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At least 307 records · Page 17Linked to original sources
PubMedDate not supplied

Blunt bowel and mesenteric injury: diagnostic performance of CT signs.

PURPOSE: Our goal was to determine the sensitivity and specificity of various CT signs of blunt bowel and mesenteric injury. METHOD: The CT findings of 31 patients with blunt abdominal trauma were retrospectively assessed by three observers in consensus. All patients had laparotomy within 24 h of CT. The study group consisted of 19 patients with surgically proven bowel and/or mesenteric injury. The control group consisted of 12 traumatized patients who had no bowel or mesenteric injury. The CT signs assessed were presence, location, and extent of intraperitoneal fluid, extraluminal air, bowel wall thickening, bowel wall discontinuity, mesenteric streaking, and mesenteric hematoma. RESULTS: In the 12 cases of bowel injury (9 transmural injury, 3 partial thickness injury), the CT sign of bowel wall thickening had sensitivity of 50% and specificity of 84% and the CT sign of bowel wall discontinuity had sensitivity of 58% and specificity of 95%. Extraluminal air was a specific but relatively insensitive sign of transmural bowel injury (sensitivity 44%, specificity 100%). In the 13 patients with mesenteric injuries, the CT sign of mesenteric hematoma had sensitivity of 54% and specificity of 94%. Isolated mesenteric streaking was a less specific sign of mesenteric injury (sensitivity 77%, specificity 44%). The finding of peritoneal fluid with no visible solid organ injury was a useful sign of bowel or mesenteric injury, occurring in 11 of 19 (58%) study patients and none of the controls (p < 0.001). CONCLUSION: Bowel wall thickening, bowel wall discontinuity, extraluminal air, and mesenteric hematoma are reasonably specific CT signs of bowel and mesenteric injury following blunt abdominal trauma. The presence of a moderate to large volume of intraperitoneal fluid without visible solid organ injury is an important sign of bowel or mesenteric injury.

Abdominal Injuries↗
PubMedDate not supplied

Distinguishing hepatic metastases from hemangiomas: qualitative and quantitative diagnostic performance through dual echo respiratory-triggered fast spin echo magnetic resonance imaging.

OBJECTIVE: To determine the relative value of qualitative (reader opinion) and quantitative (values derived from dual echo T2 fast spin echo [FSE]) measures in distinguishing hepatic metastases from hemangiomas. METHODS: Forty-nine patients with hemangiomas and 23 with metastases were studied with dual echo respiratory-triggered FSE and dynamic 2-dimensional spoiled gradient echo (GRE) imaging. Lesion T2 was estimated from signal intensity ratios on the first and second echoes. Two experienced radiologists independently evaluated groups of images based on 5 separate qualitative measures: first echo FSE, second echo FSE, first and second echo FSE, dynamic GRE, and all images together. RESULTS: The mean calculated T2s were 226 +/- 74 milliseconds for hemangiomas and 105 +/- 22 milliseconds for metastases (P < 0.001). A T2 cutoff of 130 milliseconds distinguished metastases from hemangiomas with a sensitivity of 94%, specificity of 91%, and accuracy of nearly 94%. There was no significant difference between the best quantitative measure and the best qualitative measure for either reader. CONCLUSION: Liver lesion T2 relaxation times calculated from dual echo FSE images provide information useful in discriminating metastases from hemangiomas, as does reader opinion.

Adult↗
PubMed1994

Diagnostic performance of two-dimensional versus three-dimensional transesophageal echocardiographic images of selected pathologies evaluated by receiver operating characteristic analysis.

UNLABELLED: The sensitivity and specificity of 2-D and 3-D echocardiographic images for the detection of selected morphological abnormalities were compared using receiver operating characteristic (ROC) analysis. Five experienced clinical echocardiographers blinded to the patients' diagnoses evaluated the 20 original static 2-D image sets and 20 corresponding 3-D reconstructions using a five point categorical scale that ranged from definitely abnormal to definitely normal. The ROC curve for the 3-D images was significantly (P < 0.05) closer to the ideal discrimination function than was the ROC curve for the 2-D transesophageal images (i.e., the sensitivity of the 3-D images was higher than that of the 2-D sequential images at the same specificity). IN CONCLUSION: 3-D transesophageal images provided better visual clues for the identification of morphological abnormalities than did serial 2-D echocardiographic images despite the same input information in both image formats. The use of ROC analysis assisted in the comparison of these two imaging techniques.

Adolescent↗
PubMed2004

Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography.

PURPOSE: To compare multi-detector row spiral computed tomographic (CT) angiography with digital subtraction angiography (DSA) in evaluation of the infrarenal aorta and lower-extremity arterial system. MATERIALS AND METHODS: Fifty patients with peripheral arterial occlusive disease were evaluated with multi-detector row CT angiography and DSA. Arteries depicted at CT angiography and DSA were graded separately for degree of stenosis as 23 anatomic segments (infrarenal aorta, right and left common iliac artery, internal iliac artery, external iliac artery, common femoral artery, superficial femoral artery, deep femoral artery, popliteal artery, anterior tibial artery, tibioperoneal trunk, posterior tibial artery, and peroneal artery). Grades included the following: 1, normal patency; 2, moderate (< or =50%) stenosis; 3, focal severe (>50%) stenosis; 4, multiple severe stenoses; and 5, occlusion. Three readers independently interpreted the images, and statistical analysis was performed. The results of image interpretation were evaluated for strength of agreement by using Cohen kappa statistics. On the basis of consensus readings, sensitivity, specificity, and accuracy for detection of stenotic lesions were calculated, with findings at DSA used as the reference standard. RESULTS: Substantial to almost perfect interobserver agreement was achieved in all cases. At DSA, 349 diseased segments were found among the 1,137 segments evaluated. Sensitivity, specificity, and accuracy, based on a consensus reading of multi-detector row CT angiograms, were 96%, 93%, and 94%, respectively. A statistically significant difference (P <.05) between DSA and multi-detector row CT angiography was present only in arteries graded 1 or 2. Interobserver agreement was almost perfect among the three readers for treatment recommendations based on findings at CT angiography and DSA. CONCLUSION: Multi-detector row CT angiography appears consistent and accurate in the assessment of patients with peripheral arterial occlusive disease.

Adult↗
PubMed2005

Ventilation-perfusion scanning and helical CT in suspected pulmonary embolism: meta-analysis of diagnostic performance.

PURPOSE: To perform meta-analysis of literature about the role of helical computed tomography (CT) and ventilation-perfusion (V-P) scanning in detection of acute pulmonary embolism (PE) by using summary receiver operating characteristic (ROC) curve analysis. MATERIALS AND METHODS: V-P scanning articles published from January 1985 to March 2003 and helical CT articles published from January 1990 to March 2003 in MEDLINE and EMBASE databases were included if (a) tests were performed for evaluation of acute PE, (b) conventional angiography was the reference standard, and (c) absolute numbers of true-positive, false-negative, true-negative, and false-positive results were available. Sensitivity analysis was conducted by excluding articles published before 1995. RESULTS: A total of 12 articles discussing helical CT and/or V-P scanning were included. With a random-effects model, pooled sensitivity for helical CT was 86.0% (95% confidence interval [CI]: 80.2%, 92.1%), and specificity was 93.7% (95% CI: 91.1%, 96.3%). V-P scanning yielded low sensitivity of 39.0% (95% CI: 37.3%, 40.8%) but high specificity of 97.1% (95% CI: 96.0%, 98.3%) with high probability threshold. V-P scanning yielded high sensitivity of 98.3% (95% CI: 97.2%, 99.5%) and low specificity of 4.8% (95% CI: 4.7%, 4.9%) with normal threshold. Regression coefficients for helical CT angiography were 0.588 (95% CI: -1.55, 2.74) and 4.14 (95% CI: -0.002, 8.28) versus V-P scanning with high and normal thresholds, respectively. Regression coefficients for helical CT angiography were 0.588 (95% CI: -1.55, 2.74) and 4.14 (95% CI: -0.002, 8.28) versus V-P scanning with high and normal thresholds, respectively. CONCLUSION: Helical CT has greater discriminatory power than V-P scanning with normal and/or near-normal threshold to exclude PE, while helical CT and V-P scanning with high probability threshold had similar discriminatory power in the diagnosis of PE.

Humans↗
PubMed1992

Age-associated changes of the triangular fibrocartilage of the wrist: evaluation of the diagnostic performance of MR imaging.

To define the appearance of degenerative changes of the triangular fibrocartilage (TFC) of the wrist on magnetic resonance (MR) images, the TFCs in one wrist of each of 30 healthy subjects in three age groups (20-35, 36-50, and greater than 50 years) and six TFCs from fresh cadavers were examined by means of coronal T1-weighted spin-echo sequences. Histologic findings were compared with findings on MR images in the cadaveric TFCs. It was proved that patches or lines of signal hyperintensity within the cadaveric TFCs were caused by degenerative changes and tears. Similar changes of the TFCs on MR images of the healthy subjects may have been caused by degeneration. In the healthy subjects, degenerative changes of the TFC, usually well defined on MR images, occurred at a very early age. The TFC appears to undergo stages of degeneration comparable to those of the menisci of the knee, but differentiation between traumatic and degenerative tears may be difficult.

Adult↗
PubMed2005

Diagnostic performance of duplex ultrasound in patients suspected of carotid artery disease: the ipsilateral versus contralateral artery.

BACKGROUND AND PURPOSE: To evaluate duplex ultrasonographic thresholds for the determination of 70% to 99% stenosis of the ipsilateral and contralateral internal carotid artery in patients with symptoms of amaurosis fugax, transient ischemic attack (TIA), or minor stroke based on 2 criteria: maximizing accuracy and optimizing cost-effectiveness and to compare these with current recommendations. METHODS: From January 1997 to January 2000, a prospective multicenter study was conducted including 350 consecutive patients with symptoms of amaurosis fugax, TIA, or minor stroke who underwent bilateral duplex ultrasonography and digital subtraction angiography. A linear regression analysis was performed to estimate the degree of angiographic stenosis as a function of the peak systolic velocity (PSV). PSV thresholds were calculated for the ipsilateral and contralateral carotid arteries based on maximizing accuracy and optimizing cost-effectiveness. RESULTS: The PSV measurements significantly overestimated the angiographic stenosis in the contralateral artery (9.5%; 95% CI, 6.3% to 12.7%) compared with the ipsilateral carotid artery. The recommended PSV threshold for the diagnosis of 70% to 99% stenosis is 230 cm/s. Maximizing accuracy, the optimal PSV threshold for the ipsilateral artery was 280 cm/s, and for the contralateral artery, 370 cm/s for diagnosing a 70% to 99% stenosis. Optimizing cost-effectiveness, the optimal PSV threshold was 220 cm/s for ipsilateral and 290 cm/s for contralateral carotid arteries. CONCLUSIONS: PSV measurements overestimate the degree of angiographic stenosis in the contralateral carotid artery in patients with symptoms of amaurosis fugax, TIA, or minor stroke. Separate PSV thresholds should be used for the ipsilateral and contralateral carotid artery. PSV thresholds that optimize cost-effectiveness differ from the recommended thresholds and from thresholds that maximize accuracy.

Adult↗
PubMed2006

Association of left-heart dysfunction with severe exacerbation of chronic obstructive pulmonary disease: diagnostic performance of cardiac biomarkers.

RATIONALE: Cardiac biomarkers are used to distinguish acute dyspnea due to left-heart dysfunction from that of pulmonary origin. However, they have not been assessed in the specific setting of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), where they might be released without left-heart impairment. OBJECTIVE: To assess the accuracy of troponin T and of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in the diagnosis of AECOPD associated with left ventricular (LV) dysfunction. METHODS: Both biomarkers were measured in 148 consecutive patients on intensive care unit admission for AECOPD. A panel of physicians adjudicated blindly the cause of AECOPD to be unlikely, possibly associated, or definitely associated with LV dysfunction. MEASUREMENTS AND MAIN RESULTS: The final diagnosis was AECOPD definitely associated with acute left-heart dysfunction in 31.1%, possibly associated with LV dysfunction in 13.5%, and probably not associated with LV dysfunction in 55.4%. Both NT-proBNP and troponin T levels were significantly different among the three groups. The area under the receiver operating characteristic curve was greater for NT-proBNP (0.95 vs. 0.67). A cutoff of 1,000 pg/ml was accurate to rule out left-heart involvement in AECOPD (sensitivity, 94%; negative predictive value, 94%; negative likelihood ratio, 0.08). A cutoff of 2,500 pg/ml had the best operating characteristics to rule in the diagnosis (positive likelihood ratio, 5.16). Left-heart involvement in AECOPD was the only variable independently associated with increased secretion of NT-proBNP (odds ratio, 74; 95% confidence interval, 15-375; p = 0.0001). CONCLUSION: NT-proBNP and troponin T are useful in excluding AECOPD associated with left ventricular dysfunction. NT-proBNP was the more accurate of the two.

Aged↗