Effect of head orientation on the diagnostic sensitivity of posturography in patients with compensated unilateral lesions.

Patients with compensated unilateral vestibular lesions often have no detectable abnormality on conventional posturography. The purpose of this study was to determine whether a change in head orientation could improve the diagnostic sensitivity of the test for these patients. Twenty-four patients with known unilateral vestibulopathy and twenty-four normal controls were tested on the EquiTest apparatus in four head positions: head centered, head tilted right, head tilted left, and head extended. The sensory organization test was performed for each head position, using a single trial for each sensory condition. The test sequence was randomized to account for simple order effects. The subject's equilibrium was quantified by a performance index and a composite score of all sensory conditions was calculated for each head position. Patients with unilateral vestibulopathy had more postural sway with the head tilted contralateral to the side of lesion. The difference between the mean composite scores for ipsilateral and contralateral head tilts was statistically significant (p less than 0.05). When individual trials were compared, equilibrium scores were significantly different only for sensory conditions that required vestibular input. Head extension increased postural sway in both patients and controls. Equilibrium scores were significantly different for all sensory conditions in which the support was sway-referenced. We suggest that the results of head extension in patients are similar to those found in normal individuals.(ABSTRACT TRUNCATED AT 250 WORDS)     

Current status of electronystagmography testing.

ENG testing, whether computerized or not, remains the most useful means of assessing the vestibular system. The caloric test provides invaluable site-of-lesion information that objectively documents a peripheral vestibular lesion. Double (bithermal) caloric irrigation of each ear provides a more thorough and wider range test of inner ear function than a single caloric irrigation because the vestibular system is both excited and inhibited, causing responses in opposite directions, which are important in evaluating patients with underlying spontaneous nystagmus. In an age in which economically efficient and clinically effective diagnostic methods are in high demand, ENG testing remains the gold standard of vestibular function tests.     

Diagnostic usefulness of endorectal magnetic resonance imaging with dynamic contrast-enhancement in patients with localized prostate cancer: Mapping studies with biopsy specimens

BACKGROUND: New diagnostic criteria for dynamic magnetic resonance (MR) imaging in prostate cancer are presented. The diagnostic usefulness of endorectal MR imaging with dynamic contrast-enhancement in localized prostate cancer and the validity of these criteria were evaluated. METHODS: Eighteen untreated patients who were suspected of localized prostate cancer were included in the study. They received endorectal dynamic MR imaging before systematic sextant needle biopsy. First. a mapping study with the findings of MR images and histopathology of biopsy specimens was performed in eight patients out of 18 to compare the difference in T2-weighted images with the endorectal coil and the body coil in the same individuals. Second, another mapping study was performed in all 18 patients by analyzing the findings of endorectal dynamic MR images. For the diagnosis of prostate cancer in MR imaging, we offered diagnostic criteria from our experience in addition to those in plain T2-weighted images from the literature. RESULTS: The overall diagnostic rates of endorectal dynamic MR imaging were 88.9% in accuracy, 100% in sensitivity, and 81.8% in specificity. In the comparison of the endorectal and body coils in T2-weighted images in eight patients, there was no difference in the diagnostic rates except for one more histopathologic false positive portion in endorectal MR imaging. In the second mapping study in 18 patients, the diagnostic rates were 92.6% in accuracy, 88.9% in sensitivity and 93.3% in specificity. Endorectal dynamic imaging raised the diagnostic sensitivity from 77.8 to 88.9%. CONCLUSION: The data demonstrated the validity of this diagnostic criteria and the diagnostic usefulness of endorectal dynamic MR imaging in localized prostate cancer.     

Is a raised CA 19-9 level diagnostic for a cholangiocarcinoma in patients with no history of sclerosing cholangitis ?

BACKGROUND/AIM: A cholangiocarcinoma, the second most common primary hepatic malignancy, can present with diagnostic dilemmas. The aim of this study is to assess the role of CA 19-9 in patients with a cholangiocarcinoma without primary sclerosing cholangitis. METHODS: The prospectively collected information on patients with biopsy-proven cholangiocarcinomas who had the CA 19-9 level measured was obtained (n = 68) from our computer database and medical records. These patients were compared with patients who had benign liver tumours (n = 25) and benign bile duct strictures (n = 13) who also had their CA 19-9 concentration measured. RESULTS: Sensitivity and specificity of CA 19-9 in the diagnosis of a cholangiocarcinoma were 77.9 and 76.3%, respectively, when using a cut-off value of 35 kU/l, while sensitivity and specificity were 67.5 and 86.8%, respectively, when the cut-off value was raised to 100 kU/l. The specificity was found to be higher in patients with peripheral cholangiocarcinomas (96%) using a CA 19-9 cut-off value >100 kU/l. A CA 19-9 value >600 kU/l was associated with non-resectable tumours (p = 0.05). CONCLUSIONS: This study demonstrates that CA 19-9 is a useful adjunct in the diagnosis of cholangiocarcinomas without primary sclerosing cholangitis, especially in the diagnosis of peripheral cholangiocarcinomas. However, it does not provide a reliable guide for the pathological staging of these tumours.     

Evaluation of breast lesions with contrast-enhanced ultrasound using the microvascular imaging technique: initial observations

The objective of this study was to evaluate the usefulness of contrast-enhanced ultrasound using the microvascular imaging technique in the diagnosis of breast lesions. In 104 patients with 104 breast lesions scheduled for surgery, conventional and contrast-enhanced ultrasound using the microvascular imaging technique were performed after administration of SonoVue. The enhancement patterns of breast lesions were classified as no enhancement, peripheral enhancement, homogeneous enhancement, regional enhancement, or heterogeneous enhancement based on the morphologic features of enhancement. The diagnostic value of contrast-enhanced ultrasound using the microvascular imaging technique was analyzed with the observers blinded to the clinical data and pathology (which served as the gold standard). None of the enhancement patterns was suggestive of benignity, with a sensitivity of 18.3%, specificity of 97.7%, positive predictive value (PPV) of 91.7%, negative predictive value (NPV) of 46.2%, and accuracy of 51.5%. The peripheral enhancement pattern was suggestive of malignancy, with a sensitivity of 39.5%, specificity of 98.3%, PPV of 94.4%, NPV of 69.4%, and accuracy of 73.8%. Homogeneous, regional, and heterogeneous enhancement patterns did not show meaningful diagnostic information. Contrast-enhanced ultrasound using the microvascular imaging technique provides diagnostic information on breast lesions.     

Radiologic correlates of symptom-based diagnostic criteria for chronic rhinosinusitis.

OBJECTIVE: In 1997, the Task Force on Rhinosinusitis (TFR) set forth symptom-based diagnostic guidelines for chronic rhinosinusitis (CRS). In the present study, we examined radiologic correlates of the TFR diagnostic criteria for rhinosinusitis. STUDY DESIGN AND SETTING: One hundred twenty-five consecutive patients undergoing computed tomography (CT) scans of the sinuses were studied at Oregon Health and Science University. Patients were evaluated prospectively with a questionnaire based on the TFR criteria, and their CT scans were graded according to the Lund-Mackay scoring system. RESULTS: Of the 125 patients, 115 met the symptom criteria for CRS. However, 40 of 115 had negative scans (Lund-McKay score, 0) despite meeting the diagnostic criteria for rhinosinusitis. Of 115, 75 had positive scans (Lund-McKay score, >1). Of the 10 patients who had negative diagnoses for rhinosinusitis, 9 had a positive CT scan. The Kappa coefficient was -0.103 (+/-95% confidence interval, -0.201 to -0.004), indicating poor agreement between CRS positivity and CT positivity. The sensitivity of TFR criteria for detecting a positive scan was 89%, but the specificity was poor at only 2%. CONCLUSION AND SIGNIFICANCE: Based on these pilot data, it appears that the specificity and predictive value of the current TFR criteria may not be adequate to serve as a diagnostic standard for rhinosinusitis. Additional validating data may provide guidance for improving the sensitivity and specificity of symptom-based diagnostic instruments for rhinosinusitis.     

Efficacy of the axially loaded pivot shift test for the diagnosis of a meniscal tear

Although magnetic resonance imaging (MRI) has improved the diagnostic accuracy of meniscal pathology, the authors believe that physical examination remains essential to the evaluation of knee pathology. In this study, the diagnostic accuracy of five clinical tests for meniscal pathology was prospectively evaluated in 160 patients, who thereafter underwent arthroscopy. 69% (109 knees) of the knees tested had associated ACL deficiency. There were 144 meniscal lesions in 130 of the 160 knees which were examined. The sensitivity of the tests was lower than the specificity. Conventional tests such as McMurray and Apley tests showed a low accuracy rate of 45% and 28% respectively. The diagnostic value of the axially loaded pivot shift test was significantly higher, indicating that this remains a useful diagnostic aid.     

Effectiveness of Breast-Specific Gamma Imaging (BSGI) for Breast Cancer in Korea: A Comparative Study

Abstract: Despite the fact that mammography has been the golden standard in breast cancer detection for several decades, its sensitivity decreases for women with dense breast tissue, which happens to be common in Korea. As an alternative, breast ultrasonography can be effective diagnostic modalities that complement the defect of mammography. Recently, breast‐specific gamma imaging (BSGI) has been introduced as a new diagnostic modality for breast cancer. This study was designed to analyze the effectiveness of BSGI in particular. In a retrospective study, 471 patients underwent BSGI, breast ultrasonography, and mammography simultaneously during the period between February 2009 and March 2010. The indications of BSGI were as follows: (a) patient who was diagnosed with malignancy prior to surgery, (b) patient who is under follow up after cancer surgery, (c) patient with lesions which cannot be evaluated by breast ultrasonography or mammography, (d) patient with multiple benign lesions, and (e) patient with suspicious lesion who refuses biopsy. Among these patients, 121 patients underwent biopsy, whereas others were followed up with imaging studies. We compared the BSGI results with those of mammography, breast ultrasonography, and pathology. The mean age of the patients was 49.63 ± 10.43 years. There were 107 patients with 110 malignant lesions and 364 patients with benign lesions. Total 474 lesions were evaluated. The sensitivities of BSGI, mammography, and breast ultrasonography were 94.45%, 93.64%, and 98.18%, respectively, whereas the specificities of BSGI, mammography, and breast ultrasonography were 90.93%, 90.66%, and 87.09%, respectively. The sensitivity and specificity of BSGI for axillary lymph node (LN) status were 44.7 4% and 87.88%, respectively. BSGI is a good complementary imaging modality with high sensitivity and high specificity for breast cancer detection. However, it has low efficacy for the evaluation for axillary LN status.     

Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies

BACKGROUND: A study was undertaken to assess the diagnostic value of different clinical criteria and the impact of microbiological testing on the accuracy of clinical diagnosis of suspected ventilator associated pneumonia (VAP). METHODS: Twenty five deceased mechanically ventilated patients were studied prospectively. Immediately after death, multiple bilateral lung biopsy specimens (16 specimens/patient) were obtained for histological examination and quantitative lung cultures. The presence of both histological pneumonia and positive lung cultures was used as a reference test. RESULTS: The presence of infiltrates on the chest radiograph and two of three clinical criteria (leucocytosis, purulent secretions, fever) had a sensitivity of 69% and a specificity of 75%; the corresponding numbers for the clinical pulmonary infection score (CPIS) were 77% and 42%. Non-invasive as well as invasive sampling techniques had comparable values. The combination of all techniques achieved a sensitivity of 85% and a specificity of 50%, and these values remained virtually unchanged despite the presence of previous treatment with antibiotics. When microbiological results were added to clinical criteria, adequate diagnoses originating from microbiological results which might have corrected false positive and false negative clinical judgements (n = 5) were countered by a similar proportion of inadequate diagnoses (n = 6). CONCLUSIONS: Clinical criteria had reasonable diagnostic values. CPIS was not superior to conventional clinical criteria. Non-invasive and invasive sampling techniques had diagnostic values comparable to clinical criteria. An algorithm guiding antibiotic treatment exclusively by microbiological results does not increase the overall diagnostic accuracy and carries the risk of undertreatment.     

经阴道超声输卵管显影与腹腔镜检查的对照研究

目的 :通过与腹腔镜检查的比较 ,评价经阴道超声输卵管显影对输卵管病变的诊断价值。　方法 :对 5 2例原发性或继发性不孕症病人的 10 4根输卵管在生理盐水和空气的介导下进行经阴道超声输卵管显影的检查 ,继之作腹腔镜检查并以美蓝作输卵管通色素试验 ,二者的结果作kappa分析。　 结果 :对输卵管伞端形态异常 ,2种方法的诊断符合率为 82 .7% ,超声输卵管显影的灵敏度和特异度分别为 77.4 %和 87.2 % ;对输卵管周围粘连 ,符合率为 80 .8%。灵敏度和特异度分别为 79.4 %和 83 .0 % ;对输卵管通畅性的诊断 ,3项指标分别为 87.5 % ,87.7%和 87.0 %。超声输卵管显影对输卵管病变的诊断价值与腹腔镜检查无显著性差异。　结论 :经阴道超声输卵管造影是一种可靠实用的检查方法 ,可作为不孕症初步诊断中首选方法。     

乳管镜在乳头溢液诊治中的临床应用价值

目的:探讨乳管镜在病理性乳头溢液诊断中的临床应用价值。方法:回顾性分析1 606例经乳管镜检查并行手术切除的病理性乳头溢液患者患者的临床资料。结果:乳管镜检查结果与病理结果尚不完全符合,但两种方法一致性较高(Κ=0.828)。乳管镜诊断的灵敏度为95.5%,特异度为88.6%,与病理诊断的符合率为94.0%。结论:乳管镜在乳头溢液检测中具有良好的灵敏性和特异性,且与病理结果具有高度的一致性,可作为临床诊断乳腺疾病的重要手段。     

Comparison of heel ultrasound and finger DXA to central DXA in the detection of osteoporosis. Implications for patient management.

The goal of the study was to investigate the potential discordance in patient management when a clinician assumes that a peripheral device is a diagnostic surrogate for central DXA in the detection and treatment of osteoporosis. Over a period of 2 mo, asymptomatic women seeking conventional central DXA evaluation for osteoporosis at a diagnostic imaging center were also evaluated with heel ultrasound and finger DXA peripheral imaging devices. T-Scores of -2.5 or less in screening examinations were used to evaluate the discordance between the two peripheral devices and central DXA in the identification of patients with osteoporosis. Higher T-score cutoffs (>-2.5) were also evaluated. Using central DXA as the standard for comparison, the sensitivity of heel ultrasound for screening cases was 0.34 and specificity was 0.92. For finger DXA, sensitivity was 0.23 and specificity was 0.92. Overall discordance between the peripheral devices and central DXA was 21% (heel) and 23% (finger). Heel ultrasound identified 7 out of every 22 osteoporotic patients diagnosed with central DXA. Finger DXA identified 5 out of every 22 osteoporotic patients. Using lower T-scores for the peripheral devices increased sensitivity but markedly increased discordance with DXA. The peripheral devices we studied cannot be considered equivalent surrogates for central DXA in the screening of asymptomatic women for osteoporosis.     

Correlation of pathology observed in double contrast arthrotomography and arthroscopy of the shoulder

Correlation of double contrast arthrotomography (DCAT) of the shoulder and arthroscopic surgery diagnostic results have been undertaken in 55 patients with persistent shoulder pain or involuntary shoulder instability. During the period March 1984 to December 1986, 55 patients underwent DCAT followed by videotaped diagnostic shoulder arthroscopy. The primary indication for DCAT was persistent pain in 36 patients and instability in 17 patients. DCAT was performed according to the method of El-Khoury and Albright, and all arthroscopies were performed in a similar fashion by the senior author (HJS). Both tests were reviewed separately, retrospectively, and their results were correlated. For combined (anterior and posterior) labral pathology, the sensitivity/specificity for the instability group was 0.91/0.91, respectively; sensitivity/specificity for the pain group was 0.63/0.94. DCAT accurately depicted the status of 76% of anterior labrums and 96% of posterior labrums. For complete rotator cuff tears, sensitivity/specificity was 1.0/0.94. The status of a complete rotator cuff tear was accurately depicted in 91% of patients. Partial rotator cuff tears were missed in 83% of patients by DCAT. The presence or absence of loose bodies was accurately represented by 96% of DCAT. Arthroscopy showed that 71% of the instability patients had a labral tear, compared with 44% of the pain patients. Rotator cuff pathology was present in 12% of instability patients and 42% of pain patients. These findings indicate that DCAT may be a conditionally reliable test in the diagnosis of shoulder instability. DCAT must be considered inconclusive, however, in the painful shoulder without instability. Its usefulness as a preoperative screening test is discussed, and a diagnostic algorithm is presented. DCAT does not equal the diagnostic accuracy of shoulder arthroscopy.     

Diagnostic evaluation and classification criteria in Sjögren's Syndrome

ObjectivesOur objective is to carry out a clinical study of the performance of the preliminary European classification criteria for Sjögren Syndrome and that of the criteria proposed by the American European Consensus Group.MethodsEighty-eight patients who had undergone a biopsy of the salivary gland on suspicion that they were suffering from Sjögren Syndrome were studied by two independent rheumatologists. Two pathologists independently revised the biopsies without knowing the diagnosis. With all of this information, the clinicians established, or did not establish, a diagnosis of primary Sjögren Syndrome or secondary Sjögren Syndrome. Finally, it was analysed whether or not the patients met the American European Consensus Group classification criteria and the preliminary European criteria for primary Sjögren Syndrome and secondary Sjögren Syndrome, and their sensitivity and specificity with respect to the clinical diagnosis were determined.ResultsClinicians estimated that 35 cases (39.8%) had primary Sjögren Syndrome (kappa 0.718) and 17 cases (19.3%) had secondary Sjögren Syndrome (kappa 0.761). The specificity and sensitivity of American European Consensus Group criteria, with regard to the clinical diagnosis, for primary Sjögren Syndrome were 97.2% and 48.6%, respectively. For secondary Sjögren Syndrome, the specificity was 97.2% and the sensitivity 64.7%. The preliminary European criteria for primary Sjögren Syndrome demonstrated a lesser specificity (75%), but a higher sensitivity (65.7%). In secondary Sjögren Syndrome the specificity reached 97.2% with sensitivity at 70.6%.ConclusionsThese results underline the difficulty in applying the Sjögren Syndrome classification criteria from the American European Consensus Group and the preliminary European criteria, in the diagnosis of individual patients.     

Diagnostic criteria for non-traumatic osteonecrosis of the femoral head. A multicentre study.

Six major and seven minor diagnostic criteria have been developed by the Japanese Investigation Committee for osteonecrosis of the femoral head (ONFH). We have carried out a multicentre study to clarify these. We studied prospectively 277 hips in 222 patients, from six hospitals, who had ONFH and other hip pathology and from whom histological material was available. We identified five criteria with high specificity: 1) collapse of the femoral head without narrowing of the joint space or acetabular abnormality on radiographs, including the crescent sign; 2) demarcating sclerosis in the femoral head without narrowing or acetabular abnormality; 3) a 'cold-in-hot' appearance on the bone scan; 4) a low-intensity band on T1-weighted images (band pattern); and 5) evidence of trabecular and marrow necrosis on histological examination. With any combination of two of these criteria, the sensitivity and specificity of the diagnosis were 91% and 99%, respectively.     

Comparison of optokinetic nystagmus elicited by full versus partial visual field stimulation: diagnostic implications.

Optokinetic nystagmus (OKN) testing is one method to determine central vestibular dysfunction. OKN may be elicited by partial visual field stimulation with a light bar (OKN-ENG) or by full visual field stimulation with rotating stripes in a rotational chair test booth (OKN-RVT). OKN-ENG and OKN-RVT were elicited in 36 healthy subjects and 48 patients with known peripheral or central vestibular disorders. Abnormal test results suggested central pathology in 29 of 36 healthy subjects with OKN-ENG versus 1 of 36 with OKN-RVT. Twenty-eight of 33 patients with peripheral pathology demonstrated abnormal OKN-ENG findings, whereas 4 of 33 had abnormal OKN-RVT results. Thirteen of 15 patients with central vestibular disorders had abnormal OKN-ENG, whereas 7 of 15 had abnormal OKN-RVT. Sensitivity and specificity of OKN-ENG were 86.7% and 17.4% versus 46.7% and 92.7%, respectively, for OKN-RVT. These findings were statistically significant (P < 0.00001). OKN elicited by full visual field stimulation (OKN-RVT) is a more accurate indicator of central disease than OKN elicited by partial visual field stimulation (OKN-ENG). The use of OKN-ENG to identify central vestibular dysfunction is questionable.     

Does Doppler echography have a diagnostic role in patency assessment of internal thoracic artery grafts?

The amount of literature published over the past decade comparing coronary angiography with transthoracic Doppler echocardiography assessment of internal thoracic artery graft patency after CABG is substantial. There has been no review of the available literature, and conflicting reports of diagnostic accuracy have prevented routine use of transthoracic Doppler in graft patency assessment. Thus, this article reviews the available literature on diagnostic accuracy of transthoracic Doppler echocardiography of coronary bypass grafts. Relevant studies were identified and meta-analysis of diagnostic accuracy was performed. Study quality was assessed. Quantitative data synthesis included calculation of sensitivity, specificity, summary receiver operating characteristic curve analysis, pooled analysis and meta-regression of accuracy against study quality, publication date, angina, probe frequency and diagnostic criteria. Twenty studies of 929 patients produced 26 results included for analysis. Grafts were not visualized in 93 (10%) patients. Pooled sensitivity (85%) and specificity (94%) and diagnostic odds ratio (100.7) were high. SROC analysis showed an area under the curve of 0.96. Heterogeneity of results was due to variations in diagnostic criteria and study size. Subgroup analysis showed best performance in patients with postoperative angina (p = 0.014). Study quality did not affect results. Diastolic fraction less than 0.5 (sensitivity 89%, specificity 94%) was shown to be the best criterion for prediction of stenosis. Performance was lower using peak diastolic to systolic velocity ratio less than 1 (sensitivity 85%, specificity 86%). Transthoracic Doppler echography is effective in first-line assessment of left internal thoracic artery graft patency. It shows high specificity, prevents invasive investigations and improves in patients with postoperative angina. TDE is best used in combination with other non-invasive tests due to its inability to visualize the graft. The potential for use in postoperative coronary bypass patients is high.     

Predictive value of magnetic resonance imaging in differentiating between leiomyoma and adenomyosis.

OBJECTIVE: We evaluated the role of MRI as a preoperative diagnostic tool for leiomyoma and adenomyosis. METHOD: This is a retrospective chart review at a university-based hospital. The study included 1517 women who underwent hysterectomy or myomectomy over a 5-year period, and 153 women with a preoperative pelvic MRI were included. Comparisons were made between the results of the MRI and postoperative pathology reports. RESULTS: The MRI and pathology report were the same for 136 of 144 women with leiomyoma and 12 of 31 women with adenomyosis. The MRI had 94% sensitivity and 33% specificity for leiomyoma and 38% sensitivity and 91% specificity for adenomyosis. Positive and negative predictive values of MRI for leiomyoma were 95% and 27% with 90% accuracy. Positive and negative predictive values of MRI for adenomyosis were 52% and 85%, respectively, with 80% accuracy. CONCLUSION: MRI has a high sensitivity and a low specificity for diagnosing leiomyoma and a high specificity and a low sensitivity for diagnosing adenomyosis. Due to the high cost and technical variations, we suggest using MRI only as an adjunctive diagnostic tool when ultrasound is not conclusive and differentiation between the 2 pathologies ultimately affects patient management.     

Positron emission tomography is superior to computed tomography for metastatic detection in melanoma patients

BACKGROUND: Whole-body positron emission tomography (PET) provides diagnostic information not currently available with traditional imaging and may improve the accuracy of staging melanoma patients. METHODS: A retrospective cohort review was performed of 104 patients with primary or recurrent melanoma who underwent PET to determine sensitivity/specificity for metastatic detection compared with body computed tomography (CT). One hundred fifty-seven PET and 70 CT scans were analyzed, with a median patient follow-up of 24 months. Metastases were confirmed with positive histology (87.5%) or documented disease progression (12.5%). Fifty-three patients prospectively underwent consecutive studies within a mean 3-week interval for direct comparative analysis. RESULTS: PET demonstrated 84% sensitivity (95% confidence interval [CI],.78 to.89) and 97% specificity (95% CI,.91 to.99), whereas CT showed 58% sensitivity (95% CI,.49 to.66) and 70% specificity (95% CI,.51 to.84). Exclusion of areas not evaluated on CT (head, neck/supraclavicular, extremities) increased CT sensitivity to 69% (95% CI,.59 to.77). Sixty-six consecutive PET and CT scans were performed with 81% and 57% of metastases detected, respectively. CONCLUSIONS: PET is more sensitive and specific than CT for detection of melanoma metastasis and should be considered the primary staging study for recurrent disease. PET shows greater ability to detect soft tissue, small-bowel, and lymph node metastasis that do not meet criteria designated as abnormal by CT. PET is superior to CT even when sites not routinely evaluated by CT are excluded from comparative analysis.     

梗阻性黄疸经皮肝穿刺胆道活检与影像学诊断比较研究

目的:比较经皮肝穿刺胆道造影术(PTC)下胆道活检和螺旋CT对梗阻性黄疸的诊断价值.方法:收集2010年3月-2012年12月78例因梗阻性黄疸住院的患者资料,患者均进行PTC活检和螺旋CT诊断,根据外科手术病理活检结果对两种方法进行比较.结果:78例患者中,9例确诊为良性梗阻性黄疸,69例确诊为良性梗阻性黄疸,后者包括胆管上皮源性肿瘤46例,非胆管上皮源性肿瘤23例;PTC活检灵敏度85.51％,特异度66.67％;螺旋CT灵敏度78.26％,特异度77.78％.PTC活检灵敏度高于螺旋CT,特异度低于螺旋CT,差异均有统计学意义(均P＜0.05).46例胆管癌患者中,PTC活检阳性43例(93.48％),螺旋CT阳性37例(80.43％),23例非胆管癌患者中,PTC活检阳性19例(82.61％),螺旋CT阳性17例(73.91％);PTC活检灵敏度均高于螺旋CT(P＜0.05),且PTC活检对胆管癌灵敏度高于非胆管癌(P＜0.05),螺旋CT两种病理来源灵敏度差异无统计学意义(P＞0.05).结论:PCT活检对不同类型梗阻性黄疸尤其是胆管癌诊断灵敏度均高于螺旋CT,但禁忌证多,临床可酌情选择不同方法辅助诊断.