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Accuracy of structure-derived properties in simple comparative models of protein structures.

The accuracy of comparative models of proteins is addressed here. A set of 12,732 single-template models of sequences of known high-resolution structures was built by an automated procedure. Accuracy of several structure-derived properties, such as surface area, residue accessibility, presence of pockets, electrostatic potential and others, was determined as a function of template:target sequence identity by comparing models with their corresponding experimental structures. As expected, the average accuracy of structure-derived properties always increases with higher template:target sequence identity, but the exact shape of this relationship can differ from one property to another. A comparison of structure-derived properties measured from NMR and X-ray structures of the same protein shows that for most properties, the NMR/X-ray difference is of the same order as the error in models based on approximately 40% template:target sequence identity. The exact sequence identity at which properties reach that accuracy varies between 25 and 50%, depending on the property being analyzed. A general characteristic of simple comparative models is that their surface has increased area as a consequence of being more rugged than that of experimental structures. This suggests that including solvent effects during model building or refinement could significantly improve the accuracy of surface properties in comparative models.

Amino Acids↗

Retrieval accuracy, statistical significance and compositional similarity in protein sequence database searches.

Protein sequence database search programs may be evaluated both for their retrieval accuracy--the ability to separate meaningful from chance similarities--and for the accuracy of their statistical assessments of reported alignments. However, methods for improving statistical accuracy can degrade retrieval accuracy by discarding compositional evidence of sequence relatedness. This evidence may be preserved by combining essentially independent measures of alignment and compositional similarity into a unified measure of sequence similarity. A version of the BLAST protein database search program, modified to employ this new measure, outperforms the baseline program in both retrieval and statistical accuracy on ASTRAL, a SCOP-based test set.

Data Interpretation, Statistical↗

Role of visual context and oculomotor conditions in pointing accuracy.

Localizing a target in the extrapersonal space may rely on two types of spatial coordinate systems: egocentric or exocentric. Two experiments investigated the role of these systems in the accuracy of goal-directed movements. The accuracy of pointing movements performed without visual feedback of the hand was measured in two conditions of target presentation (darkness or within a visually structured background), and in two conditions of eye-hand coordination (eye fixed on a fixation point, or with a foveation saccade). The results showed (1) that pointing accuracy increased in the presence of a visual background, and (2) enhancement of this beneficial effect by a steady retinal image of target and background, that is without a foveation saccade. An object that has to be reached in the prehension space can be localized in two ways: (1) in relation to the body (egocentric), induced by the absence of a structured visual environment, (2) in relation to the external space (exocentric), favored by the presence of a visually structured background. We investigated the importance of the localizing mode in the accuracy of reaching movements, and how the two modes can be optimized. We found better reaching accuracy with exocentric than with egocentric localization, particularly when the retinal image of the goal and its environment was stabilized in the absence of eye movements.

Eye Movements↗

Accuracy of parent mental health service reporting: results from a reverse record-check study.

OBJECTIVE: To examine the feasibility of conducting a reverse record-check study to validate parent reporting on child mental health service use and to examine the accuracy of parent reports of child mental health services. METHOD: Information about child service use was abstracted from medical records and subsequently compared with reports provided by caregivers in telephone interviews. A sample of children using outpatient psychiatric services was compared with a sample of children using outpatient orthopaedic services. Rates and correlates of successful caregiver tracking and of service use reporting accuracy were explored. RESULTS: Caregivers of nearly 30% of all index children were contacted and interviewed. Parent reports of lifetime mental health service use were more accurate than reports of lifetime receipt of orthopaedic services. Elapsed time between survey interview and last treatment episode was negatively associated with reporting accuracy. Number of clinic visits was positively associated with reporting accuracy. Preliminary findings suggested that questions about mental health services may be considered sensitive by parents whose children use them. CONCLUSIONS: Reverse record-check studies based on telephone interviews are potentially problematic with a sample drawn from a large, inner-city medical center. Findings suggest that memory difficulties may be a more important correlate of reporting accuracy than response editing (social desirability). Potential discomfort with disclosure of mental health service use does not result in service use underreporting.

Adolescent↗

Diagnostic accuracy of staging renal cell carcinomas using multidetector-row computed tomography and magnetic resonance imaging: a prospective study with histopathologic correlation.

OBJECTIVE: The aim of this prospective study is to compare the diagnostic accuracy of multidetector-row computed tomography (CT) and magnetic resonance imaging (MRI) in tumor staging of renal cell carcinomas. METHODS: In a prospective study, 82 renal cell carcinomas were assessed for tumor staging before surgery using multidetector-row CT and MRI, the results of which were then correlated to histopathologic staging. Triphasic CT (noncontrast, arterial phase, and parenchymal phase) imaging was performed using multidetector-row CT with a reconstructed slice thickness of 2 mm. In MRI, a transverse T1-weighted gradient echo sequence with and without administration of Gd-DTPA, a transverse T2-weighted respiratory-gated turbo spin echo (TSE) sequence, and a coronal T1-weighted gradient echo sequence with Gd-DTPA were used. In addition, multiphasic 3-dimensional angiography after Gd-DTPA injection and a transverse T1-weighted fat-suppression sequence were performed. RESULTS: With MRI, readers 1 and 2 correctly staged 71 and 64 tumors (overall accuracy of 0.87 and 0.78, respectively) and achieved Mantel-Haenszel chi(2) values of 66 and 63 (P < 0.0001). Computed tomography allowed correct staging of 68 and 66 tumors (readers 1 and 2, overall accuracy of 0.83 and 0.80, respectively) with Mantel-Haenszel chi(2) values of 54 and 54 for CT staging (P < 0.0001). No statistically significant difference between overall accuracy was found in the chi(2) test (P > 0.15). CONCLUSION: Magnetic resonance imaging and multidetector-row CT with its multiplanar reconstruction capabilities achieve similar accuracy in tumor staging of renal cell carcinomas.

Adult↗

The presumed influence of attention on accuracy in the developmental eye movement (DEM) test.

BACKGROUND: The developmental eye movement (DEM) test is a clinical test used widely to evaluate ocular motility function (accuracy and speed) in school-age children. PURPOSE: The purpose of this study was to investigate, retrospectively, the change in accuracy over time while performing the DEM horizontal reading task in children. METHODS: The charts from children who had performed the DEM test during a routine eye examination in a pediatric optometry service were reviewed. The study included 22 patients (6 to 11 years old, 12 boys, 10 girls) who had a routine eye examination that was precepted by one of the authors (R.C.) during the period of 1995 to 1999. Patients were divided into two categories: 1) those with abnormal DEM test results and 2) a control group consisting of those with normal DEM test results. Chart review was done consecutively within each category. Collected data included patient age, gender, refractive error, and DEM test results. For analysis, the horizontal task of the DEM was divided into two halves (I and II), Part I always preceded part II, and data was sorted as the number of errors per part. RESULTS: More errors in accuracy occurred in part II than in part I (Wilcoxon signed rank test, p < or = 0.01) of the horizontal DEM test in the group of subjects with an abnormal DEM test. No differences in the number of errors in parts I and II of the horizontal task of the DEM were found in the control group. CONCLUSIONS: Findings showed that when excessive errors in accuracy occurred, the number of errors increased over time. If the errors were caused by an oculomotor dysfunction found in the DEM, errors should be equally distributed throughout the text. If errors were caused by fatigue, a difference in parts I and II should have occurred in both the test and the control group. These findings suggest that attention may influence accuracy over time in those patients that do poorly on the DEM test.

Aging↗

Diagnostic accuracy of technologies used in low back pain assessment. Thermography, triaxial dynamometry, spinoscopy, and clinical examination.

STUDY DESIGN: A prospective blind study compared three new technologies to assess back pain. OBJECTIVE: To assess the diagnostic accuracy and comparability of thermography, triaxial dynamometry, and spinoscopy in the assessment of recent onset work-related low back pain. SUMMARY OF BACKGROUND DATA: The role of these technologies in assessing patients with low back pain is unproved. METHODS: Forty-one patients with low back pain and 46 control subjects were assessed by each technology and by two clinical examiners blind to clinical status. Twenty patients were trained to simulate a healthy back without low back pain, and 50% of the control subjects were trained to simulate the presence of a low back pain disorder. Each technology was interpreted on two occasions by each of two readers. RESULTS: Thermography performed significantly worse than did triaxial dynamometry, spinoscopy, and clinical examination. The diagnostic accuracy of the last three was similar, and inter-rater comparability did not differ significantly. Among simulators, the diagnostic accuracy of triaxial dynamometry and spinoscopy was significantly higher than that of clinical examination, although considerable inaccuracy remained in assessing individual subjects. CONCLUSIONS: The diagnostic accuracy of thermography in recent onset low back pain does not support its use. Among those simulating normality or low back pain, triaxial dynamometry and spinoscopy have greater diagnostic accuracy than does a single clinical evaluation. However, for an individual, the inaccuracy that remains limits the use of triaxial dynamometry or spinoscopy for diagnosis in recent onset low back pain.

Adult↗

Improved accuracy of pedicle screw insertion with computer-assisted surgery. A prospective clinical trial of 30 patients.

STUDY DESIGN: A prospective clinical trial was done to study the accuracy of pedicle screw placement in 30 consecutive computer-assisted orthopedic surgeries. OBJECTIVES: To determine the accuracy and clinical applicability of this new method for pedicle screw insertion. SUMMARY OF BACKGROUND DATA: Conventional screw insertion techniques have been associated with high pedicle screw malplacement rates in cadaver studies and clinical studies with postoperative computed tomography evaluation. METHODS: Thirty transpedicular, low-back, titanium instrumentations were performed with computer-assisted orthopedic surgery. The accuracy of screw placement was evaluated using a sophisticated computed tomography protocol. RESULTS: The total number of pedicle screws was 174. Of these, 139 (79.9%) could be inserted with computer-assisted orthopedic surgery. The malplacement rate of computer-assisted orthopedic surgery screws was 4.3%. In screws that were not inserted by computer-assisted orthopedic surgery, the malplacement rate was 14.3%. One malplaced screw that had not been inserted with computer-assisted orthopedic surgery caused L4 root paresis. CONCLUSIONS: The accuracy of pedicle screw placement using computer-assisted surgery proved to be superior to the accuracy obtained when using conventional techniques.

Bone Screws↗

Accuracy of thoracic pedicle screws in patients with and without coronal plane spinal deformities.

STUDY DESIGN: This retrospective observational study evaluated 399 transpedicular thoracic screws using postoperative computed tomography (CT). OBJECTIVES: To examine the in vivo accuracy of transpedicular thoracic screws in patients with and without coronal plane spinal deformities. SUMMARY OF BACKGROUND DATA: There are no comparative studies regarding the safety and accuracy of thoracic pedicle screws in patients with and without coronal plane spinal deformities. METHODS: Curve magnitude and segmental vertebral rotation were determined from preoperative radiographs. Postoperative CT was used to assess the placement accuracy of titanium thoracic pedicle screws. RESULTS: Forty-seven patients underwent instrumented posterior spinal fusion using 399 titanium thoracic pedicle screws. Fully contained screw accuracy in patients with coronal plane spinal deformities was less than in patients without coronal plane spinal deformities at T9-T12 (59% vs. 73%, P = 0.04) and overall (42% vs. 62%, P = 0.001). There was no difference between the overall percentages of acceptably positioned screws (< or = 2 mm of medial or < or = 6 mm of lateral pedicle perforation) in patients with coronal plane spinal deformities (98%) versus patients without coronal plane spinal deformities (99%) (P = 0.69). Penetration of the anterior vertebral cortex was more frequent in patients with coronal plane spinal deformities than in those without coronal plane spinal deformities (8.0% vs. 1.0%, P = 0.008). There was no correlation between the accuracy of screw placement and the degree of segmental rotation, screw proximity to the curve apex, or screw position relative to the curve concavity or convexity (P > 0.12). There were no neurologic or vascular complications. CONCLUSIONS: The overall percentage of acceptably positioned screws was 98% in patients with coronal plane spinal deformities and 99% in patients without coronal plane spinal deformities. In patients with coronal plane spinal deformities, penetration of the pedicle wall and the anterior vertebral cortex was increased at T9-T12 and overall.

Adolescent↗

In-vivo accuracy of geometrically correct three-dimensional reconstruction of human coronary arteries: is it influenced by certain parameters?

OBJECTIVE: The geometrically correct three-dimensional reconstruction of human coronary arteries by integrating intravascular ultrasound (IVUS) and biplane angiography constitutes a promising imaging method for coronaries with broad clinical potential. The determinants of the accuracy of the method, however, have not been investigated before. METHODS: In total, 17 arterial segments (right coronary artery, n=7; left anterior descending, n=4; left circumflex, n=6) derived from nine patients were three-dimensionally reconstructed by applying three-dimensional intravascular ultrasound. The degree of matching between the reconstructed lumen back-projected onto each angiographic plane and the actual lumen in each plane was used as a measure of method's accuracy. The investigated factors that could potentially affect the reliability of the method included the type of the artery (left anterior descending, left circumflex, right coronary artery) and several geometrical and morphological characteristics of the reconstructed arteries. RESULTS: The correlation between the back-projected reconstructed lumens and the actual angiographic ones was found to be high (r=0.78, P<0.001). Neither the category of the reconstructed arteries nor their particular geometrical and morphological characteristics influenced the accuracy of the reconstruction method significantly. Nonetheless, the method exhibited slightly less accuracy in the reconstruction of right coronary arteries, an observation that could be attributed to the more intense pulsatile motion that this artery experiences during the cardiac cycle compared to the left anterior descending and left circumflex artery. CONCLUSIONS: The in-vivo accuracy of three-dimensional intravascular ultrasound (3D IVUS) is significantly high regardless of the type of the coronary arteries or their particular geometrical and morphological characteristics. This finding further supports the applicability of the method for either diagnostic or investigational purposes.

Algorithms↗

Determination of accuracies of 10 models of home blood pressure monitors using an oscillometric simulator.

BACKGROUND: Patients and doctors often use home blood pressure monitoring (HBPM) to assess the control of hypertension. Despite its popularity there has always been some uncertainty with regard to its accuracy, reliability, reproducibility, and comparability. Although there are pre-market HBPM standards of accuracy, there are no standards to assure accuracy of individual HBPM units after they have been brought home. OBJECTIVE: Determination of reliability, reproducibility, and comparability of 10 models of home blood pressure monitors. METHODS: We used a Biotek BP Pump as an oscillometric simulator of systolic and diastolic blood pressures to determine reliability, reproducibility, and comparability of 10 devices. RESULTS: All of the units tested, except the Pollonex BP1000, produced reproducible readings with the pooled SD of four blood pressure settings less than 3.10 mmHg both for systolic and for diastolic measurements. The oscillometric blood pressure pump method was found to be very reproducible, with pooled differences of less than 2 mmHg and SD of less than 0.5 mmHg for a repeated series of measurements using the same monitor. Different machines of the same model were also very comparable, with pooled differences of less than 3.6 mmHg and pooled SD less than 0.7 mmHg both for systolic and for diastolic readings. There were 11-14 mmHg differences between models for all of the simulated blood pressure readings except that a 27 mmHg difference was measured at the 200 mmHg systolic blood pressure level. These differences will not necessarily be the same for measurements with humans instead of oscillometric signal generation. A system for grading the accuracy of the tested HBPM that defines accuracy of HBPM as within +/-2 SD of the average of 85 measurements is described. CONCLUSION: All models of home blood pressure monitors tested, with the exceptions of the Pollonex BP1000, produced reproducible readings and different machines of the same model were comparable.

Blood Pressure Monitors↗

Quality of reporting of orthopaedic diagnostic accuracy studies is suboptimal.

Complete and accurate reporting of diagnostic research are essential to assess the validity of its results. To improve the quality of reporting of diagnostic accuracy studies, the Standards for Reporting of Diagnostic Accuracy (STARD) steering committee has developed a checklist of 25 items. We asked whether the quality of reporting of diagnostic accuracy studies published in three major orthopaedic journals (Clinical Orthopaedics and Related Research, Journal of Bone and Joint Surgery British Volume, and Journal of Bone and Joint Surgery American Volume) would be similar across levels of study, journals, and years of publication, and would be similar to other subspecialty journals. We identified 37 articles from 2002-2004 diagnostic accuracy studies and applied the STARD checklist and scoring system. The scores ranged from 6.6 to 21.4 with a mean of 15 +/- 3.3. Only 38% of the articles (14 of 37) reported more than 2/3 of the items, and the majority failed to report nine specific items. The mean STARD scores were similar between the studies with different levels of evidence, across the three journals, and across the three years of publication. They were similar to scores for other subspecialty journals. The current standards of reporting of diagnostic accuracy studies in orthopaedic journals are suboptimal.

Diagnostic Techniques and Procedures↗

Three-dimensional rotational X-ray navigation for needle guidance in percutaneous vertebroplasty: an accuracy study.

STUDY DESIGN: The position of a needle tip displayed on a navigation system after transpedicular introduction into a vertebral body is compared with the real position of the needle tip when using a direct navigation coupling between a three-dimensional rotational X-ray (3DRX) system and a navigation system. OBJECTIVES: To assess whether the needle tip position displayed by the navigation system corresponds to the real needle position and to quantitatively determine needle navigation accuracy in a clinically relevant setting. SUMMARY OF BACKGROUND DATA: Image-guided navigation has reportedly increased the accuracy and safety of pedicle screw insertion and decreased complication rates. In former studies, the result of image-guided navigation was mainly compared qualitatively with the result of conventional fluoroscopy-guided procedures. Previously, a direct navigation coupling between a 3DRX system and a standard navigation system was introduced that bypasses the need for explicit patient-to-image registration necessary for image-guided orthopedic surgery. In a phantom experiment, the reported accuracy of navigation with the coupling to a 3DRX system was approximately 1 mm. However, in a clinical setting, additional errors can be introduced. METHODS: Twenty-three needles were placed transpedicularly into vertebral bodies of embalmed human trunks using 3DRX-guided navigation. The navigated needle tip positions were compared with the real needle tip positions manually extracted from 3DRX volumes acquired after completion of the introduction. RESULTS: The average distance between the navigated needle tip and the real position of the needle tip extracted from a postprocedure 3DRX volume was 2.5 +/- 1.5 mm. CONCLUSIONS: Accuracy of 3DRX-guided navigation is 2.5 +/- 1.5 mm in a clinically relevant setting, which is less than the accuracy determined in phantom experiments.

Aged, 80 and over↗

Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries.

STUDY DESIGN: Randomized clinical trial (level I evidence). OBJECTIVE: To compare the accuracy of non-navigation and Iso-C based navigation in pedicle screw fixation in thoracic spine deformities. SUMMARY OF BACKGROUND DATA: Thoracic pedicle screw insertion for spinal deformity correction can be associated with increased pedicle breaches. Iso-C based navigation has been reported to improve the accuracy of pedicle screw placement, but its use in the presence of deformity has not been reported. METHODS: Twenty-seven patients with scoliosis and 6 patients with kyphosis had a total of 478 thoracic pedicle screws. The average Cobb angle was 58.4 degrees +/- 8 degrees (range 50 degrees -80 degrees), and the mean kyphotic angle was 54.6 degrees +/- 4 degrees (range 51 degrees -76 degrees). By random allocation, 17 patients had screw insertion under navigation (242 screws) and 16 under fluoroscopic control (236 screws). The 2 groups were compared for accuracy of screw placement, time for screw insertion, and the number of times the C-arm had to be brought into the field. Two independent blinded observers determined accuracy using postoperative computed tomography assessments. RESULTS: There were 54 (23%) pedicle breaches in the non-navigation group as compared to only 5 (2%) in the navigation group (P < 0.001). Thirty-eight screws (16%) in the non-navigation group had penetrated the anterior or lateral cortex compared to 2 screws (0.8%) in the navigation group. Average screw insertion time in the non-navigation group was 4.61 +/- 1.05 minutes (range 1.8-6.5) compared to 2.37 +/- 0.72 minutes (range 1.16-4.5) in navigation group (P < 0.01). The C-arm had to be moved into the operation field on an average of 1.5 +/- 0.25 times (range 1-3) per screw. With single screening data, an average of 11.4 pedicles (range 9-14) could be visualized without necessity to bring the C-arm into operating field again. CONCLUSIONS: Iso-C navigation increases accuracy, and reduces surgical time and radiation in thoracic deformity correction surgeries.

Adolescent↗

Assessment of the enhancement in predictive accuracy provided by systematic biopsy in predicting outcome for clinically localized prostate cancer.

PURPOSE: Current localized prostate cancer treatment outcome nomograms rely on prostate specific antigen (PSA), tumor stage and grade. We investigated whether the addition of prostate biopsy features may enhance the accuracy of a nomogram predicting recurrence after radical prostatectomy (RP). MATERIALS AND METHODS: Clinical data from 1,152 patients who underwent RP were used and included PSA, clinical stage, biopsy Gleason grade and systematic biopsy information that quantified the amount of cancer and high grade cancer. Predictive accuracy for freedom from recurrence after RP was assessed with and without tumor quantification in the biopsy by the area under the receiver operating characteristics curve (AUC). RESULTS: Percentage and number of cores with cancer, and percentage and number of cores with high grade cancer were predictors of outcome when added to models that included PSA, Gleason grade and clinical stage (all p <0.0001). Nomogram accuracy with 3 traditional variables (AUC 0.790) was minimally enhanced with the addition of percentage or number of positive cores (AUC 0.804 and 0.800, respectively), or percentage or number of cores with high grade cancer (AUC 0.802 and 0.800, respectively). Maximum predictive accuracy of 0.811 was achieved after supplementing the traditional 3-variable nomogram with various combinations of additional pathological predictors. CONCLUSIONS: The information provided by systematic biopsies substantially improves the ability to predict outcome following RP. However, some incremental predictive accuracy was achieved by adding systematic biopsy features.

Adult↗

Comparison of accuracy between the Partin tables of 1997 and 2001 to predict final pathological stage in clinically localized prostate cancer.

PURPOSE: We validated externally the predictive accuracy of the 2001 Partin tables and compared the 1997 and 2001 versions. MATERIALS AND METHODS: We used ROC derived AUC to test the predictive accuracy of organ confinement (OC), extraprostatic extension (ECE), seminal vesicle invasion (SVI) and lymph node involvement (LNI) of 1997 and 2001 Partin tables derived probabilities. These probabilities were defined by the pretreatment clinical stage, serum prostate specific antigen and biopsy Gleason grade of 2,139 patients treated with radical prostatectomy for clinically localized prostate cancer. RESULTS: OC, ECE, SVI and LNI were noted in 63.5%, 23.1%, 10.5% and 2.9% of cases, respectively. AUC of the 2001 tables was 0.787, 0.766, 0.775 and 0.790, for OC, ECE, SVI and LNI, respectively. These values were virtually the same as the respective 1997 Partin table AUC values, namely 0.784, 0.728, 0.791 and 0.799. CONCLUSIONS: This external validation of the 2001 Partin tables confirms good predictive accuracy of the updated tables. However, predictive accuracy in this external validation data set of 2,139 European men is virtually the same as that of the original 1997 tables. Therefore, a transition from the 1997 tables to the updated 2001 version does not appear warranted unless superior accuracy is demonstrated in other external cohorts.

Adult↗

Transition zone cancers undermine the predictive accuracy of Partin table stage predictions.

PURPOSE: The Partin tables represent the most widely used predictor of pathological stage in men with localized prostate cancer (PCa). The accuracy and performance of the tables have been tested across different populations. However, to our knowledge the potential limitations that may stem from differences between transition zone (TZ) and peripheral zone (PZ) prostate cancers has not been explored. We tested the predictive accuracy and performance of the Partin tables according to TZ vs PZ tumor predominance. MATERIALS AND METHODS: Preoperative serum prostate specific antigen, clinical stage and biopsy Gleason sum data on 1,990 patients treated with radical retropubic prostatectomy were used to define the 2001 Partin probabilities of organ confinement and seminal vesicle invasion (SVI). Data on 1,320 patients who underwent staging pelvic lymphadenectomy and radical retropubic prostatectomy were used to define the probabilities of lymph node invasion (LNI) and organ confined disease (OC). ROC area under the curve was used to assess the predictive accuracy of the 2001 Partin tables relative to observed extracapsular extension (ECE), SVI, LNI and OC. Performance characteristics for each prediction were explored graphically with local regression, nonparametric smoothing plots. Results were compared between 222 TZ cancers and 1,768 PZ cancers. RESULTS: The 1,990 radical retropubic prostatectomy specimens demonstrated ECE in 689 cases (34.6%) (TZ in 58 or 27.1% and PZ in 631 or 35.8%) and SVI in 224 (TZ in 13 or 6.1% and PZ in 211 or 11.9%). The 1,320 lymphadenectomy specimens demonstrated LNI in 56 cases (TZ in 2 or 0.9% and PZ in 54 or 4.6%). OC was found in 784 cases (59.4%) (TZ in 95 or 69.9% and PZ in 689 or 58.2%). Predictive accuracy was for ECE 76.4% (TZ 69.0% and PZ 77.2%), 78.0% for SVI (TZ 73.5% and PZ 78.3%), 78.6% for LNI (TZ 44.5% and PZ 79.9%) and 79.4% for OC (TZ 73.8% and PZ 80.0%). CONCLUSIONS: The biological tumor characteristics of TZ PCa differ from those of PZ PCa. These differences appear to undermine the accuracy of pathological stage predictions.

Humans↗

Increase of accuracy in intraoperative navigation through high-resolution flat-panel volume computed tomography: experimental comparison with multislice computed tomography-based navigation.

HYPOTHESIS: High-resolution imaging, as provided by flat-panel-based volume computed tomography (fpVCT), could increase navigation accuracy and could therefore improve image-guided procedures or make novel navigated surgery concepts possible. BACKGROUND: Intraoperative navigation is an accepted tool in head and neck surgery. However, its use is limited in the lateral cranial base because of its low surgical accuracy. Surgical accuracy is substantially influenced by the resolution of the underlying data set. The fpVCT offers a resolution of nearly two times higher than multislice computed tomography (MSCT). Target registration error (TRE), as a measurement for surgical navigation accuracy, should decrease when navigation is based on fpVCT data sets. METHODS: An acrylic glass phantom with 37 fiducial points was scanned in a current MSCT and in an experimental fpVCT. Both data sets were imported in an optical navigation system. Five fiducial points were used for registration, and seven points were used for measuring TRE. The distance between the indicated pointer tip and the corresponding fiducial point in data set was measured as TRE. Registration and TRE measurement were repeated five times for each computed tomographic data set. Average TREs were calculated, and results were compared using t-test. RESULTS: The average TRE using MSCT (0.82 mm [standard deviation, 0.35 mm]) was significantly higher than that using fpVCT (0.46 mm [standard deviation, 0.22 mm]) (p < 0.01). CONCLUSION: Submillimeter surgical navigation accuracy is possible using high-resolution fpVCT. This could be highly beneficial in cranial base surgery navigation.

Humans↗