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The International Journal of... May 2023Brainstem cavernous malformations are benign subset of cerebral cavernous malformations, which need a special intervention owing to being vital and complex. The... (Review)
Review
Brainstem cavernous malformations are benign subset of cerebral cavernous malformations, which need a special intervention owing to being vital and complex. The diffusion tensor imaging technique, a well-recognized neuroimaging tool, can visualize the white matter tracts and their surroundings and provide promising surgical outcomes. This systematic review and meta-analysis evaluated the effect of preoperative diffusion tensor imaging in patients undergoing surgical resection of brainstem cavernous malformations. Five databases, including PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar, were searched using a comprehensive search strategy to find any article matching our inclusion criteria. We used Comprehensive Meta-Analysis (CMA) software to analyze the collected data, get the evidence, and report the results as event rate (ER), with their 95% confidence interval (CI). Twenty-eight studies involving 467 patients matched our criteria and 19 studies entered the analysis. Our analysis showed that, in patients undergoing surgical resection of brainstem cavernous malformations assisted by preoperative diffusion tensor imaging, 82.21% achieved total resection. About 12.4% of patients achieved partial resection, 65.65% improved, 8.07% worsened, 25.04% showed no change, 3.59% experienced postoperative re-bleeding, and 0.87% died. The utilization of preoperative diffusion tensor imaging significantly increased the proportion of improved patients and decreased the proportion of worsened patients. However, further controlled research is needed to draw a definite conclusion about the usefulness of its role.
PubMed: 37194114
DOI: 10.1080/00207454.2023.2214696 -
Neurosurgical Review Jun 2022This study aimed to systematically review the literature to determine the clinical utility and perspectives of diffusion tensor imaging (DTI) in the management of... (Review)
Review
This study aimed to systematically review the literature to determine the clinical utility and perspectives of diffusion tensor imaging (DTI) in the management of patients with brainstem cavernous malformations (BSCMs). PubMed, Embase, and Cochrane were searched for English-language articles published until May 10, 2021. Clinical studies and case series describing DTI-based evaluation of patients with BSCMs were included. Fourteen articles were included. Preoperative DTI enabled to adjust the surgical approach and choose a brainstem safe entry zone in deep-seated BSCMs. Preoperatively lower fractional anisotropy (FA) of the corticospinal tract (CST) correlated with the severity of CST injury and motor deficits. Postoperatively increased FA and decreased apparent diffusion coefficient (ADC) corresponded with the normalization of the perilesional CST, indicating motor improvement. The positive (PPV) and negative predictive value (NPV) of qualitative DTI ranged from 20 to 75% and from 66.6 to 100%, respectively. The presence of preoperative and postoperative motor deficits was associated with a higher preoperative resting motor threshold (RMT) and lower FA. A higher preoperative CST score was indicative of a lower preoperative and follow-up Medical Research Council (MRC) grade. DTI facilitated the determination of a surgical trajectory with minimized risk of WMTs' damage. Preoperative FA and RMT might indicate the severity of preoperative and postoperative motor deficits. Preoperative CST score can reliably reflect patients' preoperative and follow-up motor status. Due to high NPV, normal CST morphology might predict intact neurological outcomes. Contrarily, sparse and relatively low PPV limits the reliable prediction of neurological deficits.
Topics: Anisotropy; Brain Stem; Diffusion Magnetic Resonance Imaging; Diffusion Tensor Imaging; Humans; Pyramidal Tracts
PubMed: 35211879
DOI: 10.1007/s10143-022-01759-7 -
Journal of Internal Medicine Mar 2022Colony-stimulating factor 1 receptor (CSF1R)-related leukoencephalopathy is a rare but fatal microgliopathy. The diagnosis is often delayed due to multifaceted symptoms... (Meta-Analysis)
Meta-Analysis Review
Colony-stimulating factor 1 receptor (CSF1R)-related leukoencephalopathy is a rare but fatal microgliopathy. The diagnosis is often delayed due to multifaceted symptoms that can mimic several other neurological disorders. Imaging provides diagnostic clues that help identify cases. The objective of this study was to integrate the literature on neuroimaging phenotypes of CSF1R-related leukoencephalopathy. A systematic review and meta-analysis were performed for neuroimaging findings of CSF1R-related leukoencephalopathy via PubMed, Web of Science, and Embase on 25 August 2021. The search included cases with confirmed CSF1R mutations reported under the previous terms hereditary diffuse leukoencephalopathy with spheroids, pigmentary orthochromatic leukodystrophy, and adult-onset leukoencephalopathy with axonal spheroids and pigmented glia. In 78 studies providing neuroimaging data, 195 cases were identified carrying CSF1R mutations in 14 exons and five introns. Women had a statistically significant earlier age of onset (p = 0.041, 40 vs 43 years). Mean delay between symptom onset and neuroimaging was 2.3 years. Main magnetic resonance imaging (MRI) findings were frontoparietal white matter lesions, callosal thinning, and foci of restricted diffusion. The hallmark computed tomography (CT) finding was white matter calcifications. Widespread cerebral hypometabolism and hypoperfusion were reported using positron emission tomography and single-photon emission computed tomography. In conclusion, CSF1R-related leukoencephalopathy is associated with progressive white matter lesions and brain atrophy that can resemble other neurodegenerative/-inflammatory disorders. However, long-lasting diffusion restriction and parenchymal calcifications are more specific findings that can aid the differential diagnosis. Native brain CT and brain MRI (with and without a contrast agent) are recommended with proposed protocols and pictorial examples are provided.
Topics: Brain; Female; Humans; Leukoencephalopathies; Magnetic Resonance Imaging; Mutation; Neuroimaging; Phenotype
PubMed: 34875121
DOI: 10.1111/joim.13420 -
Neurologia I Neurochirurgia Polska 2016Recent years brought several experimental and clinical reports applying diffusion tensor tractography imaging (DTI) of the brain in epilepsy. This study was aimed to... (Review)
Review
PURPOSE
Recent years brought several experimental and clinical reports applying diffusion tensor tractography imaging (DTI) of the brain in epilepsy. This study was aimed to evaluate current evidence for adding the DTI sequence to the standard diagnostic magnetic resonance imaging (MRI) protocol in pediatric epilepsy.
MATERIAL AND METHODS
Rapid and qualitative systematic review (RAE, Rapid Evidence Assessment), aggregating relevant studies from the recent 7 years. The PubMed database was hand searched for records containing terms "tractography AND epilepsy." Only studies referring to children were included; studies were rated using "final quality of evidence."
RESULTS
Out of 144 screened records, relevant 101 were aggregated and reviewed. The synthesis was based on 73 studies. Case-control clinical studies were the majority of the material and comprised 43.8% of the material. Low 'confirmability' and low 'applicability' referred to 18 and 17 articles (29.5% and 27.9%), respectively. The sufficient quality of evidence supported performing DTI in temporal lobe epilepsy, malformations of cortical development and prior to a neurosurgery of epilepsy.
CONCLUSIONS
The qualitative RAE provides an interim estimate of the clinical relevance of quickly developing diagnostic methods. Based on the critical appraisal of current knowledge, adding the DTI sequence to the standard MRI protocol may be clinically beneficial in selected patient groups with childhood temporal lobe epilepsy or as a part of planning for an epilepsy surgery.
Topics: Child; Diffusion Tensor Imaging; Epilepsy; Humans
PubMed: 26851683
DOI: 10.1016/j.pjnns.2015.10.003 -
Ophthalmic Plastic and Reconstructive...To review and summarize the existing literature surrounding the clinical use of diffusion-weighted imaging and apparent diffusion coefficient (ADC) as diagnostic tools...
PURPOSE
To review and summarize the existing literature surrounding the clinical use of diffusion-weighted imaging and apparent diffusion coefficient (ADC) as diagnostic tools in differentiating common orbital lesions.
METHODS
A systematic literature review on the use of ADC and diffusion-weighted imaging sequences for orbital imaging was performed. Only original research articles that reported ADC values for benign or malignant lesions were included.
RESULTS
Malignant orbital tumors have an overall lower mean ADC value than benign masses. Orbital lymphoma is characterized by consistently lower ADC values compared with other malignant orbital masses; a threshold value less than 0.775 × 10 -3 mm 2 /s has been proposed to distinguish orbital lymphoma from other neoplastic and non-neoplastic orbital masses. To differentiate orbital inflammatory disease from lymphoma, an ADC threshold greater than 0.92 × 10 -3 mm 2 /s has been proposed.
CONCLUSIONS
Orbital masses encompass a host of benign and malignant etiologies and can present a diagnostic challenge on both clinical and radiological assessment. Recent advanced MRI techniques such as diffusion-weighted imaging and ADC can improve the diagnostic specificity for orbital disease, particularly in differentiating benign from malignant lesions and lymphoma from orbital inflammatory disease.
Topics: Humans; Sensitivity and Specificity; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Lymphoma; Orbital Diseases; Neuroblastoma
PubMed: 34798654
DOI: 10.1097/IOP.0000000000002092 -
Archives of Physical Medicine and... Nov 2017To undertake a systematic review and meta-analysis of the relationship between microstructural damage and cognitive function after hospitalized mixed-mechanism (HMM)... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To undertake a systematic review and meta-analysis of the relationship between microstructural damage and cognitive function after hospitalized mixed-mechanism (HMM) mild traumatic brain injury (mTBI).
DATA SOURCES
PsycInfo, EMBASE, and MEDLINE were used to find relevant empirical articles published between January 2002 and January 2016.
STUDY SELECTION
Studies that examined the specific relationship between diffusion tensor imaging (DTI) and cognitive test performance were included. The final sample comprised previously medically and psychiatrically healthy adults with HMM mTBI.
DATA EXTRACTION
Specific data were extracted including mTBI definitional criteria, descriptive statistics, outcome measures, and specific results of associations between DTI metrics and cognitive test performance.
DATA SYNTHESIS
Of the 248 original articles retrieved and reviewed, 8 studies met all inclusion criteria and were included in the meta-analysis. The meta-analysis revealed statistically significant associations between reduced white matter integrity and poor performance on measures of attention (fractional anisotropy [FA]: d=.413, P<.001; mean diffusivity [MD]: d=-.407, P=.001), memory (FA: d=.347, P<.001; MD: d=-.568, P<.001), and executive function (FA: d=.246, P<.05), which persisted beyond 1 month postinjury.
CONCLUSIONS
The findings from the meta-analysis provide clear support for an association between in vivo markers of underlying neuropathology and cognitive function after mTBI. Furthermore, these results demonstrate clearly for the first time that in vivo markers of structural neuropathology are associated with cognitive dysfunction within the domains of attention, memory, and executive function. These findings provide an avenue for future research to examine the causal relationship between mTBI-related neuropathology and cognitive dysfunction. Furthermore, they have important implications for clinical management of patients with mTBI because they provide a more comprehensive understanding of factors that are associated with cognitive dysfunction after mTBI.
Topics: Attention; Brain Concussion; Cognition; Cognition Disorders; Diffusion Tensor Imaging; Executive Function; Humans; Memory; Neuropsychological Tests
PubMed: 28433414
DOI: 10.1016/j.apmr.2017.03.019 -
European Radiology Oct 2021A variety of imaging techniques can be used to evaluate diffusion characteristics to differentiate malignant and benign pancreatic lesions. The diagnostic performance of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A variety of imaging techniques can be used to evaluate diffusion characteristics to differentiate malignant and benign pancreatic lesions. The diagnostic performance of diffusion parameters has not been systematic assessed.
PURPOSE
We aimed to investigate the diagnostic efficacy of quantitative diffusion-weighted imaging (DWI) for pancreatic lesions.
METHODS
A literature search was conducted using the PubMed, Embase, and Cochrane Library databases for studies from inception to March 30, 2020, which involves the quantitative diagnostic performance of diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) in the pancreas. Studies were reviewed according to inclusion and exclusion criteria. The quality of articles was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUATAS-2). A bivariate random-effects model was used to evaluate pooled sensitivities and specificities. Univariable meta-regression analysis was used to test the effects of factors that contributed to the heterogeneity.
RESULTS
A total of 31 studies involving 1558 patients were ultimately eligible for data extraction. The lowest heterogeneity was found in specificity of perfusion fraction (f) with the I value was 17.97% and Cochran p value was 0.28. However, high heterogeneities were found for the other parameters (all I > 50%). There was no publication bias found in funnel plot (p = 0.30) for the apparent diffusion coefficient (ADC) parameter. The pooled sensitivities for ADC, f, pure diffusion coefficient (D), and pseudo diffusivity coefficient (D*) were 83%, 81%, 76%, and 84%, respectively. The pooled specificities for ADC, f, D, and D* were 87%, 83%, 69%, and 81% respectively. The areas under the curves for ADC, f, D, and D* were 0.92, 0.87, 0.79, and 0.87 respectively.
CONCLUSION
Quantitative DWI and IVIM have a good diagnostic performance for differentiating malignant and benign pancreatic lesions.
KEY POINTS
• IVIM has high sensitivity and specificity (84% and 83%, respectively) for differential diagnosis of pancreatic lesions, which is comparable to that of the ADC (83% and 87%, respectively). • The ADC has an excellent diagnostic performance for differentiating malignant from benign IPMNs (sensitivity, 0.83; specificity, 0.92); the f has the best diagnostic performance for differentiating pancreatic carcinoma from PNET (sensitivity, 0.85; specificity, 0.85). • For the ADC, using a maximal b value < 800 s/mm has a higher diagnostic accuracy than ≥ 800 s/mm; performing in a high field strength (3.0 T) system has a higher diagnostic accuracy than a low field strength (1.5 T) for pancreatic lesions.
Topics: Diffusion Magnetic Resonance Imaging; Humans; Motion; Pancreas; Pancreatic Neoplasms; Sensitivity and Specificity
PubMed: 33847811
DOI: 10.1007/s00330-021-07880-3 -
Gynecologic Oncology Reports Nov 2021Diffusion-weighted magnetic resonance imaging (DWI) has shown promise in predicting response to therapy in several malignancies. This systematic review and meta-analysis... (Review)
Review
OBJECTIVE
Diffusion-weighted magnetic resonance imaging (DWI) has shown promise in predicting response to therapy in several malignancies. This systematic review and meta-analysis aimed to evaluate DWI in the prediction of response to treatment in patients with cervical cancer.
METHODS
A systematic search was conducted on PubMed, Web of Science, Cochrane and Google Scholar databases Studies that evaluated DWI and apparent diffusion coefficient (ADC) for response evaluation before, during and after treatment with a correlation to conventional response criteria were included. The primary endpoint was the mean ADC values of cervical cancer at these timepoints. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the quality of the studies.
RESULTS
Nine studies, comprising 270 patients, were included. Pre-treatment ADC values showed no correlation with eventual response. However, in our meta-analysis, there was a significant correlation with early treatment ADC values obtained within the first 3 weeks of therapy and response, as well as a significant correlation with the percentage change in ADC (ΔADC) and response. In addition, the pooled mean ΔADC percentage was also significantly higher in responders than in non-responders (49.7% vs 19.7%, respectively, p = 0.016).
CONCLUSION
DWI shows potential as a biomarker of early treatment response in patients with cervical carcinoma. Use of the change in ADC particularly within the first 3 weeks of therapy seems to be predictive of response and may serve as a suitable marker in the determination of early response.
PubMed: 34926764
DOI: 10.1016/j.gore.2021.100883 -
CNS Neuroscience & Therapeutics Feb 2024Amyotrophic lateral sclerosis (ALS) is a progressive motor and extra-motor neurodegenerative disease. This systematic review aimed to examine MRI biomarkers and... (Review)
Review
BACKGROUND AND OBJECTIVE
Amyotrophic lateral sclerosis (ALS) is a progressive motor and extra-motor neurodegenerative disease. This systematic review aimed to examine MRI biomarkers and neuropsychological assessments of the hippocampal and parahippocampal regions in patients with ALS.
METHODS
A systematic review was conducted in the Scopus and PubMed databases for studies published between January 2000 and July 2023. The inclusion criteria were (1) MRI studies to assess hippocampal and parahippocampal regions in ALS patients, and (2) studies reporting neuropsychological data in patients with ALS.
RESULTS
A total of 46 studies were included. Structural MRI revealed hippocampal atrophy, especially in ALS-FTD, involving specific subregions (CA1, dentate gyrus). Disease progression and genetic factors impacted atrophy patterns. Diffusion tensor imaging (DTI) showed increased mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), and decreased fractional anisotropy (FA) in the hippocampal tracts and adjacent regions, indicating loss of neuronal and white matter integrity. Functional MRI (fMRI) revealed reduced functional connectivity (FC) between the hippocampus, parahippocampus, and other regions, suggesting disrupted networks. Perfusion MRI showed hypoperfusion in parahippocampal gyri. Magnetic resonance spectroscopy (MRS) found changes in the hippocampus, indicating neuronal loss. Neuropsychological tests showed associations between poorer memory and hippocampal atrophy or connectivity changes. CA1-2, dentate gyrus, and fimbria atrophy were correlated with worse memory.
CONCLUSIONS
The hippocampus and the connected regions are involved in ALS. Hippocampal atrophy disrupted connectivity and metabolite changes correlate with cognitive and functional decline. Specific subregions can be particularly affected. The hippocampus is a potential biomarker for disease monitoring and prognosis.
Topics: Humans; Diffusion Tensor Imaging; Amyotrophic Lateral Sclerosis; Neurodegenerative Diseases; Frontotemporal Dementia; Magnetic Resonance Imaging; Hippocampus; Biomarkers; Neuropsychological Tests; Atrophy
PubMed: 38334254
DOI: 10.1111/cns.14578 -
Neuroscience and Biobehavioral Reviews Dec 2022Major Depressive Disorder (MDD) and Bipolar Disorder Depression (BDD) are common psychiatric illnesses characterized by structural and functional brain alterations and... (Review)
Review
Major Depressive Disorder (MDD) and Bipolar Disorder Depression (BDD) are common psychiatric illnesses characterized by structural and functional brain alterations and signs of neuroinflammation. In line with the neuroinflammatory pathogenesis of depressive syndromes, recent studies have demonstrated how white matter (WM) microstructural impairments detected by Diffusion Tensor Imaging, are correlated to peripheral immunomarkers in depressed patients. In this context, we performed a comprehensive systematic search on PubMed, Medline and Scopus of the original studies published till June 2022, exploring the association between immunomarkers and WM alteration patterns in patients affected by MDD or BDD. Overall, the studies included in this review showed a consistent association between blood proinflammatory and counter-regulatory immunomarkers, including regulatory T cells and natural killer cells markers, as well as measures of demyelination and dysmyelination in both MDD and BDD patients. These pathogenetic insights could outline an integrated clinical perspective to affective disorders, helping psychiatrists to develop novel biotype-to-phenotype models of depression and opening the way to tailored approaches in treatments.
Topics: Humans; Bipolar Disorder; Depressive Disorder, Major; Diffusion Tensor Imaging; Inflammation; White Matter
PubMed: 36272579
DOI: 10.1016/j.neubiorev.2022.104922