Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Diagnostic Yield of Diffusion-Weighted Brain Magnetic Resonance Imaging in Patients with Transient Global Amnesia: A Systematic Review and Meta-Analysis

  • Su Jin Lim (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Minjae Kim (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chong Hyun Suh (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sang Yeong Kim (University of Ulsan College of Medicine) ;
  • Woo Hyun Shim (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sang Joon Kim (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2020.12.14
  • Accepted : 2021.04.27
  • Published : 2021.10.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: To investigate the diagnostic yield of diffusion-weighted imaging (DWI) in patients with transient global amnesia (TGA) and identify significant parameters affecting diagnostic yield. Materials and Methods: A systematic literature search of the MEDLINE and EMBASE databases was conducted to identify studies that assessed the diagnostic yield of DWI in patients with TGA. The pooled diagnostic yield of DWI in patients with TGA was calculated using the DerSimonian-Laird random-effects model. Subgroup analyses were also performed of slice thickness, magnetic field strength, and interval between symptom onset and DWI. Results: Twenty-two original articles (1732 patients) were included. The pooled incidence of right, left, and bilateral hippocampal lesions was 37% (95% confidence interval [CI], 30-44%), 42% (95% CI, 39-46%), and 25% (95% CI, 20-30%) of all lesions, respectively. The pooled diagnostic yield of DWI in patients with TGA was 39% (95% CI, 27-52%). The Higgins I2 statistic showed significant heterogeneity (I2 = 95%). DWI with a slice thickness ≤ 3 mm showed a higher diagnostic yield than DWI with a slice thickness > 3 mm (pooled diagnostic yield: 63% [95% CI, 53-72%] vs. 26% [95% CI, 16-40%], p < 0.01). DWI performed at an interval between 24 and 96 hours after symptom onset showed a higher diagnostic yield (68% [95% CI, 57-78%], p < 0.01) than DWI performed within 24 hours (16% [95% CI, 7-34%]) or later than 96 hours (15% [95% CI, 8-26%]). There was no difference in the diagnostic yield between DWI performed using 3T vs. 1.5T (pooled diagnostic yield, 31% [95% CI, 25-38%] vs. 24% [95% CI, 14-37%], p = 0.31). Conclusion: The pooled diagnostic yield of DWI in TGA patients was 39%. DWI obtained with a slice thickness ≤ 3 mm or an interval between symptom onset and DWI of > 24 to 96 hours could increase the diagnostic yield.

Keywords

References

  1. Hodges JR, Warlow CP. Syndromes of transient amnesia: towards a classification. A study of 153 cases. J Neurol Neurosurg Psychiatry 1990;53:834-843
  2. Szabo K, Hoyer C, Caplan LR, Grassl R, Griebe M, Ebert A, et al. Diffusion-weighted MRI in transient global amnesia and its diagnostic implications. Neurology 2020;95:e206-e212
  3. Bartsch T, Alfke K, Stingele R, Rohr A, Freitag-Wolf S, Jansen O, et al. Selective affection of hippocampal CA-1 neurons in patients with transient global amnesia without long-term sequelae. Brain 2006;129:2874-2884
  4. Bartsch T, Deuschl G. Transient global amnesia: functional anatomy and clinical implications. Lancet Neurol 2010;9:205-214
  5. Bartsch T, Dohring J, Rohr A, Jansen O, Deuschl G. CA1 neurons in the human hippocampus are critical for autobiographical memory, mental time travel, and autonoetic consciousness. Proc Natl Acad Sci U S A 2011;108:17562-17567
  6. Strupp M, Bruning R, Wu RH, Deimling M, Reiser M, Brandt T. Diffusion-weighted MRI in transient global amnesia: elevated signal intensity in the left mesial temporal lobe in 7 of 10 patients. Ann Neurol 1998;43:164-170
  7. Sedlaczek O, Hirsch JG, Grips E, Peters CN, Gass A, Wohrle J, et al. Detection of delayed focal MR changes in the lateral hippocampus in transient global amnesia. Neurology 2004;62:2165-2170
  8. Ahn S, Kim W, Lee YS, Kim WY, Lee JH, Oh BJ, et al. Transient global amnesia: seven years of experience with diffusion-weighted imaging in an emergency department. Eur Neurol 2011;65:123-128
  9. Weon YC, Kim JH, Lee JS, Kim SY. Optimal diffusion-weighted imaging protocol for lesion detection in transient global amnesia. AJNR Am J Neuroradiol 2008;29:1324-1328
  10. Lewis SL. Aetiology of transient global amnesia. Lancet 1998;352:397-399
  11. Quinette P, Guillery-Girard B, Dayan J, de la Sayette V, Marquis S, Viader F, et al. What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases. Brain 2006;129:1640-1658
  12. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700
  13. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011;155:529-536
  14. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 2019;10:Ed000142
  15. Suh CH, Park SH. Successful publication of systematic review and meta-analysis of studies evaluating diagnostic test accuracy. Korean J Radiol 2016;17:5-6
  16. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-634
  17. Huber R, Aschoff AJ, Ludolph AC, Riepe MW. Transient global amnesia. Evidence against vascular ischemic etiology from diffusion weighted imaging. J Neurol 2002;249:1520-1524
  18. Winbeck K, Etgen T, von Einsiedel HG, Rottinger M, Sander D. DWI in transient global amnesia and TIA: proposal for an ischaemic origin of TGA. J Neurol Neurosurg Psychiatry 2005;76:438-441
  19. Alberici E, Pichiecchio A, Caverzasi E, Farina LM, Persico A, Cavallini A, et al. Transient global amnesia: hippocampal magnetic resonance imaging abnormalities. Funct Neurol 2008;23:149-152
  20. Enzinger C, Thimary F, Kapeller P, Ropele S, Schmidt R, Ebner F, et al. Transient global amnesia: diffusion-weighted imaging lesions and cerebrovascular disease. Stroke 2008;39:2219-2225
  21. Lee SY, Kim WJ, Suh SH, Oh SH, Lee KY. Higher lesion detection by 3.0T MRI in patient with transient global amnesia. Yonsei Med J 2009;50:211-214
  22. Ueno H, Naka H, Ohshita T, Wakabayashi S, Matsumoto M. Serial changes in delayed focal hippocampal lesions in patients with transient global amnesia. Hiroshima J Med Sci 2010;59:77-81
  23. Auyeung M, Tsoi TH, Cheung CM, Fong DY, Li R, Chan JK, et al. Association of diffusion weighted imaging abnormalities and recurrence in transient global amnesia. J Clin Neurosci 2011;18:531-534
  24. Scheel M, Malkowsky C, Klingebiel R, Schreiber SJ, Bohner G. Magnetic resonance imaging in transient global amnesia: lessons learned from 198 cases. Clin Neuroradiol 2012;22:335-340
  25. Uttner I, Prexl S, Freund W, Unrath A, Bengel D, Huber R. Long-term outcome in transient global amnesia patients with and without focal hyperintensities in the CA1 region of the hippocampus. Eur Neurol 2012;67:155-160
  26. Dohring J, Schmuck A, Bartsch T. Stress-related factors in the emergence of transient global amnesia with hippocampal lesions. Front Behav Neurosci 2014;8:287
  27. Kim J, Kwon Y, Yang Y, Jang IM, Chang Y, Park YH, et al. Clinical experience of modified diffusion-weighted imaging protocol for lesion detection in transient global amnesia: an 8-year large-scale clinical study. J Neuroimaging 2014;24:331-337
  28. Gungor Tuncer O, Aksay Koyuncu B, Vildan Okudan Z, Altindag˘ E, Tolun R, Krespi Y. Vascular ischemia as a cause of transient global amnesia: a patient series. Noro Psikiyatr Ars 2015;52:59-63
  29. Park KM, Han YH, Kim TH, Mun CW, Shin KJ, Ha SY, et al. Pre-existing structural abnormalities of the limbic system in transient global amnesia. J Clin Neurosci 2015;22:843-847
  30. Jain TP, Patel R, Gawarikar Y. Transient global amnesia: diffusion MRI findings. Indian J Radiol Imaging 2018;28:6-9
  31. Lanzone J, Ricci L, Assenza G, Ulivi M, Di Lazzaro V, Tombini M. Transient epileptic and global amnesia: real-life differential diagnosis. Epilepsy Behav 2018;88:205-211
  32. Higashida K, Okazaki S, Todo K, Sasaki T, Ohara N, Kohara N, et al. A multicenter study of transient global amnesia for the better detection of magnetic resonance imaging abnormalities. Eur J Neurol 2020;27:2117-2124
  33. Shimizu K, Hara S, Hori M, Tanaka Y, Maehara T, Aoki S, et al. Transient global amnesia: a diffusion and perfusion MRI study. J Neuroimaging 2020;30:828-832
  34. Tynas R, Panegyres PK. Factors determining recurrence in transient global amnesia. BMC Neurol 2020;20:83
  35. Ryoo I, Kim JH, Kim S, Choi BS, Jung C, Hwang SI. Lesion detectability on diffusion-weighted imaging in transient global amnesia: the influence of imaging timing and magnetic field strength. Neuroradiology 2012;54:329-334
  36. Kuhl CK, Textor J, Gieseke J, von Falkenhausen M, Gernert S, Urbach H, et al. Acute and subacute ischemic stroke at high-field-strength (3.0-T) diffusion-weighted MR imaging: intraindividual comparative study. Radiology 2005;234:509-516
  37. Toledo M, Pujadas F, Grive E, Alvarez-Sabin J, Quintana M, Rovira A. Lack of evidence for arterial ischemia in transient global amnesia. Stroke 2008;39:476-479
  38. Cianfoni A, Tartaglione T, Gaudino S, Pilato F, Saturno E, Tonali PA, et al. Hippocampal magnetic resonance imaging abnormalities in transient global amnesia. Arch Neurol 2005;62:1468-1469