RESUMEN
PURPOSE: This systematic review and meta-analysis aimed to systematically evaluate and enhance the understanding of optimal management strategies for serpentine aneurysms. METHODS: A systematic search was conducted in Medline, Scopus, and Cochrane databases up to July 8, 2024, using relevant keywords. Studies included were case series, prospective or retrospective cohorts, or randomized controlled trials with data on clinical and angiographic outcomes of intracranial serpentine aneurysms. Data extraction and quality assessment were performed independently by two authors. Statistical analysis was conducted using R, with pooled estimates under a random-effects model. RESULTS: Ten studies comprising 70 patients with 71 serpentine aneurysms were included. The majority (92.9%) were giant aneurysms. The overall rate of procedure-related complications was 33%, morbidity was 13%, and mortality was 13%. Good neurological outcomes were achieved in 76% of cases. For unruptured aneurysms, the complication rate was 34%, while no complications were observed in ruptured aneurysms. Comparative analysis between ruptured and unruptured aneurysms showed no significant differences in outcomes or complications. The technical success rate was 91%. Reconstructive methods showed a slightly higher rate of good neurological outcomes (77%) compared to deconstructive methods (70%), though complication rates were similar. CONCLUSION: Both reconstructive and deconstructive endovascular treatments for serpentine aneurysms are effective, with high rates of good neurological outcomes and acceptable complication rates.
RESUMEN
PURPOSE: In this study, we aimed to assess the effectiveness of malignancy stratification algorithms of the American College of Radiology (ACR) and European Thyroid Association (ETA) in the delineation of thyroid nodules using a database of nodules that were unequivocally diagnosed by means of histopathological examination and meticulously matched with the imaged nodules. METHODS: A total of 165 patients having 251 thyroid nodules with histopathologically proven definitive diagnoses during a 5-year period were included in this study. All patients had preoperatively undergone ultrasonography (US) examination, and US characteristics of the thyroid nodules were retrospectively analyzed and assigned in compliance with the thyroid imaging reporting and data system categories recommended by the ACR (ACR-TIRADS) and ETA (EU-TIRADS). The diagnostic effectiveness in the delineation of thyroid nodules and unnecessary fine-needle aspiration (FNAB) rates were evaluated. RESULTS: Overall, 189 nodules (75.30%) were diagnosed as benign, while 62 nodules (24.70%) were reported to be malignant based on histopathological assessment. Sensitivity and specificity rates were 71% and 75% for ACR-TIRADS and 73% and 80% for EU-TIRADS. The area under the curve values were 0.78 and 0.80 for ACR-TIRADS and EU-TIRADS, respectively. The unnecessary FNAB rates were 61% for ACR-TIRADS and 64% for EU-TIRADS as per the recommended criteria of each algorithm. CONCLUSION: The diagnostic performance of both malignancy stratification systems was signified to be moderate and sufficient in a cohort of nodules with definite histopathological diagnosis. In light of our results, we demonstrated the strengths and weaknesses of the ACR- and EU-TIRADS for physicians who should be familiar with them for optimal management of thyroid nodules.