Morphological Distribution and Internal Enhancement Architecture of Contrast‐Enhanced Magnetic Resonance Imaging in the Diagnosis of Non‐Mass‐Like Breast Lesions: A Meta‐Analysis

The aim of this study is to assess the diagnostic performance of contrast‐enhanced magnetic resonance (MR) imaging in patients with non‐mass‐like breast lesions in a meta‐analysis. Literature study was performed on PubMed data base on the diagnostic performance of MR imaging in patients with non‐mass‐like breast lesions. Details of the relevant studies were reviewed and a meta‐analysis was performed to estimate the overall sensitivity and specificity of contrast‐enhanced MR imaging of non‐mass‐like breast lesions. A summary receiver operating characteristic curve (sROC) was developed to explore the threshold effect by ROC space. Spearman correlation coefficient was calculated using Meta‐Disc version 1.4 to analyze the heterogeneity between studies. A total of 858 non‐mass‐like lesions from 15 studies were included in the meta‐analysis (sample size range: 27–131). Pooled weighted estimates of sensitivity and specificity were 50% (95% CI: 46%, 53%) and 80% (95% CI: 77%, 83%), respectively. The heterogeneity among studies was caused by other factors other than threshold effect. The findings were influenced by cancer prevalence (p = 0.0359). Subgroup analyses indicated that the sensitivity and specificity in studies with combined diagnostic criterion was higher than that in studies with single diagnostic criterion. In evaluation of non‐mass‐like breast lesions, contrast‐enhanced MRI has high specificity and relatively lower sensitivity.     

腔内超声对直肠癌术前放化疗后再分期诊断准确性的Meta分析

目的评价腔内超声对直肠癌术前放化疗后再分期诊断的准确性。方法利用PubMed、EMbase、OVID和WOK数据库,全面检索腔内超声对直肠癌术前放化疗后再分期相关的英文文献,利用SAS和MetaDiSc软件对腔内超声对直肠癌术前放化疗后再分期的敏感性和特异性进行meta分析。结果最终纳入11篇,共651例患者。腔内超声对直肠癌术前放化疗后T3-4分期诊断的敏感性为87.6%(70.9%,95.4%),特异性为66.4%(47.2%,81.4%),诊断比数比(DOR)为17.81(4.03,78.79);对淋巴结阳性诊断的敏感性和特异性,以及DOR分别为49.8%(40.1%,59.5%),78.7%(69.5%,85.7%)和3.96(2.44,6.44)。结论超声对于直肠癌术前放化疗后再分期仍然存在挑战。对于T0-2期的直肠癌,为避免过度扩大切除范围,可以先使用腔内超声对直肠癌进行再分期。不过结果提示部分T0-2期会被过度分期为T3-4期。超声对于直肠癌术前放化疗后的淋巴结的判断不佳。     

Prospective comparison of endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in the preoperative assessment of masses in the pancreatic head

AIMS: To compare the diagnostic value of endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in the differentiation of malignant from benign masses in the pancreatic head. METHODS: Within 14 months 95 prospective patients with masses in the pancreatic head were assigned for preoperative EUS and ERCP. Both procedures were performed and recorded according to a standardized protocol. Based on intraoperative findings and histology, 50 patients (53%) suffered from malignant and 45 patients (47%) from benign (inflammatory) tumors. RESULTS: Success rates were 96% for EUS and 95% for ERCP. The overall results for EUS and ERCP to predict malignant masses were, respectively: sensitivity 78 and 81%, specificity 93 and 88%, positive predictive value 93 and 89%, negative predictive value 78 and 80%, and diagnostic accuracy 85 and 84%. When EUS and ERCP were taken together, the sensitivity was 92% (specificity 85%), but the diagnostic accuracy (89%) was not significantly enhanced. The results for EUS to diagnose lymph node metastases preoperatively were: sensitivity 55%, specificity 91%, positive predictive value 69%, negative predictive value 84%, and accuracy 81%. CONCLUSIONS: EUS and ERCP have similar diagnostic accuracies to separate malignant from benign masses in the pancreatic head. Combination of both procedures is not superior to the use of one modality alone. Abnormal lymph nodes visualized on EUS in patients with inflammatory masses in the pancreatic head due to chronic pancreatitis should be interpreted cautiously.     

超声双重造影在胃癌术前TN分期中的价值

目的 在胃癌术前分期中,通过与超声内镜检查(EUS)对比分析超声双重造影(DCUS)检查的价值.方法 选择162例经病理活检证实为胃癌并进行手术切除的患者,手术前5 d内进行EUS及DCUS检查,并进行TNM分期,与术后病理检查结果对照得出正确率,并进行相互比较.结果 本组162例胃癌患者中TNM分期:42例为T1期,49例为T2期,56例为T3期,15例为T4期.DCUS和EUS术前T分期总的正确率分别为77.2%、74.7%(χ2=0.273,P=0.603),而在T3分期上DCUS优于EUS(χ2=5.009,P=0.025);在N分期上两者总的正确率分别为78.4%、57.4%(χ2=16.370,P=0.001),而两者的敏感性和特异性分别为78.4%比49.5%、78.5%比69.2%.在对阳性淋巴结诊断上DCUS的正确率较高(78.4%比49.5%,χ2=17.523,P<0.01),尤其是对低分化腺癌患者阳性淋巴结的诊断正确率较高(81.5%比42.6%,χ2=17.338,P<0.01).结论 DCUS检查在胃癌术前分期中有较好的应用价值,其在预测阳性淋巴结方面,尤其是判断低分化腺癌患者有无淋巴结转移上正确率高于EUS检查.     

How Good is Endoscopic Ultrasound in Differentiating Various T Stages of Rectal Cancer? Meta-Analysis and Systematic Review

Published data on accuracy of endoscopic ultrasound (EUS) in differentiating T stages of rectal cancers is varied. Study selection criteria were to select only EUS studies confirmed with results of surgical pathology. Articles were searched in Medline and Pubmed. Pooling was conducted by both fixed and random effects models. Initial search identified 3,630 reference articles, of which 42 studies (N = 5,039) met the inclusion criteria and were included in this analysis. The pooled sensitivity and specificity of EUS to determine T1 stage was 87.8% [95% confidence interval (CI) 85.3–90.0%] and 98.3% (95% CI 97.8–98.7%), respectively. For T2 stage, EUS had a pooled sensitivity and specificity of 80.5% (95% CI 77.9–82.9%) and 95.6% (95% CI 94.9–96.3%), respectively. To stage T3 stage, EUS had a pooled sensitivity and specificity of 96.4% (95% CI 95.4–97.2%) and 90.6% (95% CI 89.5–91.7%), respectively. In determining the T4 stage, EUS had a pooled sensitivity of 95.4% (95% CI 92.4–97.5%) and specificity of 98.3% (95% CI 97.8–98.7%). The p value for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. We conclude that, as a result of the demonstrated sensitivity and specificity, EUS should be the investigation of choice to T stage rectal cancers. The sensitivity of EUS is higher for advanced disease than for early disease. EUS should be strongly considered for T staging of rectal cancers.     

Utility of a linear array ultrasound endoscope in the evaluation of suspected pancreatic disease

Endoscopic ultrasonography (EUS) is currently being used to evaluate and stage pancreaticobiliary malignancies and neuroendocrine tumors, and to perform aspiration for cytologic diagnosis. There are currently two different commercially available EUS systems for clinical use. One system uses a mechanical radial sector scanner oriented in a plane perpendicular to the long axis of the endoscope, and the other uses an electronic convex scanner that is oriented in the long axis of the endoscope. The vast majority of the current literature reports experience using the radial scanning device in the evaluation of pancreaticobiliary abnormalities. We prospectively evaluated the linear probe as the sole instrument for EUS in 26 patients with suspected pancreatic disease. The results of the endoscopic ultrasound examination were compared with the results of surgery or long-term clinical follow-up. The sensitivity and specificity of linear array EUS for benign pancreatic disease were 93.8% and 88.2%, respectively. The sensitivity and specificity for malignant disease of the pancreas were 80.0% and 88.9%, respectively. The linear array echoendoscope, employed as the only instrument for evaluation of the pancreas, is accurate in the evaluation of pancreatic disease. The addition of EUS-guided pancreatic biopsy would be anticipated to improve the sensitivity of the linear array instrument for detecting malignancy. Presented in part at Digestive Disease Week, Boston, Mass., May 1994, and at the Ninth International Symposium on Endoscopic Ultrasonography, Bologna, Italy, December 1993.     

Accuracy of Endoscopic Ultrasound to Diagnose Nodal Invasion by Rectal Cancers: A Meta-Analysis and Systematic Review

Background  Nodal staging in patients with rectal cancer predicts prognosis and directs therapy. Published data on the accuracy of endoscopic ultrasound (EUS) for diagnosing nodal invasion in patients with rectal cancer has been inconsistent. Aim  To evaluate the accuracy of EUS in diagnosing nodal metastasis of rectal cancers. Method  Study Selection Criteria: Only EUS studies confirmed by surgical histology were selected. Data Collection and Extraction: Articles were searched in Medline, Pubmed, and CENTRAL. Statistical Method: Pooling was conducted by both fixed-effects model and random-effects model. Results  The initial search identified 3610 reference articles in which 352 relevant articles were selected and reviewed. Data were extracted from 35 studies (N = 2732) that met the inclusion criteria. Pooled sensitivity of EUS in diagnosing nodal involvement by rectal cancers was 73.2% (95% confidence interval [95% CI] 70.6–75.6). EUS had a pooled specificity of 75.8% (95% CI 73.5–78.0). The positive likelihood ratio of EUS was 2.84 (95% CI 2.16–3.72), and negative likelihood ratio was 0.42 (95% CI 0.33–0.52). All the pooled estimates, calculated by fixed- and random-effect models, were similar. SROC curves showed an area under the curve of 0.79. The P for chi-squared heterogeneity for all the pooled accuracy estimates was >.10. Conclusions  EUS is an important and accurate diagnostic tool for evaluating nodal metastasis of rectal cancers. This meta-analysis shows that the sensitivity and specificity of EUS is moderate. Further refinement in EUS technologies and diagnostic criteria are needed to improve the diagnostic accuracy.     

Resolving the blind spot of transoesophageal echocardiography: a new diagnostic device for visualizing the ascending aorta in cardiac surgery

Background: Atherosclerosis of the ascending aorta (AA) and stroke aftercardiac surgery are related. Knowledge of the location of AA-atherosclerosispre-sternotomy allows changes in surgical strategy to avoidmanipulation of the AA. The gold-standard for assessment ofAA-atherosclerosis is intraoperative epiaortic ultrasound scanning(EUS). Transoesophageal echocardiography (TOE) is unable todetect atherosclerosis in the distal AA due to the ‘blindspot’. A new method [A-View^® (Aortic-view) method]using a fluid-filled catheter may enhance the assessment ofdistal AA-atherosclerosis. The aim of this study was to evaluatewhether the A-View^® method indeed visualizes the distalAA and to assess the safety of this technology. Methods: In a cross-sectional diagnostic study, 41 patients undergoingcardiac surgery including sternotomy underwent the same work-upincluding TOE, the A-View^® method, EUS, and routine operativemonitoring. Results: With the A-View^® method, the distal AA was visible in all(100%) patients. There were no clinical important side-effectsassociated with the use of the A-View^® catheter; however,in one patient the endotracheal tube was accidentally dislocatedleading to a decrease in Sa_O2. Severity of atherosclerosis visualizedwith the A-View^® method compared with EUS results showedgood agreement between the two methods [Kappa of 0.69 (0.50–0.88)].The Bland–Altman analysis showed poor agreement in plaque-sizemeasurements (bias 0.05 cm², limits of agreement – 0.63to 0.74 cm²). Conclusions: The A-View^® method offers a minimally invasive and safeapproach to preoperatively resolving the blind spot of TOE.Compared with EUS, the A-View^® method yielded satisfactoryresults in the detection of AA-atherosclerosis. The A-View^®method seems a promising tool for patients undergoing cardiacsurgery to direct surgical management.     

STAGING OF OESOPHAGEAL CARCINOMA BY ENDOSCOPIC ULTRASOUND: PRELIMINARY EXPERIENCE

Background : Endoscopic ultrasound (EUS) is a relatively recent imaging modality that is capable of visualizing oesophageal tissue layers and para-oesophageal structures. Current pre-operative staging of oesophageal cancer is less than satisfactory, and a modality which may improve pre-operative staging, thus allowing a more rational approach to choice of treatment, may be a welcome addition to current techniques. The purpose of the present study was to evaluate the accuracy of EUS in the staging of oesophageal carcinoma in a consecutive cohort of patients. Methods : Forty-three patients with oesophageal cancer were prospectively staged with EUS using the radial scanning Olympus EUM–3 echo-endoscope. In the 28 patients who underwent surgery EUS staging was correlated with operative and histological findings to evaluate the EUS accuracy rate of assessing tumour depth (T stage), and the presence of nodal involvement (N stage) using internationally accepted TNM staging criteria. Results : Endoscopic ultrasound accuracy rates for overall T-staging was 61% whereas that of N-staging was 75%. The overall TNM pathological staging was 75% accurate by EUS. Conclusions : Compared to published literature figures for oesophageal staging by computed tomography scanning (39–54%) these results demonstrate that EUS has a reasonable accuracy rate for staging. Endoscopic ultrasound may prove to be a useful additional modality in the management of oesophageal cancer.     

Diagnostic accuracy of narrow‐band imaging for the differentiation of neoplastic from non‐neoplastic colorectal polyps: a meta‐analysis

Aim Narrow‐band imaging (NBI) is a novel imaging technology that makes the superficial vasculature of gastrointestinal mucosa visible. However, the real accuracy for the differentiation of neoplastic from non‐neoplastic polyps by NBI for the colorectum is still unknown. Method A meta‐analysis was carried out of studies which assessed the precision of NBI in the diagnosis of colorectal neoplastic polyps. Searches included PubMed and Embase and two reviewers independently assessed their quality with a modified version of the quadas and stard tools. The study pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and area under the curve (AUC). Results There were 11 relevant original papers which fulfilled the inclusion criteria. The pooled sensitivity and specificity were 0.92 (95% CI 0.90–0.93) and 0.83 (95% CI 0.81–0.86) respectively. The AUC for NBI was 0.95 [SE 0.01; DOR 53.72 (95% CI 35.66–80.92)]. The sensitivity and specificity were 0.92 (95% CI 0.90–0.94) and 0.81 (95% CI 0.78–0.84) with magnification, and 0.91 (95% CI 0.88–0.93) and 0.86 (95% CI 0.82–0.89) without magnification. For the mucosal pattern sensitivity and specificity were 0.90 (95% CI 0.85–0.940) and 0.88 (95% CI 0.82–0.93), and for vascular pattern intensity they were 0.92 (95% CI 0.90–0.94) and 0.88 (95% CI 0.83–0.91). Conclusion Narrow‐band imaging, with or without magnification, has a high diagnostic precision for colorectal neoplastic polyps using either vascular pattern intensity or mucosal pattern assessment as the measure.     

Predictive and concurrent validity of the Braden scale in long‐term care: A meta‐analysis

Pressure ulcer prevention is an important long‐term care (LTC) quality indicator. While the Braden Scale is a recommended risk assessment tool, there is a paucity of information specifically pertaining to its validity within the LTC setting. We, therefore, undertook a systematic review and meta‐analysis comparing Braden Scale predictive and concurrent validity within this context. We searched the Medline, EMBASE, PsychINFO and PubMed databases from 1985–2014 for studies containing the requisite information to analyze tool validity. Our initial search yielded 3,773 articles. Eleven datasets emanating from nine published studies describing 40,361 residents met all meta‐analysis inclusion criteria and were analyzed using random effects models. Pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive values were 86%, 38%, 28%, and 93%, respectively. Specificity was poorer in concurrent samples as compared with predictive samples (38% vs. 72%), while PPV was low in both sample types (25 and 37%). Though random effects model results showed that the Scale had good overall predictive ability [RR, 4.33; 95% CI, 3.28–5.72], none of the concurrent samples were found to have “optimal” sensitivity and specificity. In conclusion, the appropriateness of the Braden Scale in LTC is questionable given its low specificity and PPV, in particular in concurrent validity studies. Future studies should further explore the extent to which the apparent low validity of the Scale in LTC is due to the choice of cutoff point and/or preventive strategies implemented by LTC staff as a matter of course.     

An intraoperative assessment of the ascending aorta: a comparison of digital palpation, transesophageal echocardiography, and epiaortic ultrasonography

OBJECTIVES: There are a number of techniques available to assess the aorta for atheromatous disease in the intraoperative period. This study compared the relationship among the findings of digital palpation (DP), transesophageal echocardiography (TEE), and epiaortic ultrasound (EAU) in the detection of atheroma in the ascending aorta. DESIGN: A prospective, observational study. SETTING: A single-institution, cardiothoracic specialty hospital. Participants: One hundred fifty-four patients undergoing elective cardiac surgery. INTERVENTIONS: The ascending aorta of patients undergoing elective coronary artery bypass surgery was assessed for atheroma by means of the 3 techniques. Atheroma was scored as present or absent. The sensitivity and specificity of the techniques were compared. MEASUREMENTS AND MAIN RESULTS: Assuming EAU provides the "gold standard," the sensitivity of both TEE and DP were low. Digital palpation identified only 20 patients (12%); TEE 31 patients (20%); and, in contrast, EAU detected atheroma in 81 patients (53%). There were 3 and 6 false-positives by DP and TEE, respectively. CONCLUSION: Assuming EAU as the "gold standard" to detect atheroma, this study has shown that when assessing the ascending aorta neither DP nor TEE appear sensitive. This study supports the proposal that detection of atheroma should be performed by EAU.     

Endorectal ultrasound in rectal cancer

Accurate staging of rectal carcinoma is crucial for planning surgery and the indication for adjuvant therapy. Although computed tomography and magnetic resonance imaging are very sensitive in the detection metastastic disease, local staging of rectal cancer with these techniques has been disappointing. Endorectal ultrasound (EUS) remains the most accurate method for staging of rectal cancer. High accuracy rates in the assessment of the depth of infiltration (T stage) (80–90%) and in the determination of the lymph node status (70–80%) have been confirmed in several studies. Continued research and development has made the instrumentation for EUS more accurate and user‐friendly. New techniques that have contributed significantly to the evolution of EUS include three‐dimensional EUS, high‐frequency miniprobes and transrectal ultrasound‐guided biopsy techniques. Further improvement can be expected by contrast enhancement with microbubbles and colour Doppler imaging.     

Contrast‐enhanced ultrasound vs multidetector‐computed tomography for detecting liver metastases in colorectal cancer: a prospective,blinded, patient‐by‐patient analysis

Aim This study compared the sensitivity and specificity of contrast‐enhanced ultrasound (CEUS) and multidetector‐computed tomography (MDCT) in the detection of liver metastases in patients with colorectal cancer. Method Between September 2004 and December 2008, 271 consecutive patients (146 men and 125 women; median age 68 years, range: 34–91 years) with primary colorectal cancer were evaluated. All underwent combined liver ultrasound and CEUS following intravenous injection of 2.4 ml of SonoVue^TM. The interval from injection to arrival time in the hepatic vein (ATHV) was noted. Contrast‐enhanced MDCT in the portal phase was performed and interpreted blindly. In all patients, intra‐operative ultrasound was used as the reference point. In addition, magnetic resonance imaging (MRI) or biopsy was performed on all suspicious lesions or if there was inconsistency in the results. Results Liver metastases were detected in 21 (8%) patients. Both CEUS and MDCT had a sensitivity of 85.7%, with respective specificities of 97.6% and 95.6%, and positive predictive values of 75%vs 62%. The negative predictive value of both methods was 99%. In patients with and without liver metastases, ATHV was 18 and 22 s, respectively (P < 0.05). Conclusion CEUS has potential as a diagnostic alternative to MDCT in the detection of liver metastases. ATHV was shorter in patients with liver metastases.     

The value of imaging techniques in the staging of pancreatic cancer

Background The aim of this study was to assess the clinical value of endoscopic ultrasound (EUS) in the staging of pancreatic carcinoma and to compare it to ultrasonography (US) and CT.Methods We evaluated 45 patients (21 women and 24 men with a mean age of 62.1 years) who had undergone surgical treatment for pancreatic cancer between 1994 and 2004. Out analysis focused on the overall accuracy, sensitivity, and specificity of routine and Doppler US, CT, and EUS.Results Endoscopic ultrasound was the most accurate modality for local tumor staging (93.1%), vascular infiltration (90%), and lymph node assessment (87.5%). Routine US was the least accurate (82.5%, 67.5%, and 72.5%, respectively). The accuracy rates for CT and Doppler US were similar (88.1%, 82.5% and 80.0%, respectively).Conclusions Endoscopic ultrasound is the most accurate method available to stage pancreatic cancer in the preoperative period. However, the advantage of EUS over CT and US does not justify its routine use due to its high cost, low availability, and invasiveness.     

The role of transrectal ultrasound-guided biopsy in the postoperative follow-up of patients with rectal cancer

BACKGROUND: The value of endorectal ultrasound (EUS) in the diagnosis of recurrent rectal cancer is limited by the inability to differentiate between malignant and benign lesions. We have prospectively investigated the role of EUS with transrectal ultrasound-guided biopsy in the postoperative follow-up of rectal cancer. METHODS: Since 1995, patients who had undergone a sphincter-saving operation for rectal cancer (n = 312) were followed-up by a standard program including rectal palpation, carcinoembryonic antigen monitoring, computed tomography, and EUS. Transrectal EUS-guided biopsy of perirectal lesions was performed in 68 patients with perirectal lesions by using a rigid endoprobe with a 10 MHZ multiplane transducer and special targeting device. RESULTS: Overall local recurrence was observed in 36 patients. Intraluminal recurrence was diagnosed by proctoscopy in 12 patients. Transrectal EUS-guided biopsy showed pelvic recurrence in 22 of 68 patients with perirectal lesions. Biopsy specimens with benign histology were obtained from 41 patients, and the procedure failed in 5 cases (accuracy, 92%). There was a strong agreement between transrectal biopsy results and the final diagnosis (kappa = 0.84), the sensitivity and specificity being 91% and 93%, respectively. In contrast, clinical examination (kappa = 0.27), computed tomography (kappa = 0.47), or EUS (kappa = 0.42) showed only a moderate level of agreement with the histopathologic diagnosis, mainly because of the limited specificity of all 3 methods (65% vs 46% vs 57%). EUS-guided biopsy was significantly more accurate than computed tomography and EUS (P <.01). The biopsy results had a considerable impact on the management in 18 of 68 patients (26%). CONCLUSIONS: Transrectal EUS-guided biopsy is a safe and efficient method for tissue sampling of perirectal lesions. This minimally invasive and inexpensive technique improves the accuracy of endorectal ultrasound in the diagnosis of recurrent rectal cancer.     

Good sensitivity and specificity of ultrasound for detecting pseudotumors in 83 failed metal-on-metal hip replacements

Background and purpose — Ultrasound is used for imaging of pseudotumors associated with metal-on-metal (MoM) hips. Ultrasound has been compared with magnetic resonance imaging, but to date there have been no studies comparing ultrasound findings and revision findings.

Methods — We evaluated the sensitivity and specificity of preoperative ultrasound for detecting pseudotumors in 82 patients with MoM hip replacement (82 hips). Ultrasound examinations were performed by 1 of 3 musculoskeletal radiologists, and pseudotumors seen by ultrasound were retrospectively classified as fluid-filled, mixed-type, or solid. Findings at revision surgery were retrieved from surgical notes and graded according to the same system as used for ultrasound findings.

Results — Ultrasound had a sensitivity of 83% (95% CI: 63–93) and a specificity of 92% (CI: 82–96) for detecting trochanteric region pseudotumors, and a sensitivity of 79% (CI: 62–89) and a specificity of 94% (CI: 83–98) for detecting iliopsoas-region pseudotumors. Type misclassification of pseudotumors found at revision occurred in 8 of 23 hips in the trochanteric region and in 19 of 33 hips in the iliopsoas region.

Interpretation — Despite the discrepancy in type classification between ultrasound and revision findings, the presence of pseudotumors was predicted well with ultrasound in our cohort of failed MoM hip replacements.     

Limitations of ultrasonic duplex scanning for diagnosing lower limb arterial stenoses in the presence of adjacent segment disease

Purpose: The purpose of this study was to provide a quantitative evaluation of the effect of adjacent segment lesions on disease classification in lower limb arteries by ultrasonic duplex scanning.Methods: Lower limb arterial duplex scanning from the distal aorta to the popliteal artery was performed in 55 patients. Arterial lesions evaluated by visual interpretation of Doppler spectra were compared blindly with those measured by angiography.Results: To recognize severe stenoses (50% to 100% diameter reduction) in any arterial segment, duplex scanning had sensitivity and specificity rates of 74% and 96%, respectively. However, sensitivity and specificity rates increased to 80% and 98%, respectively, when there was no 50% to 100% diameter-reducing lesion in adjacent segments, whereas they decreased to 66% and 94%, respectively, when there was at least one 50% to 100% diameter-reducing lesion in adjacent segments. Moreover, among the 48 duplex misclassifications underestimating or overestimating the degree of arterial stenoses, 30 (62.5%) involved a segment with at least one 50% to 100% lesion in adjacent segments. The segments mostly affected by proximal and distal arterial lesions were the popliteal arteries and the common and deep femoral arteries, where it was found that 86% (24/28) of the misclassifications involved the presence of either proximal or distal severe stenoses.Conclusion: The results demonstrated that the presence of multiple stenoses was an important limitation of duplex scanning for the detection and quantification of lower limb arterial disease. (J VASC SURG 1994;19:650-7.)     

Gadolinium-enhanced magnetic resonance angiography, colour duplex and digital subtraction angiography of the lower limb arteries from the aorta to the tibio-peroneal trunk in patients with intermittent claudication.

OBJECTIVES: To evaluate the sensitivity, specificity, positive and negative predictive value of contrast-enhanced (gadolinium) magnetic resonance imaging (CE-MRA) and colour duplex ultrasound (CDU) of lower limb arteries. DESIGN: Prospective, single centre study. MATERIAL AND METHODS: A consecutive series of 58 patients with intermittent claudication (IC) were examined with CE-MRA and CDU from the infrarenal aorta to the tibio-peroneal trunk with digital subtraction angiography (DSA) as reference. The arterial tree was divided into 15 segments, pooled into three regions; suprainguinal, thigh and knee. Sensitivity, specificity, positive and negative predictive values for significant obstructions were calculated. Cohen Kappa statistics was used to establish agreement between the three methods. RESULTS: The sensitivity (specificity in parentheses) for significant obstructions in the suprainguinal region were 96% (94%) for CE-MRA and 91% (96%) for CDU, in the thigh region 92% (95%) for CE-MRA and 76% (99%) for CDU, and in the knee region 93% (96%) for CE-MRA and 33% (98%) for CDU. CDU failed to visualize 10% of suprainguinal, 2% of thigh and 13% of knee-region arterial segments. CONCLUSIONS: Both CE-MRA and CDU are good alternatives to DSA in the suprainguinal- and thigh-region. In the knee region only CE-MRA can be relied upon as an alternative to DSA. Imaging by CDU is not suited to situations were evaluation of runoff vessels is important.     

Study of mediastinal lymph nodes in lung cancer using transesophageal ultrasonography]

Evaluation of mediastinal lymph nodes in patients with lung cancer is fundamental for their treatment and prognosis. Chest computed tomography (CT) is presently the most utilized diagnostic modality. In recent years endoscopic ultrasound (EUS) is being employed for this purpose. We retrospectively compared the results of CT and EUS staging of 35 selected patients with postsurgical stage. A total of 175 lymph node sites were examined. Results CT vs EUS were as follows: specificity 92% vs 98%, sensitivity 88% vs 84%, positive predicted accuracy 80% vs 96%, negative predicted accuracy 95% vs 94%, overall accuracy 92% vs 95%. The region most accessible by EUS evaluation were the paraesophageal lymph nodes; the most difficult were the right superior mediastinal nodes which cannot be imaged for anatomic reasons. EUS not only allows one to arrive at correct diagnosis with less false positive results, but also permits evaluation of lymph nodes which are not enlarged. We think that EUS, in combination with CT, is an appropriate modality for staging of mediastinal lymph nodes in patients with lung cancer.