Silva Guilherme Diogo, Telles João Paulo Mota, Rimkus Carolina de Medeiros, Vieira Germana Titoneli, Yuki Emily Figueiredo Vieira Neves, de Azevedo Raymundo Soares, Tinone Gisela, Lucato Leandro Tavares, Pereira Rosa Maria, Conforto Adriana Bastos
Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Department of Radiology, Instituto de Radiologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Front Neurol. 2025 Jun 27;16:1593402. doi: 10.3389/fneur.2025.1593402. eCollection 2025.
Cerebral small vessel disease (CSVD) is a research priority to reduce the burden of stroke and dementia. The total cerebral small vessel disease (tSVD) score provides a global view of CSVD burden combining lacunes of presumed vascular origin, cerebral microbleeds, enlarged perivascular spaces, and white matter hyperintensities of presumed vascular origin. While its use in research is expanding, a systematic review of the tSVD score's reliability and validity had not yet been undertaken. We reviewed the inter-rater and intra-rater reliability for the tSVD score and its features. We also examined the associations between the tSVD score and age, hypertension, stroke and cognitive impairment.
We performed a systematic review of studies on Pubmed/MEDLINE, Embase, and Scopus databases from inception until June 21st, 2024. We included manuscripts that reported at least one of the following metrics for the tSVD or for its components: inter-rater reliability, intra-rater reliability, or associations with age, hypertension, stroke, and/or cognitive impairment. We provided summary Cohen's kappa coefficients for inter and intra-rater reliability for each feature of the tSVD score. Subgroup analysis and meta-regression models were used to evaluate the impact of raters, MRI fields, age, and median tSVD score values in inter-rater reliability. We summarized studies reporting associations between the tSVD score, stroke and cognitive impairment.
The summary Cohen's kappa values for inter-rater reliability ranged from 0.79 to 0.82 for each CSVD feature (13 studies, 8,177 participants). We found a high heterogeneity between studies (I = 94%), which may be explained by differences in rater, age, and median tSVD score. The summary Cohen's kappa values for intra-rater reliability ranged from 0.78 to 0.84 (four studies, 250 cases were randomized from 3,654 participants). Heterogeneity was low. Seven studies (6,022 participants) reported associations between tSVD scores and either age or hypertension. Fifteen studies (6,941 participants) reported associations between tSVD scores and either stroke or cognitive impairment.
The intra-rater reliability, inter-rater reliability, and construct validity of each feature of the tSVD support the use of this scale in CSVD research. However, inter-rater reliability might be influenced by rater characteristics, the median tSVD score, and participant age.
https://www.crd.york.ac.uk/prospero/, identifier CRD42022372599.
脑小血管病（CSVD）是减轻中风和痴呆负担的研究重点。全脑小血管病（tSVD）评分结合了假定血管源性腔隙、脑微出血、血管周围间隙扩大以及假定血管源性白质高信号，提供了CSVD负担的整体视图。虽然其在研究中的应用正在扩大，但尚未对tSVD评分的可靠性和有效性进行系统评价。我们回顾了tSVD评分及其特征的评分者间和评分者内可靠性。我们还研究了tSVD评分与年龄、高血压、中风和认知障碍之间的关联。
我们对PubMed/MEDLINE、Embase和Scopus数据库从创建到2024年6月21日的研究进行了系统评价。我们纳入了报告tSVD或其组成部分至少以下一项指标的手稿：评分者间可靠性、评分者内可靠性，或与年龄、高血压、中风和/或认知障碍的关联。我们为tSVD评分的每个特征提供了评分者间和评分者内可靠性的汇总Cohen's kappa系数。亚组分析和meta回归模型用于评估评分者、MRI场强、年龄和tSVD评分中位数在评分者间可靠性中的影响。我们总结了报告tSVD评分、中风和认知障碍之间关联的研究。
每个CSVD特征的评分者间可靠性的汇总Cohen's kappa值范围为0.79至0.82（13项研究，8177名参与者）。我们发现研究之间存在高度异质性（I = 94%），这可能由评分者、年龄和tSVD评分中位数的差异来解释。评分者内可靠性的汇总Cohen's kappa值范围为0.78至0.84（4项研究，从3654名参与者中随机抽取250例）。异质性较低。7项研究（6022名参与者）报告了tSVD评分与年龄或高血压之间的关联。15项研究（6941名参与者）报告了tSVD评分与中风或认知障碍之间的关联。
tSVD各特征的评分者内可靠性、评分者间可靠性和结构效度支持该量表在CSVD研究中的应用。然而，评分者间可靠性可能受评分者特征、tSVD评分中位数和参与者年龄的影响。
