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Archivio Stomatologico 1989Review of the literature shows that the common clinical parameters used in practice are inaccurate in assessing periodontal disease activity. Radiographs and probings... (Review)
Review
Review of the literature shows that the common clinical parameters used in practice are inaccurate in assessing periodontal disease activity. Radiographs and probings are, instead, relatively accurate in retrospectively assessing periodontal disease activity. Currently more sophisticated radiographic techniques are being developed to diagnose ongoing periodontal disease activity.
Topics: Humans; Periodontal Diseases; Radiography
PubMed: 2700883
DOI: No ID Found -
International Journal of Pediatric... Feb 2022This study aims to investigate the inter-rater reliability and agreement of the diagnosis of otitis media with effusion, acute otitis media, and no effusion cases based...
OBJECTIVES
This study aims to investigate the inter-rater reliability and agreement of the diagnosis of otitis media with effusion, acute otitis media, and no effusion cases based on an otoscopy image and in some cases an additional wideband tympanometry measurement of the patient.
METHODS
1409 cases were examined and diagnosed by an otolaryngologist in the clinic, and otoscopy examination and wideband tympanometry (WBT) measurement were conducted. Afterwards, four otolaryngologists (Ear, Nose, and Throat doctors, ENTs), who did not perform the acute examination of the patients, evaluated the otoscopy images and WBT measurements results for diagnosis (acute otitis media, otitis media with effusion, or no effusion). They also specified their diagnostic certainty for each case, and reported whether they used the image, wideband tympanometry, or both, for diagnosis.
RESULTS
All four ENTs agreed on the diagnosis in 57% of the cases, with a pairwise agreement of 74%, and a Light's Kappa of 0.58. There are, however, large differences in agreement and certainty between the three diagnoses. Acute otitis media yields the highest agreement (77% between all four ENTs) and certainty (0.90), while no effusion shows much lower agreement and certainty (34% and 0.58, respectively). There is a positive correlation between certainty and agreement between the ENTs across all cases, and both certainty and agreement increase for cases where a WBT measurement is shown in addition to the otoscopy image.
CONCLUSIONS
The inter-rater reliability between four ENTs was high when diagnosing acute otitis media and lower when diagnosing otitis media with effusion. However, WBT can add valuable information to get closer to the ground-truth diagnosis without myringotomy. Furthermore, the diagnostic certainty increases when the WBT is examined together with the otoscopy image.
Topics: Acoustic Impedance Tests; Humans; Infant; Otitis Media; Otitis Media with Effusion; Otoscopes; Otoscopy; Reproducibility of Results
PubMed: 35033784
DOI: 10.1016/j.ijporl.2021.111034 -
Der Chirurg; Zeitschrift Fur Alle... Aug 2008Benign liver tumors and tumor-like lesions cover a broad spectrum of differential diagnoses, varying from dysontogenetic cysts to pseudolesions. Focal nodular... (Review)
Review
Benign liver tumors and tumor-like lesions cover a broad spectrum of differential diagnoses, varying from dysontogenetic cysts to pseudolesions. Focal nodular hyperplasia, adenoma and regenerating nodules play a major role in clinical practice. Based on imaging findings, these lesions can be classified as cystic or solid, solitary or multiple, and hyper- or hypovascular. Haemangioma, FNH, steroid-associated adenoma, cystadenoma and echinococcus cysts can be reliably diagnosed using imaging techniques. The same is true for pseudolesions, which are found in particular on dynamic computed tomography. Other entities such as adenoma in cirrhotic livers, angiomyolipoma, regenerating nodules or Echinococcus alveolaris cannot be safely diagnosed by imaging and require biopsy. Morphological and functional characteristics of the most common lesions in the different imaging modalities will be discussed. Where possible, a diagnostic strategy will be presented.
Topics: Humans; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography
PubMed: 18566783
DOI: 10.1007/s00104-008-1522-x -
Computer Methods and Programs in... Aug 2020Glaucoma, an eye condition that leads to permanent blindness, is typically asymptomatic and therefore difficult to be diagnosed in time. However, if diagnosed in time,...
BACKGROUND AND OBJECTIVE
Glaucoma, an eye condition that leads to permanent blindness, is typically asymptomatic and therefore difficult to be diagnosed in time. However, if diagnosed in time, Glaucoma can effectively be slowed down by using adequate treatment; hence, an early diagnosis is of utmost importance. Nonetheless, the conventional approaches to diagnose Glaucoma adopt expensive and bulky equipment that requires qualified experts, making it difficult, costly and time-consuming to diagnose large amounts of people. Consequently, new alternatives to diagnose Glaucoma that suppress these issues should be explored.
METHODS
This work proposes an interpretable computer-aided diagnosis (CAD) pipeline that is capable of diagnosing Glaucoma using fundus images and run offline in mobile devices. Several public datasets of fundus images were merged and used to build Convolutional Neural Networks (CNNs) that perform segmentation and classification tasks. These networks are then used to build a pipeline for Glaucoma assessment that outputs a Glaucoma confidence level and also provides several morphological features and segmentations of relevant structures, resulting in an interpretable Glaucoma diagnosis. To assess the performance of this method in a restricted environment, this pipeline was integrated into a mobile application and time and space complexities were assessed.
RESULTS
Considering the test set, the developed pipeline achieved 0.91 and 0.75 of Intersection over Union (IoU) in the optic disc and optic cup segmentation, respectively. With regards to the classification, an accuracy of 0.87 with a sensitivity of 0.85 and an AUC of 0.93 were attained. Moreover, this pipeline runs on an average Android smartphone in under two seconds.
CONCLUSIONS
The results demonstrate the potential that this method can have in the contribution to an early Glaucoma diagnosis. The proposed approach achieved similar or slightly better metrics than the current CAD systems for Glaucoma assessment while running on more restricted devices. This pipeline can, therefore, be used to construct accurate and affordable CAD systems that could enable large Glaucoma screenings, contributing to an earlier diagnose of this condition.
Topics: Computers, Handheld; Diagnosis, Computer-Assisted; Eye; Fundus Oculi; Glaucoma; Humans; Wireless Technology
PubMed: 32155534
DOI: 10.1016/j.cmpb.2020.105341 -
Oral Surgery, Oral Medicine, Oral... Nov 2003The medical records of 3 patients who visited our hospital with preauricular pain and limited jaw movement were retrospectively reviewed. All were clinically evaluated,... (Review)
Review
The medical records of 3 patients who visited our hospital with preauricular pain and limited jaw movement were retrospectively reviewed. All were clinically evaluated, diagnosed through the use of conventional radiographs, and initially treated as having temporomandibular disorders (TMD). However, their symptoms did not improve and even increased or facial swelling occurred, so advanced imaging modalities were used to make a differential diagnosis. The final diagnoses of the patients were cellulitis, an inflammatory pseudotumor, and pigmented villonodular synovitis. In addition to these 3 patients, 50 others who were initially misdiagnosed during a clinical examination as having TMD on conventional radiographs were reviewed in the English-language literature. When diagnosing patients with TMD symptoms, we must consider the possibility of unusual causes, including tumors and infections or inflammations. Furthermore, in addition to usual TMD treatment procedures, an advanced radiologic examination should be performed to aid in the differential diagnosis of all patients with unceasing pain and mouth-opening limitation.
Topics: Adult; Biopsy; Cellulitis; Contrast Media; Diagnosis, Differential; Diagnostic Imaging; Facial Pain; Granuloma, Plasma Cell; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Range of Motion, Articular; Retrospective Studies; Synovitis, Pigmented Villonodular; Temporomandibular Joint Disorders; Tomography, X-Ray Computed
PubMed: 14600701
DOI: 10.1016/s1079-2104(03)00373-1 -
Current Rheumatology Reports Oct 2021Calcium pyrophosphate deposition disease (CPPD) arises from calcium pyrophosphate deposition throughout the body, leading to different clinical syndromes that may be... (Review)
Review
PURPOSE OF REVIEW
Calcium pyrophosphate deposition disease (CPPD) arises from calcium pyrophosphate deposition throughout the body, leading to different clinical syndromes that may be diagnosed using various imaging modalities. The purpose of this review is to highlight recent updates in the imaging of CPPD.
RECENT FINDINGS
Conventional radiography remains the initial test when imaging CPPD; but musculoskeletal ultrasound and conventional computed tomography (CT) may also assist in diagnosing and characterizing CPP deposits, with increased sensitivity. Dual-energy CT is also being used to differentiate CPP crystals from other crystal deposition diseases. CPP discitis has been diagnosed with MRI, but MRI has lower sensitivity and specificity than the aforementioned imaging studies in CPPD diagnosis. Assorted imaging modalities are increasingly used to diagnose CPPD involving atypical joints, avoiding invasive procedures. Each modality has its advantages and disadvantages. Future imaging may be able to provide more utility than what is currently available.
Topics: Calcium Pyrophosphate; Chondrocalcinosis; Humans; Radiography; Tomography, X-Ray Computed; Ultrasonography
PubMed: 34623546
DOI: 10.1007/s11926-021-01044-4 -
Esophagus : Official Journal of the... Oct 2023Opportunities for T4b esophageal cancer patients to receive curative surgery are increasing with the development of multidisciplinary treatments. However, the best...
BACKGROUND
Opportunities for T4b esophageal cancer patients to receive curative surgery are increasing with the development of multidisciplinary treatments. However, the best modality to accurately diagnose infiltration to the organs surrounding T4b esophageal cancer is still unknown. The aim of this study was to determine the performance of CT and MRI in diagnosing T stage in T4b esophageal cancer, with reference to the pathological diagnosis.
METHODS
A retrospective medical records review of patients with T4b esophageal cancer patients from January 2017 to December 2021 was conducted. Among 125 patients who were treated for cT4b esophageal cancer in Osaka University Hospital, 30 patients were diagnosed with cT4b esophageal cancer by CT, ycT staging with CT (contrast-enhanced images) and MRI (T2-FSE images), and curative R0 resection was performed. Preoperative MRI staging was independently performed by two experienced radiologists. The diagnostic performance of CT and MRI were examined using McNemar's test.
RESULTS
Nineteen and 12 patients were diagnosed with ycT4b by CT and MRI, respectively. Combined T4b organ resection was performed in 15 patients. A pathological diagnosis of ypT4b was made in 11 cases. In comparison to CT, MRI showed a higher diagnostic performance, specificity (47% vs. 89%, p = 0.013), and accuracy (60% vs. 90%, p = 0.015) for CT vs. MRI.
CONCLUSIONS
Our results-with reference to the pathological diagnosis-revealed that MRI had a superior diagnostic performance to CT for diagnosing T4b esophageal cancer invading the surrounding organs. An accurate diagnosis of T4b esophageal cancer may facilitate the implementation of appropriate treatment strategies.
Topics: Humans; Retrospective Studies; Neoplasm Staging; Esophageal Neoplasms; Magnetic Resonance Imaging
PubMed: 37233847
DOI: 10.1007/s10388-023-01010-2 -
Revista de Neurologia Mar 2019Epileptic seizures and epilepsy are part of daily clinical practice in neurology. Yet, the number of false positive diagnoses is surprisingly high. Almost one out of... (Review)
Review
INTRODUCTION
Epileptic seizures and epilepsy are part of daily clinical practice in neurology. Yet, the number of false positive diagnoses is surprisingly high. Almost one out of every five patients treated for epilepsy does not really have this diagnosis, which is a high percentage bearing in mind the social and medical consequences that being diagnosed with epilepsy entails.
AIMS
To summarise the most important diagnostic challenges in epilepsy, to describe possible sources of diagnostic error and to offer advice on how to avoid them.
DEVELOPMENT
Epilepsy is characterised by a tendency to suffer unprovoked epileptic seizures. The greatest obstacle when it comes to diagnosing a case of epilepsy is the fact that epileptic seizures are transient phenomena that occur relatively infrequently and the physician who must carry out the diagnosis will rarely see them. Moreover, there are other clinical events, such as syncopes or non-epileptic seizures, that may be similar to epileptic seizures in appearance and, consequently, can be mistaken for them. Finally, when interpreting the two most important complementary diagnostic techniques in epileptology, the electroencephalogram and magnetic resonance imaging of the brain, the most common errors must be taken into account in order to prevent mistaken diagnoses.
CONCLUSIONS
The diagnosis of epilepsy is a challenge and must be based on a detailed and specific medical record. If there are any reasonable doubts, from the outset, about the diagnosis of epilepsy or if the patient does not respond well to the antiepileptic treatment, we recommend referring the patient to a specialised centre to establish a definitive diagnosis.
Topics: Diagnosis, Differential; Diagnostic Errors; Electroencephalography; Epilepsy; Humans
PubMed: 30855710
DOI: 10.33588/rn.6806.2018242 -
PloS One 2022Diagnosing cardiac pauses that could produce syncopal episodes is important to guide appropriate therapy. However, the infrequent nature of these episodes can make...
Diagnosing cardiac pauses that could produce syncopal episodes is important to guide appropriate therapy. However, the infrequent nature of these episodes can make detection challenging with conventional monitoring (CM) strategies with short-term ECG monitors. Insertable cardiac monitors (ICMs) continuously monitor for arrhythmias but present a higher up-front cost. It is not well understood whether these higher costs are offset by the costs of repeat evaluation in CM strategies. We simulated the likelihood of diagnostic success and cost-per-diagnosis of pause arrhythmias with CM strategies compared to ICM monitoring. ICM device data from syncope patients diagnosed with pause arrhythmias was utilized to simulate patient pathways and diagnostic success with CM. We assumed that detected true pause episodes (≥5 seconds) were symptomatic and prompted a hospital encounter and further evaluation with CM. Subsequent true pause episodes in yet-undiagnosed patients triggered additional rounds of CM. Costs of monitoring were accrued at each encounter and represent the U.S. payer perspective. Cost per diagnosed patient was calculated as the total costs accrued for all patients divided by the number of patients diagnosed, across 1,000 simulations. During a mean 505±333 days of monitoring ICM detected 2.4±2.7 pause events per patient, with an average of 109±94 days until the first event. CM was projected to diagnose between 13.8% (24-hour Holter) and 30.2% (two 30-day monitors) of the ICM-diagnosed patients. Total diagnostic costs per ICM-diagnosed patient averaged $7,847, whereas in the CM strategies average cost-per-diagnosis ranged from $12,950±2,589 with 24-hour Holter to $32,977±14,749 for two 30-day monitors. Relative to patients diagnosed with pause arrhythmias via ICM, CM strategies diagnose fewer patients and incur higher costs per diagnosed patient.
Topics: Atrial Fibrillation; Electrocardiography; Electrocardiography, Ambulatory; Humans; Syncope
PubMed: 35749428
DOI: 10.1371/journal.pone.0270398 -
Journal of the European Academy of... Oct 2020The male and female external genital regions are anatomical areas in which various types of skin disorders may occur. Although most of these conditions can be diagnosed... (Review)
Review
The male and female external genital regions are anatomical areas in which various types of skin disorders may occur. Although most of these conditions can be diagnosed by means of clinical examination and an accurate medical history, in most cases further investigations with time-consuming and/or invasive procedures are needed in order to reach the correct diagnosis. Dermoscopy, as a modern non-invasive tool, is able to better diagnose pigmented and non-pigmented skin tumours along with various inflammatory and infectious skin and appendage disorders. The aim of this paper was to provide a review of the use of dermoscopy in genital disorders based on published data and to include personal experience gained from real life, focusing on any possible gender difference and whether disease mucosal/semimucosal dermoscopy features may differ from those observed on the skin. In conclusion, genital dermoscopy should always be considered during clinical inspection in order to enhance the diagnosis or to rule out those conditions that may look similar but that show a different dermoscopy pattern, thus narrowing down the differential diagnoses and avoiding unnecessary invasive investigations.
Topics: Dermoscopy; Diagnosis, Differential; Female; Genitalia; Humans; Male; Skin; Skin Diseases; Skin Neoplasms
PubMed: 32531092
DOI: 10.1111/jdv.16723