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Osteoporosis International : a Journal... Sep 2023Identifying the full scope of pelvic fracture patterns in older adults has gained clinical importance since the last decennium. CT is recommended as the golden standard;... (Review)
Review
Identifying the full scope of pelvic fracture patterns in older adults has gained clinical importance since the last decennium. CT is recommended as the golden standard; however, MRI has even greater diagnostic accuracy. Dual energy computed tomography (DECT) is a new and promising imaging technique, but the diagnostic accuracy in the context of pelvic fragility fractures (FFPs) has not been widely established. The aim was to provide insight into the diagnostic accuracy of different imaging techniques and the relevance for clinical practice. A systematic search was performed in the PubMed database. All studies that reported on CT, MRI or DECT imaging techniques in older adults who suffered a pelvic fracture were reviewed and, if relevant, included. Eight articles were included. In up to 54% of the patients, additional fractures were found on MRI compared to CT, and in up to 57% of the patients on DECT. The sensitivity of DECT for posterior pelvic fracture detection was similar to MRI. All patients without fractures on CT appeared to have posterior fractures on MRI. After additional MRI, 40% of the patients had a change of classification. DECT and MRI showed very similar results in terms of diagnostic accuracy. Over a third of all patients appear to have a more severe fracture classification after MRI, the majority changing to Rommens type 4. However, in only a few patients who changed of fracture classification, a change of therapy was advised. This review suggests that MRI and DECT scans are superior in diagnosing FFPs.
Topics: Humans; Aged; Tomography, X-Ray Computed; Fractures, Bone; Magnetic Resonance Imaging; Pelvic Bones; Radionuclide Imaging; Sensitivity and Specificity; Retrospective Studies
PubMed: 37286662
DOI: 10.1007/s00198-023-06812-9 -
Journal of Neuro-oncology Jan 2023To provide a summary of the diagnostic performance of F-FET-PET in the management of patients with high-grade brain gliomas or metastases from extracranial primary... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To provide a summary of the diagnostic performance of F-FET-PET in the management of patients with high-grade brain gliomas or metastases from extracranial primary malignancies.
METHODS
MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews databases were searched for studies that reported on diagnostic test parameters in radiotherapy planning, response assessment, and tumour recurrence/treatment-related changes differentiation. Radiomic studies were excluded. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool and the GRADE approach. A bivariate, random-effects model was used to produce summary estimates of sensitivity and specificity.
RESULTS
Twenty-six studies with a total of 1206 patients/lesions were included in the analysis. For radiotherapy planning of glioma, the pooled proportion of patients from 3 studies with F-FET uptake extending beyond the 20 mm margin from the gadolinium enhancement on standard MRI was 39% (95% CI, 10-73%). In 3 studies, F-FET-PET was also shown to be predictive of early responders to treatment, whereas MRI failed to show any prognostic value. For the differentiation of glioma recurrence from treatment-related changes, the pooled sensitivity and specificity of TBR 1.9-2.3 from 6 studies were 91% (95% CI, 74-97%) and 84% (95% CI, 69-93%), respectively. The respective values for brain metastases from 4 studies were 82% (95% CI, 74-88%) and 82% (95% CI, 74-88%) using TBR 2.15-3.11.
CONCLUSION
While F-FET shows promise as a complementary modality to standard-of-care MRI for the management of primary and metastatic brain malignancies, further validation with standardized image interpretation methods in well-designed prospective studies are warranted.
Topics: Humans; Contrast Media; Neoplasm Recurrence, Local; Gadolinium; Brain Neoplasms; Glioma; Positron-Emission Tomography; Magnetic Resonance Imaging; Tyrosine
PubMed: 36502457
DOI: 10.1007/s11060-022-04201-6 -
Journal of Psychiatric Research Nov 2020Although the precise pathophysiologies underlying autism spectrum disorder (ASD) has not yet been fully clarified, growing evidence supports the involvement of... (Review)
Review
BACKGROUND
Although the precise pathophysiologies underlying autism spectrum disorder (ASD) has not yet been fully clarified, growing evidence supports the involvement of neuroinflammation in the pathogenesis of this disorder, with microglia being particular relevance in the pathophysiologic processes.
OBJECTIVE
The present review aimed to systematically characterize existing literature regarding the role of microglia mediated neuroinflammation in the etiology of ASD.
METHODS
A systematic search was conducted for records indexed within Pubmed, EMBASE, or Web of Science to identify potentially eligible publications. Study selection and data extraction were performed by two authors, and the discrepancies in each step were settled through discussions.
RESULTS
A total of 14 studies comprising 1007 subjects met the eligibility criteria for this review, including 8 immunohistochemistry (IHC) studies, 5 genetic analysis studies, and 1 positron emission tomography (PET) studies. Although small in quantity, the included studies collectively pointed to a role of microglia mediated neuroinflammation in the pathogenesis of ASD.
CONCLUSION
Findings generated from this review consistently supported the involvement of neuroinflammation in the development of ASD, confirmed by the activation of microglia in different brain regions, involving increased cell number or cell density, morphological alterations, and phenotypic shifts.
Topics: Autism Spectrum Disorder; Brain; Humans; Inflammation; Microglia; Positron-Emission Tomography
PubMed: 32823050
DOI: 10.1016/j.jpsychires.2020.07.013 -
Journal of Psychiatric Research Jun 2023An increasing number of studies have used positron emission tomography (PET) to investigate molecular neurobiological differences in individuals who use cannabis. This... (Review)
Review
BACKGROUND
An increasing number of studies have used positron emission tomography (PET) to investigate molecular neurobiological differences in individuals who use cannabis. This study aimed to systematically review PET imaging research in individuals who use cannabis or have cannabis use disorder (CUD).
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, a comprehensive systematic review was undertaken using the PubMed, Scopus, PsycINFO and Web of Science databases.
RESULTS
In total, 20 studies were identified and grouped into three themes: (1) studies of the dopamine system primarily found that cannabis use was associated with abnormal striatal dopamine synthesis capacity, which was in turn correlated with clinical symptoms; (2) studies of the endocannabinoid system found that cannabis use and CUD are associated with lower cannabinoid receptor type 1 availability and global reductions in fatty acid amide hydrolase binding; (3) studies of brain metabolism found that individuals who use cannabis exhibit lower normalized glucose metabolism in both cortical and subcortical brain regions, and reduced cerebral blood flow in the lateral prefrontal cortex during experimental tasks. Heterogeneity across studies prevented meta-analysis.
CONCLUSION
Existing PET imaging research reveals substantive molecular differences in cannabis users in the dopamine and endocannabinoid systems, and in global brain metabolism, although the heterogeneity of designs and approaches is very high, and whether these differences are causal versus consequential is largely unclear.
Topics: Humans; Cannabis; Endocannabinoids; Dopamine; Brain; Positron-Emission Tomography; Hallucinogens
PubMed: 37088043
DOI: 10.1016/j.jpsychires.2023.03.045 -
Frontiers in Neuroendocrinology Jul 2023The rapid and continual development of a number of radiopharmaceuticals targeting different receptor, enzyme and small molecule systems has fostered Positron Emission... (Review)
Review
The rapid and continual development of a number of radiopharmaceuticals targeting different receptor, enzyme and small molecule systems has fostered Positron Emission Tomography (PET) imaging of endocrine system actions in vivo in the human brain for several decades. PET radioligands have been developed to measure changes that are regulated by hormone action (e.g., glucose metabolism, cerebral blood flow, dopamine receptors) and actions within endocrine organs or glands such as steroids (e.g., glucocorticoids receptors), hormones (e.g., estrogen, insulin), and enzymes (e.g., aromatase). This systematic review is targeted to the neuroendocrinology community that may be interested in learning about positron emission tomography (PET) imaging for use in their research. Covering neuroendocrine PET research over the past half century, researchers and clinicians will be able to answer the question of where future research may benefit from the strengths of PET imaging.
Topics: Humans; Neuroendocrinology; Positron-Emission Tomography; Radiopharmaceuticals; Brain
PubMed: 37423505
DOI: 10.1016/j.yfrne.2023.101081 -
The Spine Journal : Official Journal of... Jun 2023Native vertebral osteomyelitis (NVO) is a severe infection with an increasing incidence globally. Although there is no widely agreed upon reference standard for... (Meta-Analysis)
Meta-Analysis
BACKGROUND CONTEXT
Native vertebral osteomyelitis (NVO) is a severe infection with an increasing incidence globally. Although there is no widely agreed upon reference standard for diagnosis of the disease, imaging plays a crucial role. Magnetic resonance imaging (MRI) is currently the imaging modality of choice. In recent years, advances in imaging have allowed for a larger role for alternative imaging techniques in the setting of NVO.
PURPOSE
Our aim was to evaluate the diagnostic accuracy of MRI, PET/CT, and nuclear imaging, namely Gallium and Technetium scintigraphy, in the diagnosis of pyogenic NVO.
STUDY DESIGN/SETTING
We conducted a systematic review of five medical databases and included all studies from 1970 to September 2021 that compared imaging techniques and provided sufficient data for diagnostic test accuracy meta-analysis.
METHODS
Abstract screening, full text review, and data extraction were done by a pair of independent reviewers. Nonnative and nonpyogenic patients were excluded. A bivariate random effect model was used for meta-analysis.
RESULTS
Twenty studies were included in the meta-analysis, encompassing a total of 1,123 imaging studies. The meta-analysis sensitivity and specificity of MRI were 90% and 72% respectively; those of PET/CT were 93% and 80%; those of Ga were 95% and 88%; those of Tc were 86% and 39%; and the sensitivity and specificity of combined Ga and Tc were 91% and 92% respectively in the setting of suspected NVO.
CONCLUSIONS
Ga has the highest sensitivity for NVO, and its specificity is augmented when combined with Tc. MRI and PET/CT are both highly sensitive modalities, although the specificity of PET/CT is slightly better. MRI remains an appropriate initial test depending on the availability of other modalities.
Topics: Humans; Magnetic Resonance Imaging; Osteomyelitis; Positron Emission Tomography Computed Tomography; Radionuclide Imaging; Sensitivity and Specificity
PubMed: 36754150
DOI: 10.1016/j.spinee.2023.01.019 -
Current Medical Imaging 2022Peripheral lymphedema represents a debilitating condition affecting the lymphatic system of the limbs resulting from impaired drainage and excessive lymphatic fluid...
BACKGROUND
Peripheral lymphedema represents a debilitating condition affecting the lymphatic system of the limbs resulting from impaired drainage and excessive lymphatic fluid accumulation in the interstitial spaces. Lymphoscintigraphy is the imaging modality of first choice to investigate patients with peripheral lymphedema. Nevertheless, in recent times, magnetic resonance imaging (MRI) techniques have also been applied to assess patients with lymphedema.
OBJECTIVE
The present systematic review aims to appraise the evidence by providing a head-to-head comparison between lymphoscintigraphy and MRI techniques in peripheral lymphedema.
METHODS
A systematic literature search was performed using the PubMed database and Cochrane Central Register of Controlled Trials (CENTRAL). The eligibility criteria for the articles to be included in the qualitative synthesis were: 1) a study cohort or a subset of patients with a clinical diagnosis of peripheral lymphedema (either upper or lower limb); 2) execution of both MR imaging and lymphoscintigraphy in the same subset of patients. The methodological quality of the studies was assessed by an investigator using the "Quality Assessment of Diagnostic Accuracy Studies" tool, v. 2 (QUADAS-2).
RESULTS
Overall, 11 studies were ultimately included in the quantitative analysis. No meta-analysis was performed due to the heterogeneous patient samples, the different study aims of the retrieved literature, and the limited number of available articles. In the diagnosis of upper limb extremity lymphedema, the sensitivity of MRI techniques appears superior to that of lymphoscintigraphy. Comparative studies in the lower limbs are still scarce but suggest that MRI may increase the diagnostic accuracy for lymphedema.
CONCLUSION
The available literature on patients with lymphedema evaluated with both lymphoscintigraphy and MRI does not allow definite conclusions on the superiority of one imaging technique over the other. Further studies, including well-selected patient samples, are still necessary to compare the accuracy of these imaging modalities. Since MRI techniques seem to provide complementary findings to lymphoscintigraphy, it would be conceivable to acquire both imaging exams in patients with peripheral lymphedema. Furthermore, studies evaluating the clinical impact of adding MRl to the diagnostic workup are warranted.
Topics: Humans; Lymphoscintigraphy; Lymphedema; Magnetic Resonance Imaging
PubMed: 35619272
DOI: 10.2174/1573405618666220525141721 -
Diseases of the Esophagus : Official... May 2023Radiomics can interpret radiological images with more detail and in less time compared to the human eye. Some challenges in managing esophageal cancer can be addressed... (Meta-Analysis)
Meta-Analysis
Performance of radiomics-based artificial intelligence systems in the diagnosis and prediction of treatment response and survival in esophageal cancer: a systematic review and meta-analysis of diagnostic accuracy.
Radiomics can interpret radiological images with more detail and in less time compared to the human eye. Some challenges in managing esophageal cancer can be addressed by incorporating radiomics into image interpretation, treatment planning, and predicting response and survival. This systematic review and meta-analysis provides a summary of the evidence of radiomics in esophageal cancer. The systematic review was carried out using Pubmed, MEDLINE, and Ovid EMBASE databases-articles describing radiomics in esophageal cancer were included. A meta-analysis was also performed; 50 studies were included. For the assessment of treatment response using 18F-FDG PET/computed tomography (CT) scans, seven studies (443 patients) were included in the meta-analysis. The pooled sensitivity and specificity were 86.5% (81.1-90.6) and 87.1% (78.0-92.8). For the assessment of treatment response using CT scans, five studies (625 patients) were included in the meta-analysis, with a pooled sensitivity and specificity of 86.7% (81.4-90.7) and 76.1% (69.9-81.4). The remaining 37 studies formed the qualitative review, discussing radiomics in diagnosis, radiotherapy planning, and survival prediction. This review explores the wide-ranging possibilities of radiomics in esophageal cancer management. The sensitivities of 18F-FDG PET/CT scans and CT scans are comparable, but 18F-FDG PET/CT scans have improved specificity for AI-based prediction of treatment response. Models integrating clinical and radiomic features facilitate diagnosis and survival prediction. More research is required into comparing models and conducting large-scale studies to build a robust evidence base.
Topics: Humans; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Artificial Intelligence; Radiomics; Esophageal Neoplasms
PubMed: 37236811
DOI: 10.1093/dote/doad034 -
European Radiology Apr 2020Skeletal muscle metastases (SMM) are a rare entity, mainly detected at autopsy. Nevertheless, radiological and nuclear medicine imaging can contribute to the diagnosis...
AIM OF THE STUDY
Skeletal muscle metastases (SMM) are a rare entity, mainly detected at autopsy. Nevertheless, radiological and nuclear medicine imaging can contribute to the diagnosis with a significant impact on the treatment and prognosis of neoplastic patients. This study aimed to systematically review the features of SMM at imaging considering the primary tumors and the sites of occurrence.
MATERIALS AND METHODS
We conducted a systematic search of three electronic database (i.e., PubMed, Science Direct, and Web of Science) up to May 2019, without any language or time interval restriction. Two reviewers performed the search and selection process, data extraction, and synthesis. We resolved disagreements by consensus and/or involving a third reviewer. The included studies have been classified according to the Oxford Centre for Evidence Based Medicine (CEBM) grading system.
RESULTS
Out of 8598 and 1077 articles respectively for radiological and hybrid imaging, 29 papers were included. According to CEBM, twelve were level 4. Computed tomography (CT) is mainly applied and, despite the existence of CT and magnetic resonance-based classifications, these are rarely used. Positron emission tomography/CT allowed the detection of small and subtle lesion also in the extremities. Muscles of the trunk were mostly affected and mainly respiratory tumors are associated with this type of metastatic spread.
CONCLUSION
Radiological and hybrid imaging allow a precise characterization of SMM. However, a more systematic approach, including also the application of available classification systems, may increase the diagnostic accuracy for this rare type of metastases.
KEY POINTS
• Skeletal muscle metastases have heterogeneous characteristics at imaging but mostly abscess-like features and high metabolic activity are described. • Skeletal muscle metastases mainly affect the muscles of the trunk. • Pulmonary, urological, and gastrointestinal cancers are the most frequent cause of skeletal muscle metastases.
Topics: Gastrointestinal Neoplasms; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Multimodal Imaging; Muscle Neoplasms; Muscle, Skeletal; Neoplasms, Unknown Primary; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prognosis; Tomography, X-Ray Computed; Torso; Urologic Neoplasms
PubMed: 31834507
DOI: 10.1007/s00330-019-06555-4 -
Journal of Magnetic Resonance Imaging :... May 2023Accurate diagnosis of axillary lymph node metastasis (ALNM) of breast cancer patients is important to guide local and systemic treatment. (Meta-Analysis)
Meta-Analysis
Different Imaging Modalities for the Diagnosis of Axillary Lymph Node Metastases in Breast Cancer: A Systematic Review and Network Meta-Analysis of Diagnostic Test Accuracy.
BACKGROUND
Accurate diagnosis of axillary lymph node metastasis (ALNM) of breast cancer patients is important to guide local and systemic treatment.
PURPOSE
To evaluate the diagnostic performance of different imaging modalities for ALNM in patients with breast cancer.
STUDY TYPE
Systematic review and network meta-analysis (NMA).
SUBJECTS
Sixty-one original articles with 8011 participants.
FIELD STRENGTH
1.5 T and 3.0 T.
ASSESSMENT
We used the QUADAS-2 and QUADAS-C tools to assess the risk of bias in eligible studies. The identified articles assessed ultrasonography (US), MRI, mammography, ultrasound elastography (UE), PET, CT, PET/CT, scintimammography, and PET/MRI.
STATISTICAL ANALYSIS
We used random-effects conventional meta-analyses and Bayesian network meta-analyses for data analyses. We used sensitivity and specificity, relative sensitivity and specificity, superiority index, and summary receiver operating characteristic curve (SROC) analysis to compare the diagnostic value of different imaging modalities.
RESULTS
Sixty-one studies evaluated nine imaging modalities. At patient level, sensitivities of the nine imaging modalities ranged from 0.27 to 0.84 and specificities ranged from 0.84 to 0.95. Patient-based NMA showed that UE had the highest superiority index (5.95) with the highest relative sensitivity of 1.13 (95% confidence interval [CI]: 0.93-1.29) among all imaging methods when compared to US. At lymph node level, MRI had the highest superiority index (6.91) with highest relative sensitivity of 1.13 (95% CI: 1.01-1.23) and highest relative specificity of 1.11 (95% CI: 0.95-1.23) among all imaging methods when compared to US. SROCs also showed that UE and MRI had the largest area under the curve (AUC) at patient level and lymph node level of 0.92 and 0.94, respectively.
DATA CONCLUSION
UE and MRI may be superior to other imaging modalities in the diagnosis of ALNM in breast cancer patients at the patient level and the lymph node level, respectively. Further studies are needed to provide high-quality evidence to validate our findings.
EVIDENCE LEVEL
3 TECHNICAL EFFICACY: Stage 2.
Topics: Humans; Female; Positron Emission Tomography Computed Tomography; Lymphatic Metastasis; Breast Neoplasms; Network Meta-Analysis; Bayes Theorem; Positron-Emission Tomography; Sensitivity and Specificity; Magnetic Resonance Imaging; Lymph Nodes; Diagnostic Tests, Routine
PubMed: 36054564
DOI: 10.1002/jmri.28399