Diagnostic accuracy of diffusion tensor imaging in amyotrophic lateral sclerosis: a systematic review and individual patient data meta-analysis.
Diagnostic accuracy of diffusion tensor imaging in amyotrophic lateral sclerosis: a systematic review and individual patient data meta-analysis.
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DOI：
10.1016/j.acra.2013.03.017
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发表时间：
2013-09
影响因子：
4.8
通讯作者：
Pomper, Martin G.
中科院分区：
文献类型：
--
作者：
Foerster, Bradley R.;Dwamena, Ben A.;Petrou, Myria;Carlos, Ruth C.;Callaghan, Brian C.;Churchill, Cristina L.;Mohamed, Mona A.;Bartels, Claudia;Benatar, Michael;Bonzano, Laura;Ciccarelli, Olga;Cosottini, Mirco;Ellis, Cathy M.;Ehrenreich, Hannelore;Filippini, Nicola;Ito, Mizuki;Kalra, Sanjay;Melhem, Elias R.;Pyra, Timothy;Roccatagliata, Luca;Senda, Joe;Sobue, Gen;Turner, Martin R.;Feldman, Eva L.;Pomper, Martin G.
关键词：
已有大量的病例对照研究使用扩散张量成像（DTI）肌萎缩侧索硬化症（ALS）。本研究的目的是进行个体患者数据（IPD）荟萃分析，以评估DTI在使用皮质脊髓束数据诊断ALS中的诊断准确性。检索了MEDLINE、EMBASE、CINAHL和科克伦数据库（1966- 2011年4月）。如果研究使用DTI感兴趣区或纤维束成像技术比较ALS受试者和健康对照者的平均大脑皮质脊髓束各向异性分数值，则纳入研究。联系了识别文章的相应作者，以收集个体患者数据。使用Stata进行IPD荟萃分析和荟萃回归。荟萃回归协变量分析包括年龄、性别、病程和修订的肌萎缩侧索硬化症功能评定量表评分。在30项识别的研究中，11位通讯作者提供了IPD，221名ALS患者和187名健康对照受试者可用于研究。合并的受试者工作特征曲线下面积（AUC）为0.75（95%CI：0.66-0.83），合并的灵敏度为0.68（95%CI：0.62-0.75），合并的特异性为0.73（95%CI：0.66-0.80）。荟萃回归显示每个协变量的合并AUC无显著差异。合并AUC估计值存在中度至高度异质性。研究质量普遍较高。30项合格研究中有19项的数据未确定，增加了选择偏倚的可能性。使用皮质脊髓束个体患者数据，DTI的诊断准确性似乎缺乏足够的区分。将需要额外的研究努力和多模式方法，包括ALS模拟物，使神经影像学成为ALS检查的关键组成部分。
There have been a large number of case-control studies using diffusion tensor imaging (DTI) in amyotrophic lateral sclerosis (ALS). The objective of this study was to perform an individual patient data (IPD) meta-analysis for the estimation of the diagnostic accuracy measures of DTI in the diagnosis of ALS using corticospinal tract data. MEDLINE, EMBASE, CINAHL, and Cochrane databases (1966–April 2011) were searched. Studies were included if they used DTI region of interest or tractography techniques to compare mean cerebral corticospinal tract fractional anisotropy values between ALS subjects and healthy controls. Corresponding authors from the identified articles were contacted to collect individual patient data. IPD meta-analysis and meta-regression were performed using Stata. Meta-regression covariate analysis included age, gender, disease duration, and Revised Amyotrophic Lateral Sclerosis Functional Rating Scale scores. Of 30 identified studies, 11 corresponding authors provided IPD and 221 ALS patients and 187 healthy control subjects were available for study. Pooled area under the receiver operating characteristic curve (AUC) was 0.75 (95% CI: 0.66–0.83), pooled sensitivity was 0.68 (95% CI: 0.62–0.75), and pooled specificity was 0.73 (95% CI: 0.66–0.80). Meta-regression showed no significant differences in pooled AUC for each of the covariates. There was moderate to high heterogeneity of pooled AUC estimates. Study quality was generally high. Data from 19 of the 30 eligible studies were not ascertained, raising possibility of selection bias. Using corticospinal tract individual patient data, the diagnostic accuracy of DTI appears to lack sufficient discrimination in isolation. Additional research efforts and a multimodal approach that also includes ALS mimics will be required to make neuroimaging a critical component in the workup of ALS.
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