Quality Assessment Of Diagnostic Accuracy Studies Research Articles

Diagnostic value of water swallow test for dysphagia in patients with head and neck cancer: A systematic review and meta-analysis.

The diagnostic efficacy of the water swallow test (WST) is relatively robust for patients with neurogenic dysphagia; however, its diagnostic performance in identifying dysphagia among patients with HNC varies across studies. Our study aims to assess the diagnostic value of the WST for detecting dysphagia in patients with HNC. Systematic retrieval of studies on the use of WST for screening dysphagia in patients with HNC from databases up to August 1, 2023. Quality assessment of the included studies was performed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Calculate the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) to evaluate the screening ability of WST for dysphagia. A total of seven articles, encompassing eight study groups, were included, involving the analysis of 691 patients. The meta-analysis results demonstrate that the WST has a combined sensitivity, specificity, positive LR, negative LR, DOR, and AUC for diagnosing dysphagia in patients with HNC of 0.82 (95% CI [0.64, 0.92]), 0.79 (95% CI [0.70, 0.86]), 4.00 (95% CI [2.51, 6.36]), 0.22 (95% CI [0.10, 0.50]), 17.94 (95% CI [5.56, 57.92]), and 0.86 (95% CI [0.83, 0.89]), respectively. Significant heterogeneity was observed among the included studies. Meta-regression analysis showed that the pooled sensitivity of tumor sites and treatment was closely related, while the pooled specificity of treatment and version was closely related. The subgroup analysis showed that the WST's pooled sensitivity for diagnosing dysphagia in patients with nasopharyngeal cancer was 0.40 (95% CI [0.26, 0.56]), with an AUC of 0.50, lower than in other HNC sites. The WST performed better in surgical patients than in those undergoing radiotherapy (RT) or chemoradiotherapy (CRT), with lower sensitivity, specificity, and AUC values of 0.49 (95% CI [0.36, 0.61]), 0.66 (95% CI [0.59, 0.72]), and 0.64, respectively, for RT or CRT patients. The modified WST version showed different specificity values of 0.82 (95% CI [0.75, 0.87]), compared to the regular version of 0.68 (95% CI [0.61, 0.74]). Additionally, Deek's test indicated the absence of publication bias in this study (p = 0.32). The WST demonstrates favorable sensitivity and specificity in detecting dysphagia among patients with HNC. However, the diagnostic value may vary depending on factors such as tumor sites, treatment, and the specific version of the WST used.

The agreement of different techniques for muscle measurement in diagnosing sarcopenia: a systematic review and meta-analysis.

The measurement or estimation of muscle mass plays an important role in the diagnosis of sarcopenia. Beside dual-energy X-ray absorptiometry (DXA), several modalities, including bioelectrical impedance analysis (BIA), ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), have helped to provide imaging or electrical biomarkers for muscle mass. This study was aimed at summarizing the diagnostic performance of different techniques on muscle assessment for sarcopenia. Studies on the assessment of muscle mass by different techniques (compared with DXA), published from inception to 12 October, 2023 were retrieved from 4 electronic databases: the Cochrane Library, Embase, PubMed, and Web of Science. The quality assessment of included studies was conducted using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). The sensitivity, specificity, Cohen's kappa coefficient (κ), and Pearson correlation coefficient (r) with 95% confidence intervals (CIs) were pooled and presented via forest plots. The area under the curve (AUC) with 95% CI was pooled and presented via summary receiver operating characteristic (sROC) curve. A total of 28 studies involving 4,926 participants were included. Compared with DXA, the pooled sensitivity and specificity, AUC, and Cohen's κ were 0.79 (95% CI: 0.71-0.86, P<0.001), 0.95 (95% CI: 0.82-0.99, P<0.001), and 0.88 (95% CI: 0.85-0.90), and 0.61 (95% CI: 0.51-0.72) for BIA. The pooled r value between DXA and BIA or US or MRI was 0.94 (95% CI: 0.92-0.96, P<0.001), 0.69 (95% CI: 0.54-0.80, P<0.001), and 0.96 (95% CI: 0.95-0.97, P=0.21), respectively. No qualified original study in relation to CT was included. BIA, US, and MRI would provide acceptable diagnostic accuracy for sarcopenia by evaluating muscle mass in terms of sensitivity, specificity, accuracy, and their higher correlations with DXA. Further investigation is required to elucidate the value of CT in diagnosing sarcopenia.

Application of magnetic resonance imaging radiomics in endometrial cancer: a systematic review and meta-analysis.

We aimed to systematically assess the methodological quality and clinical potential application of published magnetic resonance imaging (MRI)-based radiomics studies about endometrial cancer (EC). Studies of EC radiomics analyses published between 1 January 2000 and 19 March 2023 were extracted, and their methodological quality was evaluated using the radiomics quality score (RQS) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Pairwise correlation analyses and separate meta-analyses of studies exploring differential diagnoses and risk prediction were also performed. Forty-five studies involving 3 aims were included. The mean RQS was 13.77 (range: 9-22.5); publication bias was observed in the areas of 'index test' and 'flow and timing'. A high RQS was significantly associated with therapy selection-aimed studies, low QUADAS-2 risk, recent publication year, and high-performance metrics. Raw data from 6 differential diagnosis and 34 risk prediction models were subjected to meta-analysis, revealing diagnostic odds ratios of 23.81 (95% confidence interval [CI] 8.48-66.83) and 18.23 (95% CI 13.68-24.29), respectively. The methodological quality of radiomics studies involving patients with EC is unsatisfactory. However, MRI-based radiomics analyses showed promising utility in terms of differential diagnosis and risk prediction.

Protocol for conducting a systematic review on diagnostic accuracy in clinical research

In the landscape of modern medicine, the ability to accurately diagnose various clinical conditions is paramount. As new diagnostic tools continue to emerge, their accuracy must be rigorously assessed before clinical implementation. This paper introduces a systematic review protocol tailored for diagnostic accuracy studies, drawing inspiration from a review on dysphagia screening in post-stroke patients. The protocol, designed with precision and transparency at its core, facilitates a thorough synthesis of evidence, employing tools such as the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and the Standards for Reporting of Diagnostic Accuracy Studies (STARD) checklist for robust evaluation. The protocol emphasizes registration with the PROSPERO database and adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic search approach encompasses a comprehensive exploration of databases and precise keyword combinations. Distinctive inclusion and exclusion criteria, coupled with a dual-reviewer methodology, ensure the selection of high-quality studies. This framework has the potential to serve as a benchmark for systematic reviews in diagnostic accuracy, highlighting the importance of standardization, transparency, and adaptability in clinical research. This approach paves the way for a research methodology that delves deeper into diagnostic tools across various clinical scenarios, promoting evidence-based advancements in patient care.

Diagnostic performance of metagenomic next-generation sequencing for the detection of pathogens in cerebrospinal fluid in pediatric patients with central nervous system infection: a systematic review and meta-analysis

BackgroundDetecting pathogens in pediatric central nervous system infection (CNSI) is still a major challenge in medicine. In addition to conventional diagnostic patterns, metagenomic next-generation sequencing (mNGS) shows great potential in pathogen detection. Therefore, we systematically evaluated the diagnostic performance of mNGS in cerebrospinal fluid (CSF) in pediatric patients with CNSI.MethodsRelated literature was searched in the Web of Science, PubMed, Embase, and Cochrane Library. We screened the literature and extracted the data according to the selection criteria. The quality of included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool and the certainty of the evidence was measured by the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) score system. Then, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odd’s ratio (DOR), and area under the curve (AUC) of the summary receiver operating characteristic curve (sROC) were estimated in Stata Software and MetaDisc. Subgroup analyses were performed to investigate the potential factors that influence the diagnostic performance.ResultsA total of 10 studies were included in the meta-analysis. The combined sensitivity was 0.68 (95% confidence interval [CI]: 0.59 to 0.76, I2 = 66.77%, p < 0.001), and the combined specificity was 0.89 (95% CI: 0.80 to 0.95, I2 = 83.37%, p < 0.001). The AUC of sROC was 0.85 (95% CI, 0.81 to 0.87). The quality level of evidence elevated by the GRADE score system was low.ConclusionsCurrent evidence shows that mNGS presents a good diagnostic performance in pediatric CNSI. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.

The Diagnostic Accuracy of Abdominal X-ray in Childhood Constipation: A Systematic Review of the Literature

Background: Previous systematic reviews have found insufficient and conflicting evidence for an association between the clinical and radiographic diagnosis of functional constipation. Abdominal X-ray is frequently used for the diagnosis of functional constipation in clinical practice. The objective of this study was to evaluate the diagnostic accuracy of abdominal X-ray for the evaluation of functional constipation in children. Results: Three studies were included in the final qualitative analysis. They were heterogeneous in their study design, definition of constipation, and radiologic parameters used to evaluate the abdominal X-rays. Sensitivities ranged from 73–92%, specificities ranged from 26–92%, and diagnostic accuracies ranged from 78–90%. Methods: This study involved a systematic review of English literature published between 2012 and 2022 covering children 2–18 years of age with a diagnosis of functional constipation in whom abdominal X-ray was performed. The databases searched include Medline, Embase, and Scopus. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) guidelines were followed. PROSPERO ID: CRD42022301833. Conclusions: There is insufficient evidence to support the use of abdominal X-ray as part of the diagnostic workup of functional constipation. More methodologically rigorous studies are needed to determine the utility of abdominal X-ray in the evaluation of functional constipation. The diagnosis of functional constipation should be based on history and clinical findings.

Meta-analysis: accuracy of the Baveno VI criteria for the diagnosis of high-risk varices in patients with hepatocellular carcinoma.

Diagnosing high-risk varices (HRV) is crucial for determining the prognosis and treatment strategy in patients with hepatocellular carcinoma (HCC). Although the Baveno VI consensus guidelines have been validated for assessing HRV in patients with liver cirrhosis, their applicability to those with HCC remains uncertain. This study aims to evaluate the effectiveness of the Baveno VI criteria in screening for HRV in patients with HCC. We searched for English-language articles related to Baveno criteria and HCC across PubMed, Embase, Web of Science, and Cochrane databases, covering publications from their inception until April 19, 2024. Our meta-analysis was conducted using STATA 14.0 and Meta-Disc 1.4 software. We assessed the quality of the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We analyzed pooled sensitivity (SEN), specificity (SPE), diagnostic odds ratio (DOR), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) using a random-effects model and constructed a summary receiver operating characteristic (SROC) curve. Based on established consensus, the favorable Baveno VI criteria were defined as a liver stiffness measurement (LSM) < 20 kPa and a platelet count (PLT) > 150×109/L to exclude HRV. This study is registered with PROSPERO under the registration number CRD42024533946. We finally brought four studies, including 1277 patients with HCC, into this meta-analysis. The SEN, SPE, DOR, and AUC of favorable Baveno VI criteria in screening HRV in patients with HCC were 0.90 (95% CI: 0.81-0.95), 0.33 (95% CI: 0.25-0.41), 4.44 (95% CI: 2.14-9.22), and 0.59 (95% CI: 0.55-0.64), respectively. The LR+ and LR- of the favorable Baveno VI criteria were 1.34 (95% CI: 1.19-1.50) and 0.30 (95% CI: 0.16-0.58), respectively. Subgroup and meta-regression analyses indicated that BCLC and Child-Pugh stages likely contribute to the heterogeneity in the SPE. The favorable Baveno VI criteria may not effectively screen HRV in patients with HCC. However, the current evidence is insufficient, and further studies with larger sample sizes and detailed patient subgroups are needed. https://www.crd.york.ac.uk/prospero/, identifier CRD42024533946.

Use of radiologic imaging to differentiate lipoma from atypical lipomatous tumor/well-differentiated liposarcoma: Systematic review

Background: Lipomas and atypical lipomatous tumors or well-differentiated liposarcomas (ALTs/WDLs), pose a diagnostic challenge due to their overlapping clinical and imaging features. Accurate differentiation is crucial as treatment strategies differ significantly between benign lipomas and malignant ALTs/WDLs. In recent years, medical imaging techniques have shown promise in distinguishing lipomas from ALTs/WDLs by providing enhanced visualization and assessment of various imaging parameters. Objective: This systematic review aimed to investigate the use of magnetic resonance (MR) imaging and computed tomography (CT) scan to differentiate lipomas from ALTs/WDLs. Methods: A systematic review was conducted by using MEDLINE, PubMed, PubMed Central, Cochrane Library, Google Scholar, and clinical trail.gov to identify imaging studies published between 2001 and 2022. Two independent reviewers reviewed 221 record to scrutinize the studies. The methodological quality of each included studies was assessed the using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Results: Thirteen retrospective cohort studies included 1,390 of total patients. Among them, 11 studies used MR imaging, 2 studies used CT scan and MR imaging both to differentiate lipoma from ALTs/WDLs. The significant diagnostic variables identified in the included studies were age, size, texture, mean intensity, contrast enhancement, location, septation, and nodularity. The overall, sensitivity, specificity, and accuracy of the included studies for diagnosis of lesions range from 66% to 100%, 37% to 100%, and 76% to 95%, respectively. The positive and negative predictive values range from 46.9% to 90% and 86% to 100%, respectively. Conclusion: The most frequent diagnostic features of ALTs/ WDLs include tumors ⩾110 mm in size, often in patients over 60, predominantly in the lower extremities, with an irregular shape, incomplete fat suppression, contrast enhancement, nodularity, septation &gt;2 mm, and predictive markers such as lactate dehydrogenase &gt;220 and a short tau inversion recovery-signal intensity ratio &gt;1.18.

Evaluation of deep learning and convolutional neural network algorithms for mandibular fracture detection using radiographic images: A systematic review and meta-analysis.

The use of artificial intelligence (AI) and deep learning algorithms in dentistry, especially for processing radiographic images, has markedly increased. However, detailed information remains limited regarding the accuracy of these algorithms in detecting mandibular fractures. This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Specific keywords were generated regarding the accuracy of AI algorithms in detecting mandibular fractures on radiographic images. Then, the PubMed/Medline, Scopus, Embase, and Web of Science databases were searched. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was employed to evaluate potential bias in the selected studies. A pooled analysis of the relevant parameters was conducted using STATA version 17 (StataCorp, College Station, TX, USA), utilizing the metandi command. Of the 49 studies reviewed, 5 met the inclusion criteria. All of the selected studies utilized convolutional neural network algorithms, albeit with varying backbone structures, and all evaluated panoramic radiography images. The pooled analysis yielded a sensitivity of 0.971 (95% confidence interval [CI]: 0.881-0.949), a specificity of 0.813 (95% CI: 0.797-0.824), and a diagnostic odds ratio of 7.109 (95% CI: 5.27-8.913). This review suggests that deep learning algorithms show potential for detecting mandibular fractures on panoramic radiography images. However, their effectiveness is currently limited by the small size and narrow scope of available datasets. Further research with larger and more diverse datasets is crucial to verify the accuracy of these tools in in practical dental settings.

Diagnostic Performance of Ultrasonography for Identification of Small Bowel Obstruction; a Systematic Review and Meta-analysis.

Small bowel obstruction (SBO) is known as a common cause of acute abdominal complaints in the emergency department (ED). The modality of choice for the diagnosis of SBO has not yet been established. This systematic review and meta-analysis aimed to investigate the accuracy of ultrasonography for the diagnosis of SBO. Systematic search was performed on five electronic databases including Medline, Scopus, Web of Sciences, Embase, and Cochrane Library, and the retrieval period was from the inception of each database to November 2023. The quality of the included studies were investigated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). The pooled values of diagnostic characteristics for ultrasonography were estimated using meta-Disc and Stata statistical software. Twenty-one studies with a total of 1977 patients were included in the meta-analysis. The pooled estimate for sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary ROC curve of ultrasonography for diagnosing SBO were 0.93 (95% CI: 0.91-0.95), 0.8 (95% CI: 0.77-0.83), 5.69 (95% CI: 3.64-8.89), 0.1 (95% CI: 0.07-0.16), 83.51 (95% CI: 18.12-182.91) and 0.96, respectively. The findings of this meta-analysis showed that the utilization of ultrasonography holds promise as a diagnostic imaging for SBO with high accuracy. However, additional worldwide studies are essential to get more evidence on the value of ultrasonography for the diagnosis of SBO.

Diagnostic lncRNA high expression for liver patients prognosis and medication guidance: a systematic review and meta-analysis.

The study of long non-coding RNAs (lncRNAs) has gained significant attention due to their roles in regulating gene expression and their potential as diagnostic biomarkers. This systematic review and meta-analysis aimed to evaluate the diagnostic value of high-expression lncRNAs in liver disease patients, including those with hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). A comprehensive literature search was conducted across multiple electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, up to July 2024. Studies were included if they investigated the expression of lncRNAs in liver disease patients and evaluated their diagnostic performance. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess the quality of included studies. Pooled sensitivity, specificity, diagnostic odds ratios (DOR), and summary receiver operating characteristic (SROC) curves were calculated using a bivariate random-effects model. Nine studies involving 888 samples were included in the meta-analysis. The pooled hazard ratio (HR) for overall survival (OS) was 2.01 (95% CI: 1.71-2.36), indicating a significant association between high lncRNA expression and poor liver disease outcomes. Subgroup analyses revealed a pooled odds ratio (OR) of 1.99 (95% CI: 1.53-2.60) for tissue samples and 8.62 (95% CI: 1.16-63.71) for blood samples, suggesting a stronger diagnostic value for blood-based lncRNAs. The funnel plots indicated minimal publication bias, and sensitivity analyses confirmed the robustness of the findings. High-expression lncRNAs show significant potential as diagnostic biomarkers for liver diseases, offering non-invasive, accurate, and timely diagnostic information. Despite the promising results, further research is needed to standardize detection methods, elucidate the biological functions of lncRNAs, and validate their clinical utility in diverse patient populations. Integrating lncRNA biomarkers with traditional diagnostic approaches could enhance diagnostic accuracy and improve patient management and outcomes in liver disease.

Predicting obstructive sleep apnea hypopnea syndrome using three-dimensional optical devices: A systematic review.

As a global health concern, the diagnosis of obstructive sleep apnea hypopnea syndrome (OSAHS), characterized by partial reductions and complete pauses in ventilation, has garnered significant scientific and public attention. With the advancement of digital technology, the utilization of three-dimensional (3D) optical devices demonstrates unparalleled potential in diagnosing OSAHS. This study aimed to review the current literature to assess the accuracy of 3D optical devices in identifying the prevalence and severity of OSAHS. A systematic literature search was conducted in the Web of Science, Scopus, PubMed/MEDLINE, and Cochrane Library databases for English studies published up to April 2024. Peer-reviewed researches assessing the diagnostic utility of 3D optical devices for OSAHS were included. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) guideline was employed to appraise the risk of bias. The search yielded 3216 results, with 10 articles meeting the inclusion criteria for this study. Selected studies utilized structured light scanners, stereophotogrammetry, and red, green, blue-depth (RGB-D) cameras. Stereophotogrammetry-based 3D optical devices exhibited promising potential in OSAHS prediction. The utilization of 3D optical devices holds considerable promise for OSAHS diagnosis, offering potential improvements in accuracy, cost reduction, and time efficiency. However, further clinical data are essential to assist clinicians in the early detection of OSAHS using 3D optical devices.

Diagnostic Value of Radiographic Singh Index Compared to Dual-Energy X-Ray Absorptiometry Scan in Diagnosing Osteoporosis: A Systematic Review.

Since various medications can control the rate of fractures and subsequent complications of osteoporosis, the early detection of the disease is crucial. This systematic study aimed to compare the diagnostic accuracy of Singh index (SI) with dual-energy X-ray absorptiometry (DEXA) as a benchmark standard for diagnosing osteoporosis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were utilized in the current study. A detailed search was carried out using PubMed and Scopus from inception to 30 May 2022. Examining quality of the studies was performed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). A total of 22 studies were included. In general, 50% of the studies considered SI a poor screening tool for detecting osteoporosis due to a negligible inter-observer agreement between SI and DEXA or a poor correlation of SI with the bone mineral density (BMD) category or DEXA T-score. A moderate inter-observer agreement was reported for SI in 5 (55.6%) studies. Among the studies assessing the sensitivity and specificity of SI compared to DEXA (n=13), six studies estimated a low sensitivity for SI. While there is supporting evidence indicating the potential usefulness of SI for predicting femoral neck fractures in individuals with suspected osteoporosis, numerous studies challenge its reliability and diagnostic value as a screening tool for identifying femoral neck osteoporosis. Further primary studies are required to verify the effectiveness of the SI index in identifying populations at risk of osteoporosis.

Diagnostic Accuracy of Transvaginal Ultrasound in the Evaluation of Female Infertility: A Systematic Review

Female infertility can result from issues with the fallopian tubes, uterus, and cervix. Ultrasound has become an essential component of the modern investigation of female infertility and the management of assisted conception, which is able to access endometrial and uterine factors that affect embryo implantation. To date, Transvaginal ultrasound (TVS) has become the modality of choice for the initial study of female infertility since it is widely available, cost-effective, and non-invasive. This study aims to assess the diagnostic accuracy of TVS in evaluating female infertility and how different types of abnormalities in female infertility affect the diagnostic accuracy. The systematic search in this study followed the guidelines of the Preferred Reporting Items for Systematic Reviews (PRISMA) and Meta-Analyses. The electronic databases PubMed and ScienceDirect were utilized. Papers published between 2012 and 2022 were chosen and subjected to analysis following the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). In the initial search strategy, a total of 217 articles were discovered. By applying specific criteria for inclusion and exclusion, a set of five studies involving 770 patients were chosen for analysis. Forest plot analysis of these five studies evaluating sensitivity and specificity demonstrated low heterogeneity (Q = 4.574) and moderate heterogeneity (Q = 20.771) respectively. Employing a random-effects model, transvaginal ultrasound (TVS) demonstrated a favorable overall accuracy for evaluating female infertility with a pooled sensitivity of 0.79 (95% CI: 0.60, 0.99), and a specificity of 0.96 (95% CI: 0.76, 1.17). The sensitivity and specificity may vary depending on the specific abnormality being assessed. The most observed abnormalities were endometrial polyps and uterine fibroids, while uterine cancer and adenomyosis were the least frequently observed abnormalities. Findings from this study suggest that TVS offers moderate accuracy in the evaluation of female infertility. TVS is particularly valuable when used in conjunction with hysteroscopy, as it demonstrates high accuracy in detecting and characterizing abnormalities.

Diagnostic Accuracy of Contrast-Enhanced MRI for Detection of Perineural Spread in Head and Neck Cancer: A Systematic Review and Meta-Analysis.

Objectives The aim of this study was to determine the diagnostic accuracy of contrast-enhanced magnetic resonance imaging (CE-MRI) for the detection of perineural spread (PNS) in head and neck cancer patients. Methods A systematic review of PubMed, Embase, Scopus, Web of Science and Cochrane Library databases was performed up to May 20, 2022. We included diagnostic accuracy studies that used CE-MRI for the diagnosis of PNS in patients with head and neck cancer, using histopathology from surgical specimens as the reference standard. Potential bias and applicability of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADUS-2) tool. Pooled joint effect sizes of sensitivity and specificity were calculated by applying bivariate random-effects meta-analysis model. Results Nine studies with 259 patients were included. The pooled sensitivity and specificity of CE-MRI for detecting PNS were 89% (95% confidence interval [CI]: 73-96) and 83% (95% CI: 73-90), respectively. Stratifying by MRI strength, 1.5 T had a higher sensitivity of 97% (95% CI: 47-100) compared with 3 T, which had a sensitivity of 83% (95% CI: 72-90). Both 1.5- and 3-T MRI had a similar specificity in detecting PNS of 85% (95% CI: 63-95) and 84% (95% CI: 75-91), respectively. Conclusions CE-MRI provides good diagnostic test accuracy for the detection of PNS in head and neck cancer. Current evidence suggests 1.5-T MRI provides greater sensitivity compared with 3-T MRI.

A systematic review and meta-analysis of magnetic resonance and computed tomography enterography in the diagnosis of small intestinal tumors.

To explore the potential value of magnetic resonance (MR) and computed tomography (CT) enterography in the diagnosis of small intestinal tumor (SIT). Articles reporting on the diagnosis of SIT by MR and CT enterography deposited in Chinese and foreign literature databases were identified and evaluated using the quality assessment of diagnostic accuracy studies (QUADAS). The diagnostic data extracted from the articles were adopted for meta-analysis using Meta-disc 1.40 software. Analysis was undertaken to compare the sensitivity, specificity, positive and negative likelihood ratios, and the diagnostic odds ratio (DOR) of MR and CT enterography in the diagnosis of SIT. The diagnostic values of the two imaging methods were analyzed by summary receiver operating characteristic (SROC) curves. The meta-analysis was registered at INPLASY (202380053). A total of eight articles, including 551 cases of SIT were included in this analysis. The pooled sensitivity and specificity of MR enterography were 0.92 (95% CI [0.89-0.95]) and 0.81 (95% CI [0.74-0.86]), respectively, whilst CT enterography had a sensitivity of 0.93 (95% CI [0.90-0.95]) and a specificity of 0.83 (95% CI [0.76-0.88]). For MR enterography, the combined positive likelihood ratio was 4.90 (95% CI [3.50-6.70]), the combined negative likelihood ratio was 0.10 (95% CI [0.07-0.14]), and the area under the receiver operating characteristic curve (AUROC) was 0.940. For CT enterography, the corresponding values were 5.40 (95% CI [3.90-7.40]), 0.08 (95% CI [0.06-0.12]), and 0.950, respectively. When the pretest probability for MR was assumed to be 50%, the posterior probabilities for positive and negative results were calculated as 83% and 9%, respectively. For CT enterography with a pretest probability of 50%, the posterior probabilities of positive and negative results were 84% and 8%, respectively. MR and CT enterography have high accuracy in the diagnosis of SIT and have a valuable role in the diagnosis and management of these tumors.

Application of artificial intelligence in the assessment of thyroid eye disease (TED) - a scoping review.

There is emerging evidence which suggests the utility of artificial intelligence (AI) in the diagnostic assessment and pre-treatment evaluation of thyroid eye disease (TED). This scoping review aims to (1) identify the extent of the available evidence (2) provide an in-depth analysis of AI research methodology of the studies included in the review (3) Identify knowledge gaps pertaining to research in this area. This review was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). We quantify the diagnostic accuracy of AI models in the field of TED assessment and appraise the quality of these studies using the modified QUADAS-2 tool. A total of 13 studies were included in this review. The most common AI models used in these studies are convolutional neural networks (CNN). The majority of the studies compared algorithm performance against healthcare professionals. The overall risk of bias and applicability using the modified Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool led to most of the studies being classified as low risk, although higher deficiency was noted in the risk of bias in flow and timing. While the results of the review showed high diagnostic accuracy of the AI models in identifying features of TED relevant to disease assessment, deficiencies in study design causing study bias and compromising study applicability were noted. Moving forward, limitations and challenges inherent to machine learning should be addressed with improved standardized guidance around study design, reporting, and legislative framework.

Assessment of different sonographic cervical measures to predict labor induction outcomes: a systematic review and meta-analysis.

Induction of labor (IOL) is a common obstetric approach to start or encourage uterine contractions to achieve a vaginal birth. It is recommended when continuing the pregnancy may be more dangerous for the mother or baby. Different ultrasonographic measures, such as cervical length, have been investigated as possible predictors of the outcomes of IOL. This meta-analysis aimed to assess the accuracy of ultrasound measurements in anticipating successful IOL. The study conducted a thorough search on three databases (PubMed, Scopus, and Web of Science) until 04 March 2023, to find clinical studies published in English that reported different sonographic cervical measures and their ability to predict IOL outcomes. The chosen studies were stratified based on the type of indicator reported, and a meta-analysis was conducted to determine the best indicator for both successful and failed induction. The risk of bias and concerns about the applicability of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) method. This study analyzed 57 studies with 9,338 patients. Cervical length is moderately effective in predicting successful IOL, with pooled sensitivity (SN) and specificity (SP) of 0.67 and 0.70, respectively. However, cervical length had a pooled SN and SP of 0.70 and 0.61 for predicting failed IOL. The posterior cervical angle was found to have a higher pooled SN and SP of 0.79 and 0.73 for predicting successful IOL. Fetal head-perineum distance demonstrated moderate accuracy with a pooled SN, SP, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve of 0.58, 0.66, 1.95, 0.36, 5.33, and 0.9992, respectively, for predicting successful IOL. Fetal head-perineum distance was the most effective predictor for successful IOL compared to cervical length, which only had a moderate predictive ability. Shortening of cervical length was not a useful indicator for successful IOL. On the other hand, the posterior cervical angle was the most reliable factor for predicting failed induction. The study's findings can aid in developing more effective management strategies for IOL.

The diagnostic accuracy of mean platelet volume in differentiating immune thrombocytopenic purpura from hypo-productive thrombocytopenia: A systematic review and meta-analysis.

Thrombocytopenia is defined as a decreased number of platelets in the circulating blood as a result of hypo-proliferation in marrow or peripheral destruction of platelets. Several diagnostic methods have been proposed to discriminate the underline cause of thrombocytopenia. Recent studies showed that mean platelet volume (MPV) could be used for differential diagnosis of immune thrombocytopenic purpura (ITP). Thus, we aimed to investigate the diagnostic accuracy of MPV for differential diagnosis of ITP from hypo-productive thrombocytopenia. This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA). The study protocol was registered on PROSPERO with the reference number CRD42023447789. Relevant published studies that were published up to April 10, 2023, in peer-reviewed journals were searched on electronic different databases. The methodological quality of the included studies was appraised using the quality assessment of diagnostic accuracy studies 2 (QADAS-2) tool. The pooled weight mean difference (WMD) of MPV between the ITP group and hypo-productive group was analyzed using a random-effects model meta-analysis. Relevant data were extracted using a Microsoft Excel spreadsheet and analyzed using STATA 11.0 and Meta-disc 1.4 software. Publication bias was evaluated using Deek's funnel plot asymmetry test. A total of 14 articles were included in this systematic review and meta-analysis. The comparison of MPV between groups revealed that the pooled mean value of MPV increased significantly in ITP patients compared to patients with hypo-productive thrombocytopenia (WMD = 2.03; 95% CI, 1.38-2.69). The pooled sensitivity and specificity of MPV in differentiating ITP from hypo-productive thrombocytopenia were 76.0% (95% CI: 71.0%, 80.0%) and 79.0% (95% CI: 75.0%, 83.0%), respectively. The summary positive likelihood ratio (PLR) and negative likelihood ratio (NLR)using the random effects model were 3.89 (95% CI: 2.49, 6.10) and 0.29 (95% CI: 0.18, 0.46), respectively. MPV can be used to discriminate ITP from hypo-productive thrombocytopenia. It can possess large advantages as it is noninvasive, simple, quick, inexpensive, easy to perform, reliable, and routinely generated by automated cell counters.

Diagnostic Efficacy of Serological Antibody Detection Tests for Hepatitis Delta Virus: A Systematic Review and Meta-Analysis.

Background and Aims Coinfection of hepatitis delta virus (HDV) with hepatitis B virus (HBV) causes the most severe form of viral hepatitis, and the global prevalence of HDV infection is underestimated. Although serological testing of anti-HDV antibodies is widely used in the diagnosis of HDV, its diagnostic efficacy remains unclear. This study aimed to evaluate the diagnostic efficacy of HDV serological tests, the results of which may assist in the diagnosis of HDV. Methods Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. The PubMed, Web of Science and Cochrane Library databases were searched from the beginning to 31 May 2023. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. STATA SE was used for the meta-analysis of the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio. Results Among a total of 1376 initially identified studies, only 12 articles met the final inclusion criteria. The pooled sensitivity and specificity were 1.00 (95% CI: 0.00-1.00) and 0.71 (95% CI: 0.50-0.78) for HDV total antibodies, 0.96 (95% CI: 0.83-0.99) and 0.98 (95% CI: 0.82-1.00) for anti-HDV IgM and 0.95 (95% CI: 0.86-0.98) and 0.96 (95% CI: 0.67-1.00) for anti-HDV IgG. The pooled sensitivity and specificity for HDV serological tests were 0.99 (95% CI: 0.96-1.00) and 0.90 (95% CI: 0.79-0.96). Conclusions This meta-analysis suggests that serological tests have high diagnostic performance in detecting antibodies against HDV, especially in HDV IgM and IgG. However, this conclusion is based on studies of a limited number and quality, and the development of new diagnostic tools with higher precision and reliability is still necessary.