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Mediastinal tumors: sensitivity of detection with sonography compared with CT and radiography.

The purpose of this prospective study was to evaluate the sensitivity of mediastinal sonography compared with computed tomography (CT) and chest radiography in the detection of mediastinal tumors. The sonograms, CT scans, and chest radiographs of 182 patients were interpreted blindly by three observers, and the results were compared. The proportion of diagnostic sonographic examinations varied for the different mediastinal compartments from 85% (subcarinal region) to 96% (supraaortic region). The sensitivities of sonography and chest radiography, respectively, for each compartment, with CT as the reference method, were as follows: supraaortic region, 98% and 67%; paratracheal region, 89% and 69%; aorticopulmonary window, 81% and 62%; prevascular region, 92% and 46%; subcarinal region, 69% and 31%; pericardial region, 100% and 67%; posterior mediastinum, 6% and 6%; and paravertebral region, 11% and 44%. These results show that sonography is superior to chest radiography in the diagnosis of mediastinal tumors. In certain mediastinal regions (supraaortic, pericardial, prevascular, and paratracheal), sonography is so sensitive that CT and magnetic resonance examinations may be obviated in patients with equivocal radiographic findings.

Adolescent↗

Hill-Sachs lesion: comparison of detection with MR imaging, radiography, and arthroscopy.

Magnetic resonance (MR) imaging has proved to be a valuable method for documenting Hill-Sachs lesions. The authors retrospectively analyzed the diagnostic interpretations at plain film radiography, arthroscopy, and MR imaging in 76 patients. The analysis revealed that neither radiography nor arthroscopy displayed the lesion with sufficient accuracy to represent a true standard of reference for the evaluation of MR imaging in the diagnosis of the Hill-Sachs lesion. The data from the diagnostic interpretations were analyzed in three ways, each of which revealed that findings at MR imaging were more helpful than findings at radiography and/or arthroscopy in the diagnosis of the Hill-Sachs lesion. When the agreement of findings in two or three methods was used to assign a final diagnosis, MR imaging resulted in sensitivity of 97%, specificity of 91%, and accuracy of 94% in the detection of Hill-Sachs lesions.

Adolescent↗

Intestinal Behçet disease: serial changes at radiography.

To clarify the characteristic radiographic findings and serial radiographic changes in nonsurgical cases of intestinal Behçet disease (BD), seven patients were followed up for an average of 4 1/2 years (range, 8 months to 11 years 4 months). They underwent repeated examination with barium meal studies and double-contrast barium enema meal studies and double-contrast barium enema radiography. Initial radiography revealed one to three deep ulcers in the terminal ileum or ileocecal region in five patients. The ulcers healed while patients were treated with medical therapy but recurred during the follow-up period. In four of these five patients, follow-up radiography demonstrated various changes within each case: At each examination, an enlarged ulcer or a newly developed ulcer was often found in conjunction with a healed ulcer. In the other two patients, multiple shallow ulcers or innumerable aphthoid ulcers were seen throughout the entire colon, and these ulcers showed a good response to medical treatment. These results indicate that serial radiographic changes in patients with intestinal BD may mimic those in patients with Crohn disease, with findings in the terminal ileum and colon that wax and wane with medical treatment.

Adult↗

Occult breast calcifications sampled with large-core biopsy: confirmation with radiography of the specimen.

In a series of nine stereotaxic large-core biopsies of calcifications, radiography of the specimen was used to ensure that appropriate tissue was removed. In eight cases, calcifications were evident at radiography as well as at histologic evaluation. Four cases were malignant and four were benign, and in one case in which calcification was not evident at either radiographic or histologic evaluation, a benign process was confirmed at surgical excision. Radiography of the specimen is a key component in diagnosis of breast calcifications sampled with large-core technique.

Biopsy↗

Scanning slit chest radiography: a practical and efficient scatter control design.

PURPOSE: To design a chest radiography unit that eliminates scatter. MATERIALS AND METHODS: A scanning slit radiography unit that also incorporates a conventional grid was designed. The scanning slit geometry defined a 10-mm-wide beam at the image receptor. RESULTS: With a typical heavy-duty radiographic tube, the proposed system was capable of delivering an entrance skin exposure of up to 32 microC/kg for a 1-second scan. Monte Carlo simulations indicated that the scatter-to-primary ratio (S/P) imaged with the scanning slit system alone was 0.125 for a 35 x 43-cm, 23-cm-thick Lucite phantom imaged at 140 kVp. When the system was coupled with 4:1, 8:1, and 12:1 grids, S/P decreased to 0.063, 0.055, and 0.054, respectively. CONCLUSION: A scanning slit system coupled with a conventional grid is a practical and highly efficient method of controlling scatter and will result in minimal soft-tissue and bone measurement errors in dual-energy chest radiography.

Humans↗

Quality control phantom for digital chest radiography.

PURPOSE: To develop and test a chest phantom for routine quality control testing of digital radiography systems. MATERIALS AND METHODS: The phantom was constructed from sheets of copper, aluminum, and acrylic, which were cut and arranged to yield a radiographic projection resembling that of a human thorax. Regional test objects allowed quantitative assessment of optical density, contrast detail, and spatial resolution. Validation tests were performed to assess image stability in a stable imaging environment and sensitivity to changes in image quality when they occur. RESULTS: The phantom yielded consistent pseudoclinical images when used in a routine quality control program and facilitated detection of simulated problems that were induced in imaging system performance. CONCLUSION: The chest phantom enables quantitative, full-system testing of digital radiography system as they are used clinically for chest radiography.

Humans↗

Digital chest radiography with a solid-state flat-panel x-ray detector: contrast-detail evaluation with processed images printed on film hard copy.

PURPOSE: To evaluate and compare human observer performance in a contrast-detail test by using postprocessed hard-copy images from a digital chest radiography system and conventional screen-film radiographs. MATERIALS AND METHODS: The digital radiography system is based on a large-area flat-panel x-ray detector with a structured cesium iodide scintillator layer and an amorphous silicon thin-film transistor array for image readout. Images of a contrast-detail phantom were acquired at two exposure levels by using two standard thoracic screen-film systems and the digital system at matched dose. By using images of the phantom processed with standard chest image postprocessing techniques, a four-alternative forced-choice observer perception study was performed, and the number of detectable test signals (disk-shaped objects 0.3-4.0 mm in diameter) was determined for each image type. RESULTS: On average, observers detected more test signals on digital images than on screen-film radiographs at all diameters up to 2.0 mm and an equivalent number at larger diameters. Test signals with lower inherent subject contrast were detected more readily on digital images than on screen-film images, even when x-ray exposure levels for the digital system were reduced by 20%. CONCLUSION: Observer performance in a contrast-detail detection task can be improved by using images acquired with the flat-panel digital chest radiography system as compared with those acquired with state-of-the-art screen-film combinations.

Humans↗

Electrical methods in occlusal caries diagnosis: An in vitro comparison with visual inspection and bite-wing radiography.

The aim of this study was to compare in vitro diagnostic performance of three electrical methods for occlusal caries diagnosis with that of visual inspection and bite-wing radiography. One hundred and seven extracted molar and premolar teeth were subjected to the diagnostic methods by 2 operators and subsequently sectioned for histological validation. Electrical measurements were made at site level and at surface level using two different instruments. The diagnostic parameters calculated from the results were: sensitivity, specificity, diagnostic accuracy at a theoretical caries prevalence of 10% and area under the ROC curve. The electrical methods and bite-wing radiography showed higher sensitivity and lower specificity than visual inspection. Diagnostic accuracy was significantly lower for bite-wing radiography and one electrical method than for visual inspection. Overall diagnostic performance of two electrical methods was superior.

Area Under Curve↗

Occlusal caries detection with KaVo DIAGNOdent and radiography: an in vitro comparison.

A new laser fluorescence method, KaVo DIAGNOdent, was tested with respect to reproducibility and validity and compared with radiography regarding accuracy in the detection of occlusal caries. Seventy-six extracted premolar and molar teeth were measured twice with DIAGNOdent under both wet and dry conditions, at an interval of 2 weeks. Conventional film radiographs were exposed. Microradiographic analysis of sections of the teeth served as the gold standard. Intra-class correlation coefficient and Pearson's correlation coefficient were used to assess the reproducibility and the validity of the method, respectively. The influence of time and varying humidities on DIAGNOdent readings were analysed by two-way repeated measure ANOVA. ROC curves were plotted for DIAGNOdent readings and radiographic registration of caries by 6 observers, and the areas under the curves were compared using Student's t test. Under both wet and dry conditions, the reproducibility of the DIAGNOdent method was excellent: R = 0.97 and 0.96, respectively. The diagnostic accuracy of DIAGNOdent was significantly better than that of radiography (p< or =0.001). In this in vitro study of detection of occlusal caries, the diagnostic performance of the DIAGNOdent method was superior to that of radiography.

Analysis of Variance↗

Direct digital radiography for caries detection and analysis.

Recent developments in the field of electronic imaging have provided a new set of imaging tools for intra-oral imaging and clinical diagnosis. In this chapter, we review the general structure and characteristics of image sensors used in digital radiography and their application for clinical caries detection and analysis. An overview of the literature, comparing the diagnostic accuracy of digital and film-based radiography and the impact of image-processing methods, is provided. We also describe several approaches for quantitative assessment of radiographic images for caries detection and assessment. Examples include digital subtraction radiography, and 2-D and 3-D density profiling. To increase the accuracy and reduce observer variability the use of 3-D imaging and computer-aided diagnosis is presented as future direction for clinical caries diagnosis.

Dental Caries↗

Efficacy of sealing proximal early active lesions: an 18-month clinical study evaluated by conventional and subtraction radiography.

This study assessed the efficacy of sealing proximal lesions on adult patients using a split-mouth design. Eighty-two 15- to 39-year-olds from the Dental Faculties in Copenhagen and Bogotá participated, each having 2 or more proximal lesions in the following radiographic stages: (1) lesion restricted to the outer half of enamel; (2) lesion from the inner half of enamel including the enamel dentine junction, and (3) lesion restricted to the outer third of dentine. Standardized geometrically aligned baseline and follow-up radiographs were obtained. One randomly selected lesion (test) in each patient was sealed with 1 of 2 resins. The patients were instructed to floss all the proximal lesions 3 times per week. The baseline to 18 months difference in caries lesion progression status was assessed using 3 methods: (1) radiographs were independently assessed visually; (2) radiographs were read in pairs, and (3) using subtraction radiography of digitized images. A total of 72 subjects finished the study (12.2% dropout). The compliance concerning flossing was poor (15%). For the repeated examinations kappa was 0.84 for the visual examination, 0.44 for the paired readings and 0.84 for the subtraction examination. Two test lesions and 1 control lesion were restored. For the independent radiograph assessment method 10 and 26% progressed in the test and control group, respectively (p > 0.05); with the paired radiograph method the corresponding data were 22% in the test and 47% in the control groups (p < 0.01). By subtraction radiography 44% of the test group and 84% of the control were judged to have progressed (p < 0.001). The sealing technique was superior to instructing patients to floss, and subtraction radiography appeared to be the most sensitive method for assessing lesion progression.

Adolescent↗

Soft tissue radiography for evaluating clinical activity of rheumatoid arthritis.

The value of soft tissue radiography in assessing the activity of rheumatoid arthritis was investigated in 67 patients and correlated to the clinical activity of the disease. Soft tissue radiography using a technique for mammary radiography was combined with immersion. Radiologically demonstrated periarticular oedema was most closely correlated to clinical activity. A close correlation also existed between soft tissue radiographic lesions and 99Tcm accumulation in hands.

Adult↗

Conventional radiography and bone scintigraphy in the prognostic evaluation of Legg-Calvé-Perthes disease.

PURPOSE: The role of conventional radiography and bone scintigraphy in predicting the outcome of Legg-Calvé-Perthes disease was investigated. MATERIAL AND METHODS: The 75 children reviewed (86 hips) were followed up to the primary healing of the disease. The findings at conventional radiography (obtained at presentation, at the time of maximum capital head involvement, and at the end of the healing process of the disease) were compared to early bone scintigraphy features. RESULTS AND CONCLUSIONS: Bone scintigraphy provided more accurate information concerning the extent of the necrotic process than initial radiographs. Moreover it could determine revascularization and consequently the stage of the disease. The methods was, however, unable to predict the outcome of the disease in some cases, particularly if it was performed late after the onset of symptoms. Conventional radiography provided important information about other parameters such as "head-at-risk" signs which facilitated treatment selection. Of these signs not only lateral subluxation but also metaphyseal changes strongly predispose to severe deformity of the hip joint.

Child↗

Comparison of dynamic sonography to stress radiography for assessing glenohumeral laxity in asymptomatic shoulders.

BACKGROUND: Stress radiography has been the established imaging method for quantifying glenohumeral joint laxity. Dynamic ultrasound is an alternative imaging method that may be used to measure glenohumeral laxity; however, validity and repeatability have not been examined. OBJECTIVE: To determine criterion-related validity and repeatability of a sonographic imaging method for measuring glenohumeral laxity in asymptomatic shoulders. STUDY DESIGN: Controlled laboratory study. METHODS: In experiment 1, 20 subjects were assessed for glenohumeral laxity using stress radiography and dynamic ultrasound. In the second experiment, 13 subjects were assessed for laxity in 2 separate test sessions using the dynamic ultrasound technique. RESULTS: Correlational analysis between the sonographic and radiographic measures revealed an r = 0.79 (r(2) = 0.62), indicating excellent criterion-related validity for the sonographic imaging method. Test-retest repeatability was 0.72 and 0.85 for anterior and posterior translation, respectively, and interrater repeatability was 0.96 and 0.99 for anterior and posterior translation, respectively. CONCLUSIONS: Dynamic ultrasound appears to be a valid and repeatable method for assessing glenohumeral laxity in a clinical setting. CLINICAL RELEVANCE: Based on the results of this study, dynamic ultrasound is a repeatable and valid method for measuring glenohumeral laxity and therefore may be used as a viable replacement for stress radiography during assessments of glenohumeral laxity.

Adult↗

Anterior knee motion analysis. Measurement and simultaneous radiography.

Sixteen patients with a clinically diagnosed chronic ACL deficient knee on one side and a contralateral ACL intact knee were evaluated by arthrometry and simultaneous radiography after epidural anesthesia was induced. The posterior cruciate ligament was intact in all knees. This paper reports only the anterior position of the tibia at the 89 N anterior force level of the KT-1000 arthrometer (as read from the dial) and the anterior tibial position recorded simultaneously by radiography at the 89 N dial tone. A 3 mm difference in anterior tibial position between the two knees of the same patient was considered diagnostic for ACL deficiency. Arthrometrically, 13 of the 16 patients were diagnosed accurately; radiographically, 13 of the 16 met the criterion. Moderately high significant positive correlation of paired values was obtained in ACL deficient knees by the two methods (correlation, 0.58 and two-tail probability, 0.02). In ACL intact knees there was no correlation of paired values (correlation, 0.01 and two-tail probability, 0.98). We found no numerical equivalency between the measurements obtained by the KT-1000 and simultaneous radiography. Neither did we find an apparent pattern to the differences, or formula we could use to interpolate findings of anterior tibial position from one measurement system to the other. We conclude that an examiner can substantiate a clinical diagnosis of chronic ACL deficiency with both methods. Arthrometry alone may be used to repeatedly follow conservatively treated ACL deficient knees without exposing the patient to radiation. Radiographs obtained under known anterior force levels provide a retrievable record to document the exact tibial position in relation to the femur.

Adolescent↗

Valgus stress radiography in normal ankles.

Deltoid ligament injury is thought to be rare. Signs of complete rupture of the deltoid ligament may be subtle or interpreted as another injury condition and thus are often missed acutely. No standardized method has been created to evaluate medial ligament insufficiency in acute or chronic laxity. To establish a diagnostic test for suspected isolated ruptures of the deltoid ligament, 32 subjects with no previous ankle injury underwent valgus stress radiography and nonstressed radiography of both ankles. Stress radiography in this study showed that there is a measurable but minimal range of talar tilt on valgus stress in previously uninjured ankles. This study provides the basis for diagnosis of the rare isolated rupture of the deltoid ligament of the ankle.

Adult↗

Value of skull radiography, head computed tomographic scanning, and admission for observation in cases of minor head injury.

A retrospective review of 373 adult patients admitted to Harbor General Hospital between 1980 and 1984 for minor closed head injury (Glasgow coma scale 13-15) was performed to determine the benefits of skull radiography, computed tomographic (CT) scanning of the head, and admission for observation. Variables reviewed were mental status, neurological examination, presence or absence of loss of consciousness, clinical evidence of basilar skull fracture, and fracture on skull radiography. The neurological examination (including mental status and Glasgow coma scale) in the emergency room was the best predictor of subsequent deterioration or the presence of an operative hematoma. The only patients with Glasgow coma scale scores of 15 who required surgical evacuation of an extraaxial hematoma had focal neurological deficits referable to hemispheric compression, with or without an abnormal mental status. A Glasgow coma scale score of 13 or 14 places the patient at risk either of having a hematoma requiring surgery or of deteriorating. We recommend that a head CT scan be obtained on all patients with Glasgow coma scale scores of less than 15, abnormal mental status, or hemispheric neurological deficits. If no operative lesion is found on the CT scan, the patient should be admitted for observation because there is still a risk of deterioration. Those with a Glasgow coma scale score of 15, a normal mental status, and no hemispheric neurological deficit may be discharged to be observed at home by a competent observer despite basilar or calvarial skull fracture, loss of consciousness, or cranial nerve deficit. No benefit was gained from skull radiography in any group.

Adolescent↗

Clinical significance of blood brain natriuretic peptide level measurement in the detection of heart disease in untreated outpatients: comparison of electrocardiography, chest radiography and echocardiography.

The aim of present study was to compare the predictive characteristics and cost-benefit of measuring the concentration of blood brain natriuretic peptide (BNP), compared with electrocardiography (ECG), chest radiography and echocardiography, as a diagnostic test for heart disease. The study group comprised 130 untreated patients who had symptoms suggestive of heart disease. According to the results of additional examinations and follow-up checks, 86 patients were diagnosed as having heart disease and 44 patients were judged free of heart disease. Positive findings in each test suggestive of heart disease were checked in accordance with criteria, and the number of positive and negative cases for each test was calculated. The predictive characteristics, such as specificity, sensitivity, accuracy, positive and negative predictive values, of each test and the cost-benefit value were calculated and analyzed statistically. The sensitivity, specificity and accuracy of blood BNP and echocardiography were significantly greater than those of ECG and chest radiography. Echocardiography had a significantly lower cost-benefit value compared with measuring blood BNP concentration. Thus, the blood BNP concentration had significantly higher predictive characteristics than ECG and chest radiography, and a cost-benefit value significantly greater than that of echocardiography.

Aged↗