神经系统检查正常的头痛患者的神经影像学检查：系统评价方案

Neuroimaging of headaches in patients with normal neurological examination: protocol for a systematic review.

作者信息

Kenteu Bernold, Fogang Yannick F, Nyaga Ulrich Flore, Zafack Joseline G, Noubiap Jean Jacques, Kamtchum-Tatuene Joseph

机构信息

Service de Radiologie et Imagerie Médicale, Département de Biologie et Explorations Fonctionnelles, Faculté de Médecine, de Pharmacie et d'Ontostomatologie, Université de Cheikh Anta Diop, Dakar, Senegal.

Head Neuropsychiatry Department, Bafoussam Regional Hospital, Bafoussam, Cameroon.

出版信息

BMJ Open. 2018 Feb 22;8(2):e020190. doi: 10.1136/bmjopen-2017-020190.

DOI:10.1136/bmjopen-2017-020190

PMID:29472268

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5855383/

Abstract

INTRODUCTION

Headache disorders (HD) are among the most frequent neurological disorders seen in neurology practice. Because secondary HD are rare, patients' examination is most often unremarkable. However, the will to relieve patients' anxiety and the fear of prosecutions lead to overuse of neuroimaging thus resulting in the discovery of incidental findings (IF) or normal variants that can lead to futile or harmful procedures. Knowing the probability of identifying a potentially clinically significant lesion in patients with isolated headache could facilitate decision-making and reduce health costs. This review aims to determine the prevalence of incidental findings and normal anatomic variants (NAV) on neuroimaging studies performed in patients presenting with headache and normal neurological examination.

METHOD AND ANALYSIS

Studies reporting neuroimaging findings in patients with headache and normal neurological examination and published before the 30 September 2017 will be identified by searching PubMed, Medline and EMBASE (Excerpta Medica Database). Relevant unpublished papers and conference proceedings will also be checked. Full texts of eligible studies will then be accessed and data extracted using a standard data extraction sheet. Studies will be assessed for quality and risk of bias. Heterogeneity of studies will be evaluated by the χ test on Cochrane's Q statistic. The prevalence of NAV and IF across studies and in relevant subgroups will be estimated by pooling the study-specific estimates using a random-effects meta-analysis. Visual analysis of funnel plot and Egger's test will be used to detect publication bias. The report of this systematic review will be compliant with the Meta-analysis of Observational Studies in Epidemiology guidelines.

ETHICS AND DISSEMINATION

The current study is based on published data; ethical approval is, therefore, not required. The final report of this systematic review will be published in a peer-reviewed journal. Furthermore, findings will be presented at conferences and submitted to relevant health authorities.

TRIAL REGISTRATION NUMBER

CRD42017079714.

摘要

引言

头痛性疾病（HD）是神经科门诊最常见的神经系统疾病之一。由于继发性HD较为罕见，患者的检查结果大多无异常。然而，缓解患者焦虑的意愿以及对诉讼的担忧导致神经影像学检查过度使用，从而发现一些偶然发现（IF）或正常变异，进而可能导致无效或有害的医疗程序。了解在孤立性头痛患者中发现潜在临床意义病变的可能性，有助于做出决策并降低医疗成本。本综述旨在确定在头痛且神经系统检查正常的患者中进行神经影像学检查时偶然发现和正常解剖变异（NAV）的发生率。

方法与分析

通过检索PubMed、Medline和EMBASE（医学文摘数据库），识别2017年9月30日前发表的关于头痛且神经系统检查正常患者的神经影像学检查结果的研究。还将检查相关未发表论文和会议记录。然后获取符合条件研究的全文，并使用标准数据提取表提取数据。将对研究进行质量和偏倚风险评估。通过对Cochrane Q统计量进行χ检验评估研究的异质性。使用随机效应荟萃分析汇总各研究的估计值，以估计各研究及相关亚组中NAV和IF的发生率。通过漏斗图的可视化分析和Egger检验检测发表偏倚。本系统评价的报告将符合流行病学观察性研究荟萃分析指南。