Data extraction EXCEL.

BackgroundArterial spin labeling (ASL) is a magnetic resonance imaging (MRI) technique that offers a non-invasive approach for measuring cerebral blood perfusion (CBF). CBF serves as a marker of neuronal activity, and ASL has demonstrated the potential to detect reductions in CBF associated with early-stage neurodegenerative diseases like Alzheimer’s disease (AD). Consequently, ASL has garnered growing interest as a potential diagnostic tool for AD. Despite the promise of ASL for diagnosing AD, there is a paucity of data regarding the pooled specificity and sensitivity of this technique in this context. The purpose of this systematic review and meta-analysis is to identify the accuracy of ASL in the diagnosis of AD with international clinical diagnosis as the gold standard.MethodsFour English databases and four Chinese databases were searched from their inception to 30 November 2023. Two independent reviewers extracted relevant information from the eligible articles, while the quality assessment of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). The meta-analysis was carried out using the area under the Receiver Operator Characteristic (ROC) curves (AUC) and sensitivity and specificity values. Meta-DiSc 1.4 was used to perform the statistical analysis. STATA 16.0 was used to perform publication bias and sensitivity analysis.ResultsOf 844 relevant articles retrieved, 10 studies involving 494 participants (AD patients = 262, healthy controls = 232) met the inclusion criteria and were included in the meta-analysis. However, the quality of studies was low based on QUADAS-2. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of ASL for diagnosing AD was 0.83 (95% CI: 0.78–0.87), 0.81 (95% CI: 0.76–0.86), 4.52 (95% CI: 3.40–6.00), 0.22 (95% CI: 0.17–0.28), and 19.31(95% CI: 12.30–30.31), respectively. The pooled AUC = 0.8932. There was low heterogeneity across the included studies. Finally, sensitivity analysis suggested that the results were reliable.ConclusionASL is an effective and accurate method for the diagnosis of AD. However, due to the limited quantity and quality of the included studies, the above conclusions need to be verified by more studies.PROSPERO registrationPROSPERO registration number:CRD42023484059.

背景：动脉自旋标记（Arterial spin labeling, ASL）是一种磁共振成像（magnetic resonance imaging, MRI）技术，可通过非侵入性方式测量脑血流量（cerebral blood perfusion, CBF）。脑血流量是神经元活动的标志物，而动脉自旋标记已被证实可用于检测与阿尔茨海默病（Alzheimer’s disease, AD）等早期神经退行性疾病相关的脑血流量降低情况。因此，动脉自旋标记作为阿尔茨海默病潜在诊断工具的关注度日益提升。尽管动脉自旋标记在阿尔茨海默病诊断中颇具应用前景，但目前关于该技术在该场景下的合并特异性与敏感性的数据仍较为匮乏。本系统综述与荟萃分析旨在以国际临床诊断为金标准，明确动脉自旋标记在阿尔茨海默病诊断中的准确性。

方法：本研究检索了4个英文数据库与4个中文数据库，检索时限均自建库至2023年11月30日。由2名独立评价员从符合纳入标准的文献中提取相关信息，并采用诊断准确性研究质量评价2（Quality Assessment of Diagnostic Accuracy Studies 2, QUADAS-2）工具对纳入研究进行质量评估。荟萃分析采用受试者工作特征（Receiver Operator Characteristic, ROC）曲线下面积（AUC）以及敏感性、特异性数值进行分析。统计学分析采用Meta-DiSc 1.4软件完成，发表偏倚与敏感性分析则通过STATA 16.0软件实现。

结果：本次研究共检索到844篇相关文献，其中10项涉及494名受试者（阿尔茨海默病患者262名，健康对照者232名）的研究符合纳入标准，被纳入本次荟萃分析。但根据QUADAS-2工具评估结果，纳入研究的整体质量偏低。动脉自旋标记诊断阿尔茨海默病的合并敏感性、特异性、阳性似然比、阴性似然比以及诊断比值比分别为0.83（95% CI: 0.78–0.87）、0.81（95% CI: 0.76–0.86）、4.52（95% CI: 3.40–6.00）、0.22（95% CI: 0.17–0.28）以及19.31（95% CI: 12.30–30.31）。合并AUC为0.8932。纳入研究间异质性较低。最终敏感性分析结果显示本研究结论可靠。

结论：动脉自旋标记是一种用于阿尔茨海默病诊断的有效且准确的方法。但由于纳入研究的数量与质量均存在局限，上述结论仍需更多研究加以验证。

PROSPERO注册
PROSPERO注册编号：CRD42023484059。