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Iron-sensitive magnetic resonance imaging in Parkinson’s disease: a systematic review and meta-analysis

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Abstract

Objective

To evaluate the diagnostic performance of iron-sensitive sequences targeting the substantia nigra for distinguishing patients with Parkinson’s disease from control participants and to identify factors causing heterogeneity.

Methods

A systematic literature search in the Ovid-MEDLINE and EMBASE databases was performed for studies reporting the relevant topic before March 6, 2020. The pooled sensitivity and specificity values with their 95% confidence intervals were calculated using bivariate random-effects modeling. Subgroup and meta-regression analyses were also performed to determine factors influencing heterogeneity affecting the diagnostic performance among the clinical, MRI, and analytic characteristics.

Results

A total of 22 articles including 1126 patients with Parkinson’s disease and 933 control participants were enrolled in this systematic review and meta-analysis. Of those, 12 studies used objective analyses of quantitative susceptibility measurements, and 10 visually assessed the nigrosome-1 in subjective analyses. Iron-sensitive nigral magnetic resonance imaging showed a pooled sensitivity of 92% (95% confidence interval 88–95%) and a pooled specificity of 90% (95% confidence interval 81–95%). According to subgroup and meta-regression analyses, a longer mean disease duration in patients with Parkinson’s disease (≥ 5 years), subjective analysis, a smaller size of pixel (< 0.6 mm2), a larger flip angle (> 15°), a smaller slice thickness (≤ 1 mm), and specific targeting of the substantia nigra pars compacta improved the diagnostic performance.

Conclusion

Iron-sensitive nigral magnetic resonance imaging had a favorable diagnostic performance in discriminating patients with Parkinson’s disease from control participants. Subjective analytic methods remain superior to objective approaches. Further improvements of the spatial resolution and contrast-to-noise ratio to specifically target the nigrosome-1 with objective analytic methods will be needed.

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Availability of data and materials

Yes (published data).

Code availability

Yes (statistical software: STATA 16MP).

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Acknowledgements

We would like to thank Editage (www.editage.co.kr) for English language editing.

Funding

This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korean government (MSIT; No. 2019R1F1A1063771) and by the SNUBH Research Fund (Grant No. 09-2019-003).

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea

    Se Jin Cho, Yun Jung Bae, Sung Hyun Baik, Leonard Sunwoo, Byung Se Choi, Cheolkyu Jung & Jae Hyoung Kim

  2. Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea

    Jong-Min Kim

  3. Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Gyeonggi, Republic of Korea

    Hyun Jin Kim

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  1. Se Jin Cho
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Contributions

SJC and YJB contributed to the conception and design of the study. SJC, YJB, and HJK contributed to the acquisition and analysis of the data. SJC, YJB, JMK, HJK, SHB, LS, BSC, CJ, and JHK drafted significant portions of the manuscript or the figures.

Corresponding author

Correspondence to Yun Jung Bae.

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Waived due to systematic review and meta-analysis.

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Waived due to systematic review and meta-analysis.

Conflicts of interest

The authors declare that they have no conflicts of interest.

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Cho, S.J., Bae, Y.J., Kim, JM. et al. Iron-sensitive magnetic resonance imaging in Parkinson’s disease: a systematic review and meta-analysis. J Neurol 268, 4721–4736 (2021). https://doi.org/10.1007/s00415-021-10582-x

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  • DOI: https://doi.org/10.1007/s00415-021-10582-x

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