Compared to the risk-oriented approach to ovarian lesions that is presented in the Ovarian- Adnexal Reporting and Data System (O-RADS) US Risk Stratification and Management System as a guideline, a lesion-oriented flowchart is more user-friendly for radiologists. In the present article, the O-RADS guideline has been depicted in the form of a single flowchart to explain how to approach ovarian lesions in an algorithmic manner. In addition to providing a practical flowchart, this pictorial article contains some images of the related ovarian lesions.
BackgroundIncorrect estimation of pretest probability and misinterpretation of test results can change post-test probability in medical decision making. The aim of this study was to evaluate how physicians assess weight of findings of congestive heart failure (CHF) and how much their estimation is correlated with findings’ Diagnostic Odd Ratio (DOR).MethodsThe participants were asked to answer a questionnaire based on a scenario of a patient having dyspnea. Eighteen findings in 3 categories including: history, examination and radiographic findings were inserted along a column and a row as a matrix. The respondents had to compare each finding in the column with all other findings in the row and insert a mark in boxes below the findings of the row that had greater weight compared to the finding in the column. The weight of each finding was considered as total number of “marked boxes” in front of that finding. DOR of findings was calculated using their positive and negative likelihood ratios (LRs) based on current best evidence. Findings ranked in the order of their DOR and were compared with the ranking in the order of participants-assigned weights. We examined correlation between average weights assigned by physicians and DOR of findings. In subgroup analysis correlations between average weights assigned by physicians and DOR of history, examination and radiographic findings were examined.ResultsSeventy five physicians completed the questionnaire. Correlation between ranking in the order of findings’ DOR and ranking in the order of clinicians-assigned weights was significant (p-value = 0.005 r = 0.64). In contrast correlations between participants-assigned weights and DOR of history, examination and radiographic findings were positive but non- significant (r = 0.181, p-value = 0.7, r = 0.343, p-value = 0.506 and r = 0.219, p-value = 0.723 respectively).ConclusionOur result show that although correlation between clinicians-assigned weights and DOR of entire findings was significant, correlations between clinicians-assigned weights to the different categories of findings and their DOR were not significant. Reevaluating probabilistic reasoning by emphasis on using LRs can make pretest probability estimating and interpretation of test results more objective and would ultimate in more precise and homogenous post-test probabilities.
We describe a congenital cerebellar mass in a fetus at 30 weeks GA. The lesion is detected at the prenatal third‐trimester ultrasound, confirmed by fetal MRI, and determined as medulloblastoma in postmortem pathologic evaluation.
Objectives: We evaluated the brain computed tomography (CT) scan findings of children with abnormal neurologic recovery during the postoperative period for corrective/palliative congenital heart surgery. Methods: This study was conducted at a referral educational pediatric hospital from May 2015 to May 2016. We included patients with congenital heart disease (CHD) who underwent corrective/palliative cardiac surgery presenting with abnormal neurologic recovery in the early postoperative period. We recorded the demographic data, past medical history, surgery details, type of neurological disorders leading to a brain CT scan, and postoperative coagulopathy. Results: From among 734 cardiac surgeries from May 2015 to May 2016, 40 (5.44%) patients with abnormal neurologic recovery were assessed by brain CT scans. Among them, 55% were male and 45% were female with a mean age of 14.6 months. The most frequent heart anomaly was the transposition of great arteries (27.5%), which is known as the most common cause of cardiac surgery in the first month of life. Seizure (67.5%) was the most common neurologic manifestation and had the highest predictive value for the presence of an abnormal finding in the brain CT scan (91.3%). Intracranial hemorrhage, specifically subarachnoid hemorrhage, was the most frequent underlying pathology in brain CT scans of patients presenting with seizure. The most common findings in brain CT scans included subarachnoid hemorrhage (82.6%), intraparenchymal hemorrhage (26.08%), and ischemic infarction (17.39%). Data showed that a bypass time of over 180 min could significantly increase the probability of abnormal brain CT scan findings (P value = 0.03), particularly intra-parenchymal hemorrhage (P value = 0.016). The presence of coagulopathy concomitant with seizure would significantly increase the possibility of abnormal brain CT scan findings due to an acute neurologic event (P value = 0.049). Conclusions: This study showed seizure as the most common neurologic manifestation in the early postoperative period of cardiac surgery and the intracranial hemorrhage as the most common underlying pathology in patients with neurologic symptoms. Seizure in patients with coagulopathy should be considered as a great concern for physicians to evaluate acute neurologic events more precisely.
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