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. 2023 Jul 6;18(7):e0288011.
doi: 10.1371/journal.pone.0288011. eCollection 2023.

Diagnostic test accuracy of ultrasound for orbital cellulitis: A systematic review

Mohammed Rashidul Anwar  1 , Sanjay Mahant  1   2   3   4 , Toni Agbaje-Ojo  1 , Quenby Mahood  3 , Cornelia M Borkhoff  1   2   3   4 , Patricia C Parkin  1   2   3   4 , Peter J Gill  1   2   3   4
Affiliations

Diagnostic test accuracy of ultrasound for orbital cellulitis: A systematic review

Mohammed Rashidul Anwar et al. PLoS One. .

Abstract

Background: Periorbital and orbital cellulitis are inflammatory conditions of the eye that can be difficult to distinguish using clinical examination alone. Computer tomography (CT) scans are often used to differentiate these two infections and to evaluate for complications. Orbital ultrasound (US) could be used as a diagnostic tool to supplement or replace CT scans as the main diagnostic modality. No prior systematic review has evaluated the diagnostic test accuracy (DTA) of ultrasound compared to cross-sectional imaging.

Objective: To conduct a systematic review of studies evaluating the DTA of orbital ultrasound compared with cross-sectional imaging, to diagnose orbital cellulitis.

Methods: MEDLINE, EMBASE, CENTRAL, and Web of Science were searched from inception to August 10, 2022. All study types were included that enrolled patients of any age with suspected or diagnosed orbital cellulitis who underwent ultrasound and a diagnostic reference standard (i.e., CT or magnetic resonance imaging [MRI]). Two authors screened titles/abstracts for inclusion, extracted data, and assessed the risk of bias.

Results: Of the 3548 studies identified, 20 were included: 3 cohort studies and 17 case reports/series. None of the cohort studies directly compared the diagnostic accuracy of ultrasound with CT or MRI, and all had high risk of bias. Among the 46 participants, diagnostic findings were interpretable in 18 (39%) cases which reported 100% accuracy. We were unable to calculate sensitivity and specificity due to limited data. In the descriptive analysis of the case reports, ultrasound was able to diagnose orbital cellulitis in most (n = 21/23) cases.

Conclusion: Few studies have evaluated the diagnostic accuracy of orbital ultrasound for orbital cellulitis. The limited evidence based on low quality studies suggests that ultrasound may provide helpful diagnostic information to differentiate orbital inflammation. Future research should focus studies to determine the accuracy of orbital US and potentially reduce unnecessary exposure to radiation.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: 1. PJG has received grants from the Canadian Institute of Health Research (CIHR), the PSI Foundation, and The Hospital for Sick Children. PJG has received nonfinancial support from the EBMLive Steering Committee (expenses reimbursed to attend conferences) and the CIHR Institute of Human Development, Child and Youth Health (as a member of the institute advisory board, expenses reimbursed to attend meetings). 2. SM has also received personal fees from the Journal of Hospital Medicine outside the submitted work. 3. PP has received grants from the Hospital for Sick Children Foundation and CIHR, and nonfinancial support from Mead Johnson Nutrition for a trial on oral iron supplement outside the submitted work. 4. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. PRISMA flow diagram.
Fig 2
Fig 2. Quality assessment of cohort studies.
See this image and copyright information in PMC

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References

    1. Gill PJ, Drouin O, Pound C, Quet J, Wahi G, Bayliss A, et al.. Factors associated with surgery and imaging characteristics in severe orbital infections. J Pediatr. 2022. Sep;248:66–73.e7. doi: 10.1016/j.jpeds.2022.05.010 - DOI - PubMed
    1. Eustis HS, Mafee MF, Walton C, Mondonca J. MR imaging and CT of orbital infections and complications in acute rhinosinusitis. Radiologic Clinics of North America. 1998. Nov 1;36(6):1165–83. doi: 10.1016/s0033-8389(05)70238-4 - DOI - PubMed
    1. Hauser JA, Taylor AM, Pandya B. How to image the adult patient with Fontan circulation. Circulation: Cardiovascular Imaging. 2017. May;10(5):e004273. doi: 10.1161/CIRCIMAGING.116.004273 - DOI - PubMed
    1. Krueger C, Mahant S, Begum N, Widjaja E, Science M, Parkin PC, et al.. Changes in the management of severe orbital infections over seventeen years. Hospital Pediatrics. 2021. Jun;11(6):613–21. doi: 10.1542/hpeds.2020-001818 - DOI - PubMed
    1. Jyani R, Ranade D, Joshi P. Spectrum of orbital cellulitis on magnetic resonance imaging. Cureus. 2020. Aug 11;12(8). doi: 10.7759/cureus.9663 - DOI - PMC - PubMed

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