Ramp lesions: a systematic review of MRI diagnostic accuracy and treatment efficacy

Abstract Purpose We conducted a systematic review of the published literature to assess the accuracy of Magnetic Resonance Imaging (MRI) in establishing the presence of ramp lesions (RLs) in Anterior Cruciate Ligament (ACL) deficient knees and the clinical efficacy of the surgical repair of RLs. Methods A comprehensive search of the MEDLINE, Web of Science and Scopus databases was performed according to PRISMA guidelines. Studies assessing MRI diagnostic accuracy for RLs or the clinical effect of RL repair in participants with ACL injuries were included. Diagnostic accuracy measures were pooled and plotted in forest plots. Preoperative and at last follow-up treatment efficacy outcome measures were extracted and plotted in forest plots, for graphical comprehension. Results Sixteen studies met the criteria and were included. The diagnostic analysis showed a pooled sensitivity, specificity, positive and negative likelihood ratios of 65.1% (95% CI, 59.73 to 70.42), 91.6% (95% CI, 89.14 to 94.05), 2.91 (95% CI, 2.38–3.55) and 0.53 (95% CI, 0.44–0.64), respectively, with high heterogeneity (I2 above 80%) for all measures. Treatment analysis showed improved Lysholm Knee Score, IKDC score and laxity difference between the knees in all studies after meniscal suture repair. A separate analysis showed no differences between repair of smaller, stable, RLs with meniscal sutures and repair with abrasion and trephination only. Conclusion Although the results present considerable heterogeneity, MRI seems to demonstrate moderate accuracy in the diagnosis of RLs in patients with ACL tear and the surgical repair of RLs can be associated with improved overall outcomes.

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Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: a systematic review

Chiropractic & Manual Therapies ◽

10.1186/s12998-014-0025-8 ◽

2014 ◽

Vol 22 (1) ◽

Cited By ~ 16

Author(s):

Michael S Swain ◽

Nicholas Henschke ◽

Steven J Kamper ◽

Aron S Downie ◽

Bart W Koes ◽

...

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Diagnostic Accuracy ◽

Cruciate Ligament ◽

Acl Injury ◽

Risk Of Bias ◽

Pivot Shift Test ◽

Clinical Tests ◽

Likelihood Ratios ◽

Anterior Cruciate

Abstract Background Numerous clinical tests are used in the diagnosis of anterior cruciate ligament (ACL) injury but their accuracy is unclear. The purpose of this study is to evaluate the diagnostic accuracy of clinical tests for the diagnosis of ACL injury. Methods Study Design: Systematic review. The review protocol was registered through PROSPERO (CRD42012002069). Electronic databases (PubMed, MEDLINE, EMBASE, CINAHL) were searched up to 19th of June 2013 to identify diagnostic studies comparing the accuracy of clinical tests for ACL injury to an acceptable reference standard (arthroscopy, arthrotomy, or MRI). Risk of bias was appraised using the QUADAS-2 checklist. Index test accuracy was evaluated using a descriptive analysis of paired likelihood ratios and displayed as forest plots. Results A total of 285 full-text articles were assessed for eligibility, from which 14 studies were included in this review. Included studies were deemed to be clinically and statistically heterogeneous, so a meta-analysis was not performed. Nine clinical tests from the history (popping sound at time of injury, giving way, effusion, pain, ability to continue activity) and four from physical examination (anterior draw test, Lachman’s test, prone Lachman’s test and pivot shift test) were investigated for diagnostic accuracy. Inspection of positive and negative likelihood ratios indicated that none of the individual tests provide useful diagnostic information in a clinical setting. Most studies were at risk of bias and reported imprecise estimates of diagnostic accuracy. Conclusion Despite being widely used and accepted in clinical practice, the results of individual history items or physical tests do not meaningfully change the probability of ACL injury. In contrast combinations of tests have higher diagnostic accuracy; however the most accurate combination of clinical tests remains an area for future research. Clinical relevance Clinicians should be aware of the limitations associated with the use of clinical tests for diagnosis of ACL injury.

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Diagnostic Accuracy of the Triglyceride and Glucose Index for Insulin Resistance: A Systematic Review

International Journal of Endocrinology ◽

10.1155/2020/4678526 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Adriana Sánchez-García ◽

René Rodríguez-Gutiérrez ◽

Leonardo Mancillas-Adame ◽

Victoria González-Nava ◽

Alejandro Díaz González-Colmenero ◽

...

Keyword(s):

Systematic Review ◽

Insulin Resistance ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Biochemical Marker ◽

Likelihood Ratios ◽

Tyg Index ◽

Cutoff Values ◽

Language Restriction ◽

Sensitivity Specificity

Introduction. The triglyceride and glucose (TyG) index has been described as a biochemical marker of insulin resistance (IR); however, its diagnostic accuracy remains uncertain. Objective. To summarize the evidence assessing the diagnostic accuracy of the TyG index regarding IR. Methods. A comprehensive search in MEDLINE, EMBASE, Web of Science, and Scopus was performed without any language restriction. Studies assessing the diagnostic accuracy of the TyG index against the hyperinsulinemic-euglycemic clamp (HIEC) or any other IR biochemical were assessed independently and in duplicate. Diagnostic accuracy measures (sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios) were extracted independently and in duplicate. The QUADAS-2 tool was used to assess the risk of bias of independent studies. Results. We identified 15 eligible studies with 69,922 participants and an overall quality of low to moderate. The TyG index was evaluated by HIEC and HOMA as reference tests. The highest achieved sensitivity was 96% using HIEC, and the highest specificity was of 99% using HOMA-IR, with a cutoff value of 4.68. AUC values varied from 0.59 to 0.88. Cutoff values for IR were variable between studies, limiting its comparability. Conclusion. In this systematic review, we found moderate-to-low quality evidence about the usefulness of the TyG index as a surrogate biochemical marker of IR. Due to the lack of a standardized IR definition and heterogeneity between studies, further validation and standardized cutoff values are needed to be used in clinical practice.

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Clausal Density Between Ages 4 and 9 Years for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties

Language Speech and Hearing Services in Schools ◽

10.1044/2020_lshss-20-00043 ◽

2020 ◽

pp. 1-15

Author(s):

Ling-Yu Guo ◽

Phyllis Schneider ◽

William Harrison

Keyword(s):

Diagnostic Accuracy ◽

Psychometric Properties ◽

Language Impairment ◽

Reference Data ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Criterion Validity ◽

Likelihood Ratios ◽

Generation Task ◽

Sensitivity Specificity

Purpose This study provided reference data and examined psychometric properties for clausal density (CD; i.e., number of clauses per utterance) in children between ages 4 and 9 years from the database of the Edmonton Narrative Norms Instrument (ENNI). Method Participants in the ENNI database included 300 children with typical language (TL) and 77 children with language impairment (LI) between the ages of 4;0 (years;months) and 9;11. Narrative samples were collected using a story generation task, in which children were asked to tell stories based on six picture sequences. CD was computed from the narrative samples. The split-half reliability, concurrent criterion validity, and diagnostic accuracy were evaluated for CD by age. Results CD scores increased significantly between ages 4 and 9 years in children with TL and those with LI. Children with TL produced higher CD scores than those with LI at each age level. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of CD scores were all significant at each age level, with the magnitude ranging from small to large. The diagnostic accuracy of CD scores, as revealed by sensitivity, specificity, and likelihood ratios, was poor. Conclusions The finding on diagnostic accuracy did not support the use of CD for identifying children with LI between ages 4 and 9 years. However, given the attested reliability and validity for CD, reference data of CD from the ENNI database can be used for evaluating children's difficulties with complex syntax and monitoring their change over time. Supplemental Material https://doi.org/10.23641/asha.13172129

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Differentiating School-Aged Children With and Without Language Impairment Using Tense and Grammaticality Measures From a Narrative Task

Journal of Speech Language and Hearing Research ◽

10.1044/2015_jslhr-l-15-0066 ◽

2016 ◽

Vol 59 (2) ◽

pp. 317-329 ◽

Cited By ~ 21

Author(s):

Ling-Yu Guo ◽

Phyllis Schneider

Keyword(s):

Language Development ◽

Diagnostic Accuracy ◽

Language Impairment ◽

Likelihood Ratios ◽

Verb Morphology ◽

Story Generation ◽

School Aged Children ◽

Sensitive Tool ◽

Good Diagnostic Accuracy ◽

Sensitivity Specificity

Purpose To determine the diagnostic accuracy of the finite verb morphology composite (FVMC), number of errors per C-unit (Errors/CU), and percent grammatical C-units (PGCUs) in differentiating school-aged children with language impairment (LI) and those with typical language development (TL). Method Participants were 61 six-year-olds (50 TL, 11 LI) and 67 eight-year-olds (50 TL, 17 LI). Narrative samples were collected using a story-generation format. FVMC, Errors/CU, and PGCUs were computed from the samples. Results All of the three measures showed acceptable to good diagnostic accuracy at age 6, but only PGCUs showed acceptable diagnostic accuracy at age 8 when sensitivity, specificity, and likelihood ratios were considered. Conclusion FVMC, Errors/CU, and PGCUs can all be used in combination with other tools to identify school-aged children with LI. However, FVMC and Errors/CU may be an appropriate diagnostic tool up to age 6. PGCUs, in contrast, may be a sensitive tool for identifying children with LI at least up to age 8 years.

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Imaging modalities in the diagnosis of pancreatic adenocarcinoma: A systematic review and meta-analysis of sensitivity, specificity and diagnostic accuracy

European Journal of Radiology ◽

10.1016/j.ejrad.2017.04.009 ◽

2017 ◽

Vol 92 ◽

pp. 17-23 ◽

Cited By ~ 19

Author(s):

James Toft ◽

William J. Hadden ◽

Jerome M. Laurence ◽

Vincent Lam ◽

Lawrence Yuen ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Pancreatic Adenocarcinoma ◽

Meta Analysis ◽

Imaging Modalities ◽

Sensitivity Specificity

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Value of Xpert MTB/RIF Using Bronchoalveolar Lavage Fluid for the Diagnosis of Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis

Journal of Clinical Microbiology ◽

10.1128/jcm.02170-20 ◽

2020 ◽

Author(s):

Hong-Chao Liu ◽

Yu-Lu Gao ◽

Dan-Feng Li ◽

Xi-Yi Zhao ◽

Yuan-Qing Pan ◽

...

Keyword(s):

Systematic Review ◽

Pulmonary Tuberculosis ◽

Bronchoalveolar Lavage ◽

Bronchoalveolar Lavage Fluid ◽

Meta Analysis ◽

Area Under The Curve ◽

Culture Method ◽

Lavage Fluid ◽

Likelihood Ratios ◽

Sensitivity Specificity

Background: The performance of Xpert MTB/RIF using bronchoalveolar lavage fluid (BAL) for the diagnosis of pulmonary tuberculosis (PTB) remains unclear. Therefore, a systematic review/meta-analysis was conducted. Methods: Studies published before December 31, 2019, were retrieved from the PubMed, Embase, and Web of Science databases using the keywords “pulmonary tuberculosis,” “Xpert MTB/RIF,” and “BAL.” Two independent evaluators extracted the data and assessed the bias risk of the included studies. A random-effects model was used to calculate the overall sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR, respectively), diagnostic odds ratio (DOR), and the area under the curve (AUC), as well as the respective 95% confidence intervals (CIs). Results: Nineteen trials involving 3019 participants met the inclusion criteria. Compared to the culture method, the pooled sensitivity, specificity, PLR, NLR, DOR, and the AUC with 95% CIs of Xpert MTB/RIF were 0.87 (0.84–0.90), 0.92 (0.91–0.93), 10.21 (5.78–18.02), 0.16 (0.12–0.22), 78.95 (38.59–161.53), and 0.9467 (0.9462-0.9472), respectively. Relative to the composite reference standard, the observed values were 0.69 (0.65–0.72), 0.98 (0.98–0.99), 37.50 (18.59–75.62), 0.30 (0.21–0.43), 171.98 (80.82–365.96), and 0.9691 (0.9683–0.9699), respectively. All subgroups, except children, showed high sensitivity and specificity. Conclusions: The use of Xpert MTB/RIF in the context of BAL samples has a high diagnostic performance for PTB (except for children) and may serve as an alternative rapid diagnostic tool.

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A Systematic Review and Meta-analysis of the Diagnostic Accuracy of Nucleic Acid Amplification Tests for Tuberculous Meningitis

Journal of Clinical Microbiology ◽

10.1128/jcm.01113-18 ◽

2019 ◽

Vol 57 (6) ◽

Cited By ~ 19

Author(s):

Ali Pormohammad ◽

Mohammad Javad Nasiri ◽

Timothy D. McHugh ◽

Seyed Mohammad Riahi ◽

Nathan C. Bahr

Keyword(s):

Systematic Review ◽

Nucleic Acid ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Tuberculous Meningitis ◽

Meta Analysis ◽

Nucleic Acid Amplification ◽

Data Sets ◽

Reference Standard ◽

Sensitivity Specificity

ABSTRACTThe diagnosis of tuberculous meningitis (TBM) is difficult and poses a significant challenge to physicians worldwide. Recently, nucleic acid amplification (NAA) tests have shown promise for the diagnosis of TBM, although their performance has been variable. We undertook a systematic review and meta-analysis to evaluate the diagnostic accuracy of NAA tests with cerebrospinal fluid (CSF) samples against that of culture as the reference standard or a combined reference standard (CRS) for TBM. We searched the Embase, PubMed, Web of Science, and Cochrane Library databases for the relevant records. The QUADAS-2 tool was used to assess the quality of the studies. Diagnostic accuracy measures (i.e., sensitivity and specificity) were pooled with a random-effects model. All statistical analyses were performed with STATA (version 14 IC; Stata Corporation, College Station, TX, USA), Meta-DiSc (version 1.4 for Windows; Cochrane Colloquium, Barcelona, Spain), and RevMan (version 5.3; The Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, Denmark) software. Sixty-three studies comprising 1,381 cases of confirmed TBM and 5,712 non-TBM controls were included in the final analysis. These 63 studies were divided into two groups comprising 71 data sets (43 in-house tests and 28 commercial tests) that used culture as the reference standard and 24 data sets (21 in-house tests and 3 commercial tests) that used a CRS. Studies which used a culture reference standard had better pooled summary estimates than studies which used CRS. The overall pooled estimates of sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of the NAA tests against culture were 82% (95% confidence interval [CI], 75 to 87%), 99% (95% CI, 98 to 99%), 58.6 (95% CI, 35.3 to 97.3), and 0.19 (95% CI, 0.14 to 0.25), respectively. The pooled sensitivity, specificity, PLR, and NLR of NAA tests against CRS were 68% (95% CI, 41 to 87%), 98% (95% CI, 95 to 99%), 36.5 (95% CI, 15.6 to 85.3), and 0.32 (95% CI, 0.15 to 0.70), respectively. The analysis has demonstrated that the diagnostic accuracy of NAA tests is currently insufficient for them to replace culture as a lone diagnostic test. NAA tests may be used in combination with culture due to the advantage of time to result and in scenarios where culture tests are not feasible. Further work to improve NAA tests would benefit from the availability of standardized reference standards and improvements to the methodology.

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PP9 A systematic review and meta-analysis of pre-hospital diagnostic accuracy studies

Emergency Medicine Journal ◽

10.1136/emermed-2019-999.9 ◽

2019 ◽

Vol 36 (1) ◽

pp. e4.2-e4

Author(s):

Caitlin Wilson ◽

Clare Harley ◽

Stephanie Steels

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Meta Analysis ◽

High Sensitivity ◽

Eligibility Criteria ◽

Cochrane Database ◽

Full Text Review ◽

Hospital Doctors ◽

Diagnostic Sensitivity And Specificity ◽

Sensitivity Specificity

BackgroundPre-hospital clinicians are involved in examining, treating and diagnosing patients. The accuracy of pre-hospital diagnoses is evaluated using diagnostic accuracy studies. We undertook a systematic review of published literature to provide an overview of how accurately pre-hospital clinicians diagnose patients compared to hospital doctors. A bivariate meta-analysis was incorporated to examine the range of diagnostic sensitivity and specificity.MethodsWe searched MEDLINE, CINAHL, Embase, AMED and the Cochrane Database of Systematic Reviews from 1946 to 7th May 2016 for studies where patients had been given a diagnosis by pre-hospital clinicians and hospital doctors. Key words focused on study type (‘diagnostic accuracy’), outcomes (sensitivity, specificity, likelihood ratio?, predictive value?) and setting (paramedic*, pre-hospital, ambulance, ‘emergency service?’, ‘emergency medical service?’, ‘emergency technician?’). The sole researcher screened titles and abstracts to ensure eligibility criteria were met, as well as assessing methodological quality using QUADAS-2.Results2941 references were screened by title and/or abstract. Eleven studies encompassing 3 84 985 patients were included after full-text review. The types of diagnoses in one of the studies encompassed all possible diagnoses and in the other studies focused on sepsis, stroke and myocardial infarction. Sensitivity estimates ranged from 32%–100% and specificity estimates from 14%–100%. Eight of the studies were deemed to have a low risk of bias and were incorporated into a meta-analysis, which showed a pooled sensitivity of 0.74 (0.62, 0.82) and a pooled specificity of 0.94 (0.87, 0.97).ConclusionsCurrent published research suggests that diagnoses made by pre-hospital clinicians have high sensitivity and even higher specificity. However, the paucity and varying quality of eligible studies indicates that further pre-hospital diagnostic accuracy studies are warranted especially in the field of non-life-threatening conditions and trauma.

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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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