Is MRI better than CT for detecting a vascular component to dementia? A systematic review and meta-analysis.
BACKGROUND
Identification of causes of dementia soon after symptom onset is important, because appropriate treatment of some causes of dementia can slow or halt its progression or enable symptomatic treatment where appropriate. The accuracy of MRI and CT, and whether MRI is superior to CT, in detecting a vascular component to dementia in autopsy confirmed and clinical cohorts of patients with VaD, combined AD and VaD ("mixed dementia"), and AD remain unclear. We conducted a systematic review and meta-analysis to investigate this question.


METHODS
We searched eight databases and screened reference lists to identify studies addressing the review question. We assessed study quality using QUADAS. We 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.


RESULTS
We 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.


CONCLUSIONS
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'.
School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK.
Rebecca
R
Beynon
Jonathan A C
JA
Sterne
Gordon
G
Wilcock
Marcus
M
Likeman
Roger M
RM
Harbord
Margaret
M
Astin
Margaret
M
Burke
Alysson
A
Bessell
Yoav
Y
Ben-Shlomo
James
J
Hawkins
William
W
Hollingworth
Penny
P
Whiting
D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*