Degree Of Diagnostic Confidence Research Articles

Contrast enhanced ultrasound for characterization of suspected soft tissue vascular anomalies

BackgroundEvaluation of perfusion characteristics is the key to characterize vascular anomalies. Contrast-enhanced ultrasound (CEUS) is a radiation-free modality to evaluate this in real-time and can be coupled along with Doppler-ultrasound (US). ObjectiveTo evaluate the utility of CEUS in characterization of suspected soft-tissue vascular anomalies and compare its diagnostic accuracy with Doppler-US. Materials and methodsThis was an ethically-approved cross-sectional study, done from November 2017- November 2019, involving 93 patients (55 M/38F; mean age 23.6 ± 11.9 years) in development cohort and 128 (66 M/62F; mean age 21.4 ± 11.1 years) in validation cohort. Patients suspected to have soft-tissue vascular anomalies on clinical evaluation and US were included. Clinical features, US, Doppler, subjective and quantitative CEUS features (from time-intensity curves) were evaluated. Composite gold standard employing MRI, phlebogram, DSA or biopsy was used to make the final diagnosis. The CEUS features found to be significantly different in the development cohort were prospectively validated in the validation cohort. P-value < 0.05 was considered significant, ROC curves were drawn and threshold values obtained for the various quantitative parameters. A prospective diagnosis was suggested in the validation group along with a degree of diagnostic confidence and accuracy was calculated. ResultsThe spectrum of lesions included 77 venous malformations, 46 fibro-adipose vascular anomalies, 32 vascular tumors, 20 arteriovenous malformations and 20 lymphatic malformations. All lesions were found to have distinctive temporal and morphological subjective enhancement patterns. Quantitative parameters like rise-time, mean-transit-time, time-to-peak, peak-enhancement showed significant differences between the various groups (P value < 0.05). Addition of CEUS not only increased the diagnostic accuracy of Doppler-US from 76.5% (91/119) to 88.2% (105/119), but also the degree of diagnostic confidence in characterization of soft-tissue vascular anomalies. None of the patients showed any contrast-related adverse effects. ConclusionContrast-enhanced ultrasound is useful to characterize different types of soft-tissue vascular anomalies and increases the diagnostic accuracy and confidence over Doppler-ultrasound.

Screening for interstitial lung disease in systemic sclerosis: the diagnostic accuracy of HRCT image series with high increment and reduced number of slices

ObjectivesThe objective of this study is to assess diagnostic accuracy for the detection of interstitial lung disease (ILD) in image series with high increment and reduced number of slices in...

Two-dimensional image fusion of planar bone scintigraphy and radiographs in patients with clinical scaphoid fracture: An imaging study

Although magnetic resonance imaging (MRI) is now considered the gold standard in second-line imaging of patients with suspected scaphoid fracture and negative radiographs, bone scintigraphy can be used in patients with pacemakers, metallic implants, or other contraindications to MRI. Bone scintigraphy is highly sensitive for the detection of fractures, but exact localization of scintigraphic lesions may be difficult and can negatively affect diagnostic accuracy. To investigate the influence of image fusion of planar bone scintigraphy and radiographs on image interpretation in patients with suspected scaphoid fracture. In 24 consecutive patients with suspected scaphoid fracture, a standard planar bone scintigraphy of both hands was supplemented with fusion imaging of the injured wrist. Standard and fusion images were evaluated independently by three experienced nuclear medicine physicians. In addition to the diagnosis, the degree of diagnostic confidence was scored in each case. The addition of fusion images changed the interpretation of each of the three observers in seven, four, and two cases, respectively, reducing the number of positive interpretations of two of the observers from 11 and nine cases to six and seven cases, respectively. The degree of diagnostic confidence increased significantly in two observers, and interobserver agreement increased in all three pairs of observers from 0.83, 0.57, and 0.73 to 0.89, 0.8, and 0.9, respectively. Image fusion of planar bone scintigrams and radiographs has a significant influence on image interpretation and increases both diagnostic confidence and interobserver agreement.

Evaluation of Living Renal Donors: Accuracy of Three-dimensional 16-Section CT

To retrospectively assess the sensitivity and specificity of three-dimensional (3D) 16-section computed tomography (CT) in the evaluation of vessels, pelvicalyceal system, and ureters in living renal donors, with surgical findings as the reference standard. This was a HIPAA-compliant study. Institutional review board approval was obtained for the review of subjects' medical records and data analysis, with waiver of informed consent. Forty-six renal donors (18 men, 28 women; mean age, 42 years) were examined with 16-section CT. Two blinded reviewers independently studied renal vascular and urographic anatomy of each donor CT scans by fist using 3D images alone, then transverse images alone, and finally transverse and 3D data set. Image quality, degree of diagnostic confidence, and time used for review were recorded. Sensitivity and specificity were calculated. For 3D images, transverse images, and transverse in conjunction with 3D data sets, the respective sensitivity and specificity of CT in evaluation of accessory arteries by reviewer 1 were 100% and 100%, 89% and 100%, and 100% and 100%, and those by reviewer 2 were 89% and 97%, 89% and 100%, and 89% and 100%; the respective sensitivity and specificity in evaluation of venous anomalies by reviewer 1 were 100% and 98%, 100% and 98%, and 100% and 98%, and those by reviewer 2 were 100% and 98%, 100% and 95%, and 100% and 98%. For focused comprehensive assessment of renal donors with 3D scans alone, a reviewer on average (average of reviewers 1 and 2) used 2.4 minutes per scan, demonstrated full confidence in 93%, and rated the quality as excellent in 76%. For focused assessment of renal vascular and urographic anatomy, review of 3D data set alone provides high sensitivity and specificity with regard to findings seen at surgery.

Chronic diffuse infiltrative lung disease: comparison of diagnostic accuracy of high-resolution and conventional CT.

We compared the accuracies of high-resolution CT (HRCT) and conventional CT in determining the specific diagnoses in 75 consecutive patients with chronic diffuse infiltrative lung disease. Without knowledge of clinical or pathologic data, two reviewers independently assessed three separate sets of CT scans in random order: three HRCT scans, three 10-mm collimation CT scans obtained at the same levels as the HRCT scans, and a complete conventional CT scan. The HRCT scans were obtained at the level of the aortic arch, tracheal carina, and 1 cm above the right hemidiaphragm by using 1.5-mm collimation and a high spatial resolution algorithm. Observers gave the most likely diagnosis along with their degree of diagnostic confidence. The correct diagnosis, irrespective of confidence level, was reached with 71% of the HRCT scans and with 72% of both the corresponding 10-mm and complete conventional CT scans. Confidence level 1 (definite) was reached with 49% of HRCT scans, 31% of corresponding 10-mm scans, and 43% of complete conventional CT examinations; the correct diagnosis was made in 92%, 96%, and 94% of those examinations, respectively. In none of the patients were findings on the limited HRCT scan normal when findings on the conventional CT scan were abnormal. We conclude that in most patients with chronic infiltrative lung disease a specific diagnosis can be made by obtaining a limited number of HRCT scans.