Significant Difference In Diagnostic Accuracy Research Articles

Diagnostic accuracy of point-of-care natriuretic peptide testing for chronic heart failure in ambulatory care: systematic review and meta-analysis

ObjectiveTo assess the diagnostic accuracy of point-of-care natriuretic peptide tests in patients with chronic heart failure, with a focus on the ambulatory care setting.DesignSystematic review and meta-analysis.Data sourcesOvid Medline, Cochrane...

Остеосцинтиграфия И ОФЭКТ/КТ в диагностике различных вариантов метастатического поражения костей

Purpose: To determine the diagnostic capabilities of body scan (BS) and SPECT/CT in the diagnosis of various variants of bone metastases (BM). Material and methods: The data of 37 patients with BM of breast cancer (20 patients), prostate cancer (7 patients) and other tumors various localization (10 patients) were analyzed. The study was carried out in two stages: first, BS was performed, 3 hours after intravenous introduction of an osteotropic radiopharmaceutical labeled with 99mTc (technephor or phosphotech), followed by SPECT/CT of the selected zone of interest. All studies were performed on a combined system Symbia T2 (Siemens) with a 2-slice low dose CT. Results: With BS the foci of the tumor lesion were identified in 33 cases, and in SPECT/CT in 37 cases. There were detected 159 BM (21 sites: 0.4–0.9, 59 sites: 1.0–1.9, 79 sited: 2.0–4.5 cm). The total detectable incidence of metastases with BS was 66.0 % (105 BM) of all metastases detected in comparison with SPECT/CT (159 BM). Detectability with BS increased with increasing size of detectable foci. Foci less than 1 cm are detected in isolated case (1 from 21 cases). Metastases measuring from 1 cm to 1.9 cm are detected only in 52.5 % of cases (31 from 59 cases). The detectability of large metastases (2 cm or more) with BS (92.4 %) approaches the SPECT/CT (100 %) – 73 from 79 cases. There were detected with BS 27 osteoblastic BM in comparison 56 BM with SPECT/CT (48.2 %). The detectability with BS of mixed BM (76.3 %) and octeolitic BM (75.4 %) showed no differences. Firstly it can be explained by a predominance of smaller osteoblastic foci, and secondly reparative processes in metastases, accompanied by reduction of the radiopharmaceutical. The correction of the conclusion of the BS was required just in 24 cases: in 8 cases, when the BS was marked overdiagnosis, 16 – underdiagnosis. However, BS does not lose its value as a screening. In one case, even if BS has been revealed metastasis, it is not yet accompanied by destruction of bone tissue. Despite such significant differences in diagnostic accuracy of BS and SPECT/CT, BS proved to be uninformative only in 2 cases: when undetected metastases without primary tumor identified, and in the case of the screening of metastasis the accumulation of the radiopharmaceutical in the bladder. In 2 other cases, the lack of accumulation of the radiopharmaceutical was determined by the reparation that can only be considered conditionally uninformative. However, SPECT/CT shows clear advantages in the visualization of bone metastases due to computed tomography, allowing to estimate the structure of bone tissue. In 9 cases even to SPECT-slices metastases were not accompanied by pathological accumulation of the radiopharmaceutical. Conclusion: SPECT/CT is a highly informative method for detecting bone metastases, the use of which allows reducing the time of examination and dose irradiation of patients due to the rejection of additional radiological procedures. In addition, SPECT/CT at the same time allows differential diagnosis of structural and metabolic bone changes, which increases both the accuracy of primary diagnosis and control of treatment.

Radiation Dose Reduction at Low Tube Voltage CCTA Based on the CNR Index

We compared the radiation dose and diagnostic accuracy on 120- and 100-kVp coronary computed tomography angiography (CCTA) scans whose contrast-to-noise ratio (CNR) was the same. We studied 1311 coronary artery segments from 100 patients. For 120-kVp scans, the targeted image level was set at 25 Hounsfield units (HU). For 100-kVp scans, the targeted noise level was set at 30 HU to obtain the same CNR as at 120 kVp. We compared the CNR and the radiation dose on scans acquired at 120 and 100 kVp. Invasive coronary angiography (ICA) images were evaluated by an interventional coronary angiography specialist, and CCTA images were evaluated by a radiologist. Coronary artery disease was defined as a luminal narrowing ≧50% for ICA and CCTA. With ICA considered the gold standard, the diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) was analyzed on both 120- and 100-kVp CCTA images. We also compared the diagnostic accuracy for area under the receiver operating characteristic curve of the ICA and CCTA performed at 120 and 100 kVp. Two blinded observers visually evaluated the septal branch. The mean dose-length product was 48% lower at 100 kVp than at 120 kVp (P < .01). Under the 120-kVp CCTA protocol, the area under the curve, 95% confidence interval, sensitivity, specificity, positive predictive value, and negative predictive value were 0.94%, 0.91%-0.96%, 94.0%, 93.0%, 82.3%, and 98.1%, respectively; at 100 kVp these values were 0.94%, 0.92%-0.97%, 96.1%, 92.0%, 85.2%, and 98.0%, respectively. Area under the receiver operating characteristic curve analysis revealed no significant difference in diagnostic accuracy between the two protocols (P = .87). At the same CNR, the 100-kVp CCTA protocol may help to reduce the radiation dose by approximately 50% compared to the 120-kVp protocol without degradation of diagnostic accuracy.

How to tell a patient’s story? Influence of the case narrative design on the clinical reasoning process in virtual patients

Background: Virtual patients (VPs) are narrative-based educational activities to train clinical reasoning in a safe environment. Our aim was to explore the influence of the design of the narrative and level of difficulty on the clinical reasoning process, diagnostic accuracy and time-on-task.Methods: In a randomized controlled trial, we analyzed the clinical reasoning process of 46 medical students with six VPs in three different variations: (1) patients showing a friendly behavior, (2) patients showing a disruptive behavior and (3) a version without a patient story.Results: For easy VPs, we did not see a significant difference in diagnostic accuracy. For difficult VPs, the diagnostic accuracy was significantly higher for participants who worked on the friendly VPs compared to the other two groups. Independent from VP difficulty, participants identified significantly more problems and tests for disruptive than for friendly VPs; time on task was comparable for these two groups. The extrinsic motivation of participants working on the VPs without a patient story was significantly lower than for the students working on the friendly VPs.Conclusions: Our results indicate that the measured VP difficulty has a higher influence on the clinical reasoning process and diagnostic accuracy than the variations in the narratives.

Importance of operator training and rest perfusion on the diagnostic accuracy of stress perfusion cardiovascular magnetic resonance

BackgroundClinical evaluation of stress perfusion cardiovascular magnetic resonance (CMR) is currently based on visual assessment and has shown high diagnostic accuracy in previous clinical trials, when performed by expert readers or core laboratories. However, these results may not be generalizable to clinical practice, particularly when less experienced readers are concerned. Other factors, such as the level of training, the extent of ischemia, and image quality could affect the diagnostic accuracy. Moreover, the role of rest images has not been clarified.The aim of this study was to assess the diagnostic accuracy of visual assessment for operators with different levels of training and the additional value of rest perfusion imaging, and to compare visual assessment and automated quantitative analysis in the assessment of coronary artery disease (CAD).MethodsWe evaluated 53 patients with known or suspected CAD referred for stress-perfusion CMR. Nine operators (equally divided in 3 levels of competency) blindly reviewed each case twice with a 2-week interval, in a randomised order, with and without rest images. Semi-automated Fermi deconvolution was used for quantitative analysis and estimation of myocardial perfusion reserve as the ratio of stress to rest perfusion estimates.ResultsLevel-3 operators correctly identified significant CAD in 83.6% of the cases. This percentage dropped to 65.7% for Level-2 operators and to 55.7% for Level-1 operators (p < 0.001). Quantitative analysis correctly identified CAD in 86.3% of the cases and was non-inferior to expert readers (p = 0.56). When rest images were available, a significantly higher level of confidence was reported (p = 0.022), but no significant differences in diagnostic accuracy were measured (p = 0.34).ConclusionsOur study demonstrates that the level of training is the main determinant of the diagnostic accuracy in the identification of CAD. Level-3 operators performed at levels comparable with the results from clinical trials. Rest images did not significantly improve diagnostic accuracy, but contributed to higher confidence in the results. Automated quantitative analysis performed similarly to level-3 operators. This is of increasing relevance as recent technical advances in image reconstruction and analysis techniques are likely to permit the clinical translation of robust and fully automated quantitative analysis into routine clinical practice.

Avoiding premature closure and reaching diagnostic accuracy: some key predictive factors.

Early studies suggested that experienced clinicians simply generate more accurate diagnoses than those less experienced. However, more recent studies indicate that experienced clinicians may be subject to biases in formulating and confirming hypotheses that lead to inaccuracy. The goal of this study was to identify factors associated with the ability to process information in ways that overcome premature closure and result in accurate diagnosis using a set of vignettes in which inconsistent information was introduced midway. Seventy-five participants (25 Year 3 medical students, 25 internal medicine residents in their second year of residency and 25 internal medicine faculty) were recruited to solve each of four complex clinical vignettes. In each vignette, the first four rounds of information pointed toward a narrowing range of diagnostic possibilities, but patient information presented in and after the fifth round was inconsistent with prior findings. In addition to accuracy, outcome measures were length of differential diagnosis, certainty of diagnosis, persistence in data collection and tendency to switch diagnoses. There were no significant differences in diagnostic accuracy across the three groups, each of which differed in level of training. However, across experience levels, diagnostic accuracy was associated with the mean number of items in the differential, tendency to persist (e.g. to request a greater number of rounds of information), and openness to switch (e.g. to change the most likely diagnosis on receipt of disconfirming information). Level of training (i.e. clinical experience) was not associated with accuracy on this task. As faculty clinicians certainly have more knowledge than their junior counterparts, it is important to identify ways in which cognitive factors can lead to more or less persistence and openness, and to teach clinicians how to overcome tendencies associated with error.

CT assessment-based direct surgical resection of part-solid nodules with solid component larger than 5mm without preoperative biopsy: experience at a single tertiary hospital.

To retrospectively evaluate the feasibility of CT assessment-based direct surgical resection of part-solid nodules (PSNs) with solid components > 5mm without preoperative percutaneous transthoracic needle biopsies (PTNBs). From January 2009-December 2014, 85 PSNs with solid components > 5mm on CT were included. Preoperative PTNBs were performed for 41 PSNs (biopsy group) and CT assessment-based direct resections were performed for 44 PSNs (direct surgery group). Diagnostic accuracy and complication rates of the groups were compared. Pathological results of 83 PSNs excluding two indeterminate nodules included 76 adenocarcinomas (91.6%), two adenocarcinomas in situ (2.4%) and five benign lesions (6.0%). In the biopsy group, the overall sensitivity, specificity and accuracy for the diagnosis of adenocarcinoma were 78.9% (30/38), 100% (1/1) and 79.5% (31/39), respectively. Pneumothorax and haemoptysis occurred in 11 procedures (26.8%). In the direct surgery group, the respective values for the diagnosis of adenocarcinoma were 100% (38/38), 0% (0/6) and 86.4% (38/44), respectively. Seven pneumothoraces (15.9%); no haemoptysis occurred during localization procedures. There were no significant differences in diagnostic accuracy (P = 0.559) between the two groups. CT assessment-based direct resection can be reasonable for PSNs with solid part > 5mm. • 91.6% of PSNs with solid component > 5mm were adenocarcinomas. • PTNBs for PSNs with solid component > 5mm had 79.5% accuracy. • CT-based resection for PSNs with solid component > 5mm had 86.4% accuracy. • CT-based resection without biopsy can be a reasonable option in routine practice.

Diagnostic value of X-ray, CT and MRI for sacroiliac joint lesions in patients with early stage of ankylosing spondylitis

Objective To compare the diagnostic value of X-ray, CT or MRI in detection of abnormal sacroiliac joint changes in patients with early stage ankylosing spondylitis. Methods One hundred and twenty patients with early stage ankylosing spondylitis who admitted in our hospital underwent X-ray, CT and MRI subsequently were selected, and the diagnostic value was analyzed. Results There were no statistically significant differences in diagnostic accuracy of articular cartilage swelling, joint space narrowing, joint space widening, the articular surface of cystic mass, articular sclerosis by CT and MRI(all P>0.05), except for bone erosion and bone cyst lesion(χ2 =8.179, 6.289, all P 0.05). Conclusion X-ray associated with low accuracy rate and high rate of miss diagnosis.With the high accuracy rate in detection of abnormal sacroiliac joint changes in patients with early stage ankylosing spondylitis, both CT and MRI are candidate for commonly used diagnostic methods for early diagnosis. Key words: Spondylitis, Ankylosing; Sacroiliac joint; X-rays; Tomography, X-ray computed; Magnetic resonance imaging

Utility of single-photon emission tomography/computed tomography for sentinel lymph node localization in breast cancer patients.

Sentinel lymph node (SLN) mapping is currently a routine technique in breast cancer management and preoperative scintigraphic imaging plays a crucial role in the process of SLN detection. The guidelines recommend performing planar acquisition and optional single-photon emission tomography/computed tomography (SPECT/CT) imaging. The aim of this study was to verify whether routine performing of SPECT/CT in addition to planar imaging increases the sensitivity of SLN detection in patients with early-stage breast cancer. The secondary aims were to compare radionuclide SLN imaging with intraoperative SLN detection and identify clinical and histopathological factors affecting the SLN detection rate. A total of 153 early-stage breast cancer patients underwent lymph node scintigraphy in the years 2007-2013. Breast cancer patients with staging T1-2N0M0 were included. Planar and SPECT/CT lymphoscintigraphy were performed on the day before the surgery. The data on presence or absence of SLN, their number and localization were recorded for both methods and compared with each other as well as with intraoperative blue dye staining and histopathological findings. SPECT/CT identified SLN in 119/153 and planar scintigraphy in 114/153 patients. Identification rates were 77.7 and 74.5%, respectively. Intraoperative lymph node assessment identified SLN in 76/126 cases with an identification rate of 60.3%. Identification rates for second echelon lymph node were 34.6% for hybrid imaging and 21.2% for planar scintigraphy. Statistical analysis did not yield a significant difference in diagnostic accuracy between these methods; however, the Wilcoxon signed-rank test showed that SPECT/CT significantly increases SLN identification rate compared with planar scintigraphy and intraoperative detection. Histopathological examination of excised SLN showed that 22 nodes were metastatic. SPECT/CT visualized all of these, whereas planar imaging and intraoperative lymph node detection procedure visualized 19 and 18, respectively. No clinical and histopathological factors affecting SLN detection rate were identified. Hybrid SPECT/CT lymphatic mapping yields a high SLN detection rate in patients with early-stage breast cancer and provides lymph node localization details. It identifies more SLN than planar imaging and intraoperative SLN detection. However, its limited superiority over the remaining two methods does not support its routine use for SLN localization. We suggest using SPECT/CT for SLN detection in case of equivocal planar imaging results.

Sonography of suspected acute appendicitis in children: Evaluation of the progress in performance of senior residents.

The objective of this study was to evaluate the progress in performance of senior residents in diagnosing acute appendicitis. Results were collected and compared of ultrasound examinations performed for suspected acute appendicitis by three senior residents and two faculty members over a six-month period in a university hospital setting. A grid with the sonographic findings was completed separately by the residents and the faculty members immediately after each examination. The duration of each examination was reported. The final ultrasound diagnosis was compared to the surgical and pathological results and to the clinical follow-up. The residents and faculty members performed 171 consecutive ultrasound examinations including 49 children with acute appendicitis and 122 with normal appendices. The accuracy of the diagnosis by the residents was 96%, and was similar to that of the faculty members (kappa=0.90) over the six months. The duration of the resident ultrasound examinations was significantly shorter during the second three-month period (p=0.01). No significant differences in diagnostic accuracy were demonstrated by the residents between the first and second three-month periods (p=0.06). The residents performed well when using sonography to diagnose acute appendicitis in children, and were faster during the second three-month period. I.

Comparison of diagnostic utility of semi-quantitative analysis for DAT-SPECT for distinguishing DLB from AD

PurposeIt is widely known that there is low striatal 123I-FP-CIT dopamine transporter single photon emission computed tomography (DAT-SPECT) uptake in patients with dementia with Lewy bodies (DLB). However, a consistent quantitative evaluation method for DAT-SPECT has not yet been established. There are two semi-quantitative software packages for DAT-SPECT available in Japan, namely, DaTView and DaTQUANT. The aim of this study was to identify which of these is superior for distinguishing DLB from AD. Moreover, we aimed to identify which region of the striatum is more suitable for distinguishing DLB from AD. MethodsPatients with Alzheimer's disease (AD) (n=95) and patients with DLB (n=133) who underwent DAT-SPECT were enrolled. DaTView and DaTQUANT were used as semi-quantitative analysis tools for DAT-SPECT. ResultsThere were significant correlations in DAT uptake between DaTView and entire regions by DaTQUANT. There was no significant difference in diagnostic accuracy between DaTView and DaTQUANT except in the posterior putamen by DaTQUANT. ConclusionsFor distinguishing DLB from AD, both of DaTView and DaTQUANT software are useful. Moreover, assessing the DAT uptake in entire striatum by DaTView might be sufficient for distinguishing DLB from AD.

Comparison of the accuracy of US-guided biopsy of breast masses performed with 14-gauge, 16-gauge and 18-gauge automated cutting needle biopsy devices, and review of the literature.

To compare the diagnostic accuracy of ultrasound (US)-guided core needle biopsy (CNB) of breast masses performed with 14-gauge, 16-gauge and 18-gauge needles. We retrospectively reviewed the charts of 1,112 patients who underwent US-guided breast CNB with 14-gauge, 16-gauge and 18-gauge needles. Cases with surgical excision or a minimum of 2years of imaging follow-up were included. Rates of sample inadequacy, discordance with surgical or imaging findings and upgrade of DCIS to invasive cancer or high-risk lesion to in situ or invasive cancer were computed for each needle size. The study included 703 CNBs: 203 performed with 14-gauge, 235 with 16-gauge and 265 with 18-gauge needles. There were no significant differences between 14-gauge, 16-gauge and 18-gauge needles in rates of specimen inadequacy (0%, 0.4% and 1.9%, respectively) (p = 0.084); surgical discordance (2.6%, 2.9% and 3.8%) (p = 0.76); imaging discordance (0%, 0% and 2%) (p = 1.0); DCIS upgrade (43%, 43% and 36%) (p = 1.00) or high-risk lesion upgrade (38%, 25% and 55%) (p = 0.49). There was no statistically significant difference in diagnostic accuracy of US-guided CNB of breast masses performed with 14-gauge, 16-gauge and 18-gauge needles. • Percutaneous image-guided breast core needle biopsy (CNB) is the standard of care. • Breast CNB with 14-gauge, 16-gauge and 18-gauge needles has similar diagnostic accuracy. • Smaller gauge needles can be confidently used for ultrasound-guided breast CNB.

Comparing the diagnostic accuracy of ultrasound in the community and in the hospital setting for urinary calculi: A retrospective cohort study

Objective: The objective of this article is to test whether there is a significant difference in diagnostic accuracy between hospital and community-based ultrasound (US) for the detection of urinary calculi in the United Kingdom (UK). Materials and methods: A 30-month, single-blind, retrospective cohort study of all patients referred to Kent and Canterbury Hospital urology multidisciplinary meeting for suspected urinary calculi was conducted. Only those investigated with US and non-contrast computed tomography (NCCT, the gold standard) for their calculi were included. Concordance of US and NCCT was stratified by US location: i.e. either the hospital or community setting (e.g. the latter via general practitioners (GPs) or independent radiographers). Fisher’s exact test was subsequently utilised to test for any significant difference between these two patient groups. Results: Of 2464 patients referred, 257 had both ultrasound and NCCT in their diagnostic workup. Of these, 150 and 107 patients had their US performed in hospital and community settings, respectively. No significant difference in the accuracy of US was detected between the two groups for the detection of urinary calculi when compared with NCCT. Conclusion: US carried out by independent radiographers and GPs in the community is just as accurate as US carried out by hospital sonographers for the detection of urinary calculi in the UK. Greater use of community US for the diagnosis of urinary calculi may promote greater patient/GP satisfaction and reduce hospital attendance without loss of diagnostic accuracy.

The impact of a focused vascular lower limb arterial duplex (F-VLAD) scan in management decisions for acute limb ischaemia.

To establish the diagnostic accuracy of a 'focused vascular lower limb arterial duplex scan (F-VLAD)' developed to facilitate rapid decision-making for acute limb ischaemia (ALI). Ten cases of ALI were identified from our patient database; clinical details, history and examination findings were extracted from the clinical notes. Original 'full' duplex ultrasound (DUS) pictorial reports were 're-formatted' to include only anatomical segments included in the 'F-VLAD' scan. The series of 10 reports were emailed to 1741 vascular surgeons. Each recipient received a random mixture of full and F-VLAD scans. Participants were asked regarding next step in management and confidence in decision-making (Likert scale; 1 strongly disagree, 5 strongly agree). The cases were again sent out to the same database and respondents were asked as to the cause of ischaemia (embolic or thrombosis). Eighty-one participants responded to the first survey and 43 participants to the second survey. Participants felt more confident making decisions regarding management using the full duplex report compared to the F-VLAD report (4 (3-4) vs 3 (2-4), median (IQR); p<0.001). However, there was no significant difference in diagnostic accuracy (differentiating embolus from thrombosis) when comparing the F-VLAD and full DUS reports (85.4% vs 88.3%; p=0.461). F-VLAD and 'full' DUS reports had comparable sensitivity (85.1% vs 86.8%), specificity (85.6% vs 89.2%),positive predictive value (PPV) (80.4% vs 81.9%) and negative predictive value (NPV) (89.2% vs 92.2%), respectively. The F-VLAD scan has comparable accuracy to a traditional full DUS in diagnosing the underlying aetiology of ALI. This may facilitate surgeon-performed point-of-care DUS.

Role of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of mass lesions.

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an accurate technique for sampling the pancreas and mediastinum; however, limited data are available for other mass lesions. The aim of this study was to explore the value of EUS-FNA in the differential diagnosis of all mass lesions. Data from patients who underwent EUS-FNA for the diagnosis of mass lesions, including pancreatic, mediastinal, celiac and retroperitoneal lesions were retrospectively analyzed. The accuracy was calculated by comparing the results of FNA with the results of pathological examination or follow-up surveillances in non-operated cases. A total of 150 cases were included. The location of the mass varied from the pancreas (n=62) to the mediastinum (n=29), gastrointestinal tract (n=36), celiac cavity and retroperitoneum (n=23). The sensitivity and Youdens index of EUS-FNA in the diagnosis of all lesions were 92.97% and 0.93 respectively. The accuracy of diagnosis of pancreatic, mediastinal, gastrointestinal, celiac and retroperitoneal lesions was 85.48, 89.66, 83.33 and 78.23%, respectively. Masses were categorized into parenchymal organs (n=66), luminal organs (n=36) and enlarged lymph nodes (n=33). Lesions in parenchymal organs were likely to be bigger than those in luminal organs (P=0.03) and enlarged lymph nodes (P=0.01). For solid and cystic masses, which constituted 63.3 and 14.7% of the total masses, no significant difference in diagnostic accuracy was observed (P=0.56); however, lesion sizes were significantly different between these two groups (P=0.04) and the majority of cystic masses were identified in women (P=0.03). Malignant lesions were more common in older (P=0.01) and male (P=0.03) patients. In conclusion, EUS-FNA is an effective tool in the diagnosis of unexplained mass lesions; it influences the management of patients by enabling the appropriate treatment to be identified.

Investigation into diagnostic accuracy of common strategies for automated perfusion motion correction.

Respiratory motion is a significant obstacle to the use of quantitative perfusion in clinical practice. Increasingly complex motion correction algorithms are being developed to correct for respiratory motion. However, the impact of these improvements on the final diagnosis of ischemic heart disease has not been evaluated. The aim of this study was to compare the performance of four automated correction methods in terms of their impact on diagnostic accuracy. Three strategies for motion correction were used: (1)independent translation correction for all slices, (2)translation correction for the basal slice with transform propagation to the remaining two slices assuming identical motion in the remaining slices, and (3)rigid correction (translation and rotation) for the basal slice. There were no significant differences in diagnostic accuracy between the manual and automatic motion-corrected datasets ([Formula: see text]). The area under the curve values for manual motion correction and automatic motion correction were 0.93 and 0.92, respectively. All of the automated motion correction methods achieved a comparable diagnostic accuracy to manual correction. This suggests that the simplest automated motion correction method (method 2 with translation transform for basal location and transform propagation to the remaining slices) is a sufficiently complex motion correction method for use in quantitative myocardial perfusion.

The Development of Expertise in Radiology: In Chest Radiograph Interpretation, "Expert" Search Pattern May Predate "Expert" Levels of Diagnostic Accuracy for Pneumothorax Identification.

Purpose To investigate the development of chest radiograph interpretation skill through medical training by measuring both diagnostic accuracy and eye movements during visual search. Materials and Methods An institutional exemption from full ethical review was granted for the study. Five consultant radiologists were deemed the reference expert group, and four radiology registrars, five senior house officers (SHOs), and six interns formed four clinician groups. Participants were shown 30 chest radiographs, 14 of which had a pneumothorax, and were asked to give their level of confidence as to whether a pneumothorax was present. Receiver operating characteristic (ROC) curve analysis was carried out on diagnostic decisions. Eye movements were recorded with a Tobii TX300 (Tobii Technology, Stockholm, Sweden) eye tracker. Four eye-tracking metrics were analyzed. Variables were compared to identify any differences between groups. All data were compared by using the Friedman nonparametric method. Results The average area under the ROC curve for the groups increased with experience (0.947 for consultants, 0.792 for registrars, 0.693 for SHOs, and 0.659 for interns; P = .009). A significant difference in diagnostic accuracy was found between consultants and registrars (P = .046). All four eye-tracking metrics decreased with experience, and there were significant differences between registrars and SHOs. Total reading time decreased with experience; it was significantly lower for registrars compared with SHOs (P = .046) and for SHOs compared with interns (P = .025). Conclusion Chest radiograph interpretation skill increased with experience, both in terms of diagnostic accuracy and visual search. The observed level of experience at which there was a significant difference was higher for diagnostic accuracy than for eye-tracking metrics. (©) RSNA, 2016 Online supplemental material is available for this article.

Progressing Toward a Cohesive Pediatric 18F-FDG PET/MR Protocol: Is Administration of Gadolinium Chelates Necessary?

With the increasing availability of integrated PET/MR scanners, the utility and need for MR contrast agents for combined scans is questioned. The purpose of our study was to evaluate whether administration of gadolinium chelates is necessary for evaluation of pediatric tumors on (18)F-FDG PET/MR images. First, in 119 pediatric patients with primary and secondary tumors, we used 14 diagnostic criteria to compare the accuracy of several MR sequences: unenhanced T2-weighted fast spin-echo imaging; unenhanced diffusion-weighted imaging; and-before and after gadolinium chelate contrast enhancement-T1-weighted 3-dimensional spoiled gradient echo LAVA (liver acquisition with volume acquisition) imaging. Next, in a subset of 36 patients who had undergone (18)F-FDG PET within 3 wk of MRI, we fused the PET images with the unenhanced T2-weighted MR images (unenhanced (18)F-FDG PET/MRI) and the enhanced T1-weighted MR images (enhanced (18)F-FDG PET/MRI). Using the McNemar test, we compared the accuracy of the two types of fused images using the 14 diagnostic criteria. We also evaluated the concordance between (18)F-FDG avidity and gadolinium chelate enhancement. The standard of reference was histopathologic results, surgical notes, and follow-up imaging. There was no significant difference in diagnostic accuracy between the unenhanced and enhanced MR images. Accordingly, there was no significant difference in diagnostic accuracy between the unenhanced and enhanced (18)F-FDG PET/MR images. (18)F-FDG avidity and gadolinium chelate enhancement were concordant in 30 of the 36 patients and 106 of their 123 tumors. Gadolinium chelate administration is not necessary for accurate diagnostic characterization of most solid pediatric malignancies on (18)F-FDG PET/MR images, with the possible exception of focal liver lesions.

Diagnostic Performance of ¹⁸F-FDG PET and PET/CT for the Detection of Recurrent Esophageal Cancer After Treatment with Curative Intent: A Systematic Review and Meta-Analysis.

The aim of this study was to assess the diagnostic performance of (18)F-FDG PET and integrated (18)F-FDG PET/CT for diagnosing recurrent esophageal cancer after initial treatment with curative intent. The PubMed, Embase, and Cochrane library were systematically searched for all relevant literature using the key words "(18)F-FDG PET" and "esophageal cancer" and synonyms. Studies examining the diagnostic value of (18)F-FDG PET or integrated (18)F-FDG PET/CT, either in routine clinical follow-up or in symptomatic patients in whom recurrence of esophageal cancer was suspected, were deemed eligible for inclusion. The primary outcome was the presence of recurrent esophageal cancer as determined by histopathologic biopsy or clinical follow-up. Risk of bias and applicability concerns were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Sensitivities and specificities of individual studies were meta-analyzed using bivariate random-effects models. Eight eligible studies were included for meta-analysis, comprising 486 patients with esophageal cancer who underwent (18)F-FDG PET or PET/CT after previous treatment with curative intent. The quality of the included studies assessed by the QUADAS-2 tool was considered reasonable; there were few concerns with regard to the risk of bias and applicability. Integrated (18)F-FDG PET/CT and standalone (18)F-FDG PET were used in 4 and 3 studies, respectively. One other study analyzed both modalities separately. In 4 studies, (18)F-FDG PET or PET/CT was performed as part of routine follow-up, whereas in 4 other studies the diagnostic test was performed on indication during clinical follow-up. Pooled estimates of sensitivity and specificity for (18)F-FDG PET and PET/CT in diagnosing recurrent esophageal cancer were 96% (95% confidence interval, 93%-97%) and 78% (95% confidence interval, 66%-86%), respectively. Subgroup analysis revealed no statistically significant difference in diagnostic accuracy according to type of PET scanner (standalone PET vs. integrated PET/CT) or indication of scanning (routine follow-up vs. on indication). (18)F-FDG PET and PET/CT are reliable imaging modalities with a high sensitivity and moderate specificity for detecting recurrent esophageal cancer after treatment with curative intent. The use of (18)F-FDG PET or PET/CT particularly allows for a minimal false-negative rate. However, histopathologic confirmation of (18)F-FDG PET- or PET/CT-suspected lesions remains required, because a considerable false-positive rate is noticed.

Sa1405 A Prospective Randomized Trial Comparing the 22-Gauge Needle With and Without a Side Port for Endoscopic Ultrasound Fine Needle Aspiration of Solid Pancreatic Mass Lesions

Sa1405 A Prospective Randomized Trial Comparing the 22-Gauge Needle With and Without a Side Port for Endoscopic Ultrasound Fine Needle Aspiration of Solid Pancreatic Mass Lesions Hirotoshi Ishiwatari*, Tsuyoshi Hayashi, Hiroshi Kawakami, Hiroyuki Isayama, Takao Itoi, Hiroyuki Hisai, Michihiro Ono, Yoko Abe, Natsuyo Yamamoto, Fumihide Itokawa, Tadashi Hasegawa Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan; Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Department of Gastroenterology, The University of Tokyo, Tokyo, Japan; Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan; Department of Gastroenterology, Japanese Red Cross Date General hospital, Date, Japan; Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan Background: Endoscopic ultrasound fine needle aspiration (EUS-FNA) is widely used for obtaining specimens from pancreatic mass lesions, owing to its high diagnostic accuracy, safety, and low invasiveness. However, it remains imperfect and needs modification to enable accurate diagnosis. The 22-gauge (G) fine needle aspiration (FNA) needle is widely used owing to its maneuverability. However, a 19G needle is superior in terms of tissue acquisition. To overcome this limitation, 22G FNA needles with a lateral side port have been developed. The side ports initially had a reverse beveled edge. Recently, needles with a round side port have been developed, which may reduce tissue damage and blood contamination, and improve diagnostic yield. Preliminary results have shown high diagnostic accuracy. We compared 22G FNA needles with and without a side port in pancreatic mass lesions in a multicenter prospective randomized control trial. Patients and Method: Between January and September 2013, consecutive 160 patients with a suspected solid pancreatic mass in five tertiary referral centers were enrolled. Patients were randomized to 22G FNA needle (EZ Shot 2, Olympus Medical Systems) with and without a side port groups (with and without groups, respectively). The primary endpoint was diagnostic accuracy. The secondary endpoints were adequacy of tissue acquisition and quality of the histological specimen (degree of contamination and amount of blood). Evaluations were made using a scoring system, by experienced attending pathologists, who were blinded to the clinical information, including the needle type. Results: Analysis of 158 patients (79 per group) was performed. Two patients did not undergo EUS-FNA after allocation. In four patients (three in the with group and one in the without group), EUS-FNA failed owing to difficulty of the puncture. There was no significant difference in the diagnostic accuracy rate (with group, 92.4% (73/79) vs. without group, 86.1% (68/79); P Z 0.3, Fisher’s exact test). In subgroup analysis, trainees (endosonographers with experience of fewer than 40 EUS-FNAs) had diagnostic accuracy rates of 97.4% (37/38) and 81.4% (35/43) in the with and without groups, respectively (P Z 0.03, Fisher’s exact test). Adequate samples for histological diagnosis were obtained in 61.3% (47/76) and 44.2% (34/78) of patients from the with and without groups, respectively (P Z 0.03, Fisher’s exact test). No significant difference was seen in the degree of sample contamination and amount of blood between the groups. Conclusion: There was no significant difference in diagnostic accuracy between the needle types. However, the needle with a side port allowed trainees to obtain the correct diagnosis at a higher rate. Moreover, the needle with a side port is superior for tissue acquisition.(Clinical trial registration number: UMI08120)