99mTc DPD is the preferential bone tracer for diagnosis of cardiac transthyretin amyloidosis

We emphasize the role of Tc-99m-3,3-diphosphono-1,2-propanodicarboxylicacid (DPD) scintigraphy as a noninvasive tool to distinguish transthyretin (TTR)-related cardiac amyloidosis from other forms of cardiac amyloidosis. We report the case of a 76-year-old male patient suffering from congestive heart failure in whom imaging investigation by DPD scintigraphy showed a strong cardiac uptake highly suggestive of TTR amyloidosis variant. TTR-related cardiac amyloidosis was confirmed on myocardial biopsies by immunohistochemistry analysis. This case supports the growing interest in DPD scintigraphy for typing cardiac amyloidosis and for its contribution in the place of invasive myocardial biopsy.     

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     

Diagnostic accuracy of bone scintigraphy in the assessment of cardiac transthyretin-related amyloidosis: a bivariate meta-analysis

Purpose

Cardiac transthyretin-related amyloidosis (ATTR) is a progressive and fatal cardiomyopathy. The diagnosis of this disease is frequently delayed or missed due to the limited specificity of echocardiography. An increasing amount of data in the literature demonstrate the ability of bone scintigraphy with bone-seeking radiopharmaceuticals to detect myocardial amyloid deposits, in particular in patients with ATTR. Therefore we performed a systematic review and bivariate meta-analysis of the diagnostic accuracy of bone scintigraphy in patients with suspected cardiac ATTR.

Methods

A comprehensive computer literature search of studies published up to 30 November 2017 on the role of bone scintigraphy in patients with ATTR was performed using the following search algorithm: (a) “amyloid” OR “amyloidosis” AND (b) “TTR” OR “ATTR” OR “transthyretin” AND (c) “scintigraphy” OR “scan” OR “SPECT” OR “SPET” OR “bone” OR “skeletal” OR “skeleton” OR “PYP” OR “DPD” OR “HMDP” OR “MDP” OR “HDP”. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR?) and diagnostic odds ratio (DOR) of bone scintigraphy were calculated.

Results

The meta-analysis of six selected studies on bone scintigraphy in cardiac ATTR including 529 patients provided the following results: sensitivity 92.2% (95% CI 89–95%), specificity 95.4% (95% CI 77–99%), LR+ 7.02 (95% CI 3.42–14.4), LR? 0.09 (95% CI 0.06–0.14), and DOR 81.6 (95% CI 44–153). Mild heterogeneity was found among the selected studies.

Conclusion

Our evidence-based data demonstrate that bone scintigraphy using technetium-labelled radiotracers provides very high diagnostic accuracy in the non-invasive assessment of cardiac ATTR.

     

Diagnostic performance of dual-energy CT for the detection of bone marrow oedema: a systematic review and meta-analysis

Objectives

The aim of this systematic review and meta-analysis was to assess the sensitivity and specificity of dual-energy CT (DECT) for the detection of bone marrow oedema (BME).

Methods

An electronic search of the PubMed and EMBASE databases was conducted. Bivariate modelling and hierarchical summary receiver-operating characteristic modelling were performed to evaluate the overall diagnostic performance of DECT for BME. Subgroup analysis was performed according to the assessment type (qualitative vs. quantitative) and anatomical location (spine vs. appendicular skeleton). Meta-regression analyses were performed according to the subject, study, and DECT characteristics.

Results

Twelve eligible studies (1901 lesions, 450 patients) were included. DECT exhibited a pooled sensitivity of 0.85 [95% confidence interval (CI): 0.78–0.90] and a pooled specificity of 0.97 (95% CI: 0.92–0.98) for BME detection. In addition, the diagnostic performance of qualitative assessment (sensitivity, 0.85; specificity, 0.97) was higher than that of quantitative assessment (sensitivity, 0.84; specificity, 0.88) of DECT findings. The diagnostic performance of DECT for the spine (sensitivity, 0.84; specificity, 0.98) and appendicular skeleton (sensitivity, 0.84; specificity, 0.93) were excellent. According to meta-regression analysis, the use of a tin filter, ≥ 2 image planes, and a slice thickness < 1 mm tended to exhibit higher sensitivity and hyperacute stage BME (< 24 h) tended to exhibit lower sensitivity.

Conclusions

These findings indicate that DECT has excellent sensitivity and specificity for BME detection. Qualitative assessment of DECT findings obtained using a tin filter, ≥ 2 image planes, and a 0.5-1-mm slice thickness in the acute stage BME (≥24 h) is recommended for more sensitive diagnosis.

Key Points

? Overall, DECT is useful for the detection of BME (sensitivity, 85%; specificity-97%). ? Qualitative assessment (sensitivity-85%; specificity-97%) is more accurate than quantitative assessment (sensitivity-84%; specificity-88%). ? DECT showed excellent diagnostic performance for both the spine/appendicular skeleton (sensitivity-84%/84%; specificity-98%/93%).

     

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.     

Complications following hip arthroscopy: a systematic review and meta-analysis

Purpose

The use of hip arthroscopy to address injuries and conditions about the hip is becoming more widespread. There are several narrative reviews regarding complications of hip arthroscopy but a systematic review is currently lacking. The primary goal of this study is to determine the complication rate associated with hip arthroscopy in the literature.

Methods

A search of the EMBASE and Ovid Medline databases was performed to identify articles published between 1 January 2000 and 25 November 2011 that reported a complication rate after hip arthroscopy. Appropriate inclusion and exclusion criteria were applied to identify articles, and a meta-analysis was performed to determine an overall complication rate. Complications were divided into major and minor.

Results

A total of 66 papers (n = 6,962 hip arthroscopies) were identified and deemed appropriate for analysis. The overall complication rate was found to be 4.0 % (95 % CI 2.9–5.2 %). Of the 287 complications identified in the literature, 20 were deemed major constituting a rate of 0.3 %.

Conclusions

Hip arthroscopy appears to be safe. The vast majority of complications are minor in nature. Prospective trials looking at the complications of hip arthroscopy would aid in identifying prognostic factors.

Level of evidence

Systematic review and meta-analysis, Level III.     

Treatment of chronic syndesmotic injury: a systematic review and meta-analysis

Purpose

The purpose of this study is to systematically review and meta-analyse the available literature on the treatment of chronic syndesmotic injuries of the ankle.

Methods

A systematic review of the PubMed/MEDLINE and EMBASE databases was conducted in August 2012 utilizing the keywords (treatment OR intervention) AND (injury OR sprain OR rupture) AND (syndesmosis OR syndesmotic OR “high ankle” OR “anterior inferior tibiofibular ligament” OR AITFL OR “posterior inferior tibiofibular ligament” OR PITFL OR tibiofibular diastasis). Studies that reported the outcomes of the surgical treatment of chronic syndesmotic injury were included in our review. Chronic was defined as symptoms longer than 6 months. Meta-analysis based on random-effects models was performed to pool the rates of success for different treatment methods.

Results

The search yielded 416 publications from PubMed/MEDLINE and 473 publications from EMBASE. After abstract and full-text review, 15 articles were included in this review. Treatment methods were placed into three broad surgical treatment categories: screw fixation, arthrodesis and arthroscopic debridement. The most common treatment strategy employed was screw fixation. The pooled rates of success for screw fixation, arthrodesis and arthroscopic debridement were 87.9, 79.4 and 78.7 %, respectively.

Conclusion

The current evidence on the treatment of chronic syndesmosis injuries in the ankle is limited to prospective and retrospective case series. The pooled success rates for screw fixation, arthrodesis and arthroscopic debridement each exceeded 78 %. Future high-level studies are required to discern the most appropriate treatment strategy(ies) for chronic syndesmotic injuries of the ankle.     

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.     

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     

Computed tomography for assessing resectability of gallbladder carcinoma: a systematic review and meta-analysis

PurposeThe purpose was to calculate the sensitivity and specificity of computed tomography (CT) in assessing the resectability of gallbladder carcinoma (GBCA) with meta-analysis.Materials and methodsA meta-analysis of the reported sensitivity and specificity of each study with 95% confidence intervals (CI) was performed.ResultsPooled sensitivity was 99% (95% CI), and pooled specificity was 76% (95% CI).ConclusionCT can be used as an appropriate choice for the diagnosis and assessment of resectability of GBCA.     

Sudden cardiac death in marathons: a systematic review

The aim of this systematic review is to summarise the results of cohort studies that examined the incidence of SCD in marathons and to assess the quality of the methods used. A search of the PROSPERO international database revealed no prospective or published systematic reviews investigating SCD in marathons. The review was conducted using studies that reported and characterised the incidence of SCD in people participating in marathons. Studies were identified via electronic database searches (Medline, CINAHL, SPORTDiscus and Google Scholar) from January 1, 1966 to October 1, 2014 and through manual literature searches. 7 studies met the inclusion criteria and were included in this review. 6 of the studies were conducted in the USA and 1 in the UK. These studies covered a 34-year period involving between 215,413 and 3,949,000 runners. The SCD of between 4 and 28 people are recorded in the papers and the reported estimates of the incidence of SCD in marathons ranged widely from 0.6 to 1.9 per 100,000 runners. The proportion of those suffering SCD who were male ranged from 57.1% to 100% and the mean age reported in the papers, ranged from 37 to 48. This review raises 4 methodological concerns over i) collating reports of SCD in marathons; ii) time of death in relation to the marathon; iii) the use of registrants rather than runners in the estimates of sample size and iv) limited detail on runners exercise history. These four concerns all threaten the reliability and interpretation of any estimate of SCD incidence rates in marathons. This review recommends that the methods used to collect data on SCD in marathons be improved and that a central reporting system be established.     

Diagnostic accuracy of computed tomography and ultrasound for the diagnosis of acute appendicitis: A systematic review and meta-analysis

IntroductionThe diagnosis of acute appendicitis remains challenging. This review determined the current diagnostic accuracy of CT and ultrasound for suspected acute appendicitis in adults.MethodsThis systematic review adhered to the PRISMA for diagnostic test accuracy guidelines. A systematic search was undertaken in appropriate databases. Screening of potential titles and abstracts, full-text retrieval, methodological quality assessment using QUADAS, and data extraction was performed. Meta-analyses were performed for relevant subgroups, and sensitivity analysis was completed to account for outliers. GRADE was utilized to assess the certainty of findings.Results31 studies evaluating CT, 10 evaluating US, and six evaluating both were included. Pooled sensitivity and specificity for CT was 0.972 [0.958, 0.981] and 0.956 [0.941, 0.967] respectively, and 0.821 [0.738, 0.882] and 0.859 [0.727, 0.933] for US, respectively. When analyzing subgroups based on the use of contrast enhancement, sensitivity and specificity was highest for CT with intravenous and oral contrast (0.992 [0.965, 0.998], 0.974 [0.936, 0.99]), compared to CT with intravenous contrast (0.955 [0.922, 0.974], 0.942 [0.916, 0.960]). Low-Dose CT produced comparable values (0.934 [0.885,0.963], 0.937 [0.911, 0.955]) relative to these subgroups and standard dose non-contrast CT (0.877 [0.774,0.937], 0.914 [0.827, 0.959]). US studies which excluded equivocal findings demonstrated significantly greater values than the remainder of US studies (p < 0.0001).ConclusionThe updated diagnostic test accuracies of CT, US and relevant subgroups should be implemented in light of factors such as dose, cost, and timing.Implications for practiceFor diagnosis of adult acute appendicitis:? CT with intravenous plus oral contrast enhancement yields statistically significantly greater diagnostic accuracy than CT with intravenous contrast alone.? Low-dose CT yields comparable sensitivity and specificity to standard-dose CT.? Ultrasound studies which exclude equivocal results may overinflate sensitivity and specificity.     

The accuracy of MRI in diagnosis of suspected deep vein thrombosis: systematic review and meta-analysis

Magnetic resonance imaging (MRI) may be used to diagnose deep vein thrombosis (DVT) in patients for whom ultrasound examination is inappropriate or unfeasible. We undertook a systematic review of the literature and meta-analysis to estimate the diagnostic accuracy of MRI for DVT. We searched databases of medical literature and citation lists of retrieved articles. We selected studies that compared MRI with a reference standard in patients with suspected DVT or suspected pulmonary embolus, or high-risk asymptomatic patients. Data were analysed by random effects meta-analysis. We included 14 articles in the meta-analysis. Most compared MRI with venography in patients with clinically suspected DVT. The pooled estimate of sensitivity was 91.5% (95% CI: 87.5–94.5%) and the pooled estimate of specificity was 94.8% (95% CI: 92.6–96.5%). Sensitivity for proximal DVT was higher than sensitivity for distal DVT (93.9% versus 62.1%). However, pooled estimates should be interpreted with caution as estimates of both sensitivity and specificity were subject to significant heterogeneity (P<0.001). Individual studies reported sensitivity ranging from zero to 100%, while specificity ranged from 43 to 100%. MRI has equivalent sensitivity and specificity to ultrasound for diagnosis of DVT, but has been evaluated in many fewer studies, using a variety of different techniques.