Mostardeiro Thomaz R, Schmitt Luiza Giuliani, de Campos Fillipe Thiago Xavier, Xi Yin, Brondani Torri Giovanni, Carvalho Bruno Murad, Feltrin Fabricio Stewan
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Mult Scler Relat Disord. 2025 Jan;93:106186. doi: 10.1016/j.msard.2024.106186. Epub 2024 Nov 26.
Several sequences have been developed to increase lesion detection in Multiple Sclerosis, including Double Inversion Recovery (DIR). The superiority of these pulse sequences is not well established compared to T2-FLAIR images.
This meta-analysis aims to describe if lesion detection rates are higher in DIR compared to T2-FLAIR images in a 3D acquisition comparison.
Search was performed of the PubMed/MEDLINE, EMBASE and Cochrane databases between January 1995 and December 2023.
Studies identified were assessed independently by two physicians following PRISMA guidelines. Articles were screened to exclude duplicates, review articles, not performing direct 3D DIR and 3D T2-FLAIR comparisons and abstracts. Remaining articles were reviewed in a full-text review by two physicians independently.
Cortical lesion count ranged from to 12.4 to 40.0 for DIR; 5.25 to 27.9 for T2-FLAIR, with juxtacortical lesions ranging from 4.9 to 19.7 and 4.72 to 22.0 on DIR and T2-FLAIR respectively. Intracortical lesions varied from 1.2 to 8.0 for DIR and 1.1 to 3.1 for T2-FLAIR. Infratentorial lesions mean lesions count varied from 2.0 to 12.0 for DIR, as compared to 1.45 to 8.4 for T2-FLAIR. In the periventricular WM, results varied from 11.84 to 73 and 11.31 to 69 for DIR and T2-FLAIR respectively.
R statistical software was used for data synthesis. Pooled estimates showed relative significant differences in lesion detection for intracortical (175.41 [95 % Confidence Interval (95 %-CI): 48.68; 410.16]) and infratentorial (30.56 [95 %-CI: 9.34; 55.91]) regions with the entire 95 % confidence intervals >0. Confidence intervals were <0 when counting differences for total cortical lesions (37.35 [95 %-CI:12.47; 115.54]), including juxtacortical (25.44 [95 %-CI:32.12; 131.81]) and for supratentorial WM lesions (1.93 [95 %-CI:14.41; 21.39]), including the periventricular WM (11.22 [95 %-CI:4.02; 28.90]).
The available number of studies was relatively low. Also, given significant heterogenicity for lesion load measurements in different patients for absolute differences, relative differences were only estimated from one study by the log-normal assumption.
DIR acquisition allows higher detection in intracortical and infratentorial lesions compared to T2-FLAIR.
已经开发了几种序列来提高多发性硬化症病变的检测率，包括双反转恢复序列（DIR）。与T2液体衰减反转恢复（T2-FLAIR）图像相比，这些脉冲序列的优越性尚未得到充分证实。
本荟萃分析旨在描述在三维采集比较中，DIR序列检测病变的比率是否高于T2-FLAIR图像。
于1995年1月至2023年12月期间在PubMed/MEDLINE、EMBASE和Cochrane数据库中进行检索。
两名医生按照PRISMA指南对纳入的研究进行独立评估。对文章进行筛选以排除重复项、综述文章、未进行直接三维DIR与三维T2-FLAIR比较的文章以及摘要。其余文章由两名医生独立进行全文审查。
DIR序列检测到的皮质病变数量范围为12.4至40.0；T2-FLAIR序列检测到的皮质病变数量范围为5.25至27.9，DIR序列检测到的皮质旁病变数量范围为4.9至19.7，T2-FLAIR序列检测到的皮质旁病变数量范围为4.72至22.0。DIR序列检测到的皮质内病变数量范围为1.2至8.0，T2-FLAIR序列检测到的皮质内病变数量范围为1.1至3.1。幕下病变方面，DIR序列检测到平均病变数量范围为2.0至12.0，而T2-FLAIR序列检测到的平均病变数量范围为1.45至8.4。在脑室周围白质区域，DIR序列检测到的病变数量范围为11.84至73，T2-FLAIR序列检测到的病变数量范围为11.31至69。
使用R统计软件进行数据综合。汇总估计显示，皮质内（175.41 [95%置信区间（95%-CI）：48.68；410.16]）和幕下（30.56 [95%-CI：9.34；55.91]）区域在病变检测方面存在相对显著差异，整个95%置信区间>0。在计算总皮质病变（37.35 [95%-CI：12.47；115.54]）差异时，包括皮质旁病变（25.44 [95%-CI：32.12；`131.81]）以及幕上白质病变（1.93 [95%-CI：14.41；21.39]），包括脑室周围白质病变（11.22 [95%-CI：4.02；28.90]）时，置信区间<0。
可用的研究数量相对较少。此外，鉴于不同患者病变负荷测量存在显著异质性，对于绝对差异，仅通过对数正态假设从一项研究中估计相对差异。
与T2-FLAIR相比，DIR采集能够更高地检测皮质内和幕下病变。
