Clinical Evaluation of Diagnostic Tests

Weinstein, Susan P.; Obuchowski, Nancy A.; Lieber, Michael L.

doi:10.2214/ajr.184.1.01840014

Cited by 171 publications

(141 citation statements)

References 16 publications

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Section: Discussionmentioning

confidence: 99%

“…With the receiver operating characteristic method, one calculates the diagnostic cutoff for balanced sensitivity and specifi city, but the cutoff is substantially infl uenced by the distribution of the severity of the target disease characteristics in the population ( 16 ). Therefore, the cutoff value is specifi c to the population from which it was drawn and is less generalizable ( 16 ). On the other hand, the reference range method, with which the lower limit of the reference range of CT L 2 S values is used as the diagnostic cutoff, is a conservative approach, as it yields high specifi city (approximately 97.5%) at the expense of sensitivity.…”

Section: Discussionmentioning

confidence: 99%

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Biopsy-proven Nonsteatotic Liver in Adults: Estimation of Reference Range for Difference in Attenuation between the Liver and the Spleen at Nonenhanced CT

et al. 2011

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Purpose:To establish the reference range for hepatic attenuation minus splenic attenuation difference (CT L 2 S ) values on nonenhanced computed tomographic (CT) images obtained in adults with a biopsy-proved nonsteatotic liver and determine the CT L 2 S criterion for diagnosing hepatic steatosis. Materials and Methods:This retrospective study was institutional review board approved, and all subjects had provided written informed consent. The CT L 2 S was measured in 315 liver donor candidates (207 men, 108 women; mean age, 31.5 years 6 10.1 [standard deviation]) who underwent nonenhanced CT of the liver and subsequent ultrasonographically guided liver biopsy on the same day. Nonenhanced liver CT was performed with a 16-section multidetector scanner in 154 individuals and with a 64-section multidetector scanner in 161 individuals. Biopsy specimens were analyzed for degree of hepatic steatosis and iron deposition. The CT L 2 S reference range was determined according to Clinical and Laboratory Standards Institute guideline C28-A3 in individuals with a histologically proved nonsteatotic liver. The sensitivity of nonenhanced CT for the diagnosis of 5% or greater and 30% or greater hepatic steatosis with use of the lower limit of the reference range as the diagnostic cutoff was determined. The effects of subject age and sex, CT scanner type, and hepatic iron on the CT L 2 S were evaluated by using multiple linear regression analysis. Results:Ninety-six subjects (48 men, 48 women) were found to have a histologically proved nonsteatotic liver, with an estimated reference range for CT L 2 S values of 1-18 HU. With a CT L 2 S of less than 1 HU as the criterion for hepatic steatosis, the sensitivities of nonenhanced CT for 5% or greater and 30% or greater hepatic steatosis were 18.6% (29 of 156 subjects) and 67 % (26 of 39 subjects), respectively. Subject age had a signifi cant but negligible effect on CT L 2 S (0.076-HU increase per year of age, P = .009), subject sex and scanner type had no effects on CT L 2 S , and hepatic iron deposition signifi cantly increased the CT L 2 S (1.434-HU increase per increase in iron deposition grade, P = .011). Conclusion:The histologically proved reference range of CT L 2 S values for nonsteatotic livers was 1-18 HU. A CT L 2 S of less than 1 HU could be used as a conservative criterion for diagnosing hepatic steatosis with nonenhanced CT more consistently.q RSNA, 2011

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Biopsy-proven Nonsteatotic Liver in Adults: Estimation of Reference Range for Difference in Attenuation between the Liver and the Spleen at Nonenhanced CT

et al. 2011

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“…at a single time point might result in false-negative results. Serial testing is a widely accepted epidemiological approach designed to improve the diagnostic sensitivity of a laboratory test, thereby defining bacteremia positives as at least one positive out of multiple test results (22). For several reasons, including enhanced sensitivity, three blood cultures are typically recommended when bacterial sepsis is suspected (23).…”

mentioning

confidence: 99%

Serial Testing from a 3-Day Collection Period by Use of the Bartonella Alphaproteobacteria Growth Medium Platform May Enhance the Sensitivity of Bartonella Species Detection in Bacteremic Human Patients

et al. 2013

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Patients with infection from bacteremic Bartonella spp., tested using Bartonella Alphaproteobacteria growth medium (BAPGM), were retrospectively categorized into one of two groups that included those whose blood was collected once (group 1; n ‫؍‬ 55) or three times (group 2; n ‫؍‬ 36) within a 1-week period. Overall, 19 patients (20.8%) were PCR positive for one or more Bartonella spp. using the BAPGM platform. Seven patients (12.7%) in group 1 tested positive, and 12 patients (33.3%) in group 2 tested positive. Detection was improved when the patients were tested three times within a 1-week period (odds ratio, 3.4 [95% confidence interval, 1.2 to 9.8]; P ‫؍‬ 0.02). Obtaining three sequential blood samples during a 1-week period should be considered a diagnostic approach when bartonellosis is suspected.

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“…For cut-off points obtained with sensitivity analysis, the probability of a correct diagnosis was calculated as follows [10]:…”

Section: Statistical Data Analysesmentioning

confidence: 99%

Insulin and HOMA-IR in Healthy Young Mexicans: A Cut-off Points Proposal

Murguía‐Romero

Jiménez-Flores²,

Méndez-Cruz³

et al. 2014

Intern Med

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Clinical Evaluation of Diagnostic Tests

Cited by 171 publications

References 16 publications

Biopsy-proven Nonsteatotic Liver in Adults: Estimation of Reference Range for Difference in Attenuation between the Liver and the Spleen at Nonenhanced CT

Biopsy-proven Nonsteatotic Liver in Adults: Estimation of Reference Range for Difference in Attenuation between the Liver and the Spleen at Nonenhanced CT

Serial Testing from a 3-Day Collection Period by Use of the Bartonella Alphaproteobacteria Growth Medium Platform May Enhance the Sensitivity of Bartonella Species Detection in Bacteremic Human Patients

Insulin and HOMA-IR in Healthy Young Mexicans: A Cut-off Points Proposal

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