Can follow-up radiography for acute scaphoid fracture still be considered a valid investigation?

AIM: To determine whether follow-up radiography is a valid diagnostic investigation in patients with suspected acute scaphoid fractures and normal initial radiographs. MATERIALS AND METHODS: Fifty sets of radiographs (initial and follow-up) were independently assessed by four expert observers for the presence or absence of a scaphoid fracture. Magnetic resonance imaging (MRI), performed in all cases, was used as the gold standard to determine the sensitivity, specificity, positive and negative predictive values of the observers' assessment of the follow-up radiograph. In addition, the reliability among observers of the follow-up radiograph was determined by reliability variance analysis. RESULTS: Of the 50 sets of radiographs, 35 patients had a scaphoid fracture and 15 were normal, as established from MRI report. For individual observer's assessment of the follow-up radiograph, sensitivities of 11, 9, 43 and 49%; specificities of 93, 93, 87 and 80%; positive predictive values of 80, 75, 88 and 85%; and negative predictive values of 31, 30, 39 and 40%. A reliability coefficient of more than 60% is needed for a diagnostic test to be considered reliable. Overall, the inter-observer reliability coefficient was 33%, with pair-wise inter-observer coefficients ranging from 18-53%. CONCLUSION: With poor sensitivity, poor negative predictive value and poor reliability, follow-up radiography cannot be considered a valid diagnostic examination for the detection of scaphoid fracture in patients with normal initial radiographs.     

A computer-aided diagnosis system to screen for osteoporosis using dental panoramic radiographs

OBJECTIVES: An eroded inferior cortex of the mandible detected on dental panoramic radiographs is useful for identifying post-menopausal women with low skeletal bone mineral density (BMD) or osteoporosis. The purposes of this study were to develop a computer-aided diagnosis (CAD) system that automatically determines cortical erosion of the mandible on dental panoramic radiographs and to assess the validation of this CAD system. METHODS: A CAD system was developed based on mathematical morphology for identifying post-menopausal women with low skeletal BMD or osteoporosis, based on World Health Organization criteria, by identifying whether the endosteal margin of mandibular cortical bone was eroded. The sensitivity, specificity, predictive value, accuracy and likelihood for a positive risk result were calculated using dichotomous 2 x 2 tables using 100 panoramic radiographs. RESULTS: For identifying women with low skeletal BMD, the sensitivity and specificity were 76.8% and 61.1%, respectively, the positive and negative predictive values were 90.0% and 36.7%, accuracy was 74.0% and the likelihood for positive risk was 1.96. The respective values for identifying women with osteoporosis were 94.4% and 43.8%, the positive and negative predictive values were 48.6% and 93.3%, respectively, the accuracy was 62.0% and the likelihood for positive risk was 1.68. CONCLUSION: Our results suggest that a CAD system applied to dental panoramic radiographs may be useful for identifying post-menopausal women with low skeletal BMD or osteoporosis.     

物理检查和MRI检查在前交叉韧带完全断裂中的诊断价值

目的 比较并评价物理检查、MRI检查对前交叉韧带(ACL)完全断裂的诊断价值.方法 回顾性分析2005年8月-2006年4月因单侧膝关节外伤、初诊怀疑为单纯膝关节韧带断裂或伴有半月板损伤而需入院手术的患者115例,于入院时分别行MRI检查及物理检查,后者包括前抽屉试验、Lachman试验、轴移试验.并于3日内对所有患者行关节镜检查.以膝关节镜检查为金标准,运用临床流行病学方法对各诊断试验的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、准确度进行评价和比较. 结果 经关节镜检查证实,115例患者中确诊为ACL完全断裂的有41例,物理检查和MRI检查比较,灵敏度为95.1%、92.7%,特异度为87.8%、97.3%,阳性预测值为81.3%、95.0%,阴性预测值为97.0%、96.0%,准确度为90.4%、95.7%,阳性似然比为7.80,34.33,阴性似然比为0.06,0.08. 结论 在诊断ACL完全断裂方面,MRI与物理检查相比具有更高的诊断价值,但是,专业规范的物理检查也可以获得较高的诊断价值,因此在l临床实践中不应被忽视.     

Survey of radiographic practices for periodontal disease in UK and Irish dental teaching hospitals

OBJECTIVES: To assess current radiographic practices in dental teaching hospitals for the management of patients with periodontal diseases. METHODS: All 17 dental teaching hospitals in UK and Ireland were sent a questionnaire on radiographic equipment and radiograph selection currently used for assessment of patients with destructive periodontal diseases. Opinions were recorded for advantages and disadvantages of the most frequently used radiographic views. RESULTS: A 100% response rate was achieved. All hospitals used panoramic and specific periapical radiographs as one of their radiographic regimes for patients with periodontal disease. Fifty-three per cent of respondents most frequently took panoramic and selected periapical radiographs. Twenty-four per cent took full mouth periapical radiographs (FMPAs) most frequently and 18% took a panoramic radiograph alone. Twenty-four per cent of hospitals operated a protocol for selection of radiographs for periodontal patients. CONCLUSIONS: The most commonly used views taken to assess periodontal status are panoramic radiographs with selected periapicals. Few hospitals operate a protocol for prescribing radiographs.     

Marginal bone in periodontal disease: an evaluation of image quality in panoramic and intra-oral radiography

Five observers assessed the panoramic and full-mouth (14 periapical and four posterior bitewing) radiographs of 20 patients each for the ability to interpret and measure the marginal bone level. The image quality of each site was classified as excellent, acceptable or unacceptable. Depiction errors affecting interpretability and measurability were also noted. In the upper arch, the frequency of uninterpretable and non-measurable sites was almost equal for panoramic and periapical radiography. Image quality was better with periapical radiography in the lower arch. In the posterior regions of both arches, more sites could not be measured from panoramic compared with bitewing radiographs. Due to overlapping the distal surface of the maxillary canine and the mesial surface of the first maxillary premolar could often not be interpreted in either panoramic or periapical radiographs, but infrequently in the bitewings. In the lower arch, the most frequent depiction error was inadequate density in the incisor region of panoramic radiographs. On the basis of these results, we proposed that in clinical practice the panoramic radiograph can be supplemented with individually selected periapicals. In epidemiological studies, the panoramic radiograph should be combined with a premolar bitewing radiograph.     

Fractal dimension on dental radiographs

OBJECTIVES: (1) To compare fractal dimension (FD) from periapical radiographs with FD from panoramic radiographs; (2) to correlate FD with cortical thickness and morphology; and (3) to correlate FD with a reported history of osteoporotic fractures. METHODS: Information on fracture and smoking history was obtained by a telephone interview with 281 elderly (>60 years of age) patients who had periapical and panoramic radiographs exposed on the same date. FD was measured in several locations on both types of radiograph. Mandibular cortical thickness and morphology were obtained from the panoramic radiograph. RESULTS: FD measured in the mandible was lower than FD in the maxilla. Same-jaw measurements had a higher correlation than same-side measurements. FD measured on panoramic radiographs was lower than FD from periapical radiographs. There was a negative correlation between cortical thickness and FD. FD was higher in subjects with more mandibular cortical porosities and resorption. The mean panoramic FD from subjects with a history of osteoporotic fractures was significantly higher, after adjusting for smoking, gender, age, height and weight. CONCLUSIONS: FD measured on panoramic radiographs is lower than FD measured on periapical radiographs. FD is higher in both types of radiograph in subjects with a thinner, severely eroded mandibular cortex and a history of osteoporotic fractures. This study confirms other reports that FD increases when bone mass decreases. In addition, it suggests that panoramic radiographs can be used as a possible alternative for the measurement of FD to periapical radiographs.     

A retrospective study evaluating the use of the panoramic radiograph in endodontics

Patients are referred to the endodontist to have root canal therapy performed to treat pulpal and periradicular diseases. Routinely, the only radiograph to accompany the patient is the periapical radiograph. This radiograph is inadequate in the detection of asymptomatic pathosis that may be present in other areas of the maxilla and mandible. The military's readiness mission requires that a panoramic radiograph be part of the patient's dental record. In addition to its use for personal identification purposes, the panoramic radiograph is an excellent diagnostic tool that can give the clinician an overall view of the dentoalveolar structures. This retrospective study evaluated randomly selected panoramic radiographs and recorded the presence of radiolucent and radiopaque areas not evident on a referral periapical radiograph. The results of this study found a 4.2% occurrence of undiagnosed pathosis following additional radiographs and clinical examinations.     

Diagnostic performance of general dental practitioners after lecture in identifying post-menopausal women with low bone mineral density by panoramic radiographs

OBJECTIVES: Mandibular cortical erosion detected on panoramic radiographs may be useful for identifying post-menopausal women with low skeletal bone mineral density (BMD). The purposes of this study were to calculate the diagnostic performance of general dental practitioners (GDPs) who attended a lecture on identifying post-menopausal women with low BMD from findings on panoramic radiographs and to evaluate the influence of GDPs' age on diagnostic performance. METHODS: After a 1 h lecture, 111 GDPs were asked to classify the mandibular cortex (normal or eroded) on panoramic radiographs obtained from 100 post-menopausal women who have had skeletal BMD assessment. Low BMD was defined as a BMD T score of -1.0 or less. Diagnostic performance was analysed by comparing two groups classified by mandibular cortex (women with normal cortex and women with any eroded cortex) with those classified by BMD (women with normal BMD and women with low BMD). RESULTS: The mean sensitivity, specificity, positive predictive value, negative predictive value, accuracy and likelihood ratio for a positive risk result were 73.0% (95% confidence interval [CI]; 71.3 to 74.7%), 49.0% (95% CI; 46.4 to 51.5%), 66.9% (95% CI; 66.0 to 67.8%), 57.0% (95% CI; 55.8 to 58.2%), 62.9% (95% CI; 62.1 to 63.7%) and 1.51 (95% CI; 1.44 to 1.58), respectively. GDPs' age did not influence diagnostic performance. CONCLUSIONS: Our results suggest that 73.0% of women who had low skeletal BMD can be identified by GDPs after a lecture on the use of panoramic radiographs as an aid in diagnosing low BMD; however, the diagnostic performance may not be influenced by GDPs' age.     

Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery

OBJECTIVES: The purpose of this study was to assess the diagnostic accuracy of the panoramic radiograph in the detection of carotid artery calcification using CT as the gold standard. METHODS: 110 dental patients (average age 65.2 years, range 50-82 years) with both panoramic radiographs and CT scans available were selected for the evaluation of carotid artery calcification. Two oral and maxillofacial radiologists interpreted the panoramic radiographs for the presence of carotid artery calcification. CT scans were independently interpreted by a neuroradiologist. RESULTS: The accuracy of panoramic radiographs in the detection of carotid artery calcification was 62.3%. The sensitivity and the specificity were 22.2% and 90.0%, respectively. CONCLUSIONS: Panoramic radiography has a moderate diagnostic accuracy in the detection of carotid artery calcification, but the sensitivity is low.     

Nontraumatic acute abdominal pain: unenhanced helical CT compared with three-view acute abdominal series

PURPOSE: To prospectively evaluate and compare the diagnostic accuracy of unenhanced helical computed tomography (CT) for patients with nontraumatic acute abdominal pain with that of traditional abdominal radiography. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained; this study was completed before implementation of the HIPAA. Ninety-one patients (44 men; 47 women; age range, 18-84 years; mean age, 48.5 years) with acute nontraumatic abdominal pain over a 7-month period were referred by the emergency department of one institution. These patients underwent a three-view acute abdominal series (AAS) and unenhanced helical CT. AAS included an upright chest radiograph and upright and supine abdominal radiographs. Unenhanced helical CT images with 5-mm collimation were obtained from the lung bases to the pubic symphysis, without intravenous, oral, or rectal contrast material. AAS and unenhanced helical CT images were each separately and prospectively interpreted by a different experienced radiologist who was blinded to patient history and the images and interpretation of the other examination for each patient. Final diagnosis was established with surgical, pathologic, and clinical follow-up. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and positive and negative likelihood ratios were calculated for AAS and unenhanced helical CT. Confidence intervals of 95% were calculated for each value with the standard equation for population proportions. Results of AAS and unenhanced helical CT examinations were compared with chi2 analysis. RESULTS: Among the 91 patients examined, unenhanced helical CT yielded an overall sensitivity, specificity, and accuracy of 96.0%, 95.1%, and 95.6%, respectively. The AAS interpretations yielded an overall sensitivity, specificity, and accuracy of 30.0%, 87.8%, and 56.0%, respectively. The accuracy of unenhanced helical CT was significantly greater than the accuracy of AAS (P < .05). CONCLUSION: AAS is an insensitive technique in the evaluation of nontraumatic acute abdominal pain in adults. Unenhanced helical CT is an accurate technique in the evaluation of adult patients with nontraumatic acute abdominal pain and should be considered as an alternative to radiography as the initial imaging modality.     

急性阑尾炎超声检查方法的再探讨

目的为提高急性阑尾炎超声诊断的准确性,对其超声检查方法予以进一步探讨。方法对278例疑似急性阑尾炎患者术前随机分成两组,分别行方法一、二两种检查,结果与手术病理对照。结果方法一的敏感度65.3%,特异度44.4%,阳性预测值88.7%,阴性预测值16.0%,准确度69.7%,阳性似然比1.5。方法二的敏感度90.4%,特异度84.0%,阳性预测值96.3%、阴性预测值65.6%、准确度89.2%,阳性似然比5.7。结论检查方法二明显提高了急性阑尾炎术前诊断的准确性。     

Observer performance in the assessment of periapical pathology: a comparison of panoramic with periapical radiography.

Observer performance in the assessment of the periapical pathology from panoramic and periapical radiography was examined. Five endodontists, five general practitioners and five oral radiologists were asked to assess the periapical status of 117 teeth. The observers assessed the panoramic and periapical radiographs of the teeth, which were evenly distributed throughout the jaws with a 50% probability that either an osteolytic or sclerotic lesion was present. The results of the comparison between panoramic and periapical radiography were influenced by the selection of observers. When the oral radiologists acted as observers, the mean P(A) value for periapical radiography was higher than for panoramic radiography (P less than 0.001), resulting in periapical radiography presenting a higher overall diagnostic accuracy than panoramic radiography for all 15 observers (P less than 0.01). There was, however, no difference between panoramic and periapical radiography when the two groups of endodontists and general practitioners acted as observers. The comparison of the three groups of observers showed no difference between their diagnostic accuracy when assessing panoramic radiographs. With periapical radiography, the oral radiologists demonstrated a higher diagnostic accuracy than the endodontists (P less than 0.05). The observers in each group with the highest diagnostic accuracy also had the highest intra-observer agreement. The mean intra-observer agreement of the five general practitioners was higher than those of the other two groups of observers for panoramic radiography. For periapical radiography, the mean agreement rates of the groups were comparable.     

The validity of the motion palpation test for determining patellofemoral joint articular cartilage damage

ObjectivesThis study investigated the validity of the motion palpation test (MPT) for pre-operatively grading patellofemoral joint articular cartilage damage.DesignRetrospective review of cases.ParticipantsConsecutive patients (N=188) with suspected patellofemoral joint articular cartilage damage.ProcedureThe medical records of patients who underwent clinical examination using the MPT and proceeded to undergo knee arthroscopy were reviewed.ResultsBased on arthroscopic findings the MPT revealed excellent overall sensitivity (87%), positive test predictive value (97%), and accuracy (85%), but specificity (33%) and negative test predictive values (10%) were poor. However, overall likelihood ratios for a positive (1.3) or negative (0.39) test indicated only a minimal increase in the likelihood of having articular cartilage damage with a positive test, and only a small decrease in ruling-out the condition with a negative test. With a severe MPT crepitation grade subclassification, sensitivity was 65%, specificity was 96%, positive test predictive value was 99%, negative test predictive value was 38%, and accuracy was 99%. For a moderate MPT crepitation grade sensitivity was 77%, specificity was 44%, positive predictive value was 81%, negative predictive value was 38%, and accuracy was 81%. For a mild MPT crepitation grade sensitivity was 66%, specificity was 51%, positive test predictive value was 77%, negative test predictive value was 38%, and accuracy was 62%. Positive likelihood ratios for MPT crepitation grade subclassifications revealed a large and likely conclusive increase in the likelihood of having articular cartilage damage for the severe condition (16.25, 95% CI 9.9, 22.6), but only a minimal likelihood for ruling-in the disease for mild (1.35, 95% CI −5, 7.7) or moderate (1.38, 95% CI −5, 7.7) conditions. Having a negative test was suggestive of only a small or minimal decrease in ruling-out the disease for all conditions (0.67–0.36).ConclusionsMPT is only useful as a physical examination tool for identifying patellofemoral joint articular cartilage damage when the crepitation grade subclassification is severe.     

CTA与MRA诊断动脉瘤及评估动脉瘤破裂风险的比较

 目的 比较CT血管造影术(CT angiography,CTA)与磁共振血管造影(magnetic resonance angiography,MRA)诊断动脉瘤与动脉瘤破裂的风险评估价值。方法 48例高度怀疑为颅内动脉瘤患者随机分为两组,每组24例,记为Ⅰ组和Ⅱ组,其中Ⅰ组行CTA+DSA检查,Ⅱ组行MRA+DSA检查。比较CTA及MRA对颅内动脉瘤的诊断灵敏度、诊断特异性、阳性预测值、阴性预测值及准确率。比较CTA及MRA对5 mm以上动脉瘤的诊断价值。结果 MRA诊断颅内动脉瘤的诊断灵敏度、诊断特异性、阳性预测值、阴性预测值、准确率较CTA稍低,但二者差异无统计学意义。CTA与三维增强MR血管成像(3D CE-MRA)对5 mm以上动脉瘤的诊断能力相当,但与三维时间飞跃法MR血管成像(3D TOF MRA)相比,CTA与CE-MRA的诊断灵敏度、诊断特异性、阳性预测值、阴性预测值、准确率明显较高,差异有统计学意义(P<0.05);CTA能更清楚地显示瘤颈。结论 CTA和MRA可作为诊断动脉瘤与动脉瘤破裂的风险评估的首要手段,CTA诊断的准确率及三维形态高于MRA。     

Physical examination for partial tears of the biceps tendon

BACKGROUND: The accuracy of the physical examination for tears of the long head of the biceps remains controversial. PURPOSE: The goals were 1) to characterize the occurrence of partial tears of the long head of the biceps tendon in a group of consecutive patients, and 2) to analyze the diagnostic value of various clinical tests for pathologic lesions of the proximal biceps tendon. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Of 847 consecutive patients who underwent arthroscopic procedures for a variety of shoulder conditions, 40 were found at the time of arthroscopy to have partial biceps tendon tears. The average age of these 24 men and 16 women was 59 years (range, 18-83). Preoperative physical examinations had included 9 commonly used tests for shoulder examination. Statistical analysis included sensitivity, specificity, negative predictive value, positive predictive value, and likelihood ratios for these tests. RESULTS: The prevalence rate of partial tears was 5% (40/847) of all arthroscopic procedures. The most commonly associated conditions included rotator cuff tears (85% [34/40]) and anterior instability (7.5% [3/40]). Tenderness on palpation of the long head of the biceps tendon had a sensitivity of 53%, a specificity of 54%, and a likelihood ratio of 1.13. The sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios for Speed's test were 50%, 67%, 8%, 96%, and 1.51, respectively. CONCLUSION: In patients with rotator cuff abnormality, the diagnosis of partial biceps tears cannot be made reliably with existing physical examination tests. Diagnostic arthroscopy is recommended, if clinically indicated, for potential partial tears of the long head of the biceps tendon. The treating physician should be prepared to treat unsuspected tears of the long head of the biceps tendon at the time of surgery.     

Prospective validation of the Ottawa Ankle Rules in a deployed military population

This study prospectively validated the Ottawa Ankle Rules (OAR) in patients presenting with acute ankle trauma to a deployed military clinic at Prince Sultan Air Base in Saudi Arabia. The treating physician determined whether the patient met OAR criteria. The decision to obtain radiographs was left to the discretion of the physician. All radiographs were read by a radiologist blinded to the study. Patients who were not evaluated by radiographs received follow-up in the orthopedic clinic or by telephone. Forty-five consecutive patients were enrolled over a 3-month period. Twenty-nine (64%) patients met the OAR criteria, 32 (71%) received radiographs, and 5 (11%) fractures were identified. All fractures were predicted by the OAR. The sensitivity of the OAR was 1.0 and specificity was 0.40. Negative predictive value was 1.0, positive predictive value was 0.17, likelihood ratio positive value was 1.67, and likelihood ratio negative value was 0.0. The OAR correctly predicted all ankle fractures in the military population studied.     

急诊晕厥患者危险分层评估方法的临床应用与比较

 目的 对比理解急诊晕厥患者的危险分层评估方法。方法 应用英国ROSE规则、美国SFSR规则分别对2016-06至2018-11在北京天坛医院就诊的108例晕厥患者快速评估,对所有患者随访1个月,统计分析其灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比,并对比分析两种危险分层的规则。结果 108例在1个月内有43例发生不良事件,ROSE规则评判的特异度86.2%,阴性预测值90.3%,阴性似然比0.16;而SFSR规则评判的特异度84.6%,阴性预测值85.9%,阴性似然比0.25。二种规则一致性分析的Kappa值是0.732。结论 两种危险分层规则对筛查判定非高危患者均具有重要的临床意义,可以结合患者临床实际灵活运用。     

Acute knee trauma: role of ultrasound

The purpose of this study was to determine the diagnostic accuracy of high spatial resolution ultrasonography (US) in the detection of lipohemarthrosis of the knee and to evaluate this sign as criteria of intra-articular fracture. Forty-eight patients with clinical suspicion of knee fracture were prospectively examined by conventional radiography, sonography examination and computed tomography (CT) within 48 h after trauma in order to depict direct (fracture line) and indirect (lipohemarthrosis) signs of intra-articular fracture. Lipohemarthrosis was defined as a multi-layered collection in the subquadricipital recess. CT was considered as the gold standard for both direct and indirect fracture criteria. CT imaging showed direct signs of intra-articular fracture in 31 patients (65%). Among these patients, 30 (97%) had a lipohemarthrosis. Conventional radiographs showed intra-articular fracture in 26 patients (54%). Among these, 18 (69%) had a lipohemarthrosis. Sonographic examinations could not depict any direct sign of intra-articular fracture but showed a lipohemarthrosis in 29 (93%) of patients with proven fracture via CT. This allowed the depiction of four out of five occult knee fractures. The sensitivity, specificity, positive predictive value, negative predictive value of sonography for the diagnosis of lipohemarthrosis was 97, 100, 100 and 94%, respectively, compared with 55, 100, 100 and 55% with conventional radiographs. Using lipohemarthrosis as criterion of fracture, the sensitivity, specificity, positive predictive value and negative predictive value of sonography for early detection of intra-articular knee fractures was 94, 94, 97 and 89%, respectively, compared with 84, 88, 93 and 75% with conventional radiographs. We concluded that, by showing lipohemarthrosis in the subquadricipital recess, high-resolution sonography is a reliable and accurate technique for the evaluation of intra-articular knee fractures.     

The indications for scrotal ultrasound

Scrotal ultrasound scanning is now a routine and mandatory investigation of the patient presenting with scrotal symptoms. The need for scrotal ultrasound scanning when the physical examination reveals no significant abnormality has not been previously assessed. We conducted a retrospective study of 160 patients attending for scrotal ultrasound over a period of 1 year. The accuracy of clinical examination was compared with the gold standard of ultrasound for identifying clinically significant lesions. The sensitivity, specificity and positive and negative predictive values were calculated. Four clinically relevant groups were used for analysis purposes: Group I, acutely painful scrotum with or without swelling; Group II, chronic testicular pain without swelling; Group III, chronic scrotal swelling with or without pain; and Group IV, the asymptomatic testis. In Group I, sensitivity was 100%, specificity was 81.3%, the positive predictive value was 92.1% and the negative predictive value was 100%. In Group II, sensitivity was 71.4%, specificity was 90.9%, the positive predictive value was 76.9% and the negative predictive value was 88.2%. In Group III, sensitivity was 88.9%, specificity was 66.7%, the positive predictive value was 92.3% and the negative predictive value was 57.1%. In Group IV, sensitivity was 33.3%, specificity was 100%, the positive predictive value was 100% and the negative predictive value was 93.9%. All clinically significant abnormalities were identified on clinical examination. Clinically insignificant lesions identified by ultrasound alone did not affect the clinical management. It is recommended that scrotal ultrasound is used in the acutely painful scrotum where a confident diagnosis cannot be made or there is failure to respond to treatment, and in the chronic swelling where a confident clinical diagnosis cannot be made.     

64层螺旋CT联合血清HCY水平检测用于下肢动脉狭窄闭塞性疾病诊断的临床分析

目的：探讨64层螺旋CT联合血清同型半胱氨酸（homocysteine,HCY）水平检测用于下肢动脉狭窄闭塞性疾病诊断的临床价值。方法收集2012年5月—2014年6月来我院就诊的下肢动脉狭窄闭塞性疾病疑似患者130例,分别进行64层螺旋CT检查、血清HCY检验及二者联合检验,观察各项检查临床诊断性差异。结果联合诊断灵敏度、阴性预测值、阳性似然比和阴性似然比均高于64层螺旋CT和HCY检验,而诊断误诊率低于后两者,差异均有统计学意义（P＜0.05）。结论64层螺旋CT联合血清HCY水平检测在下肢动脉狭窄闭塞性疾病的诊断中具有较好的临床诊断价值。