Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea.
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea.
J Neurol. 2021 Dec;268(12):4721-4736. doi: 10.1007/s00415-021-10582-x. Epub 2021 Apr 29.
To evaluate the diagnostic performance of iron-sensitive sequences targeting the substantia nigra for distinguishing patients with Parkinson's disease from control participants and to identify factors causing heterogeneity.
A systematic literature search in the Ovid-MEDLINE and EMBASE databases was performed for studies reporting the relevant topic before March 6, 2020. The pooled sensitivity and specificity values with their 95% confidence intervals were calculated using bivariate random-effects modeling. Subgroup and meta-regression analyses were also performed to determine factors influencing heterogeneity affecting the diagnostic performance among the clinical, MRI, and analytic characteristics.
A total of 22 articles including 1126 patients with Parkinson's disease and 933 control participants were enrolled in this systematic review and meta-analysis. Of those, 12 studies used objective analyses of quantitative susceptibility measurements, and 10 visually assessed the nigrosome-1 in subjective analyses. Iron-sensitive nigral magnetic resonance imaging showed a pooled sensitivity of 92% (95% confidence interval 88-95%) and a pooled specificity of 90% (95% confidence interval 81-95%). According to subgroup and meta-regression analyses, a longer mean disease duration in patients with Parkinson's disease (≥ 5 years), subjective analysis, a smaller size of pixel (< 0.6 mm), a larger flip angle (> 15°), a smaller slice thickness (≤ 1 mm), and specific targeting of the substantia nigra pars compacta improved the diagnostic performance.
Iron-sensitive nigral magnetic resonance imaging had a favorable diagnostic performance in discriminating patients with Parkinson's disease from control participants. Subjective analytic methods remain superior to objective approaches. Further improvements of the spatial resolution and contrast-to-noise ratio to specifically target the nigrosome-1 with objective analytic methods will be needed.
评估针对黑质的铁敏感序列在区分帕金森病患者和对照组参与者方面的诊断性能，并确定导致异质性的因素。
对 2020 年 3 月 6 日前在 Ovid-MEDLINE 和 EMBASE 数据库中进行的系统文献检索进行了研究报告。使用双变量随机效应模型计算汇总的敏感性和特异性值及其 95%置信区间。还进行了亚组和荟萃回归分析，以确定影响诊断性能的临床、MRI 和分析特征的异质性影响因素。
本系统评价和荟萃分析共纳入 22 篇文章，包括 1126 例帕金森病患者和 933 例对照组参与者。其中 12 项研究使用了定量磁化率测量的客观分析，10 项研究在主观分析中评估了黑质 1 区。铁敏感黑质磁共振成像显示汇总敏感性为 92%（95%置信区间 88-95%），汇总特异性为 90%（95%置信区间 81-95%）。根据亚组和荟萃回归分析，帕金森病患者的平均病程较长（≥5 年）、主观分析、像素较小（<0.6mm）、翻转角较大（>15°）、切片厚度较小（≤1mm）以及黑质致密部的特异性靶向均可提高诊断性能。
铁敏感黑质磁共振成像在区分帕金森病患者和对照组参与者方面具有良好的诊断性能。主观分析方法仍然优于客观方法。需要进一步提高空间分辨率和对比噪声比，以使用客观分析方法特异性地靶向黑质 1 区。
