ABSTRACT
Objetivo: Analizar la precisión diagnóstica del sistema VI-RADS® en radiólogos sin experiencia previa en su uso para diferenciar tumores de vejiga no músculo-infiltrantes de tumores de vejiga músculo-infiltrantes (TVMI) en lesiones sospechosas de malignidad en cistoscopia sin resección transuretral previa (RTU).Material y métodosEstudio retrospectivo en el que se incluyó a 18 pacientes con lesiones sospechosas en cistoscopia a los que se les realizó una RM de vejiga. Dos radiólogos sin experiencia previa en el sistema VI-RADS® evaluaron los estudios. Tras la RM, a los pacientes se les realizó una RTU de las lesiones sospechosas. Se analizaron la sensibilidad y la especificidad del sistema para valores VI-RADS® ≥3 o VI-RADS® ≥ 4, así como el índice kappa de Cohen, entre ambos radiólogos.ResultadosLos valores medios de sensibilidad y especificidad de ambos radiólogos considerando tanto los estudios VI-RADS® ≥ 3 o VI-RADS® ≥ 4 fueron del 91,7% y el 87,5, respectivamente. El índice kappa, considerando los estudios VI-RADS® ≥ 3 positivos fue de 0,551 (p<0,05) y considerando positivos los estudios VI-RADS® ≥ 4 de 0,571 (p<0,05).ConclusiónEl sistema VI-RADS® presenta unos excelentes valores de sensibilidad (91,7%) y especificidad (87,5%) en la clasificación de los TVMI cuando lo utilizan radiólogos sin experiencia previa en su uso con una moderada concordancia interobservador. (AU)
Objective: to analyze the diagnostic accuracy of the VI-RADS® system in the differentiation of non-muscle-invasive bladder tumors (NMIBT from muscle-invasive bladder tumors (MIBT in suspicious cystoscopic findings without prior transurethral resection (TUR evaluated by radiologists with no prior experience in its use.Material and methodsretrospective study carried out with 18 patients with suspicious lesions in cystoscopy. All of them underwent MRI of the bladder. Two radiologists with no prior experience in the use of the VI-RADS® system evaluated the results. All patients underwent TUR of the suspicious lesions after MRI. The sensitivity and specificity of the system were analyzed for VI-RADS® values ≥ 3 or VI-RADS® ≥ 4, as well as the Cohen's kappa coefficient between both radiologists.Resultsthe mean values of sensitivity and specificity of both radiologists considering both the VI-RADS® ≥ 3 or VI-RADS® ≥ 4 values were 91.7% and 87.5%, respectively. The kappa coefficient considering the VI-RADS® ≥ 3 as positive, was 0.551 (P<.05), while considering the VI-RADS® ≥ 4 as positive, it was 0.571 (P<.05).ConclusionThe VI--RADS® system presents excellent sensitivity (91.7% and specificity (87.5% values in the classification of MIBT performed by radiologists with no prior experience in its use, with a moderate interobserver agreement. (AU)
Subject(s)
Humans , Magnetic Resonance Spectroscopy , Muscles , Urinary Bladder Neoplasms/diagnostic imaging , Retrospective StudiesABSTRACT
OBJECTIVE: to analyze the diagnostic accuracy of the VI-RADS® system in the differentiation of non-muscle-invasive bladder tumors (NMIBT from muscle-invasive bladder tumors (MIBT in suspicious cystoscopic findings without prior transurethral resection (TUR evaluated by radiologists with no prior experience in its use. MATERIAL AND METHODS: retrospective study carried out with 18 patients with suspicious lesions in cystoscopy. All of them underwent MRI of the bladder. Two radiologists with no prior experience in the use of the VI-RADS® system evaluated the results. All patients underwent TUR of the suspicious lesions after MRI. The sensitivity and specificity of the system were analyzed for VI-RADS® values ≥ 3 or VI-RADS® ≥ 4, as well as the Cohen's kappa coefficient between both radiologists. RESULTS: the mean values of sensitivity and specificity of both radiologists considering both the VI-RADS® ≥ 3 or VI-RADS® ≥ 4 values were 91.7% and 87.5%, respectively. The kappa coefficient considering the VI-RADS® ≥ 3 as positive, was 0.551 (P<.05), while considering the VI-RADS® ≥ 4 as positive, it was 0.571 (P<.05). CONCLUSION: The VI--RADS® system presents excellent sensitivity (91.7% and specificity (87.5% values in the classification of MIBT performed by radiologists with no prior experience in its use, with a moderate interobserver agreement.
Subject(s)
Multiparametric Magnetic Resonance Imaging , Urinary Bladder Neoplasms , Humans , Muscles , Retrospective Studies , Urinary Bladder Neoplasms/diagnostic imagingABSTRACT
BACKGROUND: Non-alcoholic fatty liver disease is the most frequent liver abnormality observed in overweight or obese children and is strongly associated with metabolic syndrome and insulin resistance. OBJECTIVES: (i) To evaluate the effect of a 22-week multidisciplinary intervention program on hepatic fat fraction in overweight or obese children and (ii) to examine the effect of the intervention on cardiometabolic risk factors, self-esteem and well-being. METHODS: A total of 160 children, 9-11 years, will be recruited by pediatricians and randomly assigned to control (N = 80) or intervention (N = 80) groups. The control group will receive a family-based lifestyle and psycho-educational program (2 days/month), while the intervention group will attend the same lifestyle education and psycho-educational program plus the exercise program (3 days/week). The duration of training sessions will be 90 min of exercise, including warm-up, moderate to vigorous aerobic activities, and strength exercises. The primary outcome is the change in hepatic fat fraction (magnetic resonance imaging, MRI). Secondary outcomes include cardiometabolic risk factors such as total adiposity (dual Xray absorptiometry), visceral adiposity (MRI), functional peak aerobic capacity (cardiopulmonary exercise testing), blood pressure, muscular fitness, speedagility, and fasting blood insulin, glucose, C-reactive protein, alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase, lipid profile and psychological measurements (questionnaires). All the measurements will be evaluated at baseline prior to randomization and after the intervention. DISCUSSION: This study will provide insight in the efficacy of a multidisciplinary intervention program including healthy lifestyle education, psycho-education and supervised exercise to reduce hepatic fat and cardiometabolic risk in overweight children.
Subject(s)
Non-alcoholic Fatty Liver Disease/etiology , Overweight/complications , Overweight/therapy , Pediatric Obesity/complications , Pediatric Obesity/therapy , Weight Reduction Programs/organization & administration , Adiposity , Behavior Therapy/methods , Blood Glucose , Blood Pressure , Body Composition , Body Mass Index , C-Reactive Protein , Child , Exercise , Family , Female , Health Behavior , Humans , Life Style , Liver Function Tests , Male , Non-alcoholic Fatty Liver Disease/physiopathology , Physical Fitness , Research DesignABSTRACT
AIM: The aim of this paper was to compare the accuracy of contrast-enhanced computed tomography (CT), positron emission tomography (PET), unenhanced low-dose PET/CT (LD-PET/CT) and full-dose enhanced PET/CT (FD-PET/CT) for the initial staging of lymphoma. METHODS: One hundred and one lymphoma patients were examined by [18F]FDG-PET/CT including unenhanced low-dose CT and enhanced full-dose CT. Each modality of PET/CT was evaluated by a nuclear medicine physician and a radiologist unaware of the other modality, while the CT and PET images were interpreted separately by another independent radiologist and nuclear medicine physician respectively. The nodal and extranodal lesions detected by each technique were compared with a reference standard. RESULTS: For nodal assessment, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative LR (LR-) of LD-PET/CT were 97%, 96%, 98%, 95%, 26 and 0.02 respectively, and those of FD-PET/CT were 97%, 97%, 98%, 95%, 36 and 0.02. These results were significantly better than those of PET (sensitivity 82%, specificity 81%, PPV 88%, NPV 72%, LR+ 4.3, LR- 0.21). Likewise, both PET/CT displayed a higher sensitivity, NPV and LR- than CT (91%, 84%, 0.1 respectively). For organ evaluation, both modalities of PET/CT also had significantly better sensitivity and NPV than that of PET (LD-PET/CT: sensitivity 92%, NPV 90%; FD-PET/CT sensitivity 94%, NPV 92%; PET: sensitivity 70%, NPV 69%). The sensitivity, specificity, PPV and NPV for bone marrow involvement were 29%, 84%, 45% and 72% respectively for PET, and 29%, 90%, 56%, and 74% for both, LD-PET/CT, and FD-PET/CT. No significant differences were found between LD-PET/CT and FD-PET/CT, but FD-PET/CT detected important incidental findings in 5.9% of patients. CONCLUSION: PET/CT is an accurate technique for the initial staging of lymphomas without significant differences between LD-PET/CT and FD-PET/CT. FD-PET/CT detects relevant incidental findings that are missed on LD-PET/CT.
Subject(s)
Contrast Media , Diatrizoate Meglumine , Fluorodeoxyglucose F18 , Lymphoma/diagnostic imaging , Multimodal Imaging , Positron-Emission Tomography , Radiopharmaceuticals , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Radiation Dosage , Sensitivity and Specificity , Young AdultABSTRACT
OBJECTIVE: To describe our experience with an integrated PET/CT system in the clinical applications in Oncology. MATERIAL AND METHODS: An integrated PET/CT scanner is an in-line system combining a full-ring detector PET and a multidetector row helical CT in one machine. This is a multidisciplinary technique involving a nuclear medicine physician, a radiologist, a radiopharmacologist, and a physicist, with distinct tasks and working together. The clinical indications for PET scans are determined by the National Health System, which in Madrid is coordinated by Agencia Laín Entralgo, and are performed by a nuclear medicine physician with the help of a radiologist for CT interpretation. The combined PET/CT scans are supervised and interpreted by both a nuclear medicine physician and a radiologist. RESULTS: Between September 2003 and August 2005, a total of 2459 examinations were performed at our institution: 2200 were PET scans with low-dose noncontrast-CT for attenuation correction (clinical indications approved by NHS), and 259 were combined PET/CT scans with full-diagnostic enhanced-CT (in the setting of research programmes). The overall distribution of clinical indications for the 2459 examinations were: lung cancer 14.7%, solitary lung nodule characterization 7%, lymphoma 23.5%, colon cancer 18.5%, gastric cancer 1.9%, brain tumors 2.6%, head-neck tumors 5.5%, thyroid cancer 5%, breast cancer 4%, unknown origin cancer 4.3%, epilepsy 1.4%, others 11.6%. CONCLUSION: In our experience, the integrated PET/CT system has advantages over the stand-alone PET and/or CT. However, more studies, as the ongoing research programmes at our facility are needed for the diagnostic validation of this technique.
Subject(s)
Neoplasms/diagnosis , Positron-Emission Tomography , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Positron-Emission Tomography/methods , Tomography, X-Ray Computed/methodsABSTRACT
Objetivo. Describir nuestra experiencia con la técnica combinada tomografía por emisión de positrones-tomografía computarizada (PET/TC) en el manejo de la patología oncológica. Material y métodos. El equipo PET/TC combina en un sistema híbrido un escáner helicoidal multicorte y un escáner PET. La técnica es multidisciplinar interviniendo un médico nuclear, un radiólogo, un físico y un radiofarmacéutico, con funciones diferenciadas. Las indicaciones de la PET se determinan bajo uso tutelado en el Sistema Nacional de Salud (SNS), coordinado por la Unidad de Evaluación de Tecnologías Sanitarias de la Agencia Laín Entralgo, bajo la supervisión y realización de un médico nuclear ayudado si se requiere para interpretar la TC por un radiólogo. Cuando se usa como estudio combinado, los estudios son supervisados por un médico nuclear y un radiólogo. Resultados. Entre septiembre de 2003 y agosto de 2005 hemos efectuado 2.459 estudios: 2.200 como PET, con TC de baja dosis (indicaciones clínicas bajo uso tutelado en el SNS) y 259 como estudios realizados en el marco de proyectos de investigación utilizándose, en estos casos, como sistema híbrido en una única sesión. Los resultados globales muestran los siguientes porcentajes: cáncer de pulmón 14,7%, nódulo pulmonar solitario 7%, neoplasias linfoides 23,5%, cáncer colorrectal 18,5%, cáncer gástrico 1,9%, tumores cerebrales 2,6%, tumores de cabeza-cuello 5,5%, tiroides 5%, mama 4%, tumores de origen desconocido 4,3%, epilepsia 1,4% y otros 11,6%. Conclusión. En nuestra experiencia el sistema híbrido PET/TC aporta ventajas en comparación con la PET y/o TC aisladamente, pero son necesarios estudios de validación diagnóstica, que estamos realizando en indicaciones clínicas concretas
Objective. To describe our experience with an integrated PET/CT system in the clinical applications in Oncology. Material and methods. An integrated PET/CT scanner is an in-line system combining a full-ring detector PET and a multidetector row helical CT in one machine. This is a multidisciplinary technique involving a nuclear medicine physician, a radiologist, a radiopharmacologist, and a physicist, with distinct tasks and working together. The clinical indications for PET scans are determined by the National Health System, which in Madrid is coordinated by Agencia Laín Entralgo, and are performed by a nuclear medicine physician with the help of a radiologist for CT interpretation. The combined PET/CT scans are supervised and interpreted by both a nuclear medicine physician and a radiologist. Results. Between September 2003 and August 2005, a total of 2459 examinations were performed at our institution: 2200 were PET scans with low-dose noncontrast-CT for attenuation correction (clinical indications approved by NHS), and 259 were combined PET/CT scans with full-diagnostic enhanced-CT (in the setting of research programmes). The overall distribution of clinical indications for the 2459 examinations were: lung cancer 14.7%, solitary lung nodule characterization 7%, lymphoma 23.5%, colon cancer 18.5%, gastric cancer 1.9%, brain tumors 2.6%, head-neck tumors 5.5%, thyroid cancer 5%, breast cancer 4%, unknown origin cancer 4.3%, epilepsy 1.4%, others 11.6%. Conclusion. In our experience, the integrated PET/CT system has advantages over the stand-alone PET and/or CT. However, more studies, as the ongoing research programmes at our facility are needed for the diagnostic validation of this technique
