Home  About us  Contact
 

Diagnostic Accuracy (diagnostic + accuracy)

Distribution by Scientific Domains
Medical Sciences97%
3 Other Domains3%
Distribution within Medical Sciences
Pathology12%
Dermatology8%
Radiology & Imaging7%
Neurology5%
Cardiovascular Disease4%
Respiratory Medicine3%
Allergy & Clinical Immunology2%
35 Other Subdomains51%

Kinds of Diagnostic Accuracy

  • high diagnostic accuracy
    		•

    Selected Abstracts

    Diagnosis of Nonmelanoma Skin Cancer/Keratinocyte Carcinoma: A Review of Diagnostic Accuracy of Nonmelanoma Skin Cancer Diagnostic Tests and Technologies

    DERMATOLOGIC SURGERY, Issue 10 2007
    METTE MOGENSEN MD
    BACKGROUND Nonmelanoma skin cancer (NMSC) is the most prevalent cancer in the light-skinned population. Noninvasive treatment is increasingly used for NMSC patients with superficial lesions, making the development of noninvasive diagnostic technologies highly relevant. OBJECTIVE The scope of this review is to present data on the current state-of-the-art diagnostic methods for keratinocyte carcinoma: basal cell carcinoma, squamous cell carcinoma, and actinic keratosis. METHODS AND MATERIALS MEDLINE, BIOSIS, and EMBASE searches on NMSC and physical and clinical examination, biopsy, molecular marker, ultrasonography, Doppler, optical coherence tomography, dermoscopy, spectroscopy, fluorescence imaging, confocal microscopy, positron emission tomography, computed tomography, magnetic resonance imaging, terahertz imaging, electrical impedance and sensitivity, specificity, and diagnostic accuracy. RESULTS State-of-the-art diagnostic research has been limited in this field, but encouraging results from the reviewed diagnostic trials have suggested a high diagnostic accuracy for many of the technologies. Most of the studies, however, were pilot or small studies and the results would need to be validated in larger trials. CONCLUSIONS Some of these new imaging technologies have the capability of providing new, three-dimensional in vivo, in situ understanding of NMSC development over time. Some of the new technologies described here have the potential to make it from the bench to the clinic. [source]

    Diagnostic Accuracy of Handheld Echocardiography for Evaluation of Aortic Stenosis

    ECHOCARDIOGRAPHY, Issue 5 2010
    Arnd Schaefer M.D.
    Background: Symptomatic severe aortic stenosis is associated with increased mortality and morbidity. Early identification of these patients by echocardiography is crucial. We conducted this study to evaluate a handheld ultrasound device (HCU) in patients with suspected severe aortic stenosis (AS) in comparison to a standard echocardiography device (SE). Methods: A HCU (Vivid I; GE Healthcare) and a SE device (Philips iE 33) were used to evaluate 50 consecutive patients with suspected severe AS. Two consecutive echocardiographic studies were performed by two experienced and blinded examiners using HCU and SE device. AS was graded by mean transaortic pressure, aortic valve area (AVA), and indexed AVA (AVA adjusted for body surface area). Results: Mean difference for mean transaortic gradient, AVA and indexed AVA for the SE and HCU device were 1.28 mmHg (,0.70 to 3.26 mmHg), ,0.02 cm2 (,0.06 to 0.01 cm2), and ,0.01 cm2/m2 (,0.03 to 0.01 cm2/m2), respectively. Discrepancies between both devices were not associated with misinterpretation of the degree of AS. Conclusion: Our study demonstrates that HCU can be used to evaluate patients with suspected AS. (ECHOCARDIOGRAPHY 2010;27:481-486) [source]

    Impact of Valvular Calcification on the Diagnostic Accuracy of Transesophageal Echocardiography for the Detection of Congenital Aortic Valve Malformation

    ECHOCARDIOGRAPHY, Issue 7 2007
    Akash Makkar M.D.
    Background: Degeneration of congenital bicuspid or unicuspid aortic valves can progress more rapidly than that of tricuspid valves, and an early diagnosis significantly impacts decision making and outcome. We hypothesized that the extent of valvular calcification would negatively influence the diagnostic accuracy of multiplane transesophageal echocardiography (TEE) for the diagnosis of congenital aortic valve disease. Methods: TEE was performed in 57 patients undergoing aortic valve replacement surgery for aortic stenosis (n = 46), pure regurgitation (n = 9), or significant regurgitation with less than severe aortic stenosis (n = 2). The degree of aortic valve calcification and the number of valve cusps were determined at surgery. Results: Surgical inspection confirmed 14 bicuspid and 43 tricuspid aortic valves. Sensitivity and specificity of TEE for the diagnosis of congenital aortic valve malformation was 93% (13/14) and 91% (39/43) (P = 0.0001), respectively. In patients with no or mild aortic valve calcification (n = 13), sensitivity and specificity of TEE for the diagnosis of congenitally malformed aortic valve was 100% (5/5) and 100% (8/8) (P = 0.001), respectively. In patients with moderate or marked aortic valve calcification (n = 44), sensitivity and specificity of TEE for the diagnosis of congenitally malformed aortic valve was 89% (8/9) and 89% (31/35) (P<0.0001), respectively. In this subgroup of 44 patients, there were four false-positive and one false-negative diagnoses due to valvular calcification. Conclusions: Although TEE is highly sensitive and specific for the detection of congenital aortic valve malformations, presence of moderate or marked calcification of the aortic valve may result in false positive and false negative diagnoses. [source]

    Improving Diagnostic Accuracy Using an Evidence-Based Nursing Model

    INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 4 2004
    Rona F. Levin PhD
    Diagnósticos de enfermagem; prática baseada em evidências; precisão diagnóstica Exactitud diagnóstica; práctica basada en la evidencia; diagnósticos de enfermería PURPOSE. To propose an evidence-based model (EBM) to improve diagnostic accuracy in nursing. DATA SOURCES. Published literature, experience, and expertise of authors. DATA SYNTHESIS. Using an EBM directs clinicians on how to use the best available evidence from the literature to determine the best fit between cues and diagnoses, integrate this evidence with clinician expertise and patient preferences, and conduct a self-evaluation of the process. CONCLUSIONS. Use of an EBM to teach nurses how to ask relevant diagnostic questions and provide a framework for nurse educators to teach evidenced-based practice may lead to developing more competent diagnosticians and improving diagnostic accuracy in nursing. OBJETIVO. Propor um modelo baseado em evidências (MBE) para melhorar a precisão diagnóstica na enfermagem. FONTE DE DADOS. Literatura publicada, experiência e conhecimento das autoras. SÍNTESE DOS DADOS. A utilização de um BEM orienta as enfermeiras clínicas sobre como utilizar a melhor evidência disponível na literatura para determinar o melhor ajuste entre as pistas obtidas e os diagnósticos, integrando esta evidência com o conhecimento clínico da enfermeira e as preferências do paciente, e conduzindo a uma auto-avaliação do processo. CONCLUSÕES. O uso de um modelo de prática baseado em evidências para ensinar as enfermeiras a formular perguntas relevantes e oferecer aos educadores de enfermagem uma estrutura para o ensino da prática baseada em evidências pode levar ao desenvolvimento de dianosticadoras mais competentes e melhorar a precisão diagnóstica na enfermagem. PROPÓSITO. Proponer un modelo basado en la evidencia (MBE) para mejorar la exactitud diagnóstica en enfermería. FUENTES DE DATOS. Bibliografía publicada, experiencia y especialización de los autores. SÍNTESIS DE LOS DATOS. Utilizando un MBE guía a los clínicos en cómo utilizar la mejor evidencia disponible en la bibliografía para determinar el mejor encaje entre los datos y los diagnósticos, integrar esta evidencia con la especialidad clínica y las preferencias del paciente y llevar a cabo una auto-evaluación del proceso. CONCLUSIONES. El uso de un modelo de práctica basada en la evidencia para enseñar a las enfermeras cómo hacer preguntas diagnósticas pertinentes y proporcionar un marco de trabajo para que las enfermeras docentes enseñen la práctica basada en la evidencia, puede llevar a desarrollar mayor competencia al diagnosticar y mejoras en la exactitud diagnóstica. [source]

    Detection of Mild Hyposalivation in Elderly People Based on the Chewing Time of Specifically Designed Disc Tests: Diagnostic Accuracy

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2009
    DrOdont, Isabelle Madinier DDS
    OBJECTIVES: To compare sialometry with chewing time (including swallowing) of specifically designed disc tests. DESIGN: Index test versus reference standard (sialometry; 60 patients); reliability study (10 patients). SETTING: Outpatient dental clinic and geriatric ward, Nice University Hospital, France. PARTICIPANTS: Thirty adults and 30 older patients (mean ages 47 and 84). INTERVENTION: Index test assessment in patients with and without hyposalivation. MEASUREMENTS: Data from medical files, interviews and oral examination were collected. Sialometry (stimulated salivary flow rate (SSFR) mL/min) and disc chewing times (seconds) were measured. RESULTS: Sialometry was too long and was inappropriate for five of the 30 older persons. Chewing times were negatively correlated to sialometry results (Spearman correlation coefficient (R)=0.77, P<.001). The threshold to diagnose hyposalivation (SSFR <1 mL/min) was 40 seconds (area under the receiver operating characteristic curve (AUC)=0.921, 100% sensitivity, 72% specificity). Twenty-seven subjects with a SSFR less than 1.5 mL/min had a chewing time longer than 40 seconds, suggesting that mild hyposalivation and eating difficulties were related (AUC=0.941, 93% sensitivity, 88% specificity). Mean chewing time was greater with xerostomia (51.9 vs 30.7 seconds, P<.001) but not with dental pain (39.5 vs 39.9, P=.96). Masticatory percentage (e.g., pairs of antagonistic teeth) had no effect on chewing time (SSFR <1 mL/min, AUC=0.921; SSFR <1.5 mL/min, AUC=0.950). Reliability was better for the disc test than for sialometry (intraclass correlation 0.85 vs 0.70). CONCLUSION: This disc test was conceived to detect mild hyposalivation in geriatric patients with impaired dental health. Early detection of hyposalivation could help to suppress or avoid xerostomia-inducing drugs and to prevent oral infections and dental caries. [source]

    Diagnostic Accuracy of a New Instrument for Detecting Cognitive Dysfunction in an Emergent Psychiatric Population: The Brief Cognitive Screen

    ACADEMIC EMERGENCY MEDICINE, Issue 3 2010
    Steven P. Cercy PhD
    Abstract Objectives:, In certain clinical contexts, the sensitivity of the Mini-Mental State Examination (MMSE) is limited. The authors developed a new cognitive screening instrument, the Brief Cognitive Screen (BCS), with the aim of improving diagnostic accuracy for cognitive dysfunction in the psychiatric emergency department (ED) in a quick and convenient format. Methods:, The BCS, consisting of the Oral Trail Making Test (OTMT), animal fluency, the Clock Drawing Test (CDT), and the MMSE, was administered to 32 patients presenting with emergent psychiatric conditions. Comprehensive neuropsychological evaluation served as the criterion standard for determining cognitive dysfunction. Diagnostic accuracy of the MMSE was determined using the traditional clinical cutoff and receiver operating characteristic (ROC) curve analyses. Diagnostic accuracy of individual BCS components and BCS Summary Scores was determined by ROC analyses. Results:, At the traditional clinical cutoff, MMSE sensitivity (46.4%) and total diagnostic accuracy (53.1%) were inadequate. Under ROC analyses, the diagnostic accuracy of the full BCS Summary Score (area under the curve [AUC] = 0.857) was comparable to the MMSE (AUC = 0.828). However, a reduced BCS Summary Score consisting of OTMT Part B (OTMT,B), animal fluency, and the CDT yielded classification accuracy (AUC = 0.946) that was superior to the MMSE. Conclusions:, Preliminary findings suggest the BCS is an effective, convenient alternative cognitive screening instrument for use in emergent psychiatric populations. ACADEMIC EMERGENCY MEDICINE 2010; 17:307,315 © 2010 by the Society for Academic Emergency Medicine [source]

    Diagnostic Accuracy of Emergency Doppler Echocardiography for Identification of Acute Left Ventricular Heart Failure in Patients with Acute Dyspnea: Comparison with Boston Criteria and N-terminal Prohormone Brain Natriuretic Peptide

    ACADEMIC EMERGENCY MEDICINE, Issue 1 2010
    Peiman Nazerian MD
    Abstract Objectives:, Echocardiography is a fundamental tool in the diagnosis of acute left ventricular heart failure (aLVHF). However, a consultative exam is not routinely available in every emergency department (ED). The authors investigated the diagnostic performance of emergency Doppler echocardiography (EDecho) performed by emergency physicians (EPs) for the diagnosis of aLVHF in patients with acute dyspnea. Methods:, A convenience sample of acute dyspneic patients was evaluated. For each patient, the Boston criteria score for heart failure was calculated, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) and EDecho were contemporaneously performed. Four investigators, after a limited echocardiography course, performed EDechos and evaluated for a "restrictive" pattern on pulsed Doppler analysis of mitral inflow and reduced left ventricular (LV) ejection fraction. The final diagnosis, established after reviewing all patient clinical data except NT-proBNP and EDecho results, served as the criterion standard. Results:, Among 145 patients, 64 (44%) were diagnosed with aLVHF. The median time needed to perform EDecho was 4 minutes. Pulsed Doppler analysis was feasible in 125 patients (84%). The restrictive pattern was more sensitive (82%) and specific (90%) than reduced LV ejection fraction and more specific than the Boston criteria and NT-proBNP for the diagnosis of aLVHF. Considering noninterpretable values of the restrictive pattern and uncertain values ("gray areas") of Boston criteria (4 < Boston criteria score < 7) and of NT-proBNP (300 < NT-proBNP < 2,200 pg/mL) as false results, the accuracy of the restrictive pattern in the overall population was 75%, compared with accuracy of 49% for both NT-proBNP and Boston criteria. Conclusions:, EDecho, particularly pulsed Doppler analysis of mitral inflow, is a rapid and accurate diagnostic tool in the evaluation of patients with acute dyspnea. ACADEMIC EMERGENCY MEDICINE 2010; 17:18,26 © 2010 by the Society for Academic Emergency Medicine [source]

    Diagnostic Accuracy of the Gail Model in the Black Women's Health Study

    THE BREAST JOURNAL, Issue 4 2007
    Lisa C. Richardson MD
    No abstract is available for this article. [source]

    Diagnostic Accuracy of the Gail Model in the Black Women's Health Study

    THE BREAST JOURNAL, Issue 4 2007
    Lucile L. Adams-Campbell PhD
    Abstract:, The Gail model is used to predict the risk of breast cancer in women of diverse race/ethnic groups for clinical trial protocols. However, this model has only been validated in US white women. Using a nested case-control study design, we evaluated the diagnostic accuracy of the original Gail model (GM) and that of the revised Gail model algorithm for blacks/African-Americans (GM-B) in the Black Women's Health Study (BWHS). Risk profiles were derived via a self reported questionnaire at the time of enrollment into the BWHS in 1995. Biennial questionnaires were obtained from the participants to determine the incident cases of breast cancer. The study of 725 breast cancer cases and 725 controls revealed that the 5-year risk of breast cancer based on the GM ranged from 0.2% to 15.4% among cases and 0.2% to 13.6% among the controls. Based on the GM-B, the 5-year risk of breast cancer ranged from 0.2% to 8.7% among cases and 0.2% to 7.2% among the controls. The sensitivities of the GM and GM-B model with the standard cutoff of 1.7% were 17.9% (95% CI: 15.9,19.9%) and 4.1% (95% CI: 3.0,5.2), respectively. Both the original and the modified version of the Gail model underestimate the risk of developing breast cancer in African-American women. More importantly, the modified Gail Model (GM-B) does a worse job at predicting the development of breast cancer for blacks than the original model (GM). [source]

    Direct Comparison of the Diagnostic Accuracy of Fifty Protein Biological Markers of Pulmonary Embolism for Use in the Emergency Department

    ACADEMIC EMERGENCY MEDICINE, Issue 9 2008
    Kristen E. Nordenholz MD
    Abstract Objectives:, Pulmonary embolism (PE) is associated with abnormal concentrations of many proteins involved in inflammation, hemostasis, and vascular injury. The authors quantified the diagnostic accuracy of a battery of protein biological markers for the detection of PE in emergency department (ED) patients. Methods:, A random and a consecutive sample of ED patients evaluated for PE were prospectively enrolled at two academic EDs between August 2005 and April 2006. A plasma sample was obtained at enrollment, and all patients were followed by telephone and medical record review at 90 days for the development of venous thromboembolism (VTE) defined as PE or deep venous thrombosis (DVT), requiring the consensus of two of three blinded physician reviewers. Measurements of potential biological markers were performed by technicians blinded to the study objectives. The diagnostic accuracy of each biological marker was determined by the area under the receiver operating characteristic (ROC) curve. Results:, Fifty potential biological markers were measured in 304 ED patients, including 22 patients (7%, 95% confidence interval [CI] = 4% to 10%) with VTE. Fourteen biological markers demonstrated an area under the curve (AUC) with the lower limit of the 95% CI , 0.5. Of these, three demonstrated an AUC , 0.7: D-dimer (0.90), C-reactive protein (CRP; 0.78), and myeloperoxidase (MPO; 0.78). Conclusions:, From 50 candidate biological markers, only D-dimer, CRP, and MPO demonstrated sufficient diagnostic accuracy to suggest potential utility as biological marker of PE. [source]

    Diagnostic accuracy of cytology and immunocytology in carcinomatous effusions

    CYTOPATHOLOGY, Issue 4 2008
    G. Metzgeroth
    Background:, Immunocytology substantially improves the diagnostic accuracy of conventional cytology in the diagnosis of carcinomatous effusions. Due to the unequivocal characterization of the various cell populations, a sensitivity of 92% and specificity of 100% was achieved by immunocytology, examining samples of 1234 serous effusions. Objective:, Cytology plays a central role in the aetiological clarification of serous effusions. The sensitivity of this method for the diagnosis of carcinomatous effusions varies between 40% and 80%. The aim of the present study was to investigate whether immunocytology substantially improves the diagnostic quality of the cytological examination in the diagnosis of carcinomatous effusions. Method:, Consecutive serous effusions were examined by conventional cytology and by immunocytology. The immunocytological examination was performed on smears, using a standard panel of three antibodies against pancytokeratin, human epithelial antigen 125 and calretinin. Results:, Altogether, 1234 effusion samples were examined. A total of 603 effusions were caused by carcinomas, five by malignant mesotheliomas, 11 by malignant lymphomas and 615 by non-malignant disorders. In conventional cytology, carcinomatous effusions were correctly diagnosed in 314 samples, corresponding to a sensitivity of 52%. In 31 specimens (5%) tumour cells without further specification were described and in 161 samples (27%) the presence of tumour cells was suspected (84% overall sensitivity). A total of 97 carcinomatous effusions (16%) were diagnosed false-negatively and 50 (8%) of the 615 non-malignant effusions false-positively (92% specificity). In immunocytology, 561 carcinomatous samples were correctly diagnosed, representing a sensitivity of 93%. In six cases (1%) the presence of tumour cells was suspected. A total of 36 carcinomatous effusions (6%) were diagnosed false-negatively (94% over-all sensitivity). Out of the 615 non-malignant specimens, there were no false-positive diagnoses (100% specificity). Conclusion:, Immunocytology is a simple, cost-effective, routinely practicable method which substantially improves the diagnostic accuracy of conventional cytology in the diagnosis of carcinomatous effusions. Therefore, we recommend the use of immunocytology in all those cases where cytology on its own is not completely unequivocal. [source]

    The diagnostic value of on-site cytopathological evaluation and cell block preparation in fine-needle aspiration cytology of liver masses

    CYTOPATHOLOGY, Issue 5 2006
    K. Ceyhan
    Objective:, The aims of this study were to evaluate the typing accuracy of conventional smear (CS), cell block (CB) preparations and combined use of both procedures (CS + CB) for the diagnosis of hepatic malignancies and to determine whether immediate on-site cytopathological evaluation improves the diagnostic yield of liver fine-needle aspiration cytology (FNAC). Methods:, Ultrasound-guided FNABs were performed on 323 consecutive cases with liver masses between December 2002 and December 2004. Histologically and/or clinically correlated 167 cases were included in the study. Preliminary FNAB results, results of CS, CB, and combined use of CS and CB were compared regarding diagnostic sensitivity, specificity, and accuracy for the diagnosis of malignancy. Subtyping accuracies of different methods were also compared. Results:, The sensitivity of on-site cytopathological examination and CS were both 92.8%. The sensitivity of CS + CB was slightly better than that of CB (93.5% versus 84.8%). Specificity of all procedures was achieved 100%. Diagnostic accuracy of on-site cytopathological evaluation, CS, CB, and CS + CB were 93.9%, 93.9%, 87.2%, and 94.5%, respectively. A specific subtype diagnosis of malignant tumours could be rendered accurately on the basis of preliminary diagnosis in 71%, CS in 75.4%, CB in 78.3% and combined approach in 92% of cases. In terms of typing accuracy, 87.5% of HCCs, 93.2% of adenocarcinomas, 92.3% of neuroendocrine carcinomas, 100% of lymphomas and 100% of other malignant tumours were correctly subclassified in the final cytopathological diagnosis. The agreement between preliminary diagnosis and final cytopathological diagnosis was 77.2%. Conclusion:, With use of on-site cytopathological evaluation and combined use of CS and CB, the diagnostic accuracy of liver tumours approaches 100% and also significantly improve diagnostic and subtyping accuracy of liver malignancies. [source]

    Three-dimensional endoscopic ultrasonography for the assessment of early gastric carcinoma invasion: could it provide diagnostic innovations?

    DIGESTIVE ENDOSCOPY, Issue 2 2002
    EMAN A. SABET
    Background: This study aimed to evaluate a three-dimensional endoscopic ultrasonographic (3-D EUS) system in the assessment of the tumor invasion depth of early gastric carcinoma. Methods: Sixty-nine macroscopically early cancer lesions in 67 patients were recruited in an in vivo study. The surgically resected gastric specimens of 30 of them were re-examined in an ex vivo study. An Olympus 3-D EUS imaging system was employed in both studies. Diagnostic accuracy for tumor invasion depth was evaluated and compared with histopathological sections stained by H&E and Masson's trichrome stain. Reconstructed surface-rendering images were evaluated and compared with the endoscopic and macroscopic findings. Results: Three-dimensional EUS allowed rapid tomographic assessment of the lesions in both the in vivo and ex vivo studies. The accuracy of 3-D EUS for the assessment of tumor invasion depth was 87% in the in vivo study. The accuracy rate was significantly lower (P = 0.03) for the cancer lesions associated with ulcer fibrosis (74%) than for those with no fibrosis (97%). In the 30 subjects who underwent both studies, the accuracy rates were higher in the ex vivo than the in vivo study (94%vs 77% for all the lesions, and 93%vs 74% for cancers associated with fibrosis), but were not statistically significant. The rates of good surface-rendering images were 64% and 94% in the in vivo and ex vivo studies, respectively. The differences were attributed to the clearer dual-plane reconstruction images obtained in the ex vivo study in absence of motion artifacts. Conclusions: Three-dimensional EUS is a promising imaging technique for the assessment of tumor invasion depth of early gastric cancer. [source]

    Diagnostic accuracy of digital photography and image analysis for the measurement of foot conformation in the horse

    EQUINE VETERINARY JOURNAL, Issue 7 2008
    J. M. WHITE
    Summary Reasons for performing study: Rigorous evaluation of practicable methods for the objective assessment of foot conformation has not been performed. Objectives: To assess the practicability, precision and accuracy of the process of obtaining measurements of horses' feet using photography and image processing software. Methods: Precision study: Lateral photographs of horses' feet were obtained twice by 2 veterinary surgeons (image acquisition - IAc). Photographs were analysed by 2 masked veterinary surgeons on 2 occasions (image analysis - IAn). Measurements were compared within and between operators for self and non-self acquired photographs. Agreement indices (AIs) and 95% limits of agreement (LOA) were calculated for the IAn process alone and for the combined IAc + IAn processes. Accuracy study: Measurements obtained from lateral photographs were compared with those obtained from lateromedial radiographs. AIs and 95% LOA were calculated for each measurement. Results: Precision study: Mean intra- and interoperator AIs for the IAn process alone were ,0.90 while those for the combined IAc + IAn processes were ,0.89 for all measurements. Similar mean AIs and 95% LOA were calculated regardless of image origin. The 95% LOA for hoof angle, heel height/toe height% and coronary band angle for all comparisons were within target values. Accuracy study: Mean AIs were ,0.89 for all measurements. The 95% LOA for heel height/toe height% and coronary band angle were within target values. Conclusions: Excellent precision was identified within and between operators regardless of image origin. High levels of accuracy were also identified, especially for heel height/toe height% and coronary band angle, indicating that photography and radiography may be used interchangeably. Potential relevance: Acquisition and analysis of photographic images is an appropriate method for the objective measurement of foot conformation, both in clinical and research settings. [source]

    Diagnostic accuracy of digitized periapical radiographs validated against micro-computed tomography scanning in evaluating orthodontically induced apical root resorption

    EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 5 2008
    Alexander Dudic
    The aim of this study was to validate the use of digitized periapical radiographs in evaluating orthodontically induced apical root resorption against micro-computed tomography (micro-CT) scanning as a criterion standard test. In a standardized experimental protocol, 29 premolars in 16 subjects were tipped buccally for 8 wk. Nineteen contralateral premolars not subjected to orthodontic movement served as controls. Standardized periapical radiographs were taken before and after the experimental period (Rx method). These teeth were extracted and scanned using a micro-CT technique with a 9 ,m resolution. Two calibrated examiners assessed blindly the presence or absence of apical root resorption on digitized radiographs and three-dimensional reconstructions of the scans. Significant differences were detected between the orthodontically moved teeth and controls: 86% of the orthodontically moved teeth and 21% of the control teeth showed apical root resorption when using micro-CT as a validation method. A total of 55% of the experimental teeth and 5% of the control teeth showed resorption when assessed using Rx method. The Rx method showed a specificity of 78% and a sensitivity of 44%, which means that less than half of the cases with root resorption identified using a CT scanner were identified by radiography. Nearly all the orthodontically moved teeth showed apical root resorption. Apical root resorption may be underestimated when evaluated using digitized periapical radiographs. [source]

    MR colonography without bowel purgation for the assessment of inflammatory bowel diseases: Diagnostic accuracy and patient acceptance

    INFLAMMATORY BOWEL DISEASES, Issue 8 2007
    Jost Langhorst MD
    Abstract Background: The purpose of this pilot study was to assess the diagnostic accuracy of MR colonography (MRC) without bowel cleansing regarding its ability to quantify inflammatory bowel disease (IBD). In addition, patient acceptance was compared with conventional colonoscopy (CC). Methods: In all, 29 patients with IBD (17 ulcerative colitis; 12 Crohn's disease) were included. While CC was performed after bowel cleansing as the gold standard, MRC was based on a fecal tagging technique and performed 48,72 hours prior to CC. The presence of inflammation in each of 7 ileocolonic segments was rated for every procedure. Patients evaluated both modalities and dedicated aspects of the examination according to a 10-point-scale (1 = good, 10 = poor acceptance). Furthermore, preferences for future examinations were investigated. Results: Inflammatory segments were found by means of CC in 23 and by MRC in 14 patients. Overall sensitivity and specificity of MRC in a segment-based detection were 32% and 88%, respectively. Concerning severely inflamed segments, sensitivity increased to 53% for MRC. Overall acceptance of CC was significantly higher compared to MRC (mean value (mv) for MRT = 6.0; CC = 4.1; P = 0.003). For MRC, the placement of the rectal tube (mv = 7.3), and for CC bowel purgation (mv = 6.5), were rated as the most unpleasant. A total of 67% of patients voted for CC as the favorable tool for future examinations. Conclusions: The presented data indicate that ,fecal tagging MRC' is not suitable for an adequate quantification of inflammatory diseases of the large bowel. Furthermore, overall acceptance of endoscopic colonoscopy was superior to MRC. (Inflamm Bowel Dis 2007) [source]

    Diagnostic Accuracy of a New Instrument for Detecting Cognitive Dysfunction in an Emergent Psychiatric Population: The Brief Cognitive Screen

    ACADEMIC EMERGENCY MEDICINE, Issue 3 2010
    Steven P. Cercy PhD
    Abstract Objectives:, In certain clinical contexts, the sensitivity of the Mini-Mental State Examination (MMSE) is limited. The authors developed a new cognitive screening instrument, the Brief Cognitive Screen (BCS), with the aim of improving diagnostic accuracy for cognitive dysfunction in the psychiatric emergency department (ED) in a quick and convenient format. Methods:, The BCS, consisting of the Oral Trail Making Test (OTMT), animal fluency, the Clock Drawing Test (CDT), and the MMSE, was administered to 32 patients presenting with emergent psychiatric conditions. Comprehensive neuropsychological evaluation served as the criterion standard for determining cognitive dysfunction. Diagnostic accuracy of the MMSE was determined using the traditional clinical cutoff and receiver operating characteristic (ROC) curve analyses. Diagnostic accuracy of individual BCS components and BCS Summary Scores was determined by ROC analyses. Results:, At the traditional clinical cutoff, MMSE sensitivity (46.4%) and total diagnostic accuracy (53.1%) were inadequate. Under ROC analyses, the diagnostic accuracy of the full BCS Summary Score (area under the curve [AUC] = 0.857) was comparable to the MMSE (AUC = 0.828). However, a reduced BCS Summary Score consisting of OTMT Part B (OTMT,B), animal fluency, and the CDT yielded classification accuracy (AUC = 0.946) that was superior to the MMSE. Conclusions:, Preliminary findings suggest the BCS is an effective, convenient alternative cognitive screening instrument for use in emergent psychiatric populations. ACADEMIC EMERGENCY MEDICINE 2010; 17:307,315 © 2010 by the Society for Academic Emergency Medicine [source]

    Comparison of MY09/11 consensus PCR and type-specific PCRs in the detection of oncogenic HPV types

    JOURNAL OF CELLULAR AND MOLECULAR MEDICINE, Issue 4 2007
    C. E. Depuydt
    Abstract The causal relationship between persistent infection with high-risk HPV and cervical cancer has resulted in the development of HPV DNA detection systems. The widely used MY09/11 consensus PCR targets a 450bp conserved sequence in the HPV L1 gene, and can therefore amplify a broad spectrum of HPV types. However, limitations of these consensus primers are evident, particularly in regard to the variability in detection sensitivity among different HPV types. This study compared MY09/11 PCR with type-specific PCRs in the detection of oncogenic HPV types. The study population comprised 15, 774 patients. Consensus PCR failed to detect 522 (10.9%) HPV infections indicated by type-specific PCRs. A significant correlation between failure of consensus PCR and HPV type was found. HPV types 51, 68 and 45 were missed most frequently. The clinical relevance of the HPV infections missed by MY09/11 PCR was reflected in the fraction of cases with cytological abnormalities and in follow-up, showing 104 (25.4%) CIN2+ cases. The MY09/11 false negativity could be the result of poor sensitivity, mismatch of MY09/11 primers or disruption of L1 target by HPV integration or DNA degradation. Furthermore, MY09/11 PCR lacked specificity for oncogenic HPVs. Diagnostic accuracy of the PCR systems, in terms of sensitivity (MY09/11 PCR: 87.9%; type-specific PCRs: 98.3%) and specificity (MY09/11 PCR: 38.7%; type-specific PCRs: 76.14%), and predictive values for histologically confirmed CIN2+, suggest that type-specific PCRs could be used in a clinical setting as a reliable screening tool. [source]

    Small bowel hydro-MR imaging for optimized ileocecal distension in Crohn's disease: Should an additional rectal enema filling be performed?

    JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 1 2005
    Waleed Ajaj MD
    Abstract Purpose To assess the impact of an additional rectal enema filling in small bowel hydro-MRI in patients with Crohn's disease. Materials and Methods A total of 40 patients with known Crohn's disease were analyzed retrospectively: 20 patients only ingested an oral contrast agent (group A), the other 20 subjects obtained an additional rectal water enema (group B). For small bowel distension, a solution containing 0.2% locust bean gum (LBG) and 2.5% mannitol was used. In all patients, a breathhold contrast-enhanced T1w three-dimensional volumetric interpolated breathhold examination (VIBE) sequence was acquired. Comparative analysis was based on image quality and bowel distension as well as signal-to-noise ratio (SNR) measurements. MR findings were compared with those of conventional colonoscopy, as available (N = 25). Results The terminal ileum and rectum showed a significantly higher distension following the rectal administration of water. Furthermore, fewer artifacts were seen within group B. This resulted in a higher reader confidence for the diagnosis of bowel disease, not only in the colon, but also in the ileocecal region. Diagnostic accuracy in diagnosing inflammation of the terminal ileum was 100% in group B; in the nonenema group there were three false-negative diagnoses of terminal ileitis. Conclusion Our data show that the additional administration of a rectal enema is useful in small bowel MRI for the visualization of the terminal ileum. The additional time needed for the enema administration was minimal, and small and large bowel pathologies could be diagnosed with high accuracy. Thus, we suggest that a rectal enema in small bowel MR imaging be considered. J. Magn. Reson. Imaging 2005;22:92,100. © 2005 Wiley-Liss, Inc. [source]

    Diagnostic accuracy of shoulder ultrasound performed by a single operator

    JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2007
    DM Cullen
    Summary Both diagnostic ultrasound and magnetic resonance imaging (MRI) are used for investigation of the presence and severity of rotator cuff lesions. There is no consensus as to which is the more accurate and cost-effective study. We sought to examine the sensitivity of ultrasound, when used by one experienced radiologist with modern equipment. We compared the ultrasound and surgical results obtained from 68 patients. Ultrasound showed a sensitivity of 89% and specificity of 100% (Positive Predictive Value 100%) for full-thickness tears, and a sensitivity of 79% and specificity of 94% (Positive Predictive Value 87%) for partial-thickness tears. We found that shoulder ultrasound, in the hands of an experienced radiologist with the use of modern high-resolution equipment, is highly sensitive in differentiating complete tears and partial-thickness tears. Our results are similar to the best published results for MRI and given that ultrasound is significantly cheaper and more available, ultrasound by an experienced radiologist should be considered as a primary diagnostic tool for imaging the rotator cuff. [source]

    Diagnostic accuracy of bedside ultrasonography in the ICU: feasibility of detecting pulmonary effusion and lung contusion in patients on respiratory support after severe blunt thoracic trauma

    ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2008
    M. ROCCO
    Background: Blunt thoracic trauma is a major concern in critically ill patients. Repeated lung diagnostic evaluations are needed in order to follow up the clinical situation and the results of the therapeutic strategies. The aim of this prospective clinical study was to evaluate the possible role of lung ultrasound (LU) compared with bedside radiography (CXR) and computed tomography (CT) used as the gold standard in the evaluation of trauma patients admitted to the intensive care unit with acute respiratory failure. Method: A total of 15 thoracic trauma patients were studied at intensive care unit (ICU) arrival (T1) and 48 h later (T2) with CT, CXR and LU. We evaluated the presence of pleural effusion (PE) and lung contusion (LC). For this purpose the lung parenchyma was divided into 12 regions so that we could compare 180 lung regions at T1 and T2, respectively. Results: Sensitivity of ultrasound was 0.94 for PE and 0.86 for LC while specificity 0.99 and 0.97, respectively. The likelihood ratio was 94 (,+) and 0.06 (,,) for PE and 28.6 (,+) and 0.14 (,,) for LC. Conclusions: Ultrasound provides a reliable noninvasive, bedside method for the assessment of chest trauma patients with acute respiratory failure in the ICU. [source]

    Diagnostic accuracy of positive contrast computed tomography arthrography for the detection of injuries to the medial meniscus in dogs with naturally occurring cranial cruciate ligament insufficiency

    JOURNAL OF SMALL ANIMAL PRACTICE, Issue 7 2009
    M. S. Tivers
    Objective: To assess the usefulness of computed tomography arthrography of the stifle in diagnosing meniscal tears in dogs with cranial cruciate ligament insufficiency. Methods: A prospective clinical study was performed. Dogs were included if they had evidence of cranial cruciate ligament insufficiency or persistent or recurrent lameness following surgery for cranial cruciate ligament insufficiency. Dogs were sedated for a computed tomography scan of the affected stifle, orientated in the dorsal plane. A survey computed tomography scan was followed by a computed tomography arthrogram. A stifle arthrotomy was performed, and the surgical findings were recorded. The computed tomography scans were reviewed by three blinded reviewers, and the results were compared to the surgical findings. Results: Twenty-one computed tomography arthrograms from 20 dogs were included. At surgery, damage to the medial meniscus was identified in 14 stifles. Initial interpretation of computed tomography arthrography images was 57 to 64 per cent sensitive and 71 to 100 per cent specific for diagnosing medial meniscal injuries. Interpretation of the images on retrospective analysis was 71 per cent sensitive and 100 per cent specific, with an accuracy of 0·857. Clinical Significance: The accuracy of stifle computed tomography arthrography for the diagnosis of tears to the medial meniscus was found to be good. It is a minimally invasive and repeatable technique, which does not require general anaesthesia or specialist training to obtain the images. The ability to reliably diagnose meniscal injury without the need for surgery may be advantageous, particularly in dogs which had previously had surgery for cranial cruciate ligament insufficiency. [source]

    Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review

    JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2 2007
    M. DI NISIO
    Summary.,Background: The reported diagnostic accuracy of the D-dimer test for exclusion of deep vein thrombosis (DVT) and pulmonary embolism (PE) varies. It is unknown to what extent this is due to differences in study design or patient groups, or to genuine differences between D-dimer assays. Methods: Studies evaluating the diagnostic accuracy of the D-dimer test in the diagnosis of venous thromboembolism were systematically searched for in the MEDLINE and EMBASE databases up to March 2005. Reference lists of all included studies and of reviews related to the topic of the present meta-analysis were manually searched for other additional potentially eligible studies. Two reviewers independently extracted study characteristics using standardized forms. Results: In total, 217 D-dimer test evaluations for DVT and 111 for PE were analyzed. Several study design characteristics were associated with systematic differences in diagnostic accuracy. After adjustment for these features, the sensitivities of the D-dimer enzyme-linked immunofluorescence assay (ELFA) (DVT 96%; PE 97%), microplate enzyme-linked immunosorbent assay (ELISA) (DVT 94%; PE 95%), and latex quantitative assay (DVT 93%; PE 95%) were superior to those of the whole-blood D-dimer assay (DVT 83%; PE 87%), latex semiquantitative assay (DVT 85%; PE 88%) and latex qualitative assay (DVT 69%; PE 75%). The latex qualitative and whole-blood D-dimer assays had the highest specificities (DVT 99%, 71%; PE 99%, 69%). Conclusions: Compared to other D-dimer assays, the ELFA, microplate ELISA and latex quantitative assays have higher sensitivity but lower specificity, resulting in a more confident exclusion of the disease at the expense of more additional imaging testing. These conclusions are based on the most up-to-date and extensive systematic review of the topic area, including 184 articles, with 328 D-dimer test evaluations. [source]

    Diagnostic accuracy of a fibrosis serum panel (FIBROSpect II) compared with Knodell and Ishak liver biopsy scores in chronic hepatitis C patients

    JOURNAL OF VIRAL HEPATITIS, Issue 10 2006
    C. Christensen
    Summary., Liver biopsy is the primary method of assessing liver injury in hepatitis C patients. FIBROSpect II (FS), a diagnostic panel of three extracellular matrix remodelling markers, may be useful as a noninvasive alternative to this procedure. The purpose of this study was to correlate FS results with liver fibrosis scores to determine if this test is sufficiently accurate to be a viable alternative to liver biopsy. A total of 142 serum specimens were evaluated for fibrosis with FS and were compared with Knodell and Ishak fibrosis scores. FS reports an index score ranging from 0.1 to 1.0, which corresponds to the probability of progressive liver fibrosis. Using a FS index cut-off of 0.42, 50 of 54 patients with Ishak 3,6 were classified as having advanced fibrosis (METAVIR F2,F4) and 58 of 88 patients with Ishak 0,2 as having no/mild fibrosis (METAVIR F0,F1), resulting in a sensitivity of 93%, specificity of 66%, and an overall test accuracy of 76%. With a 38% prevalence of advanced fibrosis, the negative predictive value was 94% and positive predictive value was 63%. A biopsy length of ,2 cm was associated with higher concordance between FS results and liver fibrosis scores (P = 0.01). FS was clinically useful in ruling out advanced fibrosis in hepatitis C by identifying patients with mild disease in whom treatment could be deferred. The limitation of this test is its decreased sensitivity and specificity in the middle of the test's reporting range between scores of 0.42 and 0.80. [source]

    Diagnostic accuracy of verbal autopsies in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana

    PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2008
    Karen M. Edmond
    Summary This study evaluated the diagnostic accuracy of a verbal autopsy (VA) tool in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana and was nested within a community-based maternal vitamin A supplementation trial (ObaapaVitA trial). All stillbirths and neonatal deaths between 1 January 2003 and 30 June 2004 were prospectively included. Community VAs were carried out within 6 months of death and were classified with a primary cause of death by three experienced paediatricans. The reference standard diagnosis was obtained by the study paediatrician in 4 district hospitals in the study area. There were 20 317 deliveries, 661 stillbirths and 590 neonatal deaths with a VA diagnosis in the study population. A total of 311 stillbirths and 191 neonatal deaths had both a VA and a hospital reference standard diagnosis. The VA performed poorly for stillbirth diagnoses such as congenital abnormalities and maternal haemorrhage. Accuracy was higher for intrapartum obstetric complications and antepartum maternal disease. For neonatal deaths, sensitivity was >60% for all major causes; specificity was 76% for birth asphyxia but >85% for prematurity and infection. Overall, VA diagnostic accuracy was higher than expected in this rural African setting. Our classification system was based on the expected public health importance of the individual causes of death, differing implications for intervention and the ability to distinguish between the individual causes in low-resource settings. We believe this system was easier to use than traditional approaches and resulted in high precision and accuracy. However, further simplifications are needed to allow use of the World Health Organisation VA in routine child health programmes. The diagnostic accuracy of the VA tool should also be assessed in other regions and in multicentre studies. [source]

    Accuracy of clinical diagnosis of skin lesions

    BRITISH JOURNAL OF DERMATOLOGY, Issue 3 2008
    C.F. Heal
    Summary Background, Skin cancer is an increasing problem in fair-skinned populations worldwide. It is important that doctors are able to diagnose skin lesions accurately. Objectives, To compare the clinical with the histological diagnosis of excised skin lesions from a set of epidemiological data. We analysed diagnostic accuracy stratified by histological subtype and body site and examined the histological nature of misclassified diagnosis. Methods, All excised and histologically confirmed skin cancers in Townsville/Thuringowa, Australia from December 1996 to October 1999 were recorded. Positive predictive values (PPVs) and sensitivities were calculated for the clinical diagnoses and stratified by histological subtype and body site. Results, Skin excisions in 8694 patients were examined. PPVs for the clinical diagnoses were: basal cell carcinoma (BCC) 72·7%; squamous cell carcinoma (SCC) 49·4%; cutaneous melanoma (CM) 33·3%. Sensitivities for the clinical diagnosis were: BCC 63·9%; SCC 41·1%; CM 33·8%. For BCC, PPVs and sensitivities were higher for the trunk, the shoulders and the face and lower for the extremities. The reverse pattern was seen for SCCs. Conclusions, Diagnostic accuracy was highest for BCC, the most prevalent lesion. Most excisions were correctly diagnosed or resulted in the removal of malignant lesions. With nonmelanocytic lesions, doctors tended to misclassify benign lesions as malignant, but were less likely to do the reverse. Although a small number of clinically diagnosed common naevi subsequently proved to be melanoma (6·3%), a higher proportion of all melanomas had been classified as common naevi (20·9%). Accuracy of diagnosis was dependent on body site. [source]

    Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting

    BRITISH JOURNAL OF DERMATOLOGY, Issue 3 2008
    M.E. Vestergaard
    Summary Background, Dermoscopy is a noninvasive technique that enables the clinician to perform direct microscopic examination of diagnostic features, not seen by the naked eye, in pigmented skin lesions. Diagnostic accuracy of dermoscopy has previously been assessed in meta-analyses including studies performed in experimental and clinical settings. Objectives, To assess the diagnostic accuracy of dermoscopy for the diagnosis of melanoma compared with naked eye examination by performing a meta-analysis exclusively on studies performed in a clinical setting. Methods, We searched for publications from 1987 to January 2008 and found nine eligible studies. The selected studies compare diagnostic accuracy of dermoscopy with naked eye examination using a valid reference test on consecutive patients with a defined clinical presentation, performed in a clinical setting. Hierarchical summary receiver operator curve analysis was used to estimate the relative diagnostic accuracy for clinical examination with, and without, the use of dermoscopy. Results, We found the relative diagnostic odds ratio for melanoma, for dermoscopy compared with naked eye examination, to be 15·6 [95% confidence interval (CI) 2·9,83·7, P = 0·016]; removal of two outlier studies changed this to 9·0 (95% CI 1·5,54·6, P = 0·03). Conclusions, Dermoscopy is more accurate than naked eye examination for the diagnosis of cutaneous melanoma in suspicious skin lesions when performed in the clinical setting. [source]

    4353: Comparison of diagnostic accuracy of Fourier-domain optical coherence tomography and scanning laser polarimetery to detect glaucoma

    ACTA OPHTHALMOLOGICA, Issue 2010
    G HOLLO
    Purpose To compare diagnostic accuracy of retinal nerve fiber layer thickness (RNFLT) measurements made using RTVue-100 Fourier-domain optical coherence tomography (RTVue-OCT) and scanning laser polarimetry with variable (GDx-VCC) or enhanced compensation (GDx-ECC). Methods One eye of each of 177 consecutive patients was imaged. Healthy (n=50) and ocular hypertensive (n=28) eyes were defined as normal, preperimetric (n=33) perimetric (n=66) glaucoma eyes as diseased. Results For average RNFLT sensitivity was higher (Chi-square test, p=0.002) with RTVue-OCT (65.7 %) than with GDx-VCC (49.5 %). For superior and inferior RNFLT sensitivity was similar with all methods. For the different nerve fiber bundle parameters, sensitivity of RTVue-OCT (64.6 to 84.8 %) was consistently, up to 35 % higher (p<0.001) than that of GDx-VCC/ECC (28.3 to 72.7 %). Specificity ranged 84.6 to 98.7 % with RTVue-OCT, 92.3 to 100 % with GDx-VCC, and 94.9 to 100 % with GDx-ECC, with no significant difference between the methods except for one nerve fiber bundle parameter, for which RTVue-OCT was less specific than either GDx method (p,0.004). Diagnostic accuracy of the GDx-VCC/ECC nerve fiber indicator (NFI) and RTVue-OCT average RNFLT were similar. Of the detected glaucoma cases 87.7 % was identified both by GDx-VCC/ECC NFI and average RNFLT of RTVue-OCT. Conclusion In this clinical setting, all methods were similarly highly specific, but for localized RNFLT damage RTVue-OCT was statistically and clinically significantly more sensitive than GDx-VCC and GDx-ECC. Most detected glaucoma cases were identified with all three methods. Commercial interest [source]

    Diagnostic accuracy of Heidelberg Retina Tomograph III classifications in a Turkish primary open-angle glaucoma population

    ACTA OPHTHALMOLOGICA, Issue 1 2010
    Banu Bozkurt
    Abstract. Purpose:, This study aimed to evaluate the diagnostic accuracy of Moorfields regression analysis (MRA) and the glaucoma probability score (GPS) in primary open-angle glaucoma (POAG) and to measure the level of agreement between the two algorithms in classifying eyes as normal or abnormal in a Turkish population. Methods:, We prospectively selected 184 healthy subjects and 158 subjects with POAG, who underwent an ophthalmological examination, visual field analysis and imaging with the Heidelberg Retina Tomograph II, using HRT III software, Version 3.0. The diagnostic accuracies of the two classifications were measured when the borderline was taken as either normal (highest specificity criteria) or abnormal (highest sensitivity criteria). The agreement between them was calculated using the unweighted kappa (,) coefficient. Results:, Optic nerve head topographic parameters showed statistically significant differences between the control and POAG groups (p < 0.001). The parameters with the highest area under the receiver operating characteristic curves were global GPS (0.86), cup : disc area (0.85), rim : disc area (0.85) and vertical cup : disc (0.85). According to the highest specificity criteria, MRA had a sensitivity of 67.7% and a specificity of 95.1%, whereas the GPS had a sensitivity of 70.9% and a specificity of 88.0%. According to the highest sensitivity criteria, MRA had a sensitivity of 81.0% and a specificity of 75.0%, whereas the GPS had a sensitivity of 89.2% and a specificity of 57.6%. A moderate agreement of 68% (233 eyes) with a , coefficient of 0.51 was found between MRA and the GPS. Conclusions:, The GPS automated classification showed similar sensitivity to MRA, but considerably lower specificity, when applied in a Turkish population. [source]

    Regional Diastolic and Systolic Function by Strain Rate Imaging for the Detection of Intramural Viability during Dobutamine Stress Echocardiography in a Porcine Model of Myocardial Infarction

    ECHOCARDIOGRAPHY, Issue 5 2010
    Carsten Schneider M.D.
    The aim of this study was to evaluate diastolic and systolic strain rate measurements for differentiation of transmural/nontransmural infarction during dobutamine stress echocardiography (DSE). An ameroid constrictor was placed around the circumflex artery in 23 pigs inducing chronic vessel occlusion. Five pigs without constrictor served as controls. During high-dose DSE systolic strain rates (SRsys), systolic and postsystolic strain values (,sys, ,ps) and early and late diastolic strain rates (SRE and SRA) were determined. At week 6, animals were evaluated regarding myocardial fibrosis. Histology revealed nontransmural in 14 and transmural infarction in 9 animals. In controls, dobutamine induced a linear increase of SRsys to 12.3 ± 0.4 s,1 at 40 ,g/kg per minute (P = 0.001) and a linear decrease of SRE to ,6.6 ± 0.3 s,1 (P = 0.001). In the nontransmural group, SRsys, ,sys, ,ps at rest, and during DSE were higher and SRE was lower than in the transmural infarction group (P = 0.01). Best predictors for viability were SRsys (ROC 0.96, P = 0.0003), SRE at 10 ,g/kg per minute dobutamine stimulation (ROC 0.94, P = 0.001) and positive SR values during isovolumetric relaxation at 40 ,g/kg per minute dobutamine (ROC 0.86, P = 0.004). The extension of fibrosis correlated with SRsys at rest, ,sys at rest, and SRE at rest (P < 0.001). For the detection of viability similar diagnostic accuracies of SRE and SRsys were seen (sensitivity 93%/93%, specificity 96%/94%, respectively). Diastolic SR analysis seems to be equipotent for the identification of viable myocardium in comparison to systolic SR parameters and allows the differentiation of nontransmural from transmural myocardial infarction with high diagnostic accuracy. (Echocardiography 2010;27:552-562) [source]