Seong Jong Yun

Background and objectives: No previous studies have investigated the relationship between the optic nerve sheath diameter and raised intracranial pressure in pediatric patients or have evaluated the usefulness of optic nerve sheath diameter in ocular ultrasound and brain computed tomography/magnetic resonance imaging. This study aimed to meta‐analyze the diagnostic performance of optic nerve sheath diameter for the diagnosis of raised intracranial pressure in pediatric patients.Methods: A database search of PubMed and EMBASE was performed to identify relevant studies. Bivariate modeling and hierarchical summary receiver operating characteristics modeling were performed to evaluate diagnostic performance. A pooled diagnostic odds ratio with a 95% confidence interval, not including 1, was considered informative. Subgroup analysis was performed according to the modality (ocular ultrasound vs brain computed tomography/magnetic resonance imaging). We performed meta‐regression analyses for heterogeneity exploration.Results: Eleven studies involving 546 patients were included. According to pooled diagnostic odds ratios, optic nerve sheath diameter was informative for the evaluation of raised intracranial pressure (diagnostic odds ratio, 47; 95% confidence interval, 11–206). Optic nerve sheath diameter showed a pooled sensitivity of 0.88 (95% confidence interval, 0.79–0.94), a pooled specificity of 0.86 (95% confidence interval, 0.70–0.95), and an area under the hierarchical summary receiver operating characteristics curve of 0.93 (95% confidence interval, 0.91–0.95) for the diagnosis of raised intracranial pressure. According to the subgroup analysis, ocular ultrasound (sensitivity, 0.91 (95% confidence interval, 0.81–0.96); specificity, 0.86 (95% confidence interval, 0.65–0.96)) showed higher sensitivity and comparable specificity than optic nerve sheath diameter measured on brain computed tomography/magnetic resonance imaging (sensitivity, 0.75 (95% confidence interval, 0.51–0.99); specificity, 0.91 (95% confidence interval, 0.74–1.00)). On meta‐regression analysis, the study design, number of patients, and reference standard were the sources of heterogeneity.Conclusion: Optic nerve sheath diameter may be a useful method for predicting raised intracranial pressure in pediatric patients. We recommend that the measurement of optic nerve sheath diameter should be performed using ocular ultrasound for a more accurate diagnosis of raised intracranial pressure in pediatric patients.

Objectives. This study was conducted to compare clinicopathologic and radiologic factors between benign and malignant thyroid nodules and to evaluate the diagnostic performance of shear wave elastography (SWE) combined with B-mode ultrasonography (US) in differentiating malignant from benign thyroid nodules.Methods. This retrospective study included 92 consecutive patients with 95 thyroid nodules examined on B-mode US and SWE before US-guided fine-needle aspiration biopsy or surgical excision. B-mode US findings (composition, echogenicity, margin, shape, and calcification) and SWE elasticity parameters (maximum [Emax], mean, minimum, and nodule-to-normal parenchymal ratio of elasticity) were reviewed and compared between benign and malignant thyroid nodules. The diagnostic performance of B-mode US and SWE for predicting malignant thyroid nodules was analyzed. The optimal cutoff values of elasticity parameters for identifying malignancy were determined. Diagnostic performance was compared between B-mode US only, SWE only, and the combination of B-mode US with SWE.Results. On multivariate logistic regression analysis, age (odds ratio [OR], 0.90; P=0.028), a taller-than-wide shape (OR, 11.3; P=0.040), the presence of calcifications (OR, 15.0; P=0.021), and Emax (OR, 1.22; P=0.021) were independent predictors of malignancy in thyroid nodules. The combined use of B-mode US findings and SWE yielded improvements in sensitivity, the positive predictive value, the negative predictive value, and accuracy compared with the use of B-mode US findings only, but with no statistical significance.Conclusion. When SWE was combined with B-mode US, the diagnostic performance was better than when only B-mode US was used, although the difference was not statistically significant.

Background: Ankle ultrasound imaging could be an option with higher priority due to its lack of radiation, and cost- and time-effectiveness. However, previous studies regarding anterior tibiofibular ligament and calcaneofibular ligament injuries have shown varied results. Purpose: To evaluate the diagnostic performance of ankle ultrasound for anterior tibiofibular ligament and calcaneofibular ligament injuries. Material and Methods: PubMed and EMBASE databases were searched for diagnostic accuracy studies that used ultrasound for diagnosing anterior tibiofibular ligament and calcaneofibular ligament injuries. Bivariate and hierarchical summary receiver operating characteristic modeling were used to evaluate diagnostic performance. Subgroup analysis was performed using studies according to severity of the injury (complete and partial anterior tibiofibular ligament tear). We performed meta-regression analyses for heterogeneity exploration. Results: Ten articles involving a total of 380 patients were included. For anterior tibiofibular ligament injury, the summary sensitivity, summary specificity, and area under the hierarchical summary receiver operating characteristic curve (AUC) were 0.99, 0.92, and 0.99, respectively. For calcaneofibular ligament injury, the summary sensitivity, summary specificity, and AUC were 0.95, 0.99, and 0.95, respectively. In subgroup analysis, for complete anterior tibiofibular ligament tear, the summary sensitivity, summary specificity, and AUC were 0.96, 0.82, and 0.96, respectively. For partial anterior tibiofibular ligament tear, the summary sensitivity, summary specificity, and AUC were 0.90, 0.82, and 0.93, respectively. Among the various potential covariates, proportion of anterior tibiofibular ligament tear, ultrasound interpreter, and reference standard were associated with specificity heterogeneity. Conclusion: Ankle ultrasound demonstrates high diagnostic performance in the diagnosis of anterior tibiofibular ligament and calcaneofibular ligament injuries. We recommend ultrasound performed by a musculoskeletal radiologist as a first-line diagnostic tool to diagnose anterior tibiofibular ligament and calcaneofibular ligament injuries.

This systematic review and meta-analysis aimed to evaluate the diagnostic outcomes and complication rates and to identify potential covariates that could influence these results for computed tomography (CT)-guided core needle biopsy (CNB) of mediastinal masses. A computerized search of the PubMed and EMBASE databases was performed to identify original articles on the use of CT-guided CNB for mediastinal mass. The pooled proportions of the diagnostic yield and accuracy were assessed using random effects modeling. We assessed the pooled proportion of complication rates using random effects or fixed effects modeling. Multivariate meta-regression analyses were performed to evaluate the potential sources of heterogeneity. Eighteen eligible studies (1310 patients with 1345 CT-guided CNBs) were included. The pooled proportions of the diagnostic yield and accuracy of CT-guided CNB for mediastinal masses were 92% (18 studies, 1345 procedures) and 94% (15 studies, 803 procedures), respectively. In the subgroup analysis, the pooled proportions of the total complication rate and major complication rate were 13% and 2%, respectively. In the meta-regression analyses, the number of tissue samplings (odds ratio [OR], 3.3; p = 0.03), real-time fluoroscopy-guided (OR, 2.1; p = 0.02), and percentage of lymphoma (OR, 2.2; p < 0.001) for diagnostic yield, number of tissue samplings (OR = 2.0, p = 0.02) for diagnostic accuracy, and biopsy needle diameter (OR, 2.5; p = 0.002) for total complication rate were all sources of heterogeneity. CT-guided CNB for mediastinal mass demonstrates high diagnostic outcomes and low complication rates. The use of 20-gauge biopsy needles and obtaining ≥ 3 samples may be recommended to improve diagnostic outcomes and decrease complication rates. • The pooled estimates of diagnostic yield and accuracy of computed tomography (CT)-guided core needle biopsy (CNB) for mediastinal masses are 92% and 94%, respectively. • The pooled estimates of the total complication rate and major complication rate were 13% and 2%, respectively. • The use of a 20-gauge needle and ≥ 3 tissue samplings are recommended for CT-guided mediastinal CNB to achieve high diagnostic outcomes and lower complication rates.

To evaluate the diagnostic accuracy of ankle ultrasound for detection of anterior talofibular ligament (ATFL) tear with a reference standard of operative finding.

Background Ankylosing spondylitis (AS) is a form of chronic inflammatory arthritis characterized by sacroiliitis and a marked propensity for sacroiliac joint and spinal fusion. The modified Stoke ankylosing Spondylitis Spinal Score (mSASSS) has been used when measuring radiographic progression in aS, which only measures bony changes of anterior side in vertebral body (AV). Variation of this score is too small to assess radiographic progression in aS. Some patients have syndesmophytes on lateral side in vertebral body (LV) or ankylosis in facet joints (FJ). Objectives We planned this study to know which side of lumbar vertebra ankylosis more frequently develops in and is more correlated with lumbar flexion function. Methods We analyzed aNKylosis registry of axial Spondyloarthritis (ANKAS). In this cohort, the patients with aS are examined by anteroposterior and lateral view of X-ray every 2 years and low dose whole spine computed tomography (CT) every 5 years to determine radiographic progression. We analyzed the location of near total or total bone bridge at each level of lumbar spine by X-ray and CT in 518 patients with aS. Results Male was 78% and mean age was 38.8 ± 2.8. Ankylosis or bony bridge in sacroiliac joint (SIJ), FJ, LV and aV was respectively 55.2%, 22.8%, 21.6% and 13.1%. T12L1 was the most frequent level of ankylosis in FJ (31.7%) and LV (30.3%). For FJ and LV, there was a tendency that upper levels of spine have more ankylosis, but not in aV. The patients who didn’t have SIJ ankylosis also have a tendency of not having any bony bridge in lumbar spine (negative predictive value: 92.24%, OR 28.1, 95% CI:16.3-48.4, p=0.000). We analyzed the correlation between the flexion score of Bath aS Metrology index (BASMI) 10 and the site of ankylosis. FJ ankylosis showed the strongest correlation with lumbar flexion range (R²=0.456, p=0.000), but bony bridge of LV and aV showed weak correlation with that (respectively, R²=0.288, R²=0.155, p=0.000). We analyzed the correlation between ankylosis of FJ and bony bridge of aV or LV respectively. Ankylosis of FJ and bony bridge of LV showed a stronger correlation (R²=0.712, p=0.000) than that of aV (R²=0.515, p=0.000) Conclusion Bony bridge in LV is not only more developed and correlated with ankylosis in FJ, but also more correlated with limitation of anterior lumbar flexion than that in aV. We suggest bony changes of LV should be also included in radiographic score system for more sensitive detection of radiographic progression in aS. Disclosure of interests None declared

To evaluate the diagnostic performance of knee ultrasound for anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries.