Abstract
ObjectiveTo evaluate the overall diagnostic value related to magnetic resonance imaging (MRI) in patients with early osteonecrosis of the femoral head.MethodsBy searching multiple databases and sources, including PubMed, Cochrane, and Embase database, by the index words updated in December 2017, qualified studies were identified and relevant literature sources were also searched. The qualified studies included prospective cohort studies and cross-sectional studies. Heterogeneity of the included studies were reviewed to select proper effect model for pooled weighted sensitivity, specificity, and diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) analyses were performed for meniscal tears.ResultsForty-three studies related to diagnostic accuracy of MRI to detect early osteonecrosis of the femoral head were involved in the meta-analysis. The global sensitivity and specificity of MRI in early osteonecrosis of the femoral head were 93.0% (95% CI 92.0–94.0%) and 91.0% (95% CI 89.0%–93.0%), respectively. The global positive likelihood ratio and global negative likelihood ratio of MRI in early osteonecrosis of the femoral head were 2.74 (95% CI 1.98–3.79) and 0.18 (95% CI 0.14–0.23), respectively. The global DOR was 27.27 (95% CI 17.02–43.67), and the area under the SROC was 93.38% (95% CI 90.87%–95.89%).ConclusionsThis review provides a systematic review and meta-analysis to evaluate the diagnostic accuracy of MRI in early osteonecrosis of the femoral head. Moderate to strong evidence indicated that MRI appears to be significantly associated with higher diagnostic accuracy for early osteonecrosis of the femoral head.
Highlights
Avascular Necrosis of Femur Head (ANFH), or osteonecrosis of the femoral head, is a pathologic process, which was first seen in the weight-bearing area of the femur
Search strategy The following electronic databases were searched from their inception to December 2017: The Cochrane, PubMed, Embase database, for all the qualified trails that analyze the diagnostic accuracy of magnetic resonance imaging (MRI) of early osteonecrosis of the femoral head
Study selection The studies that met the following criteria were included in our review: (1) prospective cohort study or cross-sectional study; (2) the research objects are patients suspected with early osteonecrosis of the femoral head without other serious diseases; (3) the studies provided the data of true positive (TP), false positive (FP), false negative (FN), and true negative (TN); and (4) the publications were only available in English and Chinese
Summary
Avascular Necrosis of Femur Head (ANFH), or osteonecrosis of the femoral head, is a pathologic process, which was first seen in the weight-bearing area of the femur. The stress can lead to bone trabecular structure injury (microfracture) and influence the repair process of the femur, and if not managed timely, it leads to the collapse and deformation of the femur. ANFH results from interruption of blood supply to the bone and leads to ischemic necrosis. ANFH can be divided in Several methods for early diagnosis of ANFH have been proposed, including MRI, SPECT, CT, X-ray, DSA, and laser Doppler with different characteristics. MRI has been characterized as being non-invasive, rapid and high sensitive, and commonly used by many clinicians [4–6]. MRI has been used in many studies in the
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