Is MRI better than CT for detecting a vascular component to dementia- A systematic review and meta-analysis Full Text
BMC Neurology, 06/14/2012
Clinical Article
Beynon R et al. – There 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'.
Methods- The authors searched eight databases and screened reference lists to identify studies addressing the review question.
- They assessed study quality using QUADAS.
- They 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.
- They 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.
