Assessment of the diagnostic value of diffusion tensor imaging in patients with spinal cord compression: a meta-analysis

We investigated the diagnostic value of the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of magnetic resonance diffusion tensor imaging (DTI) in patients with spinal cord compression (SCC) using a meta-analysis framework. Multiple scientific literature databases were exhaustively searched to identify articles relevant to this study. Mean values and standardized mean differences (SMDs) were calculated for the ADC and FA in normal and diseased tissues. The STATA version 12.0 software was used for statistical analysis. Of the 41 articles initially retrieved through database searches, 11 case-control studies were eligible for the meta-analysis and contained a combined total of 645 human subjects (394 patients with SCC and 251 healthy controls). All 11 studies reported data on FA, and 9 contained data related to the ADC. The combined SMDs of the ADC and FA showed that the ADC was significantly higher and the FA was lower in patients with SCC than in healthy controls. Subgroup analysis based on the b value showed higher ADCs in patients with SCC than in healthy controls at b values of both ≤500 and >500 s/mm2. In summary, the main findings of this meta-analysis revealed an increased ADC and decreased FA in patients with SCC, indicating that DTI is an important diagnostic imaging tool to assess patients suspected to have SCC.

本研究采用荟萃分析框架，探讨磁共振弥散张量成像（magnetic resonance diffusion tensor imaging, DTI）的表观扩散系数（apparent diffusion coefficient, ADC）与各向异性分数（fractional anisotropy, FA）对脊髓压迫症（spinal cord compression, SCC）患者的诊断价值。本研究全面检索多个学术文献数据库，以筛选符合本研究主题的文献。分别计算正常组织与病变组织中ADC与FA的均数及标准化均数差（standardized mean differences, SMDs），并采用STATA 12.0软件进行统计学分析。经数据库初检获得的41篇文献中，最终有11篇病例对照研究符合荟萃分析纳入标准，合计纳入645名受试者，其中脊髓压迫症患者394例、健康对照251例。11项研究均报告了FA相关数据，其中9项包含ADC相关数据。合并后的标准化均数差结果显示，脊髓压迫症患者的ADC水平显著高于健康对照，而FA水平则显著降低。基于b值的亚组分析结果表明，当b值分别为≤500 s/mm²与＞500 s/mm²时，脊髓压迫症患者的ADC水平均高于健康对照。综上，本荟萃分析的主要研究结果显示脊髓压迫症患者的ADC水平升高、FA水平降低，提示DTI可作为评估疑似脊髓压迫症患者的重要影像学诊断工具。