ABSTRACT
Angiosarcoma is a rare type of soft tissue cancer with several clinical presentations and a poor prognosis. We present a case of a 75-year-old man who was admitted due to anemia and fatigue. The patient had undergone an endovascular repair (EVAR) of a 9 cm infrarenal aneurysm of the abdominal aorta two months ago. A computed tomography (CT) scan of the abdomen on admission indicated a Type-II endoleak and a large hematoma of the left psoas muscle with multiple sites of intramuscular extravasation. Osseous metastases were found at the head of the left femoral head and at the iliac bones. A CT guided biopsy of the femoral head revealed an angiosarcoma of unknown primary site a few days after the patient had died from intra-alveolar hemorrhage caused by lung metastases.
ABSTRACT
Background: The correct diagnosis of internal carotid artery (ICA) occlusion is crucial as it limits unnecessary intervention, whereas correct identification of patients with severe ICA stenosis is paramount in decision making and selecting patients who would benefit from intervention. We aimed to evaluate the accuracy of ultrasonography (US) in the diagnosis of ICA occlusion. Methods: We conducted a systematic review in compliance with the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) of diagnostic test accuracy studies. We interrogated electronic bibliographic sources using a combination of free text and thesaurus terms to identify studies assessing the diagnostic accuracy of US in ICA occlusion. We used a mixed-effects logistic regression bivariate model to estimate summary sensitivity and specificity. We developed hierarchical summary receiver operating characteristic (HSROC) curves. Results: We identified 23 studies reporting a total of 5,675 arteries of which 722 were proven to be occluded by the reference standard. The reference standard was digital subtraction or cerebral angiography in all but two studies, which used surgery to ascertain a carotid occlusion. The pooled estimates for sensitivity and specificity were 0.97 (95% confidence interval (CI) 0.94 to 0.99) and 0.99 (95% CI 0.98 to 1.00), respectively. The diagnostic odds ratio was 3,846.15 (95% CI 1,375.74 to 10,752.65). The positive and negative likelihood ratio were 114.71 (95% CI 58.84 to 223.63) and 0.03 (95% CI 0.01 to 0.06), respectively. Conclusions: US is a reliable and accurate method in diagnosing ICA occlusion. US can be used as a screening tool with cross-sectional imaging being reserved for ambiguous cases.
Subject(s)
Carotid Artery Diseases , Carotid Stenosis , Carotid Artery, Internal , Carotid Stenosis/diagnostic imaging , Diagnostic Tests, Routine , Humans , UltrasonographyABSTRACT
BACKGROUND: For the diagnosis of vascular prosthetic graft infection (VPGI), an intra-operative peri-graft biopsy is often required. Controversy exists regarding the use of imaging techniques in the diagnostic process. This study aimed to evaluate the diagnostic accuracy of 18-fluorine fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in VPGI. METHODS: A systematic search of electronic databases was conducted, applying a combination of free text and controlled vocabulary searches adapted to thesaurus headings, search operators, and limits to identify studies assessing the use of 18F-FDG PET in the diagnosis of VPGI. A meta-analysis was conducted using a mixed effects logistic regression bivariate model. RESULTS: Twelve studies were identified reporting a total of 433 prostheses, of which 202 were proven to be infected. Analysis of PET scan was performed using five different methods: graded uptake, focal uptake, maximum standardised uptake value (SUVmax), tissue to background ratio (TBR), and dual time point (DTP). The pooled estimates for sensitivity and specificity for graded uptake were 0.89 (95% CI 0.73-0.96) and 0.61 (95% CI 0.48-0.74), respectively; they were 0.93 (95% CI 0.83-0.97) and 0.78 (95% CI 0.53-0.92) for focal uptake; 0.98 (95% CI 0.42-0.99) and 0.80 (95% CI 0.70-0.88) for SUVmax; 0.57 (95% CI 0.39-0.73) and 0.76 (95% CI 0.64-0.85) for TBR; and 1.00 (95% CI 0.48-1.00) and 0.88 (95% CI 0.68-0.97) for DTP. Sensitivity analysis including studies that investigated the diagnostic accuracy of PET combined with computed tomography (CT) showed higher sensitivity and specificity for focal uptake, graded uptake, and SUVmax than 18F-FDG PET alone. CONCLUSIONS: This meta-analysis suggests that 18F-FDG PET has a high sensitivity in diagnosing VPGI and its accuracy can be further increased by combining PET with CT.
