BackgroundDiffusion-weighted imaging (DWI) is increasingly used to identify pathological complete responses (pCRs) to neoadjuvant chemotherapy (NAC) in breast cancer. The aim of the present study was to assess the utility of DWI using a pooled analysis.Materials and MethodsLiterature databases were searched prior to July 2017. Fifteen studies with a total of 1181 patients were included. The data were extracted to perform pooled analysis, heterogeneity testing, threshold effect testing, sensitivity analysis, publication bias analysis and subgroup analyses.ResultThe methodological quality was moderate. Remarkable heterogeneity was detected, primarily due to a threshold effect. The pooled weighted values were a sensitivity of 0.88 (95% confidence interval (CI): 0.81, 0.92), a specificity of 0.79 (95% CI: 0.70, 0.86), a positive likelihood ratio of 4.1 (95% CI: 2.9, 5.9), a negative likelihood ratio of 0.16 (95% CI: 0.10, 0.24), and a diagnostic odds ratio of 26 (95% CI: 15, 46). The area under the receiver operator characteristic curve was 0.91 (95% CI: 0.88, 0.93). In the subgroup analysis, the pooled specificity of change in the apparent diffusion coefficient (ADC) subgroup was higher than that in the pre-treatment ADC subgroup (0.80 [95% CI: 0.71, 087] vs. 0.63 [95% CI: 0.52, 0.73], P = 0.027).ConclusionsDWI may be an accurate and nonradioactive imaging technique for identifying pCRs to NAC in breast cancer. Nonetheless, there are a variety of issues when assessing DWI techniques for estimating breast cancer responses to NAC, and large scale and well-designed clinical trials are needed to assess the technique's diagnostic value.
ObjectiveTo use direct comparative studies or randomised controlled trials to compare the accuracy of cardiac magnetic resonance (CMR) and single-photon emission computed tomography (SPECT) for the detection of obstructive coronary artery disease (CAD).Materials and MethodsVarious databases were searched for original articles published prior to June 2013. Studies were selected that performed both CMR and SPECT in the same or randomised patients to detect CAD and that presented sufficient data to allow construction of contingency tables. For each study, the true-positive, false-positive, true-negative, and false-negative values were extracted or derived, and 2×2 contingency tables were constructed. To reduce heterogeneity, the meta-analysis was carried out in two parts: (1) coronary territory-based analysis and (2) patient-based analysis.Results10 studies (5 studies based on patient, 4 studies based on coronary territory, and 1 study based on both) were included in the meta-analysis with a total of 1727 patients. The methodological quality was moderate. For part (1), the summary estimates were as follows: for CMR based on patient–a sensitivity of 0.79 (95% confidence interval: 0.72–0.84) and a specificity of 0.75 (0.65–0.83); for SPECT based on patient–a sensitivity of 0.70 (0.59–0.79) and a specificity of 0.76 (0.66–0.83). For part (2), the summary estimates for CMR based on coronary territory were a sensitivity of 0.80 (0.73–0.85) and a specificity of 0.87 (0.81–0.91), and the summary estimates for SPECT based on coronary territory were a sensitivity of 0.67 (0.60–0.72) and a specificity of 0.80 (0.75–0.84).ConclusionsCompared with SPECT, CMR is more sensitive to detect CAD on a per-patient basis. Nonetheless, large scale, well-designed trials are necessary to assess its clinical value on a per-coronary territory basis.
The aim of this study was to evaluate 64-slice spiral CT image reconstruction of the portal vein in biliary obstruction. A total of 34 clinical patients with biliary obstruction were confirmed by 64-slice spiral CT scanning with portal venous phase multi-planar reconstruction (MPR) of the biliary tract, curved planar reconstruction (CPR), thin-slab minimum-intensity projection (TS-MinIP) and maximum intensity projection (MIP). The reconstructed images were reviewed to further assess the position and cause of the biliary obstruction and to judge the accuracy of diagnosis. The 64-slice spiral CT image reconstruction of the biliary obstructions determined the causes with an accuracy of 88.2% (30/34) and identified the location of the obstruction with an accuracy of 100%. A 64-slice spiral CT reconstructed image of the portal bile duct lesions was generated, which indicated the lesion morphology, location and anatomical relationship with surrounding tissues, secondary biliary stricture and the degree of expansion and is of great clinical value in the characterization and preoperative evaluation of biliary disease.
BACKGROUND AND PURPOSE To assess a 3D high‐resolution IR‐prepped fast SPGR high‐resolution MRI sequence for evaluating hypoglossal nerve lesions. METHODS The clinical data of 8 patients with hypoglossal nerve lesions admitted from December 2011 to February 2016 were retrospectively analyzed. MRI included contrast‐enhanced conventional sequences and a 3D IR‐prepped fast SPGR high‐resolution T1‐weighted (BRAVO) MRI sequence at 3T. RESULTS Eight patients had hypoglossal lesions detected by MRI. Conventional enhanced scanning could not clearly display the hypoglossal nerve and canal, while the enhanced 3D high‐resolution sequence could. In addition, multiple planar reconstruction clearly displayed the hypoglossal nerve, hypoglossal canal, and lesions in multiple planes. CONCLUSIONS Compared with conventional MRI, we show superior results from an advanced sequence to improve image quality in characterizing hypoglossal nerve lesions.
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