Diagnostic Accuracy of Comparative Computed Tomography with Stress Maneuvers for Diagnosing Isolated Syndesmotic Instability in an Acute Ankle Sprain

Category: Ankle; Sports; Trauma Introduction/Purpose: Although there are several imaging options for diagnosing the syndesmotic injury, a fundamental question that guides treatment remains unanswered. Syndesmotic instability is still challenging to diagnose correctly, and syndesmotic disruption and true syndesmotic instability should be differentiated. Currently, imaging tests quickly diagnose severe syndesmotic instability but have difficulty in diagnosing mild and moderate cases. Recently, weight-bearing CT (WB-CT) has emerged as a new modality for the examination of syndesmosis; however, studies have shown that WB-CT is not superior to conventional computed tomography (CT), and axial loading has no benefit for the diagnosis of instability. This study aims to investigate which index test between a CT in a neutral position (CTNP) and a new CT test with stress maneuvers (CTSM) can more accurately diagnose syndesmotic instability. Methods: This diagnostic accuracy-test study consecutively selected individuals older than 18 years with an orthopedic evaluation suspected for acute syndesmotic injury. The accuracy of the index tests (CTNP and CTSM) were examined using magnetic resonance imaging (MRI) as the reference standard. The external rotation and dorsiflexion of the ankle guided the stress maneuvers. Comparison measurements between the injured syndesmosis and the uninjured contralateral side of the same individual investigated syndesmotic instability regarding the translational and rotational relationship between the fibula and tibia. Sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (-LR) value analyzed the diagnostic accuracies of the index tests. Results:: The population included in this study consisted of 64 patients (34 men, 30 women; age range 18-69 years; mean age 35 years). The CTNP exam showed a sensitivity of 18.7% (95% CI, 8 to 35), a specificity of 97% (95% CI, 85 to 99), a +LR of 6.3 (95% CI, 0.8 to 50), and a -LR of 0.8 (95% CI, 0.7 to 0.9). The CTSM exam showed a sensitivity of 91% (95% CI, 76 to 99), a specificity of 94% (95% CI, 80 to 98), a +LR of 15.4 (95% CI, 4 to 59), and a -LR of 0.09 (95% CI, 0.03 to 0.28). The CTSM reflected superior accuracy because the +LR was higher than that of the CTNP, and the confidence interval (CI) for the +LR does not contain 1. Conclusion:: Nevertheless, CTNP is used routinely, this study showed that the test was insufficient for the correct diagnosis, as it presented low sensitivity result. A CTNP with a normal result was not able to exclude syndesmotic instability. The use of the stress maneuver with external rotation and dorsiflexion was a decisive factor for the correct diagnosis, considering that the CTSM exhibited high sensitivity and captured a significantly greater number of true positive cases than the CTNP. This study confirmed CTSM as an accurate method for diagnosing syndesmotic instability and opened a new approach to investigate mild and moderate challenging cases.

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Comparative Computed Tomography with Stress Manoeuvres for Diagnosing Distal Isolated Tibiofibular Syndesmotic Injury in Acute Ankle Sprain: a Protocol for an Accuracy-Test Prospective Study

10.1101/2020.01.24.20018515 ◽

2020 ◽

Author(s):

João Carlos Rodrigues ◽

Alexandre Leme Godoy dos Santos ◽

Marcelo Pires Prado ◽

José Felipe Marion Alloza ◽

Renato do Amaral Masagão ◽

...

Keyword(s):

Computed Tomography ◽

Ankle Sprain ◽

External Rotation ◽

Neutral Position ◽

List Type ◽

Index Test ◽

Syndesmotic Injury ◽

Reference Standard ◽

Link Type ◽

Accuracy Test

ABSTRACTIntroductionAlthough there are several imaging options for diagnosing syndesmotic injury, a fundamental question that guides treatment remains unanswered. Syndesmotic instability is still challenging to correctly diagnose, and syndesmotic disruption and true syndesmotic instability should be differentiated. Currently, imaging tests quickly diagnose the severe syndesmotic instability but have difficulty in diagnosing mild and moderate cases. This study aims to investigate which strategy among an existing computed tomography (CT) index test and two new add-on CT index tests with stress manoeuvres can more accurately diagnose syndesmotic instability. The secondary objective is to investigate the participants’ disability outcomes by applying the Foot and Ankle Ability Measure questionnaire.Methods and analysesThis diagnostic accuracy-test study will consecutively select individuals older than 18 years with a clinical diagnosis of suspected acute syndesmotic injury. Three strategies of the CT index test (one in the neutral position and two with stress) will examine the accuracy using magnetic resonance imaging as the reference standard. The external rotation and dorsiflexion of the ankle will guide the stress manoeuvres. Comparison measurements between the injured syndesmosis and the uninjured contralateral side of the same individual will investigate syndesmotic instability, evaluating the rotational and translational relationship between the fibula and tibia. Sensitivity, specificity, area under the ROC curve and likelihoods will compare the diagnostic accuracies of the strategies.Ethics and disseminationThe Internal Review Board and the Research Ethics Committee approved this study (registered number 62100016.5.0000.0071). All the participants will receive a spoken description of the aim of the study, and the choice to participate will be free and voluntary. Participants’ enrolment will occur after signing the written informed consent, including the terms of confidentiality. The results will be presented at national and international conferences and published in peer-reviewed journals and social media.Trial registration numberClinicalTrials.gov (identifier NCT04095598), pre-results.Strengths and limitations of this studyThis study is the first to examine the accuracy and feasibility of CT with stress manoeuvres for diagnosing syndesmotic instability.The disability outcomes will be used to evaluate syndesmotic instability diagnosed by CT with stress manoeuvres as a prognostic factor.The limitations of this study include the use of MRI as the reference standard test, which, although not perfect, is estimated to have high accuracy compared to the gold-standard arthroscopy.1An inherent degree of imprecision related to the severity of the ankle sprain and pain exacerbation may occur when the participants themselves control stress manoeuvres; therefore, some variability is unavoidable. Researchers will monitor and investigate the influence of this source of variability on the results.

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Comparative CT with stress manoeuvres for diagnosing distal isolated tibiofibular syndesmotic injury in acute ankle sprain: a protocol for an accuracy- test prospective study

BMJ Open ◽

10.1136/bmjopen-2020-037239 ◽

2020 ◽

Vol 10 (9) ◽

pp. e037239

Author(s):

João Carlos Rodrigues ◽

Alexandre Leme Godoy Santos ◽

Marcelo Pires Prado ◽

José Felipe Marion Alloza ◽

Renato Amaral Masagão ◽

...

Keyword(s):

External Rotation ◽

Characteristic Curve ◽

Contralateral Side ◽

Neutral Position ◽

Index Test ◽

Syndesmotic Injury ◽

Accuracy Test ◽

Informed Consent Form ◽

Registration Number ◽

Sensitivity Specificity

IntroductionAlthough several imaging options are available for diagnosing syndesmotic injury, a fundamental question that guides treatment remains unanswered. Syndesmotic instability is still challenging to diagnose correctly, and syndesmotic disruption and true syndesmotic instability should be differentiated. Currently, imaging tests quickly diagnose severe syndesmotic instability but have difficulty in diagnosing mild and moderate cases. This study aims to investigate which strategy among an existing CT index test and two new add-on CT index tests with stress manoeuvres more accurately diagnoses syndesmotic instability. The secondary objective is to investigate the participants’ disability outcomes by applying the Foot and Ankle Ability Measure questionnaire.Methods and analysesThis study of a diagnostic accuracy test will consecutively select individuals older than 18 years with a clinical diagnosis of a suspected acute syndesmotic injury. Three strategies of the CT index test (one in the neutral position and two with stress) will examine the accuracy using MRI as the reference standard. The external rotation and dorsiflexion of the ankle will guide the stress manoeuvres. A comparison of measurements between the injured syndesmosis and the uninjured contralateral side of the same individual will investigate the syndesmotic instability, by evaluating the rotational and translational relationships between the fibula and tibia. Sensitivity, specificity, area under the receiver operating characteristic curve and likelihood analyses will compare the diagnostic accuracies of the strategies.Ethics and disseminationThe Internal Review Board and the Einstein Ethics Committee approved this study (registered number 62100016.5.0000.0071). All participants will receive an oral description of the study’s aim, and the choice to participate will be free and voluntary. Participants will be enrolled after they sign the written informed consent form, including the terms of confidentiality. The results will be presented at national and international conferences and published in peer-reviewed journals and social media.Trial registration numberClinicalTrials.gov Registry (NCT04095598; preresults).

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Computed tomography with stress maneuvers for diagnosing syndesmotic instability

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1213 ◽

2020 ◽

Vol 14 (3) ◽

pp. 243-248

Author(s):

João Rodrigues ◽

Alexandre Godoy-Santos ◽

Marcelo Prado ◽

José Alloza ◽

Adham Amaral e Castro ◽

...

Keyword(s):

Computed Tomography ◽

Diagnostic Accuracy ◽

External Rotation ◽

Contralateral Side ◽

Decision Making Process ◽

Neutral Position ◽

Resonance Imaging ◽

Level Of Evidence ◽

Accuracy Study ◽

A New Technique

Syndesmotic instability is a fundamental question that guides treatment; despite the currently available diagnostic imaging tests, its determination is still challenging. Knowledge of the instability degree assists the physician in the decision-making process regarding surgical or nonsurgical treatments. The authors are currently conducting a prospective diagnostic accuracy study by consecutively selecting individuals aged 18 years and older with an orthopaedic clinical examination indicating suspected acute syndesmotic injury. Magnetic resonance imaging is the reference standard used for evaluating the diagnostic accuracy of 3 computed tomography index tests. These tests include the neutral position and 2 ankle stress maneuvers: external rotation and dorsiflexion. Comparative measurements between the injured syndesmosis and the uninjured contralateral side of the same individual evaluate the tibiofibular relationship and investigate syndesmotic instability. This study aims to describe a summarized research protocol for a new technique using computed tomography with stress maneuvers and to show a didactic example of syndesmotic instability diagnosis. Level of Evidence V; Diagnostic Studies; Expert Opinion.

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The Diagnostic Accuracy of Low-Dose Computed Tomography in Diagnosing Urolithiasis: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-29577/v1 ◽

2020 ◽

Author(s):

Shichu Liang ◽

Lingyu Chang ◽

Cui Wang ◽

Shengli Lu ◽

Shihan Zhang ◽

...

Keyword(s):

Computed Tomography ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Standard Dose ◽

Meta Analysis ◽

Negative Likelihood Ratio ◽

Diagnostic Value ◽

Cochrane Library ◽

Index Test ◽

Meta Analyses

Abstract Background: Urolithiasis is a prevalent health issue all over the world,To evaluate the diagnostic accuracy of low-lose computed tomography(LDCT) for detecting urolithiasis. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. PubMed, EMBASE and The Cochrane Library were searched for original diagnostic studies to identify all relevant studies published prior to May 2020. The index test was LDCT, and the reference standards were comprehensive diagnosis or standard-dose CT (SDCT). Results: 17 studies with 1,761 patients and 2,053 stones were included for the quantitative analysis. The pooled sensitivity was 0.95 (95%CI: 0.93-0.97) in patient-based studies and 0.86 (95%CI: 0.76-0.93) in urolithiasis-based studies. The pooled specificity of LDCT were 0.97 (95%CI: 0.95-0.99) in patient-based studies and 0.98 (95%CI: 0.63-1.00) in urolithiasis-based studies. The Fagan nomogram of LDCT for diagnosis of urolithiasis showed that the probability of urolithiasis is 98% if the LDCT scan is positive and 6% if the LDCT scan is negative. The likelihood ratio plot showed that the summary positive pooled likelihood ratio (LRP) and negative likelihood ratio (LRN) for LDCT was in the left upper quadrant(LUQ) area. Conclusions: LDCT has excellent diagnostic value in urolithiasis. LDCT can detect the urolithiasis specifically, but is limited to differentiate the contents of the stones.

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Comparing the diagnostic accuracy of computed tomography vs transoesophageal echocardiography for infective endocarditis − A meta-analysis

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.38.3.5139 ◽

2022 ◽

Vol 38 (3) ◽

Author(s):

Liqin Jing ◽

Yanchun Song

Keyword(s):

Computed Tomography ◽

Infective Endocarditis ◽

Diagnostic Accuracy ◽

English Language ◽

Cardiac Computed Tomography ◽

Meta Analysis ◽

Transoesophageal Echocardiography ◽

Cochrane Central Register ◽

Index Test ◽

Creative Commons

Objective: To investigate the comparative diagnostic accuracy of cardiac computed tomography (CT) and transoesophageal echocardiography (TEE) for detecting infective endocarditis. Methods: Original publications published in English language before July, 2021 were thoroughly search in PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar literature databases. Studies were included if they used CT and/or TEE as an index test, presented data on valvular complications related to infective endocarditis, and used surgical findings as to the reference standard. Results: Literature screening identified fifteen studies that fulfilled the inclusion criteria. Meta-analysis showed that CT sensitivity for detecting valvular abscesses was higher than that of TEE [0.88 (95% confidence interval [CI]: 0.82 to 0.94; 11 studies involving 842 subjects) versus 0.74 (95% CI: 0.65 to 0.84) P = 0.015; 12 studies involving 917 subjects]. TEE showed statistically significantly greater sensitivity than CT for detecting valvular vegetation [0.91 (95% CI: 0.84 to 0.97, 11 studies involving 971 subjects) versus 0.80 (95% CI: 0.69 to 0.82), 12 studies involving 915 subjects, P =0.019. In case of leaflet detection, TEE showed statistically significantly higher sensitivity than CT (0.76 vs 0.46, P =0.010). Conclusion: CT performs statistically significantly better than TEE for detecting abscesses while TEE provides statistically significant superior results for detecting vegetation. There is a need for well-designed prospective studies to further corroborate these findings. doi: https://doi.org/10.12669/pjms.38.3.5139 How to cite this:Jing L, Song Y. Comparing the diagnostic accuracy of computed tomography vs transoesophageal echocardiography for infective endocarditis − A meta-analysis . Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5139 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Stress vs. Non-Stress Radiographs in Subtle Syndesmotic Injuries

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00296 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0029

Author(s):

Nicola Krähenbühl ◽

Travis Bailey ◽

Nathan Davidson ◽

Heath Henninger ◽

Charles Saltzman ◽

...

Keyword(s):

Ankle Instability ◽

External Rotation ◽

Paired Comparison ◽

Weight Bearing ◽

Deltoid Ligament ◽

Ankle Sprains ◽

X Rays ◽

Syndesmotic Injury ◽

Stress Radiographs ◽

Clear Space

Category: Sports Introduction/Purpose: Between 1-18% of all ankle sprains and 23% of all ankle fractures involve injury to the distal tibio-fibular syndesmosis. Syndesmotic injuries can create a substantial diagnostic and therapeutic challenge for orthopaedic surgeons. While acute injuries can be assessed using conventional radiographs, subtle syndesmotic injuries may be misdiagnosed using X-rays. Misdiagnoses may result in chronic ankle instability, pain and post-traumatic osteoarthritis of the tibio-talar joint. The purpose of this study was to investigate whether syndesmotic injury was more easily diagnosed with stress vs. non-stress radiographs.radiographs.sed with stress vs. non-stress radiographs. Methods: Five pairs of cadavers (tibia plateau to toe-tip, mean 61 years, range 52-70 years) were scanned with weight-bearing CT (170 lb, w/ and w/o 10 Nm static external rotation torque). Digitally reconstructed radiographs (DRRs), which are comparable to conventional radiographs, were reconstructed from the 3D CT data. The following conditions were tested: First, intact ankles (Native) were tested. Second, one specimen from each pair underwent AITFL resection, while the contralateral underwent deltoid resection (Condition 1). Third, the remaining intact deltoid ligament or AITFL was resected in each ankle (Condition 2). Finally, the interosseous membrane (IOM) was resected in all ankles (Condition 3). Condition 3 was defined as acute syndesmotic injury. Using antero-posterior (AP) views, the tibio-fibular clear space (TFCS), tibiofibular overlap (TFO) and medial clear space (MCS) were assessed. Statistical analysis was performed using paired (comparison within groups) and unpaired (comparison between groups) t-test where p=0.05 was considered significant. Results: Regarding the TFCS, Native vs. Condition 3 in 10 Nm stress radiographs was significantly different in the deltoid group (p=0.021). Using TFO in stress and non-stressed radiographs, Native vs. Condition 2 and 3 was significantly different for the deltoid group (p=0.043), and Native vs. Condition 3 in the syndesmotic group (p=0.027). Regarding the MCS in non-stress radiographs, Native vs. Condition 3 was significantly different in the deltoid group (p=0.007), while in stress views, Native vs. Condition 2 was significant different in the syndesmotic (p=0.026) and Native vs. Condition 3 in the deltoid group (p=0.030). No differences were found comparing the conditions of the AITFL with the same conditions of the deltoid group. Conclusion: The TFCS cannot be used to assess subtle or acute syndesmotic injuries in stress and non-stress radiographs. The TFO can be used to assess a combined injury to the AITFL and deltoid ligament in stress and non-stress radiographs. The MCS can be used to assess acute syndesmotic injuries in stress and non-stress radiographs. Radiographs (stress or non-stress) cannot be used to distinguish between injuries to the AITFL or deltoid ligament. Therefore, stress and non-stress radiographs are not useful in assessment of subtle syndesmotic injuries. Stress-radiographs are not superior compared to non-stress radiographs in assessment of acute syndesmotic injuries.

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Diagnostic Accuracy of Dual-Energy CT in Detection of Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis

Canadian Association of Radiologists Journal ◽

10.1177/0846537120902062 ◽

2020 ◽

pp. 084653712090206 ◽

Cited By ~ 1

Author(s):

Waleed Abdellatif ◽

Mahmoud Ahmed Ebada ◽

Souad Alkanj ◽

Ahmed Negida ◽

Nicolas Murray ◽

...

Keyword(s):

Computed Tomography ◽

Systematic Review ◽

Pulmonary Embolism ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Acute Pulmonary Embolism ◽

Meta Analysis ◽

Dual Energy ◽

Dual Energy Computed Tomography ◽

Sensitivity Specificity

Purpose: In this systematic review and meta-analysis, we aimed to investigate the accuracy of dual-energy computed tomography (DECT) in the detection of acute pulmonary embolism (PE). Methods: We searched Medline (via PubMed), EBSCO, Web of Science, Scopus, and the Cochrane Library for relevant published studies. We selected studies assessing the accuracy of DECT in the detection of PE. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 tool. Meta-analysis was performed to calculate mean estimates of sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR). The summary receiver operating characteristic (sROC) curve was drawn to get the Cochran Q-index and the area under the curve (AUC). Results: Seven studies were included in our systematic review. Of the 182 patients included, 108 patients had PEs. The pooled analysis showed an overall sensitivity and specificity of 88.9% (95% confidence interval [CI]: 81.4%-94.1%) and 94.6% (95% CI: 86.7%-98.5%), respectively. The pooled PLR was 8.186 (95% CI: 3.726-17.986), while the pooled NLR was 0.159 (95% CI: 0.093-0.270). Cochran-Q was 0.8712, and AUC was 0.935 in the sROC curve. Conclusion: Dual-energy computed tomography shows high sensitivity, specificity, and diagnostic accuracy in the detection of acute PE. The high PLR highlights the high clinical importance of DECT as a prevalence-independent, rule-in test. Studies with a larger sample size with standardized reference tests are still needed to increase the statistical power of the study and support these findings.

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Diagnostic accuracy of urinary reagent strip to determine cerebrospinal fluid chemistry and cellularity

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.112737 ◽

2013 ◽

Vol 04 (02) ◽

pp. 140-145 ◽

Cited By ~ 10

Author(s):

Deepti Joshi ◽

Keerthi Kundana ◽

Apurva Puranik ◽

Rajnish Joshi

Keyword(s):

Cerebrospinal Fluid ◽

Diagnostic Accuracy ◽

Area Under The Curve ◽

Test Strip ◽

Index Test ◽

Csf Proteins ◽

Csf Cells ◽

Overall Performance ◽

Index Tests ◽

Csf Examination

ABSTRACT Background: The gold standard for diagnosis of meningitis depends on cerebrospinal fluid (CSF) examination by microscopy, biochemistry, and culture, which require an experienced microscopist and laboratory support. We conducted this study to determine if urinary reagent strip is useful to make a semi‑quantitative assessment of protein, glucose, and presence of leukocyte esterase in CSF. Materials and Methods: All consecutive CSF samples were evaluated in a blinded fashion. CSF was tested using Combur‑10 urinary reagent strip as an index test, and CSF microscopy and biochemistry as reference standards. Combur‑10 (Boehringer Mannheim) is a urinary reagent strip used to estimate ten parameters including protein, glucose, and leukocytes. We estimated diagnostic accuracy of each index test using corresponding cut‑off levels (glucose 1 + vs. CSF glucose >50 mg/dL; protein 1 + and 2 + vs. CSF protein >30 mg/dL and >100 mg/dL; leukocyte esterase positivity vs. >10 granulocytes in CSF sample). We constructed receiver operating curves (ROC) to evaluate overall performance of index tests and estimated area under the curve (AUC). Results: CSF samples of 75 patients were included in the study. All the three indicator tests (CSF cells, protein, and glucose) were normal in 17 (22.6%) samples. Of the three tests, diagnostic accuracy of protein estimation (1 + or more on reagent strip) was best for detection of CSF proteins greater than 30 mg/dL [sensitivity 98.1% (95% CI 90.1-100%); specificity 57.1% (95% CI 34-78.2%)], with AUC of 0.97. Sensitivity and specificity for 2 + on reagent strip and CSF protein > 100 mg/dL were 92.6% (95% CI 75.1-99.1) and 87.5% (95% CI 74.8-95.3), respectively, with AUC of 0.96 (95% CI 0.92-1.01). Leukocyte esterase positivity by test strip had a sensitivity of 85.2 (95% CI 66.3-95.8%) and specificity of 89.6 (95% CI 77.3-96.5%) for detection of CSF granulocytes of more than 10/mm3. Conclusion: Existing urinary reagent strips can be used to diagnose meningitis in low‑resource settings.

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Diagnostic accuracy of myocardial perfusion imaging in patients evaluated for kidney transplantation: a systematic review and meta-analysis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab111.034 ◽

2021 ◽

Vol 22 (Supplement_3) ◽

Author(s):

JR Kelderman ◽

FEJ Jolink ◽

S Benjamens ◽

AG Monroy Gonzalez ◽

RA Pol ◽

...

Keyword(s):

Computed Tomography ◽

Kidney Transplantation ◽

Myocardial Perfusion Imaging ◽

Myocardial Perfusion ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Perfusion Imaging ◽

Meta Analysis ◽

Emission Computed Tomography ◽

Significant Heterogeneity

Abstract Funding Acknowledgements Type of funding sources: None. Background A high prevalence of asymptomatic coronary artery disease (CAD) is found in patients with end-stage renal disease evaluated for kidney transplantation. Purpose We aimed to assess the diagnostic accuracy of myocardial perfusion imaging (MPI) for CAD in this patients population. Methods We performed a systematic literature search and meta-analysis. We retrieved studies investigating the diagnostic accuracy of single-photon emission computed tomography (SPECT) and positron emission tomography (PET) compared to the standards invasive coronary angiography (ICA) and coronary computed tomography angiography (CCTA) in patients evaluated for kidney transplantation. Results Out of 1379 records, 9 MPI SPECT studies were included in the meta-analysis with a total of 822 patients. There were no studies available using PET with ICA or CCTA as reference. Pooled sensitivity of MPI SPECT for CAD was 0.66 (95%-CI 0.52-0.78), pooled specificity 0.72 (95%-CI 0.57-84) and the area under the curve (AUC) 0.74. Positive likelihood ratio (PLR) was 2.31 (95%-CI 1.57-3.39) and negative likelihood ratio (NLR) was 0.41 (95%-CI 0.25-0.68) with an overall diagnostic odds ratio (DOR) of 5.43 (95%-CI 2.87-10.28). Significant heterogeneity existed across included studies. Conclusions MPI SPECT had a moderate diagnostic accuracy in patients evaluated for kidney transplantation, with a high rate of false-negative findings.

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The shortened combined clonidine and arginine test for growth hormone deficiency is practical and specific: a diagnostic accuracy study

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2015-0284 ◽

2016 ◽

Vol 29 (3) ◽

Cited By ~ 1

Author(s):

Reem Al Khalifah ◽

Lina Moisan ◽

Helen Bui

Keyword(s):

Growth Hormone ◽

Diagnostic Accuracy ◽

Stimulation Index ◽

False Positive Rate ◽

Hormone Deficiency ◽

Index Test ◽

Arginine Test ◽

Positive Rate ◽

Accuracy Study ◽

Index Tests

AbstractThe growth hormone (GH) stimulation protocols for clonidine and arginine tests are non-standardized and can be lengthy. We examined the specificity of both tests using a shorter duration of timed samples: 90 min for clonidine and 60 min for arginine.We retrospectively studied all children who had GH stimulation with clonidine and arginine to test for GH deficiency (GHD). We compared the diagnostic accuracy of both reference and new shortened test (index).We reviewed 243 charts (11.4±4.1 years old; 74.5% males). The combined reference test was performed on 159 children, 29 (18.3%) tested positive for GHD on the combined index test, Kappa 0.98, false positive rate 1 (0.8%), specificity 0.99, 95th CI (0.96–1), and p=1.0. The specificity of both the clonidine and arginine single index tests was 0.98%.The shortened clonidine and arginine stimulation index tests have good specificity. This is a viable option for testing children for GHD.

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