Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
University of Ulsan College of Medicine, Seoul, Republic of Korea.
Eur Radiol. 2021 Dec;31(12):9073-9085. doi: 10.1007/s00330-021-08031-4. Epub 2021 May 12.
To evaluate the diagnostic yield and performance of DWI in patients with sporadic CJD (sCJD).
A systematic literature search of the MEDLINE and EMBASE databases was performed, since their inception up to July 28, 2020. Pooled diagnostic yield of diffusion-weighted imaging was calculated using DerSimonian-Laird random-effects model. Pooled diagnostic performance of DWI (sensitivity, specificity, and area under the curve) in diagnosing sCJD among patients with rapidly progressive dementia was calculated using a bivariate random-effects model. Subgroup analysis and meta-regression were performed.
Fifteen original articles with a total of 1144 patients with sCJD were included. The pooled diagnostic yield was 91% (95% confidence interval [CI], 86 to 94%); summary sensitivity, 91% (95% CI, 84 to 95%); and specificity, 97% (95% CI, 94 to 99%). The area under the hierarchical summary receiver operating characteristic curve was 0.99 (95% CI, 0.97-0.99). Simultaneous involvement of the neocortex and striatum was the most common finding, and the neocortex was the most common site to be involved on DWI followed by striatum, thalamus, and cerebellum. Subgroup analysis and meta-regression demonstrated significant heterogeneity among the studies associated with the reference standards used for diagnosis of sCJD.
DWI showed excellent diagnostic value in diagnosis of sporadic Creutzfeldt-Jakob disease among patients with rapidly progressive dementia. Simultaneous involvement of the neocortex and striatum was the most common finding, and the neocortex was the most common site to be involved on diffusion-weighted imaging followed by striatum, thalamus, and cerebellum.
• The pooled diagnostic yield of diffusion-weighted imaging in sporadic Creutzfeldt-Jakob disease was 91%. • The diagnostic performance of diffusion-weighted imaging for predicting sporadic Creutzfeldt-Jakob disease among patients with rapidly progressive dementia was excellent, with pooled sensitivity, 91%, and specificity, 97%. • Simultaneous involvement in the neocortex and striatum was most commonly seen on diffusion-weighted imaging (60%), followed by the neocortex without striatum (30%), thalamus (21%), cerebellum (8%), and striatum without neocortex (7%).
评估弥散加权成像（DWI）在散发性克雅氏病（sCJD）患者中的诊断效能。
对 MEDLINE 和 EMBASE 数据库进行了系统的文献检索，检索时间截至 2020 年 7 月 28 日。采用 DerSimonian-Laird 随机效应模型计算 DWI 的总体诊断率。采用双变量随机效应模型计算 DWI 在诊断快速进展性痴呆患者 sCJD 中的诊断性能（敏感性、特异性和曲线下面积）。进行了亚组分析和荟萃回归分析。
纳入了 15 篇原始文献，共纳入了 1144 例 sCJD 患者。DWI 的总体诊断率为 91%（95%可信区间，86%至 94%）；总结灵敏度为 91%（95%可信区间，84%至 95%），特异性为 97%（95%可信区间，94%至 99%）。分层综合受试者工作特征曲线下面积为 0.99（95%可信区间，0.97-0.99）。皮质和纹状体同时受累是最常见的表现，而 DWI 上皮质最常受累，其次是纹状体、丘脑和小脑。亚组分析和荟萃回归显示，与用于诊断 sCJD 的参考标准相关的研究存在显著异质性。
DWI 在诊断快速进展性痴呆患者的散发性克雅氏病方面具有极好的诊断价值。皮质和纹状体同时受累是最常见的表现，而 DWI 上皮质最常受累，其次是纹状体、丘脑和小脑。
弥散加权成像在散发性克雅氏病中的总体诊断率为 91%。
弥散加权成像对预测快速进展性痴呆患者散发性克雅氏病的诊断性能优异，汇总敏感性为 91%，特异性为 97%。
DWI 上最常见的表现是皮质和纹状体同时受累（60%），其次是皮质不累及纹状体（30%）、丘脑（21%）、小脑（8%）和纹状体不累及皮质（7%）。
