From the Department of Radiology and Research Institute of Radiology (H.Y.P., C.H.S., M.J.K., W.H.S., S.J.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Medical Science (C.R.P.) Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, Korea.
AJNR Am J Neuroradiol. 2021 Aug;42(8):1429-1436. doi: 10.3174/ajnr.A7168. Epub 2021 May 27.
Disproportionately enlarged subarachnoid space hydrocephalus is a specific radiologic marker for idiopathic normal pressure hydrocephalus. However, controversy exists regarding the prognostic utility of disproportionately enlarged subarachnoid space hydrocephalus.
Our aim was to evaluate the prevalence of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus and its predictive utility regarding prognosis in patients treated with ventriculoperitoneal shunt surgery.
We used MEDLINE and EMBASE databases.
We searched for studies that reported the prevalence or the diagnostic performance of disproportionately enlarged subarachnoid space hydrocephalus in predicting treatment response.
The pooled prevalence of disproportionately enlarged subarachnoid space hydrocephalus was obtained. Pooled sensitivity, specificity, and area under the curve of disproportionately enlarged subarachnoid space hydrocephalus to predict treatment response were obtained. Subgroup and sensitivity analyses were performed to explain heterogeneity among the studies.
Ten articles with 812 patients were included. The pooled prevalence of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus was 44% (95% CI, 34%-54%). The pooled prevalence of disproportionately enlarged subarachnoid space hydrocephalus was higher in the studies using the second edition of the Japanese Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus compared with the studies using the international guidelines without statistical significance (52% versus 43%, = .38). The pooled sensitivity and specificity of disproportionately enlarged subarachnoid space hydrocephalus for prediction of treatment response were 59% (95% CI, 38%-77%) and 66% (95% CI, 57%-74%), respectively, with an area under the curve of 0.67 (95% CI, 0.63-0.71).
The lack of an established method for assessing disproportionately enlarged subarachnoid space hydrocephalus using brain MR imaging served as an important cause of the heterogeneity.
Our meta-analysis demonstrated a relatively low prevalence of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus and a poor diagnostic performance for treatment response.
蛛网膜下腔不成比例扩大性脑积水是特发性正常压力脑积水的一种特定放射学标志物。然而，蛛网膜下腔不成比例扩大性脑积水在预测预后方面的预后效用仍存在争议。
我们的目的是评估特发性正常压力性脑积水患者中蛛网膜下腔不成比例扩大性脑积水的发生率及其在脑室-腹腔分流术后治疗效果预测中的应用价值。
我们使用了 MEDLINE 和 EMBASE 数据库。
我们检索了报道蛛网膜下腔不成比例扩大性脑积水在预测治疗反应中的患病率或诊断性能的研究。
获得蛛网膜下腔不成比例扩大性脑积水的总体患病率。获得蛛网膜下腔不成比例扩大性脑积水预测治疗反应的敏感性、特异性和曲线下面积。进行亚组和敏感性分析以解释研究之间的异质性。
纳入了 10 篇文章 812 例患者。特发性正常压力性脑积水患者蛛网膜下腔不成比例扩大性脑积水的总体患病率为 44%（95%CI，34%-54%）。使用日本特发性正常压力性脑积水管理指南第二版的研究中蛛网膜下腔不成比例扩大性脑积水的患病率高于使用国际指南的研究，但无统计学意义（52%比 43%， =.38）。蛛网膜下腔不成比例扩大性脑积水预测治疗反应的敏感性和特异性分别为 59%（95%CI，38%-77%）和 66%（95%CI，57%-74%），曲线下面积为 0.67（95%CI，0.63-0.71）。
缺乏使用脑 MRI 评估蛛网膜下腔不成比例扩大性脑积水的既定方法是造成异质性的重要原因。
我们的荟萃分析表明，特发性正常压力性脑积水患者中蛛网膜下腔不成比例扩大性脑积水的发生率相对较低，对治疗反应的诊断性能较差。
