The Use of Noncontrast Quantitative MRI to Detect Gadolinium-Enhancing Multiple Sclerosis Brain Lesions: A Systematic Review and Meta-Analysis.
The Use of Noncontrast Quantitative MRI to Detect Gadolinium-Enhancing Multiple Sclerosis Brain Lesions: A Systematic Review and Meta-Analysis.
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DOI：
10.3174/ajnr.a5209
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发表时间：
2017-07
期刊：
影响因子：
--
通讯作者：
Wang Y
中科院分区：
文献类型：
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作者：
Gupta A;Al-Dasuqi K;Xia F;Askin G;Zhao Y;Delgado D;Wang Y
对于多发性硬化症（MS）患者反复注射钆的长期健康影响，以及仅依赖增强特征导致的MS病变病理生理特征的不完整，已经引起了人们的关注。进行系统回顾和荟萃分析，分析非对比MRI生物标志物是否可以区分增强性和非增强性脑MS病变。Ovid MEDLINE， Ovid Embase和Cochrane数据库，从成立到2016年8月。我们纳入了37篇关于985名接受MRI检查的MS患者的期刊文章，其中使用单个MS病变的ROI分析，将同一MRI检查中获得的t1加权对比序列与非对比序列进行比较。我们进行了随机效应荟萃分析，比较了强化病变与非强化病变的每项MRI指标的标准均差。基于dti的FA值在增强和非增强病变之间存在显著差异（P=0.02），增强病变的FA值比非增强病变低。其他最常研究的MRI生物标志物（MD、MTR或ADC）没有显著差异（p值分别为0.30、0.47和0.19）。（分别）在增强和非增强病变之间。在提供诊断准确性测量的有限研究中，基于梯度回声的QSM在区分增强和非增强MS病变方面表现最佳。不同研究的MRI技术和患者特征不同。大多数研究没有提供诊断准确性的测量方法。所有37项研究均未研究所有影像学指标。非对比MRI技术，如基于dti的FA，可以在没有钆的情况下评估MS病变的敏锐度。
Concerns have arisen about the long-term health effects of repeated gadolinium injections in multiple sclerosis (MS) patients and the incomplete characterization of MS lesion pathophysiology that results from relying on enhancement characteristics alone. To perform a systematic review and meta-analysis analyzing whether non-contrast MRI biomarkers can distinguish between enhancing and non-enhancing brain MS lesions. Ovid MEDLINE, Ovid Embase, and the Cochrane Database from inception to August 2016. We included 37 journal articles on 985 MS patients who had MRI in which T1-weighted post-contrast sequences were compared to non-contrast sequences obtained during the same MRI examination using ROI analysis of individual MS lesions. We performed random-effects meta-analyses comparing the standard mean difference of each MRI metric taken from enhancing versus non-enhancing lesions. DTI-based FA values are significantly different between enhancing and non-enhancing lesions (P=0.02), with enhancing lesions showing decreased FA compared to non-enhancing lesions. Of the other most frequently studied MRI biomarkers (MD, MTR, or ADC) none were significantly different (P-values of 0.30, 0.47, and 0.19. respectively) between enhancing and non-enhancing lesions. Of the limited studies providing diagnostic accuracy measures, gradient echo-based QSM had the best performance in discriminating between enhancing and non-enhancing MS lesions. MRI techniques and patient characteristics were variable across studies. Most studies did not provide diagnostic accuracy measures. All imaging metrics were not studied in all 37 studies. Non-contrast MRI techniques, such as DTI-based FA, can assess MS lesion acuity without gadolinium.