OBJECTIVE: Transthoracic needle aspiration biopsies (TNAB) are ideal for diagnosis of peripheral lung nodules. The purpose of the study is to investigate computerized tomography (CT) guided TNAB at Landspitali University Hospital (LUH) in regard to indications, complications, results and evaluate the diagnoses that were obtained with the biopsies. MATERIAL AND METHODS: Retrospective study where information was obtained from clinical charts at LUH. A list of TNAB done over an 18 month period in 2003 to 2004 was obtained from the Department of Medical Imaging. Indications for biopsy, pathology diagnosis, complications and treatment were studied. Further studies and final diagnosis were also studied. RESULTS: There were total of 93 patients that had TNAB. Records were available on 82 patients (46 males og 36 females). Most often the study was done because of cancer suspicion. Nodules were commonly 2-3 cm large. Most commonly there was one nodule that was peripheral. 25/82 (30%) patients developed pneumothorax after the procedure and four patients needed a chest tube. The most common diagnosis was cancer in 36/82 (44%), unspecific changes in 15/82, normal tissue in 12/82, inflammation in 9/82 and other benign causes in 10/82. The sensitivity to diagnose cancer was 61% and specificity 100%. The final diagnosis was cancer in 59/82 (72%) of the cases and benign causes in 23/82. CONCLUSIONS: The diagnostic yield of TNAB is lower in our study than in many previous studies. The rate of complications is similar. It it necessary to do followup studies in benign diagnoses because many of them have cancer when studied further.
OBJECTIVE: The aim of this study was to evaluate the diagnostic accuracy (sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)) of 64-slice multidetector computed tomography (MDCT) compared with quantitative coronary angiography (QCA) for detection of coronary artery disease (CAD). MATERIAL AND METHODS: Sixty-nine patients participating in a study of coronary in-stent restenosis were investigated. After a 64-slice MDCT scan patients were evaluated by QCA. The coronary arteries were divided into 15 segments and stenosis was graded for each segment by both methods. The diagnostic accuracy of 64-slice MDCT was evaluated using the QCA as the gold standard. RESULTS: Among the 69 patients included in the study 13 (19%) were female and 56 male. The mean age was 63 (SD 10) years. The following risk factors were present: high blood pressure 67%, elevated blood cholesterol 54%, diabetes 12% and family history of CAD 71%. Current smokers were 22% and previous smokers were 48%. Altogether 663 segments were examined. Of those 221 (33%) segments were excluded; 103 because of stents, 48 because of heavy calcification, 41 because of motion artifacts and 29 because the segments were less than 1.5 mm in diameter. The mean time between MDCT and QCA was 6.3 (SD 12.1) days. The sensitivity of 64-slice MDCT for diagnosing significant stenosis (>or= 50% according to QCA) was 20%, the specificity was 94%, PPV was 16%, NPV was 95% and the accuracy was 89%. CONCLUSION: High NPV and specificity indicates that MDCT is useful for accurately excluding significant CAD but the low sensitivity and low PPV indicate that the method is not accurate in diagnosing coronary artery stenosis of 50% or more according to QCA.
Coronary artery calcium is known to complicate the evaluation of stenoses using computer tomography (CT). The aim of this study was to analyze the effect of coronary calcification on the diagnostic accuracy of CT coronary angiography in an Icelandic population.
The study was a retrospective analysis of 417 consecutive subjects that underwent CT coronary angiography and subsequent conventional coronary angiography within 6 months. Subjects were divided based on total Agatston score: 0, 0.1-10, 10.1-100, 100.1-400, 400.1-750 and >750. Sensitivity, specificity, positive and negative predictive values were calculated for =50% stenoses diagnosed with the CT, using the conventional coronary angiography as a reference. Correlation between Agatston score and =50% stenoses was calculated.
A total of 1668 coronary artery segments in 417 individuals were evaluated (68.6% men, mean age 60.2 Â± 8.9). The total mean Agatston score was 420 (range from 0-4275). CT detected >50% stenoses with a sensitivity of 70.1%, specificity of 79.9% and positive and negative predictive values of 55.4% and 88.2%, respectively. The negative predictive value was 93.0% for Agatston score zero but 78.3% for Agatston score ?750. An Agatston score threshold of 363 predicted =50% coronary stenoses with 49.6% sensitivity.
Diagnostic accuracy is moderate with good negtive predictive value and specificity. Although coronary calcification reduces diagnostic accuracy, negative predictive value is only mildly affected for Agatston score as high as 400. Agatston score is not a good predictor of =50% coronary artery stenoses. No particular Agatston score cut-off level was identified to indicate whether CT angiography was useless or not.
The purpose of this study was to estimate the value of the transferrin receptor in serum (sTfR) for detecting iron deficiency and compare it with the value of some other blood tests for that purpose.
All patients undergoing bone marrow aspiration in the FSA Hospital, Akureyri, Iceland, in the period 1999 to 2003 were eligible to participate in this prospective study. Included participants were 89. The sensitivity, specificity, efficiency, and Youden index of ferritin, MCV, CHr, sTfR, sTfR-Ferritin-index, the iron saturation of transferrin, and the Thomas-Plot method were calculated. The complete absence of stainable iron in bone marrow was used as the definitive marker of iron depletion.
The best method to detect iron deficiency as estimated by the Youden index was the Thomas-Plot method. This method was very specific in cases without evidence of inflammatory processes (CRP 6 mg/L). The sTfR-Ferritin-index came second and sTfR was the best single blood test to detect iron deficiency according to the Youden index.
The Thomas-Plot method and the sTfR-Ferritin-index proved to be the most reliable blood tests to diagnose iron deficiency. These parameters can eliminate the need of using bone marrow aspirate to diagnose iron deficiency in some cases.