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PubMed2006

Endoscopic ultrasonography versus other diagnostic modalities in the diagnosis of choledocholithiasis.

Until recently, endoscopic retrograde cholangiopancreatography (ERCP) has been considered the gold standard for the diagnosis of and therapy in patients with suspected choledocholithiasis. However, the non-negligible complication rate of diagnostic and therapeutic ERCP has led investigators to identify different noninvasive diagnostic modalities. Endoscopic ultrasonography has been proved to be of great sensitivity (up to 97%) in the diagnosis of even tiny stones that can be easily masked by contrast medium during ERCP, without any procedure-related complications and with a negative predictive value reaching 100%, meaning that it can accurately and safely identify patients with choledocholithiasis, thereby avoiding inappropriate instrumental exploration of the common bile duct.

Cholangiography↗
PubMed1987

Diagnostic modalities in gynecologic and obstetric emergencies.

Gynecologic emergencies are an integral part of the practice of an emergency physician. In fact, the occurrence of one of these, ectopic pregnancy, has increased dramatically in recent years. Fortunately, the diagnostic modalities available to emergency physicians, particularly serologic pregnancy testing and ultrasonography, have kept pace by undergoing tremendous technologic improvements that allow more rapid and accurate diagnosis of these potential life threats. Armed with the still valuable procedure of culdocentesis as well, the emergency physician has never been in a better position to cope with the distressed gynecological patient.

Douglas' Pouch↗
PubMed1993

Reliability and validity of diagnostic modalities for temporomandibular disorders.

Temporomandibular disorders (TMD) encompass a group of musculoskeletal conditions that involve the temporomandibular joint (TMJ) or joints, the masticatory musculature, or both. These conditions are typically characterized by pain in the pre-auricular area that is usually aggravated by chewing or other jaw function and is often accompanied, either singly or in combination, by limitation of jaw movement, joint sounds, palpable muscle tenderness, or joint soreness. As with most other musculoskeletal conditions, the diagnostic "gold standard" for TMD is based upon an evaluation of the patient's history and clinical examination, supplemented, when appropriate, by TM joint imaging. It is against this "gold standard" that the reliability and validity of diagnostic modalities must be compared. With regard to electronic devices, several reviews of the scientific literature have concluded that the diagnostic reliability, validity, sensitivity, and specificity of such devices in the diagnosis of TMD have not been established. In addition, although clinical examination of the dentition may provide useful diagnostic information for some conditions, specific occlusal relationships have poor sensitivity and specificity when related to the presence or absence of TMD. TMJ imaging, when indicated, is useful in the detection of pathology within the joint, provided that validated criteria are applied to an analysis of the image. However, the assessment of condylar position as a diagnostic criterion for TMD has very poor reliability and validity.

Diagnostic Imaging↗
PubMed2006

Evaluation of a new diagnostic modality for distal assessment of advanced, obstructing hypopharyngeal cancer.

INTRODUCTION: Pre-operative endoscopic assessment of the distal extension of hypopharyngeal cancer is essential for proper surgical extirpation. This assessment is frequently not feasible in advanced, obstructing tumours. AIMS: To study the role of a proposed new diagnostic technique: intra-operative open oesophagoscopy, in distal assessment of advanced hypopharyngeal cancer. MATERIALS AND METHODS: A clinicopathological study, including 35 consecutive patients with obstructing hypopharyngeal cancer. RESULTS: Intra-operative open oesophagoscopy revealed inferior submucosal tumour extension in 19 out of 22 cases proven histopathologically, with a sensitivity, specificity and accuracy of 86, 100 and 91 per cent, respectively. Oesophageal skip lesions were detected in two cases. Intra-operative open oesophagoscopy findings surpassed data obtained from pre-operative radiological investigations and influenced the extent of resection performed. Accordingly, 19 patients had a total laryngopharyngectomy for local disease control, while 16 patients needed an additional total oesophagectomy. Histopathologically negative inferior resection margins were obtained in all cases. CONCLUSIONS: Intra-operative open oesophagoscopy was found to be a reliable diagnostic modality for distal assessment of obstructing hypopharyngeal cancer in cases in which pre-operative distal endoscopic examination was not feasible.

Adult↗
PubMed1989

Fine needle aspiration cytology in the management of solitary thyroid nodules--a comparison with other diagnostic modalities in cost-effectiveness.

This paper assesses the cost effectiveness of fine needle aspiration cytology (FNAC) as a selection criteria for surgery in solitary thyroid nodules compared to scintigraphy and ultrasonography. 98 patients who had FNAC and histological confirmation, scintigraphy and/or ultrasonography were studied. The use of combined diagnostic discriminants of positive FNAC, clinical suspicion and age above 50 years detected all malignancies and would have resulted in fewer patients being subjected to surgery--51% (FNAC) vs 90% (Scans, U/S). This resulted in cost savings of $800 per patient seen. We conclude therefore that FNAC should be the diagnostic modality of choice and that the routine use of scintigraphy and ultrasonography is not justifiable.

Biopsy, Needle↗
PubMed2006

Electron-beam CT as a diagnostic modality in pediatric nephrology and renal transplant surgery.

Electron-beam computed tomography is an imaging technology with a variety of medical applications, primarily in cardiology due to its sub-second acquisition time enabling visualization of a beating heart. Recently, this technique has also been introduced into other fields because of lower radiation exposure compared to traditional computed tomography, as well as the strengths of post-procedural three-dimensional visualization. This report evaluates electron-beam computed tomography as a diagnostic modality in pediatric nephrology patients. Seven patients reflecting typical clinical scenarios in pediatric nephrology were reviewed with regard to the value of electron-beam computed tomography and its contribution to the diagnostic workup. Electron-beam computed tomography is noninvasive and allows three-dimensional post-processing, enabling highly accurate images while requiring less radiation and acquisition time. It is very useful for clinical questions that require a detailed description of vascular and renal anatomy.

Adolescent↗
PubMed2004

Position of positron emission tomography and other imaging diagnostic modalities in esophageal cancer.

Positron emission tomography (PET) using the positron emitting glucose analogue 18F-fluorodeoxyglucose (FDG) has emerged as a useful metabolism-based wholebody imaging tool for gastro-esophageal cancer diagnosis and follow up. Most large cancer centers worldwide are now equipped for PET (or even PET-CT). Therefore, there is a growing need for a clear definition of the relative position of PET within the currently available diagnostic modalities. Significant scientific data indicate that FDG-PET adds clinically useful information to the information obtained by standard means (mainly CT and endoscopic ultrasound) throughout the different phases of clinical patient management: 1) at initial diagnosis: PET detects more frequently distant lymph node involvement and organ metastases compared to conventional diagnostics, allowing a more accurate selection of the most appropriate treatment; 2) during chemotherapy: semi-quantitative FDG-PET allows early identification of non-responding patients. Indeed, the metabolic response as measured by serial FDG-PET can be used to predict the clinical and histopathological response. Moreover, the PET-response seems to be related to overall and disease free survival; 3) after a treatment: FDG-PET allows accurate assessment of the residual tumor load; 4) in the follow up: FDG-PET allows accurate detection and restaging of recurrent disease.

Esophageal Neoplasms↗
PubMed1994

Diagnostic modalities in the pregnant patient.

Pregnancy determination may be made within 3 to 4 weeks' gestational age using radioimmunoassay or two-site ELISA assay. Using serum progesterone concentrations, serial quantitative beta-hCG levels, culdocentesis, sonography, laparoscopy, and fetal heart rate determination, the clinician is able to determine fetal viability and implantation site often within 6 to 7 weeks' gestational age. Improved sensitivity in diagnostic modalities, as well as increased awareness of the often subtle clinical findings in ectopic pregnancy are probably both responsible for the decline in morbidity and mortality seen with ectopic pregnancy over the past 25 years. As the incidence has seen an even greater increase than this decline, however, ectopic pregnancy remains the leading cause of first-trimester maternal mortality in this country. With the use of imaging in pregnancy, the question of fetal safety must also arise. The modalities currently used in the first trimester of pregnancy appear to pose minimal risks to the developing fetus if used only when necessary, and then with caution.

Female↗
PubMedDate not supplied

Evaluation of single photon emission computerised tomography (SPECT) using Tc99m-tetrofosmin as a diagnostic modality for recurrent posterior fossa tumours.

BACKGROUND: Brain Single Photon Emission Computerised Tomography (SPECT) has been established as a potentially useful tool for the assessment of recurrent brain tumours. Though brain SPECT is exquisitely sensitive in detecting viable tumour tissue in the supratentorial region, its efficacy has not been evaluated till date in case of infratentorial posterior fossa tumours. AIM OF THE STUDY: To evaluate the diagnostic utility of brain SPECT in differentiating recurrence of tumour from post-radiation gliosis in the posterior fossa of the brain. SUBJECTS AND METHODS: Twenty-one patients with primary malignant posterior fossa brain tumour were evaluated by brain SPECT with Tc99m-Tetrofosmin as the tumour-seeking agent. Clinical behaviour of the tumour observed for a minimum period of one year after the SPECT study was taken as the gold standard. STATISTICAL ANALYSIS: The Chi-square test has been used to note the significance of the association between the clinical outcome and the SPECT finding. In addition, the sensitivity and specificity of brain SPECT were also calculated. RESULT: Brain SPECT in 4 patients revealed increased tracer concentration over the primary tumour bed, which was consistent with recurrent tumour. The clinical course was consistent with tumour recurrence in 13 of the 21 patients, which included 3 patients with positive SPECT study and 10 patients with negative SPECT study. Brain SPECT revealed recurrent tumour in 4 patients whereas clinical follow-up suggested recurrence in 13 patients. The clinical course was consistent with radiation necrosis in the remaining 8 patients. In 1 brain SPECT positive patient the clinical course was consistent with post-radiation gliosis. CONCLUSION: This study demonstrates that brain SPECT is not a sensitive diagnostic modality to differentiate recurrent tumour from post-radiation gliosis in the posterior fossa of the brain.

Adolescent↗
PubMed1994

Possibilities and limitations of radioimmunoscintigraphy and conventional diagnostic modalities in choroidal melanoma.

A prospective clinical study to assess the value of immunoscintigraphy with a monoclonal antibody (MoAb) against high molecular weight melanoma associated antigen (225.28S) was performed in 43 patients with choroidal melanoma; in six patients with a lesion suspected of being choroidal melanoma, and in seven patients with a benign lesion simulating a choroidal melanoma. The results of immunoscintigraphy in choroidal melanoma were compared with results of conventional diagnostic modalities like ultrasonography and fluorescein angiography. Planar scintigraphy showed a detection rate of 49% which is comparable with other studies. The detection with scintigraphy was correlated to the size of the choroidal melanoma. The use of single photon computed tomography did not increase the sensitivity of immunoscintigraphy. Ultrasonography yielded a correct diagnosis in 37 of 42 melanomas (88%). With fluorescein angiography a correct diagnosis was obtained in 11 of 30 melanomas (36.6%). The value of immunoscintigraphy with MoAb 225.28S in small choroidal melanomas is limited; its reliability increases in large tumours. Immunohistochemistry with MoAb 225.28S showed antigen expression in 95% of the stained tissue specimens of choroidal melanoma.

Adult↗
PubMed2002

Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes.

OBJECTIVE: To prospectively examine outcomes associated with an aggressive screening protocol for blunt cerebrovascular injury (BCVI), and to compare the accuracy of computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) versus conventional angiography with respect to BCVI diagnosis. SUMMARY BACKGROUND DATA: In the past 5 years, BCVI (carotid and vertebral arteries) has been recognized with increasing frequency. Initial studies described blunt carotid injuries and their associated morbidity, while more recent reports have established the devastating potential of blunt vertebral injuries. It has been suggested that early diagnosis and anticoagulation will improve outcomes and that less-invasive diagnostic techniques than conventional angiography are desirable for screening. However, there are neither established screening criteria nor studies comparing optimal diagnostic modalities. METHODS: The screened population included all patients with cervical spine fractures, LeFort II or III facial fractures, Horner's syndrome, skull base fractures involving the foramen lacerum, neck soft tissue injury, or neurological abnormalities unexplained by intracranial injuries. Patients underwent screening with four-vessel cerebral angiography. During the first half of the study, patients also underwent helical CTA. Selected patients during this same period underwent MRA. At the time of diagnosis, anticoagulant or antiplatelet therapy was instituted unless clinically contraindicated. Results of this screening protocol were compared to a previously published cohort with cerebrovascular injuries (1995-1999) from the authors' institution. RESULTS: Two hundred sixteen patients were screened over a 2-year period (3.5% of all blunt trauma admissions). Angiography identified 24 patients with carotid artery injuries (CAI) and 43 patients with vertebral artery injuries (VAI) for an overall screening yield of 29%. While the incidence of CAI remained similar between the current study and the previous study group, the incidence of VAI diagnosis increased. Stroke rates in those with CAI were also similar between the two periods. The stroke rate in VAI, however, was markedly lower at 0% as compared to 14% in the previous group. Comparison of CTA and MRA with cerebral angiography in 143 patients demonstrated sensitivities of 47% and 50%, respectively, for CAI; sensitivities were 53% (CTA) and 47% (MRA) for VAI. CONCLUSIONS: Aggressive screening of patients with blunt head and neck trauma identified an incidence of BCVI in 1.03% of blunt admissions. Early identification, which led to early treatment, significantly reduced stroke rates in patients with VAI, but provided no outcome improvement with CAI. More encompassing screening may be required to improve outcomes for patients with CAI. However, less-invasive diagnostic techniques (CTA and MRA) are inadequate for screening. Technological advances are necessary before abandonment of conventional angiography, which remains the standard for diagnosis.

Adult↗
PubMed1990

Labetalol and MRI as initial medical and diagnostic modalities in a marfanoid patient with expanding ascending aortic aneurysm.

Marfan syndrome is a hereditable disorder of connective tissue that causes several distinct cardiovascular abnormalities, including aortic regurgitation, dissection, and aneurysm. These cardiac manifestations can be identified with echocardiography, computer tomography, and angiography. Standard treatment of an acute hypertensive crisis in Marfan syndrome uses propranolol and sodium nitroprusside. This patient with Marfan syndrome whose case is reported herein presented with chest pain, hypertensive crisis, and aortic insufficiency; labetalol was used successfully to treat the acute hypertensive crisis and magnetic resonance imaging (MRI) was used to differentiate between aortic dissection and an expanding aortic aneurysm. This report is unique in that labetalol was used to control the hypertensive crisis in Marfan syndrome and MRI was used as the initial diagnostic modality in an emergency setting.

Acute Disease↗
PubMed2002

Prenatal diagnosis of thanatophoric dysplasia in the second trimester: ultrasonography and other diagnostic modalities.

Thanatophoric dysplasia is the most common type of neonatal lethal osteochondrodysplasias, with an estimated frequency of nearly of 1 in 20,000 births. It is a disorder characterized by extremely short ribs, tubular bones and macrocephaly. The prenatal diagnosis of thanatophoric dysplasia has been well established by ultrasonography in the second trimester; however it is not always possible to differentiate the thanatophoric dysplasia fetuses from the others with skeletal dysplasias like fibrochondrogenesis or atelosteogenesis by ultrasonography. Recently, mutations in the fibroblast growth factor receptor 3 gene, located on the short arm of chromosome 4 have been identified as a cause of thanatophoric dysplasia. In this article we described the prenatal diagnosis of two fetuses with thanatophoric dysplasia at 18 and 24 weeks of gestation by ultrasonography. Postpartum radiological and histological analysis confirmed our prenatal diagnosis. Our purpose was to remind the differential prenatal diagnosis with other skeletal dysplasias and new prenatal diagnostic modalities.

Adolescent↗
PubMedDate not supplied

Acute myelomonocytic leukemia with abnormal eosinophils: a case report with multi-modality diagnostic work-up.

Acute myeloid leukemia (AML) with recurrent genetic abnormalities often carries a favorable prognosis. AML with inv(16)(p13q22) occurs predominantly in younger patients and usually shows granulocytic and monocytic differentiation with abnormal eosinophils. It is referred to as acute myelomonocytic leukemia with abnormal eosinophils (AMML Eo). We report a case in a 27-year-old man with leukocytosis (10.6 x 10(3)/microL with 34% blasts), thrombocytopenia and splenomegaly. Marrow aspiration showed 47% blasts and 33% eosinophils, of which 19% were morphologically abnormal with both eosinophilic and basophilic cytoplasmic granules. Cytochemically, the blasts were positive for myeloperoxidase while the granules of abnormal eosinophils were positive for naphthol ASD chloroacetate esterase. With flow cytometric immunophenotyping the blasts expressed CD13, CD33, CD117, myeloperoxidase and CD34. Marrow trephine showed 90% cellularity with 40% blasts expressing CD34, CD117, and myeloperoxidase on immunohistochemistry. Chromosomal analysis reveled a karyotype of 46, XY, inv(16)(p13q22). This case illustrates a typical AMML Eo confirmed by a multi-modality diagnostic approach including morphology, cytochemistry, flow cytometry, immunohistochemistry, and conventional cytogenetic study.

Adult↗
PubMed1994

Influence of the diagnostic modality on the pathological stage of clinically localized prostatic cancer.

The pathological stage at surgery is one of the most reliable prognostic indicators in patients with prostate cancer. We examined the influence of the modality of diagnosis and the prostatic-specific antigen (PSA) level on the rate of organ-confined cancer, positive surgical margins and lymph node metastasis in 345 patients treated by radical surgery. The mean PSA and Gleason score were significantly lower in patients detected by screening (n=144) compared to patients detected by routine examination (n=102) or because of urological symptoms (n=89) while the mean age was similar in the three groups (62.5 years). The rate of lymph node metastasis was correlated with the PSA level and ranged from 0% in patients with a normal PSA level (< 4 mg/L) up to 33% in patients with a PSA above 20 mg/L, screened patients had a significantly lower rate of lymph node metastasis. Thus the diagnostic modality may be an important prognostic factor to consider in clinical staging.

Journal Article↗
PubMed1997

Assessment of testicular cytology by fine-needle aspiration and the imprint technique: are they reliable diagnostic modalities?

OBJECTIVE: To investigate whether testicular cytology may be considered diagnostic in the evaluation of infertile men. PATIENTS AND METHODS: Specimens of testicular tissue obtained either surgically (imprint smear) or through fine-needle aspiration (FNA) were used as a source of cytological smears; 58 testes from 24 men with azoospermia or severe oligospermia and from five men with advanced prostate cancer were evaluated cytologically and compared with the histological diagnosis. RESULTS: FNA caused no apparent trauma. The results from FNA smears generally agreed with the histological findings but four patients with no spermatozoa in the FNA smears were diagnosed histologically as hypospermatogenic and two others judged histologically as having Sertoli-cell-only (SCO) syndrome and spermatogenic arrest had detectable spermatozoa in their FNA smears. There was complete agreement between the results of imprint smears and histological findings in those patients with SCO syndrome and spermatogenic arrest. There were no evident differences in sperm counts between hypospermatogenesis and normal spermatogenesis on the imprint slides, but FNA smears detected this difference. CONCLUSION: FNA of the testis is a relatively non-invasive and reproducible technique for evaluating qualitative and quantitative cytology. However, it is insufficient for diagnosing some testicular pathologies. Imprint smears supplement the histological diagnosis, especially if the histological slides are stained unsatisfactorily.

Adult↗
PubMed2006

Positron emission tomography: a promising diagnostic modality for head and neck pathology.

PURPOSE: The purpose of this study is to discuss the advantages of positron emission tomography (PET) imaging in the diagnosis of head and neck lesions. METHODS: To illustrate this diagnostic method, we describe the nuclear medicine basic technique, present 5 cases for comparison of the results between computed tomography (CT) scan and PET, and review the literature. RESULTS: The 5 cases show that PET allows assessment of lesions earlier and more definitively than other diagnostic images. CONCLUSIONS: PET, a nuclear medicine modality, is a promising tool for diagnosis and follow-up of head and neck lesions. PET allows assessment of changes in the tissue before they would be shown by other diagnostic images. This modality permits differentiation between malignant and benign tumors. It also has the capability to distinguish between scar tissue, necrosis, tumor recurrence, and metastatic disease. It allows the assessment of the patient's progress during therapy, making possible an early identification of nonresponders to therapy.

Carcinoma, Squamous Cell↗