Radiology Alliance for Health Services ResearchDiagnostic Accuracy of Diffusion Tensor Imaging in Amyotrophic Lateral Sclerosis: A Systematic Review and Individual Patient Data Meta-Analysis
Section snippets
Eligibility Criteria
We conducted MEDLINE (1966–April 2011), EMBASE (1999–April 2011), CINAHL (1999–April 2011), and Cochrane (2005–April 2011) searches. Search keywords included: amyotrophic lateral sclerosis, Lou Gehrig's, magnetic resonance imaging, diagnostic imaging, diagnostic tests, diffusion tensor imaging, or fractional anisotropy. Full electronic search for MEDLINE is presented in Appendix Table 1. There were no language restrictions. A manual search of reference lists from identified articles was
Study Selection
We provide the number of studies screened, assessed for eligibility, and included for review with reasons for exclusions at each stage in Figure 1. We collected individual patient data from 11 of 30 identified studies.
Study Characteristics
Study characteristics of the studies are summarized in Table 1 with additional study details in Appendix Table 2 7, 8, 13, 19, 23, 24, 25, 26, 27, 28, 29. Studies enrolled 221 ALS subjects and 187 HCs. Equipment, DTI parameters, and analysis methods varied across studies. All
Discussion
Conventional MRI findings in ALS are neither sensitive nor specific (30). Therefore, there has been great interest in using advanced neuroimaging methods such as DTI as diagnostic ALS biomarkers. Quantitative meta-analysis is necessary to properly evaluate the potential of new technologies to serve as diagnostic tests, particularly in the setting of imaging studies, which include relatively small numbers of subjects. Based on the available IPD, the meta-analysis results suggest that the mean FA
Acknowledgments
M.B. thanks Dr. John D. Carew and Dr. Govind Nair for their contributions to the article. C.E. thanks Prof. P.N. Leigh and Dr. Andy Simmons for their contributions to the article. B.R.F. thanks the Johns Hopkins Graduate Training Programs in Clinical Investigation for its mentorship. The Ciccarelli et al study was performed using a 1.5 T scanner funded by the MS Society of Great Britain and Northern Ireland and by the Department of Health National Institute of Health Research Biomedical Research
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