Objective
To assess diagnostic validity and reliability of VI-RADS in predicting muscle invasion by bladder cancer (BCa) and evaluate reviewer acceptance of VI-RADS for clinical routine.
Methods
A ...prospective multicenter study enrolled 331 patients with suspected/untreated BCa who underwent preoperative multiparametric MRI examination (mp-MRI) of the urinary bladder. Four experienced radiologists independently evaluated all mp-MRI using VI-RADS. The diagnostic validity of VI-RADS for predicting muscle invasion by BCa was calculated using histopathology of the first transurethral resection bladder tumor (TURBT) and second TURBT as the reference standards. The kappa statistics (
κ
) were applied to assess the interreader agreement (IRA). Reviewer acceptance was evaluated with questionnaires.
Results
The risk of muscle invasion in VI-RADS 2, 3, 4, and 5 after the first and second TURBT was 21.8%, 45.8%, 69.6%, and 96.4% and 24.4%, 58.3%, 87%, and 99.2%, respectively. The overall diagnostic validity of VI-RADS was high. The optimal cut-off value for predicting muscle invasion after first TURBT was > VI-RADS 3 (sensitivity = 84.1% and specificity = 92.3%), and after second TURBT was > VI-RADS 2 (sensitivity = 89.9% and specificity = 90.1%). VI-RADS categorization showed a very good IRA (
κ
= 0.93). Reviewers fully agreed with the statement, “The application of structured reporting of bladder tumor should be encouraged” (score = 20).
Conclusions
VI-RADS showed high diagnostic validity and reliability for predicting muscle invasion by BCa, especially VI-RADS 4 and 5. However, VI-RADS 2 and 3 require further modifications to enhance their diagnostic validity. VI-RADS is highly encouraged to be used in daily practice.
Key Points
• VI-RADS showed high diagnostic validity and reliability in predicting BCa muscle invasion, especially VI-RADS 4 and 5.
• In VI-RADS 2 and 3, we observed a notable percentage of BCa with muscle invasion and this would require further modifications to enhance the diagnostic validity for these scores.
• Overall VI-RADS is well-accepted by radiologists who recommend it for daily practice.
Objective
The American College of Radiology (ACR) recently published the ovarian-adnexal reporting and data system (O-RADS) to provide guidelines to physicians who interpret ultrasound (US) ...examinations of adnexal masses (AM). This study aimed to compare the O-RADS with two other well-established US classification systems for diagnosis of AM.
Methods
This retrospective multicenter study between May 2016 and December 2019 assessed consecutive women with AM detected by the US. Five experienced consultant radiologists independently categorized each AM according to O-RADS, gynecologic imaging reporting and data system (GI-RADS), and international ovarian tumor analysis (IOTA) simple rules. Pathology and adequate follow-up were used as reference standards for calculating the validity of three US classification systems for diagnosis of AM. Kappa statistics were used to assess the inter-reviewer agreement (IRA).
Results
A total of 609 women (mean age, 48 ± 13.7 years; range, 18–72 years) with 647 AM were included. Of the 647 AM, 178 were malignant and 469 were benign. Malignancy rates were comparable to recommended rates by previous literature in O-RADS and IOTA, but higher in GI-RADS. O-RADS had significantly higher sensitivity for malignancy than GI-RAD and IOTA (
p
= 0.003 and 0.0007, respectively), but non-significant slightly lower specificity (
p
> 0.05). O-RADS, GI-RADS, and IOTA showed similar overall IRA (
κ
= 0.77, 0.69, and 0.63, respectively) with a tendency toward higher IRA with O-RADS than with GI-RADS and IOTA.
Conclusions
O-RADS compares favorably with GI-RADS and IOTA. O-RADS had higher sensitivity than GI-RADS and IOTA simple rules with relatively similar specificity and reliability.
Key Points
• The malignancy rates were comparable to recommended rates by previous literature in O-RADS and IOTA, but higher in GI-RADS.
• The O-RADS had significantly higher sensitivity for malignancy than GI-RADS and IOTA (96.8% vs 92.7% and 92.1%; p = 0.003 and 0.0007, respectively), but non-significant slightly lower specificity (92.8% vs 93.6% and 93.2%, respectively; p > 0.05).
• The O-RADS, GI-RADS, and IOTA showed similar overall inter-reviewer agreement (IRA) (κ = 0.77, 0.69, and 0.63, respectively), with a tendency toward higher IRA with O-RADS than with GI-RADS and IOTA.
The Coronavirus disease 2019 (COVID-19) is an infectious disease spreading rapidly and uncontrollably throughout the world. The critical challenge is the rapid detection of Coronavirus infected ...people. The available techniques being utilized are body-temperature measurement, along with anterior nasal swab analysis. However, taking nasal swabs and lab testing are complex, intrusive, and require many resources. Furthermore, the lack of test kits to meet the exceeding cases is also a major limitation. The current challenge is to develop some technology to non-intrusively detect the suspected Coronavirus patients through Artificial Intelligence (AI) techniques such as deep learning (DL). Another challenge to conduct the research on this area is the difficulty of obtaining the dataset due to a limited number of patients giving their consent to participate in the research study. Looking at the efficacy of AI in healthcare systems, it is a great challenge for the researchers to develop an AI algorithm that can help health professionals and government officials automatically identify and isolate people with Coronavirus symptoms. Hence, this paper proposes a novel method CoVIRNet (COVID Inception-ResNet model), which utilizes the chest X-rays to diagnose the COVID-19 patients automatically. The proposed algorithm has different inception residual blocks that cater to information by using different depths feature maps at different scales, with the various layers. The features are concatenated at each proposed classification block, using the average-pooling layer, and concatenated features are passed to the fully connected layer. The efficient proposed deep-learning blocks used different regularization techniques to minimize the overfitting due to the small COVID-19 dataset. The multiscale features are extracted at different levels of the proposed deep-learning model and then embedded into various machine-learning models to validate the combination of deep-learning and machine-learning models. The proposed CoVIR-Net model achieved 95.7% accuracy, and the CoVIR-Net feature extractor with random-forest classifier produced 97.29% accuracy, which is the highest, as compared to existing state-of-the-art deep-learning methods. The proposed model would be an automatic solution for the assessment and classification of COVID-19. We predict that the proposed method will demonstrate an outstanding performance as compared to the state-of-the-art techniques being used currently.
Objective
To compare diagnostic performance and agreement between CT, MRI and combined CT/MRI in reference to LI-RADS classification system to categorize hepatic observations detected in hepatic ...patients during screening ultrasound.
Methods
240 patients with 296 liver observations detected during ultrasound surveillance underwent hepatic CT and MRI examinations, histopathology, and clinical and radiological follow-up. Using LI-RADS v2014, six radiologists evaluated the observations independently and assigned a LI-RADS category to each observation using CT, MRI and combined CT/MRI.
Results
Combined CT and MRI in LI-RADS yielded better accuracy (91.29 %), sensitivity (90.71 %) and specificity (92.31 %) for hepatocellular carcinoma (HCC) diagnosis than using MRI or CT alone; accuracy, sensitivity and specificity decreased to 85.37 %, 86.34 %, and 83.65 %, respectively, for MRI and 67.6 %, 54.10 % and 91.35 %, respectively, for CT. The intraclass agreement of the LI-RADS scores between CT, MRI and combined CT/MRI was excellent (κ=0.9624 (95 % CI: 0.9318–0.9806)).
Conclusion
CT and MRI are complementary to each other. Combined CT/MRI enabled a more precise determination of LI-RADS category of hepatic observations; however, due to the expense and minor increase in accuracy, the combined methodology should only be utilized in cases of suspected HCC.
Key Points
• Hepatic observation may be categorized differently depending on the imaging modality used.
• We compared LI-RADS categorization between CT, MRI and combined CT/MRI.
• MRI produces higher accuracy and sensitivity, while CT produces higher specificity.
• Combining CT and MRI improves LIRADS categorization reports.
• Considering additional cost, combined methodology could be restricted to challenging cases.
This study aimed to examine the validity and reproducibility of strain elastography (SE) for detecting prostate cancer (PCa) in patients with elevated prostate-specific antigen (PSA) levels. The ...study included 107 patients with elevated PSA levels. All eligible patients underwent transrectal ultrasound (TRUS) with real-time elastography (RTE) to detect suspicious lesions. Two readers independently evaluated the lesions and assigned a strain ratio and elastography score to each lesion. Histopathology was used as a reference standard to estimate the validity of RTE in predicting malignant lesions. An intraclass correlation (ICC) was performed to detect reliability of the strain ratios and elastography scores. TRUS-guided biopsy detected malignancies in 64 (59.8%) patients. TRUS with RTE revealed 122 lesions. The strain ratio index (SRI) cut-off values to diagnose malignancy were 4.05 and 4.35, with sensitivity, specificity, and accuracy of 94.7%, 91.3%, and 93.4%, respectively. An elastography score > 3 was the best cut-off value for detecting malignancy. According to readers, the sensitivity, specificity, and accuracy were 91.3-94.7%, 89.5-93.4%, and 91.3-90.9%, respectively. Excellent inter-reader agreement was recorded for SRI and elastography scores, with ICC of 0.937 and 0.800, respectively. SE proves to be an efficient tool for detecting PCa with high accuracy in patients with elevated PSA levels.
Purpose
Incorporation of virtual angioscopy (VA) in the diagnostic work-up of aortic diseases could improve the clinical value and efficiency of multidetector computed tomography angiography (MDCTA). ...We aim to evaluate the clinical usefulness of virtual aortic navigation by CT angiography in various aortic diseases as a complement to standard MDCTA.
Materials and methods
We retrospectively selected 211 patients who performed MDCTA for suspected or operated aortic diseases. VA endoluminal images of the aorta were obtained by a fly-through technique. Two senior vascular radiologists independently evaluated all MDCTA images. After 1 month, the same two radiologists independently reviewed the MDCTA images combined with CTVA images. The respective accuracy of CTVA in delineating aortic abnormalities was compared to that of MDCTA using Fisher's exact test. The Fleiss kappa (κ) statistic was used to assess the inter-reader agreement (IRA).
Results
We detected 229 abnormalities in 203 patients on MDCTA and 231 abnormalities in 205 patients on CTVA. CTVA provided significant additional findings in 63.8% (146/229) of all abnormalities diagnosed by MDCTA (
p
< 0.001, odd ratio OR = 42). Although CTVA diagnosed two abnormalities overlooked by MDCTA, the value was statistically insignificant (
p
= 0.787, OR = 1.3). Regarding postoperative abnormalities, the CTVA added significant additional findings over MDCTA (
p
= 0.006, OR = 87.4). The overall IRA for the performance of CTVA was good (κ = 0.699).
Conclusions
CTVA yields extra findings and improves diagnostic efficiency of MDCTA, especially in postoperative patients.
To compare safety and efficacy of combined therapy with conventional transarterial chemoembolization (cTACE)+microwave ablation (MWA) versus only TACE or MWA for treatment of hepatocellular carcinoma ...(HCC) >3-<5 cm.
This randomized controlled trial (NCT04721470) screened 278 patients with HCC >3-<5 cm. Patients were randomized into three groups: 90 underwent TACE (Group 1); 95 underwent MWA (Group 2); and 93 underwent combined therapy (Group 3). Patients were followed-up with contrast-enhanced CT or MRI. Images were evaluated and compared for treatment response and adverse events based on modified response evaluation criteria in solid tumor. Serum alpha-fetoprotein (AFP) concentration was measured at baseline and during every follow-up visit.
Final analysis included 265 patients (154 men, 111 women; mean age = 54.5 ± 11.8 years; range = 38-76 years). Complete response was achieved by 86.5% of patients who received combined therapy compared with 54.8% with only TACE and 56.5% with only MWA (p = 0.0002). The recurrence rate after 12 months was significantly lower in Group 3 (22.47%) than Groups 1 (60.7%) and 2 (51.1%) (p = 0.0001). The overall survival rate (three years after therapy) was significantly higher in Group 3 (69.6%) than Groups 1 (54.7%) and 2 (54.3%) (p = 0.02). The mean progression-free survival was significantly higher in Group 3 than groups 1 and 2 (p < 0.001). A decrease in AFP concentration was seen in 75%, 63%, and 48% patients of Group 3, 2, and 1, respectively.
Combined therapy with cTACE + MWA is safe, well-tolerated, and more effective than TACE or MWA alone for treatment of HCC >3-<5 cm.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
There is limited data in the literature regarding the role of nonarthrographic MRI for detecting biceps pulley (BP) lesions.
Purpose
To assess the accuracy of nonarthrographic MRI for ...detecting BP lesions, and to evaluate the diagnostic value of various MRI signs (superior glenohumeral ligament discontinuity/nonvisibility, long head of biceps (LHB) displacement sign or subluxation/dislocation, LHB tendinopathy, and supraspinatus and subscapularis tendon lesions) in detecting such lesions.
Study Type
Retrospective.
Population
84 patients (32 in BP‐lesion group and 52 in BP‐intact group‐as confirmed by arthroscopy).
Field Strength/Sequence
1.5‐T, T1‐weighted turbo spin echo (TSE), T2‐weighted TSE, and proton density‐weighted TSE spectral attenuated inversion recovery (SPAIR) sequences.
Assessment
Three radiologists independently reviewed all MRI data for the presence of BP lesions and various MRI signs. The MRI signs and final MRI diagnoses were tested for accuracy regarding detecting BP lesions using arthroscopy results as the reference standard. Furthermore, the inter‐reader agreement (IRA) between radiologists was determined.
Statistical Tests
Student's t‐tests, Chi‐squared, and Fisher's exact tests, and 4‐fold table test were used. The IRA was calculated using Kappa statistics. A P‐value <0.05 was considered statistically significant.
Results
The sensitivity, specificity, and accuracy of nonarthrographic MRI for detecting BP lesions were 65.6%–78.1%, 90.4%–92.3%, and 81%–86.9%, respectively. The highest accuracy was noticed for the LHB displacement sign (84.5%–86.9%), and the highest sensitivity was registered for the LHB tendinopathy sign (87.5%). Furthermore, the highest specificity was observed for the LHB displacement sign and LHB subluxation/dislocation sign (98.1%–100%). The IRA regarding final MRI diagnosis and MRI signs of BP lesions was good to very good (κ = 0.76–0.98).
Data Conclusion
Nonarthrographic shoulder MRI may show good diagnostic accuracy for detecting BP lesions. The LHB displacement sign could serve as the most accurate and specific sign for diagnosis of BP lesions.
Level of Evidence
3
Technical Efficacy
Stage 2
Ear malformations represent 50% of ear, nose and throat malformations. Ear malformations cause conductive hearing loss (CHL) and/or sensorineural hearing loss (SNHL) with a significant childhood ...disability worldwide. Early accurate diagnosis and treatment are mandatory to enhance language and speech development. Understanding the embryology of the ear explains the outcome of ototoxic prenatal insult according to the affected gestational age and the incidence of association among inner, middle, and external ear malformations. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations of the temporal bone are used in the evaluation of ear malformations. In this review article, the spectrum of ear malformations is discussed in detail with hints on the ear embryology, the ear radiological anatomy, and radiological determinant factors of operative reconstruction of ear anomalies.
•External and/or middle ear anomalies may occur without or with inner ear affection.•Computed Tomography and Magnetic Resonance Imaging are used in the radiological evaluation of ear malformations.•Appropriate surgical candidate selection can be done with proper interpretation of temporal bone CT and MRI.•Identify the findings that contraindicate the surgical reconstruction of ear malformations.
Background
The diagnosis of sonographically indeterminate adnexal masses (AM) signifies a major challenge in clinical practice. Early detection and characterization have increased the need for ...accurate imaging evaluation before treatment.
Purpose
To assess the validity and reproducibility of the ADNEX MR Scoring system in the diagnosis of sonographically indeterminate AM.
Study Type
A prospective multicenter study.
Population
In all, 531 women (mean age, 44 ± 11.2 years; range, 21–79 years) with 572 sonographically indeterminate AM.
Field Strength/Sequence
1.5T/precontrast T1‐weighted imaging (WI) fast spin echo (FSE) (in‐phase and out‐of‐phase, with and without fat suppression); T2‐WI FSE; diffusion‐WI single‐shot echo planner with b‐values of 0 and 1000 s/mm2; and dynamic contrast‐enhanced perfusion T1‐WI liver acquisition with volume acceleration (LAVA).
Assessment
All MRI examinations were evaluated by three radiologists, and the AM were categorized into five scores based on the ADNEX MR Scoring system. Score 1: no AM; 2: benign AM; 3: probably benign AM; 4: indeterminate AM; 5: probably malignant AM. Histopathology and imaging follow‐up were used as the standard references for evaluating the validity of the ADNEX MR Scoring system for detecting ovarian malignancy.
Statistical Tests
Four‐fold table test, kappa statistics (κ), and receiver operating characteristic (ROC) curve.
Results
In all, 136 (23.8%) AM were malignant, and 436 (76.2%) were benign. Of the 350 AM classified as score 2, one (0.3%) was malignant; of the 62 AM classified as score 3, six (9.7%) were malignant; of the 73 AM classified as score 4, 43 (58.9%) were malignant; and of the 87 AM categorized as score 5, 86 (98.9%) were malignant. The best cutoff value for predicting malignant AM was score >3 with sensitivity and specificity of 92.9% and 94.9%, respectively. The interreader agreement of the ADNEX MR Scoring was very good (κ = 0.861).
Data Conclusion
The current study supports the high validity and reproducibility of the ADNEX MR Scoring system for the diagnosis of sonographically indeterminate AM.
Level of Evidence
1
Technical Efficacy Stage
2
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