Diagnostic Performance of ASL-MRI and FDG-PET in Frontotemporal Dementia: A Systematic Review and Meta-Analysis.

Journal

AJNR. American journal of neuroradiology
ISSN: 1936-959X
Titre abrégé: AJNR Am J Neuroradiol
Pays: United States
ID NLM: 8003708

Informations de publication

Date de publication:
12 Aug 2024
Historique:
received: 03 06 2024
accepted: 01 08 2024
medline: 13 8 2024
pubmed: 13 8 2024
entrez: 12 8 2024
Statut: aheadofprint

Résumé

While the diagnosis of frontotemporal dementia (FTD) is based mostly on clinical features, [18F]-FDG PET has been investigated as a potential imaging golden standard in ambiguous cases, with arterial spin labeling (ASL) MRI gaining recent interest. The purpose of this study is to conduct a systematic review and meta-analysis on the diagnostic performance of ASL MRI in FTD patients and compare it to that of [18F]-FDG PET. A systematic search of PubMed, Scopus and EMBASE was conducted until March 13, 2024. Inclusion criteria were: original articles, patients with FTD and/or its variants, use of ASL MR perfusion imaging with or without [18F]-FDG PET, presence of sufficient diagnostic performance data. Exclusion criteria were: meeting abstracts, comments, summaries, protocols, letters and guidelines, longitudinal studies, overlapping cohorts. The quality of eligible studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) for [18F]-FDG PET and ASL MRI were calculated, and a summary receiver operating characteristic curve was plotted. Seven eligible studies were identified, which included a total of 102 FTD patients. Aside from some of the studies showing at worst an unclear risk of bias in patient selection, index test, flow and timing, all studies showed low risk of bias and applicability concerns in all categories. Data from 4 studies was included in our meta-analysis for ASL MRI and 3 studies for [18F]-FDG PET. Pooled sensitivity, specificity and DOR were 0.70 (95% CI: 0.59-0.79), 0.81 (95% CI: 0.71-0.88) and 8.00 (95% CI: 3.74-17.13) for ASL MRI, and 0.88 (95% CI: 0.71-0.96), 0.89 (95% CI: 0.43-0.99) and 47.18 (95% CI: 10.77-206.75) for [18F]-FDG PET. The number of studies was relatively small, with a small sample size. The studies used different scanning protocols as well as a mix of diagnostic metrics, all of which might have introduced heterogeneity in the data. While ASL MRI performed worse than [18F]-FDG PET in the diagnosis of FTD, it exhibited a decent diagnostic performance to justify its further investigation as a quicker and more convenient alternative. 3DPCASL, 3D pseudocontinuous ASL; AD, Alzheimer's disease; ASL, arterial spin labeling; AUC, area under the curve; CI, confidence interval; DOR, diagnostic odds ratio; FN, false negative; FP, false positive; FTD, frontotemporal dementia; LE, limbic encephalitis; NLR, negative likelihood ratio; PASL, pulsed ASL; PLD, post-label delay; PLR, positive likelihood ratio; PRISMA, PSP, progressive supranuclear palsy; Preferred Reporting Items for Systematic Reviews and Meta-Analysis; SROC, summary receiver operative characteristic; TN, true negative; TP, true positive; QUADAS-2, Quality Assessment of Diagnostic Accuracy Studies-2.

Sections du résumé

BACKGROUND BACKGROUND
While the diagnosis of frontotemporal dementia (FTD) is based mostly on clinical features, [18F]-FDG PET has been investigated as a potential imaging golden standard in ambiguous cases, with arterial spin labeling (ASL) MRI gaining recent interest.
PURPOSE OBJECTIVE
The purpose of this study is to conduct a systematic review and meta-analysis on the diagnostic performance of ASL MRI in FTD patients and compare it to that of [18F]-FDG PET.
DATA SOURCES METHODS
A systematic search of PubMed, Scopus and EMBASE was conducted until March 13, 2024.
STUDY SELECTION METHODS
Inclusion criteria were: original articles, patients with FTD and/or its variants, use of ASL MR perfusion imaging with or without [18F]-FDG PET, presence of sufficient diagnostic performance data. Exclusion criteria were: meeting abstracts, comments, summaries, protocols, letters and guidelines, longitudinal studies, overlapping cohorts.
DATA ANALYSIS METHODS
The quality of eligible studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) for [18F]-FDG PET and ASL MRI were calculated, and a summary receiver operating characteristic curve was plotted.
DATA SYNTHESIS RESULTS
Seven eligible studies were identified, which included a total of 102 FTD patients. Aside from some of the studies showing at worst an unclear risk of bias in patient selection, index test, flow and timing, all studies showed low risk of bias and applicability concerns in all categories. Data from 4 studies was included in our meta-analysis for ASL MRI and 3 studies for [18F]-FDG PET. Pooled sensitivity, specificity and DOR were 0.70 (95% CI: 0.59-0.79), 0.81 (95% CI: 0.71-0.88) and 8.00 (95% CI: 3.74-17.13) for ASL MRI, and 0.88 (95% CI: 0.71-0.96), 0.89 (95% CI: 0.43-0.99) and 47.18 (95% CI: 10.77-206.75) for [18F]-FDG PET.
LIMITATIONS CONCLUSIONS
The number of studies was relatively small, with a small sample size. The studies used different scanning protocols as well as a mix of diagnostic metrics, all of which might have introduced heterogeneity in the data.
CONCLUSIONS CONCLUSIONS
While ASL MRI performed worse than [18F]-FDG PET in the diagnosis of FTD, it exhibited a decent diagnostic performance to justify its further investigation as a quicker and more convenient alternative.
ABBREVIATIONS BACKGROUND
3DPCASL, 3D pseudocontinuous ASL; AD, Alzheimer's disease; ASL, arterial spin labeling; AUC, area under the curve; CI, confidence interval; DOR, diagnostic odds ratio; FN, false negative; FP, false positive; FTD, frontotemporal dementia; LE, limbic encephalitis; NLR, negative likelihood ratio; PASL, pulsed ASL; PLD, post-label delay; PLR, positive likelihood ratio; PRISMA, PSP, progressive supranuclear palsy; Preferred Reporting Items for Systematic Reviews and Meta-Analysis; SROC, summary receiver operative characteristic; TN, true negative; TP, true positive; QUADAS-2, Quality Assessment of Diagnostic Accuracy Studies-2.

Identifiants

DOI: 10.3174/ajnr.A8440 PMID: 39134374
pubmed: 39134374
pii: ajnr.A8440
doi: 10.3174/ajnr.A8440
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024 by American Journal of Neuroradiology.

Déclaration de conflit d'intérêts

The authors declare no conflicts of interest related to the content of this article.

Auteurs

Richard Dagher (R)

From the Department of Neuroradiology (R.D., B.B.O), MD Anderson Cancer Center, Houston, TX, USA; Mashhad University of Medical Sciences (P.A.), Razavi Khorasan, Mashhad, Iran; Russell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, MD, USA; Diagnostic Radiology Department (M.G.), Mansoura University, Egypt; Radiology and Imaging Sciences, Clinical Center (A.S.), National Institutes of Health, Bethesda, MD, USA.

Parisa Arjmand (P)

From the Department of Neuroradiology (R.D., B.B.O), MD Anderson Cancer Center, Houston, TX, USA; Mashhad University of Medical Sciences (P.A.), Razavi Khorasan, Mashhad, Iran; Russell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, MD, USA; Diagnostic Radiology Department (M.G.), Mansoura University, Egypt; Radiology and Imaging Sciences, Clinical Center (A.S.), National Institutes of Health, Bethesda, MD, USA.

Burak Berksu Ozkara (BB)

From the Department of Neuroradiology (R.D., B.B.O), MD Anderson Cancer Center, Houston, TX, USA; Mashhad University of Medical Sciences (P.A.), Razavi Khorasan, Mashhad, Iran; Russell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, MD, USA; Diagnostic Radiology Department (M.G.), Mansoura University, Egypt; Radiology and Imaging Sciences, Clinical Center (A.S.), National Institutes of Health, Bethesda, MD, USA.

Mahla Radmard (M)

From the Department of Neuroradiology (R.D., B.B.O), MD Anderson Cancer Center, Houston, TX, USA; Mashhad University of Medical Sciences (P.A.), Razavi Khorasan, Mashhad, Iran; Russell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, MD, USA; Diagnostic Radiology Department (M.G.), Mansoura University, Egypt; Radiology and Imaging Sciences, Clinical Center (A.S.), National Institutes of Health, Bethesda, MD, USA.

Mona Gad (M)

From the Department of Neuroradiology (R.D., B.B.O), MD Anderson Cancer Center, Houston, TX, USA; Mashhad University of Medical Sciences (P.A.), Razavi Khorasan, Mashhad, Iran; Russell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, MD, USA; Diagnostic Radiology Department (M.G.), Mansoura University, Egypt; Radiology and Imaging Sciences, Clinical Center (A.S.), National Institutes of Health, Bethesda, MD, USA.

Ali Sheikhy (A)

From the Department of Neuroradiology (R.D., B.B.O), MD Anderson Cancer Center, Houston, TX, USA; Mashhad University of Medical Sciences (P.A.), Razavi Khorasan, Mashhad, Iran; Russell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, MD, USA; Diagnostic Radiology Department (M.G.), Mansoura University, Egypt; Radiology and Imaging Sciences, Clinical Center (A.S.), National Institutes of Health, Bethesda, MD, USA.

Max Wintermark (M)

From the Department of Neuroradiology (R.D., B.B.O), MD Anderson Cancer Center, Houston, TX, USA; Mashhad University of Medical Sciences (P.A.), Razavi Khorasan, Mashhad, Iran; Russell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, MD, USA; Diagnostic Radiology Department (M.G.), Mansoura University, Egypt; Radiology and Imaging Sciences, Clinical Center (A.S.), National Institutes of Health, Bethesda, MD, USA.

Vivek Yedavalli (V)

From the Department of Neuroradiology (R.D., B.B.O), MD Anderson Cancer Center, Houston, TX, USA; Mashhad University of Medical Sciences (P.A.), Razavi Khorasan, Mashhad, Iran; Russell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, MD, USA; Diagnostic Radiology Department (M.G.), Mansoura University, Egypt; Radiology and Imaging Sciences, Clinical Center (A.S.), National Institutes of Health, Bethesda, MD, USA.

Haris I Sair (HI)

From the Department of Neuroradiology (R.D., B.B.O), MD Anderson Cancer Center, Houston, TX, USA; Mashhad University of Medical Sciences (P.A.), Razavi Khorasan, Mashhad, Iran; Russell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, MD, USA; Diagnostic Radiology Department (M.G.), Mansoura University, Egypt; Radiology and Imaging Sciences, Clinical Center (A.S.), National Institutes of Health, Bethesda, MD, USA.

Licia P Luna (LP)

From the Department of Neuroradiology (R.D., B.B.O), MD Anderson Cancer Center, Houston, TX, USA; Mashhad University of Medical Sciences (P.A.), Razavi Khorasan, Mashhad, Iran; Russell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, MD, USA; Diagnostic Radiology Department (M.G.), Mansoura University, Egypt; Radiology and Imaging Sciences, Clinical Center (A.S.), National Institutes of Health, Bethesda, MD, USA.

Classifications MeSH