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1. INTRODUCTION. We have developed a report and imaging management system for nuclear medicine. The report and image data are stored in the IS&C magneto-optical disk (IS&C MOD). Nuclear medicine image data are relatively small, but they are large enough to create problems when being transported over a low-speed Hospital Information System (HIS) network. Moreover, gray scale image output devices (i.e., high-resolution displays, sonoprinters) are expensive. If high quality bi-level (black and white) images were available, images could be transferred through low-speed network with inexpensive bi-level terminals or conventional page-printers. We examined images using several bi-level image conversion techniques [1, 2] in order to determine how useful the bi-level images are and to assess their suitability for use in nuclear medicine. The images were compared with original film images by ROC analysis. The modified minimized average error method was found to be superior to other methods in bone and gallium images. Its A-values are 0.83 in gallium scan and 0.85 in bone scan. 2. MATERIALS AND METHODS. Our system consists of three digital gamma cameras, a nuclear medicine data processing unit, two UNIX stations, and two personal computers. The computers and the data processing unit are connected via Ethernet and each computer has an IS&C MOD unit. Image and report data are stored in the IS&C MOD. The computers are also connected off-line through the IS&C MOD. To evaluate image quality, bone scan images and gallium scan images (1024x512, 2048x1024 pixels and 16 bits depth) were converted to bi-level images (same pixels and one bit depth) using four methods: dither method, minimized average error method (MAE)[1], modified regional adaptation method, and constrained average method. For the dither methods, three sets of dither matrix (Fatting's, Bayer's and our original matrix) were employed. The computer images were compared with original film images by ROC analysis. 3. RESULTS. The converted bi-level images were 1/16 the size of the originals. They were transferred via Ethernet, displayed on the monochrome display, and printed using a conventional page-printer (240 dpi or 300 dpi). The A-values of the original gallium and bone images on the films were 0.89 and 0.94. Modified MAE method gave better results than other methods tested, with the gallium image using this technique reading 0.83 on the A-scale; and the bone images were 0.85. 4. DISCUSSION. Generally, nuclear medicine images require lower spatial and gray level resolution than other computer imaging techniques. We compared four bi-level image conversion methods in order to know which methods are suitable to nuclear medicine images. The ROC analysis was employed to evaluate these image qualities. The MAE methods made particular texture pattern as artifacts in the intermediate gray level area. But it can express homogeneity the neutral level. The dither method images are coarse texture. It affects detectabilities of subtle abnormal findings. 5. CONCLUSIONS. The A-z values of the modified MAE images were comparable to those of original film images. Although bone images give slightly lower values, many abnormal findings can be ascertained on bi-level images. High quality bi-level image techniques are considered to be useful for nuclear medicine image database systems.
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PMID:Evaluation of bi-level image converting methods for nuclear medicine image database stored in the IS&C magneto-optical disk. 859 Dec 24

This study compared the diagnostic efficacy of four imaging modalities for the detection of artificially induced recurrent caries: intraoral film, direct digital bitewing images, tuned apertuce computed tomography (TACT) slices and iteratively restored TACT images using an in vitro model. Twenty-four posterior teeth were prepared for MOD inlay restorations. These were then restored with different restorative materials (amalgam, Herculite and Durafill). Lesions were simulated in half the number of surfaces studied. These lesions were created either at the intersection of the facial or lingual walls and the gingival floor or on the gingival floor midway between the facial and lingual walls in the proximal boxes of the MOD restorations. Analysis of observations from 8 observers using ROC curve reveal the superior diagnostic efficacy with TACT iteratively restored images (Az for TACT iteratively restored images = 0.9171, TACT slices = 0.7052, Film = 0.6608, direct digital images = 0.5979). ANOVA revealed significance with respect to the imaging modality used (p < 0.0001). The results suggest that TACT images hold promise as a more effective imaging modality than film or direct digital systems for detection of recurrent caries.
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PMID:Tuned aperture computed tomography and detection of recurrent caries. 943 68

Women suffering from type-2 diabetes mellitus (NIDDM) show a more android fat pattern than healthy females, but to date no exact determination of their fat distribution differences exists. Measurements at 15 specified body sites with an optical device, the LIPOMETER, provide a subcutaneous adipose tissue topography (SAT-Top) of the individual. SAT-Top of 20 female NIDDM patients and 122 healthy controls was measured. ROC curve analysis was applied to evaluate the discriminative power of each body site and to provide cutoff values. Then a classification tree by the CART algorithm was established, showing SAT-Top differences between the two groups. Best discriminating results were achieved by the neck site (ROC area index = 0.76, sensitivity = 61.3%, specificity = 77.8%), the four sites of the thigh (area indices from 0.71 to 0.76), and a linear combination of all body sites stemming from a previous factor analysis, which provides condensed information of the extremities SAT-Top (area index = 0.80, sensitivity = 80.4%, specificity = 64.6%). The results could be improved by a summary measure of "android fat pattern" (area index = 0.89, sensitivity = 73.6%, specificity =88.3%) and a proportional measure of SAT-distribution, the relative neck (area index = 0.84, sensitivity = 83.0%, specificity = 70.5%). Overall, 136 (95.8%) of the 142 subjects were correctly classified by the classification tree (sensitivity = 75%, specificity = 99.2%). Both methods show the expected increased upper trunk obesity and decreased lower body obesity of NIDDM women compared with healthy females. Am. J. Hum. Biol. 12:388-394, 2000. Copyright 2000 Wiley-Liss, Inc.
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PMID:ROC and CART analysis of subcutaneous adipose tissue topography (SAT-Top) in type-2 diabetic women and healthy females. 1153 29

Hypertension, dyslipidemia and type 2 diabetes, important cardiovascular risk factors, are strongly linked to obesity. Body mass index (BMI) and waist circumference (WC) are measures of obesity that can be useful in identifying individuals with these risk factors. We assessed which of the two measures is more informative at the population level. The study population included 5,149 consecutive women aged 18 to 74 recruited in an Health Center of Guadeloupe (FWI) in 1999. The areas under the ROC curves of BMI and WC and their 95% CI were computed and compared. Logistic regression analysis of BMI and WC and the areas under the ROC curves in two separate age groups (18-39 years and 40-74 years) showed that age modifies the discriminant ability of these parameters in identifying the CVD risk factors. Sensitivity equalled specificity at levels between 52-70% for BMI and 55-80% for WC. ROC areas for identifying each risk factors by BMI varied from 0.52 to 0.84 and by WC from 0.55 to 0.88. For the identifying of women with at least one CVD risk factor, in the whole population, the areas under the curves for BMI and WC (respectively, 0.71; 95% CI: 0.69-0.73 and 0.76; 95% CI: 0.74-0.78) were both significantly greater than 0.5. The difference between these correlated areas was 0.04, 95% CI [-0.05, -0.03]. The lowest values of the areas were noted in detecting women with dyslipidemia and the highest in detecting those with type 2 diabetes. Waist circumference, a practical tool that had a higher discriminant ability than BMI in identifying presence or absence of all these risk factors, appears as the best screening tool in this population.
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PMID:Body mass index (BMI) and waist circumference (WC) as screening tools for cardiovascular risk factors in Guadeloupean women. 1246 75

Prevention of chronic complications is very important in the management of type 2 diabetes, and the availability of a laboratory test individuating at risk subjects should have a marked usefulness. This study sought by the method of ROC curves the cut-off of glycated haemoglobin discriminating the subjects with microvascular, neurologic and renal complications from those without. The cut-off was identified at a glycated haemoglobin level of 7.95, showing a sensitivity of 74.8% and a specificity of 73.3%, which makes it a possible tool for evaluating the risk of complications in type 2 diabetes.
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PMID:[Cut-off level of glycosylated hemoglobin indicating the development of complications in type 2 diabetes mellitus]. 1255 97

To evaluate the value of body mass index (BMI) as predictor of waist circumference of cardiovascular risk (CRWC) and diagnostic of metabolic syndrome (MSWC) in patients with type 2 diabetes mellitus (DM 2), we assessed BMI and WC in 753 patients with DM 2 (472 women) with 23 +/- 8 years. The participants had been divided in groups in accordance with the presence or absence of ACCR or ACMS. The best BMI cut-off to predict such disturbances was evaluated in women and men. In females, BMI > or = 25.0 kg/m(2) was the best predictor of CRWC. Area under ROC curve and IC 95% were 0.7202 (0.6753 - 0.7652) for CRWC and of [0.8318 (0.7928 - 0.8708)] for MSWC. In males, IMC > or = 25.0 kg/m(2) was better predictor for CRWC presence [0.8527 (0.8098 - 0.8955)], while BMI > or = 30.0 kg/m(2) for MSWC [0.9071 (0.8708 - 0.9433)]. We conclude that BMI can be a simple way to evaluate metabolic syndrome and cardiovascular risk where there were not material and prepared professionals for the WC evaluation. We need prospective studies to evaluate if it is necessary to change the BMI cut-off adopted as indicative of these disturbances in the diabetic population.
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PMID:[Anthropometric parameters and metabolic syndrome in type 2 diabetes]. 1693 79

The metabolic syndrome (MetS) is represented by the co-occurrence of multiple metabolic and physiologic risk factors for both type 2 diabetes mellitus and atherosclerotic cardiovascular diseases. In spite of its high frequency and association with morbidity and mortality in the adult population, very little is known about its magnitude in the elderly and about the validity of the diagnostic criteria commonly used. The objective of this paper is to assess the prevalence rate of MetS and the validity of the Adult Treatment Panel III (ATP III) diagnostic criteria in an elderly Caucasian cohort, considering data from the Italian Longitudinal Study on Aging (ILSA), a population-based study with a sample of 5632 individuals aged 65-84 years at baseline (1992). Logistic regression models and ROC curve were used to test the validity of the cut off levels proposed. The prevalence of MetS was 31.5% in men, and 59.8% in women. The cut off levels suggested for both men and women by the ATP III panel indicated a significant association with the MetS for all components. Actually, the ROC analysis would suggest lower levels for glycaemia (106 mg/dl) in men, and higher levels for blood pressure in both men and women (145/95 and 135/90, respectively). Concluding, MetS is very common in the aged Caucasians and the diagnostic criteria proposed by the ATP III panel seem to be appropriate in older individuals. Small adjustments in the cut off levels could be suggested for glycaemia (men) and in blood pressure (men and women).
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PMID:Validity of the ATP III diagnostic criteria for the metabolic syndrome in an elderly Italian Caucasian population: the Italian Longitudinal Study on Aging. 1935 58

The aim of this cross-sectional study was to determine the significant limitations, sensitivity, specificity, partial correlations, and odds ratios of nutrient intake in patients with and without hypertension with Type 2 diabetes mellitus. Diabetic patients (n=220) with clinical diagnosis of hypertension and diabetic patients (n=230) without hypertension were included in this study. The questionnaire form included a list of 65 food items formed from five main food groups (grain, meat and alternatives, dairy products, vegetables-fruits and fat) and 25 dietary habits. When both groups were compared and analyzed by logistic regression, black tea consumption (OR=0.823, P<.001), vegetables-fruits scores (OR=0.853, P<.001), triglycerides (OR=0.726, P<.05), waist-to-hip ratio (WHR) (OR=0.777, P<.01) and high-density lipoprotein cholesterol (HDL-C) (OR=0.526, P<.001) made significant differences. In ROC curves, the area under the curve of black tea (0.921), vegetables-fruits (0.906), triglycerides (0.889), WHR (0.881) and HDL-C (0.820) provided high accuracy to distinguish between patients with and without hypertension (P<.001). In diabetic patients without hypertension, significant partial correlations were observed between blood pressure and dairy products (systolic: r=)0.14; diastolic: r=)0.14, P<.05), vegetables-fruits groups (systolic: r=)0.18; diastolic: r=)0.17, P<.01) and black tea intake (systolic: r=)0.23; diastolic: r=)0.22, P<.001). It has been found that higher intake of black tea and vegetables-fruits consumption in diabetic patients protect against developing hypertension.
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PMID:Nutritional risk factors for the development of hypertension in diabetic patients. 1839 30

The aim of the present study was to evaluate the performance of the Finnish diabetes risk score (FINDRISC) for identifying undiagnosed type 2 diabetes in a German population and to develop a more simplified alternative model. We invited 921 individuals with a family history of the metabolic syndrome in a cross-sectional survey. Of these, 771 subjects completed the FINDRISC questionnaire and underwent an oral glucose tolerance test. The performance of the FINDRISC was assessed using the area under the receiver operating characteristics curve (ROC-AUC). The ROC-AUC of the FINDRISC was 0.81 (0.76-0.87). We detected no difference in diabetes prevalence between individuals with or without a family history of diabetes. Two logistic regression models (continuous- and categorical-model) were developed using the diagnosis of diabetes as the dependent variable, and age, body mass index (BMI), waist circumference, use of blood pressure medication, and history of high blood glucose as independent variables. After stepwise backward elimination of the insignificant variables, the following variables remained: age, BMI, and history of high blood glucose. The ROC-AUCs for the continuous- and categorical-models were 0.88 (0.85-0.92) and 0.86 (0.82-0.90), respectively, and were significantly larger than the ROC-AUC of the FINDRISC. There was no significant difference between the ROC-AUC of fasting plasma glucose and those of the two regression models. The FINDRISC questionnaire can be used to identify undetected diabetes in a German population. The simplified version, the categorical-model, may be a useful alternative for identifying asymptomatic type 2 diabetes.
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PMID:A more simplified Finnish diabetes risk score for opportunistic screening of undiagnosed type 2 diabetes in a German population with a family history of the metabolic syndrome. 1897 53

To investigate how liver disease alter the serum glycated proteins as markers of diabetic control, we studied serum GA, A1c and especially GA/A1c ratio in 255 patients having over 35IU/L in ALT(transaminase) compared with those of 829 type 2 diabetes mellitus (DM) in cross sectional manner. 255 patients with liver diseases were divided into 69 patients with biopsy proven liver cirrhosis (LC), 66 patients with chronic hepatitis(CH) and 120 patients with fatty liver(FL) diagnosed by abdominal echography. The mean GA/A1c ratio (+/-SD) was significantly higher (p<0.0001) in LC group(3.71+/-1.03) than the other groups (3.03+/-0.45 for CH, 3.05+/-0.42 for DM), while the mean GA/A1c ratio in FL group was significantly lower(2.74+/-0.31) (p<0.0001)) than that of DM groups. In LC group the GA/A1c ratio increased significantly depending upon serum albumin and/or platelet reductions. The GA/A1c ratio was significantly correlated with the other laboratory data such as serum albumin, cholinesterase, total cholesterol levels and weakly correlated with serum hemoglobin level. We also followed the serum levels of GA and A1c and the GA/A1c ratio during about 13 months (5 times blood collections) in 18 patients enrolled in this study. Resultantly the coefficient of variation of GA/A1c ratio was the smaller than the others(GA, A1c). The ROC curve of GA/A1c ratio for LC versus FL group was the most reliable between four groups and the cut-off value for LC versus FL was 2.94. Theses results suggest that GA/A1c ratio could be an useful marker for different diagnosis when facing patients with abnormal serum ALT level in a clinical setting.
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PMID:[Relationship between glycated albumin (GA) and glycated hemoglobin (A1c) in 255 patients with liver diseases using cross-sectional laboratory data]. 1897 54


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