https://www.um.edu.mt/library/oar/handle/123456789/146277 2026-06-12T11:27:28Z 2026-06-12T11:27:28Z https://www.um.edu.mt/library/oar/handle/123456789/146273 2026-05-08T14:32:33Z 2023-01-01T00:00:00Z

Title: A comparison of fluoroscopy-guided pneumatic reduction and ultrasound-guided hydrostatic reduction of intussusception in children : a systematic review and meta-analysis Abstract: Aim: The goal of this meta-analysis was to assess the effectiveness and safety of pneumatic versus hydrostatic enema reduction of intussusception in the paediatric population. Methods: A systematic literature search was conducted by querying 3 databases namely Cochrane, PubMed, and Scopus for relevant literature published between January 2012 and January 2023. The focus of the review was on studies investigating the utilization of pneumatic or hydrostatic enema in children diagnosed with intussusception. The inclusion criteria encompassed studies that reported the success rate of enema reduction and the rate of perforation. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. The primary outcomes of interest included enema reduction success rate, perforation rate, and recurrence rate. Statistical analysis was performed using Stata Statistical Software (Release 17) and the Statistical Package for the Social Sciences. Results: A total of 46 studies were included in this meta-analysis. The studies together included data on 22,090 patients. The average age of the patients was 1.4 years, with 62% of the patients being male. The combined success rate of hydrostatic reduction under ultrasound guidance was 80.1% (SD=18), and the combined success rate of pneumatic reduction under fluoroscopy guidance was 82.0% (SD=12.7). This difference was not statistically significant (p=0.3). There was a statistically significant difference in combined rates of perforation however, with a perforation rate of 1.4% (SD=2.8) with hydrostatic reduction and 0.64% (SD=0.9) with pneumatic reduction (p=0.007). Recurrence rates were comparable between both methods of reduction, with recurrence of 5.0% (SD=6.1) with hydrostatic reduction and 4.9% (SD=6.3) with pneumatic reduction (p= 0.9). Conclusion: Fluoroscopy guided air enema and hydrostatic enema under ultrasound guidance, are both as efficacious in reducing paediatric intussusception. There is a higher rate of perforation with hydrostatic enema. Description: M.Sc.(Melit.)

2023-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/146272 2026-05-08T14:34:20Z 2023-01-01T00:00:00Z

Title: Comparison of arterial spin labelling and dynamic susceptibility contrast perfusion MR imaging in paediatric brain tumours : a systematic review and meta-analysis Abstract: Background: Brain tumours are a leading cause of mortality in children. Accurate tumour grading is essential to plan treatment and for prognostication. Perfusion imaging has been shown to correlate well with tumour grade in adults. However, there are fewer studies in paediatric patients. Moreover, there is no consensus regarding which MR perfusion technique demonstrates the highest accuracy in the latter population. Aim: To compare the diagnostic test accuracy of dynamic-susceptibility contrast and arterial spin-labelling, in their ability to differentiate between low- and high-grade paediatric brain tumours at first presentation. Methods: A systematic review of the literature and metanalysis of the extracted data was performed. PRISMA guidelines were followed. Results: 10 studies (7 ASL and 5 DSC) comprising 477 patients were included. The area under the curve (AUC) for the summary ROC of the combined studies was 0.866. The pooled AUC for ASL was 0.88, whilst that for DSC was 0.86. Pooled sensitivity was 0.824, 95% CI [0.757 - 0.876] for ASL and 0.789, 95% CI [0.552 - 0.919] for DSC. Pooled false positive rate was 0.204, 95% CI [0.142 0.285] for ASL and 0.203, 95% CI [0.081 - 0.425] for DSC. ASL appeared to perform better than DSC however the difference between the two studies was not statistically significant. Conclusion: Whilst DSC has been used more frequently than ASL in this field, the application of ASL is increasing. ASL is a contrast-free, non-invasive technique. As the diagnostic accuracy of ASL has been shown to be comparable and not inferior to DSC, its use in the diagnostic assessment of these patients should continue to be supported, however further studies with larger numbers and standardised practice are needed. Description: M.Sc.(Melit.)

2023-01-01T00:00:00Z