PDF(Pubmed)
Abstract：
OBJECTIVE: Delayed post-gadolinium magnetic resonance imaging (MRI) detects changes of endolymphatic hydrops (EH) within the inner ear in Meniere\'s disease (MD). A systematic review with meta-analysis was conducted to summarise the diagnostic performance of MRI descriptors across the range of MD clinical classifications.
METHODS: Case-controlled studies documenting the diagnostic performance of MRI descriptors in distinguishing MD ears from asymptomatic ears or ears with other audio-vestibular conditions were identified (MEDLINE, EMBASE, Web of Science, Scopus databases: updated 17/2/2022). Methodological quality was evaluated with Quality Assessment of Diagnostic Accuracy Studies version 2. Results were pooled using a bivariate random-effects model for evaluation of sensitivity, specificity and diagnostic odds ratio (DOR). Meta-regression evaluated sources of heterogeneity, and subgroup analysis for individual clinical classifications was performed.
RESULTS: The meta-analysis included 66 unique studies and 3073 ears with MD (mean age 40.2-67.2 years), evaluating 11 MRI descriptors. The combination of increased perilymphatic enhancement (PLE) and EH (3 studies, 122 MD ears) achieved the highest sensitivity (87% (95% CI: 79.92%)) whilst maintaining high specificity (91% (95% CI: 85.95%)). The diagnostic performance of \"high grade cochlear EH\" and \"any EH\" descriptors did not significantly differ between monosymptomatic cochlear MD and the latest reference standard for definite MD (p = 0.3; p = 0.09). Potential sources of bias were case-controlled design, unblinded observers and variable reference standard, whilst differing MRI techniques introduced heterogeneity.
CONCLUSIONS: The combination of increased PLE and EH optimised sensitivity and specificity for MD, whilst some MRI descriptors also performed well in diagnosing monosymptomatic cochlear MD.
CONCLUSIONS: • A meta-analysis of delayed post-gadolinium magnetic resonance imaging (MRI) for the diagnosis of Meniere\'s disease is reported for the first time and comprised 66 studies (3073 ears). • Increased enhancement of the perilymphatic space of the inner ear is shown to be a key MRI feature for the diagnosis of Meniere\'s disease. • MRI diagnosis of Meniere\'s disease can be usefully applied across a range of clinical classifications including patients with cochlear symptoms alone.
METHODS: Case-controlled studies documenting the diagnostic performance of MRI descriptors in distinguishing MD ears from asymptomatic ears or ears with other audio-vestibular conditions were identified (MEDLINE, EMBASE, Web of Science, Scopus databases: updated 17/2/2022). Methodological quality was evaluated with Quality Assessment of Diagnostic Accuracy Studies version 2. Results were pooled using a bivariate random-effects model for evaluation of sensitivity, specificity and diagnostic odds ratio (DOR). Meta-regression evaluated sources of heterogeneity, and subgroup analysis for individual clinical classifications was performed.
RESULTS: The meta-analysis included 66 unique studies and 3073 ears with MD (mean age 40.2-67.2 years), evaluating 11 MRI descriptors. The combination of increased perilymphatic enhancement (PLE) and EH (3 studies, 122 MD ears) achieved the highest sensitivity (87% (95% CI: 79.92%)) whilst maintaining high specificity (91% (95% CI: 85.95%)). The diagnostic performance of \"high grade cochlear EH\" and \"any EH\" descriptors did not significantly differ between monosymptomatic cochlear MD and the latest reference standard for definite MD (p = 0.3; p = 0.09). Potential sources of bias were case-controlled design, unblinded observers and variable reference standard, whilst differing MRI techniques introduced heterogeneity.
CONCLUSIONS: The combination of increased PLE and EH optimised sensitivity and specificity for MD, whilst some MRI descriptors also performed well in diagnosing monosymptomatic cochlear MD.
CONCLUSIONS: • A meta-analysis of delayed post-gadolinium magnetic resonance imaging (MRI) for the diagnosis of Meniere\'s disease is reported for the first time and comprised 66 studies (3073 ears). • Increased enhancement of the perilymphatic space of the inner ear is shown to be a key MRI feature for the diagnosis of Meniere\'s disease. • MRI diagnosis of Meniere\'s disease can be usefully applied across a range of clinical classifications including patients with cochlear symptoms alone.
摘要：
目的：延迟后磁共振成像（MRI）检测梅尼埃病（MD）内耳内淋巴积水（EH）的变化。进行了系统的荟萃分析评价，以总结MRI描述符在MD临床分类范围内的诊断性能。
方法：病例对照研究记录了MRI描述符在区分MD耳朵与无症状耳朵或具有其他音频前庭状况的耳朵方面的诊断性能（MEDLINE，EMBASE,WebofScience,Scopus数据库：2022年2月17日更新）。使用诊断准确性研究质量评估第2版评估方法学质量。结果使用双变量随机效应模型进行汇总，以评估敏感性，特异性和诊断比值比(DOR)。元回归评估了异质性的来源，并对个体临床分类进行亚组分析.
结果：荟萃分析包括66项独特研究和3073耳MD（平均年龄40.2-67.2岁），评估11个MRI描述符。外淋巴增强（PLE）和EH的结合（3项研究，122个MD耳朵）达到最高灵敏度（87％（95％CI：79.92％），同时保持高特异性（91％（95％CI：85.95％））。“高级耳蜗EH”和“任何EH”描述符的诊断性能在单症状耳蜗MD和明确MD的最新参考标准之间没有显着差异（p=0.3；p=0.09）。潜在的偏差来源是病例控制设计，非盲化观察者和可变参考标准，而不同的MRI技术引入了异质性。
结论：增加的PLE和EH的组合优化了MD的敏感性和特异性，而一些MRI描述符在诊断单症状性耳蜗MD方面也表现良好。
结论：•首次报道了a后延迟磁共振成像（MRI）诊断梅尼埃病的荟萃分析，包括66项研究（3073耳）。•内耳外淋巴空间的增强被证明是诊断梅尼埃病的关键MRI特征。•美尼埃病的MRI诊断可以有效地应用于一系列临床分类，包括仅有耳蜗症状的患者。
方法：病例对照研究记录了MRI描述符在区分MD耳朵与无症状耳朵或具有其他音频前庭状况的耳朵方面的诊断性能（MEDLINE，EMBASE,WebofScience,Scopus数据库：2022年2月17日更新）。使用诊断准确性研究质量评估第2版评估方法学质量。结果使用双变量随机效应模型进行汇总，以评估敏感性，特异性和诊断比值比(DOR)。元回归评估了异质性的来源，并对个体临床分类进行亚组分析.
结果：荟萃分析包括66项独特研究和3073耳MD（平均年龄40.2-67.2岁），评估11个MRI描述符。外淋巴增强（PLE）和EH的结合（3项研究，122个MD耳朵）达到最高灵敏度（87％（95％CI：79.92％），同时保持高特异性（91％（95％CI：85.95％））。“高级耳蜗EH”和“任何EH”描述符的诊断性能在单症状耳蜗MD和明确MD的最新参考标准之间没有显着差异（p=0.3；p=0.09）。潜在的偏差来源是病例控制设计，非盲化观察者和可变参考标准，而不同的MRI技术引入了异质性。
结论：增加的PLE和EH的组合优化了MD的敏感性和特异性，而一些MRI描述符在诊断单症状性耳蜗MD方面也表现良好。
结论：•首次报道了a后延迟磁共振成像（MRI）诊断梅尼埃病的荟萃分析，包括66项研究（3073耳）。•内耳外淋巴空间的增强被证明是诊断梅尼埃病的关键MRI特征。•美尼埃病的MRI诊断可以有效地应用于一系列临床分类，包括仅有耳蜗症状的患者。
