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The use of plain radiography, subtraction arthrography, nuclear arthrography, and bone scintigraphy in the diagnosis of a loose acetabular component of a total hip prosthesis: a systematic review

This meta-analysis was performed to summarize and compare the diagnostic performance and diagnostic accuracy of radiographic and scintigraphic techniques in the evaluation of patients suspected of having aseptically loose acetabular components. Twenty-eight studies, published between January 1975 and October 2004, presented sufficient data for quantitative analysis. The pooled sensitivity and specificity rates for plain radiography were 70% (95% confidence interval [CI] = 59%-79%) and 80% (95% CI = 73%-86%), respectively; those for subtraction arthrography were 89% (95% CI = 84%-93%) and 76% (95% CI = 68%-82%), respectively; and those for nuclear arthrography were 87% (95% CI = 57%-97%) and 64% (95% CI = 40%-82%), respectively. Finally, bone scintigraphy had a sensitivity of 67% (95% CI = 57%-76%) and a specificity of 75% (95% CI = 64%-83%). We found a significantly higher sensitivity for subtraction arthrography as compared with plain radiography and bone scintigraphy. Therefore, subtraction arthrography is recommended for use as an additional diagnostic technique when plain radiography is found to be inconclusive.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

The diagnostic accuracy of X-ray arthrography for triangular fibrocartilaginous complex injury: a systematic review and meta-analysis

The purpose of this study was to evaluate the diagnostic test accuracy of X-ray arthrography in the detection of TFCC tear. Both published and unpublished databases were searched from their inception to August 2010. All studies comparing the diagnostic accuracy of X-ray arthrography (index test) to arthroscopy (reference standard) for patients with suspected TFCC tears were included in this review. Twelve studies assessing 430 patients (430 wrists) satisfied the eligibility criteria and were included. X-ray arthrography presented with a pooled sensitivity of 76.2% and specificity of 92.5% for the detection of complete TFCC tear. The triple-compartment injection X-ray arthrography was superior to the single-compartment injection technique. To conclude, the diagnostic test accuracy of X-ray arthrography is limited. Neither the single- nor the triple-compartment injection arthrography method is acceptable, given their reported low sensitivities. Further evaluation of the diagnostic test accuracy of Magnetic Resonance Arthrography and Magnetic Resonance Imaging is therefore warranted.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee

PURPOSE: To assess the diagnostic test accuracy of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) and computed tomography arthrography (CTA) for the detection of chondral lesions of the patellofemoral and tibiofemoral joints.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

The diagnostic accuracy of acetabular labral tears using magnetic resonance imaging and magnetic resonance arthrography: a meta-analysis

This review concluded that both magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) may be useful adjuncts in the diagnosis of hip acetabular labral tears in adults, although MRA appeared superior to conventional MRI. Given the limitations of the evidence available and the analysis undertaken, these conclusions should be treated with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

The diagnostic test accuracy of magnetic resonance imaging, magnetic resonance arthrography and computer tomography in the detection of chondral lesions of the hip

BACKGROUND: The purpose of this study was to assess the diagnostic test accuracy of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) and multidetector arrays in CT arthrography (MDCT) for assessing chondral lesions in the hip joint.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

The value of contrast and subtraction arthrography in the assessment of aseptic loosening of total hip prostheses: a meta-analysis

This review concluded that subtraction arthrography is a sensitive technique for the detection of loosening of total hip prostheses, and that it offers added value compared with contrast arthrography, especially for the femoral component. These conclusions are supported by the data presented, but should be interpreted with caution given the possible limitations of the analysis and the likelihood that relevant studies have been missed.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Diagnostic accuracy of magnetic resonance imaging and magnetic resonance arthrography for triangular fibrocartilaginous complex injury: a systematic review and meta-analysis

This review concluded that magnetic resonance arthrography, rather than magnetic resonance imaging, be performed when there were questions about the diagnosis and subsequent management of patients with ulnar-sided wrist pain. The review process was generally well-conducted but limitations of the available evidence and the analysis undertaken mean that the authors' conclusions should be treated with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Osteoarthritis and the postmenopausal woman: epidemiological, magnetic resonance imaging, and radiological findings

This review assessed the effect of oestrogen replacement therapy (ERT) on articular cartilage in postmenopausal women. The authors concluded that there was weak evidence to suggest that ERT may protect against large joint osteoarthritis. However, a negative effect was seen on cartilage volume in postmenopausal women. The review conclusions are unlikely to be robust given concerns about the review methodology and the poor quality of the studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

The effect of treatment on radiological progression in rheumatoid arthritis: a systematic review of randomized placebo-controlled trials

This review assessed the effectiveness of drug treatments in preventing bone erosion (determined from X-rays) in rheumatoid arthritis. The authors concluded that cyclosporine, infliximab, sulphasalazine, leflunomide, methotrexate, parenteral gold, corticosteroids, auranofin and IL-1-RA are more effective than placebo. This conclusion appears reliable. Conclusions about relative effectiveness of different drugs were derived from indirect comparisons and may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

Should tetracycline treatment be used more extensively for rheumatoid arthritis: metaanalysis demonstrates clinical benefit with reduction in disease activity

This review compared the effect of tetracyclines versus placebo or conventional therapy for rheumatoid arthritis. The authors concluded that tetracyclines given for more than 3 months lead to a reduction in disease activity and acute phase reactants. The review was well-conducted, although apparent clinical differences were not considered in the analysis. Hence, the conclusion should be viewed with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears [Internet]

The objective of this review is to provide a comprehensive synthesis of the evidence examining the effectiveness of nonoperative and operative interventions for the treatment of rotator cuff tears. The report is intended for a broad audience, including professional societies developing clinical practice guidelines, patients and their care providers, as well as researchers conducting studies on treatments of this condition. Outcomes of interest include health-related quality of life, shoulder function, time to return to work, cuff integrity, pain, range of motion and strength of the shoulder.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: July 2010
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Accuracy of diagnostic imaging techniques in the diagnosis of aseptic loosening of the femoral component of a hip prosthesis: a meta-analysis

This review concluded that plain radiography, subtraction arthrography, bone scintigraphy and nuclear arthrography had similar diagnostic performance for detecting aseptic loosening of hip prostheses. However, plain radiograph and bone scintigraphy were preferred because of greater efficacy and lower morbidity. Given the review limitations and the lack of good-quality evidence supporting the stated preferred techniques, these conclusions may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Management of Frozen Shoulder: A Systematic Review and Cost-Effectiveness Analysis

Frozen shoulder is condition in which movement of the shoulder becomes restricted. It can be described as either primary (idiopathic) whereby the aetiology is unknown, or secondary, when it can be attributed to another cause. It is commonly a self-limiting condition, of approximately 1 to 3 years' duration, though incomplete resolution can occur.

Health Technology Assessment - NIHR Evaluation, Trials and Studies Coordinating Centre (UK).

Version: March 2012
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Optimizing Health System Use of Medical Isotopes and Other Imaging Modalities [Internet]

The purpose of this project was to provide national guidance on the optimal use of 99mTc during a situation of reduced supply. To accomplish this, our objective at CADTH was:

Optimal Use Report - Canadian Agency for Drugs and Technologies in Health.

Version: 2012
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Screening for Developmental Dysplasia of the Hip [Internet]

Developmental dysplasia of the hip (DDH) can lead to the later development of chronic pain, osteoarthritis, and limitations in activity. Screening for DDH has been practiced for over 40 years, but recommendations from major professional societies differ.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: March 2006
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Clinical utility of ultrasound guidance for intra-articular knee injections: a review

Intra-articular corticosteroid and hyaluronic acid injections provide short-term symptom amelioration for arthritic conditions involving structural damage or degenerative changes in the knee. Conventional palpation-guided anatomical injections frequently result in inaccurate needle placement into extra-articular tissue and adjacent structures. The purpose of this review was to determine the effect of ultrasound guidance on the accuracy of needle placement, clinical outcomes, and cost-effectiveness in comparison with anatomical landmark-guided intra-articular large joint injections, with particular emphasis on the knee. A total of 13 relevant studies were identified; five studied the knee, seven studied the shoulder, one used both the knee and shoulder, and none studied the hip. Ultrasound was used in seven studies; the remaining studies utilized air arthrography, fluoroscopy, magnetic resonance arthrography, or magnetic resonance imaging. Across all studies (using all imaging modalities and all joints), needle placement accuracy ranged from 63% to 100% with ultrasound and from 39% to 100% with conventional anatomical guidance. Imaging guidance improved the accuracy of intra-articular injections of the knee (96.7% versus 81.0%, P < 0.001) and shoulder (97.3% versus 65.4%, P < 0.001). In particular, ultrasound guidance of knee injections resulted in better accuracy than anatomical guidance (95.8% versus 77.8%, P < 0.001), yielding an odds ratio of 6.4 (95% confidence interval 2.9-14). Ultrasound guidance notably improves injection accuracy in the target intra-articular joint space of large joints including the knee. The enhanced injection accuracy achieved with ultrasound needle guidance directly improves patient-reported clinical outcomes and cost-effectiveness.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

The validity and accuracy of clinical diagnostic tests used to detect labral pathology of the hip: a systematic review

Acetabular labral tears are an area of increasing interest to clinicians involved in the diagnosis of musculoskeletal complaints of the hip. This review systematically evaluated the evidence for the diagnostic accuracy and validity of reported symptoms, physical examination and imaging in this complex population. Studies published in English prior to May 2010 were included. One reviewer searched information sources to identify relevant articles. Two reviewers independently assessed studies for inclusion, extracted data and evaluated quality using the Quality Assessment of Diagnostic Studies Tool. Twenty one studies were included. Meta-analysis was limited owing to heterogeneity between studies. Results showed Magnetic Resonance Arthrography to consistently outperform Magnetic Resonance Imaging. Computerised Tomography also showed high accuracy levels for the few studies identified. Studies investigating physical tests were of poor quality demonstrating a need for further research in this area. Symptoms likely to be present in patients presenting with acetabular labral tears were found to be anterior groin pain and mechanical hip symptoms; however, additional good quality studies are needed to consolidate findings.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

A meta-analysis of the diagnostic test accuracy of MRA and MRI for the detection of glenoid labral injury

PURPOSE: Magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) have gained increasing favour in the assessment of patients with suspected glenoid labral injuries. The purpose of this study was to determine the diagnostic accuracy of MRI or MRA in the detection of gleniod labral lesions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Diagnostic tests for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered

This summary of a Cochrane review presents what we know from research about the accuracy of imaging tests to detect tears of the rotator cuff tendons in the shoulder.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review

Shoulder pain is a significant cause of morbidity; the prevalence of self-reported pain is estimated to be between 16 and 26%, and it is the third most common cause of musculoskeletal consultation in primary care. The cause can be difficult to diagnose owing to the complex anatomy of the shoulder and the spectrum of underlying disorders. Most shoulder problems fall into three major categories: soft tissue disorders, articular injury or instability, and arthritis. The incidence of lesions increases with age as tendon tissue progressively weakens or degenerates, but repeated microtrauma or overuse from professional or athletic activity can also cause soft tissue problems in all age groups.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Evaluation, Trials and Studies Coordinating Centre (UK).

Version: 2003

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