Imaging modalities

成像方式
  • 文章类型: Journal Article
    影像质量在放射学疾病的准确诊断和有效管理中起着至关重要的作用。这篇评论探讨了这些原则,方法论,以及评估和优化各种成像模式的图像质量的策略,包括X光片,计算机断层扫描(CT),磁共振成像(MRI),超声,核医学。我们讨论了影响图像质量的关键因素,如空间分辨率,噪音,对比,和文物,突出质量保证技术,图像优化,在临床实践中减少剂量。
    Image quality plays a pivotal role in the accurate diagnosis and effective management of diseases in radiology. This review explores the principles, methodologies, and strategies for assessing and optimizing image quality across various imaging modalities, including X-ray, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine. We discuss key factors influencing image quality, such as spatial resolution, noise, contrast, and artifacts, and highlight techniques for quality assurance, image optimization, and dose reduction in clinical practice.
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  • 文章类型: Journal Article
    背景:颞下颌关节紊乱病(TMD)提出了诊断挑战,选择合适的成像方式对于准确评估至关重要。这项研究旨在比较超声检查(US)和磁共振成像(MRI)在识别TMD方面的诊断准确性和功效。
    方法:进行了全面的荟萃分析,包括比较US和MRI对TMJ疾病评估的研究。使用固定效应模型以95%置信区间(CI)计算合并比值比(OR)和相对风险(RR)。使用卡方检验和I2统计量评估异质性。纽卡斯尔-渥太华量表用于评估纳入研究的方法学质量。
    结果:纳入了六项研究,共有281人参加。荟萃分析表明,在识别TMJ疾病方面,MRI在统计学上比US更好。总OR为0.64(95%CI:0.46-0.90),总RR为0.80(95%CI:0.68-0.95)。研究间的异质性较低(χ2=2.73,df=5,p=0.74;I2=0%)。人口统计变量揭示了样本量的变化,研究中的性别比例和平均年龄。
    结论:这项荟萃分析提供了证据,表明MRI在诊断TMD方面可能比US更有效。然而,这项研究受到纳入研究数量少、人口统计学变量和研究设计差异的限制.未来更大样本和标准化方案的研究对于确认和加强这些发现至关重要。了解MRI和US对TMJ疾病的诊断准确性将有助于临床医生做出明智的决策,以进行有效的TMJ疾病评估和患者管理。
    BACKGROUND: Temporomandibular disorders (TMDs) pose diagnostic challenges, and selecting appropriate imaging modalities is crucial for accurate assessment. This study aimed to compare the diagnostic accuracy and efficacy of ultrasonography (US) and magnetic resonance imaging (MRI) in identifying TMDs.
    METHODS: A comprehensive meta-analysis was conducted, including studies that compared US and MRI for TMJ disorder assessments. Fixed-effects models were utilized to calculate pooled odds ratios (ORs) and relative risks (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the chi-squared test and I2 statistic. Newcastle-Ottawa scale was used to assess the methodological quality of the studies included.
    RESULTS: Six studies were included, involving a total of 281 participants. The meta-analysis demonstrated that MRI was statistically somewhat better than US in identifying TMJ disorders. The summary OR was 0.64 (95% CI: 0.46-0.90), and the summary RR was 0.80 (95% CI: 0.68-0.95). Heterogeneity among the studies was low (χ2 = 2.73, df = 5, p = .74; I2 = 0%). Demographic variables revealed variations in sample size, gender ratio and mean age across the studies.
    CONCLUSIONS: This meta-analysis provides evidence that MRI may be more effective than US in diagnosing TMDs. However, the study is limited by the small number of included studies and variations in demographic variables and study designs. Future research with larger samples and standardised protocols is essential to confirm and strengthen these findings. Understanding the diagnostic accuracy of MRI and US for TMJ disorders will aid clinicians in making informed decisions for effective TMJ disorder assessments and patient management.
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  • 文章类型: Journal Article
    小儿肉瘤,间充质起源的罕见恶性肿瘤,提出诊断和治疗挑战。在这次审查中,我们探讨了影像组学在重塑我们对小儿肉瘤的理解中的作用,强调方法论的考虑和应用,如诊断和预测建模。截至2023年11月进行的系统评价确定了来自PubMed/MEDLINE的72篇关于小儿肉瘤的影像组学分析的论文,WebofKnowledge,还有Scopus.按照纳入和排除标准,本次审查包括10份报告。研究,主要是回顾性的,重点关注尤因肉瘤和骨肉瘤,利用不同的成像方式,包括CT,MRI,PET/CT,PET/MRI。手动分割是常见的,提取了35个特征的中位数。影像组学质量评分(RQS)和方法论影像组学评分(METRICS)评估揭示了对非影像组学特征的一致强调,验证标准,并在最近的出版物中改进了方法上的严谨性。诊断应用程序占主导地位,探索预后和治疗反应方面的创新研究。挑战包括特征异质性和样本大小差异。不断变化的景观强调了标准化方法的必要性。尽管面临挑战,影像组学在儿科肿瘤学中的诊断和预测潜力是显而易见的,为精准医学的进步铺平了道路。
    Pediatric sarcomas, rare malignancies of mesenchymal origin, pose diagnostic and therapeutic challenges. In this review, we explore the role of radiomics in reshaping our understanding of pediatric sarcomas, emphasizing methodological considerations and applications such as diagnostics and predictive modeling. A systematic review conducted up to November 2023 identified 72 papers on radiomics analysis in pediatric sarcoma from PubMed/MEDLINE, Web of Knowledge, and Scopus. Following inclusion and exclusion criteria, 10 reports were included in this review. The studies, predominantly retrospective, focus on Ewing sarcoma and osteosarcoma, utilizing diverse imaging modalities, including CT, MRI, PET/CT, and PET/MRI. Manual segmentation is common, with a median of 35 features extracted. Radiomics Quality Score (RQS) and Methodological Radiomics Score (METRICS) assessments reveal a consistent emphasis on non-radiomic features, validation criteria, and improved methodological rigor in recent publications. Diagnostic applications dominate, with innovative studies exploring prognostic and treatment response aspects. Challenges include feature heterogeneity and sample size variations. The evolving landscape underscores the need for standardized methodologies. Despite challenges, the diagnostic and predictive potential of radiomics in pediatric oncology is evident, paving the way for precision medicine advancements.
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  • 文章类型: Case Reports
    Erdheim-Chester病(ECD)是一种罕见的组织细胞增生症,其特征是受影响器官的黄瘤浸润。我们介绍了一例62岁的ECD患者,最初表现为缩窄性心包炎。综合影像学显示全身受累,包括骷髅,轨道,垂体,肺,肾,和腹膜后,尽管没有相关症状。通过CT引导活检的组织病理学证据最终证实了ECD的诊断。患者对干扰素-α2b治疗反应良好,在5个月的随访期内,症状逐渐改善,影像学和实验室检查结果也有所改善。该病例强调了在缩窄性心包炎的鉴别诊断中考虑ECD的重要性,以及多模态成像对这种罕见疾病的准确诊断和治疗的实用性。患者对治疗的积极反应也突出了有效管理ECD的潜力,特别是早期诊断和干预。
    Erdheim-Chester Disease (ECD) is a rare form of histiocytosis characterized by xanthomatous infiltration of affected organs. We present a case of a 62-year-old man with ECD initially presenting with constrictive pericarditis. Comprehensive imaging revealed systemic involvement, including the skeleton, orbit, pituitary, lung, kidney, and retroperitoneum, despite the absence of related symptoms. The diagnosis of ECD was eventually confirmed through histopathological evidence from a CT-guided biopsy. The patient responded well to interferon-α2b treatment, with gradual symptom amelioration and improvement in imaging and laboratory findings over a 5-month follow-up period. This case highlights the importance of considering ECD in the differential diagnosis of constrictive pericarditis and the utility of multimodal imaging for accurate diagnosis and management of this rare disease. The patient\'s positive response to treatment also highlights the potential for effective management of ECD, particularly with early diagnosis and intervention.
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  • 文章类型: Systematic Review
    人工智能(AI)技术越来越多地用于医学中的计算机辅助诊断工具。这些技术还可以帮助识别早期高血压(HTN),因为这是一个全球性的健康问题。自动HTN检测使用社会人口统计,临床资料,和生理信号。此外,还可以使用各种成像方式来识别继发性HTN的迹象。本系统综述审查了自动HTN检测的相关工作。我们识别数据集,技术,和用于从临床数据开发AI模型的分类器,生理信号,和融合的数据(两者的组合)。还回顾了用于评估次级HTN的基于图像的模型。大多数研究主要利用单模态方法,如生物信号(例如,心电图,光电体积描记术),和医学成像(例如,磁共振血管造影术,超声)。令人惊讶的是,只有一小部分研究(122个中的22个)使用了多模态融合方法,将来自不同来源的数据相结合。整合临床数据的调查更少,生理信号,和医学成像来了解这些因素之间的复杂关系。讨论了未来的研究方向,可以通过对多模态数据源进行更集成的建模来为早期HTN检测构建更好的医疗保健系统。
    Artificial Intelligence (AI) techniques are increasingly used in computer-aided diagnostic tools in medicine. These techniques can also help to identify Hypertension (HTN) in its early stage, as it is a global health issue. Automated HTN detection uses socio-demographic, clinical data, and physiological signals. Additionally, signs of secondary HTN can also be identified using various imaging modalities. This systematic review examines related work on automated HTN detection. We identify datasets, techniques, and classifiers used to develop AI models from clinical data, physiological signals, and fused data (a combination of both). Image-based models for assessing secondary HTN are also reviewed. The majority of the studies have primarily utilized single-modality approaches, such as biological signals (e.g., electrocardiography, photoplethysmography), and medical imaging (e.g., magnetic resonance angiography, ultrasound). Surprisingly, only a small portion of the studies (22 out of 122) utilized a multi-modal fusion approach combining data from different sources. Even fewer investigated integrating clinical data, physiological signals, and medical imaging to understand the intricate relationships between these factors. Future research directions are discussed that could build better healthcare systems for early HTN detection through more integrated modeling of multi-modal data sources.
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  • 文章类型: Journal Article
    为了回顾成像方式在评估糖尿病视网膜疾病(DRD)的血管成分方面的证据,以通知DRD暂存系统的更新。
    由国际专家工作组对文献进行标准化叙述审查,作为DRD暂存系统更新工作的一部分,玛丽·泰勒·摩尔视觉倡议的一个项目。总的来说,有6个工作组:血管视网膜,神经视网膜,系统健康,基本和细胞机制,视觉功能,和生活质量。
    血管视网膜工作组,包括来自4个国家的16名参与者。
    使用5种方式的标准化证据网格进行文献综述:标准彩色眼底照相(CFP),宽视场彩色摄影(WFCP),标准荧光素血管造影(FA),广域FA(WFFA),和OCT血管造影(OCTA)。在从I(最高)到V(最低)的验证量表上确定证据的汇总水平。举行了五次虚拟讲习班进行讨论和达成共识。
    每种模式的证据级别。
    标准CFP的证据水平,WFCP,标准FA,WFFA,OCTA是我,II,I,I,和II分别。标准CFP的传统血管病变应继续纳入更新的分期系统,但需要更多的研究才能将它们用于治疗后的眼睛。宽场彩色照片可用于标准CFP覆盖区域内的严重程度分级,尽管这些等级可能无法直接互换。可以考虑评估WFCP上的周边视网膜,但分级方法需要澄清和验证。标准FA和WFFA提供独立的预后价值,但是应该考虑染料给药的需要。OCT血管造影术在DRD分期系统中具有巨大的潜力,但是首先需要解决各种障碍。
    本研究为评估DRD血管成分的各种成像方式的实用性提供了基于证据的建议,可以通知DRD分段系统的未来更新。尽管新的成像模式提供了丰富的信息,在实现这一潜力之前,仍然存在重大差距和未满足的研究需求。
    专有或商业披露可在本文末尾的脚注和披露中找到。
    UNASSIGNED: To review the evidence for imaging modalities in assessing the vascular component of diabetic retinal disease (DRD), to inform updates to the DRD staging system.
    UNASSIGNED: Standardized narrative review of the literature by an international expert workgroup, as part of the DRD Staging System Update Effort, a project of the Mary Tyler Moore Vision Initiative. Overall, there were 6 workgroups: Vascular Retina, Neural Retina, Systemic Health, Basic and Cellular Mechanisms, Visual Function, and Quality of Life.
    UNASSIGNED: The Vascular Retina workgroup, including 16 participants from 4 countries.
    UNASSIGNED: Literature review was conducted using standardized evidence grids for 5 modalities: standard color fundus photography (CFP), widefield color photography (WFCP), standard fluorescein angiography (FA), widefield FA (WFFA), and OCT angiography (OCTA). Summary levels of evidence were determined on a validated scale from I (highest) to V (lowest). Five virtual workshops were held for discussion and consensus.
    UNASSIGNED: Level of evidence for each modality.
    UNASSIGNED: Levels of evidence for standard CFP, WFCP, standard FA, WFFA, and OCTA were I, II, I, I, and II respectively. Traditional vascular lesions on standard CFP should continue to be included in an updated staging system, but more studies are required before they can be used in posttreatment eyes. Widefield color photographs can be used for severity grading within the area covered by standard CFPs, although these gradings may not be directly interchangeable with each other. Evaluation of the peripheral retina on WFCP can be considered, but the method of grading needs to be clarified and validated. Standard FA and WFFA provide independent prognostic value, but the need for dye administration should be considered. OCT angiography has significant potential for inclusion in the DRD staging system, but various barriers need to be addressed first.
    UNASSIGNED: This study provides evidence-based recommendations on the utility of various imaging modalities for assessment of the vascular component of DRD, which can inform future updates to the DRD staging system. Although new imaging modalities offer a wealth of information, there are still major gaps and unmet research needs that need to be addressed before this potential can be realized.
    UNASSIGNED: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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  • 文章类型: Journal Article
    鉴于其发病率增加以及对预期寿命和生活质量的不利影响,慢性肾脏病(CKD)是一个重要的世界性健康问题。这篇综述文章提供了关于CKD诊断和管理的最新信息的完整摘要,关注最新进展和创新方法。本文讨论了CKD风险评估的最新发现,强调需要利用更好的生物标志物和预测模型进行早期诊断。对尿液中的白蛋白与肌酐比率(ACR)和肾小球滤过率(GFR)等诊断工具的严格检查强调了它们在确定CKD分期和病因中的重要性。在治疗方面,这项研究探索了基于证据的技术来减少CKD的发展,比如加强血压控制,糖尿病患者的血糖管理,饮食变化,肾素-血管紧张素-醛固酮系统(RAAS)阻断。新的治疗方法,包括抗纤维化和精准医学,评估其彻底改变CKD治疗的潜力。该研究还强调了多学科治疗和患者教育的必要性,以实现CKD患者的最佳预后。它还强调了CKD的财务和社会影响,强调早期治疗对降低医疗费用和提高患者生活水平的重要性。最后,这篇综述文章提供了关于CKD诊断和治疗的全面更新,突出当前的成功和未来的潜力。它是医疗保健专业人员的宝贵资源,学者,以及希望改善CKD治疗方法和患者预后的政策制定者。
    Given its increasing incidence and detrimental effects on life expectancy and quality of life, chronic kidney disease (CKD) is a significant worldwide health concern. This review article provides a complete summary of current information on the diagnosis and management of CKD, focusing on recent advances and innovative approaches. The article discusses the most current findings on CKD risk assessment, emphasizing the need for early diagnosis utilizing better biomarkers and predictive models. A rigorous examination of diagnostic tools such as albumin-to-creatinine ratio (ACR) in urine and glomerular filtration rate (GFR) highlights their importance in determining CKD phases and etiologies. In terms of therapy, the study explores evidence-based techniques to reduce the development of CKD, such as enhanced blood pressure control, glycemic management in diabetic patients, dietary changes, and renin-angiotensin-aldosterone system (RAAS) blocking. Novel therapeutic approaches, including antifibrotic and precision medicine, are evaluated regarding their potential to revolutionize CKD treatment. The study also underlines the need for multidisciplinary therapy and patient education to achieve the best possible CKD patient outcomes. It also highlights the financial and social effects of CKD, highlighting the importance of early treatment to lower medical expenses and enhance the patient\'s standard of living. Finally, this review article provides a comprehensive update on CKD diagnosis and treatment, highlighting present successes alongside future potential. It is a valuable resource for healthcare professionals, academics, and policymakers who want to improve CKD treatment methods and patient outcomes.
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  • 文章类型: Journal Article
    要报告准确性,重复性,与彼此或与其他成像方式进行比较的X射线照片和/或立体X射线照片(EOS)上的Cobb角测量值的一致性。
    本评论遵循系统评论和荟萃分析(PRISMA)指南的首选报告项目。2021年7月21日使用Medline进行了文献检索,Embase,还有Cochrane.两名研究人员独立进行标题/摘要/全文筛选和数据提取。如果研究报告了科布角,他们就有资格,和/或它们的可重复性和一致性,在X射线照片和/或EOS上测量,彼此之间或与其他成像方式进行比较。
    在确定的2993条记录中,在标题/摘要/全文筛选期间,845个重复,2212个被排除。从合格研究的参考文献中确定了另外两项相关研究,留下14项研究纳入。两项研究比较了EOS和CT的Cobb角,而12人将射线照片与其他成像方式进行了比较:EOS,CT,MRI,数字透视,或双能X射线吸收法。站立X射线照片的角度往往高于仰卧位MRI和CT的角度,站立EOS的角度往往高于仰卧或俯卧CT的角度。不同模态之间的相关性很强(R=0.78-0.97)。所有研究的观察者之间的一致性都很好(ICC=0.77-1.00),除了一个(ICC=0.13X线照片和ICC=0.68的MRI)。
    在成像方式和患者位置的组合中比较Cobb角时,发现了高达11º的差异。这是不可能的,然而,为了确定观察到的差异是否是由于模态的变化,position,或者两者兼而有之。因此,临床医生在利用其他方式和位置的站立位X线照片阈值诊断和评估脊柱侧凸时应谨慎.
    UNASSIGNED: To report accuracy, repeatability, and agreement of Cobb angle measurements on radiographs and/or stereo-radiographs (EOS) compared against one another or against other imaging modalities.
    UNASSIGNED: This review follows Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A literature search was conducted on 21 July 2021 using Medline, Embase, and Cochrane. Two researchers independently performed title/abstract/full-text screening and data extraction. Studies were eligible if they reported Cobb angles, and/or their repeatability and agreement, measured on radiographs and/or EOS compared against one another or against other imaging modalities.
    UNASSIGNED: Of the 2993 records identified, 845 were duplicates and 2212 were excluded during title/abstract/full-text screening. Two more relevant studies were identified from references of eligible studies, leaving 14 studies for inclusion. Two studies compared Cobb angles from EOS vs CT, while 12 compared radiographs vs other imaging modalities: EOS, CT, MRI, digital fluoroscopy, or dual-energy x-ray absorptiometry. Angles from standing radiographs tended to be higher than those from supine MRI and CT, and angles from standing EOS tended to be higher than those from supine or prone CT. Correlations across modalities were strong (R = 0.78-0.97). Inter-observer agreement was excellent for all studies (ICC = 0.77-1.00), except one (ICC = 0.13 radiographs and ICC = 0.68 for MRI).
    UNASSIGNED: Differences of up to 11º were found when comparing Cobb angles across combinations of imaging modalities and patient positions. It is not possible, however, to determine whether the differences observed are due to the change of modality, position, or both. Therefore, clinicians should be careful when utilizing the thresholds for standing radiographs across other modalities and positions for diagnosis and assessment of scoliosis.
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  • 文章类型: Journal Article
    UNASSIGNED:终末期肾病(ESRD)和随后需要透析的患者的发病率不断上升。详细的术前计划和精心创建的血液透析功能通道,作为移植的桥梁或作为长期解决方案,对于降低血管通路相关的发病率和死亡率以及改善ESRD患者人群的生活质量具有至关重要的作用。除了包括身体检查在内的详细医疗检查,存在多种成像模式,以支持关于每位患者最适合的血管通路的进一步决策。这些模式提供了两者,血管树和具体病理结果的全面解剖学概述,这可能会增加访问失败或访问成熟不足的可能性。本手稿旨在对当前文献进行全面回顾,并概述血管通路规划中的不同成像方式。此外,我们提供了一种用于创建血液透析访问的分步计划算法.
    UNASSIGNED:在PubMed和Cochrane系统评价数据库中搜索后,我们审查了截至2021年发表的合格英语文献,包括指南和荟萃分析,回顾性和前瞻性队列研究。
    UNASSIGNED:双重超声作为术前血管标测的一线成像工具被广泛接受。然而,这种模式有其固有的局限性,因此,可以使用数字减影血管造影(DSA)或静脉造影和计算机断层扫描血管造影(CTA)评估具体问题.这些模式更具侵入性,与辐射暴露有关,需要肾毒性造影剂。磁共振血管造影术(MRA)可能是具有专业知识的选定中心的替代方案。
    UNASSIGNED:术前影像学建议主要基于回顾性(注册)研究和病例系列。前瞻性研究和随机试验主要与接受术前双工超声检查的ESRD患者的访问结果有关。缺乏与侵入性DSA和非侵入性横断面成像(CTA或MRA)相关的比较前瞻性数据。
    UNASSIGNED: The incidence of patients with end-stage renal disease (ESRD) and subsequent need for dialysis is continuously rising. The detailed preoperative planning and careful creation of a functioning access for hemodialysis as a bridge to transplant or as a long-term solution, has a crucial role to reduce vascular access associated morbidity and mortality and improve quality of life of the ESRD patient population. In addition to a detailed medical workup including physical exam, a variety of imaging modalities exist to support further decision making with regard to the best suited vascular access for each individual patient. These modalities provide both, a comprehensive anatomical overview of the vascular tree and specific pathologic findings, which may increase the likelihood of access failure or insufficient access maturation. This manuscript aims to provide a comprehensive review of current literature and an overview of the different imaging modalities in vascular access planning. Additionally, we provide a step-by-step planning algorithm for hemodialysis access creation.
    UNASSIGNED: After searching in PubMed and Cochrane database of systematic review, we reviewed eligible English literatures published up to 2021, including guidelines and meta-analyses, retrospective and prospective cohort studies.
    UNASSIGNED: Duplex ultrasound is widely accepted as first line imaging tool for preoperative vessel mapping. However, this modality has its inherent limitations, therefore specific questions can be assessed using digital subtraction angiography (DSA) or venography and computed tomography angiography (CTA). These modalities are more invasive, are associated with radiation exposure and require nephrotoxic contrast agents. Magnetic resonance angiography (MRA) may be an alternative in selected centers with available expertise.
    UNASSIGNED: Pre-procedure imaging recommendations are mainly based on retrospective (register-) studies and case-series. Prospective studies and randomized trials are primarily related to access outcomes in ESRD patients who underwent preoperative duplex ultrasound. Comparative prospective data related to invasive DSA and non-invasive cross-sectional imaging (CTA or MRA) are lacking.
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  • 文章类型: Systematic Review
    结外延伸(ENE)的预处理测定在人乳头瘤病毒阳性(HPV)口咽鳞状细胞癌(OPSCC)中具有重要的临床意义。不幸的是,在HPV+OPSCC中没有用于ENE放射学评估的金标准成像模式,导致有关ENE的主观评估和复杂决策。因此,对诊断测试准确性进行了系统审查,系统搜索了五个数据库,以评估用于检测HPVOPSCC中ENE的成像模式的诊断性能。使用随机效应模型对四项CT研究进行了荟萃分析。虽然使用PET/CT和“CT和MRI”为研究提供了叙述性综合。“在1772次点击中,6项研究纳入本综述.对四项CT研究的荟萃分析显示,CT的总体敏感性为77%,特异性为60%。PET/CT的敏感性为37.5%,特异性为97%。“CT和MRI”的敏感性为62%,特异性为78%。涉及CT的进一步诊断研究,最终需要PET/CT和MRI。
    Pretreatment determination of extranodal extension (ENE) has significant clinical implications in human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Unfortunately there is no gold-standard imaging modality for radiological assessment of ENE in HPV+ OPSCC, leading to subjective assessments and complex decision making concerning ENE. A systematic review of diagnostic test accuracy was therefore undertaken, with five databases systemically searched to evaluate the diagnostic performance of an imaging modality for detection of ENE in HPV+ OPSCC. A meta-analysis was conducted on four CT studies using a random-effects model. While a narrative synthesis was provided for the studies using PET/CT and \"CT and MRI.\" Out of 1772 hits, six studies were included in the review. Meta-analysis on four CT studies showed CT had an overall sensitivity of 77% and specificity of 60%. PET/CT had a sensitivity of 37.5% and specificity of 97%. \"CT and MRI\" had a sensitivity of 62% and specificity of 78%. Further diagnostic studies involving CT, PET/CT and MRI are ultimately required.
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