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Loss of the “swallow tail sign” on susceptibility-weighted imaging in the diagnosis of dementia with Lewy bodies: a systematic review and meta-analysis

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Abstract

Introduction

Loss of dorsolateral nigral hyperintensity (DNH) on iron-sensitive brain MRI is useful for Parkinson’s disease detection. DNH loss could also be of diagnostic value in dementia with Lewy bodies (DLB), an a-synuclein-related pathology. We aim to quantitatively synthesize evidence, investigating the role of MRI, a first-line imaging modality, in early DLB detection and differentiation from other dementias.

Methods

Our study was conducted according to the PRISMA statement. MEDLINE, Scopus, Web of Science, and Cochrane Library were searched using the terms like “dementia with Lewy bodies”, “dorsolateral nigral hyperintensity”, and “MRI”. Only English-written peer-reviewed diagnostic accuracy studies were included. We used QUADAS-2 for quality assessment.

Results

Our search yielded 363 search results. Three studies were eligible, all with satisfying, high quality. The total population of 227 patients included 63 with DLB and 164 with other diseases (Alzheimer disease, frontotemporal dementia, mild cognitive impairment). Using a univariate random-effects logistic regression model, our meta-analysis resulted in pooled sensitivity, specificity and DOR of 0.82 [0.62; 0.92], 0.79 [0.70; 0.86] and 16.26 ([3.3276; 79.4702], p = 0.0006), respectively, for scans with mixed field strength (1.5 and 3 T). Subgroup analysis of 3 T scans showed pooled sensitivity, specificity and DOR of 0.82 [0.61; 0.93], 0.82 [0.72; 0.89] and 18.36 ([4.24; 79.46], p < 0.0001), respectively.

Discussion

DNH loss on iron-sensitive MRI might comprise a supportive biomarker for DLB detection, that could augment the value of the DLB diagnostic criteria. Further evaluation using standardized protocols is needed, as well as direct comparison to other supportive and indicative biomarkers.

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Funding

The publication of the article in OA mode was financially supported by HEAL-Link.

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Author notes

  1. Vasilis-Spyridon Tseriotis and Theodoros Mavridis: Co-authorship.

Authors and Affiliations

  1. Department of Neurology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece

    Vasilis-Spyridon Tseriotis & Kyriaki Eleftheriadou

  2. Laboratory of Clinical Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Vasilis-Spyridon Tseriotis, Georgios Konstantis, Pavlos Pavlidis & Chryssa Pourzitaki

  3. 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Theodoros Mavridis

  4. Department of Neurology, Tallaght University Hospital (TUH)/The Adelaide and Meath Hospital, Dublin, Incorporating the National Children’s Hospital (AMNCH), Dublin, Ireland

    Theodoros Mavridis

  5. Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    David-Dimitris Chlorogiannis

  6. 1st Neurology Department of AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece

    Marianthi Arnaoutoglou

  7. Department of Neurology, General Hospital of Ioannina, Ioannina, Greece

    Konitsiotis Spyridon

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Contributions

Conceptualization: VST, KE; Literature review: VST, GK, DDC, TM; Data analysis: VST, GK; Writing—original draft preparation: VST, KE, PP, CP; Writing—review and editing: VST, TM, MA, SK; Supervision: SK.

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Correspondence to Vasilis-Spyridon Tseriotis.

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Tseriotis, VS., Mavridis, T., Eleftheriadou, K. et al. Loss of the “swallow tail sign” on susceptibility-weighted imaging in the diagnosis of dementia with Lewy bodies: a systematic review and meta-analysis. J Neurol (2024). https://doi.org/10.1007/s00415-024-12381-6

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