Diagnostic Accuracy In Differential Diagnosis Research Articles

Diagnostic accuracy of ultrasound superb microvascular imaging for breast tumor: a meta-analysis.

This meta-analysis aimed to identify the accuracy of ultrasound superb microvascular imaging (SMI) for the diagnosis of a breast tumor. We searched PubMed, Web of Science, Google Scholar, Cochrane Library, EBSCO, and CBM databases from January 1st, 2013 until February 1st, 2020 without language restrictions. Meta-analysis was conducted using STATA version 14.0 and Meta-Disc version 1.4 software. We calculated the summary statistics for sensitivity (Sen), specificity (Spe), positive and negative likelihood ratio (LR+/LR-), diagnostic odds ratio (DOR) and receiver operating characteristic (SROC) curve. Fifteen studies that met all inclusion criteria were included in this meta-analysis. A total of 955 breast neoplasm patients and 1116 patients with benign breast tumors were assessed. All breast lesions were histologically confirmed after SMI. The pooled Sen was 0.81 (95%CI=0.78-0.83); the pooled Spe was 0.71 (95%CI=0.68-0.73) The pooled LR+ was 3.24 (95%CI=2.27-4.64); the pooled negative LR-was 0.25 (95%CI=0.18-0.34) The pooled DOR of SMI in the diagnosis of breast tumor was 46.97 (95 % CI=16.72∼131.97). The area under the SROC curve was 0.87 (95%CI=0.84- 0.90). We found no evidence for publication bias (t=-0.84, p=0.42). Our meta-analysis indicates that SMI may have a high diagnostic accuracy in differential diagnosis between benign and malignant breast tumors. Thus, SMI may be a good tool for the diagnosis of breast tumors.

Contribution of Sonoelastography to Diagnosis in Distinguishing Benign and Malignant Breast Masses.

The purpose of this study was to investigate the contribution of strain index measurements and a 5-point scoring method to diagnostic accuracy in differential diagnosis of benign and malignant solid breast masses and to compare the diagnostic performances of both methods. Eighty female patients were included in this study. Before biopsy, all patients underwent ultrasound (US) and sonoelastographic examinations. The elastographic images of lesions were assessed according to the 5-point scoring method, and then elasticity scores were determined. Strain values of the masses and subcutaneous adipose tissue were measured. The diagnostic efficacies of B-mode US, sonoelastographic 5-point scoring, and strain index methods were compared with histopathologic findings. The mean age of the patients ± SD was 42 ± 13 years (range, 14-81 years). In histopathologic evaluations, 59 (74%) lesions were diagnosed as benign, and 21 (26%) were diagnosed as malignant. The mean strain index values were 10.45 ± 7.04 (range, 3.4-25.1) in malignant lesions and 2.88 ± 2.5 (range, 0.5-19.81) in benign lesions. The mean strain index for malignant lesions was significantly higher than that for benign lesions (P < .05). The highest sensitivity was found for B-mode US, and the highest specificity was found for the strain index. The diagnostic performance of the strain index was higher than that of the 5-point scoring method. The addition of a sonoelastographic examination to B-mode US prevents unnecessary biopsies. The strain index was found to be superior to the 5-point scoring method to a limited extent.

Vestibular Migraine Patients Show Lack of Habituation in Auditory Middle Latency Responses to Repetitive Stimuli: Comparison With Meniere's Disease Patients

Objectives: To compare habituation in auditory middle latency response (AMLR) to repetitive stimuli of vestibular migraine (VM) patients with Meniere's disease (MD) patients and healthy controls (HC) and to assess usefulness of AMLR for diagnosis of VM.Subjects: Thirteen unilateral definite MD patients (2 men, 11 women, mean age 50.6), 13 definite VM patients (3 men, 10 women, mean age 45.5), and 8 HC subjects (2 men, 6 women, mean age 37.1) were enrolled.Methods: The electrodes were placed on the vertex and the spinal process of the fifth cervical vertebra. Binaural click stimulation (0.1 ms, 70 dBnHL) was presented. A total of 800 responses were averaged. Averaged responses were divided into four sets (S1 to S4) according to the temporal order. No, Po, Na, and Pa were identified, and amplitudes and latencies were measured.Results: Concerning latencies, HC subjects showed a tendency of shorter latencies. However, there was no clear effect of repetitive stimulation. Concerning No-Po amplitudes, no significant differences were observed. Raw amplitudes of Na-Pa showed statistically significant differences in S1 and S2 among the groups (p < 0.01 one-way ANOVA). Differences were shown in MD vs. VM and HC vs. VM in S1 (smaller in VM) (p < 0.01 Bonferroni's test) and in MD vs. VM in S2 (smaller in VM) (p < 0.01 Bonferroni test). Relative amplitudes of Na-Pa to S1 showed statistically significant differences in S4 (p < 0.01 one-way ANOVA). Differences were shown in MD vs. VM and HC vs. VM (larger in VM) (p < 0.01 Bonferroni's test). Differences of Na-Pa amplitudes in S2 to S4 from Na-Pa amplitude in S1 were significant in S4 of VM patients (Dunnett's test).Conclusions: VM patients showed lack of habituation (potentiation) of Na-Pa amplitude in AMLR to repetitive stimuli while MD patients and HC subjects showed habituation. Observation of lack of habituation has high diagnostic accuracy for differential diagnosis of VM from MD.

Diagnostic accuracy of contrast-enhanced ultrasound for renal cell carcinoma: a meta-analysis

This meta-analysis aimed to identify the accuracy of contrast-enhanced ultrasonography (CEUS) for the diagnosis of renal cell carcinoma (RCC). We searched PubMed, Web of Science, Google Scholar, Cochrane Library, CISCOM, CINAHL, EBSCO, and CBM databases from inception through August 1, 2013 without language restrictions. Meta-analysis was conducted using STATA version 12.0 and Meta-Disc version 1.4 softwares. We calculated the summary statistics for sensitivity (Sen), specificity (Spe), positive and negative likelihood ratio (LR+/LR-), diagnostic odds ratio (DOR), and receiver operating characteristic (SROC) curve. Eleven studies that met all inclusion criteria were included in this meta-analysis. A total of 567 RCC patients and 313 patients with benign renal tumors were assessed. All renal lesions were histologically confirmed after CEUS. The pooled Sen was 0.88 (95 %CI = 0.85 ∼ 0.90); the pooled Spe was 0.80 (95 %CI = 0.75 ∼ 0.85). The pooled LR+ was 4.30 (95 %CI = 2.65 ∼ 6.99); the pooled negative LR- was 0.11 (95 %CI = 0.05 ∼ 0.22). The pooled DOR of CEUS in the diagnosis of RCC was 46.97 (95 % CI = 16.72 ∼ 131.97). The area under the SROC curve was 0.922 (standard error [SE] = 0.039). We found no evidence for publication bias (t = -1.00, P = 0.342). Our meta-analysis indicates that CEUS may have high diagnostic accuracy in differential diagnosis between benign and malignant renal tumors. Thus, CEUS may be a good tool for the diagnosis of RCC.

Validation of an optimized SPM procedure for FDG-PET in dementia diagnosis in a clinical setting.

Diagnostic accuracy in FDG-PET imaging highly depends on the operating procedures. In this clinical study on dementia, we compared the diagnostic accuracy at a single-subject level of a) Clinical Scenarios, b) Standard FDG Images and c) Statistical Parametrical (SPM) Maps generated via a new optimized SPM procedure. We evaluated the added value of FDG-PET, either Standard FDG Images or SPM Maps, to Clinical Scenarios. In 88 patients with neurodegenerative diseases (Alzheimer's Disease—AD, Frontotemporal Lobar Degeneration—FTLD, Dementia with Lewy bodies—DLB and Mild Cognitive Impairment—MCI), 9 neuroimaging experts made a forced diagnostic decision on the basis of the evaluation of the three types of information. There was also the possibility of a decision of normality on the FDG-PET images. The clinical diagnosis confirmed at a long-term follow-up was used as the gold standard. SPM Maps showed higher sensitivity and specificity (96% and 84%), and better diagnostic positive (6.8) and negative (0.05) likelihood ratios compared to Clinical Scenarios and Standard FDG Images. SPM Maps increased diagnostic accuracy for differential diagnosis (AD vs. FTD; beta 1.414, p = 0.019). The AUC of the ROC curve was 0.67 for SPM Maps, 0.57 for Clinical Scenarios and 0.50 for Standard FDG Images. In the MCI group, SPM Maps showed the highest predictive prognostic value (mean LOC = 2.46), by identifying either normal brain metabolism (exclusionary role) or hypometabolic patterns typical of different neurodegenerative conditions.

Iodine‐123 Metaiodobenzylguanidine Scintigraphy and Iodine‐123 Ioflupane Single Photon Emission Computed Tomography in Lewy Body Diseases: Complementary or Alternative Techniques?

To compare myocardial sympathetic imaging using (123)I-Metaiodobenzylguanidine (MIBG) scintigraphy and striatal dopaminergic imaging using (123)I-Ioflupane (FP-CIT) single photon emission computed tomography (SPECT) in patients with suspected Lewy body diseases (LBD). Ninety-nine patients who performed both methods within 2 months for differential diagnosis between Parkinson's disease (PD) and other parkinsonism (n = 68) or between dementia with Lewy bodies (DLB) and other dementia (n = 31) were enrolled. Sensitivity, specificity, accuracy, positive and negative predictive values of both methods were calculated. For (123) I-MIBG scintigraphy, the overall sensitivity, specificity, accuracy, positive and negative predictive values in LBD were 83%, 79%, 82%, 86%, and 76%, respectively. For (123)I-FP-CIT SPECT, the overall sensitivity, specificity, accuracy, positive and negative predictive values in LBD were 93%, 41%, 73%, 71%, and 80%, respectively. There was a statistically significant difference between these two methods in patients without LBD, but not in patients with LBD. LBD usually present both myocardial sympathetic and striatal dopaminergic impairments. (123)I-FP-CIT SPECT presents high sensitivity in the diagnosis of LBD; (123)I-MIBG scintigraphy may have a complementary role in differential diagnosis between PD and other parkinsonism. These scintigraphic methods showed similar diagnostic accuracy in differential diagnosis between DLB and other dementia.

Echo-enhanced ultrasound—a new imaging modality for the differentiation of pancreatic lesions

Echo-enhanced ultrasound is a newly available mode of imaging for differential diagnosis of pancreatic tumours. Ductal carcinomas are often hypovascularised compared with the surrounding tissue. Neuroendocrine tumours, on the other hand, are hypervascularised lesions. Tumours associated with pancreatitis have a different vascularisation pattern depending on inflammation and necrosis. Cystadenomas frequently have many vessels along the fibrotic strands. Data from prospective studies have demonstrated, on the basis of these imaging criteria, that the sensitivity and specificity of echo-enhanced sonography for differentiation of pancreatic masses are >or=85 and >or=90%, respectively. Pancreatic tumours have a different vascularisation pattern in echo-enhanced ultrasound. These characteristics can be used with high diagnostic accuracy for differential diagnosis.

4578 Evaluation of endoscopic ultrasonography and intraductal ultrasonography for the differential diagnosis of intraductal papillary mucinous tumors of the pancreas.

Objectives: IPMT has unique clinicopathological characteristics with a favourable prognosis. This tumor includes hyperplasia with no or mild dysplasia, adenomas with moderate dysplasia, and noninvasive as well as invasive adenocarcinomas. The aim of this study was to evaluate the effectiveness of EUS and IDUS as compared with US and CT for the differential diagnosis of this tumor cathegory. Patients and Methods: US, CT, EUS and IDUS were performed for 49 cases of IPMT (hyperplasia 7, adenoma 23, noninvasive 7 and invasive adenocarcinoma 12). On the basis of the histopathological analysis of another 28 cases of resected IPMT, criteria for differential diagnosis by imaging modalities were defined as follows: non-neoplastic lesion (hyperplasia) lacking wall thickening or nodule; noninvasive IPT (adenoma and intraductal carcinoma) having a nodule or wall thickening; Invasive IPT with pancreatic parenchymal invasion having a mass with a heterogenous pattern or interruption of the pancreatic duct wall by tumor invasion. Results: Differentiation of neoplastic/non-neoplastic IPMT Sensitivity (%) Specificity (%) Accuracy (%) US 33 100 42 CT 36 100 44 EUS 90 71 88 IDUS 94 29 84 Differentiation of invasive and non-invasive IPMT Sensitivity (%) Specificity (%) Accuracy (%) US 25 100 80 CT 33 100 83 EUS 55 97 88 IDUS 56 91 84 Conclusions: With the present criteria, EUS and IDUS demonstrated high sensitivity and diagnostic accuracy for the differential diagnosis of neoplastic and non-neoplastic lesions. They also showed high diagnostic accuracy for differential diagnosis of invasive and non-invasive tumors. Thus EUS and IDUS may contribute much to the choice of treatment for IPMT.