Wagner Iared

Diagnostic accuracy of sonography for pleural effusion: systematic review

CONTEXT AND OBJECTIVEnThe initial method for evaluating the presence of pleural effusion was chest radiography. Isolated studies have shown that sonography has greater accuracy than radiography for this diagnosis; however, no systematic reviews on this matter are available in the literature. Thus, the aim of this study was to evaluate the accuracy of sonography in detecting pleural effusion, by means of a systematic review of the literature.nnnDESIGN AND SETTINGnThis was a systematic review with meta-analysis on accuracy studies. This study was conducted in the Department of Diagnostic Imaging and in the Brazilian Cochrane Center, Discipline of Emergency Medicine and Evidence-Based Medicine, Department of Medicine, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.nnnMETHODnThe following databases were searched: Cochrane Library, Medline, Web of Science, Embase and Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). The references of relevant studies were also screened for additional citations of interest. Studies in which the accuracy of sonography for detecting pleural effusion was tested, with an acceptable reference standard (computed tomography or thoracic drainage), were included.nnnRESULTSnFour studies were included. All of them showed that sonography had high sensitivity, specificity and accuracy for detecting pleural effusions. The mean sensitivity was 93% (95% confidence interval, CI: 89% to 96%), and specificity was 96% (95% CI: 95% to 98%).nnnCONCLUSIONSnIn different populations and clinical settings, sonography showed consistently high sensitivity, specificity and accuracy for detecting fluid in the pleural space.

Use of Color Doppler Ultrasonography for the Prediction of Malignancy in Follicular Thyroid Neoplasms Systematic Review and Meta-analysis

Objective. The purpose of this systematic review was to obtain summary estimates of the diagnostic accuracy of color Doppler ultrasonography (CDU) in predicting malignancy in thyroid follicular neoplasms (FNs). Methods. We searched Medical Subject Headings together with the search terms “follicular,” “thyroid,” and “Doppler” in the MEDLINE, Web of Science, and Excerpta Medica databases as well as the Latin American and Caribbean Health Sciences Literature database, after which we performed manual searches of the reference lists to locate additional studies. There were no language restrictions. We included studies that assessed the diagnostic accuracy of CDU in identifying malignancy in thyroid FNs. The assessments of the quality and extraction of data were performed by 3 independent reviewers. Results. We included 4 studies, which collectively evaluated 457 thyroid FNs, 67 of which had been classified as malignant based on the evaluation of surgical biopsy samples. Moderate, rich, predominant, or exclusive internal flow on CDU of thyroid FNs was considered indicative of malignancy. The overall sensitivity of CDU was 85% (95% confidence interval [CI], 74%–93%), with an overall specificity of 86% (95% CI, 82%–89%). The overall prevalence was 14.7%, and the positive and negative predictive values were 51% and 97%, respectively. The positive likelihood ratio was 6.07, and the negative likelihood ratio was 0.18. Conclusions. Predominant internal flow seen on CDU is associated with malignancy of thyroid FNs. Absence of internal flow or predominantly peripheral flow indicates a low probability of thyroid FN malignancy.

Angioplasty versus stenting for subclavian artery stenosis

BACKGROUNDnThere is insufficient evidence to guide stent usage following angioplasty in subclavian artery stenosis. This is an update of a review first published in 2011.nnnOBJECTIVESnThe aim of this review was to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery.nnnSEARCH METHODSnFor this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched February 2014) and CENTRAL (2014, Issue 1). There was no restriction on language.nnnSELECTION CRITERIAnRandomised controlled trials of endovascular treatment of subclavian artery lesions comparing angioplasty alone and stent implantation.nnnDATA COLLECTION AND ANALYSISnTwo authors independently evaluated studies to assess eligibility. Discrepancies were resolved by discussion. If there was no agreement, the third author was asked to assess the study for inclusion.nnnMAIN RESULTSnTo date we have not identified any completed or ongoing randomised controlled trials comparing percutaneous transluminal angioplasty and stenting for subclavian artery stenosis.nnnAUTHORS CONCLUSIONSnThere is currently insufficient evidence to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery.

Comparative evaluation of digital mammography and film mammography: systematic review and meta-analysis

CONTEXT AND OBJECTIVEnMammography is the best method for breast-cancer screening and is capable of reducing mortality rates. Studies that have assessed the clinical impact of mammography have been carried out using film mammography. Digital mammography has been proposed as a substitute for film mammography given the benefits inherent to digital technology. The aim of this study was to compare the performance of digital and film mammography.nnnDESIGNnSystematic review and meta-analysis.nnnMETHODnThe Medline, Scopus, Embase and Lilacs databases were searched looking for paired studies, cohorts and randomized controlled trials published up to 2009 that compared the performance of digital and film mammography, with regard to cancer detection, recall rates and tumor characteristics. The reference lists of included studies were checked for any relevant citations.nnnRESULTSnA total of 11 studies involving 190,322 digital and 638,348 film mammography images were included. The cancer detection rates were significantly higher for digital mammography than for film mammography (risk relative, RR = 1.17; 95% confidence interval, CI = 1.06-1.29; I² = 19%). The advantage of digital mammography seemed greatest among patients between 50 and 60 years of age. There were no significant differences between the two methods regarding patient recall rates or the characteristics of the tumors detected.nnnCONCLUSIONnThe cancer detection rates using digital mammography are slightly higher than the rates using film mammography. There are no significant differences in recall rates between film and digital mammography. The characteristics of the tumors are similar in patients undergoing the two methods.

Whole-body diffusion-weighted magnetic resonance imaging versus FDG-PET/CT for initial lymphoma staging: systematic review on diagnostic test accuracy studies

CONTEXT AND OBJECTIVEnPositron emission tomography with [18]F-fluoro-2-deoxyglucose (FDG-PET/CT) has been advocated as the method of choice for lymphoma staging, since it enables whole-body analysis with high sensitivity for detection of affected areas and because it combines capacities for anatomical and functional assessment. With technological advances, magnetic resonance imaging (MRI) has emerged as an alternative to FDG-PET/CT. This systematic review with meta-analysis aimed to compare whole-body diffusion-weighted MRI (WB-MRI) with FDG-PET/CT for lymphoma staging.nnnDESIGN AND SETTINGnSystematic review on diagnostic test accuracy studies conducted at a public university.nnnMETHODSnThe Medline, Scopus, Embase and Lilacs databases were searched for studies published up to September 2013 that compared WB-MRI and FDG-PET/CT for lymphoma staging. The reference lists of included studies were checked for any relevant additional citations.nnnRESULTSnSix studies that evaluated the initial lymphoma staging in 116 patients were included. WB-MRI and FDG-PET/CT agreed in 90.5% of the cases (κ = 0.871; P < 0.0001). In most of the studies, when there was disagreement between the methods, WB-MRI overstaged in relation to FDG-PET/CT. The sensitivity of WB-MRI and FDG-PET/CT, in comparison with the clinical-radiological standard, ranged from 59 to 100% and from 63 to 100% respectively.nnnCONCLUSIONnWB-MRI is a highly sensitive method for initial lymphoma staging. It has excellent agreement with FDG-PET/CT and is a great alternative for managing lymphoma patients, without using ionizing radiation or an intravenous contrast agent.

Color Doppler imaging of the ophthalmic artery in patients with chronic heart failure

PURPOSEnTo evaluate the ophthalmic artery hemodynamics in patients with chronic heart failure.nnnMETHODSnDoppler parameters of ophthalmic artery of 18 patients with chronic heart failure in different stages of the disease were compared with 21 healthy volunteers (control group). These parameters were also correlated with echocardiographic assessments and clinical cardiologic status.nnnRESULTSnMean diastolic velocity was 5.14 ± 2.4 cm/s in the chronic heart failure group and 7.44 ± 3.5 cm/s in the control group (p=0.007). Mean resistance index of the ophthalmic artery was 0.76 ± 0.08 in the chronic heart failure group and 0.70 ± 0.08 in the control group (p=0.04). Mean systolic velocity of the ophthalmic artery was 22.03 ± 7.7 cm/s in the chronic heart failure group and 25.32 ± 9.2 cm/s in the control group (p=0.24). There was a negative correlation between the resistance index of the ophthalmic artery and systemic blood pressure of patients with chronic heart failure (r= -0.47, p=0.007). Diastolic velocity of the ophthalmic artery correlated positively with systemic blood pressure (r=0.44, p=0.02).nnnCONCLUSIONnLower diastolic velocity and higher resistance index were observed in the ophthalmic artery of chronic heart failure patients when compared to the control group, which probably reflects the presence of orbital vasoconstriction in response to low cardiac output. Therefore, the influence of these findings on the structure and function of the optic nerve head deserves investigation.

Contribuição da densidade do PSA para predizer o câncer da próstata em pacientes com valores de PSA entre 2,6 e 10,0 ng/ml

Objetivo: Estudar o perfil dos pacientes submetidos a biopsia prostatica, determinando possiveis padroes que, associados aos niveis de PSA entre 2,6 e 10,0 ng/ml, possam levar a uma diminuicao de biopsias desnecessarias. Materiais e Metodos: De 2007 a 2009, foi realizado um estudo transversal com 1.282 individuos submetidos a biopsia prostatica e que apresentavam niveis de PSA entre 2,6 e 10,0 ng/ml. Resultados: A prevalencia de câncer foi de 28,6%. Pacientes com câncer eram, em media, mais idosos, com valores de PSA e densidade de PSA mais altos e menor volume da prostata. Na analise da densidade de PSA, os pacientes com câncer tiveram media de 0,31 ng/ml/cc, enquanto nos pacientes com resultado negativo a media foi de 0,10 ng/ml/cc. Utilizando como criterio de positividade para câncer o ponto de corte de densidade de PSA de 0,15 ng/ml/cc, obtivemos especificidade de 74% e sensibilidade de 70%. Para aumentar a sensibilidade e preciso reduzir o ponto de corte. Com o valor 0,09 ng/ml/cc, obtivemos sensibilidade de 84% (IC 95%: 80–87%) e especificidade de 75% (IC 95%: 72–78%). Conclusao: O uso sistematico da densidade de PSA na indicacao de prosseguimento da investigacao do paciente com biopsia poderia reduzir a quantidade de procedimentos desnecessarios. Unitermos: Prostata; Biopsia de prostata; Câncer de prostata; Densidade de PSA.

Value of renal cortical thickness as a predictor of renal function impairment in chronic renal disease patients

Objective To determine the presence of linear relationship between renal cortical thickness, bipolar length, and parenchymal thickness in chronic kidney disease patients presenting with different estimated glomerular filtration rates (GFRs) and to assess the reproducibility of these measurements using ultrasonography. Materials and Methods Ultrasonography was performed in 54 chronic renal failure patients. The scans were performed by two independent and blinded radiologists. The estimated GFR was calculated using the Cockcroft-Gault equation. Interobserver agreement was calculated and a linear correlation coefficient (r) was determined in order to establish the relationship between the different renal measurements and estimated GFR. Results The correlation between GFR and measurements of renal cortical thickness, bipolar length, and parenchymal thickness was, respectively, moderate (r = 0.478; p < 0.001), poor (r = 0.380; p = 0.004), and poor (r = 0.277; p = 0.116). The interobserver agreement was considered excellent (0.754) for measurements of cortical thickness and bipolar length (0.833), and satisfactory for parenchymal thickness (0.523). Conclusion The interobserver reproducibility for renal measurements obtained was good. A moderate correlation was observed between estimated GFR and cortical thickness, but bipolar length and parenchymal thickness were poorly correlated.

Dopplerfluxometria na esteatose hepática

Universidade Federal de Sao Paulo (UNIFESP) Departamento de Diagnostico por Imagem Setor de Ultrassonografia

Reproducibility of a quantitative system for assessing the quality of diagnostic ultrasound

Objective To present a quantitative system for assessing the quality of ultrasound examinations-SQUALUS-and to determine its reproducibility, taking into consideration the images on file, as well as the consistency between the images obtained and the final report. Materials and Methods The system includes questions related to the number of images; the appropriateness of images in relation to the protocol established; focus adjustment; depth; gain; and appropriateness of the measurements for B-mode examinations. For Doppler examinations, the system includes questions related to the appropriateness of color images, the spectral analysis, and correction of the insonation angle. To assess the quality of the report, the system includes questions related to the consistency between the images obtained and the contents of the report. An overall numerical score was assigned by averaging the scores for image quality and for the contents of the report. Two independent examiners, each blinded to the evaluation of the other, assessed 30 different types of ultrasound examinations. Results There was statistically significant agreement between the two examiners for 8 of the 10 questions related to image quality. For the questions related to the quality of the reports, the interexaminer agreement was almost perfect. Conclusion The proposed quantitative system for assessing the quality of ultrasound examinations is a reproducible tool that can be used in audits and accreditation programs.