黑质定量磁化率成像对帕金森病诊断价值的Meta分析

Quantitative susceptibility mapping of substantia nigra in the diagnosis of Parkinson’s disease:A Meta analysis

目的对黑质定量磁化率成像(quantitative susceptibility mapping,QSM)鉴别诊断帕金森病(Parkinson’s disease,PD)的价值进行Meta分析。材料与方法检索PubMed、Embase、Web of Science、the Cochrane Library、CNKI、万方数据库、中国生物医学文献数据库和维普数据库自建库至2022年5月有关QSM对PD诊断价值的任何中英文献,由2名研究者独立筛选文献、提取数据并评价纳入研究的偏倚风险后,采用RevMan 5.0和Stata 17.0软件进行Meta分析。结果共纳入16篇文献,包括702例PD患者和497例健康对照者。Meta分析显示QSM诊断PD的合并敏感度(Sen合并)、特异度(Spe_(合并))、阳性似然比(+LR_(合并))、阴性似然比(-LR_(合并))和诊断比值比(DOR合并)分别为0.87(95%CI:0.83~0.90)、0.77(95%CI:0.69~0.84)、3.84(95%CI:2.74~5.39)、0.17(95%CI:0.12~0.22)和23.19(95%CI:13.41~40.07),受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)为0.90(95%CI:0.87~0.93)。亚组分析结果显示:测量黑质致密带[AUC=0.90(95%CI:0.87~0.92)]、扫描层厚≤1 mm[AUC=0.93(95%CI:0.91~0.95)]诊断准确性优于测量整体黑质[AUC=0.81(95%CI:0.77~0.84)]、扫描层厚>1 mm[AUC=0.88(95%CI:0.85~0.91)]。Deek’s漏斗图提示无明显发表偏倚(P=0.24)。结论当前证据显示QSM具有较高的PD诊断价值,尤其是测量黑质致密带和扫描层厚≤1 mm,可为PD的早期诊断和随诊提供影像学依据。

Objective:To systematically evaluate the diagnostic performance of quantitative susceptibility mapping(QSM)in the substantia nigra for Parkinson’s disease(PD)using Meta-analysis.Materials and Methods:A systematic literature search in the PubMed,EMBASE,the Cochrane Library,Web of Science,CNKI,Wanfang Data,China Biology Medicine disc(CBMdisc)and VIP databases was performed for studies about QSM in the diagnosis of PD from inception to May 2022.Two researchers independently screened literature,extracted data,and assessed the risk of bias of the included studies.RevMan 5.0 and Stata 17.0 software were used for Meta-analysis.Results:A total of 16 studies including 702 patients with PD and 497 healthy control participants were enrolled in this Meta-analysis.QSM showed a pooled sensitivity(Sen),specificity(Spe),positive likelihood ratio(+LR),negative likelihood ratio(-LR),and diagnostic odds ratio(DOR)with their 95%confidence intervals(CI)of 0.87(0.83-0.90),0.77(0.69-0.84),3.84(2.74-5.39),0.17(0.12-0.22)and 23.19(13.41-40.07).The area under the curve(AUC)was 0.90(0.87-0.93).According to subgroup analysis,the AUC of a specific measurement of substantial nigra pars compacta[AUC=0.90(95%CI:0.87-0.92)],slice thickness≤1 mm[AUC=0.93(95%CI:0.91-0.95)]is superior than measurement of the whole substantial pars[AUC=0.81(95%CI:0.77-0.84)],slice thickness>1 mm[AUC=0.88(95%CI:0.85-0.91)].Deek’s funnel plot showed no publication bias(P=0.24).Conclusions:The current evidence shows that QSM had a favorable diagnostic performance in diagnosing PD,especially in a specific measurement of substantial nigra or slice thickness≤1 mm,which provides imaging basis for early diagnosis and follow-up of PD.