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BMC Neurology

, 12:33

First Online: 06 June 2012Received: 31 January 2012Accepted: 06 June 2012


BackgroundIdentification of causes of dementia soon after symptom onset is important, because appropriate treatment of some causes of dementia can slow or halt its progression or enable symptomatic treatment where appropriate. The accuracy of MRI and CT, and whether MRI is superior to CT, in detecting a vascular component to dementia in autopsy confirmed and clinical cohorts of patients with VaD, combined AD and VaD -mixed dementia-, and AD remain unclear. We conducted a systematic review and meta-analysis to investigate this question.

MethodsWe searched eight databases and screened reference lists to identify studies addressing the review question. We assessed study quality using QUADAS. We estimated summary diagnostic accuracy according to imaging finding, and ratios of diagnostic odds ratios RDORs for MRI versus CT and high versus low risk of bias.

ResultsWe included 7 autopsy and 31 non-autopsy studies. There was little evidence that selective patient enrolment and risk of incorporation bias impacted on diagnostic accuracy p = 0.12 to 0.95. The most widely reported imaging finding was white matter hyperintensities. For CT 11 studies summary sensitivity and specificity were 71% 95% CI 53%-85% and 55% 44%-66%. Corresponding figures for MRI 6 studies were 95% 87%-98% and 26% 12%-50%. General infarcts was the most specific imaging finding on MRI 96%; 95% CI 94%-97% and CT 96%; 93%-98%. However, sensitivity was low for both MRI 53%; 36%-70% and CT 52%; 22% to 80%. No imaging finding had consistently high sensitivity. Based on non-autopsy studies, MRI was more accurate than CT for six of seven imaging findings, but confidence intervals were wide.

ConclusionThere is insufficient evidence to suggest that MRI is superior to CT with respect to identifying cerebrovascular changes in autopsy-confirmed and clinical cohorts of VaD, AD, and ‘mixed dementia’.

KeywordsDementia CT MRI Diagnosis Systematic review Electronic supplementary materialThe online version of this article doi:10.1186-1471-2377-12-33 contains supplementary material, which is available to authorized users.

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Autor: Rebecca Beynon - Jonathan A C Sterne - Gordon Wilcock - Marcus Likeman - Roger M Harbord - Margaret Astin - Margaret Bur


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