ABSTRACT
BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting both the upper and lower motor neurons. Deteriorating pulmonary function as a reflection of progressive respiratory muscle weakness is a common feature, accounting for the majority of deaths. The aim of the study was to describe a trend in initial pulmonary function tests (PFT) of amyotrophic lateral sclerosis (ALS) patients, in addition, differentiating between the types of disease onset, bulbar, limb muscle, and a combination. METHODS: Initial PFT were gathered from 32 consecutive patients in our clinic with the diagnosis of ALS, they were categorized by the type of disease onset. Values obtained were referenced to the 95% confidence limits for normality. RESULTS: There was evidence of significant reductions in both the FEV1 (64.7% predicted) and FVC (61.2%), with preservation of the FEV1/FVC (81.7%). The MVV was significantly reduced (43%). Total lung capacity was 93.2%, the residual volumes was increased at 145.7%. Subgroup analysis failed to show significant differences between types of disease onset. In the bulbar onset group (versus the limb group) there was a trend for the MVV to be further reduced (p = 0.15) and the RV to be higher (157.4% versus 135.9%, P = 0.24). CONCLUSIONS: ALS is a devastating disease that invariably leads to respiratory failure. Abnormal spirometric variables such as the FVC and MVV, likely reflect inspiratory muscle weakness and increased RV likely reflect expiratory muscle weakness. The type of disease onset did not result in a different pattern of PFT abnormalities.
Subject(s)
Lung/physiopathology , Adult , Aged , Amyotrophic Lateral Sclerosis/physiopathology , Female , Forced Expiratory Volume , Humans , Male , Middle Aged , Vital CapacityABSTRACT
PURPOSE: To assess the diagnostic performance and reader agreement with two-dimensional (2D) and three-dimensional (3D) display techniques for detecting colorectal polyps with spiral computed tomographic (CT) colonography. MATERIALS AND METHODS: A test set of 30 colonic segments was developed from spiral CT colonographic studies (12 with polyps and 18 without). The 12 segments with polyps contained 22 lesions (11 polyps <10 mm, 11 polyps or cancers >/=10 mm), with all findings verified with colonoscopy. Three specific 2D and 3D image-display techniques were tested. Three experienced abdominal radiologists independently analyzed each test case and were retested 6 weeks later. RESULTS: The results of readings 1 and 2 were similar for all image-display techniques among the readers. Pooled segment results were sensitivity of 89%-92% and specificity of 72%-83%. Pooled polyp size results for sensitivity and positive predictive value were 77%-86% and 74%-86% (all polyps, n = 22), 91%-100% and 85%-100% (polyps or cancers >10 mm, n = 11), and 61%-73% and 61%-80% (polyps 5-9 mm, n = 11), respectively. Overall intraobserver agreement was good for the three display techniques (kappa, 0.60-1.00); however, interobserver agreement for 2D multiplanar reformation was lower (kappa, 0.53-0.80). CONCLUSION: Among experienced abdominal radiologists, similar diagnostic performance in polyp detection was found among 2D multiplanar reformation and 3D display techniques, although individual cases showed improved characterization with 3D display techniques. Evaluation of reader agreement demonstrated good intraobserver agreement, with variable interobserver agreement.
