽

Positive Impact ◽

Methodological Approach ◽

Long Run ◽

High Inflation ◽

Positive Rate ◽

Short Run ◽

Negative Impacts ◽

The Impact

Inflation could likely cause devastating impacts where high inflation can harmful economic and social circumstances. However, only limited studies try to find the impact of inflation on the quality of air. The aim of this study is to investigate the empirical linkage between inflation and air pollution in Indonesia covering the period of 1981 until 2017 by using an error correction model (ECM) methodological approach. The result of study suggests that in the short run, higher inflation is causing the lower level of air pollution. Similarly, in the long run, higher inflation is also affecting the lower level of air pollution. While there are a lot of negative impacts of inflation in Indonesia, the finding in this study indicates a positive impact of inflation in Indonesia, which is higher inflation can reduce the air pollution. The results seem contradict with the target of central bank of Indonesia to have a low but positive rate of inflation. Based on the findings, the study suggests the policymakers in Indonesia to support a robust role of inflation stability in achieving targets related to the reduction of air pollution.

Download Full-text

To scan or not to scan: An evaluation of preoperative MRI use in primary breast cancer assessments.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e14146 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e14146-e14146

Author(s):

Tesia McKenzie ◽

Davina Matinho ◽

Olivia Scott ◽

Arbaz Khan ◽

Mila Lachica ◽

...

Keyword(s):

Breast Cancer ◽

Surgical Treatment ◽

False Positive ◽

Primary Breast Cancer ◽

True Positive ◽

Newly Diagnosed ◽

Mri Findings ◽

Positive Rate ◽

The Impact

e14146 Background: Breast cancer (BC) is the most common invasive cancer in adult females.The role of preoperative MRI in assessing the extent of primary breast cancer remains controversial. This study’s objective is to determine if MRIs performed after the diagnosis of invasive/non-invasive-breast cancer will identify additional breast cancers. We hypothesize that preoperative MRIs will result in the discovery of additional significant lesions, leading to changes in surgical treatment. Methods: A retrospective study of 389 BC patient charts were reviewed, dated from January 2000- July 2019. Files were collected from an office in the Breast Cancer Surgery Department. Information on each patient’s imaging studies, treatment, demographics, surgery, and pathology were collected and stored in anonline cloud system. Summary statistics, including proportions, percentages, and difference of proportion hypothesis tests were utilized to interpret the data. All statistical tests were conducted at a 95% confidence interval. Results: We reviewed the charts of 335 patients that met eligibility criteria. In 221 newly diagnosed cancers, a preoperative MRI was taken before treatment. 127 cancers (57.5%)showed additional finding.In BC patients with additional preoperative MRI findings, we observed 61.4%true positive and 38.6%false positive results. These values are comparable to prior studies.We determined that the treatment plan was altered in 17.6%of all patients who received an MRI and in 30.7%of patients with a true positive MRI finding, which is also consistent with previous literature.A majority of the treatment changes were from Lumpectomy to Mastectomy. Conclusions: Literature on MRI use in BC diagnosis exists; our study differs by focusing on newly diagnosed breast cancers.We discovered 35.3% of preoperative MRIs identified a true additional finding in known breast cancer. In addition, our true positive rate (61.4%) and false positive rate (22.2%) of MRI findings is comparable to those of previous studies. Plans were changed in 30.7% of additional findings supporting the idea that preoperative MRI studies are useful when organizing surgical treatment. Further studies to demonstrate the impact on local recurrence rates and overall survival, may clarify the true role of pre-operative MRI in these cases.

Download Full-text

Passive leg movement and nitric oxide-mediated vascular function: the impact of age

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00806.2014 ◽

2015 ◽

Vol 308 (6) ◽

pp. H672-H679 ◽

Cited By ~ 35

Author(s):

Joel D. Trinity ◽

H. Jonathan Groot ◽

Gwenael Layec ◽

Matthew J. Rossman ◽

Stephen J. Ives ◽

...

Keyword(s):

Nitric Oxide ◽

Vascular Function ◽

Area Under The Curve ◽

The Elderly ◽

Novel Approach ◽

Leg Movement ◽

The Impact ◽

Male Subjects ◽

Peak Increase

In young healthy men, passive leg movement (PLM) elicits a robust nitric oxide (NO)-dependent increase in leg blood flow (LBF), thus providing a novel approach to assess NO-mediated vascular function. While the magnitude of the LBF response to PLM is markedly reduced with age, the role of NO in this attenuated response in the elderly is unknown. Therefore, this study sought to determine the contribution of NO in the PLM-induced LBF with age. Fourteen male subjects (7 young, 24 ± 1 yr; and 7 old, 75 ± 3 yr) underwent PLM with and without NO synthase (NOS) inhibition achieved by intra-arterial infusion of NG-monomethyl-l-arginine (l-NMMA). LBF was determined second-by-second by Doppler ultrasound, and central hemodynamics were measured by finger photoplethysmography. NOS inhibition blunted the PLM-induced peak increase in LBF in the young (control: 668 ± 106; l-NMMA: 431 ± 95 Δml/min; P = 0.03) but had no effect in the old (control: 266 ± 98; l-NMMA: 251 ± 92 Δml/min; P = 0.59). Likewise, the magnitude of the reduction in the overall (i.e., area under the curve) PLM-induced LBF response to NOS inhibition was less in the old (LBF: −31 ± 18 ml) than the young (LBF: −129 ± 21 ml; P < 0.01). These findings suggest that the age-associated reduction in PLM-induced LBF in the elderly is primarily due to a reduced contribution to vasodilation from NO and therefore support the use of PLM as a novel approach to assess NO-mediated vascular function across the lifespan.

Download Full-text

A novel machine learning algorithm has the potential to reduce by 1/3 the quantity of ILR episodes needing review

European Heart Journal ◽

10.1093/eurheartj/ehab724.0316 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Rosier ◽

E Crespin ◽

A Lazarus ◽

G Laurent ◽

A Menet ◽

...

Keyword(s):

Machine Learning ◽

False Positive ◽

Learning Algorithm ◽

False Positive Rate ◽

Machine Learning Algorithm ◽

The Novel ◽

Funding Sources ◽

High Workload ◽

Positive Rate ◽

The Impact

Abstract Background Implantable Loop Recorders (ILRs) are increasingly used and generate a high workload for timely adjudication of ECG recordings. In particular, the excessive false positive rate leads to a significant review burden. Purpose A novel machine learning algorithm was developed to reclassify ILR episodes in order to decrease by 80% the False Positive rate while maintaining 99% sensitivity. This study aims to evaluate the impact of this algorithm to reduce the number of abnormal episodes reported in Medtronic ILRs. Methods Among 20 European centers, all Medtronic ILR patients were enrolled during the 2nd semester of 2020. Using a remote monitoring platform, every ILR transmitted episode was collected and anonymised. For every ILR detected episode with a transmitted ECG, the new algorithm reclassified it applying the same labels as the ILR (asystole, brady, AT/AF, VT, artifact, normal). We measured the number of episodes identified as false positive and reclassified as normal by the algorithm, and their proportion among all episodes. Results In 370 patients, ILRs recorded 3755 episodes including 305 patient-triggered and 629 with no ECG transmitted. 2821 episodes were analyzed by the novel algorithm, which reclassified 1227 episodes as normal rhythm. These reclassified episodes accounted for 43% of analyzed episodes and 32.6% of all episodes recorded. Conclusion A novel machine learning algorithm significantly reduces the quantity of episodes flagged as abnormal and typically reviewed by healthcare professionals. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. ILR episodes analysis

Download Full-text

The impact of P-hacking on "Redefine statistical significance"

10.31234/osf.io/bp2z4 ◽

2017 ◽

Author(s):

Harry Crane

Keyword(s):

False Positive ◽

Statistical Significance ◽

False Positive Rate ◽

Perceived Benefits ◽

Replication Rate ◽

Recent Proposal ◽

Positive Rate ◽

Replication Crisis ◽

The Impact ◽

Lower Cutoff

A recent proposal to "redefine statistical significance" (Benjamin, et al. Nature Human Behaviour, 2017) claims that false positive rates "would immediately improve" by factors greater than two and replication rates would double simply by changing the conventional cutoff for 'statistical significance' from P<0.05 to P<0.005. I analyze the veracity of these claims, focusing especially on how Benjamin, et al neglect the effects of P-hacking in assessing the impact of their proposal. My analysis shows that once P-hacking is accounted for the perceived benefits of the lower threshold all but disappear, prompting two main conclusions: (i) The claimed improvements to false positive rate and replication rate in Benjamin, et al (2017) are exaggerated and misleading. (ii) There are plausible scenarios under which the lower cutoff will make the replication crisis worse.

Download Full-text

Classification of Breast Cancer in Mammograms with Deep Learning Adding a Fifth Class

Applied Sciences ◽

10.3390/app112311398 ◽

2021 ◽

Vol 11 (23) ◽

pp. 11398

Author(s):

Salvador Castro-Tapia ◽

Celina Lizeth Castañeda-Miranda ◽

Carlos Alberto Olvera-Olvera ◽

Héctor A. Guerrero-Osuna ◽

José Manuel Ortiz-Rodriguez ◽

...

Keyword(s):

Breast Cancer ◽

Deep Learning ◽

Imaging Techniques ◽

False Positive Rate ◽

Area Under The Curve ◽

Fine Tuning ◽

Cad System ◽

Leading Role ◽

Operational Characteristics ◽

Positive Rate

Breast cancer is one of the diseases of most profound concern, with the most prevalence worldwide, where early detections and diagnoses play the leading role against this disease achieved through imaging techniques such as mammography. Radiologists tend to have a high false positive rate for mammography diagnoses and an accuracy of around 82%. Currently, deep learning (DL) techniques have shown promising results in the early detection of breast cancer by generating computer-aided diagnosis (CAD) systems implementing convolutional neural networks (CNNs). This work focuses on applying, evaluating, and comparing the architectures: AlexNet, GoogLeNet, Resnet50, and Vgg19 to classify breast lesions after using transfer learning with fine-tuning and training the CNN with regions extracted from the MIAS and INbreast databases. We analyzed 14 classifiers, involving 4 classes as several researches have done it before, corresponding to benign and malignant microcalcifications and masses, and as our main contribution, we also added a 5th class for the normal tissue of the mammary parenchyma increasing the correct detection; in order to evaluate the architectures with a statistical analysis based on the received operational characteristics (ROC), the area under the curve (AUC), F1 Score, accuracy, precision, sensitivity, and specificity. We generate the best results with the CNN GoogLeNet trained with five classes on a balanced database with an AUC of 99.29%, F1 Score of 91.92%, the accuracy of 91.92%, precision of 92.15%, sensitivity of 91.70%, and specificity of 97.66%, concluding that GoogLeNet is optimal as a classifier in a CAD system to deal with breast cancer.

Download Full-text