Cho Se Jin, Choi Byung Se, Bae Yun Jung, Baik Sung Hyun, Sunwoo Leonard, Kim Jae Hyoung
Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Front Neurol. 2021 Apr 7;12:586735. doi: 10.3389/fneur.2021.586735. eCollection 2021.
This systematic review and meta-analysis aimed to evaluate the pooled proportion of image findings of acute to subacute craniocervical arterial dissection (AD) direct signs on magnetic resonance vessel wall imaging (MR-VWI) and to identify factors responsible for the heterogeneity across the included studies. A systematic literature search in the Ovid-MEDLINE and EMBASE databases was performed for studies published on the relevant topic before April 14, 2020. Pooled sensitivity and specificity values and their 95% confidence intervals (CIs) were calculated using bivariate random-effects modeling. Meta-regression analyses were also performed to determine factors influencing heterogeneity. Eleven articles with data for 209 patients with acute to subacute craniocervical AD who underwent MR-VWI were included in this systematic review and meta-analysis. The most common findings on MR-VWI were wall hematoma (84%; 95% CI, 71%-92%), abnormal enhancement (72%; 95% CI, 49%-88%), aneurysmal dilatation (71%, 95% CI, 53%-84%), and intimal flap or double lumen signs (49%; 95% CI, 29%-71%). Among the potential covariates of heterogeneity, the presence of contrast-enhanced T1-weighted imaging (CE-T1WI) within the MR-VWI sequence combination significantly affected the pooled proportion of the intimal flap or double lumen signs. Wall hematoma and intimal flap or double lumen signs were the most common and least common direct sign image findings, respectively, on MR-VWI in patients with acute to subacute craniocervical AD. Furthermore, the absence of CE-T1WI in MR-VWI protocol was the cause of heterogeneity for the detection of the intimal flap or double lumen signs. This data may help improve MR-VWI interpretation and enhance the understanding of the radiologic diagnosis of craniocervical AD.
本系统评价和荟萃分析旨在评估急性至亚急性颅颈动脉夹层（AD）在磁共振血管壁成像（MR-VWI）上直接征象的影像表现汇总比例，并确定纳入研究中异质性的相关因素。在Ovid-MEDLINE和EMBASE数据库中对2020年4月14日前发表的相关主题研究进行了系统文献检索。使用双变量随机效应模型计算汇总敏感性和特异性值及其95%置信区间（CI）。还进行了荟萃回归分析以确定影响异质性的因素。本系统评价和荟萃分析纳入了11篇文章，这些文章包含了209例接受MR-VWI检查的急性至亚急性颅颈AD患者的数据。MR-VWI上最常见的表现为壁内血肿（84%；95%CI，71%-92%）、异常强化（72%；95%CI，49%-88%）、动脉瘤样扩张（71%，95%CI，53%-84%）以及内膜瓣或双腔征（49%；95%CI，29%-71%）。在异质性的潜在协变量中，MR-VWI序列组合中是否存在对比增强T1加权成像（CE-T1WI）显著影响内膜瓣或双腔征的汇总比例。壁内血肿和内膜瓣或双腔征分别是急性至亚急性颅颈AD患者MR-VWI上最常见和最不常见的直接征象影像表现。此外，MR-VWI方案中未使用CE-T1WI是内膜瓣或双腔征检测异质性的原因。这些数据可能有助于提高MR-VWI的解读，并增进对颅颈AD放射学诊断的理解。
