Diagnostic value of lacrimal scintigraphy in the evaluation of lacrimal drainage system obstruction: a systematic review and meta-analysis.

PURPOSE: A systematic review and meta-analysis to evaluate the diagnostic performance of lacrimal scintigraphy (LS) versus anatomical methods in the evaluation of the nasolacrimal duct obstruction (NLDO). MATERIALS AND METHODS: A systematic search was performed using electronic bibliographic databases until the end of May 2021. Inclusion criteria: (a) used LS as a diagnostic method to evaluate NLDO; (b) used anatomical studies [including syringing, irrigation, probing, and dacryocystography (DCG)] as reference tests; and (c) provided adequate crude data. A hierarchical method was used to pool the sensitivity and specificity. The hierarchical summary receiver-operating characteristic model was performed. Additionally, the studies' heterogeneity and publication bias were analyzed. All analyses were conducted by the 'Midas' module of STATA 16. RESULTS: Twelve articles (with 14 separate populations) were considered eligible to enter the meta-analysis. They were divided into two groups based on the reference standard method, called irrigation and DCG groups. In the irrigation group, the pooled sensitivity and specificity were 89% [95% confidence interval (CI), 72-96%] and 25% (95% CI, 8-56%), respectively. In DCG group, the pooled sensitivity and specificity were 97% (95% CI, 85-100%) and 27% (95% CI, 0.12-0.49), in turn. CONCLUSION: LS is a sensitive modality to evaluate the anatomical obstruction of NLD. In contrast, it shows low pooled specificity compared with anatomical methods. Thus, LS can be used as the first noninvasive modality for the evaluation of epiphora. However, in case of any abnormality, confirmatory procedures are required.

Significance of Abnormal Myocardial Perfusion Scans in Candidates for Orthotopic Liver Transplantation.

Background: The implications of cardiac risk stratification before orthotopic liver transplantation (OLT) are not well established. We studied the usefulness of myocardial perfusion imaging (MPI) in this scenario. Methods: MPI data of 24 patients (9 females), candidates of OLT, were collected. They underwent MPI as part of their preoperative risk assessment. MPIs were interpreted by 2 nuclear physicians, who had access to clinical data, scan, and semi-quantification results (i.e., quantitative perfusion single-photon emission tomography (SPECT) [QPS] and quantitative gated SPECT [QGS]). A 3rd nuclear physician, blinded to the clinical history of the subjects, re-reviewed the scans. The visual interpretations of MPI (i.e., normal vs. abnormal), ejection fraction, and transient ischemic dilation index derived from QPS and clinical and follow-up data were collected and analyzed. Results: The follow-up period was 231.0 ± 86.0 days. The MPIs were normal in 16 (66.7%) patients and abnormal in 8 (i.e., 5 mild [20.8%], 1 [4.2%] moderate, and 2 [8.3%] severe). Out of 4 patients who died during the follow-up, 1 had mild ischemia and 2 had severe ischemia. A patient who had a normal MPI died due to noncardiac reasons. A patient with abnormal MPI had 3-vessel disease on angiography. Out of the 5 patients who died or had significant coronary angiographic abnormalities, 4 had abnormal MPIs (negative predictive value = 93.8%; sensitivity = 80.0%) The MPIs of 4 patients without perioperative mortality or cardiac morbidity were abnormal (specificity = 78.9%). Conclusion: MPI seems to be remarkable in discriminating high-risk OLT patients preoperatively.