scholarly journals Evaluating the role for renal biopsy in T1 and T2 renal masses: A single-centre study

2018 ◽  
Vol 12 (5) ◽  
pp. E226-30 ◽  
Author(s):  
Dylan Hoare ◽  
Howard Evans ◽  
Heidi Richards ◽  
Rahim Samji
Keyword(s):  
Logistic Regression ◽  
Adverse Events ◽  
Diagnostic Accuracy ◽  
Renal Biopsy ◽  
Predictive Value ◽  
Lesion Size ◽  
Renal Masses ◽  
Ct Guided ◽  
Binomial Logistic Regression ◽  
T1 And T2

Introduction: Once used primarily in the identification of renal metastasis and lymphomas, various urological bodies are now adopting an expanded role for the renal biopsy. We sought to evaluate the role of the renal biopsy in a Canadian context, focusing on associated adverse events, radiographic burden, and diagnostic accuracy.Methods: This retrospective review incorporated all patients undergoing ultrasound (US)/computed tomography (CT)-guided biopsies for T1 and T2 renal masses. There were no age or lesion size limitations. The primary outcome of interest was the correlation between initial biopsy and final surgical pathology. A binomial logistic regression analysis was conducted to determine any confounding factors. Secondary outcomes included the accuracy of tumour cell typing, grading, the safety profile, and radiographic burden associated with these patients.Results: A total of 148 patients satisfied inclusion criteria for this study. Mean age and lesions size at detection were 60.9 years (±12.4) and 3.6 cm (±2.0), respectively. Most renal masses were identified with US (52.7%) or CT (44.6%). Three patients (2.0%) experienced adverse events of note. Eighty-six patients (58.1%) proceeded to radical/partial nephrectomy. Our biopsies held a diagnostic accuracy of 90.7% (sensitivity 96.2%, specificity 87.5%, positive predictive value 98.7%, negative predictive value 70.0%, kappa 0.752, p<0.0005). Binomial logistic regression revealed that age, lesion size, number of radiographic tests, time to biopsy, and modality of biopsy (US/CT) had no influence on the diagnostic accuracy of biopsies.Conclusions: Renal biopsies are safe, feasible, and diagnostic. Their role should be expanded in the routine evaluation of T1 and T2 renal masses.

scholarly journals Haemodynamic assessment of right ventricular overload in pulmonary hypertension: old parameters still fit better than new ones

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Pereira ◽  
J.G Santos ◽  
M.J Loureiro ◽  
F Ferreira ◽  
A.R Almeida ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Logistic Regression ◽  
Adverse Events ◽  
Predictive Value ◽  
Roc Curves ◽  
Multivariate Logistic Regression ◽  
Discrimination Power ◽  
Haemodynamic Parameters ◽  
All Cause Mortality ◽  
Pulmonary Arterial

Abstract Introduction Right ventricular (RV) adaptation to the increased pulmonary load is a key determinant of outcomes in pulmonary hypertension (PH). Pulmonary vascular resistance (PVR) is widely recognized as haemodynamic measure of RV overload. Cardiac filling pressure (CFP), RV stroke work (RVSW), pulmonary artery (PA) compliance and PA pulsatility index (PAPi) are emerging as new haemodynamic parameters to assess RV function. Aims To assess the predictive value of CFP, RVSW, PA compliance and PAPi in PH and to compare it with standard haemodynamic parameters. Methods Retrospective study including all consecutive right heart catheterizations performed from April/2009 to October/2019 in a PH referral centre. Procedures presenting PH were selected [mean pulmonary arterial pressure (mPAP) &gt;20 mmHg, according to the new definition of the 6st World Symposium on PH]. CFP was calculated as [right atrial pressure (RAP) − pulmonary capillary wedge pressure], value &gt;0.63 associated with RV failure; RVSW as CO / [(heart rate × (mPAP-RAP) × 0.0136], value &lt;15; PA compliance [SV / pulmonary arterial systolic pressure (PASP) − pulmonary arterial diastolic pressure (PADP)], value &lt;2.5]; PAPi [(PSAP − PDAP) / RAP, value &lt;1.85]. Multivariate logistic regression was used to identify predictors of all-cause mortality. Receiver operating characteristic (ROC) curves and area under curve (AUC) were used to assess discrimination power. Results From a total of 569 procedures, 470 fulfilled PH criteria: mean age 57.9±16.0 years, 67.7% female, 35.5% performed under pulmonary vasodilator therapy. Pre-capillary PH was diagnosed in 71.9% of cases. Chronic thromboembolic PH was the most common subtype (34.4%). Concerning standard haemodynamic parameters: mPAP was 39.0±12.0 mmHg, mean RAP 8.0±5.0 mmHg, mean RVP 7.5±5.0 uWood and CI 2.5±0.8 L/min/m2. Median value of CFP was 0.6 (IQR 0.4–0.8), RVSW 15.2 (IQR 9.7–25.0), PA compliance 2.1 (IQR 0.9–2.9) and PAPi 5.3 (IQR 3.2–8.5). All-cause mortality rate was 22.8%. Patients experiencing adverse events had lower values of cardiac index (2.3±0.6 vs 2.6±0.8 L/min/m2, p&lt;0.01), RVSW (11.2 vs 16.7, p&lt;0.01) and PA compliance (2.2 vs 2.9, p&lt;0.01) and higher values of PVR (10.0±5.5 versus 6.8±4.6 uWood, p&lt;0.01) and mean RAP (9.9±6.1 versus 7.4±4.5, p&lt;0.01). Multivariate logistic regression identified 2 independent predictors of adverse events: mean RAP (OR 1.08, 95% CI 1.02–1.13, p&lt;0.01) and PVR (OR 1.11, 95% CI 1.06–1.17, p&lt;0.01). According to the ROC curves, new haemodynamic parameters did not have acceptable discrimination power to adverse events occurrence (figure). Conclusions In this study, new haemodynamic parameters to assess RV overload in PH were not independent predictors of adverse events as opposite to standard haemodynamic parameters. Further studies are needed to clarify their predictive value, as it has major implications for understanding the arterial load in diseases of the pulmonary circulation. Funding Acknowledgement Type of funding source: None

scholarly journals Initial Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Lesions Performed by a Pulmonologist

2019 ◽  
Vol 8 (6) ◽  
pp. 821 ◽  
Author(s):  
June Hong Ahn ◽  
Jong Geol Jang
Keyword(s):  
Diagnostic Accuracy ◽  
Complication Rate ◽  
Predictive Value ◽  
Needle Biopsy ◽  
Diagnostic Yield ◽  
Safe Procedure ◽  
Transthoracic Needle Biopsy ◽  
Ct Guided ◽  
Lung Lesions ◽  
Percutaneous Transthoracic Needle Biopsy

In the diagnosis of lung lesions, computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) has a high diagnostic yield and a low complication rate. The procedure is usually performed by interventional radiologists, but the diagnostic yield and safety of CT-guided PTNB when performed by pulmonologists have not been evaluated. A retrospective study of 239 patients who underwent CT-guided PTNB at Yeungnam University Hospital between March 2017 and April 2018 was conducted. A pulmonologist performed the procedure using a co-axial technique with a 20-gauge needle. Then diagnostic yield and safety were assessed. The overall sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of malignancy were 96.1% (171/178), 100% (46/46), 100% (171/171), and 86.8% (46/53), respectively. The diagnostic accuracy was 96.9% (217/224) and the overall complication rate was 33.1% (82/248). Pneumothorax, hemoptysis, and hemothorax occurred in 27.0% (67/248), 5.2% (13/248), and 0.8% (2/248) of the patients, respectively. Univariate analyses revealed that pneumothorax requiring chest tube insertion was a significant risk factor (odds ratio, 25.0; p < 0.001) for diagnostic failure. CT-guided PTNB is a safe procedure with a high diagnostic accuracy, even when performed by an inexperienced pulmonologist. The results were similar to those achieved by interventional radiologists as reported in previously published studies.

scholarly journals Diagnostic accuracy of signal loss in in-phase gradient-echo images for differentiation between small renal cell carcinoma and lipid-poor angiomyolipomas

2020 ◽  
Vol 93 (1108) ◽  
pp. 20190975
Author(s):  
Francisco V.A. Lima ◽  
Jorge Elias ◽  
Fernando Chahud ◽  
Rodolfo B. Reis ◽  
Valdair F. Muglia
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Renal Cell ◽  
Signal Loss ◽  
Gradient Echo ◽  
Renal Masses ◽  
Phase Gradient ◽  
Subjective Analysis ◽  
Intensity Index ◽  
Low Sensitivity

Objectives: To assess the diagnostic accuracy of signal loss on in-phase (IP) gradient-echo (GRE) images for differentiation between renal cell carcinomas (RCCs) and lipid-poor angiomyolipomas (lpAMLs). Methods: We retrospectively searched our institutional database for histologically proven small RCCs (<5.0 cm) and AMLs without visible macroscopic fat (lpAMLs). Two experienced radiologists assessed MRIs qualitatively, to depict signal loss foci on IP GRE images. A third radiologist drew regions of interest (ROIs) on the same lesions, on IP and out-of-phase (OP) images to calculate the ratio of signal loss. Diagnostic accuracy parameters were calculated for both techniques and the inter-reader agreement for the qualitative analysis was evaluated using the κ test. Results: 15 (38.4%) RCCs lost their signal on IP images, with a sensitivity of 38.5% (95% CI = 23.4–55.4), a specificity of 100% (71.1–100), a positive predictive value (PPV) of 100% (73.4–100), a negative predictive value (NPV) of 31.4% (26.3–37.0), and an overall accuracy of 52% (37.4–66.3%). In terms of the quantitative analysis, the signal intensity index (SII= [(SIIP – SIOP) / SIOP] x 100) for RCCs was −0.132 ± 0.05, while for AMLs it was −0.031 ± 0.02, p = 0.26. The AUC was 0.414 ± −0.09 (0.237–0.592). Using 19% of signal loss as the threshold, sensitivity was 16% and specificity was 100%. The κappa value for subjective analysis was 0.63. Conclusion: Signal loss in “IP” images, assessed subjectively, was highly specific for distinction between RCCs and lpAMLs, although with low sensitivity. The findings can be used to improve the preoperative diagnostic accuracy of MRI for renal masses. Advances in knowledge: Signal loss on “IP” GRE images is a reliable sign for differentiation between RCC and lpAMLs.

PP26 Convey or not convey? Does crew skill level predict hospital conveyance rate in a UK regional NHS ambulance service trust?

2019 ◽  
Vol 36 (1) ◽  
pp. e10.3-e11
Author(s):  
Sarah Black ◽  
Ian Frampton
Keyword(s):  
Logistic Regression ◽  
Predictive Value ◽  
Time Of Day ◽  
Skill Level ◽  
Ambulance Service ◽  
Striking Difference ◽  
Care Providers ◽  
Binomial Logistic Regression ◽  
Health And Social Care ◽  
Clinical Records

BackgroundThis study aimed to explore how demographic, temporal and patient characteristics influenced the decision to convey in a large dataset of nearly half a million consecutive calls to an NHS Ambulance Service Trust in the course of a single year.MethodsThe retrospective dataset combined information from patient clinical records and Control system data. Thirty variables were examined using a variety of techniques, including Pearson χ2, Mantel-Haenszel test for trend and Binomial logistic regression. Challenges and benefits to combining large datasets from different sources were explored.ResultsThe binomial logistic regression model was statistically significant, χ2(21)=90409, p<0.0005, and showed that crew skill level independently predicted decision to convey. The model explained 24.3% (Nagelkerke R2) of the variance in conveyance and correctly classified 68.2% of cases. Sensitivity was 86.4%, specificity was 44.4%, positive predictive value was 33.1% and negative predictive value was 71.6%. All five predictor variables were statistically significant. Controlling for all the other variables; increasing crew skill level was independently associated with a significantly reduced likelihood of being conveyed.ConclusionsThe potential implications of this finding for ambulance services, Emergency Departments and the wider NHS are profound. Investment in community services in more rural areas may reduce ambulance conveyance, resulting in fewer avoidable admissions and easing pressure on the system. A striking difference in conveyance rates due to the time of day the 999 call was made is evident. During the ‘in hours’ period ambulance clinicians were able to discharge more patients at scene without the requirement for an ED conveyance. Conversely access to alternative health and social care providers is limited ‘out of hours’; making these services available over a longer operating period may similarly reduce ambulance conveyance rates during the evening and overnight.

scholarly journals Accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement: a study protocol for a prospective study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036033
Author(s):  
Mayara Carvalho Godinho Rigobello ◽  
Jorge Elias Junior ◽  
Carlos Alberto Grespan Bonacim ◽  
Renata Cristina de Campos Pereira Silveira ◽  
Fernanda Caroline Bonardi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Gastric Tube ◽  
Ph Measurement ◽  
Tube Placement ◽  
Combined Method ◽  
Ray Method ◽  
X Ray ◽  
The Impact

IntroductionPatients using a nasogastric tube (NGT) are vulnerable to adverse events, therefore proper assessment of these patients, verification of the correct tube placement and constant monitoring by the nursing staff are strategies that can reduce adverse events and risks associated with the care. The aim of this study will be to assess the accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement compared with the X-ray method. A further aim will be to measure and provide evidence for the direct costs of each method of confirming NGT placement and to evaluate the impact of each method on the mean direct cost of the patient.Methods and analysisThis is a prospective, single-centre study of diagnostic accuracy. Data will be collected in the clinical and surgical wards, intensive care unit and coronary care unit of a Brazilian teaching hospital. The sample will consist of 385 assessments, performed in adult patients that agree to participate in the study and that receive an NGT. The combined method and the ultrasound will be the index tests and will be performed on all study participants for later comparison with an X-ray examination, considered the reference standard and the gold standard to distinguish between gastric and pulmonary placement. Sensitivity, specificity, positive predictive value and negative predictive value will be calculated to assess the diagnostic accuracy of the methods investigated in this study, with Cohen’s kappa analysis used to evaluate the degree of concordance.Ethics and disseminationThe study was approved by the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing, registration number: 83087318.4.0000.5393. The findings will be reported through academic journals, seminars and conference presentations, social media, print media, the internet and community/stakeholder engagement activities.

scholarly journals Diagnostic accuracy of perfusion-CT using Peak Enhancement Intensity (PEI) in detecting high grade pancreatic ductal adenocarcinoma keeping histopathology as gold standard.

2019 ◽  
Vol 26 (11) ◽  
pp. 1829-1834
Author(s):  
Abdul Raouf ◽  
Adeela Abid Bukhari ◽  
Natasha Arshad ◽  
Muhammad Ahsan
Keyword(s):  
Diagnostic Accuracy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Predictive Value ◽  
Gold Standard ◽  
Ct Perfusion ◽  
Perfusion Ct ◽  
Ductal Adenocarcinoma ◽  
Correct Identification ◽  
High Grade ◽  
Ct Guided

Pancreatic ductal carcinoma is the most common primary malignancy of the pancreas and is associated with a very poor prognosis, being worldwide one of the leading cause of cancer related death. The pre-operative correct identification of this group of patients is very important to minimize unnecessary resections but remains difficult owing to the post-operative assessment of some factors such as tumor resection margins and grading. Perfusion CT (P-CT) is a new imaging technique able to provide qualitative and quantitative information on perfusion parameters of tissues, which have been demonstrated to be correlated with histological markers of angiogenesis. Objectives: To estimate the diagnostic accuracy of CT perfusion using PEI in detecting high grade pancreatic ductal adenocarcinoma keeping histopathology as gold standard. Study Design: Cross sectional study. Setting: Radiology department of Allied Hospital Faisalabad. Period: 6 months after approval from June, 2016 to Nov, 2016. Material and Methods: Permission for research was sought from hospital ethical committee. Patients were collected from OPD & indoor of Radiology and surgical department of Allied Hospital Faisalabad. Confounding variables were controlled by restriction (by excluding the subjects with history of metastatic disease or chemotherapy). CT-Perfusion examination was performed with the patient in supine position on a 128 slice Optima Multi detector CT scanner. Image guided (CT guided) biopsy was done on all patients and specimen was sent to the hospital pathology lab and histopathology was done by senior pathologist, who kept blinded to perfusion-CT analysis. Results: In this study, out of 100 cases, the diagnostic accuracy of CT perfusion using PEI in detecting high grade pancreatic ductal adenocarcinoma keeping histopathology as gold standard was recorded as 90.59%, 91.49%, 92.31%, 89.58% and 91% for sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate. Conclusion: We concluded that diagnostic accuracy of CT perfusion using PEI is higher in detection of high grade pancreatic ductal adenocarcinoma keeping histopathology as gold standard. 

Accuracy of CT-guided transthoracic needle biopsy of lung lesions: Results of 612 consecutive procedures

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18022-18022
Author(s):  
U. Ricardi ◽  
A. M. Priola ◽  
S. M. Priola ◽  
S. Novello ◽  
A. Cataldi ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Needle Biopsy ◽  
Inflammatory Cells ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Lesion Size ◽  
Maximum Diameter ◽  
Transthoracic Needle Biopsy ◽  
Ct Guided ◽  
Lung Lesions

18022 Background: CT-guided transthoracic needle biopsy (TNB) is commonly used in diagnostic work-up of lung lesions. The availability of a on-site pathologist at the time of the procedure ameliorate its sensitivity, reduce the number of biopsies and false negatives. Methods: 612 procedures (608 patients with a CT-documented central or peripheral pulmonary lesion) performed at S. Luigi Hospital between November 2002 and August 2005 were prospectively analyzed; 66% males, median age was 66 years (range 29–87). Ineligibility criteria for the procedure included severe coagulopathy, previous contralateral pneumonectomy, lesions with a maximum diameter less than 5 mm or the impossibility to understand the procedure or to maintain the clinostatism for the time of the procedure. The on-site pathologist assigned to each specimen a semiquantitative score: 0 for bloody sample without other cells, 1 for aspecific benign or inflammatory cells, 2 for malignant cells without histotype characterization and 3 for well established benign or malignant histotype. Results: Most of the procedures was performed by fine needle aspiration biopsy, while in a minority of cases a tru-cut biopsy was requested. In 57.2% of the cases a single transthoracic access (range 1–4) was used and in 31% the procedure was repeated on the basis of the radiologist/pathologist judgment. In 154 patients a surgical resection was subsequently performed, while 454 were patients non-surgical. A score of 3 was obtained in 71% of cases (88% malignancies), 2 in 12.5%, 1 in 7.5% and 0 in 9%. A definitive diagnosis was made in 83.5% of procedures, while a score of 0–1 was assigned in 101 cases. Among 458 malignancies there were 411 lung cancer, 7 non-epithelial cancers and 40 metastases with only 1 false positive. The diagnostic accuracy for benign and malignant lesions was 67% and 92%, respectively (Pearson’s test p<0.005) with overall diagnostic accuracy of 83.3%. The variables affecting diagnostic accuracy were final diagnosis (benign 67%, malignant 92%, p<0.001) and lesion size (lesion 5 cm 78%, p<0.05). The presence of cavitation or necrotic areas and location of the lesion didn’t affect the diagnostic accuracy. Conclusion: In consecutive cases of CT-guided TNB final diagnosis and lesion size affect diagnostic accuracy. No significant financial relationships to disclose.

Noninvasive Evaluation of Coronary Artery Bypass Grafts with 16-Slice Multidetector Computed Tomography

2012 ◽  
Vol 15 (1) ◽  
pp. 12 ◽  
Author(s):  
Levent Sahiner ◽  
Ali Oto ◽  
Kudret Aytemir ◽  
Tuncay Hazirolan ◽  
Musturay Karcaaltincaba ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Multidetector Computed Tomography ◽  
Coronary Artery Bypass ◽  
Predictive Value ◽  
Artery Bypass ◽  
Time Interval ◽  
Mdct Angiography ◽  
Sensitivity Specificity

<p><b>Background:</b> The aim of this study was to investigate the diagnostic accuracy of 16-slice multislice, multidetector computed tomography (MDCT) angiography for the evaluation of grafts in patients with coronary artery bypass grafting (CABG).</p><p><b>Methods:</b> Fifty-eight consecutive patients with CABG who underwent both MDCT and conventional invasive coronary angiography were included. The median time interval between the 2 procedures was 10 days (range, 1-32 days). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT for the detection of occluded grafts were calculated. The accuracy of MDCT angiography for detecting significant stenoses in patent grafts and the evaluability of proximal and distal anastomoses were also investigated.</p><p><b>Results:</b> Optimal diagnostic images could not be obtained for only 3 (2%) of 153 grafts. Evaluation of the remaining 150 grafts revealed values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the MDCT angiography procedure for the diagnosis of occluded grafts of 87%, 97%, 94%, 93%, and 92%, respectively. All of the proximal anastomoses were optimally visualized. In 4 (8%) of 50 patent arterial grafts, however, the distal anastomotic region could not be evaluated because of motion and surgical-clip artifacts. The accuracy of MDCT angiography for the detection of significant stenotic lesions was relatively low (the sensitivity, specificity, PPV, and NPV were 67%, 98%, 50%, and 99%, respectively). The number of significant lesions was insufficient to reach a reliable conclusion, however.</p><p><b>Conclusion:</b> Our study showed that MDCT angiography with 16-slice systems has acceptable diagnostic performance for the evaluation of coronary artery bypass graft patency.</p>

COMPUTED TOMOGRAPHY CORRELATION OF THORACIC LESIONS WITH TRANSTHORACIC FINE NEEDLE ASPIRATION CYTOLOGY AND BIOPSY

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Rajneesh Madhok ◽  
Ashish Gupta ◽  
Lalit Singh ◽  
Tanu Agarwal
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Fine Needle Aspiration Cytology ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Ct Guided ◽  
Fine Needle ◽  
Malignant Lesions ◽  
Needle Aspiration Cytology ◽  
Adequate Tissue

INTRODUCTION: The study is an attempt to evaluate the sensitivity, specificity, positive predictive value, negative predictive value, p Value and complications of CT guided thoracic interventions fine needle aspiration cytology and core biopsy which are used for diagnosing benign and malignant thoracic lesions. MATERIAL AND METHODS: Study included 102 Patients (87 males and 15 females) with age group ranged from 15 to 87 years.A total of 143 CT guided interventions (84 FNAC’s and 59 core biopsies) were performed in 102 patients. The tissue obtained was sent to the laboratory for histopathological and cytological analysis for a final diagnosis which would contribute to patient management. RESULTS: All( 59) core biopsies were successful in procuring adequate tissue for histopathological analysis and the yield of core biopsies was 100% .However out of 84 FNAC’s only 4 were unsuccessful in procuring adequate tissue with a failure rate of 4.8%. Post procedural biopsy complications were only three (2.1%) which were small pneumothorax. There were 75 malignant lesions and 23 benign lesions based on cytology and histopathology (4 were excluded due to inadequate sample). There was good agreement between benign and malignant lesions diagnosed on CT and that diagnosed by pathology. The most common benign and malignant lesions were granulomatous lesion and squamous cell carcinoma. CONCLUSION: Percutaneous CT guided interventions like core biopsy and fine needle aspirations cytology are simple minimal invasive procedures with good patient acceptance and low morbidity and almost negligible mortality. CT guided interventions should be performed early for diagnosis of thoracic lesions.

scholarly journals Accuracy of MSCT Coronary Angiography with 64 Row CT Scanner—Facing the Facts

2010 ◽  
Vol 4 ◽  
pp. CMC.S3864 ◽  
Author(s):  
M. Wehrschuetz ◽  
E. Wehrschuetz ◽  
H. Schuchlenz ◽  
G. Schaffler
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Diagnostic Potential ◽  
Coronary Artery Stenoses ◽  
Artery Disease ◽  
Msct Angiography

Improvements in multislice computed tomography (MSCT) angiography of the coronary vessels have enabled the minimally invasive detection of coronary artery stenoses, while quantitative coronary angiography (QCA) is the accepted reference standard for evaluation thereof. Sixteen-slice MSCT showed promising diagnostic accuracy in detecting coronary artery stenoses haemodynamically and the subsequent introduction of 64-slice scanners promised excellent and fast results for coronary artery studies. This prompted us to evaluate the diagnostic accuracy, sensitivity, specificity, and the negative und positive predictive value of 64-slice MSCT in the detection of haemodynamically significant coronary artery stenoses. Thirty-seven consecutive subjects with suspected coronary artery disease were evaluated with MSCT angiography and the results compared with QCA. All vessels were considered for the assessment of significant coronary artery stenosis (diameter reduction ≥ 50%). Thirteen patients (35%) were identified as having significant coronary artery stenoses on QCA with 6.3% (35/555) affected segments. None of the coronary segments were excluded from analysis. Overall sensitivity for classifying stenoses of 64-slice MSCT was 69%, specificity was 92%, positive predictive value was 38% and negative predictive value was 98%. The interobserver variability for detection of significant lesions had a κ-value of 0.43. Sixty-four-slice MSCT offers the diagnostic potential to detect coronary artery disease, to quantify haemodynamically significant coronary artery stenoses and to avoid unnecessary invasive coronary artery examinations.

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