Radiological assessment and surgical management of cervical spine involvement in patients with rheumatoid arthritis.

The purpose of the present systematic review was to describe the diagnostic evaluation of rheumatoid arthritis in the cervical spine to provide a better understanding of the indications and options of surgical intervention. We performed a literature review of Pub-med, Embase, and Scopus database. Upon implementing specific inclusion and exclusion criteria, all eligible articles were identified. A total of 1878 patients with Rheumatoid Arthritis (RA) were evaluated for cervical spine involvement with plain radiographs. Atlantoaxial subluxation (AAS) ranged from 16.4 to 95.7% in plain radiographs while sub-axial subluxation ranged from 10 to 43.6% of cases. Anterior atlantodental interval (AADI) was found to between 2.5 mm and 4.61 mm in neutral and flexion position respectively, while Posterior Atlantodental Interval (PADI) was between 20.4 and 24.92 mm. 660 patients with RA had undergone an MRI. A pannus diagnosis ranged from 13.33 to 85.36% while spinal cord compression was reported in 0-13% of cases. When it comes to surgical outcomes, Atlanto-axial joint (AAJ) fusion success rates ranged from 45.16 to 100% of cases. Furthermore, the incidence of postoperative subluxation ranged from 0 to 77.7%. With regards to AADI it is evident that its value decreased in all studies. Furthermore, an improvement in Ranawat classification was variable between studies with a report improvement frequency by at least one class ranging from 0 to 54.5%. In conclusion, through careful radiographic and clinical evaluation, cervical spine involvement in patients with RA can be detected. Surgery is a valuable option for these patients and can lead to improvement in their symptoms.

Blood Biomarkers for Prediction of Positive CT Findings in Mild Traumatic Brain Injury in Paediatric Population.

BACKGROUND: Paediatric Traumatic Brain Injury (TBI) has received less research attention compared to TBI in adults, despite its potential morbidity in all ages. Our aim was to determine whether neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and glucose levels at admission can reliably predict the need for imaging in children presenting with mild TBI. METHODS: We retrospectively reviewed the clinical records of paediatric patients who presented in the emergency department with mild TBI within a 5 year period and had undergone computed tomography (CT) scan of the head. RESULTS: Overall, 43 eligible patients were included in the study, with falls being the most commonly reported cause of injury. Twenty-three children had positive CT findings. Patients with abnormal CT findings were found to have higher NLR ratios compated with patients with normal CT, with the mean NLR on admission being 5.2 ± 3.8. Children with abnormal CT findings had lower PLR levels and higher glucose levels at presentation compared to children with normal CT, however the differences were not statistically significant. Using the receiver operating characteristic (ROC) curve, we found that a NLR cut off value of 6.1 yielded a sensitivity of 54.2% and a specificity of 89.5% for the prediction of abnormal CT findings. CONCLUSIONS: The findings of this study suggest that NLR may have a role in CT decision-making in the emergency department for mild TBI in paediatric patients.

Stereotactic radiosurgery for idiopathic glossopharyngeal neuralgia: A systematic review.

Background: Stereotactic radiosurgery (SRS) has recently gained space as an accepted non-invasive alternative treatment option for drug resistant Glossopharyngeal neuralgia (GPN). The purpose of this systematic review was to provide an overview of the outcomes of SRS treatment in patients with GPN. Methods: A literature review until March 2023 was performed. Data about patient's demographics, complications and recurrence rates, additional treatment post procedure as well as pain outcomes in the short and long term were collected. Studies without reported pain outcomes were excluded. Results: Sixteen studies with a total of 97 patients diagnosed with GPN who had undergone SRS were identified. The mean reported maximal radiation dose ranged from 70 to 88.7 Gy with the glossopharyngeal meatus (GPM) being the most common target in 12/16 studies. The median time from SRS till pain response was between 2 and 120 days. The mean proportion of patients requiring further treatment after SRS ranged from 11.1 to 57.14% in a time frame between 2 and 36 months post procedure. Favourable pain response rates after SRS (BNI-IIIb) ranged from 60% to 100% and 57.1%-100% in short and long term respectively. Conclusion: SRS for GPN remains a safe alternative to surgery with low complication rates and favourable pain outcomes in both short and long term.

Imaging of Peritoneal Metastases in Ovarian Cancer Using MDCT, MRI, and FDG PET/CT: A Systematic Review and Meta-Analysis.

This review aims to compare the diagnostic performance of multidetector CT (MDCT), MRI, including diffusion-weighted imaging, and FDG PET/CT in the detection of peritoneal metastases (PMs) in ovarian cancer (OC). A comprehensive search was performed for articles published from 2000 to February 2023. The inclusion criteria were the following: diagnosis/suspicion of PMs in patients with ovarian/fallopian/primary peritoneal cancer; initial staging or suspicion of recurrence; MDCT, MRI and/or FDG PET/CT performed for the detection of PMs; population of at least 10 patients; surgical results, histopathologic analysis, and/or radiologic follow-up, used as reference standard; and per-patient and per-region data and data for calculating sensitivity and specificity reported. In total, 33 studies were assessed, including 487 women with OC and PMs. On a per-patient basis, MRI (p = 0.03) and FDG PET/CT (p < 0.01) had higher sensitivity compared to MDCT. MRI and PET/CT had comparable sensitivities (p = 0.84). On a per-lesion analysis, no differences in sensitivity estimates were noted between MDCT and MRI (p = 0.25), MDCT and FDG PET/CT (p = 0.68), and MRI and FDG PET/CT (p = 0.35). Based on our results, FDG PET/CT and MRI are the preferred imaging modalities for the detection of PMs in OC. However, the value of FDG PET/CT and MRI compared to MDCT needs to be determined. Future research to address the limitations of the existing studies and the need for standardization and to explore the cost-effectiveness of the three imaging modalities is required.

A systematic review on the prevalence of preoperative and postoperative depression in lumbar fusion.

BACKGROUND: Depression and Degenerative Spine Disease (DSD) frequently co-exist. Pooled prevalence estimates of depression before and after lumbar fusion surgery has not been analyzed before. The purpose of this systematic review was to estimate the pre- and post-operative prevalence of depression in patients with DSD undergoing lumbar fusion. METHODS: A literature review until April 30th 2022 was performed. All studies on DSD patients undergoing lumbar spine fusion surgery with either a history of formal diagnosis of depression or a recording of depression using a validated tool were included. Patients with other psychiatric conditions or undergoing a different form of spinal surgery were excluded. Risk of bias of the included studies was evaluated using the Newcastle-Ottawa Scale. RESULTS: Fifteen (15) studies with a total of 98.375 patients met the inclusion and exclusion criteria and were included in the analysis. The prevalence estimate of depression in patients before surgery was 15,35 % (95% CI: 10,56-20,86%). In the 7 studies including patients who had undergone lumbar fusion, the pooled prevalence was estimated 11,46% (95% CI: 8,11-15,30%). CONCLUSION: An increased prevalence of depression in patients undergoing lumbar spine fusion was noted. Given the correlation between depression and poor surgical outcomes, strategies should be identified to prevent and treat depression in these patients.

Differentiation Between True Tumor Progression of Glioblastoma and Pseudoprogression Using Diffusion-Weighted Imaging and Perfusion-Weighted Imaging: Systematic Review and Meta-analysis.

BACKGROUND: On brain magnetic resonance imaging, both diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) are used to evaluate cerebral tumors. The purpose of this meta-analysis was to evaluate and compare the diagnostic performance of DWI and PWI in differentiating between pseudoprogression and true tumor progression of glioblastoma. METHODS: We performed a systematic review of the PubMed database from January 2000 to December 2019 for relevant studies. After application of specific inclusion and exclusion criteria, the eligible articles were evaluated for methodologic quality and risk of bias using the updated Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool. From the published study results, the pooled sensitivity, pooled specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio and their corresponding confidence intervals (% CI), and the area under the curve, were calculated individually for DWI and PWI. RESULTS: The meta-analysis included 24 studies, with a total of 900 patients. DWI was found to be slightly superior in terms of sensitivity and specificity, 0.88 (% CI 0.83-0.92) and 0.85 (% CI 0.78-0.91), respectively, compared with the respective values of PWI, 0.85 (% CI 0.81-0.89) and 0.79 (% CI 0.74-0.84). On comparison of the overall diagnostic accuracy of the MRI modalities using their respective area under the curve values (0.9156 for DWI, 0.9072 for PWI), no significant difference was demonstrated between the 2. CONCLUSIONS: Both DWI and PWI provided optimal diagnostic performance in differentiating pseudoprogression from true tumor progression in cerebral glioblastoma, and neither technique proved to be superior.

Diagnostic performance of diffusion and perfusion MRI in differentiating high from low-grade meningiomas: A systematic review and meta-analysis.

OBJECTIVES: The purpose of the present meta-analysis and systematic review was to evaluate the currently published data on the potential role of perfusion (PWI) and diffusion (DWI) weighted imaging for the assessment of meningioma grade. PATIENTS AND METHODS: A search of MEDLINE and relative reference lists was conducted to identify all the eligible studies assessing the diagnostic performance of DWI and PWI in grading meningiomas. Meta-Disc and Rev-Man were used for the statistical analysis. Methodological quality and risk of bias were assessed with the use of the updated Quality assessment of the diagnostic accuracy (QUADAS-2) tool. Pooled sensitivity, specificity and area under the summary receiver operating characteristic curve were calculated individually for DWI and PWI to demonstrate the diagnostic performance of each modality. RESULTS: Fourteen studies with 1063 patients were included. The 8 studies evaluating DWI showed a pooled sensitivity of 80% (95% CI, 74%-86%) and a pooled specificity of 76% (95% CI, 72%-79%). As for the 6 remaining studies concerning PWI, the pooled sensitivity and specificity were found 80% (95% CI, 71%-88%) and 91% (95% CI, 87%-94%), respectively. The area under the SROC curve was 0.94 (95% CI) for PWI and 0.91 (95% CI) for DWI. The comparison of the two AUCs showed that neither technique was superior with regards to the diagnostic performance. CONCLUSIONS: The current evidence proves that both techniques are efficient at differentiating high from low-grade meningiomas.