扩散张量成像在脑卒中后失语症诊断中的应用：一项荟萃分析和系统评价
Application of diffusion tensor imaging in the diagnosis of post-stroke aphasia: a meta-analysis and systematic review.
作者信息
Zhu Weiming, Deng Shizhe, Jiang Hailun, Zhang Jieying, Li Boxuan, Liu Wei, Jia Qingqing, Liu Wei, Meng Zhihong
机构信息
Clinical Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
出版信息
Front Psychol. 2023 Sep 18;14:1140588. doi: 10.3389/fpsyg.2023.1140588. eCollection 2023.
INTRODUCTION
Diffusion Tensor Imaging (DTI) indicators of different white matter (WM) fibers and brain region lesions for post-stroke aphasia (PSA) are inconsistent in existing studies. Our study examines the consistency and differences between PSA tests performed with DTI. In addition, obtaining consistent and independent conclusions between studies was made possible by utilizing DTI in PSA assessment.
METHODS
In order to gather relevant studies using DTI for diagnosing PSA, we searched the Web of Science, PubMed, Embase, and CNKI databases. Based on the screening and evaluation of the included studies, the meta-analysis was used to conduct a quantitative analysis. Narrative descriptions were provided for studies that met the inclusion criteria but lacked data.
RESULTS
First, we reported on the left hemisphere. The meta-analysis showed that fractional anisotropy (FA) of the arcuate fasciculus (AF) and superior longitudinal fasciculus (SLF), inferior frontal-occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF), and uncinate fasciculus (UF) were decreased in the PSA group in comparison with the healthy controls ( < 0.00001). However, in the comparison of axial diffusivity (AD), there was no statistically significant difference in white matter fiber tracts in the dual-stream language model of the PSA group. Elevated radial diffusivity (RD) was seen only in the IFOF and ILF ( = 0.01; = 0.05). In the classic Broca's area, the FA of the PSA group was decreased ( < 0.00001) while the apparent diffusion coefficient was elevated ( = 0.03). Secondly, we evaluated the white matter fiber tracts in the dual-stream language model of the right hemisphere. The FA of the PSA group was decreased only in the IFOF ( = 0.001). AD was elevated in the AF and UF ( < 0.00001; PUF = 0.009). RD was elevated in the AF and UF ( = 0.01; = 0.003). The other fiber tracts did not undergo similar alterations.
CONCLUSION
In conclusion, DTI is vital for diagnosing PSA because it detects WM changes effectively, but it still has some limitations. Due to a lack of relevant language scales and clinical manifestations, diagnosing and differentiating PSA independently remain challenging.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=365897.
引言
在现有研究中，不同白质（WM）纤维和脑区病变的扩散张量成像（DTI）指标用于中风后失语症（PSA）的结果并不一致。我们的研究探讨了使用DTI进行PSA检测之间的一致性和差异。此外，通过在PSA评估中使用DTI，使得在不同研究之间获得一致且独立的结论成为可能。
方法
为了收集使用DTI诊断PSA的相关研究，我们检索了Web of Science、PubMed、Embase和中国知网数据库。基于对纳入研究的筛选和评估，采用荟萃分析进行定量分析。对于符合纳入标准但缺乏数据的研究，提供叙述性描述。
结果
首先，我们报告了左半球的情况。荟萃分析表明，与健康对照组相比，PSA组的弓状束（AF）、上纵束（SLF）、额枕下束（IFOF）、下纵束（ILF）和钩束（UF）的分数各向异性（FA）降低（<0.00001）。然而，在轴向扩散率（AD）的比较中，PSA组双流语言模型中的白质纤维束没有统计学上的显著差异。仅在IFOF和ILF中观察到径向扩散率（RD）升高（=0.01；=0.05）。在经典的布洛卡区，PSA组的FA降低（<0.00001），而表观扩散系数升高（=0.03）。其次，我们评估了右半球双流语言模型中的白质纤维束。PSA组仅在IFOF中的FA降低（=0.001）。AF和UF中的AD升高（<0.00001；PUF = 0.009）。AF和UF中的RD升高（=0.01；=0.003）。其他纤维束未发生类似改变。
结论
总之，DTI对于诊断PSA至关重要，因为它能有效检测白质变化，但仍存在一些局限性。由于缺乏相关语言量表和临床表现，独立诊断和鉴别PSA仍然具有挑战性。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=365897。
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