NPV, negative predictive value

NPV,阴性预测值
  • 文章类型: Journal Article
    尽管埃塞俄比亚的保健设施正在靠近所有地区的社区建设,送货上门的比例仍然很高,并且没有进行研究来识别低出生体重(LBW)和早产新生儿,最好,另类,并在研究区域进行适当的人体测量。本研究的目的是找到简单的,最好,和替代人体测量,并确定了其检测LBW和早产新生儿的临界点。在德雷达瓦市政府进行了一项以卫生机构为基础的横断面研究,埃塞俄比亚东部。该研究包括385名在医疗机构分娩的妇女。为了评估人体测量的总体准确性,使用非参数接收器工作特性曲线。胸围(AUC=0·95)为29·4厘米,平均上臂围(AUC=0·93)为7·9厘米,被证明是LBW和胎龄的最佳人体测量学诊断指标,分别。此外,两种人体测量工具的LBW和胎龄的相关性最高(r=0·62)。与其他测量相比,脚长在检测LBW方面具有更高的灵敏度(94·8%),具有较高的阴性预测值(NPV)(98·4%)和较高的阳性预测值(PPV)(54·8%)。发现胸围和中上臂围是识别LBW和需要特殊护理的早产儿的更好的替代测量。需要更多的研究来确定更好的诊断干预措施,例如研究区域,资源有限,送货上门比例很高。
    Despite the fact that health facilities in Ethiopia are being built closer to communities in all regions, the proportion of home deliveries remains high, and there are no studies being conducted to identify low birth weight (LBW) and premature newborn babies using simple, best, alternative, and appropriate anthropometric measurement in the study area. The objective of the present study was to find the simple, best, and alternative anthropometric measurement and identified its cut-off points for detecting LBW and premature newborn babies. A health facility-based cross-sectional study was conducted in the Dire Dawa city administration, Eastern Ethiopia. The study included 385 women who gave birth in health facility. To evaluate the overall accuracy of the anthropometric measurements, a non-parametric receiver operating characteristic curve was used. Chest circumference (AUC = 0⋅95) with 29⋅4 cm and mean upper arm circumference (AUC = 0⋅93) with 7⋅9 cm proved to be the best anthropometric diagnostic measure for LBW and gestational age, respectively. Also, both anthropometric measuring tools are achieved the highest correlation (r = 0⋅62) for LBW and gestational age. Foot length had a higher sensitivity (94⋅8 %) in detecting LBW than other measurements, with a higher negative predictive value (NPV) (98⋅4 %) and a higher positive predictive value (PPV) (54⋅8 %). Chest circumference and mid-upper arm circumference were found to be better surrogate measurements for identifying LBW and premature babies in need of special care. More research is needed to identify better diagnostic interventions in situations like the study area, which has limited resources and a high proportion of home deliveries.
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  • 文章类型: Editorial
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  • 文章类型: Journal Article
    UNASSIGNED:建议使用高通量静态全幻灯片图像扫描仪来解决资源受限环境中有限的病理学服务的挑战。然而,高昂的设备成本和先进的技术,加上大量的空间来设置设备,使其在资源有限的环境中使用不切实际。在这里,我们旨在通过使用来自撒哈拉以南非洲的疑似淋巴瘤病例的淋巴结活检,对照载玻片显微镜(GSM)验证便携式全载玻片成像(WSI)装置,来应对这一挑战.
    UNASSIGNED:这是液体活检与常规病理的多中心前瞻性病例对照头对头比较研究的一部分。对于便携式WSI扫描仪验证,这项研究的病理学家评估了2021年2月至12月间经金标准病理学初步证实的105例手术淋巴结标本.由训练有素的组织技术人员根据苏木精和伊红(H&E)和免疫组织化学(IHC)染色的标准方案处理组织。然后将每个中心的H&E和IHC幻灯片数字化。数字图像被匿名化并由组织技术人员上传到符合HIPAA的服务器。三名研究病理学家在6周的冲洗后独立访问并审查了图像。描述并使用Cohens'kappa系数(κ)测量了病理学家在GSM和WSI上建立的诊断之间的一致性。
    未经评估:在GSM上,65.5%(n=84)的标本是淋巴瘤;25%被归类为良性,而9.5%为转移性。对GSM和WSI的形态学质量评估确定79.8%和53.6%的病例是高质量的,分别。当GSM的诊断与WSI进行比较时,各种诊断类别的总体一致性为93%,100%,淋巴瘤占86%,转移,和良性条件分别。WSI检测淋巴瘤的灵敏度和特异度分别为95.2%和85.7%,分别,观察者间的总体一致性(κ)为0.86;95%CI(0.70-0.95)。
    UNASSIGNED:我们证明,移动全载玻片成像(WSI)在淋巴结标本恶性浸润的初步诊断中并不逊色于常规玻璃载玻片显微镜(GSM)。我们的结果进一步提供了概念证明,即移动WSI可以适应原发性手术病理的资源受限设置,并将显着改善患者预后。
    UNASSIGNED: Telepathology utilizing high-throughput static whole slide image scanners is proposed to address the challenge of limited pathology services in resource-restricted settings. However, the prohibitive equipment costs and sophisticated technologies coupled with large amounts of space to set up the devices make it impractical for use in resource-limited settings. Herein, we aimed to address this challenge by validating a portable whole slide imaging (WSI) device against glass slide microscopy (GSM) using lymph node biopsies from suspected lymphoma cases from Sub-Saharan Africa.
    UNASSIGNED: This was part of a multicenter prospective case-control head-to-head comparison study of liquid biopsy against conventional pathology. For the portable WSI scanner validation, the study pathologists evaluated 105 surgical lymph node specimens initially confirmed by gold-standard pathology between February and December 2021. The tissues were processed according to standard protocols for Hematoxylin and Eosin (H&E) and Immunohistochemistry (IHC) staining by well-trained histotechnicians, then digitalized the H& E and IHC slides at each center. The digital images were anonymized and uploaded to a HIPAA-compliant server by the histotechnicians. Three study pathologists independently accessed and reviewed the images after a 6-week washout. The agreement between diagnoses established on GSM and WSI across the pathologists was described and measured using Cohens\' kappa coefficient (κ).
    UNASSIGNED: On GSM, 65.5% (n=84) of specimens were lymphoma; 25% were classified as benign, while 9.5% were metastatic. Morphological quality assessment on GSM and WSI established that 79.8% and 53.6% of cases were of high quality, respectively. When diagnoses by GSM were compared to WSI, the overall concordance for various diagnostic categories was 93%, 100%, and 86% for lymphoma, metastases, and benign conditions respectively. The sensitivity and specificity of WSI for the detection of lymphoma were 95.2% and 85.7%, respectively, with an overall inter-observer agreement (κ) of 0.86; 95% CI (0.70-0.95).
    UNASSIGNED: We demonstrate that mobile whole slide imaging (WSI) is non-inferior to conventional glass slide microscopy (GSM) for the primary diagnosis of malignant infiltration of lymph node specimens. Our results further provide proof of concept that mobile WSI can be adapted to resource-restricted settings for primary surgical pathology and would significantly improve patient outcomes.
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  • 文章类型: Journal Article
    UNASSIGNED:采用数字乳腺断层合成(DBT)图像合成的乳房X线照片(SM)来代替常规的全场数字乳房X线摄影(FFDM),以减少辐射剂量。
    UNASSIGNED:比较SM和FFDM之间癌症相关发现的显着性以及这些方法与DBT的组合。
    UNASSIGNED:该研究是在三级乳腺成像中心进行的,其中200名转诊接受筛查的女性被依次纳入研究.患者同时接受FFDM和DBT,并进行为期两年的随访。评估乳腺影像报告和数据系统(BI-RADS)评分的数据,乳腺密度,肿块病变,钙化,和两位乳腺放射科专家的局灶性不对称。通过CohenKappa检验对不同方法进行比较。
    未经证实:22例可能有恶性表现的患者进行了活检。以组织病理学发现和两年随访为参考,FFDM+DBT(分别为86.1和88.9)和SM+DBT(86.1和88.2)的总体敏感性和特异性没有显示有意义的差异.比较SM和FFDM,在SM上忽略了20名受试者的钙化,但后来与DBT结合时检测到。考虑到乳房成分和BI-RADS分类,读者之间有一个极好的协议。
    UNASSIGNED:考虑到患者的BI-RADS分类,SM+DBT筛查与FFDM+DBT的结果相当。尽管与FFDM相比,SM的灵敏度略低,DBT与SM联合后,未发现恶性钙化或肿块。
    UNASSIGNED: Synthesized Mammogram (SM) from Digital Breast Tomosynthesis (DBT) images is introduced to replace the routine Full Field Digital Mammography (FFDM) to reduce radiation dose.
    UNASSIGNED: to compare the conspicuity of cancer related findings between SM and FFDM and combination of these methods with DBT.
    UNASSIGNED: The study was conducted in a tertiary breast imaging center, where 200 women referred for screening were enrolled in the study sequentially. Patients underwent FFDM and DBT simultaneously and a two-year follow-up was done. Data was evaluated for Breast Imaging Reporting and Data System (BI-RADS) score, breast density, mass lesions, calcification, and focal asymmetry by two expert breast radiologists. Comparison between different methods was made by Cohen Kappa test.
    UNASSIGNED: 22 patients with likely malignant findings went under biopsy. Taking histopathologic findings and two-year follow up as reference, the overall sensitivity and specificity for FFDM+DBT (86.1 and 88.9 respectively) and SM+DBT (86.1 and 88.2) didn\'t show a meaningful difference. Comparing SM and FFDM, calcification in 20 subjects were overlooked on SM, but later detected when combined with DBT. Considering breast composition and BI-RADS categorization, an excellent agreement existed between the readers.
    UNASSIGNED: Screening with SM+DBT shows comparable results with FFDM+DBT considering BI-RADS categorization of the patients. Although SM showed slightly inferior sensitivity compared to FFDM, after combining DBT with SM no malignant appearing calcification or mass lesion was missed.
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  • 文章类型: Journal Article
    肝移植后尽量减少免疫抑制药物的策略受到同种异体移植排斥的限制。肝活检是目前诊断排斥反应的标准。然而,它增加了患者的身体和经济负担,并具有诊断局限性。在这次审查中,我们旨在强调预测和诊断急性排斥反应的不同生物标志物.我们还旨在探索分子诊断的最新进展,以提高肝活检的诊断率。
    Strategies to minimize immune-suppressive medications after liver transplantation are limited by allograft rejection. Biopsy of liver is the current standard of care in diagnosing rejection. However, it adds to physical and economic burden to the patient and has diagnostic limitations. In this review, we aim to highlight the different biomarkers to predict and diagnose acute rejection. We also aim to explore recent advances in molecular diagnostics to improve the diagnostic yield of liver biopsies.
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  • 文章类型: Journal Article
    未经证实:制定并验证诊断评分,以确定不明原因发热(FUO)中的成人起病斯蒂尔病(AOSD)。
    未经评估:单个中心,2018年1月至2021年12月FUO住院患者的回顾性病例对照研究。使用来自178例AOSD和486例FUO的临床和实验室数据,我们使用贝叶斯模型平均方法开发了AOSD/FUO(AF)评分。AF评分和Yamaguchi标准通过敏感度评估,特异性,准确度,以及在发育和验证样本中AOSD诊断的阳性/阴性预测值。
    UNASSIGNED:AOSD组皮疹患者的持续瘙痒性皮疹(PPEs)高于FUO组(52.3%vs7.4%;P<0.01)。PPEs的特异性为97.5%,灵敏度为44.9%。AF评分=PPEs×3.795+消退皮疹×2.774+血清铁蛋白×1.678+肌痛×0.958+中性粒细胞计数×0.185+血小板计数×0.004。截止值≥5.245显示,在验证组中区分AOSD和FUO的最大灵敏度为88.7%,特异性为95.8%。与山口标准相比,AF评分将准确率从82.6%提高到93.3%。
    UNASSIGNED:我们开发并验证了一种新的评分,该评分可以比Yamaguchi的标准更高的分类精度来识别FUO中的AOSD。未来需要设计多中心前瞻性研究来确认AF评分的诊断价值。
    UNASSIGNED: To develop and validate a diagnostic score to identify adult-onset Still\'s disease (AOSD) in fever of unknown origin (FUO).
    UNASSIGNED: A single center, retrospective case-control study of inpatients with FUO from January 2018 to December 2021. Using clinical and laboratory data from 178 cases with AOSD and 486 cases with FUO, we developed an AOSD/FUO (AF) score with a Bayesian Model Averaging approach. AF score and Yamaguchi\'s criteria were evaluated by sensitivity, specificity, accuracy, and positive/negative predictive value for diagnosis of AOSD in developmental and validation samples.
    UNASSIGNED: Persistent pruritic eruptions (PPEs) in patients with rashes was higher in AOSD group than FUO group (52.3% vs 7.4%; P < 0.01). PPEs yielded a specificity of 97.5% and a sensitivity of 44.9%. AF score = PPEs × 3.795+Evanescent rash × 2.774+Serum ferritin × 1.678+Myalgia × 0.958+Neutrophil count × 0.185+Platelet count × 0.004. A cut-off value ≥ 5.245 revealed the maximizing sensitivity of 88.7% and specificity of 95.8% in discriminating AOSD from FUO in the validation group. And AF score improved the accuracy from 82.6% to 93.3% compared with Yamaguchi\'s criteria.
    UNASSIGNED: We developed and validated a new score which can identify AOSD in FUO with higher classification accuracy than Yamaguchi\'s criteria. Future multi-centric prospective studies need to be designed to confirm the diagnosis value of AF score.
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  • 文章类型: Journal Article
    UNASSIGNED:由于乌克兰战争,结核病(TB)儿童诊断成像方案的最佳选择是当代挑战,这可能会导致西欧结核病病例的急剧上升。我们旨在收集所有主要研究,比较影像学模式及其对疑似或确诊肺结核(PTB)儿童肺部发现的诊断准确性。
    UNASSIGNED:我们使用预先指定的搜索词搜索数据库PubMed和Embase,从1972年到2022年的英语和非英语出版和未出版的报告。我们在排除文献综述和系统综述中通过引文检索检索报告。如果大多数研究人群年龄在0至18岁之间,确诊或疑似PTB,则研究合格。研究参与者描述了来自两种或两种以上不同成像模式的诊断图像.
    未经证实:共有15项研究调查了常规胸部X线(CXR)和计算机断层扫描(CT)对儿童PTB的诊断。九项研究调查了CT或CXR证实结核病诊断的参与者数量,所有的人,包括1244名患者,据报道,与结核病相符的发现在CT上比在CXR上更常见。只有两项研究没有将放射学结果作为其PTB诊断标准的一部分。并结合他们显示CT诊断54/54(100%)患有确诊PTB的儿童,而CXR诊断为42/54(78%)。两项研究将磁共振成像(MRI)与CXR进行了比较,表明MRI诊断的PTB儿童多于CXR。一项研究报告了更高的阳性预测值(PPV),MRI对PTB结果的敏感性和特异性优于CXR。一项研究将CXR与高千伏(高kV)CXR进行了比较,发现关于PTB确认的相容的敏感性和特异性。两项研究将超声(US)与CXR进行了比较,发现US具有更高的诊断率,并且更经常正确识别合并,纵隔LAP,和胸腔积液.
    UNASSIGNED:CT对PTB发现的诊断准确性高于CXR,核磁共振和美国,并且在可用时应该是首选的成像模式。MRI对LAP的敏感性和特异性高于CXR,胸腔积液,和空化。美国在最初的诊断工作和后续行动中表示赞赏。根据当地的可用性和专业知识,提出了儿童PTB的诊断策略。正如这份系统审查没有证据表明的那样,承认高结核病负担国家的专门知识。有疑问时可以进行CT,由于较高的诊断产量。
    UNASSIGNED: The optimal choice of protocol for diagnostic imaging in children with tuberculosis (TB) is a contemporary challenge due to the war in Ukraine, which potentially can create a steep rise in TB cases in Western Europe. We aimed to gather all primary research comparing imaging modalities and their diagnostic accuracies for pulmonary findings in children with suspected or confirmed pulmonary tuberculosis (PTB).
    UNASSIGNED: We searched the databases PubMed and Embase using pre-specified search terms, for English- and non-English published and un-published reports from the period 1972 to 2022. We retrieved reports via citation search in excluded literature reviews and systematic reviews. Studies were eligible if most of the study population was between 0 and 18 years of age with confirmed or suspected PTB, and study participants had described diagnostic images from two or more different imaging modalities.
    UNASSIGNED: A total of 15 studies investigated conventional chest X-Ray (CXR) and computed tomography (CT) in diagnosing PTB in children. Nine studies investigated the number of participants in where CT or CXR confirmed the diagnosis of TB, and all of them, including a total of 1244 patients, reported that findings compatible with TB were more frequently detected on CT than CXR. Only two studies did not include radiological findings as part of their diagnostic criteria for PTB, and combined they showed that CT diagnosed 54/54 (100 %) children with confirmed PTB, while CXR diagnosed 42/54 (78 %). Two studies compared magnetic resonance imaging (MRI) with CXR and showed that MRI diagnosed more children with PTB than CXR. One study reported a higher positive predictive value (PPV), sensitivity and specificity for PTB findings for MRI than CXR. One study compared CXR with high-kilovolt (high-kV) CXR, finding compatible sensitivity and specificity regarding confirmation of PTB. Two studies compared ultrasound (US) with CXR and found that US had a higher diagnostic yield and more often correctly identified consolidations, mediastinal LAP, and pleural effusion.
    UNASSIGNED: CT showed a higher diagnostic accuracy for PTB findings than CXR, MRI and US, and should be the imaging modality of first choice when available. MRI had a higher sensitivity and specificity than CXR for LAP, pleural effusion, and cavitation. US was complimentary in initial diagnostic work-up and follow up. A diagnostic strategy for PTB in children according to local availability and expertise is proposed, as no evidence from this systematic review shows otherwise, in acknowledgement of the expertise in high TB-burdened countries. CT can be performed when in doubt, due to the higher diagnostic yield.
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  • 文章类型: Journal Article
    UNASSIGNED:隐匿性股骨颈骨折(OFNF)的诊断和治疗延迟会对随后的生活质量产生负面影响。我们调查了通过磁共振成像(MRI)证实患有这种疾病的患者的超声检查对OFNF的诊断准确性,并将这些结果与其他临床发现进行了比较。
    UNASSIGNED:纳入94名年龄在70岁以上的急性髋部疼痛患者,但没有影像学异常发现,怀疑患有隐匿性股骨颈骨折(11名男性和83名女性,平均年龄为81.8±6.0岁)。所有病例均在24h内进行超声和MRI检查。测量股骨颈前部与前关节囊之间的超声距离(超声关节肿胀)。
    未经证实:通过MRI发现,27例患者被分配到隐匿性股骨颈骨折(OFNF)组(1例,26名女性)和非OFNF组的67名患者(10名男性,57名妇女)。两组超声关节肿胀平均为7.53±1.52mm和3.45±0.89mm,分别为(p=0.006,95%CI,3.58-4.59)。5.3mm的截断值显示0.96(0.89-0.96)的灵敏度和0.98(0.92-1.00)的特异性。
    UASSIGNED:超声检查显示隐匿性股骨颈骨折的诊断准确性非常高。因此,这种方式可以为70岁以上急性髋部疼痛患者的这种情况进行初始床边检查。
    UNASSIGNED: A delay in the diagnosis and treatment of an occult femoral neck fracture (OFNF) can negatively affect the subsequent quality of life. We investigated the diagnostic accuracy of ultrasonography for OFNF in patients confirmed with this condition by magnetic resonance imaging (MRI), and compared these results with other clinical findings.
    UNASSIGNED: Ninety-four outpatients aged above 70 years with acute hip pain but without radiographic abnormal findings who were suspected of having an occult femoral neck fracture (11 men and 83 women with a mean age of 81.8 ± 6.0 years) were enrolled. Both ultrasonography and MRI were performed in all cases within 24 h. The ultrasonographic distance between the anterior aspect of the femoral neck and the anterior joint capsule (ultrasound joint swelling) was measured.
    UNASSIGNED: By MRI findings, 27 patients were assigned to an occult femoral neck fracture (OFNF) group (1 man, 26 women) and 67 patients to a non-OFNF group (10 men, 57 women). The mean ultrasound joint swelling in both groups was 7.53 ± 1.52 mm and 3.45 ± 0.89 mm, respectively (p = 0.006, 95% CI, 3.58-4.59). A cut-off value of 5.3 mm showed a sensitivity of 0.96 (0.89-0.96) and a specificity of 0.98 (0.92-1.00).
    UNASSIGNED: Ultrasonography shows very high diagnostic accuracy for occult femoral neck fracture. This modality can thus contribute to initial bed-side examinations for this condition in patients over 70 years with acute hip pain.
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  • 文章类型: Journal Article
    UNASSIGNED:开发了一种深度学习模型,用于使用OCTB扫描检测非渗出性黄斑新生血管(neMNV)。
    未经评估:前瞻性回顾,观察性研究。
    UNASSIGNED:正常对照眼睛和患有和不患有neMNV的年龄相关性黄斑变性(AMD)的患者。
    UNASSIGNED:扫描源OCT血管造影(SS-OCTA)成像(PLEXElite9000,CarlZeissMeditec,Inc)使用6×6-mm扫描图案进行。对单个B扫描进行注释以区分玻璃疣和与neMNV相关的双层标志(DLS)。机器学习模型是在由人类分级的数据集上测试的,并将模型性能与人类分级者进行了比较。
    UNASSIGNED:测量联合交集(IoU)评分以评估分段网络性能。接收器工作特性曲线值下的面积,灵敏度,特异性,测量阳性预测值(PPV)和阴性预测值(NPV)以评估最终分类性能。使用Cohen的kappa测量算法与人类分级者确定之间的机会校正一致性。
    未经证实:共有210名患者的251只眼,包括182只DLS的眼睛和115只玻璃疣的眼睛,用于模型训练。125500次B扫描,手动注释6879个B扫描。建立了视觉变压器分割模型,从B扫描中提取DLS和玻璃疣。从体积中的所有B扫描中提取的预测掩模被投影到en面部图像,并获得每只眼睛的眼睛水平投影图。建立了二元分类算法,从投影图中识别具有neMNV的眼睛。该算法取得了82%,90%,79%,和91%的灵敏度,特异性,PPV,和净现值,分别,在先前研究中由人类分级者评估的100只眼睛的单独测试集上。曲线下面积值计算为0.91(95%置信区间,0.85-0.98)。该算法的结果显示与高级人类等级者的良好一致性(kappa=0.83,P<0.001),与初级等级者的一致性中等(kappa=0.54,P<0.001)。
    UNASSIGNED:我们的网络(代码可在https://github.com/uw-biomedical-ml/double_layer_vit上获得)通过应用纯基于变压器的模型,能够从结构B扫描中检测到neMNV的存在。
    UNASSIGNED: A deep learning model was developed to detect nonexudative macular neovascularization (neMNV) using OCT B-scans.
    UNASSIGNED: Retrospective review of a prospective, observational study.
    UNASSIGNED: Normal control eyes and patients with age-related macular degeneration (AMD) with and without neMNV.
    UNASSIGNED: Swept-source OCT angiography (SS-OCTA) imaging (PLEX Elite 9000, Carl Zeiss Meditec, Inc) was performed using the 6 × 6-mm scan pattern. Individual B-scans were annotated to distinguish between drusen and the double-layer sign (DLS) associated with the neMNV. The machine learning model was tested on a dataset graded by humans, and model performance was compared with the human graders.
    UNASSIGNED: Intersection over Union (IoU) score was measured to evaluate segmentation network performance. Area under the receiver operating characteristic curve values, sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were measured to assess the performance of the final classification performance. Chance-corrected agreement between the algorithm and the human grader determinations was measured with Cohen\'s kappa.
    UNASSIGNED: A total of 251 eyes from 210 patients, including 182 eyes with DLS and 115 eyes with drusen, were used for model training. Of 125 500 B-scans, 6879 B-scans were manually annotated. A vision transformer segmentation model was built to extract DLS and drusen from B-scans. The extracted prediction masks from all B-scans in a volume were projected to an en face image, and an eye-level projection map was obtained for each eye. A binary classification algorithm was established to identify eyes with neMNV from the projection map. The algorithm achieved 82%, 90%, 79%, and 91% sensitivity, specificity, PPV, and NPV, respectively, on a separate test set of 100 eyes that were evaluated by human graders in a previous study. The area under the curve value was calculated as 0.91 (95% confidence interval, 0.85-0.98). The results of the algorithm showed excellent agreement with the senior human grader (kappa = 0.83, P < 0.001) and moderate agreement with the junior grader consensus (kappa = 0.54, P < 0.001).
    UNASSIGNED: Our network (code is available at https://github.com/uw-biomedical-ml/double_layer_vit) was able to detect the presence of neMNV from structural B-scans alone by applying a purely transformer-based model.
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  • 文章类型: Journal Article
    目前,原发性脊髓髓内肿瘤的手术切除是治疗的主要手段。然而,考虑到狭窄的椎管和上行和下行束的密集组织的尺寸限制,脊髓髓内肿瘤切除术具有医源性神经损伤的显著风险。已经开发了术中神经生理监测(IONM)和绘图技术来评估基本神经通路的功能完整性并优化手术策略。IONM还可以告知对危险结构的即将发生的损害,并且如果发生损害,则可以与术后功能恢复相关。直接波(D波)将提供关于外侧皮质脊髓束完整性的即时反馈。在本次审查中,我们提供了关于D波用于脊髓肿瘤切除术的最新信息.我们强调了使用D波监测的神经解剖学和神经生理学见解,D波技术的技术考虑和局限性,以及与运动诱发电位和体感诱发电位的多模态联合监测。连同运动诱发电位,D波可以帮助指导肿瘤切除的范围,并提供术中警告标志和警报标准,以指导手术策略。D波还可以作为术后运动功能长期恢复的预后生物标志物。我们建议使用D波IONM可以为脊髓肿瘤切除术期间的临床决策提供关键发现。
    At present, surgical resection of primary intramedullary spinal cord tumors is the mainstay of treatment. However, given the dimensional constraints of the narrow spinal canal and dense organization of the ascending and descending tracts, intramedullary spinal cord tumor resection carries a significant risk of iatrogenic neurological injury. Intraoperative neurophysiological monitoring (IONM) and mapping techniques have been developed to evaluate the functional integrity of the essential neural pathways and optimize the surgical strategies. IONM can also inform on impending harm to at-risk structures and can correlate with postoperative functional recovery if damage has occurred. Direct waves (D-waves) will provide immediate feedback on the integrity of the lateral corticospinal tract. In the present review, we have provided an update on the utility of D-waves for spinal cord tumor resection. We have highlighted the neuroanatomical and neurophysiological insights from the use of D-wave monitoring, the technical considerations and limitations of the D-wave technique, and multimodal co-monitoring with motor-evoked potentials and somatosensory-evoked potentials. Together with motor-evoked potentials, D-waves can help to guide the extent of tumor resection and provide intraoperative warning signs and alarm criteria to direct the surgical strategy. D-waves can also serve as prognostic biomarkers for long-term recovery of postoperative motor function. We propose that the use of D-wave IONM can contribute key findings for clinical decision-making during spinal cord tumor resection.
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