Diagnostic Accuracy For Detection Research Articles

Combining public datasets for automated tooth assessment in panoramic radiographs

ObjectivePanoramic radiographs (PRs) provide a comprehensive view of the oral and maxillofacial region and are used routinely to assess dental and osseous pathologies. Artificial intelligence (AI) can be used to improve the diagnostic accuracy of PRs compared to bitewings and periapical radiographs. This study aimed to evaluate the advantages and challenges of using publicly available datasets in dental AI research, focusing on solving the novel task of predicting tooth segmentations, FDI numbers, and tooth diagnoses, simultaneously.Materials and methodsDatasets from the OdontoAI platform (tooth instance segmentations) and the DENTEX challenge (tooth bounding boxes with associated diagnoses) were combined to develop a two-stage AI model. The first stage implemented tooth instance segmentation with FDI numbering and extracted regions of interest around each tooth segmentation, whereafter the second stage implemented multi-label classification to detect dental caries, impacted teeth, and periapical lesions in PRs. The performance of the automated tooth segmentation algorithm was evaluated using a free-response receiver-operating-characteristics (FROC) curve and mean average precision (mAP) metrics. The diagnostic accuracy of detection and classification of dental pathology was evaluated with ROC curves and F1 and AUC metrics.ResultsThe two-stage AI model achieved high accuracy in tooth segmentations with a FROC score of 0.988 and a mAP of 0.848. High accuracy was also achieved in the diagnostic classification of impacted teeth (F1 = 0.901, AUC = 0.996), whereas moderate accuracy was achieved in the diagnostic classification of deep caries (F1 = 0.683, AUC = 0.960), early caries (F1 = 0.662, AUC = 0.881), and periapical lesions (F1 = 0.603, AUC = 0.974). The model’s performance correlated positively with the quality of annotations in the used public datasets. Selected samples from the DENTEX dataset revealed cases of missing (false-negative) and incorrect (false-positive) diagnoses, which negatively influenced the performance of the AI model.ConclusionsThe use and pooling of public datasets in dental AI research can significantly accelerate the development of new AI models and enable fast exploration of novel tasks. However, standardized quality assurance is essential before using the datasets to ensure reliable outcomes and limit potential biases.

Assessing the Usefulness of Ultrasonography for the Diagnosis and Evaluation of Intra-Orbital Lesions in Pediatric Patients: A Retrospective Analysis.

To assess the usefulness of ultrasonography in the diagnosis and evaluation of extraocular intra-orbital lesions in pediatric patients. Twenty-three pediatric patients with intra-orbital lesions who underwent both ultrasound and computed tomography/magnetic resonance imaging (CT/MRI) were included. The following parameters were evaluated using ultrasound: 1) lesion detection rate (presence or absence of lesions), 2) lesion characteristics, 3) lesion location (extraconal or intraconal), and 4) the lesion longest linear dimensions, and these were compared using Fisher's exact test and Mann-Whitney U test. Two lesions could not be detected using ultrasound; in the other 21 cases, the lesion characteristics diagnosed by ultrasound were correct. Diagnostic accuracy of detection and characteristics assessment using ultrasound were 91.3% and 91.3%, respectively. The lesion location was not significantly different between the two groups (intraconal/extraconal in those detected using ultrasound versus those in the absence on ultrasound = 7/14 versus 0/2, P > .999); however, in two cases that were not detected on ultrasound, the lesions were located at extraconal. Lesions that were small in longest linear dimensions on CT/MRI were not detected using ultrasound (the longest linear dimensions in lesions detected using ultrasound versus that in the absence of ultrasound: 29.5 ± 8.2 [range, 13-46] versus 10 and 11 mm, P = .043). Ultrasonography proved to be useful for visualizing and evaluating intra-orbital lesions except for lesions that were relatively small in size. Therefore, although ultrasound could not detect lesions located behind bone and bone invasion, it could be used for diagnosing and selecting treatment strategies for intra-orbital lesions.

Sex differences in time course and diagnostic accuracy of GFAP and UCH-L1 in trauma patients with mild traumatic brain injury

Glial Fibrillary Acidic Protein (GFAP) and Ubiquitin C-terminal hydrolase (UCH-L1) have been FDA-approved for clinical use in mild and moderate traumatic brain injury (TBI). Understanding sex differences in their diagnostic accuracy over time will help inform clinical practice. We sought to evaluate the sex differences in the temporal profile of GFAP and UCH-L1 in a large cohort of trauma patients presenting to the emergency department. To compare the biomarkers’ diagnostic accuracy in male versus female patients for detecting mild TBI (MTBI), and traumatic intracranial lesions on head CT. This prospective cohort study enrolled female and male adult trauma patients presenting to a Level 1 Trauma Center. All patients underwent rigorous screening to determine whether or not they had experienced a MTBI. Of 3025 trauma patients assessed, 1030 met eligibility criteria and 446 declined. Initial blood samples were obtained in 584 patients enrolled within 4 h of injury. Repeated blood sampling was conducted at 4, 8, 12, 16, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132, 144, 156, 168, and 180-h post-injury. The main outcomes included the diagnostic accuracy in detection of MTBI and traumatic intracranial lesions on head CT scan. A total of 1831 samples were drawn in 584 patients over 7 days, 362 (62%) were male and 222 (38%) were female. The pattern of elevation was similar in both sexes. Although the pattern of elevation was similar between male and female for both biomarkers, male patients had significantly higher concentrations of UCH-L1 compared to female patients at several timepoints post-injury, particularly within 24 h of injury. There were no significant differences in diagnostic accuracy for detecting MTBI or for detecting CT lesions between male and female patients at any timepoint for both GFAP and UCH-L1. Although patterns of GFAP and UCH-L1 release in trauma patients over a week post-injury was similar between the sexes, there were significantly higher concentrations of UCH-L1 in males at several timepoints post-injury. Despite this, the overall diagnostic accuracies of both GFAP and UCH-L1 over time for detecting MTBI and CT lesions were not significantly different between male and female trauma patients.

A Cytohistopathological Correlation Study of Skin Lesions in Leprosy: An Experience in a Tertiary Care Hospital in South India

Abstract Background Leprosy is a granulomatous disease caused by Mycobacterium leprae. Early detection and clinical diagnosis remain a challenge, especially in paucibacillary cases and initial lesions during early phases of leprosy. Use of cytological methods can reduce time for diagnosis, especially in peripheral centers. Objectives The present study was taken up to calculate the correlation between cytology and histopathology of skin lesions in leprosy. Material & Methods This study is a 2-year retrospective observational study taken up in the Department of Pathology, Rangaraya Medical College and Government General Hospital, Kakinada, Andhra Pradesh. A total of 49 cases of clinically suspected leprosy were included in the study. Skin biopsies and cytological smears were examined in all cases. Results A total of 49 cases of clinically suspected leprosy were included in the study. The age incidence ranged between 9 and 72 years. There was a male preponderance. The overall diagnostic accuracy of fine-needle aspiration smears was 83.3% and that of slit-skin smears was 62.1%. Conclusion Cytological examination being a simple, less time-consuming, and easy technique can enhance the diagnostic accuracy in detection of leprosy and act as an adjunct to clinical diagnosis.

Added value of zoomed-echo-planar imaging diffusion-weighted imaging for evaluation of periampullary carcinomas.

To assess the image quality feasibility and diagnostic value of zoomed diffusion-weighted imaging (z-EPI DWI) using echo-planar imaging (EPI) compared with conventional DWI (c-EPI DWI) in patients with periampullary disease. Thirty-six patients with periampullary carcinomas and fifteen with benign periampullary disease were included in this study. All the subjects underwent MR cholangiopancreatography (MRCP), c-EPI DWI, and z-EPI DWI. Two radiologists independently assessed image quality of the two image sets, including overall image quality and lesion conspicuity. In addition, signal intensity and ADC measurements of DWIs in the periampullary lesions were conducted. Diagnostic accuracies of the combined image sets of MRCP and z-EPI DWI were compared with those of a combined set of MRCP and c-EPI DWI. z-EPI DWI showed significantly better image quality scores (anatomic structure visualization, 2.94 ± 0.24; overall image quality, 2.96 ± 0.17) compared to that with c-EPI DWI (anatomic structure visualization, 2.02 ± 0.22; overall image quality, 2.04 ± 0.24) (both P < 0.01). For all the periampullary malignant lesions and small lesions (≤20 mm), there was better delineation of lesion conspicuity and the lesion margin, as well as diagnostic confidence with z-EPI DWI (all P<0.05). The rate of periampullary malignancy's hyperintense signal on z-EPI DWI was increased to 91.7% (33/36) compared to c-EPI DWI (69.4% (25/36)) (P = 0.023). For all malignant lesions and small lesions, the diagnostic accuracy scores were increased using the MRCP and z-EPI DWI combined set, compared to the MRCP and c-EPI DWI combined set (P<0.05). Diagnostic accuracy for detection and differentiation of malignant lesions from benign lesions significantly improved for the MRCP and z-EPI DWI combined set compared with MRCP and c-EPI DWI combined set (P<0.05). There were no significant differences between c-EPI DWI and z-EPI DWI in the ADC values of periampullary malignant and benign lesions (P>0.05). z-EPI DWI has an advantage that could lead to remarkable image quality improvements and enhanced lesion visualization of periampullary carcinomas. z-EPI DWI was superior to c-EPI DWI for detecting, delineating, and diagnosing the lesions, particularly for small challenging lesions.

Diagnostic Accuracy of Leucocyte Esterase Dipstick Test for The Diagnosis of Spontaneous Bacterial Peritonitis in Children with Nephrotic Syndrome

Spontaneous bacterial peritonitis (SBP), which has a high fatality rate if antibiotics are not given promptly, is one of the most serious side effects of nephrotic syndrome and ascites. Therefore, it is essential for survival to diagnose and treat SBP early. A quick dipstick test for leukocyte esterase can identify the SBP. Objective: To determine the diagnostic accuracy in detection of SBP using leucocyte esterase dipstick test in children with nephrotic syndrome taking ascitic fluid neutrophil count as gold standard. Methods: A Cross Sectional Study was carried out Khyber teaching hospital and LRH Peshawar Pakistan. This research covered patients of either gender with nephrotic syndrome and ascites. On admission, diagnostic paracentesis was performed. The ascitic fluid collected at the bedside was examined immediately using a reagent strip. The PMN cell count in ascitic fluid was then determined. A positive +3 result on a leukocyte esterase dipstick was declared positive for SBP while absolute neutrophil count more than 250 cells per mm3 was considered confirmatory. Results: A total of 107 patients were enrolled. Age of the patients ranged from 4 to 14 years. Mean age of the patients was 6.68 ± 1.239 years. Male to female ratio was 1.7: 1. The sensitivity, specificity, positive and negative predictive value of leucocyte esterase dipstick test were 86.4%, 92.0%, 73.1% and 96.4% respectively. Conclusion: It is concluded that reagent strips are quick, practical, and low-cost diagnostics with good sensitivity and specificity for identifying SBP in children with nephrotic syndrome

Diagnostic accuracy of MRI in mesorectal fascial involvement

Introduction: Evaluation of mesorectal fascial involvement in rectal cancer is of prime importance in decision making regarding treatment options.&#x0D; Objective: To determine diagnostic accuracy of Magnetic Resonance Imaging (MRI) in detection of mesorectal fascia involvement in rectal carcinoma patients using histopathology as gold standard.&#x0D; Materials &amp; Methods: A comparative study was performed in the Radiology department of Kuwait Teaching Hospital, Peshawar, from January 1, 2021, till December 31, 2021, on 155 patients of rectal carcinoma who had their MRI done for rectal cancer on 0.3T MR Machine. Surgical findings like mesorectal fascial involvement by the tumor, presence/absence of pelvic lymph nodes within 5mm of mesorectal fascia, and staging of the tumor were included as variables. Specimens were sent in formalin to a histopathologist, and findings were considered for comparison. Data were analyzed using SPSS version 23.&#x0D; Results: Out of 155 patients, 82 patients showed mesorectal fascial involvement whereas 73 patients were Circumferential Resection Margin (CRM) negative. Out of these 7 patients were falsely labeled as CRM positive on MRI, whereas 9 patients were falsely labeled as CRM negative on MRI. Positive predictive value was 91%, with negative predictive value of 88%. Diagnostic accuracy was 89.6%. Sensitivity was 89% whereas specificity was 90.4%.&#x0D; Conclusion: MRI has high sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for detection of mesorectal fascial involvement in case of rectal carcinoma taking 5mm as cut off value.

Abstract 11100: Modified EDACS-ADP Score Using Derived 12-Lead Electrocardiogram and Cardiac Electrical Biomarker

Introduction: The EDACS-ADP risk score includes 12-lead electrocardiogram (ECG) and troponin (cTn) to stratify patients presenting with chest pain. The ECG can be derived (dECG) from 3 measured leads with high correlation. A new cardiac electrical biomarker (CEB®) that correlates with cTn can be constructed in real-time from the dECG with reportedly high diagnostic accuracy for detection of acute myocardial infarction (AMI). Objective: Compare the EDACS-ADP to a modified risk score that includes substitution of dECG for ECG, and CEB® for cTn. Methods: This study included 138 consecutive patients presenting to an emergency facility with complaints of chest pain. The prevalence of AMI was 14.5% including 7 STEMI and 13 Non-STEMI. The dECG and CEB® were constructed from leads {I, II, V2} directly from an ECG device (VectraplexECG System, VectraCor Inc, Totowa, NJ). Each EDACS-ADP was calculated and compared to a modified score that utilized the dECG instead of the actual ECG, and CEB® instead of cTn. Sensitivities and specificities were calculated for the EDACS-ADP scores and respective modified scores. ROC curves were constructed to identify risk score cut-offs. Results: The CEB® showed high diagnostic accuracy for AMI with sensitivity 85%, specificity 95.8%, negative predictive value 97.4%, and positive predictive value 77.3%. The cTn showed sensitivity 100%, specificity 89.8%, negative predictive value 100%, and positive predictive value 62.5%. EDACS-ADP with ECG and cTn showed sensitivity 100%, specificity 88.1%, negative predictive value 100%, and positive predictive value 58.8% compared to the modified score with dECG and CEB that showed sensitivity 85%, specificity 94.9%, negative predictive value 97.4%, and positive predictive value 73.9%. The reported EDACS cut-off of 16 was validated by ROC curve analysis. Conclusions: The modified EDACS-ADP risk score based on substitution of the dECG for ECG and CEB® for cTn is comparable to the customary risk score. The modified risk score is easy to calculate and is available immediately allowing a shorter time to decision for possible admission. Also, the modified risk scores may be applicable in facilities where cTn is not immediately available such as in outpatient urgent care and post-acute care centers.

DIAGNOSTIC ACCURACY OF PANBIO COVID-19 RAPID ANTIGEN METHOD FOR SCREENING IN EMERGENCY CASES

Objective: To determine the diagnostic accuracy of PANBIO COVID-19 rapid antigen method in nasopharyngeal swab, for screening of COVID-19 infection in emergency cases.&#x0D; Study Design: Cross-sectional validation study.&#x0D; Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Multan, from Jan to Mar 2021.&#x0D; Methodology: After taking approval from institutional ethical review committee, total 1539 patients were included in this study according to sample size. With informed consent, nasopharyngeal swab specimens were taken for PANBIO COVID-19 rapid antigen method from each patient presenting as emergency medical/surgical case to Combined Military Hospital Multan as well as for Polymerase Chain Reaction for SARS CoV-2 RNA. PANBIO COVID-19 rapid antigen method and polymerase chain reaction for SARS CoV-2 RNA were performed simultaneously on swabs. Polymerase chain reaction for SARS CoV-2 RNA was considered to be the gold standard for comparison with the PANBIO COVID-19 rapid antigen method.&#x0D; Results: A total of 21 patients had SARS CoV-2 RNA detected by polymerase chain reaction indicating COVID-19 infection. Out of polymerase chain reaction positive patients, PANBIO™ COVID-19 Ag test was able to detect 19 cases. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy was calculated and found to be 90.47%, 100%, 100%, 99.8% and 99.8% respectively.&#x0D; Conclusion: PANBIO™ COVID-19 rapid antigen method was found to have excellent diagnostic accuracy in detection of COVID-19 infection. It can provide as a good alternate test for screening of masses with a short turn around time of only 15 minutes.

Diagnostic accuracy of narrow‐band imaging endoscopy with targeted biopsies compared with standard endoscopy with random biopsies in patients with Barrett's esophagus: A systematic review and meta‐analysis

Endoscopic surveillance for dysplasia in Barrett's esophagus (BE) with random biopsies is the primary diagnostic tool for monitoring clinical progression into esophageal adenocarcinoma. As an alternative, narrow-band imaging (NBI) endoscopy offers targeted biopsies that can improve dysplasia detection. This study aimed to evaluate NBI-guided targeted biopsies' diagnostic accuracy for detecting dysplasia in patients undergoing endoscopic BE surveillance compared with the widely used Seattle protocol. Cochrane DTA Register, MEDLINE/PubMed, EMBASE, OpenGrey, and bibliographies of identified papers were searched until 2018. Two independent investigators resolved discrepancies by consensus, study selection, data extraction, and quality assessment. Data on sensitivity, specificity, and predictive values were pooled and analyzed using a random-effects model. Of 9528 identified articles, six studies comprising 493 participants were eligible for quantitative synthesis. NBI-targeted biopsy showed high diagnostic accuracy in detection of dysplasia in BE with a sensitivity of 76% (95% confidence interval [CI]: 0.61-0.91), specificity of 99% (95% CI: 0.99-1.00), positive predictive value of 97% (95% CI: 0.96-0.99), and negative predictive value of 84% (95% CI: 0.69-0.99) for detection of all grades of dysplasia. The receiver-operating characteristic curve for NBI model performance was 0.8550 for detecting all dysplasia. Narrow-band imaging-guided biopsy demonstrated high diagnostic accuracy and might constitute a valid substitute for random biopsies during endoscopic surveillance for dysplasia in BE.

Hysteroscopic detection of chronic endometritis: Evaluating proposed hysteroscopic features suggestive of chronic endometritis

PurposeTo evaluate the proposed criteria in a large sample and in additional subgroups in order to test the validity of the hysteroscopic features widely-accepted as suggestive of CE. Method(s)All patients (n: 2675) underwent outpatient hysteroscopy, with the vaginoscopic approach technique. Hysteroscopic features such as, stromal oedema, diffuse or focal hyperaemia, “strawberry aspect”, micropolyposis and endometrial polyps, are often indicate the presence of chronic endometritis. All hysteroscopic features, alone and in combination were applied in 7 (seven) different subgroups of the sample: total sample, women in reproductive age, women with infertility issues/IVF screening, women with history of recurrent miscarriages, menopausal women, and women with hysteroscopic indication of Abnormal Uterine Bleeding (AUB) in women of reproductive age and postmenopausal bleeding (PMB). From each case, endometrial samples were obtained and immunohistochemistry, identifying CD-138, was applied in order to diagnose CE. Result(s)A total of 2675 patients were included of which, 1444 women were found with at least one of the proposed hysteroscopic features mentioned above. Stromal oedema, focal or diffuse hyperaemia and “strawberry aspect” in combination with micropolyposis demonstrated higher rates of diagnostic accuracy in the detection of CE correlated to histologic confirmation. Micropolyposis, stromal oedema, focal or diffuse hyperaemia and “strawberry aspect” offer great diagnostic accuracy in the hysteroscopic detection of Chronic Endometritis, regardless reproductive status and/or clinical presentation. Endometrial polyps are not valid hysteroscopic features in cases of suspected CE. Conclusion(s)Diagnostic hysteroscopy can accurately diagnose cases of CE, based on stromal oedema, focal or diffuse hyperaemia and “strawberry aspect”, in combination with micropolyposis. In subgroups of infertile women, higher diagnostic accuracy based on the hysteroscopic features mentioned, was more likely to be achieved. Whether endometrial polyps are suggestive of CE, when identified during office hysteroscopy, remains controversial.

The Value of Using Grey Scale Ultrasound in the Estimation of Palpable Breast Lumps in a Specialist Breast Clinic in Mosul City of Iraq

Breast carcinoma is one of the most common female malignancies affecting the females within the 30-60 years age groups in many parts of the world. The aim of the study was to assess the using of grey scale ultrasound in the evaluation of palpable breast lumps in Mosul city and compare the finding with the histopathology. Materials and Methods: The study was retrospective study which was done at Al-Khansa Specialist Breast Clinic, from January 2019 to July 2019. 155 patients with palpable breast lump were evaluated by grey scale ultrasound and their characteristics radiological features were studied and compared with the final histopathological diagnosis. Results: By ultrasound, about 60% of the cases were benign, 13.5 % were intermediate and 26.4 % were malignant compared with the histopathology which showed 71.6 % were benign and 28.4 % were malignant. The most common benign lesion was fibroadenoma while mastitis was the most common intermediate lesion diagnosed on histopathology. The specificity and sensitivity of the ultrasound in detection of breast carcinoma were 92.7% and 88.6% respectively. PPV of 82.9% and NPV of 95.3% with diagnostic accuracy 91.6%. Conclusion: In our study, the grey scale ultrasonography has high specificity, sensitivity and diagnostic accuracy in detection of breast carcinoma to reduce the morbidity and mortality of the disease. In general, ultrasound' s availability and low cost in developing countries and comfort to the patients with no radiation effect; making it considered as 1st line investigation modality in females breast lumps.

Comparison between two cell collecting methods for liquid-based brush biopsies: a consecutive and retrospective study

BackgroundThis study compares two different cell collectors, the Orcellex Brush (rigid brush) and the Cytobrush GT (nylon brush), using liquid-based cytology. A comparison of their obtainment procedures was also considered. The aim was to determine the diagnostic accuracy for detection of malignancy in oral brush biopsies. PICO-Statement: In this consecutive and retrospective study we had as population of interests, patients with oral lesions, the intervention was the brush biopsy with two different cell collectors and the control was healthy oral mucosa. The outcome of the study was to compare both cell collectors.MethodsFrom 2009 to 2018, 2018 patients with oral lesions were studied using the nylon brush (666 cases) and rigid brush (1352 cases). In the first cohort five smears per patient were taken with the nylon brush, while each patient received one smear with the rigid brush in the second cohort. These were further processed in a liquid-based procedure. Cytological evaluations were categorised into ‘negative’, which were considered as negative, whereas ‘doubtful’, ‘suspicious’ and ‘positive’ cytological results were overall considered as positive for malignancy in comparison to the final histological diagnoses. Additionally, the clinical expenditure for each collector was estimated.Results2018 clinically and histologically proven diagnoses were established, including 181 cases of squamous cell carcinomas, 524 lichen, 454 leukoplakias, 34 erythroplakias and 825 other benign lesions. The sensitivity and specificity of the nylon brush was 93.8% (95% CI 91.6–95.5%) and 94.2% (95% CI 91.8–95.5%) respectively, whereas it was 95.6% (95% CI 94.4–96.6%) and 84.9% (95% CI 83.8–87.5%) for the rigid brush. The temporal advantage using the plastic brushes was 4× higher in comparison to the nylon brush. The risk suffering from a malignant oral lesion when the result of the brushes was positive, suspicious, or doubtful was significantly high for both tests (nylon brush OR: 246.3; rigid brush OR: 121.5).ConclusionsBoth systems have a similar sensitivity, although only the rigid brush achieved a satisfactory specificity. Additional methods, such as DNA image cytometry, should also be considered to improve the specificity. Furthermore, the rigid brush proved to be more effective at taking a sufficient number of cells, whilst also being quicker and presenting less stress for the patient.

Diagnostic and prognostic value of 99mTc-Tektrotyd scintigraphy and 18F-FDG PET/CT in a single-center cohort of neuroendocrine tumors.

The aim was to assess the diagnostic value of 99mTc-Tektrotyd scintigraphy (TCT) and positron emission tomography/computed tomography using F-18 fluorodeoxyglucose (18F-FDG PET/CT) in the detection and follow-up of neuroendocrine tumors (NETs), and their predictive value for disease progression. In this retrospective cohort, TCT and 18F-FDG PET/CT were performed in 90 patients (37 men, 53 women, mean age 52.7 ±15.1), with NET. Correlation of Ki67 and tumor grade versus Krenning score and SUVmax was assessed, Kaplan-Meier analysis was used for progression-free survival (PFS), and Cox regression analysis was performed to identify the association between progression-related factors and PFS. Out of 90, true positive TCT was detected in 56 (62.2%) patients, true negative in 19 (21.1%), false positive in 4 (4.4%), false negative in 11 (12.2%), while 18F-FDG PET/CT was true positive in 69 (76.7%) patients, true negative in 10 (11.1%), false positive in 5 (5.5%), false negative in 6 (6.7%). Mean 18F-FDG PET/CT SUVmax was 6.8 ±6.2. Diagnostic sensitivity of TCT was 83.6%, specificity 82.6%, accuracy 83.3% vs. 18F-FDG PET/CT sensitivity was 92.0%, specificity 66.7%, accuracy 87.8%. A significant correlation between Ki67 and SUVmax was found in positive 18F-FDG PET/CT findings, unlike the correlation between Ki67 and Krenning score. Median PFS was 25 months (95% CI: 18.2-31.8), in 18F-FDG PET/CT positive patients 23 months (95% CI: 16.3-29.7) and 18F-FDG PET/CT negative 26 months (p = 0.279). Progression-free survival predictors were SUVmax and Krenning score. In our study, TCT and 18F-FDG PET/CT have high diagnostic accuracy in detection of NET. Higher Krenning score on TCT and SUVmax in positive 18F-FDG PET/CT findings are predictors of disease progression. 99mTc-Tektrotyd scintigraphy and 18F-FDG PET/CT can be useful complementary tools in management of patients with NETs and in predicting patients' outcome.

Identifying Myocardial Infarction Using Hierarchical Template Matching-Based Myocardial Strain: Algorithm Development and Usability Study.

BackgroundMyocardial infarction (MI; location and extent of infarction) can be determined by late enhancement cardiac magnetic resonance (CMR) imaging, which requires the injection of a potentially harmful gadolinium-based contrast agent (GBCA). Alternatively, emerging research in the area of myocardial strain has shown potential to identify MI using strain values.ObjectiveThis study aims to identify the location of MI by developing an applied algorithmic method of circumferential strain (CS) values, which are derived through a novel hierarchical template matching (HTM) method.MethodsHTM-based CS H-spread from end-diastole to end-systole was used to develop an applied method. Grid-tagging magnetic resonance imaging was used to calculate strain values in the left ventricular (LV) myocardium, followed by the 16-segment American Heart Association model. The data set was used with k-fold cross-validation to estimate the percentage reduction of H-spread among infarcted and noninfarcted LV segments. A total of 43 participants (38 MI and 5 healthy) who underwent CMR imaging were retrospectively selected. Infarcted segments detected by using this method were validated by comparison with late enhancement CMR, and the diagnostic performance of the applied algorithmic method was evaluated with a receiver operating characteristic curve test.ResultsThe H-spread of the CS was reduced in infarcted segments compared with noninfarcted segments of the LV. The reductions were 30% in basal segments, 30% in midventricular segments, and 20% in apical LV segments. The diagnostic accuracy of detection, using the reported method, was represented by area under the curve values, which were 0.85, 0.82, and 0.87 for basal, midventricular, and apical slices, respectively, demonstrating good agreement with the late-gadolinium enhancement–based detections.ConclusionsThe proposed applied algorithmic method has the potential to accurately identify the location of infarcted LV segments without the administration of late-gadolinium enhancement. Such an approach adds the potential to safely identify MI, potentially reduce patient scanning time, and extend the utility of CMR in patients who are contraindicated for the use of GBCA.

Diagnostic performance of circulating cell-free DNA for hepatocellular carcinoma: a systematic review and meta-analysis.

Background: We aimed to assess the diagnostic performance of circulating cell-free DNA (cfDNA) in hepatocellular carcinoma (HCC). Materials & methods: After a systematic literature search bivariate linear mixed models wereused to integrate sensitivity, specificity, positive likelihood ratio, negative likelihood ratioand diagnostic odds ratio. The area under receiver operating characteristics curvesof the included studies was used to estimate the diagnostic value. Results: Thirty-eight articles enrolled in quantitative synthesis. In overall analysis the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under receiver operating characteristics curves for cfDNA in distinguishing HCC patients from healthy controls were 0.54, 0.90, 5.23, 0.51, 10.27and 0.82, respectively. Conclusion: This study suggests that cfDNA has a promising diagnostic accuracy in detection of HCC.

Emerging Role of Prenatal Magnetic Resonance Imaging in the Diagnosis of Placental Adhesion Disorders and its Relation with Intraoperative Findings- A Cross-sectional Study

Introduction: Placental Adhesion Disorders (PADs) aka Placenta Accreta Spectrum (PAS) of disorders are a common cause of postpartum haemorrhage, which in turn is an avoidable cause of significant maternal morbidity and mortality. The exponential increase in the prevalence of PADs worldwide primarily ascribed to increasing percentage of caesarean section deliveries therefore contributes significantly to potentially life-threatening obstetrical emergencies. Accurate prenatal diagnosis of PAD is hence fundamental for patient management and prognostication. Imaging plays an indispensable role in the antenatal diagnosis of PAD thereby translating to improved maternal outcomes. Aim: To determine the diagnostic accuracy of prenatal Magnetic Resonance Imaging (MRI) in predicting abnormal invasive placentation and to associate MRI findings with intraoperative findings. Materials and Methods: The present cross-sectional study was conducted between March 2019 to March 2020. Pregnant females with clinically and/or sonographically suspected PAD and having major risk factors of PAD {Lower Segment Caesarean Section (LSCS) in previous and placenta previa in present gestation} were subjected to dedicated placenta protocol MRI examination. The placental morphology, localisation and adhesion suggestive features were evaluated in detail. Descriptive statistical analysis was done for final assessment. Results: A total of 27 study participants, with mean age of 28±2.15 years, showed MRI findings compatible with PAD. Placenta previa complete (66.67%); was the dominant subtype observed in the study. In terms of degree of invasion, placenta accreta in 44.44% (n=12) was predominantly observed on preliminary MRI based assessment. The most reliable MRI features predictive of placental invasion in the present study (seen in 100% cases of PAD) included T2 dark intraplacental bands, heterogenous intraplacental signal intensity, disorganised intraplacental vascularity, myometrial thinning, loss of the uteroplacental interface and maternal neovascularity. In one case, MRI erroneously over-diagnosed increta as percreta. The overall diagnostic performance of these MRI parameters was with sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of 100%, 95%; 87.5% and 100% in those with placenta percreta compared to 94.12%, 100.00%, 100% and 95% for the placenta accreta or increta cases, respectively. Conclusion: MRI has high diagnostic accuracy in detection of PADs among the high-risk patients. Dedicated placenta protocol prenatal MRI should hence be incorporated in diagnostic work- up of all high-risk patients of PAD for reaping benefits of timely management, planning and saving lives.

Diagnostic accuracy of magnetic resonance imaging in detection of intra-axial gliomas.

Objective:To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in detection of intra-axial gliomas in suspected cases keeping histopathology as gold standard.Methods:This cross-sectional study was conducted at Dow Institute of Radiology, DUHS from October 2017 - April 2018. Patients of either gender aged 30-70 years presenting with headache were included. Patients already diagnosed and referred for follow up were excluded. MRI was performed on 1.5T scanner by a trained MRI technician. T1, T2, FLAIR, diffusion weighted and T1 post contrast images were acquired and reviewed by two radiologists having more than five years post fellowship experience. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of MRI for intraaxial gliomas was calculated taking histopathology findings as gold standard.Results:Mean age of the patient`s was 51.71 ±10.85 years. Positive intraaxial gliomas on MRI were observed in 123 (79.90%) patients while on histopathology, positive intraaxial gliomas were observed in 131 (85.10%) patients. Diagnostic accuracy of MRI in detection of intra-axial gliomas taking histopathology findings as gold standard showed sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV) and overall diagnostic accuracy as 89.31%, 73.91%, 95.12%, 54.84% and 87.01%.Conclusions:MRI has high sensitivity, moderate specificity and high diagnostic accuracy in detection of intraaxial gliomas.

Detection of epidermal growth factor receptor mutations in peripheral blood circulating tumor DNA in patients with advanced non-small cell lung cancer: A PRISMA-compliant meta-analysis and systematic review.

Background:The epidermal growth factor receptor (EGFR) mutation status related to the treatment approach for advanced non-small cell lung cancer (NSCLC) patients. This study aimed to evaluate the diagnostic accuracy of peripheral blood circulating tumor DNA (ctDNA) in EGFR mutated advanced NSCLC patients.Method:The related database was systematically searched with keywords until January 19, 2020. Studies contained the histopathological and cytological advanced NSCLC samples were included, and the diagnostic data were recorded for calculating sensitivity and specificity. I 2 statistics were used for detecting heterogeneity across studies, and the meta-regression was performed to seek the source of heterogeneity.Result:A total of 32 studies with 4527 advanced NSCLC patients were included in our meta-analysis. Among them, 87% of the patients were diagnosed as stage IV. The pooled sensitivity of peripheral blood ctDNA was 0.70 (95% CI: 0.63–0.75, I 2 = 81.76) and the pooled specificity was 0.98 (95% CI: 0.96–0.99, I 2 = 88.33). The meta-regression showed that the prospective study design and the ARMS detection method were the main source of heterogeneity for sensitivity (P < .05), and the publication country (Asia or non-Asia) was the main source of heterogeneity for specificity (P < .01).Conclusion:ctDNA biopsy has high specificity and diagnostic accuracy in detection of EGFR mutation in advanced NSCLC patients. When the ctDNA gene test result is negative, we should fully consider the risk of missed diagnosis, and further tissue biopsy is still needed to undertake.

Detection of atrial shunt lesions with asingle echocardiographic parameter.

SummaryBackgroundUnrepaired left to right atrial shunt lesions can cause significant right ventricular (RV) volume overload. The parameter pulmonary to systemic shunt volume ratio (Qp:Qs) has been shown to detect even small differences between left and right ventricular stroke volume; however, four parameters are needed for its calculation. This study was carried out to evaluate the accuracy of the single parameter right ventricular outflow tract (RVOT) velocity time integral (VTI) to identify atrial shunt lesions.MethodsAll patients who underwent transesophageal echocardiography (TEE) examination at this institution between 1 January 2013 and 1 January 2018 were retrospectively analyzed. The RVOT-VTI was measured in the transthoracic echocardiography performed immediately before each TEE. The diagnostic accuracy for detection of atrial shunt lesions was tested.ResultsA total of 2797 patients with a median age of 67 years (interquartile range, IQR 54–77 years) were included in the final analysis. A total of 113 (4%) patients had a relevant atrial shunt lesion. The mean RVOT-VTI of the shunt group was 25 cm (SD ± 8.1 cm) and was significantly higher than that of the non-shunt group with 17 cm (SD ± 4.8 cm) (p < 0.001). The area under the curve (AUC) was 0.81. A total of 106 patients (93.8%) of the shunt group had a VTI of ≥16 cm. If the RVOT-VTI was <16 cm, the negative predictive value was 99.3%. If the RVOT-VTI was ≥25 cm, 22% of patients proved to have a significant shunt lesion.ConclusionIn this large retrospective analysis it could be shown that a low RVOT-VTI predicted the absence of significant atrial shunt lesions, while a high RVOT-VTI predicted the presence. The parameter should be applied in all patients with suspected atrial shunt lesions where calculation of Qp:Qs is impossible.Electronic supplementary materialThe online version of this article (10.1007/s00508-020-01659-0) contains supplementary material, which is available to authorized users.