Table 1_A systematic review of clinical and diagnostic findings, treatment, and outcomes in canine neosporosis cases evaluated by magnetic resonance imaging.docx

BackgroundWhile magnetic resonance imaging (MRI) is increasingly used in the diagnostic workup of canine central nervous system (CNS) disorders, its role in neosporosis has not been systematically characterised. Numerous questions remain regarding optimal diagnostic approaches and treatment protocols, and large-scale studies are lacking.
ObjectivesThe objective of the study was to systematically review and analyse published cases of canine neosporosis undergoing MRI examination of the CNS and identify clinical, diagnostic, and treatment variables associated with outcomes.
MethodsA comprehensive literature search was performed using PubMed and Google Scholar. The inclusion criteria were confirmation of N. caninum infection by serology, polymerase chain reaction (PCR), or histopathology, and MRI performed at diagnosis. Extracted data included signalment, clinical signs, MRI features, cerebrospinal fluid (CSF) results, serology, PCR, treatment, and outcomes. Statistical analyses assessed associations and correlations among diagnostic and outcome variables.
ResultsEighty-two cases extracted from 11 publications met the inclusion criteria. MRI commonly revealed multifocal intra-axial lesions, frequently involving the cerebellum, with variable contrast enhancement of the brain and spinal cord and meninges, and consistent contrast enhancement in the muscles. A significant association was identified between elevated cerebrospinal fluid total nucleated cell count (CSF TNCC) and positive cerebrospinal fluid polymerase chain reaction (CSF PCR). Treatment duration strongly correlated with survival. Death/euthanasia due to neosporosis occurred in one-third of the cases. Remissions were rare. Relapses occurred despite initial improvement.
ConclusionCanine neosporosis presents with diverse neurological clinical signs and MRI features. The disease mainly affects young-to-middle-aged adults with multifocal CNS involvement, and CSF is abnormal in the majority of cases. Review analyses showed that serology titres, serum creatine kinase (CK) levels, CSF TNCC, CSF PCR results, and MRI contrast had no prognostic value, while higher CSF TNCC was associated with positive CSF PCR. The only consistent prognostic marker was treatment duration—longer antimicrobial therapy was correlated with improved survival. Although the prognosis remains guarded, early recognition and prolonged antimicrobial treatment are key to improving outcomes.

背景
尽管磁共振成像（MRI）在犬类中枢神经系统（CNS）疾病的诊断检查流程中应用日益广泛，但其在犬新孢子虫病诊疗中的作用尚未得到系统阐释。目前针对该病的最优诊断方案与治疗方案仍存在诸多疑问，且缺乏大规模相关研究。

研究目的
本研究旨在系统回顾并分析已发表的接受中枢神经系统磁共振成像检查的犬新孢子虫病病例，并筛选与预后相关的临床、诊断及治疗相关变量。

研究方法
本研究通过PubMed和Google Scholar开展了全面的文献检索。纳入标准为：经血清学检测、聚合酶链式反应（PCR）或组织病理学确认感染犬新孢子虫（N. caninum），且在确诊时接受了中枢神经系统MRI检查。提取的资料包括受试动物基本特征、临床症状、MRI影像学特征、脑脊液（CSF）检测结果、血清学结果、PCR结果、治疗方案及预后情况。统计学分析用于评估诊断相关变量与预后变量之间的关联及相关性。

研究结果
从11篇文献中提取的82例病例符合纳入标准。MRI检查通常可见多灶性脑内病变，常累及小脑，脑、脊髓及脑膜可出现程度不一的对比强化，肌肉则呈现一致性对比强化。研究发现脑脊液有核细胞总数（CSF TNCC）升高与脑脊液聚合酶链式反应（CSF PCR）阳性存在显著关联。治疗时长与存活率显著相关。约三分之一的病例因新孢子虫病死亡或实施安乐死。病情缓解情况罕见，即便初始治疗后症状有所改善，仍可能出现复发。

研究结论
犬新孢子虫病的神经临床症状与MRI影像学特征均呈现多样性。该病主要累及中青年犬只，多表现为中枢神经系统多灶性受累，且多数病例的脑脊液检测结果存在异常。本次回顾分析显示，血清学滴度、血清肌酸激酶（CK）水平、脑脊液有核细胞总数、脑脊液PCR结果及MRI对比强化表现均无预后价值，仅脑脊液有核细胞总数升高与脑脊液PCR阳性相关。唯一具有一致性的预后标志物为治疗时长——更长疗程的抗菌治疗与存活率提升显著相关。尽管目前该病的预后仍需谨慎评估，但早期识别与延长抗菌治疗疗程是改善预后的关键。