Terms Of Diagnostic Performance Research Articles

Does the Addition of DWI to Fluid-Sensitive Conventional MRI of the Sacroiliac Joints Improve the Diagnosis of Sacroiliitis?

The purpose of this study was to determine whether adding DWI to conventional MRI of the sacroiliac joints improves the diagnostic performance of MRI readers in the detection of sacroiliitis. MR images of the sacroiliac joints of 63 patients with lower back pain obtained between January 2016 and December 2016 were analyzed retrospectively. Three readers reviewed the MRI studies for bone marrow edema lesions around the sacroiliac joints as a marker of active sacroiliitis and gave a diagnostic confidence score of 0-4 using MRI without DWI and MRI with DWI in separate sessions. The normalized apparent diffusion coefficient mean (nADCmean) was measured. Clinical and radiologic data using the Assessment of Spondyloarthritis International Society criteria were the reference for the diagnosis of sacroiliitis. Diagnostic performance, confidence scores, and interreader agreement for the MRI methods were compared. The nADCmean values of patients with and those without sacroiliitis were compared. The accuracy, sensitivity, and specificity of MRI without DWI were 68.3%, 69.0%, and 67.6% and for MRI with DWI were 74.6%, 69.0%, and 79.4% (accuracy and sensitivity, p > 0.100; specificity, p = 0.039). The mean confidence score for MRI without DWI was 3.60 and for MRI with DWI was 3.67 (p = 0.270). The kappa coefficient for MRI without DWI was 0.28 and for MRI with DWI was 0.46 (p = 0.041). The nADCmean in patients with sacroiliitis was 3.86 and in patients without sacroiliitis was 1.6 (p ≤ 0.001). The nADCmean AUC was 0.758 (95% CI, 0.67-0.83). The addition of DWI to conventional MRI does not significantly improve overall diagnostic performance in terms of accuracy, sensitivity, or confidence in the detection of inflammatory sacroiliitis, but it does have increased specificity and interobserver agreement. ADC threshold values can be used as predictors of sacroiliitis but give no added advantage over MRI with DWI.

Role of Diffusion Weighted MRI in Diagnosis of Cervical Cancer

Background: Diffusion weighted magnetic resonance imaging (DW-MRI) is a functional, non-invasive imaging technique which generates tissue contrast from differences in mobility of water molecules that occurs during an MR pulse sequence. Information regarding the integrity of cellular membranes and tissue cellularity can be obtained, so that DW-MRI can now be included in routine patient assessment. Aim of the Work: The aim of this study is to evaluate the role of DW-MRI in the diagnosis of cervical carcinoma, withpathological diagnosis was taken as the reference. Patients and Methods: This is a retrospective study that included 20 patients in whom cervical cancer had been suspected clinically or by transvaginal ultrasound (U/S) and the control group consisted of 20 patients in whom cervical cancer had not been suspected and MRI was performed because of other Pelvic diseases. The study was conducted in El-Demerdash Hospital. The patients were referred from the Gynecology Department to the Radiology Department (Women’s imaging unit) for further MRI assessment with diffusion weighted images (DWIs). Results: Lesions in all cases show restricted diffusion, however on apparent diffusion coefficient (ADC) map, only one case showed high signal proved to be chronic cervicitis on histopathology. Also, the mean ADC values for malignant lesions were (0.82 x10-3 mm2/sec), while the mean ADC value in the control group was (1.58x10–3 mm2/sec). Therefore, ADC value of (1.04 x10-3 mm2/sec) is a cut off between normal cervical tissue and malignant cervical lesion by sensitivity 95% and specificity 95 %. DWIs had elicited the same accuracy to Dynamic contrast-enhanced (DCE) sequences (95%) when added to the non-contrast MRI in the estimation of cancer cervix. Conclusion: Our results proved that (DW–MRI) was significantly beneficial in terms of diagnostic performance that increases the radiologist’s confidence in image interpretation. So, it implies a non-invasive technique which can be used especially if contrast intake is avoided as in pregnancy. Thus, we suggest that DWI should be included in the routine pelvic MRI protocol. The ADC value in case of cervical carcinoma was significantly lower than in the normal cervical tissue. The ADC threshold of (1.04 x10-3 mm2/sec) was a cut off value, which was detected when differentiating between cancer-affected and non-affected cervical tissues

The role of breast tomosynthesis in a predominantly dense breast population at a tertiary breast centre: breast density assessment and diagnostic performance in comparison with MRI

ObjectivesTo compare breast density measured on digital breast tomosynthesis (DBT) (BI-RADS-based breast composition and fully-automatic estimation) and magnetic resonance imaging (MRI) (BI-RADS amount of fibroglandular tissue), and to evaluate the diagnostic performance in terms of sensitivity and specificity of DBT and MRI in a predominantly dense breast population.MethodsBetween 2015 and 2016, 152 women with 103 breast malignancies, who underwent 3-T breast MRI and DBT within 2 months’ time, were enrolled in this study. Breast composition/fibroglandular tissue and findings on DBT (two readers) and MRI were reported using BI-RADS 5th edition. Digital mammography images were analysed for breast percent density (PD) using the Libra software tool.ResultsA majority of women had dense breasts as categorised by breast composition c (heterogeneously dense) (68%) and d (extremely dense) (15%). The mean PD was 44% (range, 18-89%) and the correlation between breast composition and PD was r = 0.6. The diagnostic performance of MRI was significantly higher compared to DBT for one reader as described by the area under the receiver operating characteristic (ROC) curve (p = 0.004) and of borderline significance for the other reader (p = 0.052).ConclusionsMRI had higher diagnostic performance than DBT in a dense breast population in the tertiary setting.Key Points• MRI had higher diagnostic performance than DBT in a dense breast population• Diagnostic performance of DBT was comparable to MRI in women with fatty breasts• MRI was superior to DBT in preoperative breast cancer size assessment

Characterization of Adrenal Lesions on Unenhanced MRI Using Texture Analysis: A Machine-Learning Approach.

Adrenal adenomas (AA) are the most common benign adrenal lesions, often characterized based on intralesional fat content as either lipid-rich (LRA) or lipid-poor (LPA). The differentiation of AA, particularly LPA, from nonadenoma adrenal lesions (NAL) may be challenging. Texture analysis (TA) can extract quantitative parameters from MR images. Machine learning is a technique for recognizing patterns that can be applied to medical images by identifying the best combination of TA features to create a predictive model for the diagnosis of interest. To assess the diagnostic efficacy of TA-derived parameters extracted from MR images in characterizing LRA, LPA, and NAL using a machine-learning approach. Retrospective, observational study. Sixty MR examinations, including 20 LRA, 20 LPA, and 20 NAL. Unenhanced T1 -weighted in-phase (IP) and out-of-phase (OP) as well as T2 -weighted (T2 -w) MR images acquired at 3T. Adrenal lesions were manually segmented, placing a spherical volume of interest on IP, OP, and T2 -w images. Different selection methods were trained and tested using the J48 machine-learning classifiers. The feature selection method that obtained the highest diagnostic performance using the J48 classifier was identified; the diagnostic performance was also compared with that of a senior radiologist by means of McNemar's test. A total of 138 TA-derived features were extracted; among these, four features were selected, extracted from the IP (Short_Run_High_Gray_Level_Emphasis), OP (Mean_Intensity and Maximum_3D_Diameter), and T2 -w (Standard_Deviation) images; the J48 classifier obtained a diagnostic accuracy of 80%. The expert radiologist obtained a diagnostic accuracy of 73%. McNemar's test did not show significant differences in terms of diagnostic performance between the J48 classifier and the expert radiologist. Machine learning conducted on MR TA-derived features is a potential tool to characterize adrenal lesions. 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.

Comment: Tau CSF proteins for diagnosis but tau PET imaging for AD diagnosis and staging.

With upcoming therapeutic approaches based on tau pathology, biomarkers of this pathology are urgently needed.1,2 In this issue of Neurology® , Mattsson and colleagues3 compared PET imaging of tau pathology with CSF measurements (total tau [t-tau] and phosphorylated tau [p-tau]), and related these measures in terms of diagnostic performance for Alzheimer disease (AD).

Unsupervised Locality-Preserving Robust Latent Low-Rank Recovery-Based Subspace Clustering for Fault Diagnosis

With the increasing demand for unsupervised learning for fault diagnosis, the subspace clustering has been considered as a promising technique enabling unsupervised fault diagnosis. Although various subspace clustering methods have been developed to deal with high-dimensional and non-linear data, analyzing the intrinsic structure from the data is still challenging. To address this issue, a new subspace clustering method based on locality-preserving robust latent low-rank recovery (L2PLRR) was developed. Unlike conventional subspace clustering methods, the developed method maps the high-dimensional and non-linear data into a low-dimensional latent space by preserving local similarities of the data with the goal of resolving the difficulty in analyzing the high-dimensional data. Likewise, in the developed L2PLRR method, learned features correspond to low-rank coefficients of the data in the latent space, which will be further used for fault diagnosis (e.g., identification of health states of an object system). The efficacy of the developed L2PLRR method was verified with a bearing fault diagnosis application by comparing with conventional and state-of-the-art subspace clustering methods in terms of diagnostic performance.

Comparative study of probabilistic neural network and back propagation network for fault diagnosis of refrigeration systems

Fault diagnosis is of crucial importance to mechanical systems. To find an efficient way of conducting fault diagnosis for refrigeration systems, probabilistic neural network, and back-propagation network were employed to diagnose seven types of typical faults for a 90-ton centrifugal chiller. These include system-level faults such as refrigerant leak/undercharge, refrigerant overcharge, and excess oil and also component-level faults such as condenser fouling, reduced condenser water flow, noncondensables in the refrigerant, and reduced evaporator water flow. Eight major features of the chiller system were selected as indicative parameters for diagnosing. The establishment of the fault diagnosis models based on the probabilistic neural network and back-propagation network and the optimization processes of the networks were elaborated. Comparison in terms of diagnostic performance was performed based on the optimized networks. The results showed that the overall diagnostic performance of the probabilistic neural network was better than that of the back-propagation network. The probabilistic neural network has a correct rate that was 3.48% higher than that of back-propagation, and its diagnosis time was lower by more than 400 times. Moreover, the diagnosis of a single probabilistic neural network training was more reliable than that of the back-propagation network. It was also demonstrated that system-level faults were more difficult to be recognized by the model than component-level faults because of their widespread influence on the system operation. The probabilistic neural network model has a better performance on system-level faults with an improvement of correct rates about 4%∼8.7% from those of back-propagation model.

MRI in chronic groin pain: sequence diagnostic reliability compared to systematic surgical assessment.

To determine the diagnostic reliability of magnetic resonance imaging (MRI) sequences in chronic groin pain (CGP) compared to surgery and try to propose a suitable MRI protocol. Forty-three consecutive patients with resistant clinical CGP underwent a pre-surgical pelvis MRI. Eight MRI sequences were acquired: axial fast spin-echo T1-weighted (FSE T1), coronal FSE T1, axial-oblique (in symphysis plane) proton density weighted with fat saturation (PDFS), coronal PDFS, sagittal PDFS, axial FSE T1 with fat saturation and gadolinium enhancement (FSGE), coronal FSE T1 FSGE and axial FSE T1 with Valsalva maneuver (VM). These sequences were reviewed for pubic symphysis assessment, adductor longus (AL) tendon and abdominal wall (AW) injuries. The same surgeon operated on all of these patients (26 AL and 49 AW). Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative prospective value (NPV) and accuracy of each sequence and combinations for AL or AW injuries were calculated in comparison to surgical findings. One hundred ninety-two sequences were obtained. Coronal T1 FSGE and axial T1 VM proved to be the most reliable sequences (accuracy: 91.67% in AL and 83.33% in AW). The best sequence combination was coronal T1, axial PDFS, sagittal PDFS and axial T1 VM (accuracy: 77.78%; Se: 100.00%, Sp: 69.23%, PPV: 55.56%, NPV: 100.00%). MRI has 77.78% accuracy, 100.00% sensitivity, 69.23% specificity, 55.56% PPV and 100.00% NPV in evaluating CGP, with coronal T1-axial PDFS-sagittal PDFS-axial T1 VM as the optimal protocol in terms of diagnostic performance within a reasonable scan time. Diagnostic performance of MRI was examined in the evaluation of CGP using surgery as reference standard.

Using quantitative features extracted from T2-weighted MRI to improve breast MRI computer-aided diagnosis (CAD).

Computer-aided diagnosis (CAD) has been proposed for breast MRI as a tool to standardize evaluation, to automate time-consuming analysis, and to aid the diagnostic decision process by radiologists. T2w MRI findings are diagnostically complementary to T1w DCE-MRI findings in the breast and prior research showed that measuring the T2w intensity of a lesion relative to a tissue of reference improves diagnostic accuracy. The diagnostic value of this information in CAD has not been yet quantified. This study proposes an automatic method of assessing relative T2w lesion intensity without the need to select a reference region. We also evaluate the effect of adding this feature to other T2w and T1w image features in the predictive performance of a breast lesion classifier for differential diagnosis of benign and malignant lesions. An automated feature of relative T2w lesion intensity was developed using a quantitative regression model. The diagnostic performance of the proposed feature in addition to T2w texture was compared to the performance of a conventional breast MRI CAD system based on T1w DCE-MRI features alone. The added contribution of T2w features to more conventional T1w-based features was investigated using classification rules extracted from the lesion classifier. After institutional review board approval that waived informed consent, we identified 627 breast lesions (245 malignant, 382 benign) diagnosed after undergoing breast MRI at our institution between 2007 and 2014. An increase in diagnostic performance in terms of area under the curve (AUC) from the receiver operating characteristic (ROC) analysis was observed with the additional T2w features and the proposed quantitative feature of relative T2w lesion intensity. AUC increased from 0.80 to 0.83 and this difference was statistically significant (adjusted p-value = 0.020).

Combination of hand-held probe and microscopy for fluorescence guided surgery in the brain tumor marginal zone

BackgroundVisualization of the tumor is crucial for differentiating malignant tissue from healthy brain during surgery, especially in the tumor marginal zone. The aim of the study was to introduce a fluorescence spectroscopy-based hand-held probe (HHF-probe) for tumor identification in combination with the fluorescence guided resection surgical microscope (FGR-microscope), and evaluate them in terms of diagnostic performance and practical aspects of fluorescence detection. Material and MethodsEighteen operations were performed on 16 patients with suspected high-grade glioma. The HHF-probe and the FGR-microscope were used for detection of protoporphyrin (PpIX) fluorescence induced by 5-aminolevulinic acid (5-ALA) and evaluated against histopathological analysis and visual grading done through the FGR-microscope by the surgeon. A ratio of PpIX fluorescence intensity to the autofluorescence intensity (fluorescence ratio) was used to quantify the spectra detected by the probe. ResultsFluorescence ratio medians (range 0 – 40) measured by the probe were related to the intensity of the fluorescence in the FGR-microscope, categorized as “none” (0.3, n=131), “weak” (1.6, n=34) and “strong” (5.4, n=28). Of 131 “none” points in the FGR-microscope, 88 (67%) exhibited fluorescence with the HHF-probe. For the tumor marginal zone, the area under the receiver operator characteristics (ROC) curve was 0.49 for the FGR-microscope and 0.65 for the HHF-probe. ConclusionsThe probe was integrated in the established routine of tumor resection using the FGR-microscope. The HHF-probe was superior to the FGR-microscope in sensitivity; it detected tumor remnants after debulking under the FGR-microscope. The combination of the HHF-probe and the FGR-microscope was beneficial especially in the tumor marginal zone.

Impact of the use of an endorectal coil for 3 T prostate MRI on image quality and cancer detection rate

This work aims to assess the impact of an additional endorectal coil on image quality and cancer detection rate within the same patients. At a single academic medical center, this transversal study included 41 men who underwent T2- and diffusion-weighted imaging at 3 T using surface coils only or in combination with an endorectal coil in the same session. Two blinded readers (A and B) randomly evaluated all image data in separate sessions. Image quality with respect to localization and staging was rated on a five-point scale. Lesions were classified according to their prostate imaging reporting and data system (PIRADS) score version 1. Standard of reference was provided by whole-mount step-section analysis. Mean image quality scores averaged over all localization-related items were significantly higher with additional endorectal coil for both readers (p < 0.001), corresponding staging-related items were only higher for reader B (p < 0.001). With an endorectal coil, the rate of correctly detecting cancer per patient was significantly higher for reader B (p < 0.001) but not for reader A (p = 0.219). The numbers of histologically confirmed tumor lesions were rather similar for both settings. The subjectively rated 3-T image quality was improved with an endorectal coil. In terms of diagnostic performance, the use of an additional endorectal coil was not superior.

Measurement system design for leak detection in hydraulic pressurized networks

This paper compares four sensor placement strategies which differ according to their evaluation criteria (EC). The first involves the minimisation of the expected number of candidate models, and the second is based on maximising joint entropy. The first methodology shows better results in terms of diagnostic performance. However, the second is promising due to faster execution time. The third strategy is a combination of the first two. Finally, a fourth strategy involves consideration of the cost of the sensor placement at each location in addition to the EC of the third strategy. The four strategies are evaluated in terms of performance, computational load and cost. Since there is only mild competition between the three criteria, a hierarchical multicriteria decision-making approach is employed to identify the best sensor placement strategy. Two case studies are used for illustration. The results show that the sensor placement strategies are useful for identifying optimised sensor configurations for new configurations as well as for evaluating the performance of existing sensor configurations. Using a hierarchical multicriteria decision-making technique, the fourth sensor placement strategy satisfies all criteria well, making it the best strategy.

Scapholunate Interosseous Ligament Tears: Diagnostic Performance of 1.5 T, 3 T MRI, and MR Arthrography—A Systematic Review and Meta-analysis

The study aimed to perform a systematic review and meta-analysis for evaluating the diagnostic accuracy of 1.5 Tesla and 3.0 Tesla magnetic resonance imaging (MRI), and magnetic resonance arthrography (MRA), in the detection of scapholunate interosseous ligament (SLIL) injury.A literature search was performed (until July 2015) using the PubMed (MEDLINE), Embase, ISI Web of Science, Scopus, and conference proceedings. Original studies evaluating the diagnostic accuracy of MRI or MRA in the detection of SLIL injuries using arthroscopy or open surgery as the reference standard were included.Of the initial 930 published records and 103 conference proceedings, 24 studies (1902 MRI examinations) were included (median SLIL injury prevalence: 33% [interquartile range: 25-42]). Heterogeneity was detected for 1.5 T MRI (chi-square: 47.93, P < 0.001) but not for 3.0 T MRI (chi-square: 8.00, P value: 0.09) and MRA (chi-square: 14.54, P value: 0.34) studies. The sensitivities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 45.7% (95% confidence interval: 40.1-51.4), 75.7% (66.8-83.2), and 82.1% (76.1-87.2), respectively. The specificities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 80.5% (77.3-83.4), 97.1% (89.8-99.6), and 92.8% (90.2-94.9), respectively. The diagnostic odds ratios of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 5.56 (2.71-11.39), 23.23 (3.16-171.00), and 65.04 (32.89-128.62) (P value < 0.001), respectively. The results were consistent after addressing publication bias and sensitivity analyses.MRA is superior to 3.0 T MRI, and 3.0 T MRI is superior to 1.5 T MRI in terms of diagnostic performance. 3.0 T MRI has the highest specificity for the detection of SLIL injuries.

Diagnostic performance of real-time strain sonoelastography in BI-RADS 4 and 5 breast masses

The purpose of this study was to evaluate the diagnostic performance of sonoelastography by using real-time strain ratio and qualitative 5-stage elasticity score in breast lesions for which ultrasonographic evaluation suggested malignancy (BI-RADS 4 and 5 lesions). From January 2012 to October 2012, 168 solid breast lesions were investigated using sonoelastography. The strain ratios and the elasticity scores were calculated. Final diagnosis was made by histopathological analysis. Areas under the curve and cut-off points were used to assess diagnostic performance of sonoelastography. The sensitivity, and specificity of these two imaging tests were compared using McNemar test. The strain ratios of malignant lesions (mean value=9.3) and benign lesions (mean value=3.75) were significantly different (P<0.00001). Using a cut-off value of 4.79, strain ratio had 78.8% sensitivity, 78.3% specificity, 86.7% positive predictive value (PPV) and 67% negative predictive value (NPV). Using a 5-stage elasticity score system, a 83.3% sensitivity, 74.6% specificity, 85.7% PPV and 71.0% NPV were obtained. Our study indicates that sonoelastography has good clinical value to discriminate between benign and malignant breast lesions. There are no differences in terms of diagnostic performance in differentiating malignant from benign lesions when strain ratio or color scoring are used alone. However the diagnostic performance is increased when strain ratio and color scoring evaluations are used in combination.

MRI and diffusion-weighted MRI to diagnose a local tumour regrowth during long-term follow-up of rectal cancer patients treated with organ preservation after chemoradiotherapy.

ObjectivesTo assess the value of MRI and diffusion-weighted imaging (DWI) for diagnosing local tumour regrowth during follow-up of organ preservation treatment after chemoradiotherapy for rectal cancer.MethodsSeventy-two patients underwent organ preservation treatment (chemoradiotherapy + transanal endoscopic microsurgery or “wait-and-see”) and were followed with MRI including DWI (1.5 T) every 3 -months during the first year and 6 months during following years. Two readers scored each MRI for local regrowth using a confidence level, first on standard MRI, then on standard MRI+DWI. Histology and clinical follow-up were the standard reference. Receiver operating characteristic curves were constructed and areas under the curve (AUC) and corresponding accuracy figures calculated on a per-scan basis.ResultsFour hundred and forty MRIs were assessed. Twelve patients developed local regrowth. AUC/sensitivity/specificity for standard MRI were 0.95/58 %/98 % (R1) and 0.96/58 % /100 % (R2). For standard MRI+DWI, these numbers were 0.86/75 %/97 % (R1) and 0.98/75 %/100 % (R2). After adding DWI, the number of equivocal scores decreased from 22 to 7 (R1) and from 40 to 20 (R2).ConclusionsAlthough there was no overall improvement in diagnostic performance in terms of AUC, adding DWI improved the sensitivity of MRI for diagnosing local tumour regrowth and lowered the rate of equivocal MRIs.Key Points• DWI improves sensitivity for detecting local tumour regrowth after organ preservation treatment.• In particular, DWI can aid in detecting small local recurrence.• DWI reduces the number of equivocal scores.

Transvaginal ultrasound for preoperative assessment of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis.

To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of deep myometrial infiltration in patients with endometrial cancer, comparing subjective and objective methods. An extensive search was performed in MEDLINE (PubMed) and EMBASE for studies published between January 1989 and December 2014. The eligibility criterion was use of TVS for preoperative assessment of myometrial infiltration by subjective evaluation and/or objective measurements. Objective measurements included, specifically, the approaches of Gordon (ratio of the distance between endometrium-myometrium interface and maximum tumor depth to the total myometrial thickness) and Karlsson (endometrial tumor thickness/anteroposterior uterine diameter ratio), in women with endometrial cancer, using the surgical pathological data as a reference standard. Study quality was assessed using the QUADAS-2 tool. Our extended search identified a total of 184 citations, among which we examined the full text of 24 articles. Overall pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of TVS for detecting deep myometrial infiltration were 82% (95% CI, 76-87%), 81% (95% CI, 76-85%), 4.3 (95% CI, 3.6-5.3) and 0.22 (95% CI, 0.16-0.30), respectively. We did not observe differences among the three methods in terms of diagnostic performance. Significant heterogeneity was found for sensitivity and specificity of all three methods (I(2) range, 60.6-95.0). The main limitation was that very few studies compared different approaches in the same set of patients. Diagnostic performance of TVS for detecting deep myometrial infiltration in women with endometrial cancer is moderate.

OP07.10: Transvaginal ultrasound for preoperative assessment of myometrial invasion in patients with endometrial cancer: a systematic review and meta‐analysis

To evaluate the diagnostic accuracy of TVUS in the preoperative detection of deep myometrial infiltration (MI) in patients with endometrial cancer (EC), using the surgical-pathologic data as a reference standard. An extensive search was performed in Medline (Pubmed) and EMBASE from January 1989 to January 2015. Quality was assessed using QUADAS-2 tool. Our extended search identified 184 citations but we finally examined the full text of the 30 articles. Overall pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of TVS for detecting deep myometrial infiltration was 82% (95% CI, 76–87%), 81% (95% CI, 76–85%), respectively. We did not observe differences among all three methods in terms of diagnostic performance. Significant heterogeneity was found for sensitivity and specificity for all three methods (I2 values ranging from 60.57 to 94.96). Overall diagnostic performance of TVS for detecting deep myometrial infiltration in women with endometrial cancer is acceptable. However, more studies with improved quality in design and using TVUS only in low risk cases and comparing several approaches in the same set of women are needed.

Thyroid Nodules with 2 Prior Inadequate Fine-Needle Aspiration Results: Effect of Increasing the Diameter of the Needle

The major limitation of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) procedures of thyroid nodules are the cytologically nondiagnostic results. The role of increasing the diameter of the needle in the third FNAB (FNAB#3) due to inadequate cytology has as yet not been investigated. The aim of the present study was to evaluate whether increasing the needle diameter could improve the cytologic sampling of thyroid nodules following 2 previous nondiagnostic US-FNAB results. Between July 2012 and December 2012, 140 consecutive patients with 2 prior nondiagnostic US-FNAB results were enrolled in this prospective investigation. Group 22G consisted of 70 patients (78.5% women; mean age, 52 years) having nodules examined with a 22-gauge (G) needle. Group 27G consisted of 70 patients (75.7% women; mean age, 53 years) having nodules examined with a 27-G needle. The rate of nondiagnostic FNAB results was 42.8% (30 of 70) in group 22G and 64.3% (45 of 70) in group 27G, which was a significant difference (P = .011). The large-bore (22 G) needle was found to be statistically significantly superior compared with the small-bore (27 G) needle in diagnostic ability for predominantly solid (P = .014), irregular (P = .013), and halo-free (P = .021) nodules. The accuracy rate was 64.6 and 38% for large-bore (22 G) and small-bore (27 G) needles, respectively. The results of our study showed that increasing the needle lumen diameter significantly improves diagnostic performance in terms of adequate aspirated material and diagnostic accuracy rate following 2 prior nondiagnostic US-FNABs.

Diagnostic performance of IOTA simple rules for adnexal masses classification: a comparison between two centers with different ovarian cancer prevalence

ObjectiveThe aim of this study was to compare the diagnostic performance of the IOTA simple rules for classifying adnexal masses when used in two centers with different ovarian cancer prevalence. Study designA prospective study was performed between June 2012 and December 2013 at two different centers with different ovarian cancer prevalence. Center A had high ovarian malignancy prevalence and Center B had low malignancy rates. Eligible patients were all women diagnosed as having a persistent adnexal mass. Examiners had to analyze the masses according to IOTA simple rules (SR) providing a diagnosis of malignant, benign or inconclusive. Those cases classified as inconclusive were then examined by an expert examiner (the same examiner in center A, a different examiner in center B), who had to classify the mass as malignant, benign or uncertain according to his subjective impression (SI). Definitive histologic diagnosis from tumors removed surgically was used as gold standard. The diagnostic performance was assessed by calculating the sensitivity and specificity, positive and negative likelihood ratios, for SR and SR+SI assessments. McNemar test was used for comparing sensitivity and specificity. ResultsDuring this period, 247 women were eligible for this study. The rate of inconclusive masses was 18.4% and 18.0% for centers A and B, respectively (p>0.05). Ovarian malignancy rate was significantly higher in center A as compared with center B (27.2% versus 11.3%), (p=0.001). When analyzing only cases classifiable by SR, sensitivity in center A was significantly higher (100% versus 84.6% p=0.001), but specificity was similar in both centers (93.9% and 95.8% respectively). When analyzing SR plus SI, sensitivity in center A was significantly higher (100% versus 86.7% p=0.001), but specificity was similar in both centers (89.9% and 88.8%, respectively). ConclusionsThe diagnostic performance in terms of sensitivity of IOTA rules is higher in a center with higher prevalence of ovarian malignancy.

Use of 100 kV versus 120 kV in computed tomography pulmonary angiography in the detection of pulmonary embolism: effect on radiation dose and image quality.

To determine the effective radiation dose and image quality resulting from 100 versus 120 kilovoltage (kV) protocols among patients referred for computed tomography pulmonary angiography (CTPA). Sixty-six patients with clinical suspicion of pulmonary embolism (PE) were prospectively enrolled. Two CTPA protocols (group A: n=33, 100 kV/115 mAs; group B: n=33, 120 kV/90 mAs) were compared. Two experienced radiologists assessed image quality in terms of diagnostic performance and effect of artefacts. Image quality parameters [CT attenuation, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR)] and effective radiation dose between the two protocols were compared. The contrast enhancement in central and peripheral pulmonary arteries was significantly higher in group A than in group B (P<0.001) with the identical SNR (P=0.26), whereas the CNR was significantly higher in group A than in group B (P<0.001). The effective radiation dose for the 100 and 120 kV scans was 3.2 and 6.8 mSv, respectively. Reducing the tube voltage from 120 to 100 kV in CTPA allows a significant reduction of radiation dose without significant loss of diagnostic image quality.