Purpose
To perform a systematic review and meta-analysis to quantify the technical success rate of adrenal venous sampling (AVS) with and without intraprocedural computed tomography (CT).
Methods
A ...systematic search of the Medline, Scopus, EMBASE, and Web of Science databases for comparative studies using intraprocedural CT was undertaken. More than 1,000 records were screened using titles and abstracts. Full texts of 121 studies were reviewed and 14 eligible studies were identified. Nine studies had adequate comparative data and were included in the meta-analysis.
Results
A research synthesis was performed and data from 809 patients were pooled in multiple random effect models. Overall success rate of AVS without and with intraprocedural CT was 72.7% (59.3–83.0%) and 92.5% (86.6–95.9), respectively. The addition of intraprocedural CT increased the technical success rate by 19.8% (
P
< 0.001), with an odds ratio (OR) of 5.5 (3.3–9.2;
P
< 0.01). In meta-regression, odds of success with intraprocedural CT was associated with younger age (beta: 0.16 ± 0.05;
P
:0.001), higher body mass index (BMI; beta:0.08 ± 0.03;
P
:0.002), and higher selectivity index (defined as the ratio of cortisol in the adrenal vein to that in the inferior vena cava; beta:0.35 ± 0.08,
P
< 0.001). We found a linear inverse association between operator’s success without CT and improved success with intraprocedural CT (
R
2
: 0.86).
Conclusions
Intraprocedural CT is not required for every case, but can be performed in difficult cases or when operators' success is limited. The benefit was more pronounced in younger patients with higher BMI, female gender, and with higher selectivity.
Level of evidence
III Systematic review and meta-analysis of non-randomized clinical trials.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objective
To evaluate the behavior of a publicly available deep convolutional neural network (DCNN) bone age algorithm when presented with inappropriate data inputs in both radiological and ...non-radiological domains.
Methods
We evaluated a publicly available DCNN-based bone age application. The DCNN was trained on 12,612 pediatric hand radiographs and won the 2017 RSNA Pediatric Bone Age Challenge (concordance of 0.991 with radiologist ground-truth). We used the application to analyze 50 left-hand radiographs (appropriate data inputs) and seven classes of inappropriate data inputs in radiological (i.e., chest radiographs) and non-radiological (i.e., image of street numbers) domains. For each image, we noted if (1) the application distinguished between appropriate and inappropriate data inputs and (2) inference time per image. Mean inference times were compared using ANOVA.
Results
The 16Bit Bone Age application calculated bone age for all pediatric hand radiographs with mean inference time of 1.1 s. The application did not distinguish between pediatric hand radiographs and inappropriate image types, including radiological and non-radiological domains. The application inappropriately calculated bone age for all inappropriate image types, with mean inference time of 1.1 s for all categories (
p
= 1).
Conclusion
A publicly available DCNN-based bone age application failed to distinguish between appropriate and inappropriate data inputs and calculated bone age for inappropriate images. The awareness of inappropriate outputs based on inappropriate DCNN input is important if tasks such as bone age determination are automated, emphasizing the need for appropriate oversight at the data input and verification stage to avoid unrecognized erroneous results.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Objective
To determine whether the presence, number, and topography (digit location and symmetry) of Heberden's nodes are associated with the incidence and progression of radiographic osteoarthritis ...(OA) of the knee.
Methods
We analyzed 8,023 knees (with 8 years of follow‐up) from the Osteoarthritis Initiative. Cox regression was performed on Heberden's node presence, total number, location, and symmetry (using 2 symmetry index models) obtained at baseline physical examination as well as self‐report of Heberden's node presence for evaluation of association with radiographic knee OA incidence (development of a Kellgren/Lawrence grade of ≥2) and progression (worsening in the medial joint space narrowing score of ≥1). Covariate adjustments relevant to OA outcomes were performed.
Results
The presence of Heberden's nodes (in 64% of the subjects) at baseline physical examinations, but not subjective self‐report of Heberden's nodes, was associated with radiographic knee OA incidence (hazard ratio HR 1.19 and 95% confidence interval 95% CI 1.001–1.402 approached statistical significance). Each additional Heberden's node found on physical examination was associated with knee OA incidence (HR 1.03 95% CI 1.000–1.054 approached statistical significance) and progression (HR 1.04 95% CI 1.016–1.063). Knee OA incidence and progression were associated with Heberden's nodes located on the third digit (HR 1.26 95% CI 1.068–1.487 and 1.18 95% CI 1.019–1.361, respectively) and first digit (HR 1.186 95% CI 0.992–1.418 approached statistical significance and HR 1.26 95% CI 1.084–1.453, respectively). Heberden's node symmetry was associated with knee OA incidence (model 1 HR 1.09 95% CI 0.997–1.185 approached statistical significance) and progression (model 2 HR 1.13 95% CI 1.035–1.234).
Conclusion
The number of Heberden's nodes, their locations, and symmetry were associated with knee OA incidence and progression over 8 years.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Recent studies have introduced elevated lipoprotein(a) (Lp(a)) as a risk factor for coronary heart disease (CHD). This study investigated whether the addition of Lp(a) as a novel biomarker to the ...Framingham Risk Score (FRS) model improves CHD risk prediction.
The study included 1101 Iranian subjects (443 non-diabetic and 658 diabetic patients) who were followed for 10 years (2003-2013). Lp(a) levels and CHD events were recorded for each participant.
The Net Reclassification Index (NRI) after adding Lp(a) to the FRS model was 19.57% and the discrimination slope was improved (0.160 vs. 0.173). The Akaike Information Criterion (AIC), a measure of model complexity, decreased significantly after adding Lp(a) to the FRS model (691.9 vs. 685.4, P value: 0.007).
The study concluded that adding Lp(a) to the FRS model improves CHD risk prediction in an Iranian population without making the model too complex. This could help clinicians to better identify individuals who are at risk of developing CHD and to implement appropriate preventive measures.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background A growing body of evidence suggests an association between lower serum 25-hydroxy vitamin D (25(OH)VitD) levels and adverse cardiovascular events. Patients with type 2 diabetes mellitus ...(T2DM) are at increased risk for developing coronary heart disease (CHD). 25-Hydroxy vitamin D deficiency is highly prevalent, especially among patients with T2DM. This study aimed to evaluate the predictive value of serum 25(OH)VitD in improvement of CHD risk stratification in patients with T2DM. Methods In an open cohort, community-dwelling T2DM patients were followed up for first CHD event. Patients were divided into 4 categories, based on 25(OH)VitD quartiles. Cox regression analysis was used to obtain hazard ratios. Results A total number of 2,607 T2DM patients were followed up for median time of 8.5 years. During follow-up, 299 patients experienced CHD events. Patients in the lowest quartile experienced more CHD events. Adjusted hazard ratios (95% CI) for developing CHD events were 0.77 (0.55-1.07) for second quartile, 0.52 (0.38-0.73) for third quartile, and 0.43 (0.31-0.60) for fourth quartile, compared with the first quartile. The incidence rate decreased as serum 25(OH)VitD increased, which remained significant after stepwise adjustments ( P value for trend ≤.001). Addition of 25(OH)VitD to traditional risk factors in Framingham Risk Score successfully reclassified 29% of study population. Conclusions Serum 25(OH)VitD is an independent predictor of future adverse CHD events in patients with T2DM. Addition of 25(OH)VitD status to Framingham Risk Score improves CHD risk prediction in patients with T2DM.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Pancreatic ductal adenocarcinoma is one of the leading causes of cancer-related deaths. With surgical resection being the only definitive treatment, improvements in technique has led to an increase ...in number of candidates undergoing resection by inclusion of borderline resectable disease patients to the clearly resectable group. Post-operative complications associated with pancreaticoduodenectomy and distal pancreatectomy include delayed gastric emptying, anastomotic failures, fistula formation, strictures, abscess, infarction, etc. The utility of dual-phase CT with multiplanar reconstruction and 3D rendering is increasingly recognized as a tool for the assessment of complications associated with vascular resection and reconstruction such as hemorrhage, pseudoaneurysm, vascular thrombosis, and ischemia. Prompt recognition of the complications and distinction from benign post-operative findings such as hepatic steatosis and mesenteric fat necrosis on imaging plays a key role in helping decrease the morbidity and mortality associated with surgery. We discuss, with case examples, some of such common and uncommon findings on imaging to familiarize the abdominal radiologists evaluating post-operative imaging in both acute and chronic post-operative settings.
Abstract Background The association between homocysteine (Hcy) and metabolic syndrome (MetS)-related disorders remains to be unveiled. First, the role of Hcy–MetS interaction in prediction of ...coronary heart disease (CHD) was assessed. Next, we investigated whether serum Hcy improves CHD risk-prediction beyond MetS and traditional risk factors (TRFs). Design A prospective study of 5893 community-dwelling participants (two sub-cohorts, 3286 diabetic and 2607 non-diabetic; ∼8.5 years of follow-up). Methods Clustering of Hcy with MetS components was assessed using exploratory factor-analysis. Cox regression hazard ratio (HR) was used to predict CHD using Hcy level and MetS status. Baseline model included MetS and TRFs. Addition of Hcy and hyper-homocysteinemia (HHcy) to the baseline model was evaluated in two separate models. Results Hcy was correlated with MetS components, especially with systolic blood pressure. The factor linking MetS to CHD is the factor through which Hcy is linked to MetS. HHcy and MetS interacted as risk factors for CHD. Conclusion Hcy adds to the value of MetS and TRFs for CHD risk-prediction by reclassifying around 47.3–49.0% of the overall and 21.6–28.1% of the intermediate-risk population.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ
MR Imaging of Autoimmune Pancreatitis Hafezi-Nejad, Nima; Singh, Vikesh K; Fung, Christopher ...
Magnetic resonance imaging clinics of North America,
08/2018, Volume:
26, Issue:
3
Journal Article
Peer reviewed
Autoimmune pancreatitis (AIP) is characterized by autoimmune inflammatory destruction of the pancreatic tissue. Imaging plays an essential role in the diagnosis. AIP type 1 is the pancreatic ...manifestation of immunoglobulin G4 (IgG4)-related disease and is associated with IgG4-positive plasma cell infiltration and fibrosis of multiple organ systems. Type 2 is a related disease with pancreatic inflammation with or without concurrent inflammatory bowel disease. The authors demonstrate the imaging findings that are associated with the pancreatic and extra-pancreatic manifestations of AIP. They emphasize the common MR imaging and magnetic resonance cholangiopancreatography findings to help make the diagnosis of AIP.
Background:
The cause of mucoid degeneration (MD) of the anterior cruciate ligament (ACL), which is commonly observed on magnetic resonance imaging (MRI) of patients with knee pain, has yet to be ...elucidated. Despite the limited evidence on the relationship between ACL lesions (injury and MD) and tibial morphologic features (ie, posterior tibial slope), the potential association between the presence of ACL MD and medial and lateral tibial slope (MTS and LTS) has not been well-established.
Purpose:
To investigate whether MTS and LTS measurements are associated with the presence of ACL MD.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
Consecutive knee MRI examinations of patients referred by an orthopaedic surgeon for potential internal joint derangements were identified within a 4-year period. The presence of ACL MD and the MTS/LTS values were assessed by independent expert observers in consensus in a blinded fashion. From 413 consecutive knee MRI scans, a sample of 80 knees, including 32 knees with ACL MD (cases) and 48 knees with normal ACL (controls), were selected using propensity score matching method for age, sex, body mass index, and presence of severe medial tibiofemoral compartment cartilage damage. The association between ACL MD and MTS/LTS was evaluated using conditional regression models.
Results:
Knees with ACL MD had higher values of LTS (mean ± SD, 7.18° ± 3.58°) in comparison with control knees (5.32° ± 3.35°). Conditional regression analysis revealed a significant association between LTS measurements (not MTS) and ACL MD; every 1° increase in LTS was associated with a 17% (95% CI, 1%-35%) higher probability of having ACL MD.
Conclusion:
Excessive LTS was associated with the presence of ACL MD, independent of participants’ age, sex, BMI, and cartilage damage severity.
This study analyzed data from 67.8 million persons in 195 countries between 1980 and 2015 using the Global Burden of Disease study data and methods. The rapid increase in the prevalence and disease ...burden of elevated BMI highlights the need for continued focus on this major issue.
PDF
