scholarly journals Does Magnetic Resonance Imaging Grading Correlate With Return to Sports After Bone Stress Injuries? A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652199380
Author(s):  
Tim Hoenig ◽  
Adam S. Tenforde ◽  
André Strahl ◽  
Tim Rolvien ◽  
Karsten Hollander
Keyword(s):  
Magnetic Resonance Imaging ◽  
Systematic Review ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Return To Sports ◽  
Resonance Imaging ◽  
Bone Stress ◽  
Stress Injuries ◽  
The Mean ◽  
Mean Time

Background: While some studies have failed to reveal any significant relationship between magnetic resonance imaging (MRI) grading and return to sports after bone stress injuries, others have reported either a linear or nonlinear relationship. Purpose: To evaluate the prognostic value of MRI grading for time to return to sports and rate of return to sports after bone stress injuries. Study Design: Systematic review and meta-analysis. Methods: A systematic search was performed in PubMed, Web of Science, SPORTDiscus, and Google Scholar. Studies reporting return to sports data after bone stress injuries using MRI grading systems were included in this review. The risk of bias was evaluated using the Quality in Prognosis Studies tool. Meta-analyses were performed to summarize the mean time to return to sports. The Pearson correlation was used to determine the relationship between time to return to sports and MRI grade. A meta-analysis of proportions was conducted to determine the percentage of athletes who successfully returned to sports. Results: A total of 16 studies with 560 bone stress injuries met inclusion criteria. Higher MRI-based grading was associated with an increased time to return to sports ( P < .00001). Pooled data revealed that higher MRI-based grading correlated with a longer time to return to sports ( r = 0.554; P = .001). Combining all anatomic locations, the mean time to return to sports was 41.7 days (95% CI, 30.6-52.9), 70.1 days (95% CI, 46.9-93.3), 84.3 days (95% CI, 59.6-109.1), and 98.5 days (95% CI, 85.5-112.6) for grade 1, 2, 3, and 4 injuries, respectively. Trabecular-rich sites of injury (eg, pelvis, femoral neck, and calcaneus) took longer to heal than cortical-rich sites of injury (eg, tibia, metatarsal, and other long-bone sites of injury). Overall, more than 90% of all athletes successfully returned to sports. Conclusion: The findings from this systematic review indicate that MRI grading may offer a prognostic value for time to return to sports after the nonsurgical treatment of bone stress injuries. Both MRI grade and location of injury suggest that individually adapted rehabilitation regimens and therapeutic decisions are required to optimize healing and a safe return to sports.

scholarly journals Correlation between disability measure and Black Hole (T1 hypointense lesion) lesion load in brain magnetic resonance imaging of patients with multiple sclerosis: Protocol for a systematic review and meta-analysis

2021 ◽  
Author(s):  
Amir Valizadeh ◽  
Elham Barati ◽  
Mohammad Ali Sahraian ◽  
Mohammad Reza Fattahi ◽  
Mana Moassefi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Systematic Review ◽  
Web Of Science ◽  
Citation Index ◽  
Meta Analysis ◽  
Brain Magnetic Resonance Imaging ◽  
Correlation Coefficients ◽  
Resonance Imaging ◽  
Lesion Load

Abstract Rationale: As the role of neurodegeneration in the pathophysiology of multiple sclerosis (MS) has become more prominent, the formation and evolution of chronic or persistent T1-hypointense lesions (Black Holes) have been used as markers of axonal loss and neuronal destruction to measure disease activity. However, findings regarding this subject are controversial. In this study we aim to clarify the level of importance of T1 hypointense lesions for estimating the prognosis of patients.Objectives: To evaluate the correlation between T1 hypointensities (Black holes) lesion load (lesion mean volume) on brain MRI with disability level of patients with Relapsing-Remitting Multiple Sclerosis (RRMS) or Secondary-Progressive Multiple Sclerosis (SPMS).Data sources: We will search MEDLINE (through PubMed), Embase, CENTRAL, Science Citation Index – Expanded (Web of Science), and Conference Proceedings Citation Index – Science (Web of Science). We won’t consider any timeframe, language, or geographical restrictions.Methods: Standard systematic review protocol methodology is employed. Eligibility criteria is reported in line with PICOTS system. Population is limited to adult patients diagnosed with RRMS or SPMS, based on the McDonald criteria. Index (prognostic factor) of interest will be T1 hypointense (black hole) lesion mean volume (lesion load) on brain Magnetic Resonance Imaging (MRI). There will be no comparators. Outcome of interest will be the disability measure using Expanded Disability Status Scale (EDSS). For the timing domain, we will include studies only if the outcome was measured at the same time MRI was performed (or with a very close time interval between). Inpatient and outpatient settings will both be included. All included studies will be assessed for the risk of bias using a tailored version of the Quality In Prognosis Studies (QUIPS) tool. Extracted correlation coefficients will be converted to the Fisher’s z scale and a meta-analysis will be performed on the results. We will then convert back the results to correlation coefficients again for the sake of presentation. For the purpose of assessing heterogeneity we will use prediction intervals. If feasible, we will also try to perform subgroup and sensitivity analyses. We will also evaluate the publication bias using Funnel plots and assess the confidence in cumulative evidence using an adapted version of the GRADE for prognostic factor research.

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