Volumes and velocities: Meta-analysis of PC-MRI studies in normal pressure hydrocephalus

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2024-11-19 DOI:10.1007/s00701-024-06333-2

Helen Whitley, Petr Skalický, Awista Zazay, Adéla Bubeníková, Ondrej Bradáč

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引用次数: 0

Abstract

Purpose

Phase contrast magnetic resonance imaging (PC-MRI) represents an opportunity to non-invasively investigate cerebral spinal fluid (CSF) flow in patients with idiopathic normal pressure hydrocephalus (iNPH). Studies in recent years have explored the diagnostic and prognostic value of PC-MRI derived parameters. This review aims to identify all PC-MRI studies of iNPH published since 2010, synthesise a review based on collated results, and analyse specific flow parameters identified in the selected studies.

Methods

Our protocol was prospectively registered on PROSPERO [CRD42020180826]. We systematically searched four databases: Pubmed, Web of Science, Ovid, and Cochrane library to identify all eligible studies. Quality assessment was performed using a modified Newcastle–Ottawa Scale [19]. Systematic review was conducted according to Prisma guidelines. A random-effects model was used to perform meta-analysis on the available flow parameters.

Results

Eighteen records were identified for inclusion. Five studies were eligible for meta-analysis, representing 107 iNPH patients and 82 controls. CSF flow parameters available for analysis were stroke volume and peak velocity. Both were significantly higher than controls (p = 0.0007 and p = 0.0045 respectively) according to our random-effects analysis, consistent with a model of hyper-dynamic CSF in iNPH. Our systematic review revealed average stroke volumes in iNPH ranging from 43uL to over 200uL. Peak velocity values ranged from 5.9 cm/s to 12.8 cm/s.

Conclusion

Significant increases in stroke volume and peak velocity values in iNPH patients suggest a place for PC-MRI as supplementary evidence in the diagnostic work-up of iNPH. Although shunting reduces aqueductal stroke volume and peak velocity, the ability of pre-shunt values to reliably predict treatment response remains complicated. We suggest that it may be more appropriate to consider a range of values that reflect varying probabilities of shunt success. We recommend that future studies should prioritise standardising PC-MRI protocols, and before then PC-MRI findings should be considered supportive rather than determinative.

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体积与速度：正常压力脑积水 PC-MRI 研究的元分析。

目的：相位对比磁共振成像（PC-MRI）为无创检查特发性正常压力脑积水（iNPH）患者的脑脊液（CSF）流提供了机会。近年来的研究探索了 PC-MRI 衍生参数的诊断和预后价值。本综述旨在确定自2010年以来发表的所有关于iNPH的PC-MRI研究，在整理结果的基础上进行综述，并分析所选研究中确定的特定血流参数：我们的研究方案在 PROSPERO [CRD42020180826]上进行了前瞻性注册。我们系统地检索了四个数据库：Pubmed、Web of Science、Ovid 和 Cochrane 图书馆，以确定所有符合条件的研究。研究质量评估采用改良的纽卡斯尔-渥太华量表[19]。根据 Prisma 指南进行了系统综述。采用随机效应模型对现有的血流参数进行荟萃分析：结果：共发现 18 项可纳入研究的记录。五项研究符合荟萃分析的条件，代表了 107 名 iNPH 患者和 82 名对照组。可用于分析的脑脊液流动参数为冲程量和峰值速度。根据我们的随机效应分析，两者均明显高于对照组（分别为 p = 0.0007 和 p = 0.0045），这与 iNPH 的 CSF 高动态模型一致。我们的系统回顾显示，iNPH 的平均卒中容量从 43uL 到超过 200uL 不等。峰值速度值从 5.9 厘米/秒到 12.8 厘米/秒不等：结论：iNPH 患者卒中容量和峰值速度值的显著增加表明，PC-MRI 可作为 iNPH 诊断工作的补充证据。虽然分流可减少导水管卒中量和峰值速度，但分流前的数值能否可靠地预测治疗反应仍很复杂。我们建议，考虑一系列反映分流成功概率的数值可能更合适。我们建议未来的研究应优先考虑 PC-MRI 方案的标准化，在此之前，PC-MRI 结果应被视为支持性而非决定性的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.