scholarly journals The use of new cohesive ophthalmic viscoelastic in cataract surgery

2020 ◽  
Vol 12 (4) ◽  
pp. 51-56
Author(s):  
Igor A. Loskutov ◽  
Alina V. Korneeva ◽  
Pavel A. Lebedev
Keyword(s):  
Postoperative Period ◽  
Intraoperative Complications ◽  
Corneal Thickness ◽  
Sodium Hyaluronate ◽  
Maximum Diameter ◽  
Efficacy And Safety ◽  
Ophthalmic Surgery ◽  
Aim Analysis ◽  
Group I ◽  
Significant Difference

The article presents the results of an original study which was dedicated to the investigation of the new cohesive viscoelastic Cogevisc (sodium hyaluronate 1.6%) in ophthalmic surgery. Aim. Analysis of the efficacy and safety of a new cohesive viscoelastic (Cogevisc, Solopharm) in phacoemulsification. Patients and Methods. The clinical study was based on an assessment of the clinical and functional state of 80 patients (80 eyes), which were divided into 2 groups depending on viscoelastic used during the phacoemulsification procedure (Softshell technology): in group I (40 patients, 40 eyes) Viscoat was used to protect tissues, and Amvisc Plus was added to create volume; in group II (40 patients, 40 eyes) Viscoat was used to protect tissues, and Kogevisc was used to create volume. In the postoperative period, all patients received standard anti-inflammatory treatment. There was no significant difference in mean age, gender, preoperative intraocular pressure (IOP) and preoperative central corneal thickness (CCT) between the two groups. Before surgery and in the postoperative period (in one day, 7 days, and 1 month), IOP, CCT, and endothelial cell density (ECD) were measured. The duration of the procedure and the amount of the consumed fluid were estimated. Results. There was no significant difference in IOP, CCT, ECD 1 day and 1 week postoperatively between the two groups. Mean absolute refractive error was also not significantly different between the two groups. There was no significant difference in procedure duration between groups I and II (1523.81 75.66 seconds, 1500.33 92.56 seconds, respectively, p 0.001). No complications were observed during the intraocular lens implantation in both groups. Conclusion. The investigated viscoelastic Cogevisc allows creating and effectively maintaining the necessary depth of the anterior chamber and the maximum diameter of the pupil, which simplifies different stages of phacoemulsification and minimizes the risk of intraoperative complications. Promising for further research is its use in combination with an adhesive viscoelastic of the same production. Reduced cost of Cogevisc is the advantage of this viscoelastic.

Optimization of postoperative management of patients undergoing functional endoscopic sinus surgery

2018 ◽  
pp. 26-31
Author(s):  
Sergey Bezshapochny ◽  
Andrey Loburets ◽  
Valery Loburets
Keyword(s):  
Nasal Cavity ◽  
Postoperative Period ◽  
Sodium Hyaluronate ◽  
Sinus Surgery ◽  
Control Group ◽  
Nasal Breathing ◽  
Traditional Therapy ◽  
Significant Difference ◽  
Water Salt ◽  
Experimental Group

Topicality: The result of surgical treatment depends largely on the chosen method of management of the postoperative period, the main purpose of which is to reduce the effects of surgical trauma. Despite the wide variety of drugs for local and systemic use, the question of pharmacotherapy of the operated sinus remains open to this day. The main properties that a modern drug should possess are safety and high clinical efficacy. Aim: to study the clinical efficacy of topical application of a complex preparation based on a saline solution containing sodium hyaluronate and dexpanthenol in patients with chronic sinusitis after functional endoscopic sinus surgery (FESS). Materials and Methods: Clinical and laboratory studies were conducted on 47 patients with chronic rhinosinusitis who underwent surgery using the FESS technique. Patients were divided into 2 groups according to the principle of the postoperative period. Patients of research group (n=21), except for traditional therapy, was used locally NASOMER (a preparation based on a water-salt solution containing sodium hyaluronate and dexpanthenol); to the control group (n=26) patients entered, in the postoperative period received traditional therapy. Traditional therapy included a toilet of the nasal cavity, the use of short-course topical decongestants, irrigation of the nasal cavity with water-salt solutions. Criteria of clinical effectiveness: data of endoscopy of the nasal cavity, rhinomanometry, activity of the mucociliary transport system. The effectiveness of functional research methods in the postoperative period was determined on the 7th and 14th day of treatment. Results: On the 3rd day of the study, an increase in the swelling of the nasal cavity was observed in patients of both clinical groups, correlated with difficulty in nasal breathing. On the 7th day, a decrease in edema was observed in patients of both groups, but in the experimental group, the index of nasal breathing, according to rhinomanometry, was significantly (p<0.05) different from the control group, and was respectively 1.54±0.14 and 2.04±0.19 kPa/l*s. On the 14th day of the study, no significant difference was observed between these indicators. When studying the activity of the ciliated epithelium of the mucous membrane of the nasal cavity, it was proved that patients of the experimental group on day 7 after surgery showed a statistically significant difference in this indicator compared to the control group (17.8±1.0 and 22.7±2.1 min. respectively). Conclusions: The use of NASOMER after surgical intervention in patients with chronic rhinosinusitis contributes to more effective treatment compared with traditional therapy, as evidenced by the rapid recovery of the main functional parameters according to active posterior rhinomanometry and mucociliary clearance. Based on the results of the studies performed, the use of NASOMER for pharmacotherapy in the postoperative period is recommended for patients who have undergone rhinosurgical interventions with the aim of reducing the period of postoperative rehabilitation as an effective anti-inflammatory and wound-healing agent.

scholarly journals Comparative clinical evaluation of efficacy and safety of a formulation containing ciclopirox 8% in the form of a therapeutic nail lacquer in two different posologies for the treatment of onychomycosis of the toes

2012 ◽  
Vol 87 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Sergio Schalka ◽  
Samanta Nunes ◽  
Antonio Gomes Neto
Keyword(s):  
Treatment Resistance ◽  
Comparative Trial ◽  
Trichophyton Mentagrophytes ◽  
Weekly Dose ◽  
Efficacy And Safety ◽  
Therapeutic Success ◽  
Group I ◽  
Nail Lacquer ◽  
Significant Difference ◽  
Treatment Objective

BACKGROUND: The use of topical antifungal agents in the treatment of onychomycosis is of great value in clinical practice as there are different limitations regarding the use of systemic treatment. OBJECTIVE: To evaluate the efficacy and safety of a nail lacquer formulation containing ciclopirox 8% in two different posologies: the traditional regimen (3/2/1) and a regimen of weekly use. METHODS: A blind, randomized, comparative trial which included 41 patients divided into 02 groups, with Group I using the nail lacquer once weekly and Group II using the traditional regimen (3/2/1). Both groups applied the medication for 06 months. RESULTS: The species most frequently found in groups I and II were Trichophyton rubrum (55% and 61.9%) and Trichophyton mentagrophytes (30% and 19%). There was a tendency to a higher level of treatment resistance by T. mentagrophytes infection in both groups, without any predilection for sex, age, proportion of the nail affected at the beginning of the study, duration of the clinical disease and quantity of nails affected per person. Both groups had significant levels of mycological cure, clinical response and therapeutic success and there was no statistically significant difference between groups I and II (p >0.05). CONCLUSION: The nail lacquer containing ciclopirox 8% was equally effective at a weekly dose when compared to the traditional dosing (3/2/1), allowing a more comfortable regimen.

Effect of Silver Nitrate Application on the Success of Endoscopic Dacryocystorhinostomy

2021 ◽  
pp. 194589242110427
Author(s):  
Yaser S. Çetin ◽  
Ramazan Akın ◽  
Ufuk Düzenli ◽  
Mahfuz Turan ◽  
Nazım Bozan
Keyword(s):  
Silver Nitrate ◽  
Success Rate ◽  
Postoperative Period ◽  
Revision Surgery ◽  
Granuloma Formation ◽  
Stent Insertion ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Silicone Stent

Objectives To compare the clinical outcomes of patients undergoing additional procedures in endoscopic endonasal dacryocystorhinostomy (End-DCR) surgery and discuss the factors affecting the success of End-DCR surgery in light of relevant literature. Methods The study included 155 patients who underwent End-DCR surgery in our clinic due to epiphora. This was a prospective randomized, single-blind, controlled trial. Group I (control) included 54 patients who did not undergo silicone stent insertion or silver nitrate application, group II included 51 patients who underwent silicone stent insertion only, and group III included 50 patients who underwent silver nitrate application only. Statistical analysis was performed on follow-up data regarding anatomic and functional success rates. Results Revision surgery was performed in 16 patients who developed persistent epiphora in the postoperative period, including 6 in group I, 7 in group II, and 3 in group III ( P = .4). The most common reason for revision surgery was stenosis of the neo-ostium ( n = 8), followed by granulation tissue formation ( n = 5) and synechia formation ( n = 3). Granuloma formation was the most common postoperative complication, and a significant difference was found among the groups with regard to granuloma formation ( P = .04). At postoperative month 12, the functional success rate was estimated to be 88%, 86%, and 94%, and the anatomic success rate was estimated to be 94%, 92%, and 96% in groups I, II, and III, respectively, with no significant difference, found among the 3 groups with regard to both rates ( P = .79 and P = .76, respectively). Conclusion The results indicated that stenting and silver nitrate application did not affect surgical success. Our preliminary results on silver nitrate cauterization showed that it is an effective, inexpensive, and practical method to reduce granulation formation in the postoperative period.

scholarly journals ‘Comparison of Safety and Performance of Two Ophthalmic Viscosurgical Devices in Cataract Surgery’

2021 ◽  
Author(s):  
öznur işcan ◽  
Banu Torun Acar ◽  
Burcu Nurozler Tarakcı
Keyword(s):  
Endothelial Cell ◽  
Cataract Surgery ◽  
Corneal Thickness ◽  
Anterior Chamber Depth ◽  
Sodium Hyaluronate ◽  
Significant Difference ◽  
The Mean ◽  
Group 2 ◽  
And Performance ◽  
Group 1

Abstract Purpose: To compare the safety and performance of two ophthalmic viscosurgical devices (OVDs) Bio-Hyalur SV (Sodium Hyaluronate 3.0%) (Biotech Healthcare Group, Luzern, Switzerland) and Protectalon (sodium hyaluronate 2.0%) (VSY Biotechnology, Turkey) in cataract surgery. Methods: One hundred twenty eyes of one hundred twenty patients who underwent phacoemulsification surgery were included in the study. Postoperatively sixty eyes using Bio-Hyalur-SV were classified as Group 1, and sixty eyes using Protectalon as Group 2. Patients aged 45 and over, Grade I, II or III unilateral / double stained cataract, healthy eyes creating cataract inclueded in this study . Endothelial cell morphological parameters including endothelial cell density (ECD), cell number, cell area, coefficient of variation (CV) in cell size, cell hexagonality and central corneal thickness (CCT) were measured preoperatively and at postoperative first week, first and third month visits.Intraocular pressure (IOP) was measured with an applanation tonometer at every visit. Results: . There was a statistically significant decrease in the mean ECD all follow-up times when compared with the preoperative visit (p=0.000). In terms of mean ECD levels there was no significant difference between the two groups within three months postoperatively (p=0.616) In the first week after surgery, there was an significant increase in CCT in Group 1 and Group 2 respectively (p=0.000). The IOP was <23 mmHg in all of the patients on the first day after surgery. There was no significant difference in the incidence of IOP peaks between the two groups in every vizits. In both groups, a significant increase was observed in the mean IOP at first day, first week, and first month after surgery compared to preoperative values (p=0.000). But no significant difference in IOP increase in Group 1 (P=0.092), Group 2 (P=0.013) compared to preoperative values ​​at third month postoperatively (p <0.001 significant with Bonferrotti correction). Conclusion: The two OVD’s used in this study during cataract surgery were safe and effective. Both OVD’s resulted in similar rates of transient IOP increases and corneal endothelial damage also provided good anterior chamber depth and were fairly easy to remove.

scholarly journals Non-Conservative Therapy in the Prevention of Subepithelial Fibroplasia after LASEK Hypermetropia Correction

2018 ◽  
Vol 15 (2) ◽  
pp. 200-206
Author(s):  
S. A. Korotkikh ◽  
A. E. Bogachev ◽  
A. S. Shamkin
Keyword(s):  
Dry Eye ◽  
Postoperative Period ◽  
Sodium Hyaluronate ◽  
Early Postoperative Period ◽  
Diagnostic Methods ◽  
Dry Eye Syndrome ◽  
Control Group ◽  
Study Group ◽  
Postoperative Therapy ◽  
Significant Difference

The results of observation of patients who underwent vision eximerlaser correction by the LASEK method regarding medium degree of hyperopia were analyzed.Purpose:to investigate the severity of the «dry eye» syndrome and corneal subepithelial fibroplasia in patients after laser correction of  hyperopia by the LASEK method, and their prevention by reducing  the preservative action on the eye surface.Patients and methods.The study included 40 patients (76 eyes), aged 21–46 years (32.98 ± 1.79) who underwent LASEK surgery for  moderate hyperopia (4.03 ± 0.38 D). Patients were divided into two  groups: 1) control group (20 patients, 37 eyes) — postoperative  therapy included the corneoprotector “Stilavit®” and the preparation  of hyaluronic acid “Oksial®”, containing preservatives;  2) the study group (20 patients, 39 eyes) — postoperative therapy  included the corneoprotector “Hilozar-comod®” and the artificial tear  preparation “Hilo-comod®”, which did not contain reservatives. Ophthalmic examination included, in addition to standard diagnostic  methods, the Norn test, the Schirmer test, the staining of the eye  surface with lissamine green. In addition, a questionnaire was  conducted on a modified OSDI questionnaire; there a section  characterizing the quality of vision (section B) was removed.Results.The analysis of the obtained data showed that in the study group there was less pronounced “dry eye” syndrome at 3,6,12  months after the operation. The maximum difference in the  indicators of the “dry eye” syndrome between the groups was at 3  and 6 months of the postoperative period. When evaluating corneal  subepithelial fibroplasia, maximum attention was paid to the  frequency and the intensity index. It was shown a significant  difference in the intensity of the haze between the study group and the control group by 26.1 % at 3 months, by 62.2 % at 6  months and by 65.3 % 12 months after the operation. Conclusion.Nonconservative therapy with sodium hyaluronate and  dexapanthenol in the early postoperative period and only sodium  hydrolurate allows to reduce the severity of the dry eye syndrome  after laser correction of hypermetropia and, as a result, to reduce  the intensity of haze development by 65.3 %, and its frequency on 11,5 %.

scholarly journals Investigation of corneal topographic and densitometric properties of Wilson's disease patients with or without a Kayser-Fleischer ring

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Mehmet Fuat Alakus ◽  
Mehtap Caglayan ◽  
Nazım Ekin ◽  
Hasan Oncul ◽  
Esref Arac ◽  
...  
Keyword(s):  
Wilson’S Disease ◽  
Imaging System ◽  
Corneal Thickness ◽  
Wilson's Disease ◽  
Corneal Transparency ◽  
Group Iii ◽  
Corneal Densitometry ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Abstract Background To investigate the topographic measurements and densitometry of corneas in Wilson’s disease (WD) patients with or without a Kayser-Fleischer ring (KF-r) compared to healthy individuals. Methods This cross-sectional study included 20 WD patients without a KF-r (group I), 18 WD patients with a KF-r (group II), and 20 age-matched controls (group III). The Pentacam high resolution imaging system is used to determine corneal topographic measurements and densitometry. Results Mean age for groups I, II and III was 25.40 ± 6.43 years (14–36 years), 25.38 ± 6.96 years (16–39 years), 23.60 ± 6.56 years (17–35 years), respectively (P = 0.623). There was no significant difference between the groups in terms of the anterior corneal densitometry values (P > 0.05), while the 6–10 mm and 10–12 mm mid stroma and the 2–6 mm, 6–10 mm, and 10–12 mm posterior corneal densitometry values in group II were significantly higher than those in groups I and III (for all values, P <  0.05). However, the 10–12 mm posterior corneal densitometry values in group I were also significantly higher than those in group III (P = 0.038). The central corneal thickness (CCT), thinnest corneal thickness (tCT), and corneal volume (CV) values in groups I and II were significantly lower than those in group III (for CCT values, P = 0.011 and P = 0.009; for tCT values, P = 0.010 and P = 0.005; for CV values, P = 0.043 and P = 0.029). Conclusion In WD patients with a KF-r, corneal transparency decreased in the peripheral posterior and mid stromal corneal layers; for these patients, corneal transparency may be impaired not only in the peripheral cornea but also in the paracentral cornea.

scholarly journals MyoRing Implantation in Comparison with MyoRing Implantation Combined with Corneal Collagen Crosslinking for Keratoconus

2019 ◽  
Vol 16 (1S) ◽  
pp. 85-90
Author(s):  
G. M. Kazakbaeva
Keyword(s):  
Corneal Thickness ◽  
Efficacy And Safety ◽  
Collagen Crosslinking ◽  
Corrected Visual Acuity ◽  
Number Of Patients ◽  
Significant Difference ◽  
Corneal Collagen Crosslinking ◽  
The Difference ◽  
Corneal Collagen

Purpose: tо estimate the effectiveness of complete corneal ring (MyoRing) implantation compared with MyoRing implantation combined with corneal collagen crosslinking (CXL) for keratoconus treatment for 36 months follow-up. Patients and Methods. There were 101 patients (124 eyes) with progressing keratoconus aged 18–59 years in the study. Intracorneal rings were implanted in all patients. The patients were divided into 2 groups. MyoRing implantation was performed in a series of 59 patients (76 eyes) with keratoconus II–III Amsler classification, 42 patients (48 eyes) had MyoRing implantation combined with CXL. Implantation of a MyoRing in the corneal pocket was performed using a PocketMaker microkeratome and corneal intrastromal implantation system. Results. Keratometry was reduced in both groups; after MyoRing implantation for 8,45 D and MyoRing combined with CXL for 7,44 D, the spherical equivalent decreased for 7,72 and 6,29 D respectively, after 36 months. The cylinder decreased to 3,33 D with MyoRing alone and to 3,11 D with MyoRing combined with CXL. The smallest corneal thickness remained stable during 36 months after the procedure. There was an improvement in uncorrected and corrected visual acuity, and the difference in the CRF within the period of up to 12 months after the operation. It can be explained by the pseudochase formation in the group with a combined procedure. Conclusion. The implantation of the MyoRing IRC and the combination of MyoRing with CXL showed efficacy and safety in stabilizing keratoconus stabilization, as well as correction of comorbided ametropia 3 years after surgery. Both MyoRing implantation and MyoRing combined with CXL were effective in the stabilization of progressive keratoconus, as well as the correction of ametropia 3 years after surgery. There was no significant difference in MyoRing implantation and its combination with corneal crosslinking in visual and refractive results. The refractive power of the cornea was only one exeption. Long follow-up and randomized prospective studies with a large number of patients are needed.

scholarly journals EFFICACY AND SAFETY OF MORPHINE HYDROCHLORIDE IN CANCER PATIENTS WITH CHRONIC PAIN

2019 ◽  
Vol 18 (4) ◽  
pp. 27-33
Author(s):  
R. A. Zukov ◽  
O. P. Bobrova ◽  
G. N. Gildeeva ◽  
D. V. Butuzova ◽  
E. A. Ershova
Keyword(s):  
Chronic Pain ◽  
Adverse Effects ◽  
Cancer Patients ◽  
Pain Syndrome ◽  
Chronic Pain Syndrome ◽  
Efficacy And Safety ◽  
Strong Intensity ◽  
Group I ◽  
Significant Difference ◽  
Morphine Hydrochloride

Purpose of the study: to assess the efficacy and safety of morphine hydrochloride in the form of 10 mg filmcoated tablets and 1 % solution for injection in cancer patients with chronic pain syndrome of strong intensity.Material and Methods. The study included 110 cancer patients with chronic pain syndrome of strong intensity. The study was conducted in compliance with the principles of the Helsinki Declaration, ICH GCP, GOST R 52379-2005, as well as other Russian laws regulating the conduct of clinical trials and work with opioid analgesics. Patients were randomized at a 1:1 ratio. Group I received 10 mg film-coated morphine tablets, 1 tablet orally every 4 hours for 7 days. Group II received 1 % morphine solution for injection, intramuscularly, 4 mg every 4 hours for 7 days. A Numeric Rating Scale for Pain (NRS, 0–100 mm) was used to assess the level of pain. The safety assessment was based on the collection of data on the registration of adverse events, including opioid-associated adverse effects.Results. Enteral and parenteral morphine administration for 7 days demonstrated a statistically significant decrease in the intensity of pain syndrome in cancer patients. The use of morphine hydrochloride in tablets reduced the number of additional analgesics prescribed for cancer patients. Regarding opioid-associated adverse effects, a statistically significant difference in the incidence of constipation between two groups was observed.Conclusion. The study showed that tablets and injectable dosage forms of morphine hydrochloride were comparable in efficacy and safety profile, thus predetermining the widespread clinical use of drugs produced by the domestic manufacturer in accordance with the “pain relief ladder”, proposed by WHO. 

scholarly journals Comparing Resident Outcomes in Cataract Surgery at Different Levels of Experience: A retrospective case series

2020 ◽  
Author(s):  
Mathias Melega ◽  
Rodrigo Lira ◽  
Iuri Silva ◽  
Bruna Ferreira ◽  
Hermano Filho ◽  
...  
Keyword(s):  
Intraoperative Complications ◽  
Corneal Thickness ◽  
Case Series ◽  
Statistical Analyses ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Retrospective Case ◽  
Exact Test ◽  
First Semester ◽  
Significant Difference

Abstract BackgroudTo evaluate outcomes of resident-performed cataract surgeries in different training levels in a retrospective case series.MethodsA total of 730 surgeries performed by residents were evaluated into three groups: surgeries performed during residents’ first semester of training in phacoemulsification (S1), surgeries performed during the second semester (S2), and surgeries performed during the third semester (S3). The primary outcome was the incidence of intraoperative complications in each group. Secondary outcomes were the comparisons between initial and final corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), and central corneal thickness (CCT) in each group. Descriptive statistical analyses were employed in the presentation of the results using central tendency and variance measurements. The groups’ continuous variables were compared using the t-test or ANOVA (parametric variables) or the Mann-Whitney or Kruskal-Wallis tests (non-parametric variables). Statistical analyses of the categorical variables were performed using Fisher’s exact test or the chi-squared test.ResultsThe rate of complications within six weeks of follow up was 24 out of 102 eyes (23.53%) in the S1 group, 63 out of 301 eyes (20.93%) in the S2 group, and 37 out of 327 (11.31%) in the S3 group (p = 0.001). There was no significant difference in CDVA (p = 0.298), ECD (p = 0.067), IOP (p = 0.217), or CCT (p = 0.807) between the groups.ConclusionsWhen measured by rates of complications and by the aforementioned parameters, surgical competency was found to improve as surgical experience and frequency increased. Therefore, this study identified some patterns of skill development that can be applied to teaching strategies and better assist surgeons in training.

scholarly journals Value of Contrast-Enhanced Ultrasound in Adjusting the Classification of Chinese-TIRADS 4 Nodules

2022 ◽  
Vol 2022 ◽  
pp. 1-6
Author(s):  
Hong Cheng ◽  
Shuang-Shuang Zhuo ◽  
Xin Rong ◽  
Ting-Yue Qi ◽  
Hong-Guang Sun ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Maximum Diameter ◽  
Diagnostic Efficiency ◽  
Contrast Enhanced Ultrasound ◽  
Predictive Values ◽  
Group I ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Group Ii

Objectives. To explore the value of applying contrast-enhanced ultrasound (CEUS) in adjusting the classification of category 4 nodules in the Chinese-Thyroid Imaging Report and Data System (C-TIRADS). Methods. The data of preoperative conventional ultrasound and CEUS examinations of 125 C-TIRADS 4 nodules in 109 patients were retrospectively analyzed. We divided the thyroid nodules into two groups based on whether recommend by the guide fine-needle aspiration (FNA). Group I included C-TIRADS 4A nodules with a maximum diameter ≤15 mm and C-TIRADS 4B and 4C nodules with a maximum diameter ≤10 mm, and Group II included C-TIRADS 4A nodules with a maximum diameter >15 mm and C-TIRADS 4B and 4C nodules with a maximum diameter >10 mm. In CEUS, thyroid nodules showing suspicious malignant features such as hypoenhancement or early washout were adjusted to a level higher in the C-TIRADS classification; thyroid nodules showing possible benign features such as iso- or hyperenhancement were adjusted to a level lower; and thyroid nodules showing no enhancement were adjusted to C-TIRADS 3. Taking the pathological results as the gold standard, the receiver operating characteristic (ROC) curves of the C-TIRADS classification before and after the adjustment based on CEUS were plotted, and the diagnostic efficiency was compared. Results. The sensitivity, specificity, accuracy, and positive and negative predictive values of the C-TIRADS classification for the diagnosis of thyroid nodule malignancy before the adjustment based on the CEUS results were 83.6%, 63.8%, 74.4%, 72.7%, and 77.1%, respectively, and these values were 91.0%, 82.8%, 87.2%, 85.9%, and 88.9%, respectively, after the adjustment. The area under the ROC curve (AUC) was 0.737 and 0.869, respectively, showing a significant difference (Z = 3.288, P = 0.001 ). The diagnostic efficiency of C-TIRADS classification after the adjustment based on the CEUS results in both groups was improved compared with the result before the adjustment, and the difference in Group II was significant (Z = 2.931, P = 0.003 ). Conclusions. CEUS significantly improved the diagnostic performance in the adjustment of C-TIRADS 4 nodule classification, especially for the nodules which needs FNA recommended by the C-TIRADS.

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