The true clinical significance of renography in nephro-urology

Woolfson, Robin G.; Neild, Guy H.

doi:10.1007/bf01267689

Cited by 10 publications

(4 citation statements)

References 163 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Evaluation of suspected obstruction in adults using diuresis renography is an important clinical procedure [1–10]; however, the vast majority of studies are performed in institutions that perform fewer than three studies per week. To assist physicians with scan interpretation, particularly those with limited training or experience, we have previously developed [11] and validated [12] a renal expert system (RENEX) for detecting renal obstruction using 99m Tc-mercaptoacetyltriglycine (MAG3) renal scans before and after administration of furosemide, at a standardized expert level.…”

Section: Introductionmentioning

confidence: 99%

iRENEX: a clinically informed decision support system for the interpretation of 99mTc-MAG3 scans to detect renal obstruction

Garcia

Taylor

Folks

et al. 2012

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

Purpose Decision support systems for imaging analysis and interpretation are rapidly being developed and will have an increasing impact on the practice of medicine. RENEX is a renal expert system to assist physicians evaluate suspected obstruction in patients undergoing mercaptoacetyltriglycine (MAG3) renography. RENEX uses quantitative parameters extracted from the dynamic renal scan data using QuantEM™II and heuristic rules in the form of a knowledge base gleaned from experts to determine if a kidney is obstructed; however, RENEX does not have access to and could not consider the clinical information available to diagnosticians interpreting these studies. We designed and implemented a methodology to incorporate clinical information into RENEX, implemented motion detection and evaluated this new comprehensive system (iRENEX) in a pilot group of 51 renal patients. Methods To reach a conclusion as to whether a kidney is obstructed, 56 new clinical rules were added to the previously reported 60 rules used to interpret quantitative MAG3 parameters. All the clinical rules were implemented after iRENEX reached a conclusion on obstruction based on the quantitative MAG3 parameters, and the evidence of obstruction was then modified by the new clinical rules. iRENEX consisted of a library to translate parameter values to certainty factors, a knowledge base with 116 heuristic interpretation rules, a forward chaining inference engine to determine obstruction and a justification engine. A clinical database was developed containing patient histories and imaging report data obtained from the hospital information system associated with the pertinent MAG3 studies. The system was fine-tuned and tested using a pilot group of 51 patients (21 men, mean age 58.2±17.1 years, 100 kidneys) deemed by an expert panel to have 61 unobstructed and 39 obstructed kidneys. Results iRENEX, using only quantitative MAG3 data agreed with the expert panel in 87 % (34/39) of obstructed and 90 % (55/61) of unobstructed kidneys. iRENEX, using both quantitative and clinical data agreed with the expert panel in 95 % (37/39) of obstructed and 92 % (56/61) of unobstructed kidneys. The clinical information significantly (p<0.001) increased iRENEX certainty in detecting obstruction over using the quantitative data alone. Conclusion Our renal expert system for detecting renal obstruction has been substantially expanded to incorporate the clinical information available to physicians as well as advanced quality control features and was shown to interpret renal studies in a pilot group at a standardized expert level. These encouraging results warrant a prospective study in a large population of patients with and without renal obstruction to establish the diagnostic performance of iRENEX.

show abstract

Section: Introductionmentioning

confidence: 99%

iRENEX: a clinically informed decision support system for the interpretation of 99mTc-MAG3 scans to detect renal obstruction

Garcia

Taylor

Folks

et al. 2012

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

show abstract

“…Captopril renography is a functional test used to detect the angiotensin II dependence of GFR; in a positive test, the pre‐administration of oral captopril 25–50 mg delays the uptake of tracer, reduces peak uptake, prolongs parenchymal transit and slows excretion, as well as affecting divided function in unilateral disease [32]. The utility of the test may be limited by confounding factors, e.g.…”

Section: Investigation Of Rasmentioning

confidence: 99%

Renovascular hypertension: diagnosis and management

Connolly

Woolfson

2005

BJU International

Self Cite

View full text Add to dashboard Cite

“…2. d. Captopril renography is useful in identifying haemodynamically significant stenosis in FMD and is helpful in predicting the benefit of re‐vascularization of a stenosed kidneys [3]. Contrast radiography is particularly useful in the early detection of FMD, showing intra‐renal stenosis and complex arterial anatomy.…”

Section: Volume 96 Number 5 October 2005 Euus 2005:4mentioning

confidence: 99%

Correct answers to multiple choice questions appearing in the European Urology Update Series 2005

2005

BJU International

View full text Add to dashboard Cite

Correct answers to multiple choice questions appearing in the European Urology Update Series 20055. d. The mean incidence of prostate cancer found at autopsy is 37.6% [7]. Despite the disease being rare in young men, several investigators found prostate tumours in men aged < 40 years [8][9][10]. Autopsy cancers are, by definition, latent (i.e. not apparent during life) but are not always insignificant (tumour volume < 0.2 mL, confined to the prostate, Gleason score < 7 [2]). Holund [11] found high-grade tumours in 16% of the examined prostates.6. c. In the ERSPC, Schröder et al . [12] found that the rate of prostate cancer detection (with a biopsy indicated by a PSA of ≥ 3.0 ng/mL) per number of indicated biopsies was 21.5% (96/446) at a PSA of 3.0-3.9 ng/mL. In this study the old (biopsy indication ≥ 4.0 ng/mL and/or abnormal DRE/ TRUS) and the new ( ≥ 3.0 ng/mL) protocol for prostate cancer screening were compared. REFERENCES

show abstract

The true clinical significance of renography in nephro-urology

Cited by 10 publications

References 163 publications

iRENEX: a clinically informed decision support system for the interpretation of 99mTc-MAG3 scans to detect renal obstruction

iRENEX: a clinically informed decision support system for the interpretation of 99mTc-MAG3 scans to detect renal obstruction

Renovascular hypertension: diagnosis and management

Correct answers to multiple choice questions appearing in the European Urology Update Series 2005

Contact Info

Product

Resources

About