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Diagnostic performance of loss of nigral hyperintensity on susceptibility-weighted imaging in parkinsonism: an updated meta-analysis

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Abstract

Objectives

To evaluate diagnostic performance of loss of nigral hyperintensity on SWI in differentiating idiopathic Parkinson’s disease (IPD) or primary parkinsonism (including IPD and Parkinson-plus syndrome) from healthy/disease controls.

Methods

MEDLINE/PubMed and EMBASE databases were searched to identify original articles investigating the diagnostic performance of loss of nigral hyperintensity for differentiating IPD or primary parkinsonism from healthy/disease control, up to April 3, 2020. Pooled sensitivity and specificity were calculated using a bivariate random-effects model. The proportion of nondiagnostic scan, inter- and intrareader agreement, and the proportion of concordance between clinical laterality and imaging asymmetry were also pooled.

Results

Nineteen articles covering 2125 patients (1097 with primary parkinsonism, 1028 healthy/disease controls) were included. For discrimination between IPD and healthy/disease controls, pooled sensitivity and specificity were 0.96 (95% CI, 0.91–0.98) and 0.95 (95% CI, 0.92–0.97). For discrimination between primary parkinsonism and healthy/disease controls, pooled sensitivity and specificity were 0.87 (95% CI, 0.75–0.94) and 0.93 (95% CI, 0.85–0.97). The pooled proportion of non-diagnostic scans on random-effects modeling was 4.2% (95% CI, 2.5–6.9%). The inter- and intrareader agreements were almost perfect, with the pooled coefficients being 0.84 (95% CI, 0.78–0.89) and 0.96 (95% CI, 0.89–0.99), respectively. The pooled proportion of concordant cases was 69.3% (95% CI, 58.4–78.4%).

Conclusions

Loss of nigral hyperintensity on SWI can differentiate IPD or primary parkinsonism from a healthy/disease control group with high accuracy. However, the proportion of non-diagnostic scans is not negligible and must be taken into account.

Key Points

• For discrimination between idiopathic Parkinson’s disease and healthy/disease controls, pooled sensitivity and specificity of loss of nigral hyperintensity were 0.96 and 0.95.

• For discrimination between primary parkinsonism and healthy/disease controls, pooled sensitivity and specificity of loss of nigral hyperintensity were 0.87 and 0.93.

• The pooled proportion of non-diagnostic scans on random-effects modeling was 4.2%.

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Abbreviations

AD:

Alzheimer’s disease

CBD:

Corticobasal degeneration

CI:

Confidence interval

DC:

Disease control

ET:

Essential tremor

FOV:

Field of view

FTD:

Frontotemporal dementia

HC:

Healthy control

HSROC:

Hierarchical summary receiver operating characteristic

IPD:

Idiopathic Parkinson’s disease

IQR:

Interquartile range

LBD:

Lewy body dementia

MCI:

Mild cognitive impairment

MSA:

Multiple system atrophy

MSA-C:

MSA with cerebellar features

MSA-P:

MSA with predominant parkinsonism

PSP:

Progressive supranuclear palsy

SCI:

Subjective cognitive impairment

SD:

Standard deviation

SWI:

Susceptibility-weighted imaging

UPDRS:

Unified Parkinson’s Disease Rating Scale

VP:

Vascular parkinsonism

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul, 05505, Republic of Korea

    Pyeong Hwa Kim, Da Hyun Lee, Chong Hyun Suh, Minjae Kim, Woo Hyun Shim & Sang Joon Kim

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  1. Pyeong Hwa Kim
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  2. Da Hyun Lee
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  4. Minjae Kim
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Correspondence to Chong Hyun Suh.

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The scientific guarantor of this publication is Chong Hyun Suh.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was not required for this study because this study is a systematic review and meta-analysis.

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IRB approval was not required for this study because this study is a systematic review and meta-analysis.

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Kim, P.H., Lee, D.H., Suh, C.H. et al. Diagnostic performance of loss of nigral hyperintensity on susceptibility-weighted imaging in parkinsonism: an updated meta-analysis. Eur Radiol 31, 6342–6352 (2021). https://doi.org/10.1007/s00330-020-07627-6

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