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Scandinavian Journal of Trauma,... Oct 2016Viscoelastic assays have been promoted as an improvement over traditional coagulation tests in the management of trauma patients. Rotational thromboelastometry (ROTEM®)... (Review)
Review
A systematic review on the rotational thrombelastometry (ROTEM®) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients.
INTRODUCTION
Viscoelastic assays have been promoted as an improvement over traditional coagulation tests in the management of trauma patients. Rotational thromboelastometry (ROTEM®) has been used to diagnose coagulopathy and guide hemostatic therapy in trauma. This systematic review of clinical studies in trauma investigates the ROTEM® parameters thresholds used for the diagnosing coagulopathy, predicting and guiding transfusion and predicting mortality.
METHODS
Systematic literature search was performed using MEDLINE, EMBASE and Cochrane databases. We included studies without restricting year of publication, language or geographic location. Original studies reporting the thresholds of ROTEM® parameters in the diagnosis or management of coagulopathy in trauma patients were included. Data on patient demographics, measures of coagulopathy, transfusion and mortality were extracted. We reported our findings according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Quality assessment and risk of bias were performed using Newcastle Ottawa Scale (NOS) and the quality assessment of diagnostic accuracy studies (QUADAS-2) tools, respectively.
RESULTS
A total of 13 observational studies involving 2835 adult trauma patients met the inclusion criteria. Nine studies were prospective and four were retrospective. There were no randomized controlled trials. The quality of the included studies was moderate (mean NOS 5.92, standard deviation 0.26). Using QUADAS-2, only 1 study (7.6 %) had low risk of bias in all domains, and 9 studies (69.2 %) had low risk of applicability concerns. Outcomes from 13 studies were grouped into three categories: diagnosis of coagulopathy (n = 10), prediction of massive transfusion or transfusion guidance (n = 6) and prediction of mortality (n = 6). Overall, specific ROTEM® parameters measured (clot amplitude and lysis) in the extrinsically activated test (EXTEM) and the fibrin-based extrinsically activated test (FIBTEM) were consistently associated with the diagnosis of coagulopathy, increased risk of bleeding and massive transfusion, and prediction of mortality. Presence of hyperfibrinolysis by ROTEM® was associated with increased mortality.
CONCLUSIONS
Most of the evidence indicates that abnormal EXTEM and FIBTEM clot amplitude (CA5, CA10) or maximal clot firmness (MCF) diagnose coagulopathy, and predict blood transfusion and mortality. The presence of fibrinolysis (abnormal lysis index [LI30] or maximum lysis [ML]) was also associated with mortality. ROTEM® thus, may be of value in the early management of trauma patients.
Topics: Blood Coagulation Disorders; Blood Coagulation Tests; Blood Transfusion; Global Health; Hemostasis; Humans; Practice Guidelines as Topic; Survival Rate; Thrombelastography; Wounds and Injuries
PubMed: 27716278
DOI: 10.1186/s13049-016-0308-2 -
Ultrasound in Obstetrics & Gynecology :... Apr 2022To perform a systematic review and meta-analysis of the diagnostic test accuracy of ultrasound and magnetic resonance imaging (MRI) and compare the performance of the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To perform a systematic review and meta-analysis of the diagnostic test accuracy of ultrasound and magnetic resonance imaging (MRI) and compare the performance of the two modalities in the diagnosis of placenta accreta spectrum (PAS).
METHODS
This was a systematic review conducted following the Cochrane Diagnostic Test Accuracy Reviews guideline. A literature search was performed in five databases: PubMed, EMBASE, PMC, The Cochrane Library and BVS-Bireme between 27 July and 4 August 2020. The search was updated on 18 August 2021. We included observational studies evaluating diagnostic accuracy in women with risk factors for PAS who had undergone both ultrasound and MRI examinations, published in English between 2011 and 2021. Quality Assessment of Diagnostic Accuracy Studies-2 was used to evaluate the quality of the studies. Forest plots for sensitivity and specificity with 95% CIs and receiver-operating-characteristics curves for ultrasound and MRI were constructed.
RESULTS
The literature search identified 266 studies. After reviewing the titles and abstracts of the articles, 51 were selected for full-text review and 17 studies including 1301 women with MRI and ultrasound data available were selected for the meta-analysis. The study population included 457 cases with PAS diagnosed using the gold standard method (intraoperative or histopathological analysis). The overall quality of the evaluated studies was considered satisfactory according to QUADAS-2. The meta-analysis revealed a sensitivity of 0.833 (95% CI, 0.776-0.878) and specificity of 0.834 (95% CI, 0.746-0.897) for ultrasound. For MRI, sensitivity was 0.838 (95% CI, 0.786-0.879) and specificity was 0.831 (95% CI, 0.770-0.878). There was no statistically significant difference between the two modalities. The Cochran's Q values indicated a high level of heterogeneity of sensitivity and specificity of ultrasound and MRI across studies.
CONCLUSIONS
Ultrasound and MRI have similar accuracy in the diagnosis of PAS. These results suggest that, in a setting with a high prevalence of risk factors, the choice of imaging modality for initial screening for PAS should depend on the availability of equipment and the examiner's expertise. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Female; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Placenta Accreta; Pregnancy; Sensitivity and Specificity; Ultrasonography
PubMed: 35041250
DOI: 10.1002/uog.24861 -
European Journal of Preventive... Aug 2016Insertable or implantable cardiac monitors (ICMs) continuously monitor the heart rhythm and record irregularities over 3 years, enabling the diagnosis of infrequent... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Insertable or implantable cardiac monitors (ICMs) continuously monitor the heart rhythm and record irregularities over 3 years, enabling the diagnosis of infrequent rhythm abnormalities associated with syncope and stroke. The enhanced recognition capabilities of recent ICM models are able to accurately detect atrial fibrillation (AF) and have led to new applications of ICMs for the detection and monitoring of AF.
METHODS AND RESULTS
Based on a systematic literature search, two indications were identified for ICMs for which considerable evidence, including randomized studies, exists: diagnosing the underlying cardiac cause of unexplained recurrent syncope and detecting AF in patients after cryptogenic stroke (CS). Three randomized controlled trials (RCTs) were identified that compared the effectiveness of ICMs in diagnosing patients with unexplained syncope (n = 556) to standard of care. A meta-analysis was conducted in order to generate an overall effect size and confidence interval of the diagnostic yield of ICMs versus conventional monitoring. In the indication CS, one RCT and five observational studies were included in order to assess the performance of ICMs in diagnosing patients with AF (n = 1129). Based on these studies, there is strong evidence that ICMs provide a higher diagnostic yield for detecting arrhythmias in patients with unexplained syncope and for detection of AF in patients after CS compared to conventional monitoring.
CONCLUSIONS
Prolonged monitoring with ICMs is an effective tool for diagnosing the underlying cardiac cause of unexplained syncope and for detecting AF in patients with CS. In all RCTs, ICMs have a superior diagnostic yield compared to conventional monitoring.
Topics: Atrial Fibrillation; Electrocardiography, Ambulatory; Humans; Stroke; Syncope
PubMed: 26864396
DOI: 10.1177/2047487316632628 -
European Journal of Endocrinology Aug 2016To perform a systematic review of published literature on adrenal biopsy and to assess its performance in diagnosing adrenal malignancy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To perform a systematic review of published literature on adrenal biopsy and to assess its performance in diagnosing adrenal malignancy.
METHODS
Medline In-Process and Other Non-Indexed Citations, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trial were searched from inception to February 2016. Reviewers extracted data and assessed methodological quality in duplicate.
RESULTS
We included 32 observational studies reporting on 2174 patients (39.4% women, mean age 59.8 years) undergoing 2190 adrenal mass biopsy procedures. Pathology was described in 1621/2190 adrenal lesions (689 metastases, 68 adrenocortical carcinomas, 64 other malignancies, 464 adenomas, 226 other benign, 36 pheochromocytomas, and 74 others). The pooled non-diagnostic rate (30 studies, 2013 adrenal biopsies) was 8.7% (95%CI: 6-11%). The pooled complication rate (25 studies, 1339 biopsies) was 2.5% (95%CI: 1.5-3.4%). Studies were at a moderate risk for bias. Most limitations related to patient selection, assessment of outcome, and adequacy of follow-up. Only eight studies (240 patients) could be included in the diagnostic performance analysis with a sensitivity and specificity of 87 and 100% for malignancy, 70 and 98% for adrenocortical carcinoma, and 87 and 96% for metastasis respectively.
CONCLUSIONS
Evidence based on small sample size and moderate risk of bias suggests that adrenal biopsy appears to be most useful in the diagnosis of adrenal metastasis in patients with a history of extra-adrenal malignancy. Adrenal biopsy should only be performed if the expected findings are likely to alter the management of the individual patient and after biochemical exclusion of catecholamine-producing tumors to help prevent potentially life-threatening complications.
Topics: Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adrenal Glands; Biopsy; Female; Humans; Male; Middle Aged; Neoplasm Metastasis
PubMed: 27257146
DOI: 10.1530/EJE-16-0297 -
The Cochrane Database of Systematic... Nov 2023Keratoconus remains difficult to diagnose, especially in the early stages. It is a progressive disorder of the cornea that starts at a young age. Diagnosis is based on... (Review)
Review
BACKGROUND
Keratoconus remains difficult to diagnose, especially in the early stages. It is a progressive disorder of the cornea that starts at a young age. Diagnosis is based on clinical examination and corneal imaging; though in the early stages, when there are no clinical signs, diagnosis depends on the interpretation of corneal imaging (e.g. topography and tomography) by trained cornea specialists. Using artificial intelligence (AI) to analyse the corneal images and detect cases of keratoconus could help prevent visual acuity loss and even corneal transplantation. However, a missed diagnosis in people seeking refractive surgery could lead to weakening of the cornea and keratoconus-like ectasia. There is a need for a reliable overview of the accuracy of AI for detecting keratoconus and the applicability of this automated method to the clinical setting.
OBJECTIVES
To assess the diagnostic accuracy of artificial intelligence (AI) algorithms for detecting keratoconus in people presenting with refractive errors, especially those whose vision can no longer be fully corrected with glasses, those seeking corneal refractive surgery, and those suspected of having keratoconus. AI could help ophthalmologists, optometrists, and other eye care professionals to make decisions on referral to cornea specialists. Secondary objectives To assess the following potential causes of heterogeneity in diagnostic performance across studies. • Different AI algorithms (e.g. neural networks, decision trees, support vector machines) • Index test methodology (preprocessing techniques, core AI method, and postprocessing techniques) • Sources of input to train algorithms (topography and tomography images from Placido disc system, Scheimpflug system, slit-scanning system, or optical coherence tomography (OCT); number of training and testing cases/images; label/endpoint variable used for training) • Study setting • Study design • Ethnicity, or geographic area as its proxy • Different index test positivity criteria provided by the topography or tomography device • Reference standard, topography or tomography, one or two cornea specialists • Definition of keratoconus • Mean age of participants • Recruitment of participants • Severity of keratoconus (clinically manifest or subclinical) SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), Ovid MEDLINE, Ovid Embase, OpenGrey, the ISRCTN registry, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). There were no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 29 November 2022.
SELECTION CRITERIA
We included cross-sectional and diagnostic case-control studies that investigated AI for the diagnosis of keratoconus using topography, tomography, or both. We included studies that diagnosed manifest keratoconus, subclinical keratoconus, or both. The reference standard was the interpretation of topography or tomography images by at least two cornea specialists.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted the study data and assessed the quality of studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. When an article contained multiple AI algorithms, we selected the algorithm with the highest Youden's index. We assessed the certainty of evidence using the GRADE approach.
MAIN RESULTS
We included 63 studies, published between 1994 and 2022, that developed and investigated the accuracy of AI for the diagnosis of keratoconus. There were three different units of analysis in the studies: eyes, participants, and images. Forty-four studies analysed 23,771 eyes, four studies analysed 3843 participants, and 15 studies analysed 38,832 images. Fifty-four articles evaluated the detection of manifest keratoconus, defined as a cornea that showed any clinical sign of keratoconus. The accuracy of AI seems almost perfect, with a summary sensitivity of 98.6% (95% confidence interval (CI) 97.6% to 99.1%) and a summary specificity of 98.3% (95% CI 97.4% to 98.9%). However, accuracy varied across studies and the certainty of the evidence was low. Twenty-eight articles evaluated the detection of subclinical keratoconus, although the definition of subclinical varied. We grouped subclinical keratoconus, forme fruste, and very asymmetrical eyes together. The tests showed good accuracy, with a summary sensitivity of 90.0% (95% CI 84.5% to 93.8%) and a summary specificity of 95.5% (95% CI 91.9% to 97.5%). However, the certainty of the evidence was very low for sensitivity and low for specificity. In both groups, we graded most studies at high risk of bias, with high applicability concerns, in the domain of patient selection, since most were case-control studies. Moreover, we graded the certainty of evidence as low to very low due to selection bias, inconsistency, and imprecision. We could not explain the heterogeneity between the studies. The sensitivity analyses based on study design, AI algorithm, imaging technique (topography versus tomography), and data source (parameters versus images) showed no differences in the results.
AUTHORS' CONCLUSIONS
AI appears to be a promising triage tool in ophthalmologic practice for diagnosing keratoconus. Test accuracy was very high for manifest keratoconus and slightly lower for subclinical keratoconus, indicating a higher chance of missing a diagnosis in people without clinical signs. This could lead to progression of keratoconus or an erroneous indication for refractive surgery, which would worsen the disease. We are unable to draw clear and reliable conclusions due to the high risk of bias, the unexplained heterogeneity of the results, and high applicability concerns, all of which reduced our confidence in the evidence. Greater standardization in future research would increase the quality of studies and improve comparability between studies.
Topics: Humans; Artificial Intelligence; Keratoconus; Cross-Sectional Studies; Physical Examination; Case-Control Studies
PubMed: 37965960
DOI: 10.1002/14651858.CD014911.pub2 -
European Journal of Radiology Jul 2015Diagnosing acute pulmonary embolism (PE) is an indication for scintillation V/Q imaging (planar and SPECT) and/or CTPA. This study reviews, compares and aggregates the... (Meta-Analysis)
Meta-Analysis Review
Planar and SPECT ventilation/perfusion imaging and computed tomography for the diagnosis of pulmonary embolism: A systematic review and meta-analysis of the literature, and cost and dose comparison.
Diagnosing acute pulmonary embolism (PE) is an indication for scintillation V/Q imaging (planar and SPECT) and/or CTPA. This study reviews, compares and aggregates the published diagnostic performance of each modality and assesses the short-term consequences in terms of diagnostic outcomes, monetary cost, and radiation burden. We performed a formal literature review of available data and aggregated the finding using a summary receiver operating characteristic. A decision tree approach was used to estimate cost and dose per correct diagnosis. The review found 19 studies, which comprised 27 data sets (6393 examinations, from 5923 patients). The results showed that planar V/Q was significantly inferior to both V/Q SPECT and CTPA with no difference between the latter two. CTPA represents best value; £129 per correct diagnosis compared to £243 (SPECT) and £226 (planar). In terms of radiation burden V/Q SPECT was the most effective with a dose of 2.12 mSv per correct diagnosis compared with 3.46 mSv (planar) and 4.96 (CTPA) mSv. These findings show no performance difference between V/Q SPECT and CTPA; planar V/Q is inferior. CTPA is clearly the most cost effective technique. V/Q SPECT should be considered in situations where radiation dose is of concern or CTPA is inappropriate.
Topics: Humans; Lung; Perfusion Imaging; Pulmonary Embolism; ROC Curve; Radiation Dosage; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ventilation-Perfusion Ratio
PubMed: 25868674
DOI: 10.1016/j.ejrad.2015.03.013 -
Diagnostic accuracy of interleukin-2 receptor in sarcoidosis: a systematic review and meta-analysis.Expert Review of Respiratory Medicine 2023Soluble interleukin-2 receptor (sIL-2 R), a valuable diagnostic biomarker for sarcoidosis, has been reported with variable results. Based on the literatures currently... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Soluble interleukin-2 receptor (sIL-2 R), a valuable diagnostic biomarker for sarcoidosis, has been reported with variable results. Based on the literatures currently accessible, a systematic review and meta-analysis of the diagnostic performance of serum sIL-2 R for sarcoidosis were performed.
METHODS
Relevant studies investigating sIL-2 R for sarcoidosis diagnosis in several databases were searched and data on sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were pooled by STATA 16.0 software. Overall test performance was assessed using summary receiver operating characteristic curves and the area under the curve (AUC). Potential publication bias was assessed by Deeks test.
RESULTS
We included eleven studies involving 1,424 subjects, with 1,099 cases of sarcoidosis and 325 of non-sarcoidosis. The pooled parameters of sIL-2 R in diagnosing sarcoidosis were summarized as follows: sensitivity, 0.85 (95% CI: 0.72-0.93); specificity, 0.88 (95% CI: 0.72-0.96); PLR, 7.3 (95% CI: 2.7-20.1); NLR, 0.17 (95% CI:0.08-0.36); DOR, 44 (95% CI: 8-231); and the AUC, 0.93 (95% CI: 0.90-0.95). No publication bias was identified ( = 0.64).
CONCLUSIONS
Evidence suggests sIL-2 R performs well in diagnosing sarcoidosis. Nevertheless, results of sIL-2 R assay should be interpreted with other diagnostic examinations.
Topics: Humans; Sensitivity and Specificity; ROC Curve; Receptors, Interleukin-2; Sarcoidosis
PubMed: 37334768
DOI: 10.1080/17476348.2023.2225772 -
International Ophthalmology Feb 2021To review the basic principles of ultra-widefield fundus autofluorescence (UWF-FAF) and discuss its clinical application for a variety of retinal and choroidal disorders. (Review)
Review
PURPOSE
To review the basic principles of ultra-widefield fundus autofluorescence (UWF-FAF) and discuss its clinical application for a variety of retinal and choroidal disorders.
METHODS
A systematic review of the PubMed database was performed using the search terms "ultra-widefield," "autofluorescence," "retinal disease" and "choroidal disease."
RESULTS
UWF-FAF imaging is a recently developed noninvasive retinal imaging modality with a wide imaging range that can locate peripheral fundus lesions that traditional fundus autofluorescence cannot. Multiple commercially available ultra-widefield imaging systems, including Heidelberg Spectralis and Optomap Ultra-Widefield systems, are available to the clinician. Imaging by UWF-FAF is more comprehensive; it can reflect the content and distribution of the predominant ocular fluorophore in retinal pigment epithelial cells and evaluate the metabolic status of RPE of various retinal and choroidal disorders.
CONCLUSION
UWF-FAF can detect abnormalities that traditional fundus autofluorescence cannot; therefore, it can be used to better elucidate disease pathogenesis, analyze genotype-phenotype correlations, diagnose and monitor disease.
Topics: Fluorescein Angiography; Fundus Oculi; Humans; Optical Imaging; Retina; Retinal Diseases
PubMed: 33040254
DOI: 10.1007/s10792-020-01609-9 -
Frontiers in Endocrinology 2022Both anaplastic thyroid carcinoma (ATC) and thyroid lymphoma (TL) clinically present as rapidly enlarging neck masses. Unfortunately, in this situation, like in any... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Both anaplastic thyroid carcinoma (ATC) and thyroid lymphoma (TL) clinically present as rapidly enlarging neck masses. Unfortunately, in this situation, like in any other thyroid swelling, a routine fine-needle aspiration (FNA) cytology is the first and only diagnostic test performed at the initial contact in the average thyroid practice. FNA, however, has a low sensitivity in diagnosing ATC and TL, and by the time the often "inconclusive" result is known, precious time has evolved, before going for core-needle biopsy (CNB) or incisional biopsy (IB) as the natural next diagnostic steps.
OBJECTIVES
To determine the diagnostic value of CNB in the clinical setting of a rapidly enlarging thyroid mass, a systematic review and meta-analysis of the available data on CNB reliability in the differential diagnosis of ATC and TL.
METHODS
A PubMed, Embase and Web of Science database search was performed on June 23th 2021. Population of interest comprised patients who underwent CNB for clinical or ultrasonographical suspicion of ATC or TL, patients with a final diagnosis of ATC or TL after CNB, or after IB following CNB.
RESULTS
From a total of 17 studies, 166 patients were included. One hundred and thirty-six were diagnosed as TL and 14 as ATC following CNB. CNB, with a sensitivity and positive predictive value of 94,3% and 100% for TL and 80,1% and 100% for ATC respectively, proved to be superior to FNA (reported sensitivity for TL of 48% and for ATC of 61%). Furthermore, the need for additional diagnostic surgery after CNB was only 6.2% for TL and 17.6% for ATC.
CONCLUSIONS
Immediately performing CNB for a suspected diagnosis of ATC and TL in a rapidly enlarging thyroid mass is more appropriate and straightforward than a stepped diagnostic pathway using FNA first and awaiting the result before doing CNB.
Topics: Biopsy, Large-Core Needle; Humans; Lymphoma; Reproducibility of Results; Thyroid Carcinoma, Anaplastic; Thyroid Neoplasms; Thyroid Nodule
PubMed: 36204100
DOI: 10.3389/fendo.2022.971249 -
PloS One 2016Congenital infection caused by Toxoplasma gondii can cause serious damage that can be diagnosed in utero or at birth, although most infants are asymptomatic at birth.... (Meta-Analysis)
Meta-Analysis Review
Performance of Polymerase Chain Reaction Analysis of the Amniotic Fluid of Pregnant Women for Diagnosis of Congenital Toxoplasmosis: A Systematic Review and Meta-Analysis.
INTRODUCTION
Congenital infection caused by Toxoplasma gondii can cause serious damage that can be diagnosed in utero or at birth, although most infants are asymptomatic at birth. Prenatal diagnosis of congenital toxoplasmosis considerably improves the prognosis and outcome for infected infants. For this reason, an assay for the quick, sensitive, and safe diagnosis of fetal toxoplasmosis is desirable.
GOAL
To systematically review the performance of polymerase chain reaction (PCR) analysis of the amniotic fluid of pregnant women with recent serological toxoplasmosis diagnoses for the diagnosis of fetal toxoplasmosis.
METHOD
A systematic literature review was conducted via a search of electronic databases; the literature included primary studies of the diagnostic accuracy of PCR analysis of amniotic fluid from pregnant women who seroconverted during pregnancy. The PCR test was compared to a gold standard for diagnosis.
RESULTS
A total of 1.269 summaries were obtained from the electronic database and reviewed, and 20 studies, comprising 4.171 samples, met the established inclusion criteria and were included in the review. The following results were obtained: studies about PCR assays for fetal toxoplasmosis are generally susceptible to bias; reports of the tests' use lack critical information; the protocols varied among studies; the heterogeneity among studies was concentrated in the tests' sensitivity; there was evidence that the sensitivity of the tests increases with time, as represented by the trimester; and there was more heterogeneity among studies in which there was more time between maternal diagnosis and fetal testing. The sensitivity of the method, if performed up to five weeks after maternal diagnosis, was 87% and specificity was 99%.
CONCLUSION
The global sensitivity heterogeneity of the PCR test in this review was 66.5% (I(2)). The tests show low evidence of heterogeneity with a sensitivity of 87% and specificity of 99% when performed up to five weeks after maternal diagnosis. The test has a known performance and could be recommended for use up to five weeks after maternal diagnosis, when there is suspicion of fetal toxoplasmosis.
Topics: Amniotic Fluid; Female; Humans; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Parasitic; Prenatal Diagnosis; Toxoplasma; Toxoplasmosis, Congenital
PubMed: 27055272
DOI: 10.1371/journal.pone.0149938