Diagnostic Accuracy of 3D Contrast-Enhanced T1 High Resolution Isotropic Volume Excitation MRI for Non-Cavernous Intracranial Dural Arteriovenous Fistula

2021 ◽  
Vol 104 (11) ◽  
pp. 1769-1776
Keyword(s):  
Arteriovenous Fistula ◽  
Predictive Value ◽  
Dural Arteriovenous Fistula ◽  
High Sensitivity ◽  
Dural Sinus ◽  
Venous Dilatation ◽  
Contrast Enhanced ◽  
Keywords Dural Arteriovenous Fistula ◽  
Dural Venous Sinus ◽  
Sensitivity Specificity

Objective: To determine the accuracy of 3D contrast-enhanced THRIVE MRI in diagnosis of non-cavernous intracranial dural AVF compared with DSA. Materials and Methods: Thirty-three patients including fourteen dural AVF cases and nineteen control subjects, were included in the present study. They underwent 3D contrast-enhanced THRIVE MRI by 3T, contrast-enhanced MRA, and DSA. Two independent readers reviewed 3D contrast-enhanced THRIVE images for the presence of transosseous arterial feeders, low signal intensity curvilinear structures in the dural venous sinus, shaggy dural sinus, and cortical venous dilatation. Diagnostic performance values were calculated for 3D contrast-enhanced THRIVE MRI. Results: The 3D contrast-enhanced THRIVE MRI identified 23 from 29 locations of dural AVFs. The overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 91.4%, 79.3%, 93.5%, 67.6% and 96.3%, respectively. Shaggy dural sinus and dilated cortical veins were found in 78.6% and 85.7%, respectively. Conclusion: The 3D contrast-enhanced THRIVE MRI is a valuable tool for diagnosis of dural AVF as well as exclusion of dural AVF due to high sensitivity and specificity. Keywords: Dural arteriovenous fistula; Dural AVF; 3D contrast-enhanced THRIVE MRI

scholarly journals Use of β-D-glucan in diagnosis of suspected Pneumocystis jirovecii pneumonia in adults with HIV infection

2021 ◽  
pp. 095646242110222
Author(s):  
Thomas Juniper ◽  
Chris P Eades ◽  
Eliza Gil ◽  
Harriet Fodder ◽  
Killian Quinn ◽  
...  
Keyword(s):  
Predictive Value ◽  
Diagnostic Tests ◽  
Elevated Serum ◽  
Clinical Information ◽  
High Sensitivity ◽  
Pneumocystis Pneumonia ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Alternative Diagnosis ◽  
Positive Threshold ◽  
Sensitivity Specificity

Objectives: An elevated serum (1-3)-β-D-glucan (BDG) concentration has high sensitivity for a diagnosis of Pneumocystis pneumonia (PCP) in people with HIV (PWH). At the current manufacturer-recommended positive threshold of 80 pg/mL (Fungitell), specificity for PCP is variable and other diagnostic tests are required. We evaluated the utility of serum BDG for diagnosis of suspected PCP in PWH at three inner-London hospitals to determine BDG concentrations for diagnosis and exclusion of PCP. Methods: From clinical case records, we abstracted demographic and clinical information and categorised patients as having confirmed or probable PCP, or an alternative diagnosis. We calculated sensitivity, specificity and positive predictive value (PPV) of serum BDG concentrations >400 pg/mL and negative predictive value (NPV) of BDG <80 pg/mL. Results: 76 patients were included; 29 had laboratory-confirmed PCP, 17 had probable PCP and 30 had an alternative diagnosis. Serum BDG >400 pg/mL had a sensitivity of 83%, specificity of 97% and PPV 97% for diagnosis of PCP; BDG <80 pg/mL had 100% NPV for exclusion of PCP. Conclusions: In PWH with suspected PCP, BDG <80 pg/mL excludes a diagnosis of PCP, whereas BDG concentrations >400 pg/mL effectively confirm the diagnosis. Values 80–400 pg/mL should prompt additional diagnostic tests.

Impact of non-contrast enhanced volumetric MRI-based feeder localization in the treatment of spinal dural arteriovenous fistula

2016 ◽  
Vol 9 (2) ◽  
pp. 178-182 ◽  
Author(s):  
Santhosh Kumar Kannath ◽  
Bejoy Thomas ◽  
P Sankara Sarma ◽  
Jayadevan Enakshy Rajan
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Definitive Treatment ◽  
Spinal Angiography ◽  
Vertebral Level ◽  
Spinal Dural Arteriovenous Fistula ◽  
Historical Cohort ◽  
Contrast Enhanced ◽  
The Impact

BackgroundThe preoperative localization of the feeder of spinal dural arteriovenous fistula (SDAVF) could simplify the diagnostic spinal angiographic procedure. Localization by non-contrast-enhanced MRI-based techniques is an attractive option. However, the usefulness of such an approach for evaluation of SDAVF has not yet been reported.ObjectiveTo study the impact of non-contrast MRI-based feeder localization, followed by targeted spinal angiography, in the evaluation of SDAVF before endovascular intervention.Materials and methodsProspectively collected data were analyzed and the level of the feeder was localized preoperatively. The procedural time for targeted spinal angiography was calculated and compared with that of a historical cohort, who underwent routine spinal angiographic examination before the study period. Follow-up MRI was carried out to assess the reliability of this model for detection of occasional metachronous lesions that might be missed with this approach.ResultsSeven patients underwent targeted spinal angiography during the study. The feeder level was accurately identified in five patients and was localized to one vertebral level in six patients. The correlation between MRI and DSA was statistically significant. The number of spinal levels assessed was fewer and overall procedure time was significantly shorter compared to historical cohort (58 min vs 162 min, respectively; p<0.001). Intervention was coupled with targeted angiography in two patients. Follow-up MRI demonstrated flow voids in one patient, who had recurrent fistula at one vertebral level below the previously embolized feeder.ConclusionsThe non-contrast MRI-based localization technique can reliably detect the level of feeder and help in therapeutic planning of SDAVF. The localization techniques potentially shorten the angiographic procedure and may facilitate simultaneous endovascular definitive treatment. Inclusion of follow-up MRI may be useful for detection of synchronous or metachronous lesions if a targeted approach is adopted. Additionally, this helps to identify failed endovascular therapy.

scholarly journals Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA

2016 ◽  
Vol 18 (1) ◽  
pp. 18 ◽  
Author(s):  
Sevastiţa Iordache ◽  
Mădălin Ionuţ Costache ◽  
Carmen Florina Popescu ◽  
Costin Teodor Streba ◽  
Sergiu Cazacu ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Diagnostic Algorithm ◽  
High Sensitivity ◽  
Clinical Decision ◽  
Needle Aspiration ◽  
Clinical Tool ◽  
Decision Algorithm ◽  
Contrast Enhanced ◽  
Pancreatic Masses ◽  
Sensitivity Specificity

Aims: It is well known that endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has a high sensitivity (over 85%) and specificity (100%) for diagnosis of pancreatic cancer. The aim of the study was to establish a EUS based clinical diagnostic algorithm in patients with pancreatic masses and negative cytopathology after EUS-FNA, based on previously published results and cut-offs of real-time elastographic (RTE) EUS and contrast-enhanced harmonic (CEH) EUS. Material and methods: We included in the study a subgroup of 50 consecutive patients with focal pancreatic masses which underwent EUS examinations with negative EUS-FNA. RTE-EUS and CEH-EUS were performed sequentially in all patients. The sensitivity, specificity and accuracy of these methods were calculated separately. A clinical decision algorithm based on elastography followed by CEH was established. Results: For the diagnosis of possible malignancy, the sensitivity, specificity and accuracy of RTE-EUS were: 97.7%, 77.4%, and 84% respectively. CEH-EUS had similar results: 89.5%, 80.7%, and 84%, respectively. In 25 patients with soft/mixed appearance during elastography,sequential assessment using contrast-enhanced EUSwas performed. The specificity of CEH-EUS for detection of chronic pancreatitis in this sub-set of patients was excellent (100%). In other 25 patients with hard appearance in elastography (low strain) CEH-EUS had an excellent specificity (100%) and accuracy (93%) in the detection of pancreatic cancer. Conclusions: The proposed algorithm with sequential use of elastography followed by CEH could be a good clinical tool in the set of patients with negative EUS-FNA results for the differentiation between benign and malignant focal pancreatic masses. 

scholarly journals New technologies in breast cancer detection – contrast enhanced dual-energy spectral mammography

2019 ◽  
pp. 49-61
Author(s):  
A. V. Chernaya ◽  
S. N. Novikov ◽  
P. V. Krivorotko ◽  
R. Kh. Ulyanova ◽  
V. V. Danilov
Keyword(s):  
Breast Cancer ◽  
Digital Mammography ◽  
Predictive Value ◽  
New Technologies ◽  
Malignant Tumors ◽  
Dual Energy ◽  
Post Contrast ◽  
Morphological Studies ◽  
Contrast Enhanced ◽  
Sensitivity Specificity

Purpose: to study the possibilities of contrast enhanced dual-energy spectral mammography (CESM) in the diagnostics of malignant tumors in the breast.Material and methods. Forty-seven patients with suspicious for breast cancer (BC) lesions underwent CESM. Digital mammography (MMG) and post-contrast images were correlated with the results of path morphological studies after surgery or puncture biopsy was performed.Results. Sensitivity, specificity and overall accuracy in the diagnostics of breast cancer were 83.3%, 85.7%, 85.1% for digital mammography and 91.6%, 91.4%, 91.4% for CESM, respectively. The positive predictive value was 66.6% for digital MMG and 78.5% for CESM. The negative predictive value (NPV) was 96.9% for the CESM and exceeded NPV of the digital MMG, which was 93.7%.Conclusion. Thus, these findings suggest that CESM is an effective method for the diagnostics of malignant tumors in the breast.

A Negative Antinuclear Antibody Does Not Indicate Autoantibody Negativity in Myositis: Role of Anticytoplasmic Antibody as a Screening Test for Antisynthetase Syndrome

2016 ◽  
Vol 44 (2) ◽  
pp. 223-229 ◽  
Author(s):  
Rohit Aggarwal ◽  
Namrata Dhillon ◽  
Noreen Fertig ◽  
Diane Koontz ◽  
Zengbiao Qi ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Predictive Value ◽  
Antinuclear Antibody ◽  
High Sensitivity ◽  
Epithelial Cell Line ◽  
Antisynthetase Syndrome ◽  
Control Groups ◽  
Serum Samples ◽  
Cytoplasmic Staining ◽  
Sensitivity Specificity

Objective.To evaluate the utility of anticytoplasmic autoantibody (anti-CytAb) in antisynthetase antibody–positive (anti-SynAb+) patients.Methods.Anti-SynAb+ patients were evaluated for antinuclear antibody (ANA) and anti-CytAb [cytoplasmic staining on indirect immunofluorescence (IIF)] positivity. Anti-SynAb+ patients included those possessing anti-Jo1 and other antisynthetase autoantibodies. Control groups included scleroderma, systemic lupus erythematosus, Sjögren syndrome, rheumatoid arthritis, and healthy subjects. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy of anti-CytAb, and ANA were assessed. Anti-CytAb and ANA testing was done by IIF on human epithelial cell line 2, both reported on each serum sample without knowledge of the clinical diagnosis or final anti-SynAb results.Results.Anti-SynAb+ patients (n = 202; Jo1, n = 122; non-Jo1, n = 80) between 1985–2013 with available serum samples were assessed. Anti-CytAb showed high sensitivity (72%), specificity (89%), NPV (95%), and accuracy (86%), but only modest PPV (54%) for anti-SynAb positivity. In contrast, ANA showed only modest sensitivity (50%) and poor specificity (6%), PPV (9%), NPV (41%), and accuracy (12%). Positive anti-CytAb was significantly greater in the anti-SynAb+ patients than ANA positivity (72% vs 50%, p < 0.001), and 81/99 (82%) ANA-negative patients in the anti-SynAb+ cohort had positive anti-CytAb. In contrast, the control groups showed high rates for ANA positivity (93.5%), but very low rates for anti-CytAb positivity (11.5%). Combining anti-CytAb or Jo1 positivity showed high sensitivity (92%) and specificity (89%) for identification of anti-SynAb+ patients.Conclusion.Assessing patients for anti-CytAb serves as an excellent screen for anti-SynAb+ patients using simple IIF. Cytoplasmic staining should be assessed and reported for patients suspected of having antisynthetase syndrome and a negative ANA should not be used to exclude this diagnosis.

scholarly journals Usefulness of Modified CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma Using Sonazoid

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 828
Author(s):  
Katsutoshi Sugimoto ◽  
Tatsuya Kakegawa ◽  
Hiroshi Takahashi ◽  
Yusuke Tomita ◽  
Masakazu Abe ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Predictive Value ◽  
Arterial Phase ◽  
Liver Imaging ◽  
Adrenal Rest Tumor ◽  
Contrast Enhanced ◽  
Rim Enhancement ◽  
Diagnostic Usefulness ◽  
Adrenal Rest ◽  
Sensitivity Specificity

The Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) was introduced for classifying suspected hepatocellular carcinoma (HCC). However, it cannot be applied to Sonazoid. We assessed the diagnostic usefulness of a modified CEUS LI-RADS for HCC and non-HCC malignancies based on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Patients with chronic liver disease at risk for HCC were evaluated retrospectively. Nodules ≥1 cm with arterial phase hyperenhancement, no early washout (within 60 s), and contrast defects in the Kupffer phase were classified as LR-5. Nodules showing early washout, contrast defects in the Kupffer phase, and/or rim enhancement were classified as LR-M. A total of 104 nodules in 104 patients (median age: 70.0 years; interquartile range: 54.5–78.0 years; 74 men) were evaluated. The 48 (46.2%) LR-5 lesions included 45 HCCs, 2 high-flow hemangiomas, and 1 adrenal rest tumor. The PPV of LR-5 for HCC was 93.8% (95% confidence interval (CI): 82.8–98.7%). The 22 (21.2%) LR-M lesions included 16 non-HCC malignancies and 6 HCCs. The PPV of LR-M for non-HCC malignancies, including six intrahepatic cholangiocarcinomas, was 100% (95% CI: 69.8–100%). In conclusion, in the modified CEUS LI-RADS for Sonazoid, LR-5 and LR-M are good predictors of HCC and non-HCC malignancies, respectively.

scholarly journals XPERT MYCOBACTERIUM TUBERCULOSIS/RIFAMPICIN ASSAY: A BOON IN TUBERCULOSIS DIAGNOSTICS

2016 ◽  
Vol 9 (5) ◽  
pp. 225 ◽  
Author(s):  
Sevitha Bhat ◽  
Kavya Ramamurthy ◽  
Shalini Shenoy ◽  
Aseem Rangnekar
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Predictive Value ◽  
High Sensitivity ◽  
Mortality And Morbidity ◽  
Indicator Tube ◽  
Promising Tool ◽  
Causes Of Mortality ◽  
Conventional Microscopy ◽  
Tb Diagnostics ◽  
Sensitivity Specificity

ABSTRACTObjectives: Mycobacterium tuberculosis (MTB) remains one of the most significant causes of mortality and morbidity in developing countriesespecially India. India has the highest burden of TB, with an estimated incidence figure of 2.1 million cases out of the 9 million cases of TB globally.Diagnosis of TB relies on conventional microscopy and culture with drawbacks related to sensitivity, specificity, turn around time (TAT). The aim ofthis study was to evaluate the performance of Xpert MTB/rifampicin (RIF) assay (GX) for MTB detection in pulmonary and extrapulmonary clinicalsamples.Methods: A total of 209 clinical specimens (182: pulmonary and 27: extrapulmonary) were processed using auramine smear, culture by mycobacteriagrowth indicator tube and GenXpert.Results: The sensitivity of GenXpert was 62.63% for pulmonary and 55% for extrapulmonary samples. The sensitivity and specificity of GX were100% for the smear positive cases. The sensitivity, specificity, positive predictive value, and negative predictive value of the GX for smear negativecases were 67.8%, 97.5%, 90.4%, and 89.6%, respectively. RIF resistance was detected in 3.8% the samples.Conclusion: GenXpert, with short TAT, high sensitivity, specificity and less technical expertise required is a promising tool in TB diagnostics for thefuture.Keywords: GenXpert, Tuberculosis diagnosis, Molecular method, Rifampicin resistance.

scholarly journals Role of MRI in the Diagnosis of Injury to the Lisfranc Ligament Complex

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0029
Author(s):  
Christopher Kreulen ◽  
Eric Giza ◽  
Eva Escobedo ◽  
Cyrus Bateni ◽  
Michael Doherty
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
High Sensitivity ◽  
Lisfranc Injury ◽  
Radiology Reports ◽  
Lisfranc Ligament ◽  
Sensitivity Specificity

Category: Sports Introduction/Purpose: Subtle Lisfranc ligamentous injuries are difficult to diagnose and magnetic resonance is becoming a useful tool. The purpose of this study is to evaluate the efficacy of magnetic resonance (MR) imaging for the diagnosis of injuries of the Lisfranc ligament complex. Methods: The radiology database was searched between Jan 1, 2010 and Mar 10, 2015 to identify patients over the age of 18 years who had MR imaging of the foot for suspected injury of the Lisfranc ligament complex. MR images were reviewed by 2 fellowship trained musculoskeletal radiologists, whom were blinded to the original radiology reports. Findings were categorized as: no injury or injury present. Injury was deemed to be present if 2 of the 3 components of C1-M2 ligament showed disruption or signal alterations on T1 and T2 weighted images. Disagreements were resolved by consensus. Correlation was made with surgical findings whenever performed. In patients not undergoing surgery, the presence or absence of injury was determined by clinical examination performed by an orthopedic surgeon and follow-up. Sensitivity, specificity, positive predictive value(PPV), and negative predictive value (NPV) of MR for diagnosis of Lisfranc ligament complex injury was determined. Results: Of 60 patients, 9 were excluded due to a lack of follow-up. Lisfranc injury was determined to be present on MR in 26 patients and 18 underwent surgery. Injury was confirmed in 16, and 2 were intact. 2 patients underwent closed reduction and were clinically determined to be injured. 6 of the injured 26 patients were sprained and not injured/torn on clinical evaluation. Of the 25 patients determined to have no injury on MR, 24 were intact clinically. 1 patient had a Lisfranc injury on follow-up. Sensitivity, specificity, PPV and NPV of MR for detection of significant Lisfranc injury were 94.7% (CI: 73.9% to 99.9%), 75% (CI: 56.6% to 88.5%), 69.2% (CI: 55% to 80.5%) and 96% (CI: 77.9% to 99.4%) respectively. Conclusion: MR has a high sensitivity and negative predictive value for diagnosis of injury to the Lisfranc ligament complex. MR of the foot should be considered in patients with clinical suspicion of injury to the Lisfranc ligament complex, and it is highly accurate in excluding such injuries.

Isolated demyelinating syndromes: comparison of CSF oligoclonal bands and different MR imaging criteria to predict conversion to CDMS

2001 ◽  
Vol 7 (6) ◽  
pp. 359-363 ◽  
Author(s):  
M Tintoré ◽  
A Rovira ◽  
L Brieva ◽  
E Grivé ◽  
R Jardí ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
High Sensitivity ◽  
Oligoclonal Bands ◽  
High Negative Predictive Value ◽  
Csf Oligoclonal Bands ◽  
Sensitivity Specificity

Aim of the study: To evaluate and compare the capacity of oligoclonal bands (OB) and three sets of MR imaging criteria to predict the conversion of clinically isolated syndromes (CIS) to clinically definite multiple sclerosis (CDMS). Patients and methods: One hundred and twelve patients with CIS were prospectively studied with MR imaging and determination of OB. Based on the clinical follow-up (conversion or not conversion to CDMS), we calculated the sensitivity, specificity accuracy, positive and negative predictive value of the OB, and MR imaging criteria proposed by Paty et al, Fazekas et al and Barkhof et al. Results: CDMS developed in 26 (23.2%) patients after a mean follow-up of 31 months (range 12-62). OB were positive in 70 (62.5%) patients and were associated with a higher risk of developing CDMS. OB showed a sensitivity of 81%, specificity of 43%, accuracy of 52%, positive predictive value (PPV) of 30% and negative predictive value (NPV) of 88%. Paty and Fazekas criteria showed the same results with a sensitivity of 77%, specificity of 51%, accuracy of 57%, positive predictive value of 32% and negative predictive value of 88%. Barkhof criteria showed a sensitivity of 65%, specificity of 70%, accuracy of 69%, PPV of 40% and NPV of 87%. The greatest accuracy was achieved when patients with positive OB and three or four Barkhof's criteria were selected. Conclusions: We observed a high prevalence of OB in CIS. OB and MR imaging (Paty's and Fazekas' criteria) have high sensitivity. Barkhof's criteria have a higher specificity. Both OB and MR imaging criteria have a high negative predictive value.

Sensitivity, Specificity, and Positive Predictive Value of Technetium 99-HMPAO SPECT in Discriminating Alzheimer's Disease from other Dementias

1997 ◽  
Vol 10 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Donna L. Masterman ◽  
Mario F. Mendez ◽  
Lynn A. Fairbanks ◽  
Jeffrey L. Cummings
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Single Photon ◽  
Photon Emission ◽  
High Sensitivity ◽  
Hmpao Spect ◽  
Clinical Diagnoses ◽  
Sensitivity Specificity

Investigators have reported high sensitivity and specificity values for single photon emission computerized tomography (SPECT) when distinguishing Alzheimer's disease (AD) patients from normal elderly controls or from selected patient groups. The role of SPECT in identifying AD among unselected patients with memory complaints requires investigation. We examined 139 consecutive patients with 99Tc-HMPAO SPECT. NINCDS-ADRDA diagnoses were determined blind to SPECT results, and scans were read and classified by visual inspection blind to clinical diagnoses. Bilateral temporoparietal hypoperfusion (TP) occurred in 75% of probable, 65% of possible, and 45% of unlikely AD patients, yielding a sensitivity of 75% and a specificity of 52% when comparing probable AD versus unlikely AD groups. A positive predictive value of 78% was obtained based on a 69% prevalence of AD in our total clinic population. Patients with false-positive results included a variety of dementing illnesses; all patients with bilateral hypoperfusion had dementia. A pattern of TP on SPECT scans is seen in most patients with AD, but could be found in other dementias as well and cannot be regarded as specific to AD. Reduced TP perfusion discriminated between demented and nondemented individuals. Further strategies for SPECT interpretation that improve diagnostic specificity should be sought.

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