Accuracy of multi-slice computed tomography for measurement of left ventricular ejection fraction compared with cardiac magnetic resonance imaging and two-dimensional transthoracic echocardiography: a systematic review and meta-analysis

Background

Multi-slice computed tomography (MSCT) allows non-invasive assessment of the coronary arteries and simultaneously can provide measurement of left ventricular ejection fraction (LVEF). The accuracy of newer MSCT generations (64-slice or more) for assessment of LVEF compared with magnetic resonance imaging (MRI) and two-dimensional transthoracic echocardiography (TTE) has not been evaluated in a meta-analysis.

Purpose

To evaluate, via a systematic literature review and meta-analysis, whether MSCT can assess LVEF with high accuracy compared with MRI and TTE.

Methods

Electronic databases and reference lists for relevant published studies were searched. Twenty-seven eligible studies provided mean LVEF% with its standard deviation (SD) measured by MSCT versus MRI and TTE. Meta-analysis of weighted mean difference (WMD) and Bland–Altman method were used to quantify the mean difference and agreement between MSCT compared with MRI and TTE.

Results

The results of combining 12 studies showed no significant difference in LVEF% between MSCT and MRI with a WMD of −0.11 (−1.48, 1.26, 95% CI), p = 0.88. Bland–Altman analysis showed excellent agreement between MSCT and MRI with a bias of 0.0 (−3.7, 3.7 ± 1.96SD) with 95% CI. The results of combining 15 studies showed no significant difference in LVEF between MSCT versus TTE measurements with a WMD of 0.19 (−1.13 to 1.50; 95% CI), p = 0.87. Bland–Altman analysis showed excellent agreement between MSCT and TTE with a bias of 0.3 (−4.7, 5.7 ± 1.96SD) with 95% CI.

Conclusion

The newer MSCT generations can provide accurate LVEF measurement compared to MRI and TTE. MSCT represents a valid technique for the combined evaluation of LVEF and coronary artery disease.     

Quantification of blood velocity and flow rates in the uterine vessels using echo planar imaging at 0.5 Tesla

Purpose:

To measure uterine artery and vein blood velocity and flow rate profiles using MRI during normal pregnancy.

Materials and Methods:

A two‐shot velocity magnitude‐encoded echo planar imaging (EPI) sequence is used at a magnetic field 0.5T. Data analysis procedures, necessary to overcome problems associated with low signal to noise ratio (SNR), and a spatial resolution comparable to the vessel size were used.

Results:

The measured blood flow values averaged over nine volunteers for the mean velocity are 5.33 and 3.97 cm/s and for the unilateral flow rate are 203 and 274 mL/min (for the arteries and veins respectively). Values for the flow rate are consistent with ultrasound Doppler studies. Arterial velocity measurements are more pulsatile than venous ones and validation calculations performed on average velocity values would suggest that the nature of blood flow in the uterine vessels is laminar.

Conclusion:

This study presents the first report of noninvasive quantitative measurements of uterine artery and vein blood velocity and flow rate profiles using MRI during normal pregnancy. Consistent and reproducible measurements have been obtained by subject specific sequence optimization and data analysis procedures. J. Magn. Reson. Imaging 2010;31:921–927. ©2010 Wiley‐Liss, Inc.     

乳腺MR的计算机辅助检测:系统回顾和荟萃分析

目的通过评价放射科医师鉴别乳腺良、恶性病变的准确性来探讨乳腺MR的计算机辅助检测(CAD)的价值。方法进行相关的文献检索,包括所有商业许可运行的自动     

Computer-aided detection in breast MRI: a systematic review and meta-analysis

Objectives

To evaluate the additional value of computer-aided detection (CAD) in breast MRI by assessing radiologists?? accuracy in discriminating benign from malignant breast lesions.

Methods

A literature search was performed with inclusion of relevant studies using a commercially available CAD system with automatic colour mapping. Two independent researchers assessed the quality of the studies. The accuracy of the radiologists?? performance with and without CAD was presented as pooled sensitivity and specificity.

Results

Of 587 articles, 10 met the inclusion criteria, all of good methodological quality. Experienced radiologists reached comparable pooled sensitivity and specificity before and after using CAD (sensitivity: without CAD: 89%; 95% CI: 78?C94%, with CAD: 89%; 95%CI: 81?C94%) (specificity: without CAD: 86%; 95% CI: 79?C91%, with CAD: 82%; 95% CI: 76?C87%). For residents the pooled sensitivity increased from 72% (95% CI: 62?C81%) without CAD to 89% (95% CI: 80?C94%) with CAD, however, not significantly. Concerning specificity, the results were similar (without CAD: 79%; 95% CI: 69?C86%, with CAD: 78%; 95% CI: 69?C84%).

Conclusions

CAD in breast MRI has little influence on the sensitivity and specificity of experienced radiologists and therefore their interpretation remains essential. However, residents or inexperienced radiologists seem to benefit from CAD concerning breast MRI evaluation.     

Exercise blood pressure and cardiac structure: A systematic review and meta-analysis of cross-sectional studies

ObjectivesA hypertensive response to exercise (HRE) is associated with cardiovascular disease and high blood pressure (BP). Sub-clinical changes to cardiac structure may underlie these associations, although this has not been systematically determined. Via systematic review and meta-analysis, we aimed to (1) assess the relationship between exercise BP and cardiac structure, and (2) determine if cardiac structure is altered in those with an HRE, across various study populations (including those with/without high BP at rest).Design and methodsThree online databases were searched for cross-sectional studies reporting exercise BP, HRE and cardiac structural variables. Random-effects meta-analyses and meta-regressions were used to calculate pooled correlations between exercise BP and cardiac structure, and pooled mean differences and relative risk between those with/without an HRE.ResultsForty-nine studies, (n = 23,707 total; aged 44 ± 4 years; 63% male) were included. Exercise systolic BP was associated with increased left ventricular (LV) mass, LV mass index, relative wall thickness, posterior wall thickness and interventricular septal thickness (p < 0.05 all). Those with an HRE had higher risk of LV hypertrophy (relative risk: 2.6 [1.85–3.70]), increased LV mass (47 ± 7 g), LV mass index (7 ± 2 g/m²), relative wall thickness (0.02 ± 0.005), posterior wall thickness (0.78 ± 0.20 mm), interventricular septal thickness (0.78 ± 0.17 mm) and left atrial diameter (2 ± 0.52 mm) vs. those without an HRE (p < 0.05 all). Results were broadly similar between studies with different population characteristics.ConclusionsExercise systolic BP is associated with cardiac structure, and those with an HRE show evidence towards adverse remodelling. Results were similar across different study populations, highlighting the hypertension-related cardiovascular risk associated with an HRE.     

Diagnostic role of postmortem CK-MB in cardiac death: a systematic review and meta-analysis

Biochemical analysis of creatine kinase MB (CK-MB), which is a biomarker of myocardial damage, is used as a potential adjunct test in clinical and forensic     

Does blood flow restriction training enhance clinical outcomes in knee osteoarthritis: A systematic review and meta-analysis

ObjectiveTo systematically review the efficacy of blood flow restriction training (BFRT) on individuals with knee osteoarthritis (OA).DesignSystematic review with meta-analysis.Literature searchEight electronic databases were searched by one researcher.Study selection criteriaRandomised clinical trials (RCTs) comparing BFRT to regular resistance training (RT) for knee OA.Data synthesisOne reviewer selected the eligible RCTs and exported the data. Two reviewers evaluated study quality using the PEDro scale. We performed meta-analysis where appropriate using a random-effects model. We rated the quality of evidence using GRADE.ResultsFive studies were eligible. The key outcomes analysed were pain, self-reported function, objective physical function, strength and muscle size. Across all comparisons, there was low to moderate quality evidence of no difference between BFRT and traditional RT.ConclusionThe limited available evidence does not suggest that BFRT enhances outcomes for people with knee OA. These findings do not support clinicians using BFRT in people with knee OA. Instead, evidence-based messages regarding exercise and education should remain the mainstay of rehabilitation. Additional studies should clarify whether some people with knee OA who cannot complete an adequate exercise programme due to pain, might still benefit from BFRT to facilitate less painful exercise.     

Analysis of pulse wave velocity in the thoracic aorta by flow-sensitive four-dimensional MRI: reproducibility and correlation with characteristics in patients with aortic atherosclerosis

Purpose:

To measure aortic pulse wave velocity (PWV) using flow‐sensitive four‐dimensional (4D) MRI and to evaluate test–retest reliability, inter‐ and intra‐observer variability in volunteers and correlation with characteristics in patients with aortic atherosclerosis.

Materials and Methods:

Flow‐sensitive 4D MRI was performed in 12 volunteers (24 ± 3 years) and 86 acute stroke patients (68 ± 9 years) with aortic atherosclerosis. Retrospectively positioned 28 ± 4 analysis planes along the entire aorta (inter‐slice‐distance = 10 mm) and frame wise lumen segmentation yielded flow‐time‐curves for each plane. Global aortic PWV was calculated from time‐shifts and distances between the upslope portions of all available flow‐time curves.

Results:

Inter‐ and intra‐observer variability of PWV measurements in volunteers (7% and 8%) was low while test–retest reliability (22%) was moderate. PWV in patients was significantly higher compared with volunteers (5.8 ± 2.9 versus 3.8 ± 0.8 m/s; P = 0.02). Among 17 patient characteristics considered, statistical analysis revealed significant (P < 0.05) but low correlation of PWV with age (r = 0.25), aortic valve insufficiency (r = 0.29), and pulse pressure (r = 0.28). Multivariate modeling indicated that aortic valve insufficiency and elevated pulse pressure were significantly associated with higher PWV (adjusted R² = 0.13).

Conclusion:

Flow‐sensitive 4D MRI allows for estimating aortic PWV with low observer dependence and moderate test–retest reliability. PWV in patients correlated with age, aortic valve insufficiency, and pulse pressure. J. Magn. Reson. Imaging 2012;35:1162‐1168. © 2012 Wiley Periodicals, Inc.     

Quantification of aortic valve area at 256-slice computed tomography: Comparison with transesophageal echocardiography and cardiac catheterization in subjects with high-grade aortic valve stenosis prior to percutaneous valve replacement

Purpose

The purpose of this study was to compare planimetric aortic valve area (AVA) measurements from 256-slice CT to those derived from transesophageal echocardiography (TEE) and cardiac catheterization in high-risk subjects with known high-grade calcified aortic stenosis.

Methods and materials

The study included 26 subjects (10 males, mean age: 79 ± 6; range, 61–88 years). All subjects were clinically referred for aortic valve imaging prior to percutaneous aortic valve replacement from April 2008 to March 2009. Two radiologists, blinded to the results of TEE and cardiac catheterization, independently selected the systolic cardiac phase of maximum aortic valve area and independently performed manual CT AVA planimetry for all subjects. Repeated AVA measurements were made to establish CT intra- and interobserver repeatability. In addition, the image quality of the aortic valve was rated by both observers. Aortic valve calcification was also quantified.

Results

All 26 subjects had a high-grade aortic valve stenosis (systolic opening area <1.0 cm²) via CT-based planimetry, with a mean AVA of 0.62 ± 0.18. In four subjects, TEE planimetry was precluded due to severe aortic valve calcification, but CT-planimetry was successfully performed with a mean AVA of 0.46 ± 0.23 cm². Mean aortic valve calcium mass score was 563.8 ± 526.2 mg. Aortic valve area by CT was not correlated with aortic valve calcium mass score. A bias and limits of agreement among CT and TEE, CT and cardiac catheterization, and TEE and cardiac catheterization were −0.07 [–0.37 to 0.24], 0.03 [−0.49 to 0.55], 0.12 [−0.39 to 0.63] cm², respectively. Differences in AVA among CT and TEE or cardiac catheterization did not differ systematically over the range of measurements and were not correlated with aortic valve calcium mass score.

Conclusion

Planimetric aortic valve area measurements from 256-slice CT agree well with those derived from TEE and cardiac catheterization in high-risk subjects with known high-grade calcified aortic stenosis.     

The utility of MRI for pre-operative T and N staging of gastric carcinoma: a systematic review and meta-analysis

Objective:

To perform a meta-analysis and literature review regarding the diagnostic accuracy of MRI for pre-operative tumour depth invasion (T) and regional lymph node invasion (N) staging of gastric carcinoma (GC).

Methods:

Articles were identified through systematic search of Medline, PubMed, Cochrane Library, Web of Science, Springerlink and several Chinese databases. The study quality was assessed by the quality assessment for studies of diagnostic accuracy. 2 reviewers independently extracted and assessed the data from 11 eligible studies. A meta-analysis was then carried out. Subgroup and sensitivity analyses were also performed.

Results:

11 studies (439 patients) were finally included in the current review. Among these studies, the significant evidence of heterogeneity was only discovered for specificity in T4 stage (I² = 59.8%). Pooled sensitivity and specificity of MRI to diagnose T stage tumour (T3–4 vs T1–2) were 0.93 [95% confidence interval (CI), 0.89–0.96] and 0.91 (95% CI, 0.87–0.95), respectively. Pooled estimates of sensitivity and specificity of MRI to diagnose N stage tumour (N0 vs N+) were 0.86 (95% CI, 0.80–0.92) and 0.67 (95% CI, 0.54–0.79), respectively. Subgroup analyses showed that diffusion-weighted imaging was more helpful for T staging.

Conclusion:

The present systematic review suggests that MRI has a good diagnostic accuracy for pre-operative T staging of GC and should be widely used in clinical work. However, the ability for N staging is relatively poor on MRI.

Advances in knowledge:

In the pre-operative staging of GC, MRI was a useful tool and may enhance accuracy for the T staging of advanced GC.Gastric carcinoma (GC) is the fourth most common cancer and the second leading cause of cancer-related death with a 5-year survival rate of <20% around the world.¹ The disease is more common in Asian countries, especially China, Japan and Republic of Korea.^2,3 Accurate assessment of local tumour depth invasion (T) and regional lymph node invasion (N) plays an essential role in predicting prognosis and determining the most appropriate treatment planning.^4,5The pre-operative staging of GC has been based on a multimodality approach, such as endoscopic ultrasonography (EUS), CT, MRI and positron emission tomography (PET).^6,7 EUS and CT have been widely used for GC staging in previous years.⁸ Of course, different imaging modalities have themselves relative merits. CT with ionized radiation requires the injection of iodine contrast medium.⁹ EUS is an invasive technique requiring sedation¹ and is highly operator dependent.¹⁰ PET highly depends upon the standardized uptake value and the pathological subtype of the cancer.¹¹MRI is a powerful imaging method with high soft-tissue contrast, with technical versatility for sequence selection and modification, and without ionizing radiation. However, it was unsuitable for the staging of GC owing to its long acquisition time and susceptibility to motion artefacts in previous years. With technology improved and shorter imaging time, these limitations have recently been partially overcome.¹²Recently, there has been much research using MRI to assess pre-operative staging of GC. Nevertheless, the number of patients in each study has been insufficient, and the results varied among the articles. Also, the limited imaging field of view of MRI in a single session makes it difficult to stage the distant metastasis (M).¹³ Therefore, the objective of this study was to perform a systematic review and meta-analysis regarding the diagnostic accuracy of MRI for pre-operative T and N staging of GC.     

Performance of bone tracer for diagnosis and differentiation of transthyretin cardiac amyloidosis: a systematic review and meta-analysis

PURPOSEBone tracers have been validated for many years in detecting transthyretin cardiac amyloidosis (TTR-CA). However, several new studies suggest conflicting results. Our study aimed to systematically evaluate the accuracy of bone radiotracers for diagnosis and differentiation of TTR-CA via a systematic review and meta-analysis.METHODSWe retrieved articles assessing the performance of bone tracer in diagnosing and differentiating TTR-CA from PubMed, the Cochrane Library, ScienceDirect, and DOAJ databases, dating up to 10 July 2020. The meta-analysis was conducted through Stata 16 software, and the risk of bias for the included studies was assessed by the QUADAS-2 tool. Moreover, we made a comprehensive review.RESULTSFourteen articles were included in the systematic review, and 9 in the meta-analysis. The pooled sensitivity was 0.97 (95% confidence interval [95% CI] 0.85–0.99) with heterogeneity (I²=73.5, 95% CI 55.6–91.2), and the specificity was 0.92 (95% CI 0.82–0.96) with heterogeneity (I²=42.0, 95% CI 0.0–86.9). The pooled positive and negative likelihood ratios were 11.49 (95% CI 5.07–26.0) and 0.03 (95% CI 0.01–0.18), respectively. The diagnostic odds ratio was 341 (95% CI 53–2194), and the area under the receiver operating characteristic curve was 0.96 (95% CI 0.94–0.97).CONCLUSIONThe findings evidence that the bone radiotracer is a valuable noninvasive approach that provides high accuracy for diagnosing TTR-CA and plays a modest role in differentiating TTR-CA from immunoglobulin amyloid light-chain cardiac amyloidosis. ^99mTc-HMDP may be more accurate than ^99mTc-PYP, ^99mTc-DPD, and ¹⁸F-NaF in the TTR-CA detecting process, and ¹⁸F-NaF is a promising bone tracer to diagnose and differentiate TTR-CA.

Cardiac amyloidosis (CA) is a group of fatal diseases with poor prognosis (1, 2), which occurs when amyloid (misfolded protein fragments) are deposited in the myocardial extracellular matrix, small blood vessels, and the conduction system (1, 2). The two most frequent types of CA are transthyretin CA (TTR-CA) and immunoglobulin amyloid light-chain CA (AL-CA) (1–5). TTR-CA could be acquired from the aggregation of wildtype TTR (TTRwt), mutant TTR (TTRm), and other types of TTR (3–6). Without typical symptoms, TTR-CA is easily misdiagnosed and underdiagnosed (7, 8), especially in the early stage. From the clinical perspective, doctors often get frustrated in diagnosing TTR-CA and distinguishing TTR-CA from AL-CA, which would delay the optimal treatment and lead to poor prognosis (2).The well-known gold standard for diagnosing TTR-CA depends on endomyocardial biopsy (EMB) (1, 7, 9). Other diagnostic criteria have also been considered (6, 10, 11), such as biopsies from involved organs combined with significant echocardiography findings. Early diagnosis and differentiation of TTR-CA are crucial for the treatment and prognosis (7, 11). Although biopsy combined with additional measures (genotyping or immunohistochemistry) can diagnose and differentiate TTR-CA, biopsy, especially the EMB, cannot be used as a routine procedure due to its possible invasive complications (1–5). Recently, plenty of studies on noninvasive examinations emerged, trying to discuss the early diagnosis of TTR-CA and the differentiation between TTR-CA and AL-CA (10, 12–26). The most representative method is the application of gamma-emitting bone tracers, such as ^99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (^99mTc-DPD), ^99mTc-pyrophosphate (^99mTc-PYP), and ^99mTc-hydroxymethylene diphosphonate (^99mTc-HMDP) (12–24). Besides, the positron emission tomography (PET) bone tracer ¹⁸F-sodium fluoride (¹⁸F-NaF) has also been used to explore the diagnosis and differentiation of TTR-CA (25, 26).Most studies suggest that bone tracers can diagnose and differentiate TTR-CA. A prior meta-analysis has partly reported the diagnostic accuracy of gamma-emitting bone tracers in TTR-CA (27). Nevertheless, the differentiation of TTR-CA from AL-CA was not fully elaborated, and it did not provide a systematic review and include the positron-emitting bone tracer ¹⁸F-NaF. More importantly, several new studies have indicated that bone radiotracers present suboptimal sensitivity in detecting some TTR-CA (28, 29), which contradicts previous analyses. Therefore, we sought to provide further evidence on the role of bone tracers in TTR-CA diagnosis and CA subtype differentiation by performing a more comprehensive systematic review and a meta-analysis.     

Effectiveness of a supervised rehabilitation compared with a home-based rehabilitation following anterior cruciate ligament reconstruction: A systematic review and meta-analysis

ObjectiveThis systematic review aimed to compare the effectiveness of supervised rehabilitation with regard to knee function with that of home-based rehabilitation in patients undergoing anterior cruciate ligament reconstruction (ACLR).MethodsThe databases searched were: the Cochrane Central Register of Controlled Trials (Central), EMBASE, MEDLINE (via Ovid) and PEDro. All randomized controlled trials comparing supervised rehabilitation (SVR) with home-based rehabilitation (HBR) following ACLR were included. Two reviewers evaluated the study quality using the Cochrane Risk of Bias Assessment (RoB 2.0) tool. Estimates are presented as standardized mean differences (SMD) with 95% confidence intervals (CIs). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.ResultsA total of nine studies met the inclusion criteria, and five studies were included in the meta-analysis. The key outcomes analyzed were self-reported knee function and knee muscle strength. Across all comparisons, there was very low-quality evidence of no significant difference between the SVR and HBR groups at 24 weeks.ConclusionsThe limited evidence available does not suggest that SVR results in superior outcomes than HBR in patients with ACLR. Additional studies are needed to clarify whether patient characteristics and study protocols with longer interventions effect the results.