Similar Diagnostic Information Research Articles

Application of Differential Subsampling with Cartesian Ordering in Evaluating Left Ovarian Venous Reflux for Pretreatment Planning for Pelvic Venous Disorders.

The diagnosis of a common cause of chronic pelvic pain can be made by visualizing reflux in the ovarian veins. Fluoroscopic venography is the gold standard for diagnosing ovarian vein reflux, but it is an invasive technique that exposes patients to ionizing radiation. MRI, with its lack of ionizing radiation and capability of high-temporal and spatial-resolution vascular imaging, has the potential to provide similar diagnostic information. This retrospective report describes and assesses the utility of a dynamic contrast-enhanced MRI technique based on Differential Subsampling with Cartesian Ordering (DISCO)-MRI in 30 patients with chronic pelvic pain. Among the 14 patients who underwent both DISCO-MRI and fluoroscopic venograms, 11 (78.6%) exhibited concordant results, while 3 patients (21.4%) had discordant findings. These results suggest the potential of multiphasic contrast-enhanced DISCO-MRI as a non-invasive diagnostic tool for evaluating chronic pelvic pain.

Abstract 15237: Feasibility and Diagnostic Accuracy of Handheld Echocardiography in Patients Hospitalized With Acute Coronary Syndrome

Introduction: Transthoracic echocardiography (TTE) is recommended in every acute coronary syndrome (ACS) patient, but is time-consuming and not always deliverable. Development of handheld echocardiography (HHE) devices provide a fast, low-cost method to facilitate rapid bedside clinical assessment of those patients. Hypothesis: We hypothesized that evaluation of hospitalized ACS patients using HHE is feasible and provide similar information to standard TTE in detecting important cardiac pathology. Methods: Patients admitted with ACS were prospectively enrolled, and underwent both bedside HHE (Philips Lumify) and clinical TTE evaluation. Independent analysis of HHE and TTE images was performed by a blinded expert team to determine key predetermined imaging findings that might alter management of ACS patients (Table 1). The TTE analysis was repeated for these variables after 1 month. Agreement of HHE vs TTE was assessed with kappa statistics and compared to agreement of TTE vs TTE as reference standard. Results: The analysis included 108 patients (mean age 65y, 78% male). Duration of HHE was a third faster than targeted clinical TTE (8.2±1.8min vs 12.1±5.0min; p<0.001). Agreement in detecting the following variables was good (>0.60) and similar for HHE vs TTE compared to TTE vs TTE: left ventricle (LV) dilatation, LV hypertrophy, LV ejection fraction <40%, anterior and inferior wall motion abnormalities, right ventricle (RV) dilatation, pericardial effusion, aortic stenosis, ventricle septum defect, and takotsubo cardiomyopathy. Agreement between HHE vs TTE was less good than TTE vs TTE for detection of lateral wall motion abnormalities, RV dysfunction, and LV thrombus. Conclusions: In ACS patients, bedside HHE is faster and provides similar diagnostic information to TTE for the majority of key echo findings. However, important exceptions exist, in particular HHE is less good at detecting lateral wall motion abnormalities, RV dysfunction and LV thrombus.

Diagnostic accuracy of ultrasound for the assessment of Baker’s cysts: a meta-analysis

BackgroundBaker’s cyst is the most common cystic disease of the knee, and a fast and accurate diagnosis of Baker’s cyst is essential for a better management. Ultrasound is a rapid, portable, widely available, inexpensive and noninvasive imaging modality. However, the diagnostic accuracy of ultrasound on Baker’s cyst still remains undetermined. We conducted the first meta-analysis to comprehensively assess the accuracy of ultrasound for the detection of Baker’s cyst.MethodsPubMed, Embase and Web of Science were searched from inception to July 14, 2022, without language restrictions. Studies providing cross-tabulations of ultrasound versus pathology (gold standard) or MRI (standard imaging technique) for diagnosis of Baker’s cyst were included. Indicators for the diagnostic accuracy of ultrasound, including sensitivity, specificity and area under the curve, were calculated using a bivariate model. Sensitivity analysis was conducted to evaluate the heterogeneity and robustness of the results.ResultsA total of 13 studies with 1,011 subjects (mean age 32.2 years; men 53.5%) met the inclusion criteria. The pooled sensitivity, specificity and area under the curve of ultrasound for diagnosis of Baker’s cyst, compared with pathology, were 0.97 (95% confidence intervals: 0.73–1.00), 1.00 (0.98–1.00) and 1.00 (0.99–1.00), respectively. The pooled estimates of ultrasound versus MRI were 0.94 (0.87–0.98) for sensitivity, 1.00 (0.83–1.00) for specificity and 0.97 (0.95–0.98) for area under the curve. Sensitivity analysis did not change the results materially.ConclusionUltrasound shows excellent diagnostic accuracy for the assessment of Baker’s cyst and provides similar diagnostic information (absent or present) compared to MRI. Because of its advantages of low cost, portability and accessibility, ultrasound is likely to be a choice of imaging technique for screening Baker’s cyst in clinical and population settings as well as in follow-ups.

Comparison of different assays for the detection of anticyclic citrullinated peptide antibodies in patients with rheumatoid arthritis.

ObjectiveTo evaluate a novel fully automated immunoturbidimetric assay developed by Qiangsheng Biotechnology Company for the detection of anticyclic citrullinated peptide antibodies (anti-CCP) in serum of patients with rheumatoid arthritis (RA) and compare it to the conventional EUROIMMUN- anti-CCP ELISA. Two other commonly used automated assays, the Elecsys anti-CCP assay, an ECLIA that is run on the Modular Analystics E170 (Cobas Diagnostics, Germany), and an anti-CCP CLIA developed by YHLO that is run on the iFlash 3000 Chemiluminescence Immunoassay Analyzer, were included as reference standards.MethodsA total of 264 serum samples were collected from patients attending the First People’s Hospital of Wenling affiliated to Wenzhou Medical University between July 2020 and November 2020. These included 131 serum samples collected from patients with RA, 70 serum samples collected from patients with other autoimmune diseases, and 63 serum samples collected from healthy controls at a physical examination. The clinical performance and sensitivity and specificity of the four anti-CCP assays for the diagnosis of RA were compared using receiver operating characteristic (ROC) curve analysis.ResultsThe Kappa statistic indicated almost perfect agreement between the EUROIMMUN-anti-CCP ELISA and the Elecsys anti-CCP ECLIA (Cobas) (0.863), the EUROIMMUN-anti-CCP ELISA and the anti-CCP CLIA (YHLO) (0.862), and the Elecsys anti-CCP ECLIA (Cobas) and the anti-CCP CLIA (YHLO) (0.816). On ROC curve analysis, AUC values were 0.955 for the EUROIMMUN-anti-CCP ELISA, 0.948 for the anti-CCP CLIA (YHLO), 0.947 for the Elecsys anti-CCP ECLIA (Cobas) and 0.903 for Qiangsheng, indicating all the assays had a good diagnostic performance for RA.ConclusionThe anti-CCP assays provided similar diagnostic information. The novel fully automated immunoturbidimetric assay for anti-CCP developed by Qiangsheng Biotechnology Company may be especially useful for large scale clinical screening in RA as it has a shorter testing time than the commercially available alternatives.

Abstract 11506: Optimal Detection of Ascending Aorta Aneurysms in Obese Patients

Introduction: Obesity is a known risk factor for the development of aneurysm of the ascending aorta (AscAoA). 2-D echo is the most commonly used cardiac imaging modality. 2-D Echo has a limited 90-degree field of view, and the ascending aorta may not be well visualized. Obesity causes further compromise of the field of view, as the 2-D transducer cannot be positioned in the rib space. Cardiac MRI (CMR) does not have this limitation. This study was designed to assess the detection of aneurysm of the ascending aorta in obese patients comparing 2-D echo and CMR. Hypothesis: Because of full field of view capability, CMR may be superior to 2-D Echo for the detection of aneurysm of ascending aorta in obese patients. Methods: An institutional cardiac imaging database was queried for all obese patients with a BMI greater than/equal to 30. The study cohort was composed of obese patients who had a 2-D and CMR within a 6-month period. The number of patients with AscAoA, defined as ascending aorta diameter >3.5 cm measured perpendicular to flow, was computed for both 2-D and CMR modalities. Detection rates for AscAoA were statistically compared using McNemar test. Results: Of the 6930 patients in the cardiac imaging database, 4373 were obese, of which 275 had both 2-D and CMR within a 6-month period, constituting the study cohort. Only 32 of 275 patients had a 2-D Echo report with an entered value for the diameter of the ascending aorta (10.6%), an indicator of the technical difficulty encountered when measuring the ascending aorta with 2-D Echo. Conversely, 274 patients had a CMR report with an entered diameter value for the ascending aorta (99.64%). The formal CMR report identified 167 AscAoA among the 275 patients in the study cohort, for a detection rate of 58.9%. 2-D Echo only identified 12 patients with an AscAoA in the same patient cohort, for a detection rate of 4.36%. The detection rate of aneurysm of the ascending aorta was significantly different between the 2 modalities (p-value <0.001). Conclusions: Despite 2-D and CMR offering similar diagnostic information regarding left ventricular function and valve function in obese patients, CMR reports a numeric value for the ascending aorta diameter 8 times more often than 2-D, and CMR detects AscAoA 13 times more often than 2-D in obese patients.

Microstructural breast tissue characterization: A head-to-head comparison of Diffusion Weighted Imaging and Acoustic Radiation Force Impulse elastography with clinical implications

PurposeHead-to-head comparison of Diffusion Weighted Imaging (DWI) and Acoustic Radiation Force Impulse (ARFI) elastography regarding the characterization of breast lesions in an assessment setting. MethodPatients undergoing an ultrasound examination including ARFI and an MRI protocol including DWI for the characterization of a BI-RADS 3–5 breast lesion between 06/2013 and 10/2016 were eligible for inclusion in this retrospective, IRB-approved study. 60 patients (30–84 years, median 50) with a median lesion size of 16 mm (range 5–55 mm) were included. The maximum shear wave velocity (SWVmax) and mean apparent diffusion coefficient (ADCmean) for each lesion were retrospectively evaluated by a radiologist experienced in the technique. Histology was the reference standard. Diagnostic performances of ARFI and DWI were assessed using ROC curve analysis. Spearman’s rank correlation coefficient and multivariate logistic regression were used to investigate the independence of both tests regarding their diagnostic information to distinguish benign from malignant lesions. ResultsCorresponding areas under the ROC curve for differentiation of benign (n = 16) and malignant (n = 49) lesions were 0.822 (ARFI) and 0.871 (DWI, p-value = 0.48). SWVmax and ADCmean values showed a significant negative correlation (ρ = −0.501, p-value < 0.001). In multivariate analysis, combination of ARFI and DWI did not improve the results of each single modality, thus no significant independent diagnostic information was present. ConclusionSignificant correlation between quantitative findings of ARFI and DWI in breast lesions exists. Thus, ARFI provides similar diagnostic information as a DWI-including protocol of an additional “problem-solving” MRI for the characterization of a sonographically evident breast lesion, improving the immediate patient management in the assessment setting.

Unobtrusive, in-home assessment of older adults’ everyday activities and health events: associations with cognitive performance over a brief observation period

ABSTRACT In-home assessment of everyday activities over many months to years may be useful in predicting cognitive decline in older adulthood. This study examined whether a comparatively brief data collection period (3 months) may yield similar diagnostic information. A total of 91 community-dwelling older adults without dementia underwent baseline neuropsychological testing and completed weekly computer-based surveys assessing health-related events/activities. A subset of participants wore fitness tracker watches assessing daily sleep and physical activity patterns, used a sensor-instrumented pillbox, and had their computer use frequency recorded on a daily basis. Similar patterns in computer use, sleep and medication use were noted in comparison to prior literature with more extensive data collection periods. Greater computer use and sleep, as well as self-reported pain and independence, were also linked to better cognition. These activities and symptoms may be useful correlates of cognitive function even when assessed over a relatively brief monitoring period.

Abstract 13179: Distinct Biomarker Profiles for Pediatric and Adult Dilated Cardiomyopathy

Introduction: Pediatric and adult dilated cardiomyopathy (DCM) represent distinct entities with divergent gene expression, histopathology, and response to medical therapies. Prognostically important serum biomarkers identified in adults have failed to provide similar diagnostic and prognostic information for children with DCM. We hypothesized that pediatric and adult DCM populations display different biomarker profiles. Methods: Pediatric control (≤18y), pediatric DCM, and adult DCM plasma samples were analyzed using the SOMAscan biomarker platform to simultaneously measure over 1300 known protein analytes. Pediatric control and DCM subjects were age- and gender-matched. Most samples were obtained within 2 years of diagnosis. Biomarkers were compared between groups with p-value &lt;0.05 (false discovery rate) and fold change (ratio of means) &gt;2 considered significant. Principal component analysis was used to visualize differences in proteomic data. Results: The study included 39 pediatric control (mean age 3y, IQR 1-14), 39 pediatric DCM (median age 2.7y, IQR 1-13), and 40 adult DCM (median age 53y, IQR 46-63) subjects. Twenty plasma peptides were upregulated in pediatric DCM compared to controls. Plasma renin and 6-phosphogluconate dehydrogenase represented potential pediatric-specific biomarkers. Pediatric DCM subjects clustered into 4 distinct subgroups with unique biomarker profiles and distinguishing clinical characteristics suggesting the pediatric DCM phenotype may represent a heterogeneous group of diseases. Conclusions: This feasibility study provides important evidence that distinct biomarker profiles are present in pediatric and adult DCM patients. These findings provide preliminary data to inform the design of larger prospective studies to validate pediatric DCM specific biomarkers and investigate their prognostic value.

Breast MRI in the era of diffusion weighted imaging: do we still need signal-intensity time curves?

ObjectiveDynamic contrast-enhanced imaging of the initial (IP) and delayed phase (DP) is an integral part of any clinical breast MRI protocol. Furthermore, DWI is increasingly used as an add-on sequence by the breast-imaging community. We investigated whether DWI could be used as a substitute DP.Material and methodsOne hundred thirty-two consecutive patients with equivocal or suspicious findings at ultrasound and/or mammography received a full diagnostic breast MRI according to international recommendations. Histopathological verification served as reference standard. We evaluated three sections of the MRI protocol: IP, DP, and apparent diffusion coefficient (ADC) maps derived from DWI. Circular ROIs (regions of interest, mean size 5–10 mm2) were drawn into the enhancing parts of the lesion (first postcontrast). ROIs were transferred to the corresponding location on ADC maps and IP and DP images. Mean ROI values were investigated signal intensity (SI): (1) Initial-phase enhancement = (SI(IP) − SI(precontrast))/SI(precontrast); (2) Delayed-phase enhancement = (SI(DP) − SI(IP))/SI(IP); (3) ADC. Multiparametric combinations were computed using logistic regression analysis: (1) IP+: Initial-phase enhancement and ADC; (2) Curve: Initial-phase enhancement and delayed-phase enhancement; (3) Curve+: Curve and ADC. The diagnostic performances of these feature combinations to diagnose malignancy were compared by the area under the receiver-operating characteristics curve (AUC).ResultsOne hundred thirty-two patients (age: mean = 57.1 years, range 23–83 years) with 145 lesions were included (malignant/benign 101/44). IP+ (AUC = 0.877) outperformed Curve (AUC = 0.788, p = 0.03). Curve+ was not superior to IP+ (p = 1).ConclusionDWI could substitute DP. Because DWI is typically used as an add-on to IP and DP, our results might help to abbreviate and to simplify current practice of breast MRI.Key Points• DWI provides similar but superior diagnostic information for diagnosis of malignancy in enhancing breast lesions compared to DP.• Adding DP to DWI does not provide incremental information to distinguish benign from malignant lesions.• DWI could substitute DP. As DWI is typically used as an add-on to IP and DP, our findings might help to abbreviate and to simplify current breast MRI practice.

Prognostic and diagnostic significance of mid-regional pro-atrial natriuretic peptide in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: data from the ACE 2 Study

Purpose: To compare the diagnostic and prognostic value of mid-regional pro-ANP (MR-proANP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with acute dyspnea.Methods: MR-proANP and NT-proBNP were measured with commercial immunoassays at hospital admission (n = 313), on day 2 (n = 234), and before discharge (n = 91) and compared for diagnosing acute heart failure (HF; n = 143) and to predict mortality among patients with acute HF and acute exacerbation of chronic obstructive pulmonary disease (AECOPD; n = 84) separately.Results: The correlation coefficient between MR-proANP and NT-proBNP was 0.89 (p < 0.001) and the receiver-operating area under the curve (AUC) was 0.85 (95% CI 0.81–0.89) for MR-proANP and 0.86 (0.82–0.90) for NT-proBNP to diagnose acute HF. During a median follow-up of 816 days, mortality rates were 46% in acute HF patients and 42% in AECOPD patients. After adjustment for other risk variables by multivariate Cox regression analysis, MR-proANP and NT-proBNP concentrations were associated with mortality in patients with acute HF, but only MR-proANP were associated with mortality among patients with AECOPD: hazard ratio (lnMR-proANP) 1.98 (95% CI 1.17–3.34).Conclusion: MR-proANP and NT-proBNP concentrations provide similar diagnostic and prognostic information in patients with acute HF. In contrast to NT-proBNP, MR-proANP measurements also provided independent prognostic information in AECOPD patients.

Comparação de dois critérios de classificação de jogadores de futebol profissional da assimetria lateral de força dos membros inferiores

Prospective studies have indicated that assessing muscle function by the isokinetic test in the preseason is able to identify muscle strength variables that can be associated with injuries in the hamstring muscles of professional soccer players. However, the results are conflicting and could be related to the different cutoff points for the categorization of athletes in asymmetric or symmetric. Based on these conflicting results, the present study aims to: i) Identify the cutoff points of lateral asymmetry (LA) of the 95% confidence interval for the peak torque in soccer players, evaluated by the isokinetic test, taking into consideration the mean population value; ii) Compare LA between 15% cutoff point proposed in literature and the upper limit of 95% confidence interval (UP) of the study population. Sixty-four professional soccer players performed five knee flexion and extension repetitions at rate of 60°/s, with a one-minute interval. To determine the cutoff point for strength asymmetries, the UP was used, and for the purpose of diagnostic concordance of information among the different values, the McNemar’s χ² test was applied. The proportion between symmetric and asymmetric athletes was not different from the 15% cutoff point and the general population, both for knee flexors (χ² = 0.5, p = 0.250) and the knee extensors (χ² = 2.0, p = 0.125). It was concluded that the cutoff point of 15% referenced in literature for the general population provides similar diagnostic information for the classification of professional soccer players.

A pilot study: portable out-of-center sleep testing as an early sleep apnea screening tool in acute ischemic stroke.

IntroductionPrompt diagnosis of obstructive sleep apnea (OSA) after acute ischemic stroke (AIS) is critical for optimal clinical outcomes, but in-laboratory conventional polysomnograms (PSG) are not routinely practical. Though portable out-of-center type III cardiopulmonary sleep studies (out-of-center cardiopulmonary sleep testing [OCST]) are widely available, these studies have not been validated in patients who have recently suffered from AIS. We hypothesized that OCST in patients with AIS would yield similar results when compared to conventional PSG.MethodsPatients with AIS had simultaneous type III OCST and PSG studies performed within 72 hours from symptom onset. The accuracy of OCST was compared to PSG using: chi-square tests, receiver operatory characteristic curves, Bland–Altman plot, paired Student’s t-test/Wilcoxon signed-rank test, and calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).ResultsTwenty-one out of 23 subjects with AIS (age 61±9.4 years; 52% male; 58% African-American) successfully completed both studies (9% technical failure). Nearly all (95%) had Mallampati IV posterior oropharynx; the mean neck circumference was 16.8±1.6 in. and the mean body mass index (BMI) was 30±7 kg/m2. The apnea hypopnea index (AHI) provided by OCST was similar to that provided by PSG (19.8±18.0 vs 22.0±22.7, respectively; P=0.49). On identifying subjects by OCST with an AHI ≥5 on PSG, OCST had the following parameters: sensitivity 100%, specificity 85.7%, PPV 93%, and NPV 100%. On identifying subjects with an AHI ≥15 on PSG, OCST parameters were as follows: sensitivity 100%, specificity 83.3%, PPV 81.8%, and NPV 100%. Bland–Altman plotting showed an overall diagnostic agreement between OCST and PSG modalities for an AHI cutoff >5, despite fine-grained differences in estimated AHIs.ConclusionCompared with PSG, OCST provides similar diagnostic information when run simultaneously in AIS patients. OCST is a reliable screening tool for early diagnosis of OSA in AIS patients.

Comparison of 18F-FET PET and Perfusion-Weighted MR Imaging: A PET/MR Imaging Hybrid Study in Patients with Brain Tumors

PET using O-(2-(18)F-fluoroethyl)-L-tyrosine ((18)F-FET) provides important diagnostic information in addition to that from conventional MR imaging on tumor extent and activity of cerebral gliomas. Recent studies suggest that perfusion-weighted MR imaging (PWI), especially maps of regional cerebral blood volume (rCBV), may provide similar diagnostic information. In this study, we directly compared (18)F-FET PET and PWI in patients with brain tumors. Fifty-six patients with gliomas were investigated using static (18)F-FET PET and PWI. For comparison, 8 patients with meningiomas were included. We generated a set of tumor and reference volumes of interest (VOIs) based on morphologic MR imaging and transferred these VOIs to the corresponding (18)F-FET PET scans and PWI maps. From these VOIs, tumor-to-brain ratios (TBR) were calculated, and normalized histograms were generated for (18)F-FET PET and rCBV maps. Furthermore, in rCBV maps and in (18)F-FET PET scans, tumor volumes, their spatial congruence, and the distance between the local hot spots were assessed. For patients with glioma, TBR was significantly higher in (18)F-FET PET than in rCBV maps (TBR, 2.28 ± 0.99 vs. 1.62 ± 1.13; P < 0.001). Histogram analysis of the VOIs revealed that (18)F-FET scans could clearly separate tumor from background. In contrast, deriving this information from rCBV maps was difficult. Tumor volumes were significantly larger in (18)F-FET PET than in rCBV maps (tumor volume, 24.3 ± 26.5 cm(3) vs. 8.9 ± 13.9 cm(3); P < 0.001). Accordingly, spatial overlap of both imaging parameters was poor (congruence, 11.0%), and mean distance between the local hot spots was 25.4 ± 16.1 mm. In meningioma patients, TBR was higher in rCBV maps than in (18)F-FET PET (TBR, 5.33 ± 2.63 vs. 2.37 ± 0.32; P < 0.001) whereas tumor volumes were comparable. In patients with cerebral glioma, tumor imaging with (18)F-FET PET and rCBV yields different information. (18)F-FET PET shows considerably higher TBRs and larger tumor volumes than rCBV maps. The spatial congruence of both parameters is poor. The locations of the local hot spots differ considerably. Taken together, our data show that metabolically active tumor tissue of gliomas as depicted by amino acid PET is not reflected by rCBV as measured with PWI.

Histogram analysis reveals a better delineation of tumor volume from background in 18F-FET PET compared to CBV maps in a hybrid PET–MR studie in gliomas

Anatomical imaging with magnetic resonance imaging (MRI) is currently the method of first choice for diagnostic investigation of glial tumors. However, different MR sequences may over- or underestimate tumor size and thus it may not be possible to delineate tumor from adjacent brain. In order to compensate this confinement additonal MR sequences like perfusion weighted MRI (PWI) with regional cerebral blood volume (rCBV) or positron emission tomography (PET) with aminoacids are used to gain further information. Recent studies suggest that both of theses image modalities provide similar diagnostic information. For comparison tumor to brain ratios (TBR) with mean and maximum values are frequently used but results from different studies can often not be checked against each other. Furthermore, especially the maximum TBR in rCBV is at risk to be falsified by artifacts (e.g. blood vessels). These confinements are reduced by the use of histograms since all information of the VOIs are equally displayed. In this study we measured and compared the intersection of tumor and reference tissue histograms in 18F-FET PET and rCBV maps in glioma patients. MethodsTwenty-seven glioma patients with contrast enhancing lesion on T1-weighted MR images were investigated using static 18F-FET PET and rCBV in MRI using a PET–MR hybrid scanner. In all patients diagnosis was confirmed histologically (7 grade II gliomas, 6 grade III gliomas and 14 grade IV gliomas). We generated a set of tumor and reference tissue Volumes-of-Interest (VOIs) based on T1 weighted images in MRI with the tumor VOI defined by contrast enhancement and transferred these VOIs to the corresponding 18F-FET PET scans and rCBV maps. From these VOIs we generated tumor and reference tissue histograms with a unity of one for each curve integral and measured the proportion of the area under the tumor curve that falls into the reference curve for 18F-FET PET and rCBV maps for each patient. ResultsThe mean proportion of the area under the tumor curve that falls into the reference curve was smaller in FET PET than in rCBV maps (13.1±19.5% vs. 45.0±21.3%; p<0.001). ConclusionsMeasuring the intersection of tumor and reference tissue histograms in 18F-FET PET and rCBV maps based on identical VOIs defined in anatomical images with tumor marked by contrast enhancement in T1-weighted images can easily be performed and indicates that tumor volume can better be discriminated from background in 18F-FET PET compared to rCBV in MRI. With this approach artefacts (e.g. blood vessels) impair the results to a lesser degree compared to the mean and especially maximal TBRs which are often used when comparing these two image modalities.

Endosonography of the Normal Mediastinum: The Experts Approach

Endosonography of the mediastinum is an important modality of imaging for chest diseases. Both radial and linear endoscopic ultrasound (EUS) can give similar diagnostic information. Linear EUS is also useful in fine-needle aspiration from masses and lymph nodes. The authors present the techniques of imaging of different structures in normal mediastinum by linear EUS. This article is part of an expert video encyclopedia.

Abstract WMP58: The Portable Sleep Study as an Early Obstructive Sleep Apnea Screening Tool In Acute Ischemic Stroke

Background: Prompt diagnosis of obstructive sleep apnea (OSA) after acute ischemic stroke (AIS) is critical for optimal clinical outcomes, but full bedside polysomnograms are not routinely practical. To validate a potentially practical diagnostic portable cardiopulmonary sleep study (PSS) after such strokes, we compared it to conventional polysomnography (PSG). Methods: Simultaneous bedside Level 3 (Embletta X100) PSS and PSG studies were performed in patients &lt;72 hours from stroke onset. The accuracy of PSS was compared to PSG using: Chi-square tests, Receiver-Operatory Characteristic curves, Bland-Altman plot, paired Student t-test /Wilcoxon signed rank test and calculation of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV). Results: Twenty one out of 23 acute ischemic stroke patients (age 61+ 9.4; 52% male; 58% African-American), successfully completed both of the simultaneous screenings (9% technical failure). Ten AIS patients (48%) were diagnosed with OSA. Nearly all (90%) had Mallampati IV posterior oropharynx; the mean neck circumference was 17.3± 1.3 inches; the mean BMI was 35.1 ±5 kg/m 2 . The Apnea Hypopnea Index (AHI) provided by PSS was similar to that provided by PSG (29.1± 16.8 vs. 27.6 + 20.2, respectively; p=0.10). In identifying patients with AHI ≥ 5 on PSG, PSS screening had the following parameters: sensitivity 100%; specificity 85.7%; PPV 91%; NPV 100%. For AHI ≥ 15 on PSG, PSS screening parameters were as follows: Sensitivity 100%; Specificity 83.3%; PPV 71.4%; NPV 100%. Bland-Altman plotting showed overall diagnostic agreement between PSS and PSG modalities for an AHI cutoff of &gt; 5, despite finer-grained differences in estimated AHIs. Conclusions: Compared with PSG, PSS provides similar diagnostic information when run simultaneously in acute ischemic stroke patients. PSS potentially can serve as a reliable screening tool for early diagnosis of obstructive sleep apnea in acute ischemic stroke patients.

Comparison of urine protein-to-creatinine ratio in urine samples collected by cystocentesis versus free catch in dogs

To assess whether urine protein-to-creatinine (UPC) ratios determined in urine samples collected by cystocentesis versus those collected by free catch provide similar diagnostic information for dogs. Evaluation study. 115 client-owned dogs evaluated because of various health problems requiring urinalysis or to screen for proteinuria in an area endemic for leishmaniasis. 230 paired urine samples, 1 collected by cystocentesis and 1 by free catch, were collected from the 115 dogs. The UPC ratio was determined in paired urine samples (n = 162) from 81 dogs with no indication of active inflammation according to urine sediment analysis. On the basis of the UPC ratio of urine sample collected by cystocentesis, dogs were classified as nonproteinuric (UPC ratio < 0.2), borderline proteinuric (UPC ratio of 0.2 to 0.5), or proteinuric (UPC ratio > 0.5), according to the International Renal Interest Society (IRIS). The correlation between UPC ratio in urine samples collected by cystocentesis and by free catch was strong (r(2) = 0.90); 75 of 81 (92.6%) dogs had UPC ratios from both urine samples that resulted in classification in the same IRIS substage with a kappa coefficient of 0.83. The UPC ratio in dogs was minimally affected in urine samples collected by free catch, thus allowing correct grading of proteinuria with this method. The high reliability of the UPC ratio in free-catch urine samples coupled with the ease of collection should increase the use of this value for assessment of proteinuria.

Evaluation of novel biomarkers for the diagnosis of acute destabilised heart failure in patients with shortness of breath

Objective:The evaluation of novel biomarkers for the diagnosis of acute destabilised heart failure (HF).Design:Prospectively conducted study on diagnostic accuracy.Setting:Emergency department of a tertiary care hospital.Patients:251 consecutive patients presenting to the...

The Safe Use of Adenosine to Enhance Diagnostic Capabilities of MRI Cardiac Studies

This poster focuses on a multidisciplinary approach to safe and effective use of MRI technology to evaluate coronary artery disease by using adenosine as a stressing agent. Previously patients underwent far more invasive and expensive procedures to obtain similar diagnostic information. Although cardiac adenosine studies also present inherent risks, with proper training and appropriate screening tools adverse events can be rare and easily managed. This study is becoming the standard tool the cardiologists use to evaluate coronary artery disease prior to more invasive procedures. The poster includes a procedure summary, patient screening tools, monitoring considerations, a charting sample, and study images.

AGA Institute Medical Position Statement on Acute Pancreatitis

AGA Institute Medical Position Statement on Acute Pancreatitis