Diagnostic value of white matter hyperintensities in temporal pole and external capsule for CADASIL: a Meta-analysis / 国际脑血管病杂志

ABSTRACT

Objective:To evaluate the clinical value of temporal pole and external capsule white matter hyperintensities (WMHs) on the diagnosie of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) by meta-analysis.Methods:PubMed, Cochrane, Embase, VIP database, China Biomedical Literature database, CNKI, Wanfang Data Service Platform were retrieved. The relevant literature of temporal pole and external capsule WMHs for the diagnosis of CADASIL was collected. The retrieval time limit was from the establishment of the databases to April 1, 2020. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the quality of literature. Stata 15.1 software was used for statistical analysis. The fitted Summary Receiver Operating Characteristic (SROC) curve and combined diagnostic effect size were used to evaluate the diagnostic value of temporal pole and external capsule WMHs for CADASIL.Results:A total of 9 articles involving 10 studies were enrolled, including 880 patients. The combined sensitivities of temporal pole and external capsule WMHs for CADASIL were 0.67 (95% confidence interval [ CI] 0.54-0.78) and 0.84 (95% CI 0.72-0.91) respectively, the combined specificities were 0.64 (95% CI 0.47-0.78) and 0.44 (95% CI 0.36-0.53) respectively, the combined positive likelihood ratios were 1.9 (95% CI 1.4-2.6) and 1.5 (95% CI 1.2-1.8) respectively, the combined negative likelihood ratios were 0.51 (95% CI 0.42-0.63) and 0.37 (95% CI 0.20-0.69) respectively, the odds ratios of combined diagnosis were 4 (95% CI 3-5) and 4 (95% CI 2-9) respectively, and the area under the SROC curves were 0.71 (95% CI 0.66-0.74) and 0.62 (95% CI 0.58-0.66) respectively. Conclusions:The temporal pole and external capsule WMHs have limited diagnostic value for CADASIL, and other factors need to be comprehensively considered in the clinical diagnosis process.