Clinical utility of ultrasonography imaging in musculoskeletal conditions: a systematic review and meta-analysis. (Response to letter to editor)

Background: Carotid plaque morphology plays an important role in determining outcome of carotid artery stenting (CAS). Intravascular ultrasound (IVUS) and its extension VH (Virtual Histology)-IVUS evaluate plaque characteristics in real time and guide decision making during stenting. To date, there is no consensus about indications of IVUS and its validated methods. This systematic review and meta-analysis aims to evaluate the clinical utility of IVUS in carotid artery interventions (CAS) and develop a future consensus for research and practice parameters. Methods: A systematic review and meta-analysis was performed of the English literature articles published till February 2021. Studies reporting on IVUS parameters and findings and also its performance compared with other imaging modalities were included in review. Pooled prevalence with 95% confidence intervals (CI) was calculated. The statistical analysis was conducted in R version 3.6.2. Results: A total of 2015 patients from 29 studies were included. Proportional meta-analysis was performed on 1566 patients from 11 studies. In 9 studies, stroke/transient ischemic attack (TIA) had a pooled prevalence of 4% (95% CI 3%–5%) while asymptomatic stroke had a pooled prevalence of 46% (95% CI 31%–62%) in 4 studies following IVUS. Two studies reported that IVUS detected more plaque protrusion compared with angiography (n=33/396 vs 11/396). IVUS led to stent type or size change in 8 of 48 cases which were missed on angiography in 3 other studies. Concordance between VH-IVUS and true histology was good at 80% to 85% reported in 2 studies. Conclusions: This systematic review and meta-analysis showed, though IVUS fared better to computed tomography (CT)/magnetic resonance (MR) angiography for better stent selection during CAS, with low to moderate risk of bias in the studies included. However, large scale, preferably randomized controlled studies are needed to predict its role in determining clinical outcome.

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Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta‐analysis

Journal of Clinical Nursing ◽

10.1111/jocn.15192 ◽

2020 ◽

Vol 29 (9-10) ◽

pp. 1527-1538 ◽

Cited By ~ 1

Author(s):

Jacqueline K. Benfield ◽

Lisa F. Everton ◽

Philip M. Bath ◽

Timothy J. England

Keyword(s):

Systematic Review ◽

Acute Stroke ◽

Clinical Utility ◽

Meta Analysis

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Tensor Fascia Latae Muscle Structure and Activation in Individuals With Lower Limb Musculoskeletal Conditions: A Systematic Review and Meta-Analysis

Sports Medicine ◽

10.1007/s40279-019-01251-1 ◽

2020 ◽

Vol 50 (5) ◽

pp. 965-985

Author(s):

Manuela Besomi ◽

Liam Maclachlan ◽

Rebecca Mellor ◽

Bill Vicenzino ◽

Paul W. Hodges

Keyword(s):

Systematic Review ◽

Lower Limb ◽

Meta Analysis ◽

Musculoskeletal Conditions ◽

Muscle Structure

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Accuracy and clinical utility of in vitro cytometric profiling to personalize chemotherapy: Preliminary findings of a systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e22188 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e22188-e22188 ◽

Cited By ~ 1

Author(s):

Christian Apfel ◽

Kimberly Souza ◽

Cyrill Hornuss ◽

Larry Weisenthal ◽

Robert Alan Nagourney

Keyword(s):

Systematic Review ◽

Patient Outcomes ◽

Sensitivity And Specificity ◽

Clinical Utility ◽

Tumor Response ◽

Meta Analysis ◽

Standard Of Care ◽

Tumor Diameter ◽

Guided Therapy

e22188 Background: Cytometric analysis, or in-vitro functional profiling, has been developed as a method to predict tumor response to different drugs with the premise to personalize chemotherapy and improve patient outcomes. Methods: We performed a systematic review and a meta-analysis a) of correlative studies using cytometric profiling that reported diagnostic accuracy (sensitivity and specificity) and b) of effectiveness studies comparing patient outcomes when allocated to treatment guided by a cytometric assay versus population-based standard of care. We used Meta-DiSc software to find pooled sensitivity and specificity and analyze the summary receiver operating characteristic (sROC) curve and used Review Manager 5.1 to generate forest plots on overall tumor response (50% or greater decrease in tumor diameter) and on 1-year overall survival. Results: We included 28 mostly retrospective trials (n=664) reporting accuracy data and 15 prospective trials (n=1917) reporting therapeutic efficacy data. The accuracy of correlative study revealed an overall sensitivity of 0.922 (95% confidence interval 0.888 to 0.948), specificity of 0.724 (95% CI 0.669 to 0.774) and an area under the sROC curve of 0.893 (SE=0.023, p<0.001). Studies comparing the clinical utility revealed a two-fold overall tumor response for an assay-guided therapy versus standard of care therapy (odds ratio 2.04, 95% CI 1.62 to 2.57, p<0.001). Similarly, patients who received assay-guided therapy compared to those who received standard of care or physician’s choice had a significantly higher 1-year survival rate (OR 1.44, 95% CI 1.06 to 1.95, p=0.02). Conclusions: Despite various limitations of individual studies, the aggregate and fairly consistent evidence of these data suggests cytometric profiling to be accurate, to improve overall tumor response, and to increase 1-year patient survival. Given the enormous potential for our society, a well-designed and sufficiently-powered randomized controlled trial is urgently needed to validate these results.

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