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Diagnostic accuracy of DAT-SPECT and MIBG scintigraphy for dementia with Lewy bodies: an updated systematic review and Bayesian latent class model meta-analysis

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Abstract

Purpose

Imperfect clinical reference standards can preclude accurately estimating the diagnostic accuracy of DAT-SPECT and MIBG myocardial scintigraphy for diagnosing DLB. To investigate the validity of unadjusted accuracy, we updated our previous meta-analysis.

Methods

Literature search was updated to March 18, 2018. We also examined published systematic review reports. Two investigators extracted data and rated study validity using the QUADAS-2 tool. We performed a Bayesian latent class model meta-analysis accounting for imperfect reference standards.

Results

We evaluated 27 studies including 2236 patients. With the exception of two DAT-SPECT studies that involved postmortem neuropathological verification, studies were susceptible to bias from imperfect reference standards. Compared with the unadjusted accuracy estimates, the adjusted sensitivity values were similar, whereas the adjusted specificity values were generally lower for detecting α-synuclein pathology in the brain. The adjusted summary sensitivity and specificity were 0.86 (95% credible interval [CrI], 0.76–0.95) and 0.81 (CrI, 0.70–0.92), and 0.93 (CrI, 0.74–1.00) and 0.75 (CI, 0.47–0.94) for visual and semi-quantitative assessments of DAT-SPECT, respectively; 0.92 (CrI, 0.81–0.99) and 0.80 (CrI, 0.67–0.93), and 0.87 (CrI, 0.74–0.98) and 0.80 (CrI, 0.69–0.93), for delayed- and early-phase scans of MIBG scintigraphy, respectively. When diagnosing the typical clinical syndrome, the adjusted accuracy values were similar to the unadjusted estimates. The adjusted sensitivity and specificity were 0.89 (CrI, 0.75–0.98) and 0.87 (CrI, 0.72–0.97), and 0.97 (CrI, 0.78–1.0) and 0.70 (CrI, 0.43–0.92) for visual and semi-quantitative assessments of DAT-SPECT, respectively; and 0.93 (CrI, 0.81–0.98) and 0.90 (CrI, 0.73–0.97), and 0.85 (CrI, 0.66–0.96) and 0.96 (95% CI, 0.83–1.0) for delayed- and early-phase scans of MIBG scintigraphy, respectively.

Conclusions

In our adjusted analyses, both imaging biomarkers had high diagnostic accuracy for detecting the hallmark pathology in the brain and for diagnosing the typical clinical syndrome.

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Acknowledgments

The authors would like to thank Drs. Koji Kamagata, Yuta Manabe, Alan Thomas, and Giorgio Treglia for providing additional data from their original studies; Drs. Nandini Dendukuri and Ian Schiller for providing their original codes in R to depict adjusted summary receiver operating characteristic curves and credible regions for adjusted summary sensitivity and specificity, which we modified and ported to Stata; and Ms. Naomi Sawabe for assisting with the literature search and data extraction.

Contributors

TN and TT had full access to the data set of this study and take responsibility for the integrity of data and the accuracy of data analysis. Conception and design: TN, KI, and TT. Literature search: TN and TT. Article screening: TN and TT. Eligibility decision and data collection: TN, KI, and TT. Statistical analysis: TT. Interpretation of data: TN, KI, and TT. Draft of manuscript: TN and TT. Critical revision: TN, KI, and TT. Supervision: KI. All authors made substantial contributions to the intellectual content of the paper and gave final approval for the final version of the manuscript.

Funding

This study was funded by The Ministry of Education, Culture, Sports, Science, and Technology, Japan (grant numbers: 23591760 and 26460755).

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Authors and Affiliations

  1. Department of Radiology, Komaki City Hospital, Komaki, Japan

    Takashi Nihashi

  2. Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Takashi Nihashi

  3. Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, Japan

    Kengo Ito

  4. Section of General Internal Medicine, Department of Emergency and General Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan

    Teruhiko Terasawa

  5. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA

    Teruhiko Terasawa

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Correspondence to Teruhiko Terasawa.

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The funding sources had no role in the design or conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

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Nihashi, T., Ito, K. & Terasawa, T. Diagnostic accuracy of DAT-SPECT and MIBG scintigraphy for dementia with Lewy bodies: an updated systematic review and Bayesian latent class model meta-analysis. Eur J Nucl Med Mol Imaging 47, 1984–1997 (2020). https://doi.org/10.1007/s00259-019-04480-8

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