Sensitivity of diffusion-weighted magnetic resonance imaging in transient global amnesia as a function of time from symptom onset
© 2021 Society for Academic Emergency Medicine..
BACKGROUND: The objective was to systematically evaluate the sensitivity of diffusion-weighted magnetic resonance imaging (DW-MRI) for transient global amnesia (TGA) across various time frames compared to the reference-standard clinical criteria.
METHODS: All indexed publications related to TGA and MRI through June 2020 were retrieved by a medical librarian. Two independent reviewers identified original research studies of adults with a clinical diagnosis of TGA using Caplan and Hodges and Warlow criteria (reference standard) who were evaluated with DW-MRI. Pooled estimates and its 95% confidence intervals (CI) for the proportion of acute TGA patients with positive DW-MRI (i.e., sensitivity) were obtained using random-effects meta-analysis for various time frames. Quality assessment was performed using the revised Quality of Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.
RESULTS: After screening 665 reports, we identified 81 potentially relevant studies. Twenty-three studies representing 1688 patients met eligibility criteria, but not all studies had data available for meta-analysis. The pooled sensitivity (also described as positivity rate) of DW-MRI was 15.6% (95% CI = 2.6%-35.0%) between 0 and 12 h from symptom onset, 23.1% (95% CI = 6.1%-45.7%) at 0-24 h, 72.8% (95% CI = 40.8%-96.3) at 12-24 h, 68.8% (95% CI = 44.8%-88.8%) at 24-36 h, 72.4% (95% CI = 59.8%-83.5%) at 36-48 h, 82.8% (95% CI = 54.7%-99.6%) at 48-60 h, 66.9% (95% CI = 47.5%-83.9%) at 60-72 h, and 72.0% (95% CI = 30.1%-100.0%) at 72-96 h. There was significant concern for risk of bias in the QUADAS-2 domains of patient selection and index test, yielding a low level of certainty in the pooled estimates.
CONCLUSION: DW-MRI lesions are uncommon in patients with TGA early after symptom onset, but the sensitivity (i.e., positivity rate) of DW-MRI increases with time. Despite the limited quality of existing evidence, obtaining an early DW-MRI in patients with clinical diagnosis of TGA in the acute setting is likely a low-yield test.
| Errataetall: |
CommentIn: Acad Emerg Med. 2022 Aug;29(8):1033-1036. - PMID 35633071 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:29 |
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| Enthalten in: |
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine - 29(2022), 4 vom: 30. Apr., Seite 398-405 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wong, Matthew L [VerfasserIn] |
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| Anmerkungen: |
Date Completed 28.04.2022 Date Revised 15.08.2022 published: Print-Electronic CommentIn: Acad Emerg Med. 2022 Aug;29(8):1033-1036. - PMID 35633071 Citation Status MEDLINE |
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| doi: |
10.1111/acem.14390 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM330588648 |
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| 245 | 1 | 0 | |a Sensitivity of diffusion-weighted magnetic resonance imaging in transient global amnesia as a function of time from symptom onset |
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| 500 | |a Date Revised 15.08.2022 | ||
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| 500 | |a CommentIn: Acad Emerg Med. 2022 Aug;29(8):1033-1036. - PMID 35633071 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021 Society for Academic Emergency Medicine. | ||
| 520 | |a BACKGROUND: The objective was to systematically evaluate the sensitivity of diffusion-weighted magnetic resonance imaging (DW-MRI) for transient global amnesia (TGA) across various time frames compared to the reference-standard clinical criteria | ||
| 520 | |a METHODS: All indexed publications related to TGA and MRI through June 2020 were retrieved by a medical librarian. Two independent reviewers identified original research studies of adults with a clinical diagnosis of TGA using Caplan and Hodges and Warlow criteria (reference standard) who were evaluated with DW-MRI. Pooled estimates and its 95% confidence intervals (CI) for the proportion of acute TGA patients with positive DW-MRI (i.e., sensitivity) were obtained using random-effects meta-analysis for various time frames. Quality assessment was performed using the revised Quality of Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool | ||
| 520 | |a RESULTS: After screening 665 reports, we identified 81 potentially relevant studies. Twenty-three studies representing 1688 patients met eligibility criteria, but not all studies had data available for meta-analysis. The pooled sensitivity (also described as positivity rate) of DW-MRI was 15.6% (95% CI = 2.6%-35.0%) between 0 and 12 h from symptom onset, 23.1% (95% CI = 6.1%-45.7%) at 0-24 h, 72.8% (95% CI = 40.8%-96.3) at 12-24 h, 68.8% (95% CI = 44.8%-88.8%) at 24-36 h, 72.4% (95% CI = 59.8%-83.5%) at 36-48 h, 82.8% (95% CI = 54.7%-99.6%) at 48-60 h, 66.9% (95% CI = 47.5%-83.9%) at 60-72 h, and 72.0% (95% CI = 30.1%-100.0%) at 72-96 h. There was significant concern for risk of bias in the QUADAS-2 domains of patient selection and index test, yielding a low level of certainty in the pooled estimates | ||
| 520 | |a CONCLUSION: DW-MRI lesions are uncommon in patients with TGA early after symptom onset, but the sensitivity (i.e., positivity rate) of DW-MRI increases with time. Despite the limited quality of existing evidence, obtaining an early DW-MRI in patients with clinical diagnosis of TGA in the acute setting is likely a low-yield test | ||
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| 700 | 1 | |a Gerberi, Danielle J |e verfasserin |4 aut | |
| 700 | 1 | |a Edlow, Jonathan A |e verfasserin |4 aut | |
| 700 | 1 | |a Dubosh, Nicole M |e verfasserin |4 aut | |
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