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Global Spine Journal Feb 2019Systematic review. (Review)
Review
DESIGN
Systematic review.
OBJECTIVE
To conduct a systematic review to (1) summarize various classification systems used to describe cervical ossification of the posterior longitudinal ligament (OPLL) and (2) evaluate the diagnostic accuracy of various imaging modalities and the reliability of these classification systems.
METHODS
A search was performed to identify studies that used a classification system to categorize patients with OPLL. Furthermore, studies were included if they reported the diagnostic accuracy of various imaging modalities or the reliability of a classification system.
RESULTS
A total of 167 studies were deemed relevant. Five classification systems were developed based on X-ray: the 9-classification system (0.60%); continuous, segmental, mixed, localized or focal, circumscribed and others (92.81%); hook, staple, bridge, and total types (2.40%); distribution of OPLL (2.40%); and K-line classification (4.19%). Six methods were based on computed tomography scans: free-type, contiguous-type, and broken sign (0.60%); hill-, plateau-, square-, mushroom-, irregular-, or round-shaped (5.99%); rectangular, oval, triangular, or pedunculate (1.20%); centralized or laterally deviated (1.80%); plank-, spindle-, or rod-shaped (0.60%); and rule of nine (0.60%). Classification systems based on 3-dimensional computed tomography were bridging and nonbridging (1.20%) and flat, irregular, and localized (0.60%). A single classification system was based on magnetic resonance imaging: triangular, teardrop, or boomerang. Finally, a variation of methods was used to classify OPLL associated with the dura mater (4.19%).
CONCLUSIONS
The most common method of classification was that proposed by the Japanese Ministry of Health, Labour and Welfare. Other important methods include K-line (+/-), signs of dural ossification, and patterns of distribution.
PubMed: 30775213
DOI: 10.1177/2192568217720421 -
Clinical Radiology May 2018To evaluate the degree of concordance amongst the currently available guidelines informing the use of uterine artery embolisation (UAE), and identify any inconsistencies...
AIM
To evaluate the degree of concordance amongst the currently available guidelines informing the use of uterine artery embolisation (UAE), and identify any inconsistencies present.
MATERIALS AND METHODS
Standards of practice and quality improvement guidelines were retrieved through a search of PubMed and EMBASE. Additional sets of guidelines were retrieved directly from the websites of known obstetrics and gynaecology and radiological associations.
RESULTS
Eleven guidelines were retrieved from organisations located in Europe, North America, and Australia. Two main points of divergence were identified in the presented guidance: firstly, on whether submucosal, subserosal, and/or pedunculate fibroids should be considered a relative contraindication to UAE; secondly, on whether UAE should be recommended as an option in patients desiring future fertility.
CONCLUSIONS
The guidelines reviewed generally suggest UAE to be a safe and effective option for fibroid treatment that can be offered as an alternative to surgical management; however, the number of differing interpretations arising from an apparently similar pool of evidence raises questions about the objectivity of practice guidelines. Although practice guidelines are understood to be a synthesis of clinical evidence and expert opinion, a systematic approach to presenting evidence is necessary to clearly distinguish empirically versus experientially informed guidance.
Topics: Female; Humans; Practice Guidelines as Topic; Uterine Artery Embolization
PubMed: 29352594
DOI: 10.1016/j.crad.2017.12.005