An Automated System for the Detection and Diagnosis of Kidney Lesions in Children from Scintigraphy Images

Designing a system for computer aided diagnosis is a complex procedure requiring an understanding of the biology of the disease, insight into hospital workflow and awareness of available technical solutions. This paper aims to show that a valuable system can be designed for diagnosing kidney lesions in children and adolescents from 99m Tc-DMSA scintigraphy images. We present the chain of analysis and provide a discussion of its performance. On a per-lesion basis, the classification reached an ROC-curve area of 0.96 (sensitivity/specificity e.g. 97%/85%) measured using an independent test group consisting of 56 patients with 730 candidate lesions. We conclude that the presented system for diagnostic support has the potential of increasing the quality of care regarding this type of examination

Improving the accuracy of 99Tcm-mercaptoacetyltriglycine clearance by using two blood samples instead of one?

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

The Swedish Reflux Trial in Children: I. Study Design and Study Population Characteristics

Purpose: We compared the rates of febrile urinary tract infection, kidney damage and reflux resolution in children with vesicoureteral reflux treated in 3 ways, including antibiotic prophylaxis, endoscopic therapy and surveillance with antibiotics only for symptomatic urinary tract infection. Materials and Methods: Children 1 to younger than 2 years with grade reflux were recruited into this prospective, open, randomized, controlled, multi-center study and followed for 2 years after randomization. The main study end points were recurrent febrile urinary tract infection, renal status on dimercaptosuccinic acid scintigraphy and reflux status. Outcomes were analyzed by the intent to treat principle. Results: During a 6-year period 128 girls and 75 boys entered the study. In 96% of cases reflux was detected after urinary tract infection. The randomization procedure was successful and resulted in 3 groups matched for relevant factors. Recruitment was slower than anticipated but after patients were entered adherence to the protocol was good. Of the children 93% were followed for the intended 2 years without a treatment arm change. All except 2 patients completed 2-year followup scintigraphy. Conclusions: Recruitment was difficult but a substantial number of children were entered and randomly assigned to 3 groups with similar basic characteristics. Good adherence to the protocol made it possible to address the central study questions

The relevance of urodynamic studies for urge syndrome and dysfunctional voiding:A multicenter controlled trial in children

Purpose: The objective of this study was to compare prospectively, in urge syndrome and dysfunctional voiding, clinical patterns with urodynamic patterns, to assess changes in urodynamic patterns after treatment, and to correlate urodynamic patterns and parameters with treatment outcome. Materials and Methods: In the European Bladder Dysfunction Study 97 children with clinically diagnosed urge syndrome received standard treatment, to which was randomly added placebo, oxybutynin or bladder training with online feedback. In a separate branch 105 children with clinically diagnosed dysfunctional voiding were randomly allocated to standard treatment or standard treatment plus pelvic floor training with online feedback. In all children urodynamic studies were performed before and immediately after treatment. Results: In urge syndrome detrusor overactivity was present in 33% of cases before and 27% after treatment (of which 65% were de novo). Detrusor overactivity did not correlate with treatment outcome. In dysfunctional voiding increased pelvic floor activity during voiding, which was present in 67% of cases before and 56% after treatment (of which 45% were de novo), did not correlate with treatment outcome. In urge syndrome as well as in dysfunctional voiding neither maximum detrusor pressure during voiding, cystometric bladder capacity, bladder compliance nor free flow patterns correlated with treatment outcome. Conclusions: Neither detrusor overactivity nor increased pelvic floor activity during voiding correlated with treatment outcome. Standard treatment could be the first choice in urge syndrome as well as in dysfunctional voiding, reserving urodynamic studies for patients in whom this first approach fails