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CT diagnosis of Fitz-Hugh and Curtis syndrome: value of the arterial phase scan.

Joo SH, Kim MJ, Lim JS, Kim JH, Kim KW - Korean J Radiol (2007 Jan-Feb)

Bottom Line: The diagnostic accuracy of FHCS on each image set was compared for each reader by analyzing the area under the receiver operating characteristic curve (Az).The interobserver agreement for FHCS as the diagnosis was moderate on only the PP images (wk = 0.413), but it was substantial on the biphasic images (wk = 0.719).Inclusion of the AP scan is helpful to depict the increased perihepatic enhancement, and it improves the diagnostic accuracy of FHCS on CT.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul 120-752, Korea. kimnex@yumc.yonsei.ac.kr.

ABSTRACT

Objective: We wanted to evaluate the role of the arterial phase (AP) together with the portal venous phase (PP) scans in the diagnosis of Fitz-Hugh-Curtis syndrome (FHCS) with using computed tomography (CT).

Materials and methods: Twenty-five patients with FHCS and 25 women presenting with non-specifically diagnosed acute abdominal pain and who underwent biphasic CT examinations were evaluated. The AP scan included the upper abdomen, and the PP scan included the whole abdomen. Two radiologists blindly and retrospectively reviewed the PP scans first and then they reviewed the AP plus PP scans. The diagnostic accuracy of FHCS on each image set was compared for each reader by analyzing the area under the receiver operating characteristic curve (Az). Weighted kappa (wk) statistics were used to measure the interobserver agreement for the presence of CT signs of the pelvic inflammatory disease (PID) on the PP images and FHCS as the diagnosis based on the increased perihepatic enhancement on both sets of images.

Results: The individual diagnostic accuracy of FHCS was higher on the biphasic images (Az = 0.905 and 0.942 for reader 1 and 2, respectively) than on the PP images alone (Az = 0.806 and 0.706, respectively). The interobserver agreement for the presence of PID on the PP images was moderate (wk = 0.530). The interobserver agreement for FHCS as the diagnosis was moderate on only the PP images (wk = 0.413), but it was substantial on the biphasic images (wk = 0.719).

Conclusion: Inclusion of the AP scan is helpful to depict the increased perihepatic enhancement, and it improves the diagnostic accuracy of FHCS on CT.

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Related in: MedlinePlus

Receiver operating characteristic curves for reader 1 (A) and reader 2 (B) for the diagnosis of Fitz-Hugh-Curtis syndrome. The accuracy of the arterial phase plus portal venous phase set showed high statistical significance compared with using only the portal venous phase set for reader 2 (p = 0.0003) (B), and it nearly approached statistical significance for reader 1 (p = 0.0516) (A). The overall accuracy was superior for the arterial phase plus portal venous phase image set in respect to using only the portal venous phase set.
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Figure 1: Receiver operating characteristic curves for reader 1 (A) and reader 2 (B) for the diagnosis of Fitz-Hugh-Curtis syndrome. The accuracy of the arterial phase plus portal venous phase set showed high statistical significance compared with using only the portal venous phase set for reader 2 (p = 0.0003) (B), and it nearly approached statistical significance for reader 1 (p = 0.0516) (A). The overall accuracy was superior for the arterial phase plus portal venous phase image set in respect to using only the portal venous phase set.

Mentions: For the both readers, the accuracy (Az value) of the diagnosis of FHCS was higher with the AP plus the PP image set (Az, 0.905; 95% CI, 0.808-1.000 for reader 1; Az, 0.942;95% CI, 0.882-1.000 for reader 2) as compared with using only the PP image set (Az, 0.806; 95% CI, 0.683-0.930 for reader 1; Az, 0.706; 95% CI, 0.562-0.849 for reader 2) (Fig. 1). The difference in the diagnostic accuracy between the AP plus PP image set and using only the PP image set was statistically significant for reader 2 (p = 0.0003), and it nearly approached statistical significance for reader 1 (p = 0.0516). The overall false positive and (false) negative results, specificities, PPVs and NPVs on the both image sets for each reader are presented in Table 1. When an overall grade 3 for the visual grade was used as the cut-off value for the diagnosis of FHCS, the sensitivities were significantly higher (p = 0.000 for the both readers; McNemar test) with the AP plus the PP image set (88% for the both readers) than with using only the PP image set (28% for reader 1 and 4% for reader 2) (Fig. 2).


CT diagnosis of Fitz-Hugh and Curtis syndrome: value of the arterial phase scan.

Joo SH, Kim MJ, Lim JS, Kim JH, Kim KW - Korean J Radiol (2007 Jan-Feb)

Receiver operating characteristic curves for reader 1 (A) and reader 2 (B) for the diagnosis of Fitz-Hugh-Curtis syndrome. The accuracy of the arterial phase plus portal venous phase set showed high statistical significance compared with using only the portal venous phase set for reader 2 (p = 0.0003) (B), and it nearly approached statistical significance for reader 1 (p = 0.0516) (A). The overall accuracy was superior for the arterial phase plus portal venous phase image set in respect to using only the portal venous phase set.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2626697&req=5

Figure 1: Receiver operating characteristic curves for reader 1 (A) and reader 2 (B) for the diagnosis of Fitz-Hugh-Curtis syndrome. The accuracy of the arterial phase plus portal venous phase set showed high statistical significance compared with using only the portal venous phase set for reader 2 (p = 0.0003) (B), and it nearly approached statistical significance for reader 1 (p = 0.0516) (A). The overall accuracy was superior for the arterial phase plus portal venous phase image set in respect to using only the portal venous phase set.
Mentions: For the both readers, the accuracy (Az value) of the diagnosis of FHCS was higher with the AP plus the PP image set (Az, 0.905; 95% CI, 0.808-1.000 for reader 1; Az, 0.942;95% CI, 0.882-1.000 for reader 2) as compared with using only the PP image set (Az, 0.806; 95% CI, 0.683-0.930 for reader 1; Az, 0.706; 95% CI, 0.562-0.849 for reader 2) (Fig. 1). The difference in the diagnostic accuracy between the AP plus PP image set and using only the PP image set was statistically significant for reader 2 (p = 0.0003), and it nearly approached statistical significance for reader 1 (p = 0.0516). The overall false positive and (false) negative results, specificities, PPVs and NPVs on the both image sets for each reader are presented in Table 1. When an overall grade 3 for the visual grade was used as the cut-off value for the diagnosis of FHCS, the sensitivities were significantly higher (p = 0.000 for the both readers; McNemar test) with the AP plus the PP image set (88% for the both readers) than with using only the PP image set (28% for reader 1 and 4% for reader 2) (Fig. 2).

Bottom Line: The diagnostic accuracy of FHCS on each image set was compared for each reader by analyzing the area under the receiver operating characteristic curve (Az).The interobserver agreement for FHCS as the diagnosis was moderate on only the PP images (wk = 0.413), but it was substantial on the biphasic images (wk = 0.719).Inclusion of the AP scan is helpful to depict the increased perihepatic enhancement, and it improves the diagnostic accuracy of FHCS on CT.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul 120-752, Korea. kimnex@yumc.yonsei.ac.kr.

ABSTRACT

Objective: We wanted to evaluate the role of the arterial phase (AP) together with the portal venous phase (PP) scans in the diagnosis of Fitz-Hugh-Curtis syndrome (FHCS) with using computed tomography (CT).

Materials and methods: Twenty-five patients with FHCS and 25 women presenting with non-specifically diagnosed acute abdominal pain and who underwent biphasic CT examinations were evaluated. The AP scan included the upper abdomen, and the PP scan included the whole abdomen. Two radiologists blindly and retrospectively reviewed the PP scans first and then they reviewed the AP plus PP scans. The diagnostic accuracy of FHCS on each image set was compared for each reader by analyzing the area under the receiver operating characteristic curve (Az). Weighted kappa (wk) statistics were used to measure the interobserver agreement for the presence of CT signs of the pelvic inflammatory disease (PID) on the PP images and FHCS as the diagnosis based on the increased perihepatic enhancement on both sets of images.

Results: The individual diagnostic accuracy of FHCS was higher on the biphasic images (Az = 0.905 and 0.942 for reader 1 and 2, respectively) than on the PP images alone (Az = 0.806 and 0.706, respectively). The interobserver agreement for the presence of PID on the PP images was moderate (wk = 0.530). The interobserver agreement for FHCS as the diagnosis was moderate on only the PP images (wk = 0.413), but it was substantial on the biphasic images (wk = 0.719).

Conclusion: Inclusion of the AP scan is helpful to depict the increased perihepatic enhancement, and it improves the diagnostic accuracy of FHCS on CT.

Show MeSH
Related in: MedlinePlus