Is MRI better than CT for detecting a vascular component to dementia? A systematic review and meta-analysis.
Is MRI better than CT for detecting a vascular component to dementia? A systematic review and meta-analysis.
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DOI：
10.1186/1471-2377-12-33
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发表时间：
2012-06-06
期刊：
影响因子：
2.6
通讯作者：
Whiting P
中科院分区：
文献类型：
--
作者：
Beynon R;Sterne JA;Wilcock G;Likeman M;Harbord RM;Astin M;Burke M;Bessell A;Ben-Shlomo Y;Hawkins J;Hollingworth W;Whiting P
在症状出现后立即确定痴呆症的原因很重要，因为对某些痴呆症原因的适当治疗可以减缓或阻止其进展，或者在适当的情况下实现对症治疗。在尸检和临床队列中确诊的VaD、合并AD和VaD(“混合性痴呆”)和AD患者中，MRI和CT的准确性以及MRI是否优于CT，在检测痴呆的血管成分方面是否优于CT尚不清楚。我们对这一问题进行了系统的回顾和荟萃分析。我们搜索了8个数据库并筛选了参考文献列表，以确定涉及审查问题的研究。我们使用QUADAS对研究质量进行评估。我们根据影像表现、MRI与CT的诊断优势比(RDOR)以及高风险与低风险的偏倚来评估总体诊断的准确性。我们包括7例尸检和31例非尸检研究。几乎没有证据表明选择性患者入选和纳入风险对诊断准确性有影响(p = 为0.12到0.95)。最广泛报道的影像表现是白质高信号。CT(11项研究)的总敏感性和特异性分别为71%(95%CI 53%~85%)和55%(44%~66%)。MRI(6项研究)的相应数字分别为95%(87%-98%)和26%(12%-50%)。MRI(96%；95%CI 94%~97%)和CT(96%；93%~98%)是最特异的影像表现。然而，MRI(53%；36%-70%)和CT(52%；22%-80%)的敏感性都很低。没有一种影像发现具有一贯的高敏感性。基于非尸检研究，对于七种影像表现中的六种，MRI比CT更准确，但可信区间很大。没有足够的证据表明，在尸检证实的VaD、AD和混合性痴呆的临床队列中，MRI在识别脑血管变化方面优于CT。
Identification of causes of dementia soon after symptom onset is important, because appropriate treatment of some causes of dementia can slow or halt its progression or enable symptomatic treatment where appropriate. The accuracy of MRI and CT, and whether MRI is superior to CT, in detecting a vascular component to dementia in autopsy confirmed and clinical cohorts of patients with VaD, combined AD and VaD (“mixed dementia”), and AD remain unclear. We conducted a systematic review and meta-analysis to investigate this question. We searched eight databases and screened reference lists to identify studies addressing the review question. We assessed study quality using QUADAS. We estimated summary diagnostic accuracy according to imaging finding, and ratios of diagnostic odds ratios (RDORs) for MRI versus CT and high versus low risk of bias. We included 7 autopsy and 31 non-autopsy studies. There was little evidence that selective patient enrolment and risk of incorporation bias impacted on diagnostic accuracy (p = 0.12 to 0.95). The most widely reported imaging finding was white matter hyperintensities. For CT (11 studies) summary sensitivity and specificity were 71% (95% CI 53%-85%) and 55% (44%-66%). Corresponding figures for MRI (6 studies) were 95% (87%-98%) and 26% (12%-50%). General infarcts was the most specific imaging finding on MRI (96%; 95% CI 94%-97%) and CT (96%; 93%-98%). However, sensitivity was low for both MRI (53%; 36%-70%) and CT (52%; 22% to 80%). No imaging finding had consistently high sensitivity. Based on non-autopsy studies, MRI was more accurate than CT for six of seven imaging findings, but confidence intervals were wide. There is insufficient evidence to suggest that MRI is superior to CT with respect to identifying cerebrovascular changes in autopsy-confirmed and clinical cohorts of VaD, AD, and ‘mixed dementia’.
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影响因子：
--
作者：
AHARONPERETZ, J;CUMMINGS, JL;HILL, MA
通讯作者：
HILL, MA
影响因子：
--
作者：
ENGEL, PA;GELBER, J
通讯作者：
GELBER, J
影响因子：
11
作者：
ERKINJUNTTI, T;HALTIA, M;PAETAU, A
通讯作者：
PAETAU, A
影响因子：
--
作者：
Gifford, DR;Holloway, RG;Vickrey, BG
通讯作者：
Vickrey, BG
影响因子：
3.5
作者：
ERKINJUNTTI, T;KETONEN, L;PALO, J
通讯作者：
PALO, J