Intravoxel Incoherent Motion Model in Differentiating the Pathological Grades of Esophageal Carcinoma: Comparison of Mono-Exponential and Bi-Exponential Fit Model

PurposeTo compare the diagnostic efficiency of the mono-exponential model and bi-exponential model deriving from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in differentiating the pathological grade of esophageal squamous cell carcinoma (ESCC).MethodsFifty-four patients with ESCC were divided into three groups of poorly-differentiated (PD), moderately-differentiated (MD), and well-differentiated (WD), and underwent the IVIM-DWI scan. Mono-exponential (Dmono, D*mono, and fmono) and bi-exponential fit parameters (Dbi, D*bi, and fbi) were calculated using the IVIM data for the tumors. Mean parameter values of three groups were compared using a one-way ANOVA followed by post hoc tests. The receiver operating characteristic curve was drawn for differentiating pathological grade of ESCC. Correlations between pathological grades and IVIM parameters were analyzed.ResultsThere were significant differences in fmono and fbi among the PD, MD and WD ESCC groups (all p<0.05). The fmono were 0.32 ± 0.07, 0.23 ± 0.08, and 0.16 ± 0.05, respectively, and the fbi were 0.35 ± 0.08, 0.26 ± 0.10, and 0.18 ± 0.07, respectively. There was a significant difference in the Dmono between the WD and the PD group (1.48 ± 0.51* 10-3 mm2/s versus 1.05 ± 0.44*10-3 mm2/s, p<0.05), but there was no significant difference between the WD and MD groups, MD and PD groups (all p>0.05). The D*mono, Dbi, and D*bi showed no significant difference among the three groups (all p>0.05). The area under the curve (AUC) of Dmono, fmono and fbi in differentiating WD from PD ESCC were 0.764, 0.961 and 0.932, and the sensitivity and specificity were 92.9% and 60%, 92.9% and 90%, 85.7% and 100%, respectively. The AUC of fmono and fbi in differentiating MD from PD ESCC were 0.839 and 0.757, and the sensitivity and specificity were 78.6% and 80%, 85.7% and 70%, respectively. The AUC of fmono and fbi in differentiating MD from WD ESCC were 0.746 and 0.740, and the sensitivity and specificity were 65% and 85%, 80% and 60%, respectively. The pathologically differentiated grade was correlated with all IVIM parameters (all p<0.05).ConclusionsThe mono-exponential IVIM model is superior to the bi-exponential IVIM model in differentiating pathological grades of ESCC, which may be a promising imaging method to predict pathological grades of ESCC.

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Intravoxel incoherent motion MRI in evaluating inflammatory activity in ulcerative colitis: a pilot study

Acta Radiologica ◽

10.1177/0284185120931689 ◽

2020 ◽

pp. 028418512093168

Author(s):

Joanna Podgórska ◽

Katarzyna Pasicz ◽

Edyta Zagórowicz ◽

Andrzej Mróz ◽

Bogumił Gołębiewski ◽

...

Keyword(s):

Ulcerative Colitis ◽

Characteristic Curve ◽

Area Under The Curve ◽

Inflammatory Activity ◽

Intravoxel Incoherent Motion ◽

Perfusion Fraction ◽

Mayo Score ◽

Grade Classification ◽

Significant Difference ◽

Bowel Segments

Background A non-invasive tool for the assessment of ulcerative colitis (UC) activity is needed for treatment control. Purpose To determine the efficacy of intravoxel incoherent motion (IVIM) in assessing inflammatory activity in UC. Material and Methods In this prospective study, 20 adult patients underwent 3.0-T magnetic resonance imaging (MRI) IVIM diffusion-weighted imaging (DWI) with 10 b-values (0–900 s/mm2) 0–6 days after biopsies entailing colonoscopy. The inflammatory activity of large bowel segments was graded on endoscopy with Mayo score and on pathology with a six‑grade classification system. IVIM‑derived parameters (f, D, and D*) calculated from regions of interest placed within the bowel wall were correlated with both scores (56 and 34 bowel segments, respectively). Radiologists were blinded to endoscopy and pathology results. A T-test and Wilcoxon rank sum test was used in comparisons and receiver operating characteristic curve analysis was performed. Results Statistically significant differences were found between histopathologically inactive or mild activity and moderate to severe activity in f (respectively: mean = 0.19 and mean = 0.28, P = 0.024; area under the curve [AUC] = 0.723, sensitivity 0.82, specificity 0.59, accuracy 0.67 for a 0.185 cut-off value) and D (mean = 1.34 × 10−3mm2/s and mean = 1.07 × 10−3mm2/s, P = 0.0083; AUC = 0.735, sensitivity 0.91, specificity 0.54, accuracy 0.66 for cut-off value 1.24 × 10−3mm2/s). No significant difference in D* was noted. No significant correlation between Mayo endoscopic subscore, and f, D, nor D* was found. Conclusion IVIM perfusion fraction correlates with UC activity and might represent emerging tool in assessment of inflammatory activity.

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Discriminating Malignancy in Thyroid Nodules: The Nomogram Versus the Kwak and ACR TI-RADS

Otolaryngology ◽

10.1177/0194599820939071 ◽

2020 ◽

Vol 163 (6) ◽

pp. 1156-1165

Author(s):

Juan Xiao ◽

Qiang Xiao ◽

Wei Cong ◽

Ting Li ◽

Shouluan Ding ◽

...

Keyword(s):

Thyroid Nodules ◽

Characteristic Curve ◽

Area Under The Curve ◽

Diagnostic Study ◽

Diagnostic Efficiency ◽

Training Set ◽

Multivariable Logistic Regression Model ◽

Predictive Values ◽

Validation Set ◽

Sensitivity Specificity

Objective To develop an easy-to-use nomogram for discrimination of malignant thyroid nodules and to compare diagnostic efficiency with the Kwak and American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS). Study Design Retrospective diagnostic study. Setting The Second Hospital of Shandong University. Subjects and Methods From March 2017 to April 2019, 792 patients with 1940 thyroid nodules were included into the training set; from May 2019 to December 2019, 174 patients with 389 nodules were included into the validation set. Multivariable logistic regression model was used to develop a nomogram for discriminating malignant nodules. To compare the diagnostic performance of the nomogram with the Kwak and ACR TI-RADS, the area under the receiver operating characteristic curve, sensitivity, specificity, and positive and negative predictive values were calculated. Results The nomogram consisted of 7 factors: composition, orientation, echogenicity, border, margin, extrathyroidal extension, and calcification. In the training set, for all nodules, the area under the curve (AUC) for the nomogram was 0.844, which was higher than the Kwak TI-RADS (0.826, P = .008) and the ACR TI-RADS (0.810, P < .001). For the 822 nodules >1 cm, the AUC of the nomogram was 0.891, which was higher than the Kwak TI-RADS (0.852, P < .001) and the ACR TI-RADS (0.853, P < .001). In the validation set, the AUC of the nomogram was also higher than the Kwak and ACR TI-RADS ( P < .05), each in the whole series and separately for nodules >1 or ≤1 cm. Conclusions When compared with the Kwak and ACR TI-RADS, the nomogram had a better performance in discriminating malignant thyroid nodules.

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Diagnostic accuracy of total macular and ganglion cell layer thickness in differentiating different stages of glaucoma: an SD-OCT study

Malaysian Journal of Ophthalmology ◽

10.35119/myjo.v3i3.221 ◽

2021 ◽

Vol 3 (3) ◽

pp. 92-108

Author(s):

Wen Yee Lee ◽

Norlina Mohd Ramli ◽

Amir Samsudin ◽

Mimiwati binti Zahari ◽

Azida Juana binti Wan Ab Kadir ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Ganglion Cell ◽

Ganglion Cell Layer ◽

Cell Layer ◽

Characteristic Curve ◽

Visual Fields ◽

Imaging Method ◽

Discrimination Ability ◽

Significant Difference ◽

Sd Oct

Purpose: To determine the diagnostic accuracy of mean macular retinal thickness (mRT) and macular ganglion cell layer (mGCL) thickness measured by Spectralis spectral-domain optical coherence tomography (SD-OCT) posterior pole thickness map (PPTM) in differentiating between normal and glaucoma eyes of different severity.Study design: Cross-sectional study.Methods: All subjects were divided into normal and glaucoma groups according to the visual fields-based Glaucoma Staging System. They underwent slit-lamp examination, Humphrey visual field test, and SD-OCT (PPTM) imaging. mRT and mGCL thickness measurements were recorded. Analysis of variance with the least significant difference post hoc test was used for pairwise comparison. Ability to discriminate between normal eyes and those with differing severity of glaucoma was assessed using the area under the receiver operating characteristic curve (AUROC).Results: A total of 201 eyes from 201 subjects were enrolled in this study. The mean glaucoma was 290.2 ± 12.1 μm, 270.1 ± 17.0 μm, and 259.1 ± 15.0 μm, respectively. Mean mGCL thickness for the corresponding three groups was 32.3 ± 2.8 μm, 27.6 ± 3.3 μm and 22.2 ± 3.8μm, respectively. AUROC analysis showed excellent diagnostic discrimination between glaucoma and normal subjects for mRT (AUC: 0.90) and mGCL thickness (AUC: 0.92). The cut-off value of mRT was 274.9 μm (90% sensitivity, 75% specificity) and of mGCL thickness was 27.9 μm (93% sensitivity, 74% specificity). The discrimination ability performance of mRT and mGCL thickness deteriorated with increasing severity of glaucoma with mGCL thickness (AUC: 0.67–0.87) performing slightly better than mRT for all grades (AUC: 0.58–0.71).Conclusions: mRT and mGCL thickness measurement on PPTM showed great sensitivity and specificity to discern between normal and glaucomatous subjects. The discrimination ability of mRT and mGCL thickness, however, decreases with increasing grade of glaucoma. We believe SD-OCT PPTM offers an alternative imaging method to detect early glaucoma.

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Diagnostic efficacy of serum and urinary netrin-1 in the early detection of diabetic nephropathy

Journal of Investigative Medicine ◽

10.1136/jim-2021-001785 ◽

2021 ◽

pp. jim-2021-001785

Author(s):

Rasha A Elkholy ◽

Reham L Younis ◽

Alzahraa A Allam ◽

Rasha Youssef Hagag ◽

Muhammad Tarek Abdel Ghafar

Keyword(s):

Diabetic Nephropathy ◽

Early Detection ◽

Characteristic Curve ◽

Fasting Blood Glucose ◽

Area Under The Curve ◽

Diagnostic Value ◽

Control Group ◽

Diagnostic Efficacy ◽

Significant Difference ◽

Patients With Diabetes

This study aimed to assess the diagnostic value of serum and urinary netrin-1 in patients with type 2 diabetes mellitus (T2DM) at different stages of diabetic nephropathy (DN) and to compare its efficacy of estimation in serum with that in the urine. This study was carried out on 135 patients with T2DM and 45 healthy subjects. The patients with diabetes were divided according to urinary albumin creatinine ratio (UACR) into: T2DM with normoalbuminuria, incipient DN with microalbuminuria, and overt DN with macroalbuminuria groups. Serum and urinary levels of netrin-1 were measured by ELISA. The mean levels of serum and urinary netrin-1 were significantly higher in the microalbuminuric and macroalbuminuric patients with DN than those in the normoalbuminuric patients with T2DM, with the highest values detected in macroalbuminuric patients with DN. Urinary netrin-1 level was significantly higher in the normoalbuminuric T2DM group than control group, whereas no significant difference existed regarding serum netrin-1 level. In T2DM groups, the urinary and serum netrin-1 correlated with each other and were independently related to fasting blood glucose, UACR, and estimated glomerular filtration rate. Receiver operating characteristic curve analysis showed that the area under the curve of urinary netrin-1 was 0.916 which is significantly higher than that of serum netrin-1 (0.812) for the detection of incipient DN and reached 0.938 on coestimation of both urinary and serum netrin-1. In conclusion, netrin-1 is a potential diagnostic marker for early detection of DN with its estimation in urine has higher accuracy than that of serum.

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Procalcitonin and Conventional Markers of Inflammation in Peritoneal Dialysis Patients and Peritonitis

Peritoneal Dialysis International ◽

10.1177/089686080602600221 ◽

2006 ◽

Vol 26 (2) ◽

pp. 240-248 ◽

Cited By ~ 11

Author(s):

Galip Guz ◽

Bulent Colak ◽

Kenan Hizel ◽

Kadriye A. Reis ◽

Yasemin Erten ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Operating Characteristic ◽

Characteristic Curve ◽

Area Under The Curve ◽

Hemodialysis Patients ◽

Biochemical Tests ◽

Reactive Protein ◽

Markers Of Inflammation ◽

Median Serum ◽

Significant Difference

Objectives To determine the significance of a newly described marker of inflammation procalcitonin (PCT), and to investigate its relationship to conventional markers of inflammation, such as C-reactive protein (CRP), fibrinogen, and erythrocyte sedimentation rate (ESR), in patients on peritoneal dialysis (PD) and with peritonitis. Design A prospective, observational clinical study. Setting The Nephrology Division of a University-affiliated teaching hospital. Patients and Methods 51 consecutive patients on PD were included in the study. Of this number, 16 developed peritonitis during the observational period. Baseline PCT, CRP, and fibrinogen concentrations and ESR of 51 PD patients were determined at a time point (TB) prior to any evidence of infection. These results were compared with laboratory values from 74 hemodialysis patients and 34 nonuremic control subjects. All PD patients then were followed prospectively for evidence of peritonitis. In addition to routine blood tests, including hemoglobin and leukocyte count, and routine biochemical tests, blood samples were taken to measure PCT, CRP, and fibrinogen concentrations and ESR at the time (T0) when patients first were diagnosed with PD peritonitis and also on the 4th (T4) and the 14th (T14) days after treatment for peritonitis was initiated. PCT was assayed by immunoluminometry. Results No significant difference was observed between baseline median serum PCT concentrations in PD and hemodialysis patients; however, in both groups, baseline median PCT concentrations were significantly higher than those of nonuremic controls ( p < 0.05). The 16 patients on PD who developed peritonitis had 21 PD peritonitis episodes during the study period. The increased PCT concentration observed at T0 in PD peritonitis episodes decreased with therapy, and this change was statistically significant ( p < 0.05). In a receiver operating characteristic curve analysis for peritonitis, the area under the curve (AUC) for PCT was 0.80, which was significantly lower than the AUC for CRP and greater than the AUCs for fibrinogen and ESR. The sensitivity of PCT for peritonitis was lower than the sensitivity of conventional markers of inflammation; however, the specificity of PCT was higher. Conclusions Median serum PCT concentration in PD patients was significantly higher than in nonuremic controls but not hemodialysis patients. Serum PCT concentrations may serve as a useful adjunct to traditional markers of inflammation in detecting and monitoring inflammation and peritonitis in PD patients.

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Myo-Inositol Oxygenase as a Novel Marker in the Diagnosis of Acute Kidney Injury

Journal of Medical Biochemistry ◽

10.1515/jomb-2017-0027 ◽

2018 ◽

Vol 37 (1) ◽

pp. 1-6

Author(s):

Cuma Mertoglu ◽

Murat Gunay ◽

Ali Gurel ◽

Mehmet Gungor

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Sensitivity And Specificity ◽

Cystatin C ◽

Area Under The Curve ◽

Kidney Injury ◽

Diagnostic Sensitivity ◽

Diagnostic Efficiency ◽

Characteristic Analysis ◽

Diagnostic Sensitivity And Specificity

SummaryBackground: Due to the lack of diagnostic efficiency of serum creatinine in acute kidney injury (AKI), there is a pressing need to develop novel diagnostic markers. Therefore, in this study, we evaluated myo-inositol oxygenase (MIOX), neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C in terms of their applicability in the diagnosis of AKI. Methods: We enrolled a total of 39 AKI patients and 38 healthy controls in the study. We compared the levels of serum MIOX, NGAL and cystatin C between the two groups. Results: We found that the concentrations of serum creatinine, blood-urea nitrogen, MIOX and cystatin C were higher in the AKI group. According to the receiver operating characteristic analysis, the area under the curve (AUC) values were 0.694 (95% CI 0.579-0.794) for MIOX and 0.976 (95% CI; 0.912-0.997) for cystatin C. For MIOX, when the cut-off concentration was set to 77.3 pg/mL, the diagnostic sensitivity and specificity were found to be 53.8% (95% CI; 37.2-69.9) and 81.5 (95% CI; 65.7-92.3), respectively. For cystatin C, at the cut-off value of 14 mg/L, the diagnostic sensitivity and specificity were 94.8% (95% CI; 82.7-99.4) and 94.7 % (95% CI 82.3-99.4), respectively. Conclusion: The measurement of serum MIOX and cystatin C levels is valuable for the diagnosis of AKI. Further research is needed for the evaluation of the potential use of MIOX as a kidney-specific enzyme in the early diagnosis of AKI.

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Differentiation of soft-tissue lymphoma from undifferentiated sarcoma: apparent diffusion coefficient histogram analysis

Acta Radiologica ◽

10.1177/0284185120951959 ◽

2020 ◽

pp. 028418512095195

Author(s):

Ji Hyun Hong ◽

Won-Hee Jee ◽

Sunyoung Whang ◽

Chan-Kwon Jung ◽

Yang-Guk Chung ◽

...

Keyword(s):

Diffusion Coefficient ◽

Soft Tissue ◽

Apparent Diffusion Coefficient ◽

Characteristic Curve ◽

Area Under The Curve ◽

Histogram Analysis ◽

Undifferentiated Sarcoma ◽

Single Slice ◽

Significant Difference ◽

Apparent Diffusion

Background Making the preoperative diagnosis of soft-tissue lymphoma is important because the treatments for lymphoma and sarcoma are different. Purpose To determine the reliability and accuracy of single-slice and whole-tumor apparent diffusion coefficient (ADC) histogram analysis when differentiating soft-tissue lymphoma from undifferentiated sarcoma. Material and Methods Patients with confirmed soft-tissue lymphoma or undifferentiated sarcoma who underwent 3-T magnetic resonance imaging (MRI), including diffusion-weighted imaging, were included. Single-slice and whole-tumor ADC histogram analyses were performed using software. Mean, standard deviation (SD), 5th and 95th percentiles, skewness, and kurtosis were compared between groups, and a receiver operating characteristic curve with area under the curve (AUC) was obtained. Results Thirteen patients with soft-tissue lymphoma and 12 patients with undifferentiated sarcoma were included. ADC histogram analysis of single-slice and whole-tumor, mean, SD, and 5th and 95th percentiles was significantly lower in lymphoma than in undifferentiated sarcoma. Whole-tumor analysis kurtosis was significantly higher in lymphoma than in undifferentiated sarcoma. All AUCs were high in single-slice and whole-tumor analysis: 0.987 vs. 1.000 in mean; 0.821 vs. 0.782 in SD; 0.949 vs. 0.949 in 5th percentile; and 1.000 vs. 1.000 in 95th percentile without significant difference. AUC of kurtosis in whole-tumor ADC histogram analysis was 0.750. Conclusion Single-slice and whole-tumor ADC histogram analysis seems to be reliable and accurate for differentiating soft-tissue lymphoma from undifferentiated sarcoma.

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Measuring Kidney Perfusion, pH, and Renal Clearance Consecutively Using MRI and Multispectral Optoacoustic Tomography

Molecular Imaging and Biology ◽

10.1007/s11307-019-01429-z ◽

2019 ◽

Vol 22 (3) ◽

pp. 494-503 ◽

Cited By ~ 1

Author(s):

Atul S. Minhas ◽

Jack Sharkey ◽

Edward A. Randtke ◽

Patricia Murray ◽

Bettina Wilm ◽

...

Keyword(s):

Renal Clearance ◽

Clearance Rate ◽

Area Under The Curve ◽

Kidney Cortex ◽

Imaging Method ◽

Ph Measurements ◽

Optoacoustic Tomography ◽

Significant Difference ◽

Kidney Perfusion ◽

Magnetic Resonance Imaging Mri

Abstract Purpose: To establish multi-modal imaging for the assessment of kidney pH, perfusion, and clearance rate using magnetic resonance imaging (MRI) and multispectral optoacoustic tomography (MSOT) in healthy mice. Kidney pH and perfusion values were measured on a pixel-by-pixel basis using the MRI acidoCEST and FAIR-EPI methods. Kidney filtration rate was measured by analyzing the renal clearance rate of IRdye 800 using MSOT. To test the effect of one imaging method on the other, a set of 3 animals were imaged with MSOT followed by MRI, and a second set of 3 animals were imaged with MRI followed by MSOT. In a subsequent study, the reproducibility of pH, perfusion, and renal clearance measurements were tested by imaging 4 animals twice, separated by 4 days. The contrast agents used for acidoCEST based pH measurements influenced the results of MSOT. Specifically, the exponential decay time from the kidney cortex, as measured by MSOT, was significantly altered when MRI was performed prior to MSOT. However, no significant difference in the cortex to pelvis area under the curve (AUC) was noted. When the order of experiments was reversed, no significant differences were noted in the pH or perfusion values. Reproducibility measurements demonstrated similar pH and cortex to pelvis AUC; however, perfusion values were significantly different with the cortex values being higher and the pelvic values being lower in the second imaging time. We demonstrate that using a combination of MRI and MSOT, physiological measurements of pH, blood flow, and clearance rates can be measured in the mouse kidney in the same imaging session.

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Validation of ICMR Neurocognitive Toolbox for Dementia in the Linguistically Diverse Context of India

Frontiers in Neurology ◽

10.3389/fneur.2021.661269 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mansi Verma ◽

Manjari Tripathi ◽

Ashima Nehra ◽

Avanthi Paplikar ◽

Feba Varghese ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Linguistic Diversity ◽

Neuropsychological Test ◽

Area Under The Curve ◽

Cognitive Screening ◽

Indian Languages ◽

Middle Income ◽

Significant Difference ◽

Diagnosis Of Dementia

Objectives: The growing prevalence of dementia, especially in low- and middle-income countries (LMICs), has raised the need for a unified cognitive screening tool that can aid its early detection. The linguistically and educationally diverse population in India contributes to challenges in diagnosis. The present study aimed to assess the validity and diagnostic accuracy of the Indian Council of Medical Research-Neurocognitive Toolbox (ICMR-NCTB), a comprehensive neuropsychological test battery adapted in five languages, for the diagnosis of dementia.Methods: A multidisciplinary group of experts developed the ICMR-NCTB based on reviewing the existing tools and incorporation of culturally appropriate modifications. The finalized tests of the major cognitive domains of attention, executive functions, memory, language, and visuospatial skills were then adapted and translated into five Indian languages: Hindi, Bengali, Telugu, Kannada, and Malayalam. Three hundred fifty-four participants were recruited, including 222 controls and 132 dementia patients. The sensitivity and specificity of the adapted tests were established for the diagnosis of dementia.Results: A significant difference in the mean (median) performance scores between healthy controls and patients with dementia was observed on all tests of ICMR-NCTB. The area under the curve for majority of the tests included in the ICMR-NCTB ranged from 0.73 to 1.00, and the sensitivity and specificity of the ICMR-NCTB tests ranged from 70 to 100% and 70.7 to 100%, respectively, to identify dementia across all five languages.Conclusions: The ICMR-NCTB is a valid instrument to diagnose dementia across five Indian languages, with good diagnostic accuracy. The toolbox was effective in overcoming the challenge of linguistic diversity. The study has wide implications to address the problem of a high disease burden and low diagnostic rate of dementia in LMICs like India.

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Evaluation on the Diagnostic Efficiency of Different Methods in Detecting COVID-19.

10.21203/rs.3.rs-100604/v1 ◽

2020 ◽

Author(s):

Haitao Yang ◽

Yuzhu Lan ◽

Xiujuan Yao ◽

Sheng Lin ◽

Baosong Xie

Keyword(s):

Sensitivity And Specificity ◽

Operating Characteristic ◽

Web Of Science ◽

Characteristic Curve ◽

Positive Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Diagnostic Efficiency ◽

Summary Receiver Operating Characteristic ◽

Operating Characteristic Curve ◽

Higher Sensitivity

Abstract Objective: To evaluate the diagnostic efficiency of different methods in detecting COVID-19.Methods: PubMed, Web of Science and Embase databases were searched for identifing eligible articles. All data were calculated utilizing Meta Disc 1.4, Revman 5.3.2 and Stata 12. The diagnostic efficiency was assessed via these indicators including summary sensitivity and specificity, positive likelihood ratio (PLR), negative LR (NLR), diagnostic odds ratio (DOR), summary receiver operating characteristic curve (sROC) and calculate the AUC. Results: 18 articles (3648 cases) were included. EPlex: pooled sensitivity was 0.94; specificity 1.0; PLR 90.91; NLR 0.07; DOR 1409.49; AUC=0.9979, Q*=0.9840. Panther Fusion: pooled sensitivity was 0.99; specificity 0.98; PLR 42.46; NLR 0.02; DOR 2300.38; AUC=0.9970, Q*=0.9799. Simplexa: pooled sensitivity was 1.0; specificity 0.97; PLR 26.67; NLR 0.01; DOR 3100.93; AUC=0.9970, Q*=0.9800. Cobas®: pooled sensitivity was 0.99; specificity 0.96; PLR 37.82; NLR 0.02; DOR 3754.05; AUC=0.9973, Q*=0.9810. RT-LAMP: pooled sensitivity was 0.98; specificity 0.99; PLR 36.22; NLR 0.04; DOR 751.24; AUC=0.9905, Q*=0.9596. Xpert Xpress: pooled sensitivity was 0.99; specificity 0.97; PLR 27.44; NLR 0.01; DOR 3488.15; AUC=0.9977, Q*=0.9829.Conclusions: These methods (ePlex, Panther Fusion, Simplexa, Cobas®, RT-LAMP and Xpert Xpress) bear higher sensitivity and specificity, and might be efficient methods complement to the gold standard.

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