The management of patients with IBD requires evaluation with objective tools, both at the time of diagnosis and throughout the course of the disease, to determine the location, extension, activity and severity of inflammatory lesions, as well as, the potential existence of complications. Whereas endoscopy is a well-established and uniformly performed diagnostic examination, the implementation of radiologic techniques for assessment of IBD is still heterogeneous; variations in technical aspects and the degrees of experience and preferences exist across countries in Europe. ECCO and ESGAR scientific societies jointly elaborated a consensus to establish standards for imaging in IBD using magnetic resonance imaging, computed tomography, ultrasonography, and including also other radiologic procedures such as conventional radiology or nuclear medicine examinations for different clinical situations that include general principles, upper GI tract, colon and rectum, perineum, liver and biliary tract, emergency situation, and the postoperative setting. The statements and general recommendations of this consensus are based on the highest level of evidence available, but significant gaps remain in certain areas such as the comparison of diagnostic accuracy between different techniques, the value for therapeutic monitoring, and the prognostic implications of particular findings.
The aim of this study was to assess the diagnostic accuracy of dualsource computed tomography (DSCT) for evaluation of coronary artery disease (CAD) in a population with extensive coronary calcifications without heart rate control. Thirty patients (24 male, 6 female, mean age 63.1±11.3 years) with a high pre-test probability of CAD underwent DSCT coronary angiography and invasive coronary angiography (ICA) within 14 ± 9 days. No beta-blockers were administered prior to the scan. Two readers independently assessed image quality of all coronary segments with a diameter ≥1.5 mm using a four-point score (1: excellent to 4: not assessable) and qualitatively assessed significant stenoses as narrowing of the luminal diameter >50%. Causes of false-positive (FP) and false-negative (FN) ratings were assigned to calcifications or motion artifacts. ICA was considered the standard of reference. Mean body mass index was 28.3 ± 3.9 kg/m 2 (range 22.4-36.3 kg/m 2 ), mean heart rate during CT was 70.3 ± 14.2 bpm (range 47-102 bpm), and mean Agatston score was 821 ± 904 (range 0-3,110). Image quality was diagnostic (scores 1-3) in 98.6% (414/420) of segments (mean image quality score 1.68 ± 0.75); six segments in three patients were considered not assessable (1.4%). DSCT correctly identified 54 of 56 significant coronary stenoses. Severe calcifications accounted for false ratings in nine segments (eight FP/one FN) and motion artifacts in two segments (one FP/one FN). Overall sensitivity, specificity, positive and negative predictive value for evaluating CAD were 96.4, 97.5, 85.7, and 99.4%, respectively. First experience indicates that DSCT coronary angiography provides high diagnostic accuracy for assessment of CAD in a high pre-test probability population with extensive coronary calcifications and without heart rate control.
The median, radial, and ulnar nerves of the upper limbs may be affected by various peripheral neuropathies, each of which may be categorized according to its cause, as either an entrapment or a nonentrapment neuropathy. Entrapment neuropathies, also referred to as nerve compression syndromes, include the supracondylar process syndrome, pronator syndrome, anterior interosseous nerve syndrome, carpal tunnel syndrome, posterior interosseous nerve syndrome, cubital tunnel syndrome, and Guyon canal syndrome. Nonentrapment neuropathies include traumatic nerve injuries, infectious and inflammatory conditions, polyneuropathies, and mass lesions at anatomic locations where entrapment syndromes typically do not occur. Although clinical examination and electrophysiologic testing are the cornerstone of the diagnostic work-up, in certain cases magnetic resonance (MR) imaging may provide key information about the exact anatomic location of a lesion or may help narrow the differential diagnosis. In patients with a diagnosis of peripheral neuropathy, MR imaging may help establish the cause of the condition and provide information crucial for conservative management or surgical planning. In addition, knowledge of the normal anatomy and of the possible causes, typical clinical findings, and MR imaging features of peripheral neuropathies that affect the median, radial, and ulnar nerves allows greater confidence in the diagnosis.
Endoscopic US is more accurate than dynamic CT and MR imaging in the diagnosis of pancreatic tumor, particularly for tumors less than 3 cm in diameter.
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