Evaluation of the added value of 1H-magnetic resonance spectroscopy for the diagnosis of pediatric brain lesions in clinical practice
Karen ManiasSimrandip K. GillNiloufar ZarinabadPaul DaviesMartin EnglishDaniel FordLesley MacPhersonIna Nicklaus‐WollenteitAdam OatesGuirish A. SolankiJenny AdamskiMartin WilsonAndrew C. Peet
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Abstract:
Magnetic resonance spectroscopy (MRS) aids noninvasive diagnosis of pediatric brain tumors, but use in clinical practice is not well documented. We aimed to review clinical use of MRS, establish added value in noninvasive diagnosis, and investigate potential impact on patient care.Sixty-nine children with lesions imaged using MRS and reviewed by the tumor board from 2014 to 2016 met inclusion criteria. Contemporaneous MRI diagnosis, spectroscopy analysis, histopathology, and clinical information were reviewed. Final diagnosis was agreed on by the tumor board at study end.Five cases were excluded for lack of documented MRI diagnosis. The principal MRI diagnosis by pediatric radiologists was correct in 59%, increasing to 73% with addition of MRS. Of the 73%, 19.1% (95% CI, 9.1%-33.3%) were incorrectly diagnosed with MRI alone. MRS led to a significant improvement in correct diagnosis over all tumor types (P = .012). Of diagnoses correctly made with MRI, confidence increased by 37% when adding MRS, with no patients incorrectly re-diagnosed. Indolent lesions were diagnosed noninvasively in 85% of cases, with MRS a major contributor to 91% of these diagnoses. Of all patients, 39% were managed without histopathological diagnosis. MRS contributed to diagnosis in 68% of this group, modifying it in 12%. MRS influenced management in 33% of cases, mainly through avoiding and guiding biopsy and aiding tumor characterization.MRS can improve accuracy and confidence in noninvasive diagnosis of pediatric brain lesions in clinical practice. There is potential to improve outcomes through avoiding biopsy of indolent lesions, aiding tumor characterization, and facilitating earlier family discussions and treatment planning.Keywords:
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To determine the role of intraoperative frozen sections (FSs) in the management of patients with central nervous system (CNS) lesions, 60 consecutive intraoperative clinical diagnoses of CNS lesions were presented and compared with concomitantly obtained FS diagnoses. Clinical diagnoses were established byhistory, physical examination, imaging techniques, and gross appearance of the abnormal tissue in situ. Tissue samples were obtained intraoperatively and processed for FS diagnoses. The findings of the FS diagnoses were reported to the operating room and compared with the clinical diagnoses. The remainingbiopsy samples were used to prepare paraffin-embedded tissue sections from which the definitive diagnoses were made. Comparison of the clinical and FS diagnoses, using paraffin-embedded tissue as the true diagnosis, shows that FS diagnosis has a limited contribution to intraoperative patient management by the neurosurgeon. The rate of diagnostic failures between the two techniques was very similar; clinical diagnoses and FSs were misinterpreted in 12 and 11 of the 60 cases, respectively. Compared to a clinical diagnosis, the intraoperative FS technique provided no significant improvement in diagnosis and management; it altered the intraoperative management of the patients in 2 of 60 cases.
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Although it is widely recognized that diagnosis plays a central role in clinical medicine, in recent years the primacy of diagnosis has come under attack from several sources. 1. "Billable terms" are replacing traditional medical diagnoses. The former are based on International Classification of Diseases lists, which include many non-diagnoses such as symptoms and signs. 2. Diagnosis often gets short shrift because of the perceived urgency of discharge. 3. The problem oriented record, in practice, has frequently led to a shift in emphasis from synthesis of findings to fragmentation of problems. 4. Presumptive diagnoses frequently metamorphose into established diagnoses in medical records, even if incorrect. 5. A number of authors have apparently disparaged the importance of diagnosis. Nonetheless, it is clear that diagnosis must continue to play a central role in clinical medicine. We propose several ways by which we can resist these forces and assure that diagnosis retains its appropriate position of primacy.
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Introduction: Skin biopsy probably is the most important ancillary aid to confirm clinical diagnosis. The interpretation of many skin biopsies requires the identification and integration of two different morphological features – the tissue reaction pattern and the pattern of inflammation. Aim: To correlate histopathological diagnosis with clinical diagnosis in various non neoplastic skin lesions. Materials and Methods: The present study was a prospective and observational type of study. A total number of 197 participants were included after satisfying the eligibility criteria with due permission from Department of Dermatology. Only those patients who had given valid informed consent were included in the study. Results: Out of 197 biopsies studied, histopathological diagnosis in 167 biopsies (84.8%) was consistent with clinical diagnosis, while in 30 biopsies (15.2%) histopathological diagnosis was not consistent with clinical diagnosis. Conclusion: Out of 197 cases (M=111, F=86) biopsies studied, histopathological diagnosis was consistent with clinical diagnosis in 167 biopsies (84.8%), while in 30 biopsies (15.2%) the histopathological diagnosis was not consistent with clinical diagnosis. The skin biopsy remains the gold standard for diagnosis which can be supported with other techniques to confirm the diagnosis. This emphasizes the significance of histopathology in diagnosing non neoplastic skin disorders.
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Urgent laparoscopy was carried out in 684 patients because of acute abdominal pains. Laparoscopic diagnoses have been compared with the clinical tentative diagnoses on one hand and with the operative or final clinical diagnosis on the other hand. The referring diagnoses were in 20% "acute abdomen" without an attempt to uncriminating a particular organ, the clinical tentative diagnosis turned out to be wrong in 40% regarding the inspected a cause of abdominal pains. Laparoscopic diagnoses compared with operative findings proved to be wrong in 10 out of 296 cases but only in 2 out of these 10 patients the indication of operation remained incertain. In 1 out of 388 patients conservatively treated according to the laparoscopic finding, the further clinical course forced to operate upon, i. e. to change the diagnosis fundamentally. The high diagnostic reliability of urgent laparoscopy in patients with an "acute abdomen" decisively contributed to diminishing the number of explorative laparotomies and advancing indicated operations.
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Aim . In this research, we compare the antemortem and postmortem diagnosis in fatal head injury cases with the purpose of establishing the structure and causes of incorrect diagnoses. Material and methods . 1223 cases of fatal outcomes with the clinical diagnosis of death from head trauma were examined. In each case, we carried out a comparison of the clinical and autopsy diagnosis in terms of all report headings in order to establish reasons for divergence in the antemortem and postmortem diagnoses and the role of incorrect clinical diagnostics in the onset of death. Results . In 35% of cases, the clinical head trauma diagnoses were incorrectly categorized. In 22.6% cases, the antemortem diagnoses were formulated not in correspondence with the modern classifi cation and terms of ICD-10. In 11.7% cases, the violation of the etiopathogenesis principle was observed. Clinical diagnoses were not supported by objective data and examination results in 4.5% cases. The discrepancy between the clinical and autopsy diagnoses in terms of the ‘underlying disease’, ‘complications’ and ‘concomitant’ headings was 15.6%, 10.1% and 14.0% from all the studied cases, respectively. Subjective reasons are found to statistically predominate among the identifi ed reasons for the divergence of diagnoses. Conclusion . It is established that fi nal clinical diagnoses in fatal head injury cases fail to fully meet the criteria of structure, nosology, etiopathogenesis and reliability. Erroneous diagnoses are found to result from underestimation of clinical data, insuffi cient observation and instrumental examination of patients, incorrect formulation of the fi nal clinical diagnosis.
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Introduction: The brain tumor is an abnormal growth of tissue in the brain, which is one of the most important challenges in neurology. Brain tumors have different types. Some brain tumors are benign and some brain tumors are cancerous and malignant. Glioblastoma Multiforme (GBM) is the most common and deadliest malignant brain tumor in adults. The average survival rate for people with this type of brain tumor is about 15 months. Brain tumors are more common in men and are more dangerous. The most important diagnostic modality for tumor detection is magnetic resonance imaging (MRI). MRI is a non-invasive diagnostic method that provides anatomical images of the tumors. In recent decades, advanced MRI techniques have been increasingly developed to better tumor detection. One of these methods is Magnetic Resonance Spectroscopy (MRS) imaging. The MRS technique is used to study human brain metabolites and evaluate the neurochemical profile of the brain tissue. Unlike the MRI, MRS is able to grade the tumor. Depending on the grade and metabolites of the tumor, MRS can complement MRI images in medical diagnoses. The purpose of this study is to use machine learning to discriminate between normal and tumorous voxels in MRS data which can lead to a reduction in human error in the diagnosis of neurologist, radiologist, neuroscientists and etc.
Materials and Method: According to the neurologist's comment, magnetic resonance spectroscopy imaging was performed on 7 patients with GBM at the imaging center of Imam Khomeini Hospital in Tehran. The radiologist labeled all the tumor and normal voxels. Preprocessing step, including baseline correction and water suppression was performed by TARQUIN software. In processing step, signals of each voxel were extracted and the concentration of the metabolites was calculated. For classification of normal and tumorous voxels, Support Vector Machine was done using Statistics and Machine Learning Toolbox by MATLAB software.
Results: For classifying the data, the support vector machine (SVM) was used. The results of classifiers showed 87% accuracy, 82% specificity and 93% sensitivity. For classify these data, the Gaussian kernel was used. Using the linear kernel, the accuracy obtained 63%, specificity obtained 56% and sensitivity obtained 68%.
Conclusion: The results showed that, the accuracy for SVM with Gaussian kernel is significantly higher than SVM with linear kernel. This result shows that; this dataset may have nonlinear distribution. Therefore, the nonlinear classifiers may show better results than linear classifiers.
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Background: Accurate diagnosis of orofacial tumours is important as this determines the treatment options as well as the eventual treatment outcome. Agreement between clinical and histopathological diagnosis becomes important in this regard. Aims: The aim was to determine the level of agreement between clinical and histopathology diagnosis of orofacial lesions. Method: This is a retrospective study of all histopathology reports seen at KATH maxillofacial unit. Thedata collected included, clinical diagnosis and histological diagnosis. Results: A total of 567 histopathology reports were evaluated. The percentage of agreement between clinical and histopathological diagnosis was 62.8%. Conclusion: The agreement between clinical and histopathological diagnosis was high. However clinicians cannot rely on only the clinical diagnosis in managing patients.
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To verify the rate of diagnostic fitting between the clinic and the indentification-aided for diagnosis and differential diagnosis system, for emerging infections diseases (EID) established.314 cases of 49 kinds of contagious diseases diagnosed and another 186 patients with fever who not diagnosed were tested by the system.Preliminary verification was made in 314 cases diagnosed which classified to 49 kinds of contagious diseases of infectious diseases and the results showed that the coincidence rate of clinical diagnosis and first diagnosis of this system was 61.9%; the suggestive rate of first three diagnoses was 78.1%, and that of first five diagnoses was 86.6%. The diagnosis of another 186 patients with fever were diagnosed by the system and the results showed that the coincidence rate of clinical diagnosis and first diagnosis was 59.7%; the suggestive rate of first three diagnoses was 77.9%, and that of first five diagnoses was 85.4%.The system can accurately suggest impossible diagnosis and differential diagnosis, and be useful for our medical work.
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Objectives: Aim of this study is to determine the ability of junior doctors to document a clinical diagnosis and accuracy of the diagnosis. Methods: This single centre study included case records of patients admitted to the Professorial Medical Unit (PMU) and Emergency Treatment Unit (ETU) at Colombo South Teaching Hospital (CSTH). The junior doctors’ on admission diagnosis is compared with the medical consultants’ diagnosis. Only case records of patients belonging to four common specialty domains were studied. Results: In the PMU out of 200 case records no diagnosis or symptom as a diagnosis was documented in 99(49.5%) cases and a diagnosis was documented in 68(34.0%) case records of which 53(77.9%) diagnoses were concordant with the medical consultants’ diagnosis. When case records of patients admitted to ETU were considered, no diagnosis or symptom as a diagnosis was documented in 56(56.0%) case records and a diagnosis was documented in only 21(21.0%) case records of which 15(71.4%) diagnoses were concordant with the medical consultants’ diagnosis. Documentation of correct diagnosis improved with the grade of the doctor, from IMO to MR in both study settings and also with the order of clerking. Conclusions: Recording of symptom based diagnosis or no diagnosis remains high among most of the junior doctors in all specialty domains and at all grades.
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