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Neuroscience and Biobehavioral Reviews Jan 2023Functional magnetic resonance spectroscopy (fMRS) can be used to investigate neurometabolic responses to external stimuli in-vivo, but findings are inconsistent. We... (Meta-Analysis)
Meta-Analysis Review
Functional magnetic resonance spectroscopy (fMRS) can be used to investigate neurometabolic responses to external stimuli in-vivo, but findings are inconsistent. We performed a systematic review and meta-analysis on fMRS studies of the primary neurotransmitters Glutamate (Glu), Glx (Glutamate + Glutamine), and GABA. Data were extracted, grouped by metabolite, stimulus domain, and brain region, and analysed by determining standardized effect sizes. The quality of individual studies was rated. When results were analysed by metabolite type small to moderate effect sizes of 0.29-0.47 (p < 0.05) were observed for changes in Glu and Glx regardless of stimulus domain and brain region, but no significant effects were observed for GABA. Further analysis suggests that Glu, Glx and GABA responses differ by stimulus domain or task and vary depending on the time course of stimulation and data acquisition. Here, we establish effect sizes and directionality of GABA, Glu and Glx response in fMRS. This work highlights the importance of standardised reporting and minimal best practice for fMRS research.
Topics: Humans; Glutamic Acid; Glutamine; Magnetic Resonance Spectroscopy; Brain; gamma-Aminobutyric Acid
PubMed: 36332780
DOI: 10.1016/j.neubiorev.2022.104940 -
European Journal of Nuclear Medicine... Jun 2021Advanced medical image analytics is increasingly used to predict clinical outcome in patients diagnosed with gastrointestinal tumors. This review provides an overview on... (Review)
Review
PURPOSE
Advanced medical image analytics is increasingly used to predict clinical outcome in patients diagnosed with gastrointestinal tumors. This review provides an overview on the value of radiomics in predicting response to treatment in patients with gastrointestinal tumors.
METHODS
A systematic review was conducted, according to PRISMA guidelines. The protocol was prospectively registered (PROSPERO: CRD42019128408). PubMed, Embase, and Cochrane databases were searched. Original studies reporting on the value of radiomics in predicting response to treatment in patients with a gastrointestinal tumor were included. A narrative synthesis of results was conducted. Results were stratified by tumor type. Quality assessment of included studies was performed, according to the radiomics quality score.
RESULTS
The comprehensive literature search identified 1360 unique studies, of which 60 articles were included for analysis. In 37 studies, radiomics models and individual radiomic features showed good predictive performance for response to treatment (area under the curve or accuracy > 0.75). Various strategies to construct predictive models were used. Internal validation of predictive models was often performed, while the majority of studies lacked external validation. None of the studies reported predictive models implemented in clinical practice.
CONCLUSION
Radiomics is increasingly used to predict response to treatment in patients suffering from gastrointestinal cancer. This review demonstrates its great potential to help predict response to treatment and improve patient selection and early adjustment of treatment strategy in a non-invasive manner.
Topics: Artificial Intelligence; Gastrointestinal Neoplasms; Humans
PubMed: 33326049
DOI: 10.1007/s00259-020-05142-w -
The British Journal of Radiology Oct 2023The purpose of this meta-analysis was to determine the value of dynamic contrast-enhanced-MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in evaluating the... (Meta-Analysis)
Meta-Analysis
The assessment of pathological response to neoadjuvant chemotherapy in muscle-invasive bladder cancer patients with DCE-MRI and DWI: a systematic review and meta-analysis.
OBJECTIVE
The purpose of this meta-analysis was to determine the value of dynamic contrast-enhanced-MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in evaluating the pathological response of muscle invasive bladder cancer (MIBC) to neoadjuvant chemotherapy (NAC), and further indirectly compare the diagnostic performance of DCE-MRI and DWI.
METHODS
Literatures associated to DCE-MRI and DWI in the evaluation of pathological response of MIBC to NAC were searched from PubMed, Cochrane Library, web of science, and EMBASE databases. The quality assessment of diagnostic accuracy studies 2 tool was used to assess the quality of studies. Pooled sensitivity (SE), specificity (SP), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curves (AUC) with their 95% confidence intervals (CIs) were calculated to evaluate the diagnostic performance of DCE-MRI and DWI in predicting the pathological response to NAC in patients with MIBC.
RESULTS
There were 11 studies involved, 6 of which only underwent DCE- MRI examination, 4 of which only underwent DWI examination, and 1 of which underwent both DCE- MRI and DWI examination. The pooled SE, SP, PLR, NLR, DOR of DCE-MRI were 0.88 (95% CI: 0.78-0.93), 0.88 (95% CI: 0.67-0.96), 7.4 (95% CI: 2.3-24.2), 0.14 (95% CI: 0.07-0.27), and 53 (95% CI: 10-288), respectively. The pooled SE, SP, PLR, NLR, DOR of DWI were 0.83 (95% CI: 0.75-0.88), 0.88 (95% CI: 0.81-0.93), 7.1 (95% CI: 4.3-11.7), 0.20 (95% CI: 0.14-0.28), and 36 (95% CI:18-73), respectively. The AUCs of SROC curve for DCE-MRI and DWI were 0.93 (95% CI: 0.91-0.95) and 0.92 (95% CI: 0.89-0.94), respectively. There were no significant differences between DWI and DCE-MRI for SE, SP, and AUC.
CONCLUSION
This meta-analysis demonstrated high diagnostic performance of both DCE-MRI and DWI in predicting the pathological response to NAC in MIBC. DWI might be a potential substitute for DCE-MRI, with no significant difference in diagnostic performance between the two. However, caution should be taken when applying our results, as our results were based on indirect comparison.
ADVANCES IN KNOWLEDGE
No previous studies have comprehensively analysed the value of DCE-MRI and DWI in evaluating the pathological response to NAC in MIBC. According to the current study, both DCE-MRI and DWI yielded high diagnostic performance, with the AUCs of 0.93 and 0.92, respectively. Indirect comparison no significant difference in the diagnostic performanceof DCE-MRI and DWI.
Topics: Humans; Neoadjuvant Therapy; Diffusion Magnetic Resonance Imaging; Magnetic Resonance Imaging; ROC Curve; Muscles; Sensitivity and Specificity; Neoplasms
PubMed: 37660472
DOI: 10.1259/bjr.20230239 -
European Radiology Dec 2012To assess whether magnetic resonance imaging (MRI) can identify pre-treatment differences or monitor early response in breast cancer patients receiving neoadjuvant... (Review)
Review
OBJECTIVES
To assess whether magnetic resonance imaging (MRI) can identify pre-treatment differences or monitor early response in breast cancer patients receiving neoadjuvant chemotherapy.
METHODS
PubMed, Cochrane library, Medline and Embase databases were searched for publications until January 1, 2012. After primary selection, studies were selected based on predefined inclusion/exclusion criteria. Two reviewers assessed study contents using an extraction form.
RESULTS
In 15 studies, which were mainly underpowered and of heterogeneous study design, 31 different parameters were studied. Most frequently studied parameters were tumour diameter or volume, K(trans), K(ep), V(e), and apparent diffusion coefficient (ADC). Other parameters were analysed in only two or less studies. Tumour diameter, volume, and kinetic parameters did not show any pre-treatment differences between responders and non-responders. In two studies, pre-treatment differences in ADC were observed between study groups. At early response monitoring significant and non-significant changes for all parameters were observed for most of the imaging parameters.
CONCLUSIONS
Evidence on distinguishing responders and non-responders to neoadjuvant chemotherapy using pre-treatment MRI, as well as using MRI for early response monitoring, is weak and based on underpowered study results and heterogeneous study design. Thus, the value of breast MRI for response evaluation has not yet been established.
KEY POINTS
Few well-validated pre-treatment MR parameters exist that identify responders and non-responders. Eligible studies showed heterogeneous study designs which hampered pooling of data. Confounders and technical variations of MRI accuracy are not studied adequately. Value of MRI for response evaluation needs to be established further.
Topics: Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Female; Humans; Magnetic Resonance Imaging; Neoadjuvant Therapy
PubMed: 22983282
DOI: 10.1007/s00330-012-2653-5 -
Acta Neurochirurgica Feb 2023Patients with the dementia subtype idiopathic normal pressure hydrocephalus (iNPH) may improve clinically following cerebrospinal fluid (CSF) diversion (shunt) surgery,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Patients with the dementia subtype idiopathic normal pressure hydrocephalus (iNPH) may improve clinically following cerebrospinal fluid (CSF) diversion (shunt) surgery, though the predictors of shunt response remain debated. Currently, radiological features play an important role in the diagnosis of iNPH, but it is not well established which radiological markers most precisely predict shunt responsive iNPH.
OBJECTIVE
To conduct a systematic review and meta-analysis to identify radiological predictors of shunt responsiveness, evaluate their diagnostic effectiveness, and recommend the most predictive radiological features.
METHODS
Embase, MEDLINE, Scopus, PubMed, Google Scholar, and JSTOR were searched for original studies investigating radiological predictors of shunt response in iNPH patients. Included studies were assessed using the ROBINS-1 tool, and eligible studies were evaluated using a univariate meta-analysis.
RESULTS
Overall, 301 full-text papers were screened, of which 28 studies were included, and 26 different radiological features were identified, 5 of these met the inclusion criteria for the meta-analysis: disproportionately enlarged subarachnoid space (DESH), callosal angle, periventricular white matter changes, cerebral blood flow (CBF), and computerized tomography cisternography. The meta-analysis showed that only callosal angle and periventricular white matter changes significantly differentiated iNPH shunt responders from non-responders, though both markers had a low diagnostic odds ratio (DOR) of 1.88 and 1.01 respectively. None of the other radiological markers differentiated shunt responsive from shunt non-responsive iNPH.
CONCLUSION
Callosal angle and periventricular changes are the only diagnostically effective radiological predictors of shunt responsive iNPH patients. However, due to the DORs approximating 1, they are insufficient as sole predictors and are advised to be used only in combination with other diagnostic tests of shunt response. Future research must evaluate the combined use of multiple radiological predictors, as it may yield beneficial additive effects that may allow for more robust radiological shunt response prediction.
Topics: Humans; Hydrocephalus, Normal Pressure; Magnetic Resonance Imaging; Radiography; Ventriculoperitoneal Shunt; Cerebrospinal Fluid Shunts
PubMed: 36435931
DOI: 10.1007/s00701-022-05402-8 -
The Cochrane Database of Systematic... May 2018Acute sinusitis is a common reason for primary care encounters. It causes significant symptoms including facial pain, congested nose, headache, thick nasal mucus, fever,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acute sinusitis is a common reason for primary care encounters. It causes significant symptoms including facial pain, congested nose, headache, thick nasal mucus, fever, and cough and often results in time off work or school. Sinusitis treatment focuses on eliminating causative factors and controlling the inflammatory and infectious components. The frozen, dried, natural fluid extract of the Cyclamen europaeum plant delivered intranasally is thought to have beneficial effects in relieving congestion by facilitating nasal drainage, and has an anti-inflammatory effect.
OBJECTIVES
To assess the effectiveness of topical intranasal Cyclamen europaeum extract on clinical response in adults and children with acute sinusitis.
SEARCH METHODS
We searched CENTRAL, which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE, Embase, and trials registers (ClinicalTrials.gov; WHO ICTRP) in January 2018. We also searched the reference lists of included studies and review literature for further relevant studies and contacted trial authors for additional information.
SELECTION CRITERIA
Randomised controlled trials comparing Cyclamen europaeum extract administered intranasally to placebo, antibiotics, intranasal corticosteroids, or no treatment in adults or children, or both, with acute sinusitis. Acute sinusitis was defined by clinical diagnosis and confirmed by nasal endoscopy or by radiological evidence.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data and assessed trial quality. We used standard methodological procedures expected by Cochrane.
MAIN RESULTS
We included two randomised controlled trials that involved a total of 147 adult outpatients with acute sinusitis confirmed by radiology or nasal endoscopy who were assigned to Cyclamen europaeum nasal spray or placebo study arms for up to 15 days. The risk of selection and detection bias was unclear, as allocation concealment and blinding of outcome assessors were not reported in either study. Attrition was high (60%) in one study, although dropouts were balanced between study arms.Neither study reported our two primary outcomes: proportion of participants whose symptoms resolved or improved at 14 days and 30 days. No serious adverse events or complications related to treatment were reported; however, more mild adverse events such as nasal and throat irritation, mild epistaxis, and sneezing occurred in Cyclamen europaeum group participants (50%) compared to placebo group participants (24%) (risk ratio 2.11, 95% confidence interval 1.35 to 3.29); moderate-quality evidence.
AUTHORS' CONCLUSIONS
The effectiveness of Cyclamen europaeum for people with acute sinusitis is unknown. Although no serious side effects were observed, 50% of participants who received Cyclamen europaeum reported adverse events compared with 24% of those who received placebo.
Topics: Acute Disease; Adult; Anti-Inflammatory Agents; Cyclamen; Humans; Nasal Polyps; Plant Extracts; Randomized Controlled Trials as Topic; Rhinitis; Sinusitis
PubMed: 29750825
DOI: 10.1002/14651858.CD011341.pub2 -
Clinical Nuclear Medicine May 2016Neoadjuvant chemoradiotherapy (CRT) is indicated in locally advanced rectal adenocarcinoma where there is a high risk of local recurrence based on preoperative imaging.... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Neoadjuvant chemoradiotherapy (CRT) is indicated in locally advanced rectal adenocarcinoma where there is a high risk of local recurrence based on preoperative imaging. Optimal radiological assessment of CRT response is unknown, and metabolic assessment of the tumor has been suggested to gauge response before surgical resection.
PATIENTS AND METHODS
A systematic search of the MEDLINE database was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement to identify papers comparing pre- and post-CRT PET/CT in patients with locally advanced rectal adenocarcinoma with histopathological assessment of tumor regression. Papers were assessed with the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool. Meta-analysis was performed for response index (RI) and SUVmax post-CRT.
RESULTS
Ten of 69 studies met inclusion criteria containing a total of 538 patients. Methodological quality was high with low heterogeneity. In all studies, post-CRT PET/CT showed a reduction in SUVmax and the RI irrespective of histological findings. Tumors confirmed to have regressed after CRT had a mean difference of 12.21% higher RI (95% confidence interval, 6.51-17.91; P < 0.00001) compared with nonresponders. Mean difference between pre- and post-CRT SUVmax groups was -2.48 (95% confidence interval, -3.06 to -1.89; P < 0.00001) with histopathological responders having a lower post-CRT SUVmax.
CONCLUSIONS
The available evidence suggests that PET/CT may be a useful addition to the current imaging modalities in the assessment of treatment response.
Topics: Adenocarcinoma; Chemoradiotherapy; Fluorodeoxyglucose F18; Humans; Neoadjuvant Therapy; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Rectal Neoplasms
PubMed: 26914561
DOI: 10.1097/RLU.0000000000001166 -
Medicine Feb 2015The efficacy of the different apparent diffusion coefficients (ADCs) in predicting different responses to preoperative chemoradiation therapy (CRT) in patients with... (Meta-Analysis)
Meta-Analysis Review
Effectiveness of the apparent diffusion coefficient for predicting the response to chemoradiation therapy in locally advanced rectal cancer: a systematic review and meta-analysis.
The efficacy of the different apparent diffusion coefficients (ADCs) in predicting different responses to preoperative chemoradiation therapy (CRT) in patients with locally advanced rectal cancer (LARC) is controversial. We did this meta-analysis to evaluate the efficacy of different ADCs predicting different responses to CRT in patients with LARC.We systematically searched the MEDLINE, Embase, and Cochrane Library databases for articles published from January 1, 1990, to June 3, 2014. Pooled estimates were calculated using a bivariate random-effects model for the ADCs before and after CRT (pre- and post-ADC), as well as the change between the pre- and post-ADC (ΔADC). The values of the 3 ADCs for judging different response endpoints, which were defined according to the tumor grading (TRG) system and downstaging of T (tumor) or N (nodal) stages (TN downstaging), were assessed.We included 16 studies with a total of 826 patients. The sensitivity, specificity, DOR, and AUC were 75% (95% CI 57%-87%), 70% (95% CI 50%-84%), 6.81 (95% CI 2.46-18.88), and 0.79 (95% CI 0.75-0.82), respectively, for the pre-ADC in predicting a good response; 76% (95% CI 63%-85%), 87% (95% CI 78%-92%), 20.68 (95% CI 11.76-36.39), and 0.89 (95% CI 0.86-0.91), respectively, for the post-ADC; and 78% (95% CI 65%-87%), 77% (95% CI 62%-87%), 11.82 (95% CI 4.65-30.04), and 0.84 (95% CI 0.81-0.87), respectively, for the ΔADC. The post-ADC demonstrated the highest specificity and DOR (P < 0.001), although sensitivity did not differ between the 3 types of ADC (P = 0.380, 0.192, and 0.214). For predicting a pathological complete response (pCR), the post-ADC had the highest specificity (P < 0.001and 0.030) but lowest sensitivity (P < 0.001). The ΔADC had the highest DOR; however, this difference was not statistically significant (P = 0.146).The ADC is a reliable and reproducible measure and could serve as a promising noninvasive tool for evaluating the response to CRT in patients with LARC; the post-ADC and ΔADC are particularly promising. The ΔADC had the highest diagnostic performance to predict a pCR compared with the pre-ADC and post-ADC. The value of the ADCs to predict T or N downstaging requires further investigation.
Topics: Chemoradiotherapy; Female; Forecasting; Humans; Male; Rectal Neoplasms; Statistics as Topic
PubMed: 25674749
DOI: 10.1097/MD.0000000000000517 -
AJR. American Journal of Roentgenology Apr 2022Traditional approaches for evaluating multiple myeloma (MM) treatment response have low sensitivity for residual disease. Recent studies highlight the utility of... (Meta-Analysis)
Meta-Analysis
Traditional approaches for evaluating multiple myeloma (MM) treatment response have low sensitivity for residual disease. Recent studies highlight the utility of whole-body MRI or FDG PET/CT in evaluating treatment response, with increasing emphasis on DWI. This systematic review was conducted to assess the diagnostic accuracy of whole-body MRI and FDG PET/CT for MM treatment response assessment. Studies in which whole-body MRI or FDG PET/CT was used to evaluate MM treatment response were identified through search of the PubMed and EMBASE databases through June 30, 2021. Pooled sensitivity and specificity for detecting response were calculated by bivariate modeling. The diagnostic performances of whole-body MRI and FDG PET/CT were compared. Subgroup analyses were conducted to assess studies comparing the modalities and studies in which whole-body MRI included DWI. Twelve studies comprising 373 patients were included: six evaluated both modalities, four evaluated whole-body MRI only, and two evaluated FDG PET/CT only. Of studies of MRI, five included DWI. Pooled sensitivity and specificity were 87% (95% CI, 75-93%) and 57% (95% CI, 37-76%) for whole-body MRI versus 64% (95% CI, 45-79%) and 82% (95% CI, 75-88%) for FDG PET/CT (sensitivity, = .29; specificity, = .01). For studies directly comparing the modalities, pooled sensitivity and specificity were 90% (95% CI, 80-100%) and 56% (95% CI, 44-68%) for whole-body MRI versus 66% (95% CI, 47-85%) and 81% (95% CI, 72-90%) for FDG PET/CT (sensitivity, = .18; specificity, < .001). Sensitivity and specificity were 93% (95% CI, 75-98%) and 57% (95% CI, 21-87%) for DWI versus 74% (95% CI, 60-85%) and 56% (95% CI, 38-73%) for whole-body MRI without DWI (sensitivity, = .27; specificity, = .99). The AUC values were 0.84 for whole-body MRI, 0.83 for FDG PET/CT, and 0.92 for DWI. FDG PET/CT had significantly higher specificity, and whole-body MRI had higher sensitivity (though nonsignificant). DWI may contribute to the high sensitivity of whole-body MRI. The results of this meta-analysis suggest potential complementary roles of whole-body MRI and FDG PET/CT in assessment of MM treatment response. Future studies should explore their combination through PET/MRI.
Topics: Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Multiple Myeloma; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity; Whole Body Imaging
PubMed: 34704461
DOI: 10.2214/AJR.21.26381 -
Cancers Mar 2021Radiomics may increase the diagnostic accuracy of medical imaging for localized and metastatic RCC (mRCC). A systematic review and meta-analysis was performed. Doing so,... (Review)
Review
Radiomics may increase the diagnostic accuracy of medical imaging for localized and metastatic RCC (mRCC). A systematic review and meta-analysis was performed. Doing so, we comprehensively searched literature databases until May 2020. Studies investigating the diagnostic value of radiomics in differentiation of localized renal tumors and assessment of treatment response to ST in mRCC were included and assessed with respect to their quality using the radiomics quality score (RQS). A total of 113 out of 1098 identified studies met the criteria and were included in qualitative synthesis. Median RQS of all studies was 13.9% (5.0 points, IQR 0.25-7.0 points), and RQS increased over time. Thirty studies were included into the quantitative synthesis: For distinguishing angiomyolipoma, oncocytoma or unspecified benign tumors from RCC, the random effects model showed a log odds ratio (OR) of 2.89 (95%-CI 2.40-3.39, < 0.001), 3.08 (95%-CI 2.09-4.06, < 0.001) and 3.57 (95%-CI 2.69-4.45, < 0.001), respectively. For the general discrimination of benign tumors from RCC log OR was 3.17 (95%-CI 2.73-3.62, < 0.001). Inhomogeneity of the available studies assessing treatment response in mRCC prevented any meaningful meta-analysis. The application of radiomics seems promising for discrimination of renal tumor dignity. Shared data and open science may assist in improving reproducibility of future studies.
PubMed: 33802699
DOI: 10.3390/cancers13061348