[Analysis of the adequacy of diagnostic indications of the following application techniques of cerebral MR: MR spectroscopy, diffusion, gadolinum perfusion and cerebral functional-activation MR in advanced neurological diagnosis]

Cabrera A, Fernandez-Ruanova MB, Saralegui I, Astigarraga E, Vicente I, Mateos B, Fernandez-Pardavila E, Villanua J, Capelastegui A, Romera MC, Gomez-Beldarrain MA, Catalan G
Record ID 32011000156
Original Title: Análisis de la adecuación de las indicaciones diagnósticas de las siguientes técnicas de aplicación de la RM cerebral: Espectroscopia por RM, Difusión, Perfusión de Gadolinio y RM funcional-activación cerebral en el diagnóstico neurológico avanzado
Authors' objectives: The main objective proposed was to assess the diagnostic utility of advanced neuroradiological techniques of diffusion, perfusion, spectroscopy and functional magnetic resonance in neurological pathology. Secondary objectives included determining the indications and limitations of the three advanced MR techniques according to be available evidence, the level of implementation of these techniques in the Basque Autonomous Community and their level of use, as well as two fi eld studies in patients with transitory cerebral ischaemia and primary cerebral glial strain neoplasies.
Authors' results and conclusions: 928 articles have been located, distributed as follows: 247 on Spectroscopy, 504 on PW-DW of Gd and 215 on FMRI, in 38 articles PW-DW and MRS were done. A systematic review, which studied the utility of resonance during the acute phase of cerebral ischaemia and a meta-analysis, which compared the total concentration of NAA/Cr reason in patients with multiple sclerosis compared with healthy controls, were identifi ed. 105 publications dealing with diff usion and perfusion MR on cerebral-vascular pathology were selected for reading. The majority were a series of cases of which 65 (63%) were prospective and only 7 multicentre. 39 publications concerning CNS neoplasies were selected for reading, of which 18 corresponded to publications about proton spectroscopy, 11 about PW and 5 about DW. Five combined the use of more than one of these techniques: Three combined PW and MRS and 2 combined all 3 techniques. Sixteen articles dealing with multiple sclerosis were selected for reading of which 14 corresponded to publications about proton spectroscopy, 1 about PW and 1 about DW. A total of 39 articles about the use of magnetic resonance in CNS pathologies around the central region and about the lateralisation of the language function in patients earmarked for surgery were selected. As a general rule, the methodological validity of the articles is not optimal. The majority corresponded to clinical series of both prospective and retrospective cases and there is no correct definition of the control group. Advanced magnetic resonance imaging techniques aid and complement the diagnosis and the management of patients with an ischaemic, tumoural or desmyelinizating pathology (but none of them by themselves) can replace the already existing techniques. Prospective and multi-centre surveys must be carried out to standardise these techniques and to determine the most appropriate DW, PW and MRS sequences and parameters for the early detection and selection of patients with cerebral ischaemia in which it is possible to predict a benefi t of early reperfusion with treatment, in order to determine the type and histological degree of tumours of the CNS and the degree of cerebral lesion in patients with multiple sclerosis. Functional MR is one of the fastest-expanding advanced magnetic resonance fields and the one that has aroused greatest interest. Nevertheless, until today, almost all studies have focused on the fi eld of basic science without an excessive impact on day-to-day clinical practice. Direct comparisons between techniques are diffi cult as diff erent tasks are used to determine motor or language activation. There are no multi-centre studies or clinical tests that compare the techniques.
Authors' recommendations: The authors conclude that the data obtained on advanced magnetic resonance imaging techniques is not sufficient to recommend its use in patients with ischaemic, tumoural or desmyelinizating pathologies.
Authors' methods: The following tasks were performed: - Systematic review of the literature, critical reading and synthesis of scientifi c evidence up to December 2005. - Two prospective studies: — Prognostic and diagnostic value of diff usion in Transitory Ischaemic Accidents (TIA). — Grading of glial tumours. - Survey to determine the degree to which these techniques are implemented in our community.
Project Status: Completed
Year Published: 2009
English language abstract: An English language summary is available
Publication Type: Rapid Review
Country: Spain
MeSH Terms
  • Diagnostic Techniques, Neurological
  • Magnetic Resonance Angiography
  • Magnetic Resonance Imaging
  • Magnetic Resonance Spectroscopy
  • Diffusion Magnetic Resonance Imaging
  • Brain Ischemia
  • Brain Neoplasms
  • Sclerosis
  • Esclerosis
  • Neoplasias Encefálicas
  • Isquemia Encefálica
  • Imagen de Difusión por Resonancia Magnética
  • Espectroscopía de Resonancia Magnética
  • Imagen por Resonancia Magnética
  • Técnicas de Diagnóstico Neurológico
Organisation Name: Basque Office for Health Technology Assessment
Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz
Contact Name: Lorea Galnares-Cordero
Contact Email: lgalnares@bioef.eus
Copyright: <p>Basque Office for Health Technology Assessment (OSTEBA)</p>
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.