Diagnostic performance of T2 gradient echo, susceptibility-weighted imaging, and quantitative susceptibility mapping for patients with multiple system atrophy–parkinsonian type: a systematic review and meta-analysis

• Published in: European radiology Vol. 32; no. 1; pp. 308 - 318
• Main Authors: Lim, Su Jin, Suh, Chong Hyun, Shim, Woo Hyun, Kim, Sang Joon
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2022; Springer Nature B.V
• Subjects: Atrophy; Basal ganglia; Central nervous system diseases; Diagnostic Radiology; Heterogeneity; Humans; Imaging; Internal Medicine; Interventional Radiology; Magnetic Resonance Imaging; Mapping; Medical diagnosis; Medical imaging; Medicine; Medicine & Public Health; Meta-analysis; Modelling; Movement disorders; Multicenter Studies as Topic; Multiple System Atrophy - diagnostic imaging; Neuro; Neurodegenerative diseases; Neuroradiology; Parameter sensitivity; Parkinson Disease - diagnostic imaging; Parkinson's disease; Performance evaluation; Phase shift; Prospective Studies; Radiology; Sensitivity; Sensitivity and Specificity; Statistical analysis; Susceptibility; Ultrasound; Magnetic resonance imaging; Multiple system atrophy; Parkinson disease
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-021-08174-4

Objectives To investigate the diagnostic performance of T2*-weighted gradient echo (GRE) imaging, susceptibility-weighted imaging (SWI), or quantitative susceptibility mapping (QSM) in differentiating multiple system atrophy–parkinsonian type (MSA-P) from Parkinson’s disease (PD). Methods A systematic literature search through the MEDLINE and EMBASE databases was performed, starting on September 8, 2020, to identify studies evaluating the diagnostic performance of putaminal hypointensity on T2* GRE or SWI and phase shift on QSM in differentiating MSA-P from PD. The pooled sensitivity and specificity were obtained using hierarchical logistic regression modeling and hierarchical summary receiver operating characteristic (HSROC) modeling. The pooled diagnostic yields of T2* GRE, SWI, or QSM among MSA-P patients were calculated using the DerSimonian–Laird random-effects model. Results Twelve original articles with 985 patients were finally included. SWI was performed in seven studies, T2* GRE was performed in three studies, and QSM was performed in two studies. The pooled sensitivity and specificity were 0.65 (95% CI 0.51–0.78) and 0.90 (95% CI 0.83–0.95), respectively. The area under the HSROC curve was 0.87 (95% CI 0.84–0.90). The Higgins I 2 statistic calculations revealed considerable heterogeneity in terms of both sensitivity ( I 2 = 72.12%) and specificity ( I 2 = 70.38%). The coupled forest plot revealed the threshold effect. For the nine studies in which area under the curve (AUC) was obtainable, the AUC ranged from 0.68 to 0.947, with a median of 0.819. The pooled diagnostic yield of T2* GRE, SWI, or QSM was 66% (95% CI 51–78%). Conclusions Putaminal hypointensity on T2* GRE or SWI and phase shift on QSM might be a promising diagnostic tool in differentiating MSA-P from PD. Further large multicenter prospective study is warranted. Key Points • Three different index tests, definitions of positive image findings, thresholds, the way how to draw ROIs, reference standard, and MRI parameters could affect the heterogeneity of the study. • The pooled sensitivity and specificity were 0.65 (95% CI 0.51–0.78) and 0.90 (95% CI 0.83–0.95), respectively. • The pooled diagnostic yield of T2* GRE, SWI, or QSM was 66% (95% CI 51–78%).