Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2022; 10(34): 12594-12604
Published online Dec 6, 2022. doi: 10.12998/wjcc.v10.i34.12594
Three-dimensional time-of-flight magnetic resonance angiography combined with high resolution T2-weighted imaging in preoperative evaluation of microvascular decompression
Chen Liang, Ling Yang, Bin-Bin Zhang, Shi-Wen Guo, Rui-Chun Li
Chen Liang, Bin-Bin Zhang, Shi-Wen Guo, Rui-Chun Li, Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Chen Liang, Department of Radiology Medical Physics, University Medical Center Freiburg, University of Freiburg, Freiburg 79108, Germany
Ling Yang, Department of Aviation Psychology Research, Xi’an Civil Aviation Hospital, Xi’an 710082, Shaanxi Province, China
Author contributions: Liang C wrote the main manuscript and participated in all analyses; Liang C and Yang L contributed to the study concept and design; Zhang BB, Guo SW, and Li RC participated in the literature search, data extraction, and quality assessment; and all authors read and approved the final manuscript.
Supported by the Key Research and Development Plan of Shaanxi Province, No. 2021SF-298.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2020 Checklist, and the manuscript was prepared and revised according to the PRISMA 2020 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chen Liang, MD, Associate Chief Physician, Doctor, Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an 710061, Shaanxi Province, China. liangchen01@xjtu.edu.cn
Received: September 12, 2022
Peer-review started: September 12, 2022
First decision: September 27, 2022
Revised: September 29, 2022
Accepted: November 8, 2022
Article in press: November 8, 2022
Published online: December 6, 2022
Processing time: 81 Days and 1.7 Hours
Abstract
BACKGROUND

Neurovascular compression (NVC) is the main cause of primary trigeminal neuralgia (TN) and hemifacial spasm (HFS). Microvascular decompression (MVD) is an effective surgical method for the treatment of TN and HFS caused by NVC. The judgement of NVC is a critical step in the preoperative evaluation of MVD, which is related to the effect of MVD treatment. Magnetic resonance imaging (MRI) technology has been used to detect NVC prior to MVD for several years. Among many MRI sequences, three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is the most widely used. However, 3D TOF MRA has some shortcomings in detecting NVC. Therefore, 3D TOF MRA combined with high resolution T2-weighted imaging (HR T2WI) is considered to be a more effective method to detect NVC.

AIM

To determine the value of 3D TOF MRA combined with HR T2WI in the judgment of NVC, and thus to assess its value in the preoperative evaluation of MVD.

METHODS

Related studies published from inception to September 2022 based on PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Studies that investigated 3D TOF MRA combined with HR T2WI to judge NVC in patients with TN or HFS were included according to the inclusion criteria. Studies without complete data or not relevant to the research topics were excluded. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to assess the quality of included studies. The publication bias of the included literature was examined by Deeks’ test. An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize data. Data analysis was performed using the MIDAS module of statistical software Stata 16.0. Two independent investigators extracted patient and study characteristics, and discrepancies were resolved by consensus. Individual and pooled sensitivities and specificities were calculated. The I² statistic and Q test were used to test heterogeneity. The study was registered on the website of PROSERO (registration No. CRD42022357158).

RESULTS

Our search identified 595 articles, of which 12 (including 855 patients) fulfilled the inclusion criteria. Bivariate analysis showed that the pooled sensitivity and specificity of 3D TOF MRA combined with HR T2WI for detecting NVC were 0.96 [95% confidence interval (CI): 0.92-0.98] and 0.92 (95%CI: 0.74-0.98), respectively. The pooled positive likelihood ratio was 12.4 (95%CI: 3.2-47.8), pooled negative likelihood ratio was 0.04 (95%CI: 0.02-0.09), and pooled diagnostic odds ratio was 283 (95%CI: 50-1620). The area under the receiver operating characteristic curve was 0.98 (95%CI: 0.97-0.99). The studies showed no substantial heterogeneity (I2= 0, Q = 0.001 P = 0.50).

CONCLUSION

Our results suggest that 3D TOF MRA combined with HR T2WI has excellent sensitivity and specificity for judging NVC in patients with TN or HFS. This method can be used as an effective tool for preoperative evaluation of MVD.

Keywords: Three-dimensional time-of-flight magnetic resonance angiography, High resolution T2 weighted imaging, Neurovascular compression, Microvascular decompression, Meta-analysis

Core Tip: This meta-analysis included a total of 855 patients from 12 studies. The results indicated that three-dimensional time-of-flight magnetic resonance angiography combined with high resolution T2-weighted imaging has excellent diagnostic accuracy for judging neurovascular compression in patients with trigeminal neuralgia or hemifacial spasm. It can be used as an effective tool for preoperative evaluation of microvascular decompression.