Predictive performance of blood urea nitrogen to serum albumin ratio in elderly patients with gastrointestinal bleeding.

INTRODUCTION: Acute gastrointestinal (GI) bleeding is one of the most important and the common causes of patients visiting the emergency department. Dehydrated state leads to increased blood urea nitrogen (BUN) and decreased albumin level. Many scoring systems had been developed to predict outcomes for patients with GI bleeding. Among the many scoring systems, the AIMS65 score was a simple and accurate risk assessment scoring tool. Therefore, in this study, we evaluated the prognostic performance of the blood urea nitrogen to serum albumin ratio (B/A ratio) compared to the AIMS65 score tool in elderly patients with GI bleeding. MATERIAL AND METHODS: This was a retrospective cohort study of patients with GI bleeding in our institution from February 2018 through May 2020. Baseline characteristic data were obtained. The data were compared with the prevalence of ICU admission and in-hospital mortality. The B/A ratio and the AIMS65 score as predictors of ICU admission and in-hospital mortality was evaluated using the area under the receiver operating characteristic (AUROC) curve. RESULTS: In the 596 patients included in the study, of whom 188 (31.5%) were admitted to the ICU and 36 (6.0%) died during hospitalization. Multivariate logistic regression analysis revealed that the B/A ratio was significant predictors of ICU admission and in-hospital mortality. In addition, the B/A ratio was significant higher in ICU admission patients and non-survivors. The AUROC value of the B/A ratio was 0.682 and that of the AIMS65 score was 0.699 for predicting ICU admission. For predicting in-hospital mortality, the AUROC value was 0.770 and 0.763, respectively. CONCLUSION: The B/A ratio is as simple and useful tool for predicting outcomes for old aged GI bleeding patients as the AIMS65 score.

Comparison of IVC diameter ratio, BUN/creatinine ratio and BUN/albumin ratio for risk prediction in emergency department patients.

INTRODUCTION: Early prediction of patients' prognosis in the emergency department (ED) is important. Patients' conditions such as dehydration help predict prognosis. The ratio of serum blood urea nitrogen to creatinine (BUN/Cr ratio) and inferior vena cava (IVC) diameter is often used to determine dehydration. Also, serum albumin levels reflect nutritional conditions such as dehydration. In this study, we evaluated the performance of BUN/Cr ratio, IVC diameter ratio, and BUN/Albumin ratio as predictive markers for in-hospital mortality and ICU admission among various diseases in ED. MATERIAL AND METHODS: This retrospective cohort study utilized data from patients who had abdominal and pelvic computed tomography (APCT) performed at our institution from 2015 to 2018. The measurement of IVC diameter from computed tomography, the BUN/Cr ratio, and the BUN/Albumin ratio were calculated. Differences in the performance among the BUN/Cr ratio, the IVC diameter ratio, and the BUN/Albumin ratio for predicting outcomes were evaluated by the area under the receiver operating characteristic (AUROC) curve. RESULTS: A total of 914 patients were enrolled and 78 patients (8.5%) were admitted to the ICU, and 71 patients (7.8%) died during the clinical process. Multivariate logistic regression showed that only the BUN/Albumin ratio was a significant predictor of inhospital mortality and ICU admission. CONCLUSION: Among dehydration markers the BUN/Albumin ratio is a simple and useful tool for predicting the outcomes of patients visiting the ED.

Diagnostic outcome and safety of CT-guided core needle biopsy for mediastinal masses: a systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the diagnostic outcomes and complication rates and to identify potential covariates that could influence these results for computed tomography (CT)-guided core needle biopsy (CNB) of mediastinal masses. METHODS: A computerized search of the PubMed and EMBASE databases was performed to identify original articles on the use of CT-guided CNB for mediastinal mass. The pooled proportions of the diagnostic yield and accuracy were assessed using random effects modeling. We assessed the pooled proportion of complication rates using random effects or fixed effects modeling. Multivariate meta-regression analyses were performed to evaluate the potential sources of heterogeneity. RESULTS: Eighteen eligible studies (1310 patients with 1345 CT-guided CNBs) were included. The pooled proportions of the diagnostic yield and accuracy of CT-guided CNB for mediastinal masses were 92% (18 studies, 1345 procedures) and 94% (15 studies, 803 procedures), respectively. In the subgroup analysis, the pooled proportions of the total complication rate and major complication rate were 13% and 2%, respectively. In the meta-regression analyses, the number of tissue samplings (odds ratio [OR], 3.3; p = 0.03), real-time fluoroscopy-guided (OR, 2.1; p = 0.02), and percentage of lymphoma (OR, 2.2; p < 0.001) for diagnostic yield, number of tissue samplings (OR = 2.0, p = 0.02) for diagnostic accuracy, and biopsy needle diameter (OR, 2.5; p = 0.002) for total complication rate were all sources of heterogeneity. CONCLUSIONS: CT-guided CNB for mediastinal mass demonstrates high diagnostic outcomes and low complication rates. The use of 20-gauge biopsy needles and obtaining ≥ 3 samples may be recommended to improve diagnostic outcomes and decrease complication rates. KEY POINTS: • The pooled estimates of diagnostic yield and accuracy of computed tomography (CT)-guided core needle biopsy (CNB) for mediastinal masses are 92% and 94%, respectively. • The pooled estimates of the total complication rate and major complication rate were 13% and 2%, respectively. • The use of a 20-gauge needle and ≥ 3 tissue samplings are recommended for CT-guided mediastinal CNB to achieve high diagnostic outcomes and lower complication rates.

The prevalence of Baker cyst in relation to the arrangement pattern between the medial head of gastrocnemius tendon and the semimembranosus tendon.

PURPOSE: The purpose of this study was to investigate whether Baker cyst (BC) was related to the specific arrangement of the medial head of gastrocnemius tendon (MHGT) and the semimembranosus tendon (SMT). MATERIALS AND METHODS: Patients who underwent knee MRI with "Baker cyst" in PACS from August 2017 to February 2018 were included in this study. Patients who did not have BC in a knee MRI performed during the same period were included in the control group. A total 210 patients were selected for inclusion in this study. For the imaging analysis, the arrangement pattern between MHGT and SMT was classified into three types: type 1, concave; type 2, flat; and type 3, convex. When imaging analysis was performed, the amount of effusion, the presence of osteoarthritis, and major ligament and meniscal tears were also described. Univariate and multivariate logistic regression analyses were performed. Statistical significance was considered at p < 0.05. RESULTS: The frequency of types 1, 2, and 3 was statistically significant depending on the presence or absence of BC (p < 0.001). The frequency of type 3 was the highest in the presence of BC, while that of type 1 was the highest in the absence of BC. BC was more common in type 2 (OR = 2.54; 95% CI = 1.27-5.07) and type 3 (OR = 4.09; 95% CI = 1.88-8.89). CONCLUSION: BC is more likely to occur in patients with SMT having a convex shape for MHGT. KEY POINTS: • Based on axial image of MRI only, one can predict which patients are morphologically more prone to develop a Baker cyst. • On axial images of MRI, Baker cyst is more likely to occur in patients with semimembranosus tendon having a convex shape for medial head of gastrocnemius tendon. • Baker cyst is not associated with the amount of effusion, OA, or internal derangement.

Feasibility of point-of-care knee ultrasonography for diagnosing anterior cruciate and posterior cruciate ligament tears in the ED.

OBJECTIVE: To evaluate the feasibility of point-of-care knee ultrasonography (POCUS) compared with knee magnetic resonance imaging (MRI) for diagnosing anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears in patients with acute knee trauma. MATERIAL AND METHODS: A prospective study was conducted in a tertiary hospital emergency department; acute (within 1-week) knee trauma patients with suspected ACL or PCL tear were recruited. Two POCUS performers (a board-certified emergency physician and a musculoskeletal radiologist) independently evaluated the ACL and PCL using POCUS. Findings were classified as normal appearance or ligament tear. Final radiology reports of knee MRI were used as the reference standard. We calculated the diagnostic values (sensitivity, specificity, and accuracy) for POCUS obtained by both POCUS performers. Kappa values (k) were calculated for inter-observer agreement between the two POCUS performers. RESULTS: Sixty-two patients were enrolled. Compared with the reference standard, POCUS showed acceptable sensitivity (90.6-100%), specificity (90.0-97.7%), and accuracy (91.9-96.8%). Inter-observer agreement between the two POCUS performers was excellent (k = 0.853-0.903). CONCLUSION: POCUS demonstrates excellent precision as compared to MRI in the diagnosis of ACL and PCL tears. The findings of POCUS could be used for immediate diagnosis and further pre-operative imaging in patients with acute knee trauma.

Screening of Pediatric Facial Fractures by Brain Computed Tomography: Diagnostic Performance Comparison With Facial Computed Tomography.

OBJECTIVES: Facial bone fractures secondary to head trauma are more common in children than in adults. Recently, multidetector row computed tomography (CT) has been considered superior to conventional radiography. Some studies have reported that facial soft tissue injuries require both facial and brain CT and that brain CT is helpful in screening facial bone fractures. However, these studies included only adult patients. The aim of this study was to evaluate the diagnostic performance of brain CT and the need for additional facial CT to detect facial bone fractures in emergency pediatrics. METHODS: This multicenter study was conducted retrospectively in 2 tertiary hospitals in Seoul, Republic of Korea. The data were collected from the medical records of pediatric patients younger than 8 years who had undergone both brain and facial CT on the same day in the emergency department. All CT scans were retrospectively and independently evaluated by 1 board-certified radiologist and 1 board-certified emergency medicine physician. A P value of <0.05 was considered statistically significant. RESULTS: Sensitivity was 92.31%, specificity was 100%, positive predictive value was 100%, negative predictive value was 99.31%, and accuracy was 99.36% for the emergency physician; all parameters were 100% for the radiologist. CONCLUSIONS: Brain CT showed high diagnostic performance to detect facial bone fractures with high accuracy in pediatric patients. As emergency physicians, we should consider facial bone fractures when reviewing brain CT images of pediatric patients with blunt head and face trauma.

Systematic review and meta-analysis of magnetic resonance imaging features for diagnosis of adhesive capsulitis of the shoulder.

OBJECTIVES: To perform a systematic review and meta-analysis to identify magnetic resonance imaging (MRI) features that will aid in the diagnosis of adhesive capsulitis of the shoulder (ACS) and provide a summary of the diagnostic accuracy of the identified features METHODS: The MEDLINE and EMBASE databases were searched for studies assessing the diagnostic accuracy of MRI features of ACS. Overlapping descriptors used to denote the same imaging finding in different studies were subsumed under a single feature. The pooled accuracy including the diagnostic odd ratios (DORs) with 95% confidence intervals (CIs) of the identified features was calculated using a bivariate random-effects model. RESULTS: In total, 15 studies were included, and 74 overlapping descriptors were subsumed under six features. All six features were found to be informative for ACS diagnosis [coracohumeral ligament thickening: DOR, 13; 95% CI, 6-29; fat obliteration of the rotator interval (RI): DOR, 8; 95% CI, 3-24; RI enhancement: DOR, 44; 95% CI, 14-141; axillary joint capsule enhancement: DOR, 52; 95% CI, 27-98; inferior glenohumeral ligament (IGHL) hyperintensity: DOR, 31; 95% CI, 8-115; IGHL thickening: DOR, 28; 95% CI, 11-70]. The sensitivity and specificity of enhancement of the RI and axillary joint capsule and IGHL hyperintensity were > 80%. CONCLUSIONS: Six informative MRI features for ACS diagnosis were identified in this study with RI and axillary joint capsule enhancement and IGHL hyperintensity showing the highest diagnostic accuracy. Informative features observed on non-arthrogram MRI can be as helpful as features observed on direct magnetic resonance arthrography for ACS diagnosis. KEY POINTS: • Six informative MRI features for ACS diagnosis were identified (diagnostic odds ratio > 1). • RI and axillary joint capsule enhancement and IGHL hyperintensity showed high sensitivities/specificities (> 80%). • The use of non-arthrogram MRI is recommended for ACS diagnosis.

Diagnostic Outcome of Image-Guided Percutaneous Core Needle Biopsy of Sclerotic Bone Lesions: A Meta-Analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the diagnostic outcome (diagnostic yield and accuracy) of image-guided percutaneous core needle biopsy (CNB) of sclerotic bone lesions. MATERIALS AND METHODS: A computerized search of the PubMed and EMBASE databases was performed to identify relevant original articles on the use of image-guided percutaneous CNB of sclerotic bone lesions. The pooled proportions of the diagnostic yield and pooled accuracy estimates were assessed using random-effects modeling. We also performed subgroup analyses of the diagnostic yield according to the drill systems (battery-powered vs manual). Heterogeneity among studies was determined using the inconsistency index (I2). Meta-regression analyses were performed to evaluate the potential sources of heterogeneity. RESULTS: Fifteen eligible studies, involving 969 sclerotic bone lesions for diagnostic yield, and 242 sclerotic bone lesions for diagnostic accuracy, were included. The pooled proportion of the diagnostic yield of image-guided percutaneous CNB of sclerotic bone lesions was 74% (95% CI, 62-84%), and the pooled accuracy estimate for differentiation between benign and malignant lesions was 87% (95% CI, 77-93%). In the subgroup analysis, the pooled proportion of the diagnostic yield of the battery-powered drill system (76.7% [95% CI, 64.0-85.8%]) was higher than that of the manual drill system (65.2% [95% CI, 58.0-71.8%]). In the meta-regression analyses, no variables were significantly different (p = 0.13-0.93). CONCLUSION: In conclusion, we determined that image-guided percutaneous CNB of sclerotic bone lesions is an accurate diagnostic technique with good diagnostic yield, particularly when the battery-powered bone biopsy system is used.

Diagnostic Performance of Ultrasonography for Detection of Pediatric Elbow Fracture: A Meta-analysis.

STUDY OBJECTIVE: We evaluate the diagnostic performance of ultrasonography for detection of elbow fracture in pediatric patients with trauma. METHODS: PubMed and EMBASE databases were searched for diagnostic accuracy studies that used ultrasonography for detection of elbow fracture in pediatric patients. Bivariate modeling and hierarchic summary receiver operating characteristic (ROC) modeling were conducted to evaluate diagnostic performance. The pooled proportions of the false-negative rate were assessed with a DerSimonian-Laird random-effects model. We performed meta-regression analyses for heterogeneity exploration. RESULTS: Ten articles involving a total of 519 patients were included. The summary sensitivity, summary specificity, and area under the hierarchic summary ROC curve were 96% (95% confidence interval 88% to 99%), 89% (95% confidence interval 82% to 94%), and 0.97 (95% confidence interval 0.95 to 0.98), respectively. The pooled proportion of the false-negative rate of ultrasonography was 3.7%. Among the various potential covariates, ultrasonographic performer (pediatric emergency physician versus others) and presence of extra musculoskeletal ultrasonographic training (trained versus not reported) were associated with heterogeneity of the specificity. CONCLUSION: Elbow ultrasonography demonstrated high performance in the diagnosis of pediatric elbow fracture, particularly in studies of physicians with extra training in musculoskeletal ultrasonography. Ultrasonography may be performed by trained physicians as a first-line diagnostic tool to diagnose pediatric elbow fracture.

Diagnostic performance of emergency physician-performed point-of-care ultrasonography for acute appendicitis: A meta-analysis.

OBJECTIVE: To assess the sensitivity and specificity of emergency physician-performed point-of-care ultrasonography (EP-POCUS) for diagnosing acute appendicitis (AA). MATERIAL AND METHODS: The PubMed and EMBASE databases were searched, and the diagnostic performance of EP-POCUS was evaluated using bivariate modeling and hierarchical summary receiver operating characteristic curves. Subgroup analysis was performed for pediatric patients to compare EP-POCUS and radiologist-performed ultrasonography (RADUS). Meta-regression analyses were performed according to patient and study characteristics. RESULTS: In 17 studies (2385 patients), EP-POCUS for diagnosing AA exhibited a pooled sensitivity of 84% (95% confidence interval [CI]: 72%-92%) and a pooled specificity of 91% (95% CI: 85%-95%), with even better diagnostic performance for pediatric AA (sensitivity: 95%, 95% CI: 75%-99%; specificity: 95%, 95% CI: 85%-98%). A direct comparison revealed no significant differences (p = 0.18-0.85) between the diagnostic performances of EP-POCUS (sensitivity: 81%, 95% CI: 61%-90%; specificity: 89%, 95% CI: 77%-95%) and RADUS (sensitivity: 74%, 95% CI: 65%-81%; specificity: 97%, 95% CI: 93%-98%). The meta-regression analyses revealed that study location, AA proportion, and mean age were sources of heterogeneity. Higher sensitivity and specificity tended to be associated with an appendix diameter cut-off value of 7 mm and the EP as the initial operator. CONCLUSION: The diagnostic performances of EP-POCUS and RADUS were excellent for AA, with EP-POCUS having even better performance for pediatric AA. Accurate diagnoses may be achieved when the attending EP is the initial POCUS operator and uses a 7-mm cut-off value.

Efficiency of knee ultrasound for diagnosing anterior cruciate ligament and posterior cruciate ligament injuries: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the diagnostic performance of knee ultrasound for anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries. MATERIALS AND METHODS: PubMed and EMBASE databases were searched for diagnostic accuracy studies that used ultrasound for diagnosing ACL and PCL injuries. Bivariate and hierarchical summary receiver operating characteristic modeling was used to evaluate diagnostic performance. Subgroup analysis was performed by assessing studies conducted using the ultrasound technique (functional ultrasound versus conventional ultrasound) for diagnosing ACL injury. We performed meta-regression analyses for a potential source of heterogeneity. RESULTS: Eleven (938 ultrasound/878 patients) and six articles (281 ultrasound/237 patients) were included for ACL and PCL injuries respectively. The summary sensitivity, summary specificity, and area under the hierarchical summary receiver operating characteristic for ACL and PCL injuries were 0.88 (95% confidence interval [CI], 0.81-0.93) and 0.99 (95% CI, 0.49-1.00), 0.96 (95% CI, 0.91-0.98) and 0.99 (95% CI, 0.73-1.00), and 0.97 (95% CI, 0.96-0.98) and 1.00 (95% CI, 0.99-1.00) respectively. In subgroup analysis, there was no significant difference between sensitivity (p = 0.63) and specificity (p = 0.72) of functional and conventional ultrasound. Among the various potential covariates, patient enrollment, patient position, and ultrasound performer were associated with heterogeneity in terms of sensitivity, and proportion of the ACL injury was associated with heterogeneity in terms of specificity. CONCLUSION: Knee ultrasound demonstrates high diagnostic performance for ACL and PCL injuries, particularly when performed by experienced musculoskeletal radiologists. Future prospective studies to compare the cost- and time-effectiveness between ultrasound and magnetic resonance imaging and to determine the optimal ultrasound parameters are warranted.

High performance of critical shoulder angle for diagnosing rotator cuff tears on radiographs.

PURPOSE: Previous studies have reported that a high critical shoulder angle (CSA) is associated with rotator cuff tears (RCTs). However, the available evidence concerning the strength of the association of these parameters with the pathogenesis of RCTs is conflicting. The aim in the present meta-analysis was to assess the diagnostic performance of CSA for detecting RCTs. METHODS: The PubMed and EMBASE databases were searched for diagnostic accuracy studies of CSA for detecting RCT. Quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We calculated the pooled diagnostic accuracy of CSA, including diagnostic odd ratios (DORs) with 95% confidence intervals (CIs). Bivariate random-effect modeling with forest plots and hierarchical summary receiver operating characteristic curves was performed to evaluate the pooled sensitivity and specificity of CSA. For heterogeneity exploration, we performed meta-regression analyses. RESULTS: Eight studies including 902 patients (460 patients with RCT and 442 control patients) were included. According to DOR, CSA was an informative feature for RCT (DOR 8; 95% CI 4-16). The overall diagnostic performance of CSA for RCT was good (sensitivity 71% [95% CI 61-80%]; specificity, 77% [95% CI 65-86%]). Meta-regression analyses revealed that the sensitivity of CSA could be higher for differentiating full-thickness RCTs and normal patients. Furthermore, the specificity of CSA could be higher using a cut-off value of 35°. CONCLUSION: CSA on plain radiographs has good diagnostic performance for RCTs. A cut-off value of 35° is recommended for more accurate diagnosis of full-thickness RCTs. Measuring CSA on plain radiographs may provide clinicians with a readily available and reliable method for detecting RCT in daily practice. LEVEL OF EVIDENCE: Diagnostic studies, Level III.

Diagnostic performance of diffusion-weighted imaging for differentiating benign and malignant gallbladder lesions: A systematic review and meta-analysis.

BACKGROUND: Although diffusion-weighted imaging (DWI) has been characterized as an alternative imaging modality for gallbladder (GB) lesions, it has not been routinely used in clinical practice because of relatively low signal-to-noise ratio. PURPOSE: To assess the sensitivity and specificity of the diagnostic performance of DWI for differentiating benign and malignant GB lesions. STUDY TYPE: Meta-analysis. POPULATION: Patients with GB lesions. FIELD STRENGTH/SEQUENCE: DWI at 3.0T or 1.5T. ASSESSMENT: PubMed and EMBASE were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy guidelines. STATISTICAL TESTS: Bivariate modeling and hierarchical summary receiver operating characteristic (HSROC) modeling were performed to compare the overall diagnostic performance of DWI. Subgroup analyses were performed for qualitative and quantitative assessment of the DWI. Meta-regression analyses were performed according to the characteristics of the patients, study, and MRI. RESULTS: Eight studies (including 557 patients) were included. The DWI exhibited a pooled sensitivity of 91%, a pooled specificity of 87%, and HSROC of 0.95. In subgroup analyses, qualitative assessment (sensitivity, 90%; specificity, 87%; HSROC, 0.94) was more accurate than quantitative assessment (sensitivity, 82%; specificity, 86 %; HSROC, 0.88). On meta-regression analysis, studies that used 3.0T field strength and thinner slices (≤5 mm) reported a significantly higher sensitivity (P ≤ 0.02) than those using only 1.5T field strength and thicker slices (>5 mm). DATA CONCLUSION: DWI can discriminate malignant from benign GB lesions with excellent diagnostic performance in both qualitative and quantitative assessments. To enhance the diagnostic ability of DWI, images obtained with thinner slices (≤5 mm) with 3T field strength and qualitative assessment are recommended. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1375-1388.

Comparison between 3D isotropic and 2D conventional MR arthrography for diagnosing rotator cuff tear and labral lesions: A meta-analysis.

BACKGROUND: Although 3D-isotropic MR arthrography has been characterized as a substitute imaging tool for rotator cuff tear (RCT) and labral lesions, it has not been commonly used in clinical practice because of controversy related to image blurring and indistinctness of structural edges. PURPOSE: To perform a comparison of the diagnostic performance of 3D-isotropic MR arthrography and 2D-conventional MR arthrography for diagnosis of RCT (solely RCT, full/partial-thickness supraspinatus [SST]-infraspinatus [IST] tear, or subscapularis [SSc] tear) and labral lesions. STUDY TYPE: Meta-analysis. POPULATION: Patients with shoulder pain. FIELD STRENGTH/SEQUENCE: 3D-isotropic and 2D-conventional MR arthrography at 3.0T or 1.5T. ASSESSMENT: PubMed and EMBASE were searched following the PRISMA guidelines. STATISTICAL TESTS: Bivariate modeling and hierarchical summary receiver operating characteristic modeling were performed to compare the overall diagnostic performance of 3D-isotropic and 2D-conventional MR arthrography. Multiple-subgroup analyses were performed for diagnosing RCT, full/partial-thickness SST-IST tear, SSc tear, and labral lesions. Meta-regression analyses were performed according to subject, study, and MR arthrography characteristics including 3D-isotropic sequences (turbo spine echo [TSE] vs. gradient echo [GRE]). RESULTS: Eleven studies (825 patients) were included. Overall, 3D-isotropic MR arthrography had similar pooled sensitivity (0.90 [95% CI, 0.87-0.93]) (P = 0.95) and specificity (0.92 [95% CI, 0.87-0.95]) (P = 0.99), relative to 2D-conventional MR arthrography (sensitivity, 0.91 [95% CI, 0.86-0.94]); specificity, 0.92 [95% CI, 0.87-0.95]). Multiple-subgroup analyses showed that sensitivities (P = 0.13-0.91) and specificities (P = 0.26-0.99) on 3D-isotropic MR arthrography for diagnosing RCT, full/partial-thickness SST-IST tear, SSC tear, and labral lesions were not significantly different from 2D-conventional MR arthrography. On meta-regression analysis, 3D-TSE sequence demonstrated higher sensitivity (P < 0.01) than 3D-GRE for RCT and labral lesions. DATA CONCLUSION: 3D-isotropic MR arthrography can replace 2D-conventional MR arthrography. 3D-isotropic MR arthrography using TSE sequence is recommended for more accurate diagnosis, as it demonstrates increased sensitivity. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;48:1034-1045.

ADC as a useful diagnostic tool for differentiating benign and malignant vertebral bone marrow lesions and compression fractures: a systematic review and meta-analysis.

OBJECTIVES: To assess the sensitivity and specificity of quantitative assessment of the apparent diffusion coefficient (ADC) for differentiating benign and malignant vertebral bone marrow lesions (BMLs) and compression fractures (CFs) METHODS: An electronic literature search of MEDLINE and EMBASE was conducted. Bivariate modelling and hierarchical summary receiver operating characteristic modelling were performed to evaluate the diagnostic performance of ADC for differentiating vertebral BMLs. Subgroup analysis was performed for differentiating benign and malignant vertebral CFs. Meta-regression analyses according to subject, study and diffusion-weighted imaging (DWI) characteristics were performed. RESULTS: Twelve eligible studies (748 lesions, 661 patients) were included. The ADC exhibited a pooled sensitivity of 0.89 (95% confidence interval [CI] 0.80-0.94) and a pooled specificity of 0.87 (95% CI 0.78-0.93) for differentiating benign and malignant vertebral BMLs. In addition, the pooled sensitivity and specificity for differentiating benign and malignant CFs were 0.92 (95% CI 0.82-0.97) and 0.91 (95% CI 0.87-0.94), respectively. In the meta-regression analysis, the DWI slice thickness was a significant factor affecting heterogeneity (p < 0.01); thinner slice thickness (< 5 mm) showed higher specificity (95%) than thicker slice thickness (81%). CONCLUSIONS: Quantitative assessment of ADC is a useful diagnostic tool for differentiating benign and malignant vertebral BMLs and CFs. KEY POINTS: • Quantitative assessment of ADC is useful in differentiating vertebral BMLs. • Quantitative ADC assessment for BMLs had sensitivity of 89%, specificity of 87%. • Quantitative ADC assessment for CFs had sensitivity of 92%, specificity of 91%. • The specificity is highest (95%) with thinner (< 5 mm) DWI slice thickness.

Diagnostic performance of dual-energy CT for the detection of bone marrow oedema: a systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review and meta-analysis was to assess the sensitivity and specificity of dual-energy CT (DECT) for the detection of bone marrow oedema (BME). METHODS: An electronic search of the PubMed and EMBASE databases was conducted. Bivariate modelling and hierarchical summary receiver-operating characteristic modelling were performed to evaluate the overall diagnostic performance of DECT for BME. Subgroup analysis was performed according to the assessment type (qualitative vs. quantitative) and anatomical location (spine vs. appendicular skeleton). Meta-regression analyses were performed according to the subject, study, and DECT characteristics. RESULTS: Twelve eligible studies (1901 lesions, 450 patients) were included. DECT exhibited a pooled sensitivity of 0.85 [95% confidence interval (CI): 0.78-0.90] and a pooled specificity of 0.97 (95% CI: 0.92-0.98) for BME detection. In addition, the diagnostic performance of qualitative assessment (sensitivity, 0.85; specificity, 0.97) was higher than that of quantitative assessment (sensitivity, 0.84; specificity, 0.88) of DECT findings. The diagnostic performance of DECT for the spine (sensitivity, 0.84; specificity, 0.98) and appendicular skeleton (sensitivity, 0.84; specificity, 0.93) were excellent. According to meta-regression analysis, the use of a tin filter, ≥ 2 image planes, and a slice thickness < 1 mm tended to exhibit higher sensitivity and hyperacute stage BME (< 24 h) tended to exhibit lower sensitivity. CONCLUSIONS: These findings indicate that DECT has excellent sensitivity and specificity for BME detection. Qualitative assessment of DECT findings obtained using a tin filter, ≥ 2 image planes, and a 0.5-1-mm slice thickness in the acute stage BME (≥24 h) is recommended for more sensitive diagnosis. KEY POINTS: • Overall, DECT is useful for the detection of BME (sensitivity, 85%; specificity-97%). • Qualitative assessment (sensitivity-85%; specificity-97%) is more accurate than quantitative assessment (sensitivity-84%; specificity-88%). • DECT showed excellent diagnostic performance for both the spine/appendicular skeleton (sensitivity-84%/84%; specificity-98%/93%).

Efficacy of double inversion recovery magnetic resonance imaging for the evaluation of the synovium in the femoro-patellar joint without contrast enhancement.

OBJECTIVE: To investigate the efficacy of double inversion recovery (DIR) sequence for evaluating the synovium of the femoro-patellar joint without contrast enhancement (CE). METHODS: Two radiologists independently evaluated the axial DIR and CE T1-weighted fat-saturated (CET1FS) images of 33 knees for agreement; the visualisation and distribution of the synovium were evaluated using a four-point visual scaling system at each of the five levels of the femoro-patellar joint and the location of the thickest synovium. The maximal synovial thickness at each sequence was measured by consensus. RESULTS: The interobserver agreement was good (κ = 0.736) for the four-point scale, and was excellent for the location of the thickest synovium on DIR and CET1FS (κ = 0.955 and 0.954). The intersequential agreement for the area with the thickest synovium was also excellent (κ = 0.845 and κ = 0.828). The synovial thickness on each sequence showed excellent correlation (r = 0.872). CONCLUSION: The DIR showed as good a correlation as CET1FS for the evaluation of the synovium at the femoro-patellar joint. DIR may be a useful MR technique for evaluating the synovium without CE. KEY POINTS: • DIR can be useful for evaluating the synovium of the femoro-patellar joint. • Interobserver and intersequential agreements between DIR and CET1FS were good. • Mean thickness of the synovium was significantly different between two sequences.

Diagnostic Performance of In-Phase and Opposed-Phase Chemical-Shift Imaging for Differentiating Benign and Malignant Vertebral Marrow Lesions: A Meta-Analysis.

OBJECTIVE: The purpose of this study was to assess the diagnostic performance of in-phase and opposed-phase chemical-shift imaging (CSI) for differentiating benign and malignant vertebral bone marrow lesions (BMLs). MATERIALS AND METHODS: The PubMed and EMBASE databases were searched for diagnostic accuracy studies comparing conventional gradient-echo CSI or the Dixon method for differentiating benign and malignant vertebral BMLs with histopathologic or best-value comparator results. Methodologic quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Bivariate modeling and hierarchical summary ROC (HSROC) modeling were performed to evaluate the diagnostic performance of CSI. For heterogeneity exploration, we performed meta-regression analyses. RESULTS: Twelve studies including 663 lesions of 591 patients were included. CSI showed a pooled sensitivity of 0.92 (95% CI, 0.84-0.96), pooled specificity of 0.89 (95% CI, 0.81-0.93), and HSROC AUC of 0.95 (95% CI, 0.93-0.97) for differentiating benign from malignant vertebral BMLs. The corresponding values for differentiating benign from malignant compression fractures were 0.96 (95% CI, 0.81-0.99), 0.89 (95% CI, 0.83-0.93), and 0.93 (95% CI, 0.91-0.95). In meta-regression analysis, minimum TR (< 100 ms), flip angle (< 50°), and Dixon method tended to have higher specificity. Study population, slice thickness (< 5 mm), minimum TE (< 2.3 ms), flip angle (< 50°), and blinding also significantly affected heterogeneity (p < 0.05). CONCLUSION: In-phase and opposed-phase CSI has excellent diagnostic performance for differentiating benign and malignant vertebral BMLs. CSI with a short TR, small flip angle, and Dixon method is recommended for more accurate diagnosis as specificity increases.

Point-of-care wrist ultrasonography in trauma patients with ulnar-sided pain and instability.

OBJECTIVE: We evaluated the effectiveness of point-of-care wrist ultrasonography compared with 3T-magnetic resonance imaging (MRI) for diagnosing triangular fibrocartilage complex (TFCC) injuries in trauma patients with ulnar-sided pain and instability. Moreover, we assessed the inter-observer variability between an emergency physician and a musculoskeletal radiology fellow. MATERIAL AND METHODS: A prospective cross-sectional study was conducted in an emergency department; patients with ulnar-sided sprain and instability were recruited. An emergency physician and a musculoskeletal radiology fellow independently evaluated the TFC, meniscal homologue, volar and dorsal distal radioulnar ligaments, and extensor carpi ulnaris using point-of-care ultrasonography. Findings were classified as normal, partial rupture, or complete rupture. Wrist 3T-MRI was used as the reference standard. We compared the diagnostic values for point-of-care ultrasonography obtained by both reviewers using DeLong's test. Intra-class correlation coefficients (ICCs) were calculated for agreement between each reviewer and the reference standard, and directly between the two reviewers. RESULTS: Sixty-five patients were enrolled. Point-of-care wrist ultrasonography showed acceptable sensitivity (97.2-99.1%), specificity (96.8-97.3%), and accuracy (96.9-97.9%); these diagnostic performance values did not differ significantly between reviewers (p=0.58-0.98). Agreement between each reviewer and the reference standard was excellent (emergency physician, ICC=0.964; musculoskeletal radiology fellow, ICC=0.976), as was the inter-observer agreement (ICC=0.968). CONCLUSION: Point-of-care wrist ultrasonography is as precise as MRI for detecting TFCC injuries, and can be used for immediate diagnosis and further preoperative imaging. Moreover, it may shorten the interval from emergency department admission to surgical intervention while reducing costs.

Intentional cyanoacrylate ingestion: A rare cause of delayed gastric perforation requiring gastric wedge resection.

Cyanoacrylate (LOCTITE® 401™) is a fast-acting adhesive available nationwide, with medical and household uses. Most cases of cyanoacrylate exposure are accidental and occur in children less than 5years old. Various routes of exposure have been reported including the dermal, oral, ocular, otic, nasal, and urethral routes; however, very few result in serious complication and mortality. Although a few cases of airway obstruction related to cyanoacrylate ingestion have been reported, intentional cyanoacrylate ingestion-induced gastrointestinal tract injury has scarcely been reported. In addition, there have been no reports of serious complications following intentional cyanoacrylate ingestion requiring surgical intervention. Herein, we report a case of intentional ingestion of cyanoacrylate in a 70-year-old man who required gastric wedge resection due to delayed gastric perforation.