Baradaran Hediyeh, Mtui Edward E, Richardson Joshua E, Delgado Diana, Dunning Allison, Marshall Randolph S, Sanelli Pina C, Gupta Ajay
Departments of Radiology, NewYork-Presbyterian Hospital, New York, NY.
Samuel J. Wood Library & C.V. Starr Biomedical Information Center, New York, NY.
J Neuroimaging. 2016 Sep;26(5):481-8. doi: 10.1111/jon.12347. Epub 2016 Apr 15.
BACKGROUND & PURPOSE: Abnormalities in apparent diffusion coefficient (ADC), fractional anisotropy (FA), and mean diffusivity (MD) values can be used to assess microstructural damage to white matter tracts and could represent a quantitative marker of chronic ischemia and thereby potentially serve as a stroke risk factor or a measure of existing subclinical ischemic disease burden. We performed a systematic review and 3 separate meta-analyses to evaluate the association between unilateral carotid steno-occlusion and ipsilateral ADC, FA, or MD abnormality.
MATERIALS & METHODS: A comprehensive literature search evaluating the association of carotid disease and quantitative white matter diffusion imaging was performed. The included studies examined patients for ADC, FA, and MD values ipsilateral and contralateral to the site of carotid artery disease. Three meta-analyses using standardized mean differences with assessment of study heterogeneity were performed.
Of the 2,920 manuscripts screened, 6 met eligibility for meta-analysis. Of the included manuscripts, 2 studied ADC values, 6 studied FA values, and 2 studied MD values. Our 3 meta-analyses showed standardized mean difference for ADC, FA, and MD values between cerebral hemispheres ipsilateral and contralateral to carotid artery disease site as 1.13 (95% CI: .79-1.47, P < .001), -.42 (95% CI: -.62 to -.21, P < .001), and .23 (95% CI: -.32 to -.77, P = .41), respectively. Measures of heterogeneity showed mild heterogeneity in the 3 meta-analyses.
Carotid artery disease is associated with significant ADC and FA value changes, suggesting that carotid disease is associated with quantifiable white matter microstructural damage.
表观扩散系数（ADC）、分数各向异性（FA）和平均扩散率（MD）值的异常可用于评估白质束的微观结构损伤，并可代表慢性缺血的定量标志物，从而有可能作为中风危险因素或现有亚临床缺血性疾病负担的衡量指标。我们进行了一项系统评价和三项独立的荟萃分析，以评估单侧颈动脉狭窄闭塞与同侧ADC、FA或MD异常之间的关联。
进行了一项全面的文献检索，以评估颈动脉疾病与定量白质扩散成像之间的关联。纳入的研究检查了颈动脉疾病部位同侧和对侧的患者的ADC、FA和MD值。进行了三项荟萃分析，使用标准化均数差值并评估研究的异质性。
在筛选的2920篇手稿中，6篇符合荟萃分析的纳入标准。在纳入的手稿中，2篇研究了ADC值，6篇研究了FA值，2篇研究了MD值。我们的三项荟萃分析显示，颈动脉疾病部位同侧和对侧大脑半球之间的ADC、FA和MD值的标准化均数差值分别为1.13（95%CI：0.79 - 1.47，P < 0.001）、 - 0.42（95%CI： - 0.62至 - 0.21，P < 0.001）和0.23（95%CI： - 0.32至 - 0.77，P = 0.41）。异质性检验显示三项荟萃分析中均存在轻度异质性。
颈动脉疾病与显著的ADC和FA值变化相关，提示颈动脉疾病与可量化的白质微观结构损伤有关。
