Computed tomography pulmonary angiography (CTPA) for the detection of pulmonary embolism (PE) among trauma patients: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Computed tomography pulmonary angiography (CTPA) is a standard imaging technique employed for the detection of pulmonary embolism (PE). This systematic review and meta-analysis aims to examine the prevalence of PE among the trauma patients undergoing CTPA. METHODS: A comprehensive search across PubMed, Scopus, Google Scholar, and Web of Science yielded 13 studies encompassing 5,570 individuals conducted following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline. Studies that used CTPA for the detection of PE among the trauma patients were selected. This resulted in an evaluation of prevalence, trauma types, clinical manifestations, radiological findings, and mortality rates of PE among traumatic patients undergoing CTPA. RESULTS: The overall prevalence of PE among trauma patients undergoing CTPA was 18% (95% CI = 13-24%). After pooling the existing data, femur fractures were determined to be the most prevalent trauma type (12%). The most prevalent clinical manifestations of PE among trauma patients included shortness of breath, chest pain, and altered vital signs. Radiological findings encompassed various pulmonary abnormalities, such as opacity, ground-glass opacities, and pleural effusions. Mortality rates of PE among the trauma patients ranged from 0% to 29.4% across the included studies. CONCLUSION: This study provides comprehensive insights into the prevalence, clinical manifestations, radiological findings and mortality of PE among trauma patients undergoing CTPA. According to our findings, lower threshold for CTPA is recommended in patients with lower extremity or spine fractures.

Role of Intravoxel Incoherent Motion and Dynamic-Contrast-Enhanced Perfusion in Response Prediction of Patients with Colorectal Cancer after Neoadjuvant Chemotherapy.

BACKGROUND: Colorectal cancer (CRC) is a complex malignancy requiring multimodal treatment strategies, including neoadjuvant chemoradiation therapy (Neo-CRT), to improve patient outcomes. However, the response to Neo-CRT varies among individuals, which necessitates the development of reliable predictors of treatment response. The present study aimed to investigate the role of intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced (DCE) perfusion in predicting treatment response in CRC patients after Neo-CRT. METHODS: This study was conducted on patients diagnosed with locally advanced CRC who received Neo-CRT. IVIM and DCE perfusion imaging were performed before and after CRT. Quantitative parameters, including perfusion fraction (f), diffusion coefficient (D), and transfer constant (Ktrans), were calculated from the imaging data. Treatment response was assessed based on the pathological response after surgery. Statistical data were analyzed in SPSS v. 26 using the t-test and the chi-square method. RESULTS: A total of 51 patients (female: male = 22:29, mean age = 58.14±3.49) participated in the study. Among all the patients, 15 (29.4%) cases had good responses, while 36 (70.58%) cases did not respond to treatment. All DCE parameters showed higher sensitivity and specificity than IVIM D*. Ve, Kep, and DCE Ktrans indicated significant predictive power for treatment response. Ktrans was the most accurate parameter for predicting response to treatment. Overall sensitivity and specificity of DCE were 88.8% [95% CI: 80-95.6], and 80 % [95% CI: 65-90], and those of IVIM were 65.5% and 81%, respectively. Sensitivity and specificity for DCE + IVIM were 79.5% and 93.5%, and those of DCE + IVIM + standard magnetic resonance imaging were 80.2% and 86%, respectively. CONCLUSION: IVIM and DCE perfusion imaging could serve as promising tools for predicting treatment response in CRC patients after Neo-CRT.

Evidence Supporting Diagnostic Value of Liver Imaging Reporting and Data System for CT- and MR Imaging-based Diagnosis of Hepatocellular Carcinoma: A Systematic Review and Meta-analysis.

Background: Based on the Liver Imaging Data and Reporting System (LI-RADS) guidelines, Hepatocellular Carcinoma (HCC) can be diagnosed using imaging criteria in patients at risk of HCC. Objective: This study aimed to assess the diagnostic value of LI-RADS in high-risk patients with HCC. Material and Methods: This systematic review is conducted on international databases, including Google Scholar, Web of Science, PubMed, Embase, PROQUEST, and Cochrane Library, with appropriate keywords. Using the binomial distribution formula, the variance of each study was calculated, and all the data were analyzed using STATA version 16. The pooled sensitivity and specificity were determined using a random-effects meta-analysis approach. Also, we used the chi-squared test and I2 index to calculate heterogeneity among studies, and Funnel plots and Egger tests were used for evaluating publication bias. Results: The pooled sensitivity was estimated at 0.80 (95% CI 0.76-0.84). According to different types of Liver Imaging Reporting and Data Systems (LI-RADS), the highest pooled sensitivity was in version 2018 (0.83 (95% CI 0.79-0.87) (I2: 80.6%, P of chi 2 test for heterogeneity <0.001 and T2: 0.001). The pooled specificity was estimated as 0.89 (95% CI 0.87-0.92). According to different types of LI-RADS, the highest pooled specificity was in version 2014 (93.0 (95% CI 89.0-96.0) (I2: 81.7%, P of chi 2 test for heterogeneity <0.001 and T2: 0.001). Conclusion: LI-RADS can assist radiologists in achieving the required sensitivity and specificity in high-risk patients suspected to have HCC. Therefore, this strategy can serve as an appropriate tool for identifying HCC.

Value of Conventional MRI, DCE-MRI, and DWI-MRI in the Discrimination of Metastatic from Non-Metastatic Lymph Nodes in Rectal Cancer: A Systematic Review and Meta-Analysis Study.

BACKGROUND: Today, despite many studies on the diagnosis of metastasis to lymph nodes (LNs) in Rectal Cancer (RC), its diagnosis is still very challenging for radiologists. The purpose of the present study was to the assessment of the diagnostic value of conventional MRI, DCE-MRI, and DWI-MRI in the discrimination of metastatic from non-metastatic lymph nodes in RC. METHODS: In the present meta-analysis study, we surveyed international databases including PubMed, Scopus, Embase, and Science Direct with appropriate keywords. Using the binomial distribution formula, the variance of each study was calculated and the data were analyzed using STATA version 14. Finally, the results of the studies were entered into the random-effects meta-analysis.  Also, we used the chi-squared test and I2 index to calculate heterogeneity among studies, and for evaluating publication bias, Funnel plots and Egger tests were used. RESULTS: 31 articles published between 2005 and 2021, comprising 2517 patients were included in the present study. The sensitivity and specificity of DCE-MRI were 83% (74% to 80%), and 86% (80% to 93%), respectively with PPV 84% (76% to 89%) and NPV 88% (79% to 95%). Also, the sensitivity and specificity of DWI-MRI were 81% (74% to 88%), and 74% (78% to 91%), respectively with PPV 63% (54% to 74%), NPV 85% (77% to 93%), AUC 80 % (75% to 86%) and accuracy 82% (75% to 88%). For conventional MRI, the sensitivity 74% (67% to 80%), specificity 77% (71% to 83%), PPV 62% (48% to 69%), NPV 70% (62% to 77%), AUC 78% (72% to 83%) and 71% accuracy (68% to 78%) was obtained. CONCLUSION: Based on our finding DCE-MRI is the most suitable technique for the discrimination of metastatic lymph nodes in rectal cancer.