Longitudinal Changes of White Matter Hyperintensities in Sporadic Small Vessel Disease: A Systematic Review and Meta-analysis.
Longitudinal Changes of White Matter Hyperintensities in Sporadic Small Vessel Disease: A Systematic Review and Meta-analysis.
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DOI：
10.1212/wnl.0000000000201205
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发表时间：
2022-11-29
期刊：
影响因子：
9.9
通讯作者：
Wardlaw, Joanna M.
中科院分区：
文献类型：
--
作者：
Jochems, Angela C. C.;Arteaga, Carmen;Chappell, Francesca;Ritakari, Tuula;Hooley, Monique;Doubal, Fergus;Maniega, Susana Munoz;Wardlaw, Joanna M.
白色高信号（WMH）是小血管疾病（SVD）的常见影像学特征，与不良临床结局相关。随着时间的推移WMH进展是很好的描述，但最近也注意到回归，虽然频率和相关因素是未知的。这项系统性综述和荟萃分析旨在评估散发性SVD中纵向个体内WMH体积变化。我们在EMBASE和MEDLINE中检索了截至2022年1月28日的关于在≥2个时间点使用MRI检查散发性SVD成人患者的WMH体积变化的文章。我们根据研究特征对人群进行了分类（健康/社区居民、卒中、认知、其他血管危险因素和抑郁）。我们使用Knapp-Hartung校正进行随机效应荟萃分析，以确定平均WMH体积变化（以毫升为单位的变化，颅内体积百分比[%ICV]或毫升/年），95% CI和预测区间（PI，增加和减少的限度）。使用非随机研究的偏倚风险评估工具评估偏倚风险。我们遵循系统性综述和荟萃分析指南中的首选报告。41篇文章，12，284名参与者，符合纳入标准。13篇文章在所有领域的偏倚风险较低。平均WMH体积随时间增加1.74 mL（95% CI 1.23-2.26; PI −1.24至4.73 mL; 27篇文章，N = 7，411，平均时间间隔2.7年，SD = 1.65）; 0.25% ICV（95% CI 0.14-0.36; PI −0.06至0.56; 6篇文章，N = 1，071，平均时间间隔3.5年，SD = 1.54）;或0.58 mL/y（95% CI 0.35-0.81; PI −0.26至1.41; 8篇文章，N = 3，802）。此外，13篇文章特别提到和/或提供了WMH回归的数据，这些回归发生在与SVD相关的无症状、卒中和认知障碍中。净平均WMH体积随时间推移而增加掩盖了广泛的变化（例如，平均增加1.75 mL，范围从1.25 mL减少到4.75 mL增加），多达三分之一的参与者明确记录了回归。需要更多关于潜在机制、相关因素和临床相关性的知识，因为WMH消退可能是一个重要的干预目标。
White matter hyperintensities (WMHs) are frequent imaging features of small vessel disease (SVD) and related to poor clinical outcomes. WMH progression over time is well described, but regression was also noted recently, although the frequency and associated factors are unknown. This systematic review and meta-analysis aims to assess longitudinal intraindividual WMH volume changes in sporadic SVD. We searched EMBASE and MEDLINE for articles up to 28 January 2022 on WMH volume changes using MRI on ≥2 time points in adults with sporadic SVD. We classified populations (healthy/community-dwelling, stroke, cognitive, other vascular risk factors, and depression) based on study characteristics. We performed random-effects meta-analyses with Knapp-Hartung adjustment to determine mean WMH volume change (change in milliliters, percentage of intracranial volume [%ICV], or milliliters per year), 95% CI, and prediction intervals (PIs, limits of increase and decrease) using unadjusted data. Risk of bias assessment tool for nonrandomized studies was used to assess risk of bias. We followed Preferred Reporting in Systematic Review and Meta-Analysis guidelines. Forty-one articles, 12,284 participants, met the inclusion criteria. Thirteen articles had low risk of bias across all domains. Mean WMH volume increased over time by 1.74 mL (95% CI 1.23–2.26; PI −1.24 to 4.73 mL; 27 articles, N = 7,411, mean time interval 2.7 years, SD = 1.65); 0.25 %ICV (95% CI 0.14–0.36; PI −0.06 to 0.56; 6 articles, N = 1,071, mean time interval 3.5 years, SD = 1.54); or 0.58 mL/y (95% CI 0.35–0.81; PI −0.26 to 1.41; 8 articles, N = 3,802). In addition, 13 articles specifically mentioned and/or provided data on WMH regression, which occurred in asymptomatic, stroke, and cognitive disorders related to SVD. Net mean WMH volume increases over time mask wide-ranging change (e.g., mean increase of 1.75 mL ranging from 1.25 mL decrease to 4.75 mL increase), with regression documented explicitly in up to one-third of participants. More knowledge on underlying mechanisms, associated factors, and clinical correlates is needed, as WMH regression could be an important intervention target.