Specificity Of Ultrasonography In Diagnosis Research Articles

Diagnostic value of ultrasonography for injury of anterior talofibular ligament and anterior inferior tibiofibular ligament distal fascicle in patients with ankle fractures.

To explore the diagnostic value of ultrasonography for injuries of anterior talofibular ligament (ATFL) and anterior inferior tibiofibular ligament distal fascicle (ATiFL-DF) in patients with ankle fractures. Clinical data of 51 patients with ankle fractures who were clinically suspected of ligament injuries and underwent ankle ultrasonography examination and arthroscopy in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from April 2019 to March 2023 were retrospectively analyzed. Using arthroscopic findings as the gold standard, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasonography in diagnosing ATFL and ATiFL-DF injuries were evaluated; and Kappa consistency test was further performed. The sensitivity and specificity of ultrasonography in diagnosis of ATFL injury were 100.0% and 92.3%, with the PPV of 92.6% and NPV of 100.0%. Ultrasonography findings exhibited excellent concordance with arthroscopic results (kappa=0.849). The sensitivity and specificity of ultrasonography in diagnosis of ATiFL-DF injury was 86.7% and 33.3%, with the PPV of 90.7% and NPV of 25.0%. But the consistence between ultrasonography and arthroscopic results was poor (kappa=0.168). Ultrasonography is a reliable diagnostic modality for assessing injuries to the ATFL in patients with ankle fractures; however, its specificity is limited when evaluating injuries to the ATiFL-DF. Therefore, ankle arthroscopy is necessary for ankle fracture patients with negative findings of ATiFL-DF in ultrasonography.

Evaluation and Comparison of Sensitivity and Specificity of Ultrasonography in Placenta Accreta Diagnosis in the Second and Third Trimesters.

Ultrasound is the selected technique for the detection of placenta accreta spectrum (PAS). This method can detect PAS in 80%-50% of cases. This study aimed to assess and compare the sensitivity and specificity of ultrasonography in the diagnosis of PAS after the first trimester. In this prospective study that was performed in 2020-2021 on 79 patients at high risk of PAS, all cases underwent ultrasonography in both 18-22 weeks of gestational age (GA) and 32-34 weeks of GA for evaluation of accreta. As per the risk factors, the delivery plan for all mothers was cesarean section. During the cesarean section, the placenta was examined for accreta, and if it was attached to the uterus, a diagnosis of placenta accreta was ascertained and a total abdominal hysterectomy was performed if the patient's bleeding was not controlled during the operation. The final diagnosis of PAS was made based on the pathology report. Ultrasound evaluation for PAS in 18-22 weeks of GA had 79.17% specificity, 51.61% sensitivity, 61.54% positive predictive value, and 71.70% negative predictive value. Ultrasound imaging for PAS in 32-34 weeks of GA had 60.8% specificity, 90% sensitivity, 62.52% positive predictive value, and 90.33% negative predictive value. It should be concluded that PAS is a critical condition and if the patient is diagnosed in the second or third trimester, special strategies should be applied.

Diagnostic Accuracy of Ultrasonography for Detection of Intussusception in Children; a Systematic Review and Meta-Analysis.

The diagnosis of intussusception can be challenging in children due to the fact that the findings of clinical evaluations are nonspecific and most of the patients present with unclear history. Therefore, in this systematic review and meta-analysis, we aimed to investigate the diagnostic accuracy of ultrasonography for detection of intussusception and also compare the efficacy of point-of-care ultrasound (POCUS) with radiologist-performed ultrasound (RADUS). Two independent reviewers systematically searched different online electronic databases including MEDLINE, Scopus, Web of Science, Google Scholar, Embase, and Cochrane from inception to December 1, 2022 to identify published papers reporting accuracy of ultrasonography for diagnosis of intussusception. The quality assessment of the included studies was investigated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. A total of 1446 records were retrieved in the initial search of databases. After screening the titles, a total of 344 studies were retrieved for the detailed assessment of full-text. Finally, 37 studies were included in qualitative and quantitative analysis. The pooled sensitivity and specificity of ultrasonography for diagnosis of intussusception were 0.96 (95% CI: 0.95-0.97) and 0.97 (95% CI: 0.97-0.98), respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 24.57 (95% CI: 8.26-73.03) and 0.05 (95% CI: 0.04-0.08), respectively. The area under the hierarchical summary receiver operating characteristic (HSROC) curve was 0.989. Mete-regression showed that there is no significant difference between diagnostic performance of POCUS and RADUS (p = 0.06 and rDOR (diagnostic odds ratio) = 4.38 (95% CI: 0.92-20.89)). This meta-analysis shows that ultrasonography has excellent sensitivity, specificity, and accuracy for diagnosis of intussusception in pediatric patients. Moreover, we found that diagnostic performance of POCUS is similar to that of RADUS for diagnosis of intussusception.

Evaluation of contrast-enhanced ultrasound for activity of rheumatoid arthritis: A protocol for systematic review and meta-analysis.

Background:Contrast-enhanced ultrasound (CEUS) refers to a technique that uses contrast medium to strengthen the echo of backscatter, which can significantly improve the resolution, sensitivity and specificity of ultrasound diagnosis. As a quantitative imaging examination of blood flow signals, CEUS has allowed detection of synovial microvascularization in the joints of patients with rheumatoid arthritis (RA). However, the results of these studies have been contradictory. Therefore, the purpose of this study is to evaluate the value of CEUS in the activity of RA disease.Methods:We will search PubMed, Embase, Cochrane Library, and CNKI from their inception to the December 20, 2020, without restrictions of language and publication status. Two investigators will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. This study will only include high quality clinical cohort or case control studies. Statistical analysis was performed by using the Review Manager version 5.3 and the STATA version 14.0 (Stata Corp, College Station, TX, USA) softwares.Results:This systematic review will determine the value of CEUS in RA activity scores.Conclusion:The results of this study will provide a useful basis for high-quality CEUS to evaluate RA activity score.Systematic review registration:INPLASY2020120125.

Utility of MR proton density fat fraction and its correlation with ultrasonography and biochemical markers in nonalcoholic fatty liver disease in overweight adolescents.

Background Clinical or biochemical markers that have good correlation with magnetic resonance proton density fat fraction (MR PDFF) can be used as simple tools for the screening for nonalcoholic fatty liver disease (NAFLD) and in determining the degree of fatty infiltration of the liver. The objective of this study was to determine the degree of relationship between MR PDFF and ultrasonography (USG) grades of fatty liver, and clinical and biochemical parameters of adolescents and to determine the sensitivity and specificity of USG for diagnosis of NAFLD. Methods This prospective study included 34 overweight adolescents (mean age, 12.1 ± 1.5 years; range, 10-15.1 years; 10 girls and 24 boys) who underwent both USG and magnetic resonance imaging (MRI). Correlation analysis was performed between MR fat fraction and USG grades of fatty liver, and clinical and biochemical parameters of fatty liver disease. Results MR fat fraction had a moderate positive correlation with serum alanine transaminase (ALT) and aspartate transaminase (AST) (ρ = 0.634, p < 0.001, ρ = 0.516, p = 0.002, respectively) and had a negligible or weak correlation with body mass index (BMI), BMI standard deviation score (SDS), waist circumference (WC), fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), serum triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and total cholesterol levels. The sensitivity and specificity of USG in the diagnosis of NAFLD were 81% (95% confidence interval 54%-95%) and 50% (27%-73%), respectively. The MR fat fraction had a moderate positive correlation with ultrasound grades of fatty liver (ρ = 0.487, p = 0.003). Conclusions Serum ALT and AST are potential biochemical markers to assess the degree of hepatic steatosis in NAFLD, which needs validation in further studies. USG can be used as a screening tool for NAFLD, but the diagnosis should be confirmed by estimating the MR fat fraction.

Role of Ultrasound Scan in Non-Traumatic Acute Abdomen Presenting in Surgery Department of a Tertiary Care Center

Introduction: An acute abdomen is defined as a clinical condition characterized by severe abdominal pain developing suddenly over several hours or less. Ultrasonography (USG) helps the managing surgeons arrive at early diagnosis and rule out alternative diseases, thus reducing negative laparotomy rate. This study analyzed the diagnostic yield of USG in patients with non-traumatic acute abdomen presenting to Surgery department via Emergency department/outpatient department of a tertiary hospital. Methods: This cross-sectional observational study included 110 patients with non-traumatic acute abdominal pain who were sent for USG examination. The percentage concordance of USG diagnosis with the final diagnosis at discharge was determined in terms of sensitivity, specificity, positive and negative predictive values for acute abdomen. Results: Of 110 patients, correct clinical diagnosis was made in 83 patients (75%) while USG made a correct diagnosis in 101 patients (91%). Hence, with the help of USG, accuracy of diagnosing cause of acute abdomen increased by 16 %. The sensitivity and specificity of USG in diagnosis of acute appendicitis were 87.7% and 98.3% respectively. Conclusion: USG is easily available and non-invasive modality without radiation exposure and requiring minimal patient preparation. USG should, therefore, be an important routine diagnostic investigation in patients presenting with acute abdomen.

Ultrasonography in Diagnosis of Myofascial Pain Syndrome and Reliability of Novel Ultrasonic Indexes of Upper Trapezius Muscle.

Myofascial pain syndrome (MPS) is a common non-articular musculoskeletal disorder. It is characterized by local and referred pain due to the presence of myofascial trigger points (MTrPs). MTrPs most commonly involve the upper trapezius muscle and can be visualized using ultrasound imaging. This study was designed to determine the inter-rater reliability of some new ultrasonographic indices of the upper trapezius muscle and the sensitivity and specificity of 2D ultrasound imaging in the diagnosis of MPS. This semi-experimental study enrolled 15 participants of both genders (mean age: 40.60 ± 5.74 years) with suspected symptoms of MPS. In the first step of the study, the sensitivity and specificity of ultrasonography for diagnosis of MPS was determined in a double blind manner. In the second step, some ultrasonographic measurements, such as muscle thickness, area of MTrPs in longitudinal view, echogenicity of MTrPs in longitudinal view, echogenicity of muscle with MTrPs in longitudinal and transverse views, and the pennation angle of the upper trapezius muscle were measured twice and their reliability was determined using the value of the mean of the two measurements. The sensitivity and specificity of ultrasonographic diagnosis were 91% and 75%, respectively. The inter-rater reliability of upper trapezius muscle thickness, pennation angle, area of MTrPs, echogenicity of active MTrPs in longitudinal view, echogenicity of muscle with MTrPs in transverse view and echogenicity of muscle with MTrPs in longitudinal view were 0.91, 0.96, 0.93, 0.83, 0.93, and 0.91, respectively. 1. Our findings indicated that ultrasonography is a useful method for the diagnosis of MPS owing to its high sensitivity. 2. Appropriate reliability of the quantitative ultrasonographic indices of interest, especially the area of MTrPs and their echogenicity, could be useful for long-term monitoring and designing interventional studies for better management of the syndrome.

Analysis of fetal echocardiography parameters in the diagnosis of fetal aortic coarctation

Objective To explore the diagnostic sensitivity and specificity of echocardiography parameters, and the diagnostic value of multiple parameters score. Methods Forty-nine cases of the fetus checked by fetal echocardiography and were indicated aortic coarctation. According to the results of follow-up, the cases were divided into the positive and negative groups. Comprehensive analysis were performed in fetal echocardiography parameters, such as diameter ratio and velocity ratio of ventricle, aorta, pulmonary artery, ductus artery, middle cerebral artery and umbilical artery. Results Diameter ratio of left ventricle/right ventricle(LV/RV), pulmonary artery/aorta(PA/AO), aortic isthmus/ductus artery(AI/DA), and velocity ratioof middle cerebral artery/inner umbilical artery(MCA/inUA) were calculated, ROC curve showed their area under ROC were>0.5 with a significant statistical significance (P<0.05). The Chi-square test showed that the consistency of any single ratio was relatively low. When the number of the ratiois increased to 3-4, the Kappa value was 0.687(P=0.000) and 0.649(P=0.000), respectively, which had relatively high diagnostic value. Conclusions Ultrasonic diagnosis of fetal coarctation of aorta has certain difficulty, and the value of single hemodynamic parameter of fetal echocardiography in diagnosis of fetal aortic coarctation is lower, so that the comprehensive evaluation and combined multiple ultrasonic parameters can improve the sensitivity and specificity of ultrasound diagnosis. Key words: Echocardiography; Fetal heart; Aortic coarctation

Specificity of Ultrasonography in Diagnosis of Liver Cirrhosis: Does APRI Improve Accuracy?

Purpose: Ultrasonography (US) is commonly used in evaluation of liver disease. If cirrhosis could be reliably diagnosed on US, it would be useful and might obviate the need for additional testing. There is scant data on the specificity (Sp) of US. A recent study from Japan and China evaluated 142 patients with surgically resected HCC. They found that the Sp of US in diagnosis of liver cirrhosis to be 73.5%. We sought to evaluate the Sp of US in patients with liver disease without clinical evidence of cirrhosis or portal hypertension. We further studied whether combining US findings with APRI scores improved Sp for cirrhosis. Determining the level of cirrhosis is important in surveillance of patients infected with hepatitis C. Methods: We reviewed all patients who had a dedicated US prior to liver biopsy (Bx) from January 1st, 2003 through December 31st, 2011 at our medical center. This yielded a total of 79 patients. The Metavir cirrhosis staging system was used with cirrhosis being F4 and significant fibrosis labeled as a combination of F3 and F4. APRI scores within 3 months of liver Bx were available for only 31 of the 79 patients with dedicated US. Sensitivities (Sn), specificities, negative and positive predictive values were calculated for US and US with APRI score in detecting significant fibrosis (F3/F4) and cirrhosis (F4). Results: A total of 79 US evaluations of the liver were performed which had complete data. The distribution of gender was 84.8% male and 15.2% female. The patient ethnicity was 46.8% Caucasian, 30.4% African American, and 22.8% other. The results of our study can be seen in the table below. When APRI scores were added, the results were affected greatest for F3/F4 raising the Sn to 76.2%, while just the F4 Sn was only 72.2%. The most common indication for imaging was hepatitis C (64.4%), followed by abnormal liver function tests (21.9%) and hepatitis B and C (4.1%). Conclusion: Non-invasive imaging is a vital part of monitoring and evaluation of liver cirrhosis. The gold standard for evaluation of liver cirrhosis is still a liver Bx. Our study showed that the combination of APRI scores and US imaging increased the Sn of detecting F3/F4 while having little effect on detection of just F4. Studies have shown that US Sn and Sp are of the lowest when it comes to radiologic evaluation of cirrhosis, 52.4% and 73.5%, respectively. We improved on these values and with the addition of APRI scores to 76.7% and 83.7%. Further investigation is needed to try and determine a completely non-invasive way of assessing for cirrhosis.Table: No Caption available.

Review of the Evidence on Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism

This review summarizes the evidence regarding the efficacy of techniques for diagnosis of deep venous thrombosis (DVT) and pulmonary embolism. We searched for studies using MEDLINE, MICROMEDEX, the Cochrane Controlled Trials Register, and the Cochrane Database of Systematic Reviews through June 2006. We reviewed randomized controlled trials, systematic reviews of trials, and observational studies if no trials were available. Paired reviewers assessed the quality of each included article and abstracted the data into summary tables. Heterogeneity in study designs precluded mathematical combination of the results of the primary literature. Our review found 22 relevant systematic reviews and 36 primary studies. The evidence strongly supports the use of clinical prediction rules, particularly the Wells model, for establishing the pretest probability of DVT or pulmonary embolism in a patient before ordering more definitive testing. Fifteen studies support that when a D-dimer assay is negative and a clinical prediction rule suggests a low probability of DVT or pulmonary embolism, the negative predictive value is high enough to justify foregoing imaging studies in many patients. The evidence in 5 systematic reviews regarding the use of D-dimer, in isolation, is strong and demonstrates sensitivities of the enzyme-linked immunosorbent assay (ELISA) and quantitative rapid ELISA, pooled across studies, of approximately 95%. Eight systematic reviews found that the sensitivity and specificity of ultrasonography for diagnosis of DVT vary by vein; ultrasonography performs best for diagnosis of symptomatic, proximal vein thrombosis, with pooled sensitivities of 89% to 96%. The sensitivity of single-detector helical computed tomography for diagnosis of pulmonary embolism varied widely across studies and was below 90% in 4 of 9 studies; more studies are needed to determine the sensitivity of multidetector scanners. While the strength of the evidence varies across questions, it is generally strong.

Diagnostic Medical Ultrasound Technology

Ultrasound has been used as a diagnostic medical tool for nearly half a century. Collaborative efforts between individuals from a variety of disciplines have resulted in a continual evolution in ultrasound technology. Early ultrasound investigations proceeded simultaneously and independently within several major centers located throughout the world. Advances in technology typically preceded and enabled more sophisticated medical research in the field. Once sufficient experience was obtained, the new equipment and imaging methods could be used for clinical applications. In this review, the author focuses on the major advances in technology that have resulted in the state-of-the-art ultrasound systems currently in use. These include the introduction of amplitude mode, brightness mode, real-time, and Doppler ultrasound. Recent progress in the field, including color flow imaging and the addition of digital technology, has expanded the range and specificity of ultrasound diagnosis while improving the quality of equipment and enhancing the image content. Future improvements to the field include three-dimensional ultrasound and the addition of a variety of ultrasound contrast agents. Improvements in existing technology and future advances hold the promise of placing ultrasound at the forefront of the medical imaging modalities.

Improvement in specificity of ultrasonography for diagnosis of breast tumors by means of artificial intelligence.

A set of ultrasonograms of lesions from 200 patients between the ages of 14 and 93 years who underwent mammography followed by ultrasonographic examination and excisional biopsy has been studied with computer vision techniques to improve the ultrasonographic specificity of the diagnosis. Selected features representing the texture of the lesion were calculated and then classified by an artificial neural network. This network was biased toward correctly classifying all the malignant cases at the expense of some misclassification of the benign cases. The network diagnosed the malignant cases with 100% sensitivity and 40% specificity (compared with 0% specificity for the radiologists diagnosing the same set of cases in the breast imaging setting), and tests performed with a leave-one-out technique indicate that the network will generalize well to new cases. This suggests that methods based on neural network classification of texture features show promise for potentially decreasing the number of unnecessary biopsies by a significant amount in patients with sonographically identifiable lesions.