Iron-sensitive magnetic resonance imaging in Parkinson's disease: a systematic review and meta-analysis.

Abstract

OBJECTIVE:

To evaluate the diagnostic performance of iron-sensitive sequences targeting the substantia nigra for distinguishing patients with Parkinson's disease from control participants and to identify factors causing heterogeneity.

METHODS:

A systematic literature search in the Ovid-MEDLINE and EMBASE databases was performed for studies reporting the relevant topic before March 6, 2020. The pooled sensitivity and specificity values with their 95% confidence intervals were calculated using bivariate random-effects modeling. Subgroup and meta-regression analyses were also performed to determine factors influencing heterogeneity affecting the diagnostic performance among the clinical, MRI, and analytic characteristics.

RESULTS:

A total of 22 articles including 1126 patients with Parkinson's disease and 933 control participants were enrolled in this systematic review and meta-analysis. Of those, 12 studies used objective analyses of quantitative susceptibility measurements, and 10 visually assessed the nigrosome-1 in subjective analyses. Iron-sensitive nigral magnetic resonance imaging showed a pooled sensitivity of 92% (95% confidence interval 88-95%) and a pooled specificity of 90% (95% confidence interval 81-95%). According to subgroup and meta-regression analyses, a longer mean disease duration in patients with Parkinson's disease (≥ 5 years), subjective analysis, a smaller size of pixel (< 0.6 mm2), a larger flip angle (> 15°), a smaller slice thickness (≤ 1 mm), and specific targeting of the substantia nigra pars compacta improved the diagnostic performance.

CONCLUSION:

Iron-sensitive nigral magnetic resonance imaging had a favorable diagnostic performance in discriminating patients with Parkinson's disease from control participants. Subjective analytic methods remain superior to objective approaches. Further improvements of the spatial resolution and contrast-to-noise ratio to specifically target the nigrosome-1 with objective analytic methods will be needed.

• Authors: Se Jin Cho, Yun Jung Bae, Jong-Min Kim, Hyun Jin Kim, Sung Hyun Baik, Leonard Sunwoo, Byung Se Choi, Cheolkyu Jung, Jae Hyoung Kim
• Journal: Journal of neurology (J Neurol) Vol. 268 Issue 12 Pg. 4721-4736 (Dec 2021) ISSN: 1432-1459 [Electronic] Germany
• PMID: 33914142 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: © 2021. Springer-Verlag GmbH Germany, part of Springer Nature.

Chemical References

• Iron

Topics

• Humans
• Iron
• Magnetic Resonance Imaging
• Parkinson Disease (diagnostic imaging)
• Sensitivity and Specificity
• Substantia Nigra (diagnostic imaging)