Cureus最新文献

{"title":"Stomach Volvulus Combined With Small Bowel Obstruction Eight Years After Laparoscopic Gastric Plication: A Case Report.","authors":"Nikolaos Pararas, Anastasia Pikouli, Despoina Papantoniou, Dionysios Dellaportas, Emmanouil Pikoulis","doi":"10.7759/cureus.118504","DOIUrl":"https://doi.org/10.7759/cureus.118504","url":null,"abstract":"<p><p>Laparoscopic gastric plication (LGP) is a restrictive bariatric procedure that reduces gastric volume without resection and without the use of staplers or prosthetic materials. We present the case of a 25-year-old female patient who had undergone LGP eight years earlier and presented with acute abdominal pain, vomiting, and recurrent episodes of obstructive jaundice. Computed tomography demonstrated gastric volvulus, and emergency laparotomy revealed a partially unfolded plicated fundus due to ruptured sutures, causing a mixed-type gastric volvulus, together with intussusception of ischemic, hypertrophic gastric mucosa from the plicated fundus through the pylorus into the duodenum, obstructing the duodenal lumen. We took down the plication, reduced the intussuscepted mucosa, and performed a sleeve gastrectomy. The postoperative course was uneventful, and the jaundice resolved. Gastric volvulus and mucosal intussusception causing obstruction are rare but potentially devastating late complications of greater curvature plication. Awareness of this spectrum of complications allows timely recognition and treatment and should be considered when choosing a bariatric procedure.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118504"},"PeriodicalIF":1.3,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13695339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Chronic Constipation and Fecaloma in a Patient With Partial Agenesis of the Corpus Callosum: A Case Report.","authors":"Ikenna Joel Edward, Pamela Momah, Nima Maharjan","doi":"10.7759/cureus.118495","DOIUrl":"https://doi.org/10.7759/cureus.118495","url":null,"abstract":"<p><p>Symptoms of functional constipation are associated with dysregulation of the brain-gut axis (BGA). BGA stands as a framework that accounts for the bidirectional interaction between the central nervous system (CNS), autonomic nervous system (ANS), and the enteric nervous system (ENS). Considering these interactions, the brain (CNS) becomes central to bowel movement/defecation. Consequently, it becomes evident why conditions of the CNS or impacts on the CNS could lead to functional constipation. This case report highlights the intricate relationship between the CNS and GI motility via the BGA. The clinical presentation of partial agenesis of the corpus callosum and refractory fecaloma demonstrates an association between structural neurological deficits and impaired visceral sensory processing, though further studies/investigation are needed to establish a causal link (direct) to the patient's disrupted ability or physiological urge to defecate.  Acute management, such as manual evacuation, can be necessary in severe chronic constipation with fecaloma to prevent life-threatening stercoral perforation. Additionally, long-term management of neurogenic constipation should evolve beyond a standard approach. Individualized management strategies could be considered, which may involve transitioning from an urge-based to a time-based defecation routine, alongside adjuncts like prokinetic agents (e.g., prucalopride) and regular abdominal massage.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118495"},"PeriodicalIF":1.3,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13713215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concordance Between Trial Efficacy and Real-World Effectiveness of Sodium-Glucose Cotransporter 2 Inhibitors in Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis.","authors":"Ahmed Hassanien, Mohamed Elhenedy, Mohamed Elgohari","doi":"10.7759/cureus.118487","DOIUrl":"https://doi.org/10.7759/cureus.118487","url":null,"abstract":"<p><p>Randomized trials established the efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors in heart failure with reduced ejection fraction (HFrEF). We assessed whether their effectiveness in routine practice is concordant with trial efficacy, appraising and pooling each evidence stream separately. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov were searched from January 1, 2015 to July 2026 for randomized trials and comparative observational studies of SGLT2 inhibitors vs. placebo or nonuse in adults with left ventricular ejection fraction ≤40% reporting mortality or heart failure hospitalization. Risk of bias was assessed with the Cochrane Risk of Bias 2 and the Newcastle-Ottawa Scale. Adjusted all-cause mortality was pooled by random-effects meta-analysis with the Hartung-Knapp adjustment; other outcomes were synthesized narratively. Trial and observational estimates were never combined, and certainty was graded with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Eleven studies were included (two trials and nine observational). For all-cause mortality, the pooled observational HR (0.75, 95% CI 0.71-0.79; I² = 0%) indicated a larger apparent benefit than the pooled trial estimate (HR 0.87, 0.77-0.98). In one registry, the association attenuated to borderline nonsignificance after adjustment for background therapy. For heart failure hospitalization, a consistent trial benefit (HR 0.69, 0.62-0.78) contrasted with attenuated or null real-world estimates (HR 0.84-1.03). Real-world mortality associations with SGLT2 inhibitors in HFrEF are directionally concordant with trial efficacy, but their larger magnitude most plausibly reflects residual confounding, including co-prescription of other guideline-directed therapy. Real-world hospitalization estimates diverged from trials, likely reflecting outcome ascertainment. With very low-certainty observational evidence, the trial estimate remains the best guide to causal benefit.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118487"},"PeriodicalIF":1.3,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13695040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence for Automated Continuous Quantification of Left Ventricular Ejection Fraction From Standard Adult Transthoracic Echocardiography: A Systematic Review.","authors":"Aniket Dembi, Hilary Patankar, Simran Dhadda, Amer Hasanovic","doi":"10.7759/cureus.118446","DOIUrl":"https://doi.org/10.7759/cureus.118446","url":null,"abstract":"<p><p>Left ventricular ejection fraction (LVEF) guides diagnosis and treatment across cardiovascular disease, but its measurement from transthoracic echocardiography (TTE) is operator-dependent and subject to observer variability. Artificial intelligence (AI) methods that estimate a continuous LVEF value have proliferated. This systematic review aimed to summarise how closely they agree with reference measurements at the group and individual-patient level. Following PRISMA 2020 guidelines and protocol registration on the International Prospective Register of Systematic Reviews (PROSPERO: CRD420261419064), we searched MEDLINE and Embase (via Ovid), Scopus, and IEEE Xplore from January 2015 to 10 September 2026, with forward and backward citation searching, for peer-reviewed journal articles of AI-derived continuous LVEF from standard adult TTE that reported an error or agreement metric against a reference standard. Risk of bias was assessed with a tailored Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Results were summarised as unweighted study-level medians without pooling. We included 108 studies. Most were retrospective (86 of 108), and 34 reported an external or independent test cohort as their main result. EchoNet-Dynamic or CAMUS were used in 54 studies. Systematic bias was small (median absolute bias: 1.5 EF percentage points, interquartile range: 0.5 to 3.4; 68 studies). Typical average error was moderate (median mean absolute error: 4.9 points, 62 studies). The median width of the study-specific 95% limits of agreement was 26 points (interquartile range: 22 to 30; 66 studies). Only 10 of 66 studies (15%) had limits within ±10 points, the usual gap between clinical LVEF decision thresholds. The limits were similarly wide when external results were used wherever available (median width: 26.3 points) and somewhat narrower in studies at low risk of bias (23.6 points). AI methods reproduce reference LVEF with small systematic bias, but individual-patient disagreement in most studies exceeds the difference between clinical LVEF categories and the agreement expected between two expert readers. On current evidence, automated LVEF is better suited to assistive use with expert oversight than to stand-alone measurement, pending prospective, externally validated evaluation.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118446"},"PeriodicalIF":1.3,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13695091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes and Safety of Spatially Fractionated Radiotherapy for Malignant Tumors: A Systematic Review and Evidence Map.","authors":"Nandan M Shanbhag, Abdulrahman Bin Sumaida, Khalid S Balaraj","doi":"10.7759/cureus.118441","DOIUrl":"https://doi.org/10.7759/cureus.118441","url":null,"abstract":"<p><p>Spatially fractionated radiotherapy (SFRT) concentrates high doses in selected tumor regions while delivering lower doses between them. This systematic review evaluated clinical outcomes, treatment delivery, and harms across SFRT techniques, with particular attention to comparative evidence. PubMed, Europe PMC, and ClinicalTrials.gov were last searched on September 19, 2026; CINAHL, CENTRAL, Scopus, and WHO ICTRP were last searched on August 7, 2026. The original searches and selection were conducted by the corresponding author, with substantive artificial intelligence (AI) assistance and human checks across review stages. The September extension introduced further AI-assisted source verification and analysis. Eligible reports described patients receiving intentional SFRT for malignant tumors. Results were grouped by clinical question and synthesized without meta-analysis. Appraisal used the Cochrane risk-of-bias tool for randomized trials (RoB 2), Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I), and design-matched Joanna Briggs Institute (JBI) tools; selected comparative questions underwent Grading of Recommendations Assessment, Development and Evaluation (GRADE) evaluation. The final corpus comprised 151 reports representing 137 investigations. Evidence was predominantly noncomparative, with heterogeneous treatments, outcome definitions, and follow-up. A prematurely terminated randomized trial documented one response among nine participants assigned to GRID plus standard radiotherapy, with one unknown outcome, and one among three assigned to standard radiotherapy. A nonrandomized study in bulky unresectable non-small-cell lung cancer reported responses in 19/20 PATHY participants versus 4/20 receiving conventional palliative radiotherapy, but prognosis-based allocation prevented causal interpretation. Certainty was very low for four defined comparative questions. Several cohorts reported early tumor shrinkage or symptom improvement, while prospective evidence also showed nonuniform pain changes, progression, and relapse after initial response. Severe complications included obstruction, late genitourinary injury, and fatal carotid hemorrhage. Differences in endpoints, treatment combinations, analysis units, missingness, and possible cohort overlap precluded a defensible pooled effect or unique participant total. Restrictions by source access, design, era, and overlap preserved descriptive evidence of activity and delivery but did not establish comparative superiority, durable benefit, or general safety. SFRT warrants indication-specific evaluation with defined patient-important outcomes, reproducible dosimetry, and complete toxicity follow-up. The protocol and subsequent robustness amendment were retrospective and unregistered. No specific funding was received.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118441"},"PeriodicalIF":1.3,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Management of Decompensated Peripartum Cardiomyopathy With Severe Left Ventricular Dysfunction: A Case Report.","authors":"Renard Ramkeesoon, Amanda C Sang, Keevan Singh, Candice Ramdin","doi":"10.7759/cureus.118447","DOIUrl":"https://doi.org/10.7759/cureus.118447","url":null,"abstract":"<p><p>Peripartum cardiomyopathy (PPCM) is a potentially life-threatening cause of heart failure that may be difficult to distinguish from the physiological symptoms of pregnancy. We report the case of a 42-year-old woman at 34 weeks of gestation who presented with progressive dyspnea and was found to have severe global left ventricular systolic dysfunction with an ejection fraction of approximately 20%. Despite initial improvement with diuresis, she developed recurrent acute decompensated heart failure requiring intensive care unit readmission. Point-of-care ultrasonography (POCUS) demonstrated pulmonary congestion and reduced forward flow, with a left ventricular outflow tract velocity-time integral (LVOT VTI) of 10 cm. Following hemodynamic optimization with diuresis and inotropic support, cesarean delivery was performed under general anesthesia with invasive monitoring and titrated vasoactive support. Postoperatively, LVOT VTI increased to 15 cm with corresponding clinical improvement. This case highlights the value of serial hemodynamic assessment, including POCUS, and multidisciplinary perioperative management in severe PPCM with recurrent decompensation.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118447"},"PeriodicalIF":1.3,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13695428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recanalization of the Paraumbilical Vein Mimicking an Umbilical Hernia: A Case Report.","authors":"Giovana A Cavalcanti, Bruna A Ferreira, Ana Sofia F Pereira, Olival C da Fonseca Neto","doi":"10.7759/cureus.118472","DOIUrl":"https://doi.org/10.7759/cureus.118472","url":null,"abstract":"<p><p>Portal hypertension associated with chronic liver disease may lead to recanalization of the paraumbilical vein and the development of portosystemic collateral vessels, classically manifesting as caput medusae. Although this finding is uncommon in contemporary clinical practice, dilated paraumbilical collaterals may present as an umbilical protrusion and mimic an umbilical hernia. Recognition of this condition is crucial because inadvertent surgical injury to these vessels may result in severe, potentially life-threatening hemorrhage. We report a case of a 77-year-old male with compensated hepatitis C virus-related cirrhosis (Child-Pugh class A; Model for End-Stage Liver Disease (MELD) score 10) who presented with an asymptomatic, reducible 2 cm umbilical protrusion initially considered an umbilical hernia. Doppler ultrasonography of the abdominal wall was performed and demonstrated a patent, recanalized paraumbilical vein communicating with the left portal vein branch and extending into the superficial abdominal wall, with drainage toward the epigastric and femoral venous systems. These findings were consistent with extensive portosystemic collateral circulation, representing caput medusae and accounting for the apparent umbilical protrusion. Recognition of the vascular nature of the lesion prevented an unnecessary surgical intervention and its associated hemorrhagic risk. This case emphasizes the importance of considering portosystemic collateral vessels in the differential diagnosis of umbilical protrusions in patients with chronic liver disease. Differential diagnoses include true umbilical hernia, isolated abdominal wall varices, venous malformations, and metastatic umbilical nodules such as Sister Mary Joseph's nodule. Doppler ultrasonography is a readily accessible, noninvasive method for characterizing the lesion, demonstrating vascular flow, identifying communication with the portal venous system, and defining the extent of collateral circulation. Therefore, vascular imaging should be considered before surgical repair of an apparent umbilical hernia in patients with cirrhosis or other conditions associated with portal hypertension. Caput medusae may present as an umbilical protrusion mimicking a hernia, and careful clinical assessment combined with Doppler ultrasonography is essential for accurate diagnosis and prevention of potentially catastrophic surgical hemorrhage.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118472"},"PeriodicalIF":1.3,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13694124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restrictive Potassium Supplementation Strategy in a General Intensive Care Unit: A Before-and-After Quality Improvement Audit in a Mixed Critical Care Population.","authors":"Deveshwar Bhalla, Rasi Mizori, Waqas Akhtar, Riaz Aziz, Hementi Patel, Fraser Hanks, Andrew Retter, Angelo Sousa, Diogo Braga","doi":"10.7759/cureus.118434","DOIUrl":"https://doi.org/10.7759/cureus.118434","url":null,"abstract":"<p><strong>Purpose: </strong>Potassium supplementation thresholds in intensive care vary widely and have historically lacked strong supporting evidence. The TIGHT K trial demonstrated non-inferiority of a restrictive potassium threshold in cardiac surgical patients; applicability to general intensive care populations is unclear.</p><p><strong>Methods: </strong>Retrospective before-and-after quality improvement audit in a mixed adult intensive care unit (ICU), comparing two one-week periods before (May 2025) and after (September 2025) reducing the intravenous potassium supplementation threshold from <4.5 to <3.6 mmol/L.</p><p><strong>Results: </strong>Forty-eight patients were included (22 pre-, 26 post-guideline) with comparable baseline characteristics. Mean intravenous potassium administrations per patient fell by 17.4% (from 9.41 to 7.77 administrations per patient), and the proportion of supplementation episodes initiated at K⁺ ≥4.0 mmol/L fell from 32.9% to 11.4% (a 21.5 percentage-point absolute reduction, equivalent to a 65.2% relative reduction). Pre-supplementation potassium was lower post guideline (3.44 vs 3.83 mmol/L; p <0.001), but potassium correction (ΔK) was unchanged (p = 0.51), and arrhythmia burden did not increase.</p><p><strong>Conclusion: </strong>A restrictive potassium supplementation threshold reduced potassium use without evidence of harm in a general intensive care population, supporting wider applicability beyond cardiac surgery, although larger prospective studies are needed.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118434"},"PeriodicalIF":1.3,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Observable Behavior: A Narrative Review of Integrated Clinical, Biological, and Functional Assessment in Children With Autism Spectrum Disorder.","authors":"Florencia Sanabria","doi":"10.7759/cureus.118440","DOIUrl":"https://doi.org/10.7759/cureus.118440","url":null,"abstract":"<p><p>Assessment of children with autism spectrum disorder must characterize everyday functioning, co-occurring conditions, and individual support needs alongside diagnostic classification. This narrative review examines the evidence and clinical rationale for integrated clinical, biological, and functional assessment in pediatric autism and presents SMART-NB as a proposed framework for organizing these dimensions. The review combines selected clinical guidelines and research publications with conceptual analysis and a targeted literature update, distinguishing established assessment principles from the author-developed framework. Three findings emerge. First, standardized observational instruments contribute to diagnosis but require interpretation alongside developmental history, caregiver information, differential diagnosis, and clinical judgment. Second, co-occurring sleep disturbances, gastrointestinal symptoms, nutritional problems, sensory impairments, and pain can influence behavior and participation and warrant clinically directed evaluation; their association with autism does not establish causation. Third, symptom severity does not fully describe adaptive functioning, supporting assessment across functional domains and everyday contexts. SMART-NB proposes connecting clinical, medical and biological, and demand-related profiles with seven functional domains, individualized goals, and longitudinal reassessment. The demand dimension examines available capacity, physiological and emotional burden, environmental requirements, and supports. Its proposed contribution is to document how assessment findings inform care priorities. Existing multidimensional approaches already address overlapping aspects of this task; the incremental value of this particular organization remains untested. The reviewed evidence supports multidimensional assessment but does not establish the validity, reliability, or clinical utility of SMART-NB. This review is not systematic, and extension beyond autism remains a hypothesis requiring condition-specific evaluation. Development should proceed from operational specification, independent content assessment, and feasibility studies to the evaluation of measurement properties and comparative clinical outcomes.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118440"},"PeriodicalIF":1.3,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Computed Tomography for Radiographically Occult Scaphoid Fractures and Concordance With Magnetic Resonance Imaging: A Systematic Review.","authors":"Rohin Wong, Andrien Rajakumar, Arkar Lwin, Zina Al-Kaisy, Paul Defty-Wallace, Rashed Al-Khudairi","doi":"10.7759/cureus.118468","DOIUrl":"https://doi.org/10.7759/cureus.118468","url":null,"abstract":"<p><p>Scaphoid fractures are the most common carpal bone fracture. Non-union and avascular necrosis are complications of a missed fracture. Therefore, if plain radiographs are normal and symptoms persist, further imaging such as computed tomography (CT) or magnetic resonance imaging (MRI) are often performed. Previous systematic reviews have largely compared their diagnostic accuracy indirectly using separate patient cohorts. Our objective is to determine the diagnostic accuracy of CT for occult scaphoid fractures in patients who underwent both CT and MRI following a negative or equivocal initial radiograph, and to assess concordance between CT and MRI findings. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. OVID MEDLINE, OVID Embase, and the Cochrane Library were searched for studies published from inception up to August 31, 2026. Eligible studies enrolled adults with clinically suspected scaphoid fracture and a negative or equivocal initial radiograph who subsequently underwent both CT and MRI. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Studies affected by partial verification or incorporation bias were excluded from quantitative synthesis. CT sensitivity and specificity were pooled using a bivariate random-effects model. Concordance between CT and MRI was reported using percentage agreement and Cohen's kappa. Eight studies met the inclusion criteria. Six studies contributed to the primary pooled analysis of CT diagnostic accuracy, with one study reporting two CT readers. Using the first reader data from that study, alongside the five other studies, pooled CT sensitivity was 79% (95% CI 61.5-89.8%) and specificity was 94.4% (95% CI 82.1-98.4%). A sensitivity analysis using the second reader produced a sensitivity of 69.2% (95% CI 48.0-84.6%), with an unchanged specificity of 94.4% (95% CI 85.5-98.0%). Three studies provided CT-MRI concordance data; two demonstrated almost perfect agreement, with Cohen's kappa values of 0.91. The dual-energy CT study demonstrated lower concordance. Three studies used a reference standard independent of both CT and MRI and demonstrated mixed comparative findings. Overall, one study was judged to have low risk of bias, and seven were high risk of bias. In the included studies, CT demonstrated high specificity but more limited sensitivity for occult scaphoid fracture in paired CT-MRI cohorts. These findings align with existing literature reviewing unpaired data sets. Therefore, the findings suggest that CT remains a relevant alternative to MRI, especially in centres where MRI is unavailable or contraindicated, or for surgical planning.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118468"},"PeriodicalIF":1.3,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13694059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}