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Evidence-based outcomes on diagnostic accuracy of quantitative ultrasound for assessment of pediatric osteoporosis — a systematic review

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Abstract

Background

Dual-energy absorptiometry (DXA) is the current reference standard for assessing pediatric osteoporosis; however due to its areal nature, it has limitations. Thus, quantitative ultrasound (QUS), a modality free of ionizing radiation, has been proposed as a potential surrogate for DXA.

Objective

To semi-quantitatively assess the diagnostic accuracy of QUS for evaluating pediatric osteoporosis according to the U.S. Preventive Services Task Force guidelines.

Materials and methods

We retrieved articles on the diagnostic accuracy of quantitative US for assessing abnormal bone quality or quantity in patients of mean age ≤19 years from MEDLINE, EMBASE and Cochrane Library CCTR databases. Evidences were analyzed for reliability, construct and criterion validity, and responsiveness of quantitative US, according to the following questions: (1) How reliable is the acquisition of QUS measurements? (2) Is QUS diagnostically accurate to characterize bone strength and quality in osteoporotic children? (3) Is QUS sensitive to detect changes in bone status over time? (4) Is QUS able to predict future skeletal fractures/degeneration? Three reviewers independently evaluated the quality of reporting and methodological quality using the Standards for Reporting of Diagnostic Accuracy (STARD) and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tools.

Results

Out of 262 retrieved references (215 unique), we included 28 studies (1,963 patients; 807 reported boys and 761 girls, others unspecified; reported mean age, 0–19 years). The mean quality of reporting score was “excellent” in 24/28 (86%) studies; 11/28 (39%) studies had “adequate” research design quality.

Conclusion

There is no evidence of the diagnostic value of QUS at the present time despite the overall excellent and adequate research design quality of primary studies. Although QUS can produce reliable measurements, insufficient evidence has been reported to support other clinimetric properties of this technique.

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Acknowledgments

This study was presented as a Scientific Poster at the 2013 Society for Pediatric Radiology Scientific Annual Meeting in San Antonio, TX.

Conflicts of interest

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Authors and Affiliations

  1. Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, Canada

    Kuan Chung Wang, Kuan Chieh Wang, Afsaneh Amirabadi, Edward Cheung & Andrea S. Doria

  2. Library Services, The Hospital for Sick Children, Toronto, Canada

    Elizabeth Uleryk

  3. Department of Family and Community Medicine, University of Toronto, Toronto, Canada

    Rahim Moineddin

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  1. Kuan Chung Wang
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Correspondence to Andrea S. Doria.

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Wang, K.C., Wang, K.C., Amirabadi, A. et al. Evidence-based outcomes on diagnostic accuracy of quantitative ultrasound for assessment of pediatric osteoporosis — a systematic review. Pediatr Radiol 44, 1573–1587 (2014). https://doi.org/10.1007/s00247-014-3041-x

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  • DOI: https://doi.org/10.1007/s00247-014-3041-x

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