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

Abstract

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 I2 statistic calculations revealed considerable heterogeneity in terms of both sensitivity (I2 = 72.12%) and specificity (I2 = 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%).