ABSTRACT
Background and purpose: Early diagnosis is important for treatment and prognosis of obstructive sleep apnea (OSA)in children. Polysomnography (PSG) is the gold standard for the diagnosis of OSA. However, due to various reasons, such as inconvenient implementation, less equipped in primary medical institutions, etc., it is less used in children, especially in young children. This study aims to establish a new diagnostic method with imaging data of upper airway and clinical signs and symptoms. Methods: In this retrospective study, clinical and imaging data were collected from children ≤10 years old who underwent nasopharynx CT scan(low-dose protocol)from February 2019 to June 2020,including 25 children with OSA and 105 non-OSA. The information of the upper airway (A-line; N-line; nasal gap; upper airway volume; upper and lower diameter, left and right diameter and cross-sectional area of the narrowest part of the upper airway) were measured in transaxial, coronal, and sagittal images. The diagnosis of OSA and adenoid size were given according to the guidelines and consensus of imaging experts. The information of clinical signs, symptoms, and others were obtained from medical records. According to the weight of each index on OSA, the indexes with statistical significance were screened out, then were scored and summed up. ROC analysis was performed with the sum as the test variable and OSA as the status variable to evaluate the diagnostic efficacy on OSA. Results: The AUC of the summed scores (ANMAH score) of upper airway morphology and clinical index for the diagnosis of OSA was 0.984 (95% CI 0.964-1.000). When sum = 7 was used as the threshold (participants with sum>7 were considered to have OSA), the Youden's index reached its maximum at which point the sensitivity was 88.0%, the specificity was 98.1%, and the accuracy was 96.2%. Conclusion: The morphological data of the upper airway based on CT volume scan images combined with clinical indices have high diagnostic value for OSA in children; CT volume scanning plays a great guiding role in the selection of treatment scheme of OSA. It is a convenient, accurate and informative diagnostic method with a great help to improving prognosis. Highlights: - Early diagnosis of OSA in children is very important for the treatment.- However, the traditional diagnostic gold-standard PSG is difficult to implement.- This study aims to explore convenient and reliable diagnostic methods for children.- A new diagnostic model was established combining CT with signs and symptoms.- The diagnostic method in this study is highly effective, informative, and convenient.
ABSTRACT
Objective: To evaluate the diagnostic performance of standard diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI), for differentiating benign and malignant soft tissue tumors (STTs). Materials and methods: A thorough search was carried out to identify suitable studies published up to September 2020. The quality of the studies involved was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The pooled sensitivity (SEN), specificity (SPE), and summary receiver operating characteristic (SROC) curve were calculated using bivariate mixed effects models. A subgroup analysis was also performed to explore the heterogeneity. Results: Eighteen studies investigating 1319 patients with musculoskeletal STTs (malignant, n=623; benign, n=696) were enrolled. Thirteen standard DWI studies using the apparent diffusion coefficient (ADC) showed that the pooled SEN and SPE of ADC were 0.80 (95% CI: 0.77-0.82) and 0.63 (95% CI: 0.60-0.67), respectively. The area under the curve (AUC) calculated from the SROC curve was 0.806. The subgroup analysis indicated that the percentage of myxoid malignant tumors, magnet strength, study design, and ROI placement were significant factors affecting heterogeneity. Four IVIM studies showed that the AUCs calculated from the SROC curves of the parameters ADC and D were 0.859 and 0.874, respectively. The AUCs for the IVIM parameters pseudo diffusion coefficient (D*) and perfusion fraction (f) calculated from the SROC curve were 0.736 and 0.573, respectively. Two DKI studies showed that the AUCs of the DKI parameter mean kurtosis (MK) were 0.97 and 0.89, respectively. Conclusion: The DWI-derived ADC value and the IVIM DWI-derived D value might be accurate tools for discriminating musculoskeletal STTs, especially for non-myxoid SSTs, using more than two b values, with maximal b value ranging from 600 to 800 s/mm2, additionally, a high-field strength (3.0 T) optimizes the diagnostic performance.
