Comparison of short-term memory and visual sensory analysis as sources of information.
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Stress Tl-201 tomography (SPECT) is widely used for evaluating myocardial viability. To assess its value, redistribution (RD) on SPECT was compared with metabolic imaging using FDG. Thirty patients with coronary artery disease underwent stress-3 hour Tl-201 SPECT and PET using N-13 ammonia and FDG. RD was classified into 4 grading, including complete RD (CR), incomplete RD (IR), persistent defect (PD) and additional minimal RD (MR) defined as no definite RD on visual analysis but faint RD with Bull's eye quantitative analysis (QNT). All but one segment with CR or IR were viable regions (normal or ischemic regions) by PET. Of 74 segments without RD on visual analysis, 31 segments (42%) had RD by QNT (MR). All of them were viable regions by PET. Thus, QNT identified 31 segments (63%) of the metabolically viable segments which the visual Tl-201 analysis did not show RD and classified as myocardial scar. However, even such QNT cannot detect ischemic myocardium in 18 segments (42%) containing metabolic activity on PET. These data indicate that QNT of RD on Tl-201 SPECT is considered as a valuable means for assessing myocardial ischemia.
Eighty four patients (168 eyes) with low tension glaucoma were retrospectively reviewed (mean follow-up was 28 months). The mean age was 66 years, and 69% were females. Regression analysis of their automated Humphrey fields (a mean of eight fields per eye) showed progression in 50% of patients and in 37% of eyes. There was no statistically significant difference between patients with progression and non-progression with respect to age (p less than 0.05) or intraocular pressure (p less than 0.5). Visual field defects were located most frequently in the superior hemifield in both groups of patients. A considerable proportion of patients had advanced field loss at the time of diagnosis.
The ability of transcutaneous recordings of gastric electrical activity to detect gastric electrical abnormalities was determined by simultaneous measurements of gastric electrical activity with surgically implanted serosal electrodes and cutaneous electrodes in six patients undergoing abdominal operations. Transient abnormalities in gastric electrical activity were seen in five of the six patients during the postoperative period. Recognition of normal gastric electrical activity by visual analysis was possible 67% of the time and with computer analysis 95% of the time. Ninety four per cent of abnormalities in frequency were detected by visual analysis and 93.7% by computer analysis. Abnormalities involving a loss of coupling, however, were not recognised by transcutaneous recordings. Transcutaneous recordings of gastric electrical activity assessed by computer analysis can usually recognise normal gastric electrical activity and tachygastria. Current techniques, however, are unable to detect abnormalities in electrical coupling.
Our "vision" laboratory has been working for several years on stimulation methods and data processing. We present here the results of an analysis of correlation functions between VEPs obtained by flashes and patterned stimulations. This study provides additional information about possible interpretations.
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To determine whether a new approach to interpretation could improve the accuracy of thallium-201 single photon emission computed tomography (SPECT) for detection of left anterior descending coronary artery disease in patients with left bundle branch block, 69 patients were evaluated. Forty-four had angiographically proved coronary artery disease; the remaining 25 were considered to have a "low" (mean 13.5 +/- 6.4%, range 3.4% to 24.9%) likelihood of disease before thallium-201 scintigraphy. The conventional scintigraphic criterion for detection of left anterior descending artery disease (septal, anterior or apical defects) was compared with a new criterion that required the apex to be abnormal to indicate left anterior descending disease. The normalcy rates in the low likelihood patient group were significantly improved by using the new approach, from 16% to 80% (p less than 0.0001) by visual analysis and from 24% to 64% (p = 0.003) by quantitative SPECT polar map analysis. The sensitivity for left anterior descending disease was similar for the conventional and the new method by visual (100% vs. 94%) and quantitative (100% vs. 83%) analyses. In contrast, the specificity was significantly improved by using the new approach, from 14% to 79% (p = 0.0006) by visual analysis and 14% to 64% (p = 0.007) by quantitative analysis. In conclusion, septal and anterior thallium-201 SPECT defects are common in patients with left bundle branch block without coronary artery disease, resulting in low specificity for left anterior descending artery disease. The normalcy rates and accuracy for detection of left anterior descending coronary artery disease were significantly better when an apical defect was used as the criterion for disease.
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ST-segment depression and slope were compared in three lead systems (V5, CC5, and CM5) and in two groups of patients using both visual analysis of electrocardiographic paper and computerized techniques. Bipolar lead CC5 was found to be comparable to lead V5 when visual analysis of electrocardiographic recordings was utilized. Bipolar lead CM5 was found not to be comparable to lead V5 and to be less sensitive if classic criteria for slope were used. The technique of computerized analysis mad measurements of slope and amplitude to a reproducible level not possible with the standard technique. Statistically significant differences were found between the exercise electrocardiographic leads utilizing computerized electrocardiographic analysis . We conclude that computerized techniques of electrocardiographic analysis require new criteria for defining an abnormal repolarization response. The criteria must be specific for different electrocardiographic leads if the repolarization changes in these leads are to have comparable diagnostic significance.
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Previous quantitation of exercise-redistribution planar 201TI scintigraphy has shown high sensitivity and specificity in the detection of coronary artery disease and improved detection of individual coronary stenoses over visual analysis. By using similar methodology based on the circumferential profile method, we studied 133 patients to quantitatively assess the extent, depth, and severity of thallium defects compared with consensus visual analysis. These quantitative measurements are objective, requiring only three operator interactions. In comparing quantitative and visual results, a close correlation was found for measurement of extent of thallium defect (r = 0.73) and severity of defect (r = 0.79). In detecting patients with the high-risk scintigraphic pattern of a severe stress thallium defect, a quantitative depth score of greater than or equal to 36 had an 81% sensitivity and an 82% specificity. Thus, this nearly automatic, computerized quantitative method allows objective determination of extent, severity, and depth of planar 201TI defects.
The difference tables gives, on a numeric table, the difference between first and second examination. The confidence interval is given out by a statistical test (T-test) which can be applied to the following parts of visual field: pathological area, whole field. We present a number of visual field examinations (Program 33) from glaucomatous patients, analysed through "change mode". We can make the following remarks: When we assess an improvement, it is underlined in "Delta Program", which indicates: significant improvement. When the visual field is unchanged, "Delta Program" indicates a fluctuation: aggravation or improvement (almost always insignificant). A subjective alteration is always underlined by "Delta Program". The program allows an objective interpretation and, when it is combined with the usual objective interpretation, makes the evaluation of campimetric deficiency easier. The importance of statistical analysis, besides the fact that it associates the visual field to one or several mean values, is to set it off as exactly as possible. Flammer and coll. (1985) propose a new index: "corrected loss variation".
The diagnostic performance of automatic analysis of the exercise electrocardiogram in detecting ischaemic heart disease was studied in 147 patients with angiographically documented coronary disease. The results were compared with the results of visual analysis of the same recordings. Using a bicycle ergometer we tried to reach at least 90 per cent of the predicted maximal heart rate of the patient. Two bipolar thoracic leads (CM5, CC5) were used. In the visual analysis the criterion of the so-called ischaemic ST segment was applied. For the automatic analysis the population was divided into a learning group (N=87) and a testing group (N=60). In the learning group first critical values were computed for different ST measurements that provided optimal separation between patients with (CAG POS.) and without (CAG. NEG.) significant coronary stenoses as revealed by coronary arteriography. These critical values were kept unchanged when applied to the testing group. With respect to the visual method an increase of the sensitivity by 0-45 and 0-36 was obtained by the automatic analysis in the learning and testing group, respectively. The best separation between CAG. POS. and CAG. NEG. group was reached using a criterion consisting of a linear combination of the slope of the initial part of the ST segment and the ST depression; the sensitivity being 0-70 and 0-60, respectively, in the learning and testing group. Using a criterion based on the area between the baseline and the ST segment (the SX integral) these values were 0-42 and 0-49, respectively. All specificities were kept to at least 0-90.
The efficiency of 99Tcm-methylene diphosphonate (MDP) and 99Tcm-dicarboxypropane diphosphonate (DPD) to detect pathologically increased bone uptake was evaluated both by computed quantitative intra-individual and visual inter-individual comparison. Twelve patients with altogether 44 metastases in ribs and lumbar vertebrae were evaluated quantitatively. The lesion to normal bone ratio (mean +/- SD) was, with MDP, 2.9 +/- 1.6 and with DPD 2.4 +/- 1.2 (p less than 0.001), and the normal bone to soft tissue ratios with MDP 8.5 +/- 5.0 and with DPD 9.4 +/- 6.1 (NS). Visual analysis of 162 patients with 334 focal lesions showed no significant difference between two MDP preparations and one DPD preparation. Visual and quantitative comparison in the three most common malignancies studied (breast, prostatic, and lung carcinoma) gave the same result. Because the lesion to normal bone ratios were high with both agents, and there was no significant difference on visual analysis, both radiopharmaceuticals are considered to be relevant bone seeking agents and the difference between MDP and DPD is only academic and not of practical value.
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One hundred and twenty seven eyes of 127 patients were studied by means of a Kodak 47B Wratten blue gelatin filter in conjunction with the Friedmann Mark 1 visual field analyser. There were 49 patients in the normal group, 50 patients in the ocular hypertension group, and 28 patients in a group with early glaucoma. A simple scoring system did not show a useful difference between these three groups. However, use of a derived threshold value for each target group designated by the letters B to P (giving selective blue field scores) differentiated between normal subjects and those with early glaucomatous field loss. When used with a calculated upper limit of normal to give a specificity of 96%, this test had a sensitivity of 64%. Of the ocular hypertension group 22% gave abnormal results in comparison with normal persons. This simple adaptation to the Friedmann protocol may aid the ophthalmologist in the detection and confirmation of early glaucoma.
A system for scoring dicentric chromosomes by image analysis comprised fully automatic location of mitotic cells, automatic retrieval, focus and digitization at high resolution, automatic rejection of nuclei and debris and detection and segmentation of chromosome clusters, automatic centromere location, and subsequent rapid interactive visual review of potential dicentric chromosomes to confirm positives and reject false positives. A calibration set of about 15,000 cells was used to establish the quadratic dose response for 60Co gamma-irradiation. The dose-response function parameters were established by a maximum likelihood technique, and confidence limits in the dose response and in the corresponding inverse curve, of estimated dose for observed dicentric frequency, were established by Monte Carlo techniques. The system was validated in a blind trial by analysing a test set comprising a total of about 8000 cells irradiated to 1 of 10 dose levels, and estimating the doses from the observed dicentric frequency. There was a close correspondence between the estimated and true doses. The overall sensitivity of the system in terms of the proportion of the total population of dicentrics present in the cells analysed that were detected by the system was measured to be about 40%. This implies that about 2.5 times more cells must be analysed by machine than by visual analysis. Taking this factor into account, the measured review time and false positive rates imply that analysis by the system of sufficient cells to provide the equivalent of a visual analysis of 500 cells would require about 1 h for operator review.