Is there an indication for computed tomography and magnetic resonance imaging in the evaluation of coronary artery bypass grafts?

This meta-analysis evaluates the diagnostic accuracy of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for bypass graft occlusion and stenosis detection compared with coronary angiography in post-coronary artery bypass graft patients. The indication for noninvasive imaging in post-coronary artery bypass graft patients with these techniques is discussed. Overall, MRI had significantly lower sensitivity (81%) and specificity (91%) for occlusion detection than MDCT (96% and 98%, respectively). Only 2 studies assessed the accuracy of stenosis detection with MRI. Stenosis detection with MDCT had a pooled sensitivity of 89% and specificity of 97%. Multidetector computed tomography is therefore superior to MRI for the noninvasive detection of coronary bypass graft occlusion and stenosis. For stenosis detection, the accuracy of MDCT is, however, not sufficient to warrant a wide clinical use. The remaining indication for MRI-guided bypass graft assessment is in combination with myocardial evaluation such as magnetic resonance perfusion, wall motion, and stress test as a "one-stop-shop" procedur

Challenges and strategies of children and adolescents with inflammatory bowel disease: a qualitative examination

© 2007 Nicholas et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

The clinical value of a negative multi-detector computed tomographic angiography in patients suspected of coronary artery disease: a meta-analysis

The aim of this meta-analysis was to calculate the sensitivity of contrast-enhanced multi-detector computed tomography (MDCT) compared with coronary angiography (CAG) in incident patients suspected of coronary artery disease (CAD). We searched PubMed, Embase, bibliographies of original papers and reviews to identify original papers including >= 20 patients. Two independent reviewers selected papers and judged eligible papers on quality. Heterogeneity was assessed and homogeneous subgroups were pooled. Of the 15 included studies, ten provided moderately homogeneous patient-based analyses with absolute diagnostic numbers (n=630 patients). Pooled sensitivity was 89% (95% confidence interval: 85-92%). Scanners with 16 detectors (n=4) had higher sensitivities (pooled sensitivity: 91%) than four-detector scanners (n=6; pooling not possible due to heterogeneity). Seven studies reported sensitivity for a proximal stenosis, but different definitions were used making pooling impossible; sensitivities ranged from 75 to 100%. The sensitivity of four- and 16-detector MDCT is not sufficient to rule out any stenosis in patients suspected of CAD. No conclusions can be drawn with respect to the sensitivity for clinically relevant or proximal stenoses

Is there an indication for computed tomography and magnetic resonance imaging in the evaluation of coronary artery bypass grafts?

This meta-analysis evaluates the diagnostic accuracy of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for bypass graft occlusion and stenosis detection compared with coronary angiography in post-coronary artery bypass graft patients. The indication for noninvasive imaging in post-coronary artery bypass graft patients with these techniques is discussed. Overall, MRI had significantly lower sensitivity (81%) and specificity (91%) for occlusion detection than MDCT (96% and 98%, respectively). Only 2 studies assessed the accuracy of stenosis detection with MRI. Stenosis detection with MDCT had a pooled sensitivity of 89% and specificity of 97%. Multidetector computed tomography is therefore superior to MRI for the noninvasive detection of coronary bypass graft occlusion and stenosis. For stenosis detection, the accuracy of MDCT is, however, not sufficient to warrant a wide clinical use. The remaining indication for MRI-guided bypass graft assessment is in combination with myocardial evaluation such as magnetic resonance perfusion, wall motion, and stress test as a "one-stop-shop" procedure

De incidentie van inflammatoire darmziekten in Nederland tussen 1999 en 2002

De incidentie van inflammatoire darmziekten (ibd) lijkt toe te nemen. Doel van dit onderzoek was om prospectief de incidentie van de ziekte van Crohn, colitis ulcerosa en de tussenvorm vast te stellen bij kinderen in Nederland tussen 1999 en 2002. Aan alle kinderartsen in Nederland werd maandelijks gevraagd of ze in de afgelopen maand kinderen met ibd hadden gediagnosticeerd. Indien dit het geval was, werd een uitgebreide vragenlijst toegestuurd. Ook werd een landelijke database met alle histologische gegevens van genomen biopten geraadpleegd. Volgens vooraf gestelde criteria beoordeelden twee onafhankelijke beoordelaars uitdraaien van deze database op nieuwe ibd-gevallen. Gevallen gevonden in de palga-database werden ‘waarschijnlijk’ of ‘mogelijk’ ibd genoemd. Op basis van geslacht, geboortedatum, biopsiedatum en woonplaats werden overeenkomstige gevallen tussen beide systemen gezocht. Leeftijdsspecifieke incidentiecijfers werden berekend voor het jaar 2000. In totaal zijn in drie jaar 564 gevallen gevonden. Dit komt neer op een incidentiecijfer van 5,2 nieuwe gevallen per 100.000 kinderen per jaar. De incidentie stijgt exponentieel met de leeftijd. Slechts 24% van alle gevallen werd door de kinderarts gemeld, de rest van de nieuwe patiënten werd via de pathologie opgespoord. Epidemiologische onderzoeken naar de incidentie van ziekten die gebruikmaken van enkel actieve melding door artsen, kunnen vertekend zijn, wat leidt tot te lage incidentiecijfers