Measuring diagnostic accuracy of imaging parameters in pelvic lipomatosis

Objectives

To study whether the individual radiological findings can help predict diagnosis of pelvic lipomatosis (PL) or, specifically appreciate its progression.

Methods

Data from 32 clinically proven cases of PL and 25 controls were collected. Two reviewers were recruited for a blinded evaluation, image features were recorded in terms of: (1) bladder shape; (2) bladder-rectosigmoid morphological indexes including ratio of superior–inferior to anterior–posterior length of bladder (SI/AP), angle between anterior and posterior wall (AAP), relative length of posterior urethra (rLPU), angle between bladder and seminal vesicle (ABS) and rectosigmoid morphological index (RMI); (3) secondary complications. Results were evaluated by an unpaired t test and ROC analysis.

Results

The sensitivity and specificity were 40.6% and 100% for pear and banana-shaped bladder, 62.5% and 100% for SI/AP, 40.6% and 100% for AAP, 62.5% and 100% for ABS, 78.1% and 72% for rLPU, 59.4% and 96% for RMI, respectively. These radiological findings partially correlated with the severity of disease weighted by hydronephrosis and treatment grade. Image analysis demonstrated high prevalence of glandular cystitis (100%) and hydronephrosis (73.4%).

Conclusion

We conclude that PL is a progressive disease involving multiple pelvic organs with high prevalence of intractable cystitis and hydronephrosis. The imaging characteristics can help predict diagnosis and, specifically appreciate progression.     

Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis

Objectives  

To estimate the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting additional lesions and contralateral cancer not identified using conventional imaging in primary breast cancer.     

MRI对原发性乳腺癌病人的术前评估:诊断准确性的系统性回顾及荟萃分析

目的评估MRI在发现原发性乳腺癌病人行常规影像未能识别的额外病灶以及对侧癌灶的诊断准确性。方法通过系统性回顾及荟萃分析评估诊断准确性以及MRI对外科手术的影响。结果回顾50篇文章,共计10811例女性     

Lexicon for standardized interpretation of gamma camera molecular breast imaging: observer agreement and diagnostic accuracy

Purpose  

To determine interobserver agreement and diagnostic accuracy using a lexicon for standardized interpretation of molecular breast imaging (MBI) studies by breast radiologists.     

MR cholangiography in symptomatic gallstones: diagnostic accuracy according to clinical risk group

PURPOSE: To assess the use of combined color Doppler ultrasonography (US), power Doppler US, and spectral wave analysis (SWA) in differentiating malignant and benign musculoskeletal tumors. MATERIALS AND METHODS: Seventy-nine musculoskeletal tumors (34 malignant, 45 benign) were examined with color and power Doppler US and SWA. Two radiologists independently assessed US images and SWA findings. Echotexture and vessel characteristics such as stenoses, occlusions, loops, shunts, trifurcations, vascular pattern, and resistive index were evaluated. All tumors were subject to US-guided or open biopsy for histologic correlation. RESULTS: Combined color and power Doppler US and SWA revealed four major (stenosis, occlusion, trifurcation, vascular pattern) and three minor (shunt, self loop, resistive index) vessel characteristics, which proved helpful in differentiating benign from malignant lesions. Echotexture showed moderate sensitivity (82% [28 of 34 tumors]) and low specificity (38% [17 of 45 tumors]). When comparing several combinations of vessel characteristics, a combination of any two major characteristics demonstrated the best results (sensitivity, 94% [33 of 39 tumors]; specificity, 93% [three of 45 tumors]). Combining more than two characteristics resulted in lower sensitivity. CONCLUSION: Combined color and power Doppler US and SWA may enable assessment of vascular architecture and altered flow of musculoskeletal tumors. Vascular architecture analysis enables differentiation of benign and malignant lesions and evaluation of musculoskeletal tumors.     

退变性症状性腰椎侧弯的临床与影像学诊断价值探讨

目的：研究退变性症状性腰椎侧弯(DLS)的病因、诊断和治疗。方法：回顾性分析13例DLS的病史、临床表现、影像学表现、手术及随访结果。结果：13例随访6～24月，平均14月，优5例，良好7例，满意1例，无并发症发生，侧弯平均矫正度为61％，前突矫正平均20％。结论：①椎间盘和关节突关节的退变导致椎体的旋转半脱位是DLS产生的主要因素；②手术的目的是减压和稳定，恢复腰椎的生理前突比矫正侧弯更重要，影像学检查对DLS的诊断、治疗及愈后的判断具有较高的价值。     

Ultrasound visualization of the breast in symptomatic patients

More than 400 breast patients (primarily symptomatic) have been examined with ultrasound alone and in combination with low-dose mammography. Symptomatic pregnant women and young patients with palpable masses were examined with ultrasound alone. In young, dense breasts, ultrasound was found to surpass mammography in the differential diagnosis of both cystic and solid masses. In older patients, the tumor characteristics displayed on ultrasound augmented those of mammography, resulting in increased diagnostic accuracy.     

Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging

Objective The objective was to evaluate the findings and diagnostic accuracy of ultrasound in antero-lateral ankle impingement (ALI) with clinical and arthroscopic correlation. Design and patients Seventeen elite footballers with chronic ankle pain were referred for ultrasound with a clinical diagnosis of ALI (n = 8) or a control condition (n = 9; lateral mechanical instability, osteochondral defect, intra-articular bodies and osteoarthritis). Ultrasound examination included the antero-lateral gutter for abnormal synovial tissue (synovitic lesion), lateral ligament integrity, tibiotalar joint and osseous spurs of the distal tibia and talus. Ultrasound findings were correlated with subsequent arthroscopic appearance. Results Ultrasound examination detected a synovitic mass in the antero-lateral gutter in all 8 footballers with clinical ALI (100%) and in 2 patients with a control diagnosis (22%). Arthroscopic correlation of antero-lateral synovitis and fibrosis was present in all 10 cases (100%). The synovitic lesion was seen at ultrasound as a nodular soft tissue mass of mixed echogenicity within the antero-lateral gutter, which extruded anteriorly with manual compression of the distal fibula against the tibia. Increased blood supply was detected using power Doppler imaging in only 1 patient. The synovitic lesion measured >10 mm in its maximum dimension in 7 footballers with clinical ALI and <10 mm in the control group. Additional ultrasound findings in patients with abnormal antero-lateral synovial tissue included an anterior talofibular ligament injury in all patients (n = 10), a tibiotalar joint effusion (n = 6) and osseous spurs (n = 4). Antero-lateral synovitic tissue was accurately identified at ultrasound in the absence of an effusion (n = 4). No synovitic lesion was detected at ultrasound or arthroscopy in the remaining 7 patients with a control diagnosis. Conclusion Ultrasound is accurate in detecting synovitic lesions within the antero-lateral gutter, demonstrating associated ligamentous injuries and in differentiating soft tissue from osseous impingement. Synovitic lesions in two control patients suggest that abnormal antero-lateral soft tissue does not necessarily imply the presence of symptomatic ALI. Synovitic lesions in excess of 10 mm were associated with symptoms. Ultrasound will not demonstrate osteocartilaginous lesions or stress fractures and may overlook some loose bodies. Ultrasound findings together with clinical correlation can be used to direct arthroscopic examination and surgical debridement.     

The diagnostic accuracy of MR imaging in osteoid osteoma

OBJECTIVE: To analyse the MR imaging appearances of a large series of osteoid osteomas, to assess the ability of MR imaging to detect the tumour, and to identify potential reasons for misdiagnosis. DESIGN AND PATIENTS: The MR imaging findings of 43 patients with osteoid osteoma were reviewed retrospectively and then compared with other imaging modalities to assess the accuracy of MR localisation and interpretation. RESULTS: The potential for a missed diagnosis was 35% based solely on the MR investigations. This included six tumours which were not seen and nine which were poorly visualised. The major determinants of the diagnostic accuracy of MR imaging were the MR technique, skeletal location, and preliminary radiographic appearances. There was a wide spectrum of MR signal appearances of the lesion. The tumour was identified in 65% of sequences performed in the axial plane. The nidus was present in only one slice of the optimal sequence in 27 patients. Reactive bone changes were present in 33 and soft tissue changes in 37 patients. CONCLUSION: Reliance on MR imaging alone may lead to misdiagnosis. As the osteoid osteoma may be difficult to identify and the MR features easily misinterpreted, optimisation of MR technique is crucial in reducing the risk of missing the diagnosis. Unexplained areas of bone marrow oedema in particular require further imaging (scintigraphy and CT) to exclude an osteoid osteoma.