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Radiology. Cardiothoracic Imaging Jun 2024Purpose To perform a systematic review and meta-analysis to assess the effect of enzyme replacement therapy on cardiac MRI parameters in patients with Fabry disease.... (Meta-Analysis)
Meta-Analysis
Purpose To perform a systematic review and meta-analysis to assess the effect of enzyme replacement therapy on cardiac MRI parameters in patients with Fabry disease. Materials and Methods A systematic literature search was conducted from January 1, 2000, through January 1, 2024, in PubMed, ClinicalTrials.gov, Embase, and Cochrane Library databases. Study outcomes were changes in the following parameters: left ventricular wall mass (LVM), measured in grams; LVM indexed to body mass index, measured in grams per meters squared; maximum left ventricular wall thickness (MLVWT), measured in millimeters; late gadolinium enhancement (LGE) extent, measured in percentage of LVM; and native T1 mapping, measured in milliseconds. A random-effects meta-analysis of the pooled mean differences between baseline and follow-up parameters was conducted. The study protocol was registered in PROSPERO (CRD42022336223). Results The final analysis included 11 studies of a total of 445 patients with Fabry disease (mean age ± SD, 41 years ± 11; 277 male, 168 female). Between baseline and follow-up cardiac MRI, the following did not change: T1 mapping (mean difference, 6 msec [95% CI: -2, 15]; two studies, 70 patients, = 88%) and LVM indexed (mean difference, -1 g/m [95% CI: -6, 3]; four studies, 290 patients, = 81%). The following measures minimally decreased: LVM (mean difference, -18 g [95% CI: -33, -3]; seven studies, 107 patients, = 96%) and MLVWT (mean difference, -1 mm [95% CI: -2, -0.02]; six studies, 151 patients, = 90%). LGE extent increased (mean difference, 1% [95% CI: 1, 1]; three studies, 114 patients, = 85%). Conclusion In patients with Fabry disease, enzyme replacement therapy was associated with stabilization of LVM, MLVWT, and T1 mapping values, whereas LGE extent mildly increased. Fabry Disease, Enzyme Replacement Therapy (ERT), Cardiac MRI, Late Gadolinium Enhancement (LGE) © RSNA, 2024.
Topics: Fabry Disease; Humans; Enzyme Replacement Therapy; Magnetic Resonance Imaging; Heart Ventricles
PubMed: 38842453
DOI: 10.1148/ryct.230154 -
The Cochrane Database of Systematic... Jun 2024Neovascular age-related macular degeneration (AMD) is a progressive eye disease characterized by choroidal neovascularization (CNV) and is a leading cause of vision loss... (Meta-Analysis)
Meta-Analysis Review
RATIONALE
Neovascular age-related macular degeneration (AMD) is a progressive eye disease characterized by choroidal neovascularization (CNV) and is a leading cause of vision loss and disability worldwide. Although intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is an effective treatment option that helps to prevent vision loss or to improve visual acuity in people with neovascular AMD, treatment imposes a significant financial burden on patients and healthcare systems. A biosimilar is a biological product that has been developed to be nearly identical to a previously approved biological product. The use of biosimilars may help reduce costs and so may increase patient access to effective biologic medicines with similar levels of safety to the drugs on which they are based.
OBJECTIVES
To assess the benefits and harms of anti-VEGF biosimilar agents compared with their corresponding anti-VEGF agents (i.e. the reference products) that have obtained regulatory approval for intravitreal injections in people with neovascular AMD.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, two other databases, and two trials registries together with reference checking and contact with study authors to identify studies that are included in the review. The latest search date was 2 June 2023.
ELIGIBILITY CRITERIA
We included randomized controlled trials (RCTs) that compared approved anti-VEGF biosimilars with their reference products for treating the eyes of adult participants (≥ 50 years) who had an active primary or recurrent choroidal neovascularization lesion secondary to neovascular AMD.
OUTCOMES
Our outcomes were: best-corrected visual acuity (BCVA), central subfield thickness (CST), vision-related quality of life, serious ocular and non-ocular adverse events (AE), treatment-emergent adverse events (TEAEs), anti-drug antibodies (ADAs), and serum concentrations of biosimilars and reference drugs.
RISK OF BIAS
We assessed the risk of bias (RoB) for seven outcomes reported in a summary of findings table by using the Cochrane RoB 2 tool.
SYNTHESIS METHODS
We synthesized results for each outcome using meta-analysis, where possible, by calculating risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for dichotomous outcomes and continuous outcomes, respectively. Where this was not possible due to the nature of the data, we summarized the results narratively. We used GRADE to assess the certainty of evidence for prespecified outcomes.
INCLUDED STUDIES
We included nine parallel-group multi-center RCTs that enrolled a total of 3814 participants (3814 participating eyes), with sample sizes that ranged from 160 to 705 participants per study. The mean age of the participants in these studies ranged from 67 to 76 years, and the proportion of women ranged from 26.5% to 58.7%. Ranibizumab (Lucentis) was the reference product in seven studies, and aflibercept (Eyelea) was the reference product in two others. All the included studies had been supported by industry. The follow-up periods ranged from 12 to 52 weeks (median 48 weeks). Five studies (56%) were conducted in multi-country settings across Europe, North America and Asia, two studies in India, and one each in Japan and the Republic of Korea. We judged all the included studies to have met high methodological standards.
SYNTHESIS OF RESULTS
With regard to efficacy, our meta-analyses demonstrated that anti-VEGF biosimilars for neovascular AMD resulted in little to no difference compared with the reference products for BCVA change at 8 to 12 weeks (MD -0.55 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, 95% CI -1.17 to 0.07; 8 studies, 3603 participants; high-certainty evidence) and the proportion of participants who lost fewer than 15 letters in BCVA at 24 to 48 weeks (RR 0.99, 95% CI 0.98 to 1.01; 7 studies, 2658 participants; moderate-certainty evidence). Almost all participants (96.6% in the biosimilar group and 97.0% in the reference product group) lost fewer than 15 letters in BCVA. The evidence from two studies suggested that there was no evidence of difference between biosimilars and reference products in vision-related quality of life measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) summary scores at 24 to 48 weeks (MD 0.82, 95% CI -0.70 to 2.35; 2 studies, 894 participants; moderate-certainty evidence). With regard to the safety profile, meta-analyses also revealed little to no difference between anti-VEGF biosimilars and the reference products for the proportion of participants who experienced serious ocular AEs (RR 1.24, 95% CI 0.68 to 2.26; 7 studies, 3292 participants; moderate-certainty evidence), and for TEAEs leading to investigational product discontinuation or death (RR 0.96, 95% CI 0.63 to 1.46; 8 studies, 3497 participants; moderate-certainty evidence). Overall, 1.4% of participants in the biosimilar group and 1.2% in the reference product group experienced serious ocular adverse events. The most frequently documented serious ocular AEs were retinal hemorrhage and endophthalmitis. Although the evidence is of low certainty due to imprecision, meta-analysis suggested that anti-VEGF biosimilars led to no difference compared with the reference products for cumulative incidence of ADAs (RR 0.84, 95% CI 0.58 to 1.22; 8 studies, 3066 participants; low-certainty evidence) or mean maximum serum concentrations (MD 0.42 ng/mL, 95% CI -0.22 to 1.05; subgroup of 3 studies, 100 participants; low-certainty evidence). We judged the overall risk of bias to be low for all studies.
AUTHORS' CONCLUSIONS
In our review, low to high certainty evidence suggests that there is little to no difference, to date, between the anti-VEGF biosimilars approved for treating neovascular AMD and their reference products in terms of benefits and harms. While anti-VEGF biosimilars may be a viable alternative to reference products, current evidence for their use is based on a limited number of studies - particularly for comparison with aflibercept - with sparse long-term safety data, and infrequent assessment of quality of life outcomes. Our effect estimates and conclusions may be modified once findings have been reported from studies that are currently ongoing, and studies of biosimilar agents that are currently in development.
FUNDING
Cochrane Eyes and Vision US Project is supported by grant UG1EY020522, National Eye Institute, National Institutes of Health. Takeshi Hasegawa and Hisashi Noma were supported by Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (Grant numbers: 22H03554, 19K03092, 24K06239).
REGISTRATION
Protocol available via doi.org/10.1002/14651858.CD015804.
Topics: Aged; Humans; Angiogenesis Inhibitors; Antibodies, Monoclonal, Humanized; Aptamers, Nucleotide; Bevacizumab; Bias; Biosimilar Pharmaceuticals; Choroidal Neovascularization; Intravitreal Injections; Macular Degeneration; Randomized Controlled Trials as Topic; Ranibizumab; Receptors, Vascular Endothelial Growth Factor; Recombinant Fusion Proteins; Vascular Endothelial Growth Factor A; Visual Acuity; Middle Aged; Male; Female
PubMed: 38829176
DOI: 10.1002/14651858.CD015804.pub2 -
Cardiology Apr 2024The use of angiotensin II receptor blockers (ARBs) in the treatment of hypertrophic cardiomyopathy (HCM) remains a subject of controversy.
INTRODUCTION
The use of angiotensin II receptor blockers (ARBs) in the treatment of hypertrophic cardiomyopathy (HCM) remains a subject of controversy.
METHODS
We conducted a comprehensive search of the Cochrane Library, PubMed, EMBASE, ClinicalTrials.gov, and Web of Science databases until October 2023 to identify articles investigating the effects of ARBs in patients diagnosed with HCM. Predefined criteria were utilized for selecting data on study characteristics and results.
RESULTS
The study included a total of 387 patients from 6 randomized controlled trials, which were reported in 7 articles. The results of the meta-analysis revealed that the utilization of ARBs did not yield a reduction in left ventricular (LV) mass (p = 0.07) and maximum LV wall thickness (p = 0.25), nor did it demonstrate any improvement in LV fibrosis (p = 0.39). Furthermore, there was no significant impact observed on early diastolic mitral annular velocity (p = 0.19) and LV ejection fraction (p = 0.44).
CONCLUSIONS
The administration of ARBs does not appear to yield improvements in cardiac structure, function, and myocardial fibrosis in patients with HCM.
PubMed: 38599198
DOI: 10.1159/000538638 -
Scientific Reports Jan 2024We conducted a systematic review and meta-analysis to evaluate the visual, anatomical, and safety outcomes of the intravitreal faricimab, a novel vascular endothelial... (Meta-Analysis)
Meta-Analysis
We conducted a systematic review and meta-analysis to evaluate the visual, anatomical, and safety outcomes of the intravitreal faricimab, a novel vascular endothelial growth factor (VEGF)/angiopoietin-2 (Ang-2) bispecific agent, in neovascular age-related macular degeneration (nAMD) patients. The follow-up times in the included studies ranged from a minimum of 36 weeks to a maximum of 52 weeks. EMBASE, Ovid-Medline, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, the WHO ICTRP, ClinicalTrial.gov, the EU Clinical Trials Register, and Chinese Clinical Trial Registry (ChiCTR) were searched (The last literature search was performed on August 17, 2023) for randomized controlled trials (RCTs) comparing faricimab with control groups for neovascular age-related macular degeneration (nAMD). The risk of bias for eligible RCTs was independently assessed using the Cochrane Risk of Bias Tool by two authors (W.-T.Y. and C.-S.W.). The meta-analysis was conducted using Review Manager 5.4 software. The mean best corrected visual acuity (BCVA), central subfield thickness (CST), total choroidal neovascularization (CNV) area, and total lesion leakage were analyzed as continuous variables and the outcome measurements were reported as the weighted mean difference (WMD) with a 95% confidence interval (CI). The ocular adverse events and ocular serious adverse events were analyzed as dichotomous variables and the outcome measurements were analyzed as the odds ratios (ORs) with a 95% CI. Random-effects model was used in our study for all outcome synthesizing due to different clinical characteristics. Four RCTs with 1,486 patients were eligible for quantitative analysis. There was no statistically significant difference between intravitreal faricimab and anti-VEGF in BCVA [weighted mean difference (WMD) = 0.47; 95% CI: (- 0.17, 1.11)]. The intravitreal faricimab group showed numerically lower CST [WMD = - 5.96; 95% CI = (- 7.11, - 4.82)], total CNV area [WMD = - 0.49; 95% CI = (- 0.68, - 0.30)], and total lesion leakage [WMD = - 0.88; 95% CI = (- 1.08, - 0.69)] after intravitreal therapy compared with the intravitreal anti-VEGF group. There were no statistically significant differences between intravitreal faricimab and anti-VEGF in ocular adverse events (AEs) [pooled odds ratio (OR) = 1.10; 95% CI = (0.81, 1.49)] and serious adverse events (SAEs) [pooled OR = 0.84; 95% CI = (0.37, 1.90)]. The intravitreal bispecific anti-VEGF/angiopoietin 2 (Ang2) antibody faricimab with a extended injection interval was non-inferior to first-line anti-VEGF agents in BCVA. It was safe and had better anatomical recovery. Large, well-designed RCTs are needed to explore the potential benefit of extended faricimab for nAMD. This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022327450).
Topics: Humans; Angiogenesis Inhibitors; Antibodies, Bispecific; Intravitreal Injections; Macular Degeneration
PubMed: 38291069
DOI: 10.1038/s41598-024-52942-3 -
Clinical Ophthalmology (Auckland, N.Z.) 2023Scheimpflug Pentacam Tomography is becoming crucial in the diagnosis and monitoring of keratoconus, as well as in pre- and post-corneal refractive care, but there are... (Review)
Review
Scheimpflug Pentacam Tomography is becoming crucial in the diagnosis and monitoring of keratoconus, as well as in pre- and post-corneal refractive care, but there are still some inconsistencies surrounding its evidence base diagnostic outcome. Therefore, this study aimed at employing meta-analysis to systematically evaluate the keratometric, pachymetric, and pachymetric progression indices used in the diagnosis of Keratoconus. The review protocol was registered with PROSPERO (Identifier: CRD4202310058) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, MEDLINE, Web of Science, and EMBASE were used for data search, followed by a quality appraisal of the included studies using the revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2). Meta-analysis was conducted using the meta (6.5.0) and metafor (4.2.0) packages in R version 4.3.0, as well as Stata. A total of 32 studies were included in the analysis. All keratometry (K) readings (flattest meridian, K1; steepest meridian, K2, maximum, Kmax) were significantly steeper in keratoconic compared to normal eyes: [MD (95% CI)], K1 [2.67 (1.81; 3.52)], K1-back [-0.71 (-1.03; -0.39)], K1-front [4.06 (2.48; 5.63)], K2 [4.32 (2.89; 5.75)], K2-back [-1.25 (-1.68; -0.82)], K2-front [4.82 (1.88; 7.76)], Kmax [7.57 (4.80; 10.34)], and Kmean [2.80 (1.13; 4.47)]. Additionally, corneal thickness at the center, CCT [-61.19 (-73.79; -48.60)] and apex, pachy-apex [-41.86 (-72.64; -11.08)] were significantly thinner in keratoconic eyes compared to normal eyes. The pooled estimates for pachymetric progression index (PPI): PPImin [0.66 (0.43; 0.90)], PPImax [1.26 (0.87; 1.64)], PPIavg [0.90 (0.68; 1.12)], and Ambrosio relational thickness (ART): ARTmax [-242.77 (-288.86; -196.69)], and ARTavg [-251.08 (-308.76; -195.39)] revealed significantly more rapid pachymetric progression in keratoconic eyes than in normal eyes. The Pentacam Scheimpflug-derived keratometric, pachymetric, and pachymetric progression indices are good predictors in discriminating KC from normal eyes.
PubMed: 38143558
DOI: 10.2147/OPTH.S436492 -
Journal of the American Heart... Dec 2023Carotid intima-media thickness (cIMT) has been widely used as a predictor of future cardiovascular disease (CVD); however, various definitions of cIMT exist. This study... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Carotid intima-media thickness (cIMT) has been widely used as a predictor of future cardiovascular disease (CVD); however, various definitions of cIMT exist. This study provides a systematic review and meta-analysis of the associations between different cIMT definitions and CVD.
METHODS AND RESULTS
A systematic review of the different cIMT definitions used in prospective cohort studies was performed. The relationships between cIMT of different definitions (common carotid artery IMT [CCA-IMT], internal carotid artery IMT [ICA-IMT], combined segments [combined-IMT], mean CCA-IMT, and maximum CCA-IMT) with future stroke, myocardial infarction (MI), and CVD events were analyzed using random effects models. Among 2287 articles, 18 articles (14 studies) with >10 different cIMT definitions were identified and included in our meta-analysis. After adjusting for age and sex, a 1-SD increase in CCA-IMT was associated with future stroke (hazard ratio [HR], 1.32 [95% CI, 1.27-1.38]), MI (HR, 1.27 [95% CI, 1.22-1.33]), and CVD events (HR, 1.28 [95% CI, 1.19-1.37]). A 1-SD increase in ICA-IMT was related to future stroke (HR, 1.25 [95% CI, 1.11-1.42]) and CVD events (HR, 1.25 [95% CI, 1.04-1.50]) but not MI (HR, 1.26 [95% CI, 0.98-1.61]). A 1-SD increase in combined-IMT was associated with future stroke (HR, 1.30 [95% CI, 1.08-1.57]) and CVD events (HR, 1.36 [95% CI, 1.23-1.49]). Maximum CCA-IMT was more strongly related than mean CCA-IMT with risk of MI, and both measures were similarly associated with stroke and CVD events.
CONCLUSIONS
Combined-IMT is more strongly associated with CVD events compared with single-segment cIMT definitions. Maximum CCA-IMT shows a stronger association with MI than mean CCA-IMT. Further research is warranted to validate our findings and to standardize the cIMT measurement protocol, as well as to explore underlying mechanisms.
Topics: Humans; Carotid Intima-Media Thickness; Cardiovascular Diseases; Prospective Studies; Carotid Artery, Common; Stroke; Myocardial Infarction; Risk Factors
PubMed: 38014663
DOI: 10.1161/JAHA.123.031217 -
Journal of Clinical Medicine Oct 2023Exercise therapy as part of the clinical management of patients with neuromuscular diseases (NMDs) is complicated by the limited insights into its efficacy. There is an... (Review)
Review
Exercise therapy as part of the clinical management of patients with neuromuscular diseases (NMDs) is complicated by the limited insights into its efficacy. There is an urgent need for sensitive and non-invasive quantitative muscle biomarkers to monitor the effects of exercise training. Therefore, the objective of this systematic review was to critically appraise and summarize the current evidence for the sensitivity of quantitative, non-invasive biomarkers, based on imaging and electrophysiological techniques, for measuring the effects of physical exercise training. We identified a wide variety of biomarkers, including imaging techniques, i.e., magnetic resonance imaging (MRI) and ultrasound, surface electromyography (sEMG), magnetic resonance spectroscopy (MRS), and near-infrared spectroscopy (NIRS). Imaging biomarkers, such as muscle maximum area and muscle thickness, and EMG biomarkers, such as compound muscle action potential (CMAP) amplitude, detected significant changes in muscle morphology and neural adaptations following resistance training. MRS and NIRS biomarkers, such as initial phosphocreatine recovery rate (V), mitochondrial capacity (Q), adenosine phosphate recovery half-time (ADP t), and micromolar changes in deoxygenated hemoglobin and myoglobin concentrations (Δ[deoxy(Hb + Mb)]), detected significant adaptations in oxidative metabolism after endurance training. We also identified biomarkers whose clinical relevance has not yet been assessed due to lack of sufficient study.
PubMed: 37959299
DOI: 10.3390/jcm12216834 -
Sports Medicine - Open Nov 2023Understanding the physical qualities of male, adolescent rugby league players across age groups is essential for practitioners to manage long-term player development....
What Tests are Used to Assess the Physical Qualities of Male, Adolescent Rugby League Players? A Systematic Review of Testing Protocols and Reported Data Across Adolescent Age Groups.
BACKGROUND
Understanding the physical qualities of male, adolescent rugby league players across age groups is essential for practitioners to manage long-term player development. However, there are many testing options available to assess these qualities, and differences in tests and testing protocols can profoundly influence the data obtained.
OBJECTIVES
The aims of this systematic review were to: (1) identify the most frequently used tests to assess key physical qualities in male, adolescent rugby league players (12-19 years of age); (2) examine the testing protocols adopted in studies using these tests; and (3) synthesise the available data from studies using the most frequently used tests according to age group.
METHODS
A systematic search of five databases was conducted. For inclusion, studies were required to: (1) be original research that contained original data published in a peer-reviewed journal; (2) report data specifically for male, adolescent rugby league players; (3) report the age for the recruited participants to be between 12 and 19 years; (4) report data for any anthropometric quality and one other physical quality and identify the test(s) used to assess these qualities; and (5) be published in English with full-text availability. Weighted means and standard deviations were calculated for each physical quality for each age group arranged in 1-year intervals (i.e., 12, 13, 14, 15, 16, 17 and 18 years) across studies.
RESULTS
37 studies were included in this systematic review. The most frequently used tests to assess anthropometric qualities were body mass, standing height, and sum of four skinfold sites. The most frequently used tests to assess other physical qualities were the 10-m sprint (linear speed), 505 Agility Test (change-of-direction speed), Multistage Fitness Test (aerobic capacity), bench press and back squat one-repetition maximum tests (muscular strength), and medicine ball throw (muscular power). Weighted means calculated across studies generally demonstrated improvements in player qualities across subsequent age groups, except for skinfold thickness and aerobic capacity. However, weighted means could not be calculated for the countermovement jump.
CONCLUSION
Our review identifies the most frequently used tests, but highlights variability in the testing protocols adopted. If these tests are used in future practice, we provide recommended protocols in accordance with industry standards for most tests. Finally, we provide age-specific references for frequently used tests that were implemented with consistent protocols. Clinical Trial Registration This study was conducted in accordance with the Preferred Reporting Items of Systematic Review and Meta-analysis guidelines and was registered with PROSPERO (ID: CRD42021267795).
PubMed: 37947891
DOI: 10.1186/s40798-023-00650-z -
Graefe's Archive For Clinical and... Jun 2024Corneal collagen crosslinking (CXL) is the primary treatment for progressive keratoconus which has a significant impact on vision and quality of life. Our study aimed to... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Corneal collagen crosslinking (CXL) is the primary treatment for progressive keratoconus which has a significant impact on vision and quality of life. Our study aimed to compare the efficacy and safety of epithelium-on versus epithelium-off CXL to treat keratoconus.
METHODS
We searched PubMed, Medline, Embase, Web of Science, and Scopus databases. We included studies that compared standard epithelium-off with epithelium-on CXL. The primary outcome measures were changes in corrected distance visual acuity (CDVA) and maximum keratometry (Kmax), and the secondary outcomes were uncorrected distance visual acuity (UDVA), central corneal thickness (CCT), and adverse events. A meta-analysis was performed on the primary and secondary outcomes based on the weighted mean differences between baseline to 12-month follow-up.
RESULTS
The search retrieved 887 publications with 27 included in the systematic review. A total of 1622 eyes (1399 patients; age 25.51 ± 4.02 years) were included in comparisons of epithelium-off to epithelium-on CXL in keratoconus. Epithelium-off CXL treated 800 eyes and epithelium-on CXL for 822 eyes. At 12-month follow-up, CDVA and Kmax showed no significant difference between the epithelium-off and epithelium-on CXL. The secondary outcomes showed that UDVA was better in epithelium-off CXL (- 0.11D, 95% CI - 0.12, - 0.1; p < 0.001) and there was more thinning in CCT in epithelium-off CXL (- 3.23 μm, 95% CI - 4.64, - 1.81; p <0.001).
CONCLUSION
Epithelium-off and epithelium-on CXL were both effective to treat progressive keratoconus. Further research is needed to compare the long-term outcomes and safety of both CXL protocols for adaptation into clinical practice.
Topics: Keratoconus; Humans; Cross-Linking Reagents; Collagen; Photosensitizing Agents; Epithelium, Corneal; Photochemotherapy; Visual Acuity; Riboflavin; Ultraviolet Rays; Corneal Topography; Corneal Stroma
PubMed: 37938377
DOI: 10.1007/s00417-023-06287-8 -
European Radiology May 2024This systematic review aimed to appraise the reliability and comprehensiveness of imaging methods in studies that used three-dimensional assessment of the... (Review)
Review
Recommendations for standard criteria for the positional and morphological evaluation of temporomandibular joint osseous structures using cone-beam CT: a systematic review.
OBJECTIVE
This systematic review aimed to appraise the reliability and comprehensiveness of imaging methods in studies that used three-dimensional assessment of the temporomandibular joint (TMJ) in order to propose a standardized imaging method.
METHODS
Six databases/search engines were searched up until September 2022. The outcomes of interest included measurements of the mandibular condyle, glenoid fossa, joint spaces, or the entire TMJ. Two checklists were utilized: one to assess the risk of bias, with a maximum score of 37, and the other, a pre-designed checklist consisting of 22 items to evaluate the comprehensiveness of the methods used, with a maximum score of 33.
RESULTS
Out of the 2567 records retrieved, only 14 studies, which used cone bean computed tomography (CBCT), were deemed eligible and thus included in the qualitative analysis. Three studies were deemed of low risk of bias, while the remaining studies were rated as moderate to high risk of bias, primarily due to improper reporting of inter-observer agreement, varying reliability values, and a limited number of cases included in the reliability analysis. Regarding the comprehensiveness of the methods used, only four studies achieved relatively high scores. The deficiencies observed were related to the reporting of variables such as slice thickness and voxel size, absence of or improper reporting of intra- and inter-examiner reliability analyses, and failure to assess all osseous components of the TMJ.
CONCLUSION
CBCT-based methods used to assess the positions and morphology of TMJ bony structures appear to be imperfect and lacking in comprehensiveness. Hence, criteria for a standardized assessment method of these TMJ structures are proposed.
CLINICAL RELEVANCE STATEMENT
Accurately, comprehensively, and reliably assessing the osseous structures of the temporomandibular joint will provide valid and valuable diagnostic features of the normal temporomandibular joint, and help establish potential associations between these osseous features and temporomandibular disorders.
REGISTRATION
The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42020199792).
KEY POINTS
•Although many methods have been introduced to assess the osseous structure of the temporomandibular joint, they yielded inconsistent findings. •None of the published studies comprehensively assessed the temporomandibular joint. •Recommendations for a comprehensive temporomandibular joint osseous assessment method were suggested for better validity and reliability of future research.
Topics: Humans; Cone-Beam Computed Tomography; Temporomandibular Joint; Reproducibility of Results; Imaging, Three-Dimensional; Temporomandibular Joint Disorders
PubMed: 37878020
DOI: 10.1007/s00330-023-10248-4