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<meta name="HW.identifier" content="/ajnr/early/2024/12/26/ajnr.A8440.atom" />
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<meta name="DC.Title" content="Diagnostic Performance of ASL-MRI and FDG-PET in Frontotemporal Dementia: A Systematic Review and Meta-Analysis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8440" />
<meta name="DC.Date" content="2024-12-27" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2025 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND: While the diagnosis of frontotemporal dementia (FTD) is based mostly on clinical features, [18F]-FDG-PET has been investigated as a potential imaging standard in ambiguous cases, with arterial spin-labeling (ASL) MRI gaining recent interest.

PURPOSE: The purpose of this study is to conduct a systematic review and meta-analysis on the diagnostic performance of ASL MRI in patients with FTD and compare it with that of [18F]-FDG-PET.

DATA SOURCES: A systematic search of PubMed, Scopus, and Embase was conducted until March 13, 2024.

STUDY SELECTION: Inclusion criteria were original articles, patients with FTD and/or its variants, use of ASL MR perfusion imaging with or without [18F]-FDG-PET, and presence of sufficient diagnostic performance data. Exclusion criteria were meeting abstracts, comments, summaries, protocols, letters and guidelines, longitudinal studies, and overlapping cohorts.

DATA ANALYSIS: The quality of eligible studies was assessed by using the Quality Assessment of Diagnostic Accuracy Studies-2. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) for [18F]-FDG-PET and ASL MRI were calculated, and a summary receiver operating characteristic curve was plotted.

DATA SYNTHESIS: Seven eligible studies were identified, which included a total of 102 patients with FTD. Aside from some of the studies showing, at worst, an unclear risk of bias in patient selection, index test, flow, and timing, all studies showed low risk of bias and applicability concerns in all categories. Data from 4 studies were included in our meta-analysis for ASL MRI and 3 studies for [18F]-FDG-PET. Pooled sensitivity, specificity, and DOR were 0.70 (95% CI: 0.59–0.79), 0.81 (95% CI: 0.71–0.88), and 8.00 (95% CI: 3.74–17.13) for ASL MRI and 0.88 (95% CI: 0.71–0.96), 0.89 (95% CI: 0.43–0.99), and 47.18 (95% CI: 10.77–206.75) for [18F]-FDG-PET.

LIMITATIONS: The number of studies was relatively small, with a small sample size. The studies used different scanning protocols as well as a mix of diagnostic metrics, all of which might have introduced heterogeneity in the data.

CONCLUSIONS: While ASL MRI performed worse than [18F]-FDG-PET in the diagnosis of FTD, it exhibited a decent diagnostic performance to justify its further investigation as a quicker and more convenient alternative.

3DPCASL
:   3D pseudocontinuous ASL
AD
:   Alzheimer disease
ASL
:   arterial spin-labeling
bvFTD
:   behavioral variant of frontotemporal dementia
DOR
:   diagnostic odds ratio
FN
:   false-negative
FP
:   false-positive
FTD
:   frontotemporal dementia
NLR
:   negative likelihood ratio
PASL
:   pulsed ASL
PLD
:   postlabel delay
PLR
:   positive likelihood ratio
PRISMA
:   Preferred Reporting Items for Systematic Reviews and Meta-Analysis
QUADAS-2
:   Quality Assessment of Diagnostic Accuracy Studies-2
SROC
:   summary receiver operative characteristic
TN
:   true-negative
TP
:   true-positive" />
<meta name="DC.Contributor" content="Richard Dagher" />
<meta name="DC.Contributor" content="Parisa Arjmand" />
<meta name="DC.Contributor" content="Burak Berksu Ozkara" />
<meta name="DC.Contributor" content="Mahla Radmard" />
<meta name="DC.Contributor" content="Mona Gad" />
<meta name="DC.Contributor" content="Ali Sheikhy" />
<meta name="DC.Contributor" content="Max Wintermark" />
<meta name="DC.Contributor" content="Vivek Yedavalli" />
<meta name="DC.Contributor" content="Haris I. Sair" />
<meta name="DC.Contributor" content="Licia P. Luna" />
<meta name="article:published_time" content="2024-12-26" />
<meta name="article:section" content="NEUROPSYCHIATRIC IMAGING" />
<meta name="citation_title" content="Diagnostic Performance of ASL-MRI and FDG-PET in Frontotemporal Dementia: A Systematic Review and Meta-Analysis" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND:&lt;/h3&gt;
&lt;p&gt;While the diagnosis of frontotemporal dementia (FTD) is based mostly on clinical features, [&lt;sup&gt;18&lt;/sup&gt;F]-FDG-PET has been investigated as a potential imaging standard in ambiguous cases, with arterial spin-labeling (ASL) MRI gaining recent interest.&lt;/p&gt;&lt;h3&gt;PURPOSE:&lt;/h3&gt;
&lt;p&gt;The purpose of this study is to conduct a systematic review and meta-analysis on the diagnostic performance of ASL MRI in patients with FTD and compare it with that of [&lt;sup&gt;18&lt;/sup&gt;F]-FDG-PET.&lt;/p&gt;&lt;h3&gt;DATA SOURCES:&lt;/h3&gt;
&lt;p&gt;A systematic search of PubMed, Scopus, and Embase was conducted until March 13, 2024.&lt;/p&gt;&lt;h3&gt;STUDY SELECTION:&lt;/h3&gt;
&lt;p&gt;Inclusion criteria were original articles, patients with FTD and/or its variants, use of ASL MR perfusion imaging with or without [&lt;sup&gt;18&lt;/sup&gt;F]-FDG-PET, and presence of sufficient diagnostic performance data. Exclusion criteria were meeting abstracts, comments, summaries, protocols, letters and guidelines, longitudinal studies, and overlapping cohorts.&lt;/p&gt;&lt;h3&gt;DATA ANALYSIS:&lt;/h3&gt;
&lt;p&gt;The quality of eligible studies was assessed by using the Quality Assessment of Diagnostic Accuracy Studies-2. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) for [&lt;sup&gt;18&lt;/sup&gt;F]-FDG-PET and ASL MRI were calculated, and a summary receiver operating characteristic curve was plotted.&lt;/p&gt;&lt;h3&gt;DATA SYNTHESIS:&lt;/h3&gt;
&lt;p&gt;Seven eligible studies were identified, which included a total of 102 patients with FTD. Aside from some of the studies showing, at worst, an unclear risk of bias in patient selection, index test, flow, and timing, all studies showed low risk of bias and applicability concerns in all categories. Data from 4 studies were included in our meta-analysis for ASL MRI and 3 studies for [&lt;sup&gt;18&lt;/sup&gt;F]-FDG-PET. Pooled sensitivity, specificity, and DOR were 0.70 (95% CI: 0.59–0.79), 0.81 (95% CI: 0.71–0.88), and 8.00 (95% CI: 3.74–17.13) for ASL MRI and 0.88 (95% CI: 0.71–0.96), 0.89 (95% CI: 0.43–0.99), and 47.18 (95% CI: 10.77–206.75) for [&lt;sup&gt;18&lt;/sup&gt;F]-FDG-PET.&lt;/p&gt;&lt;h3&gt;LIMITATIONS:&lt;/h3&gt;
&lt;p&gt;The number of studies was relatively small, with a small sample size. The studies used different scanning protocols as well as a mix of diagnostic metrics, all of which might have introduced heterogeneity in the data.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;While ASL MRI performed worse than [&lt;sup&gt;18&lt;/sup&gt;F]-FDG-PET in the diagnosis of FTD, it exhibited a decent diagnostic performance to justify its further investigation as a quicker and more convenient alternative.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2024/12/26" />
<meta name="citation_mjid" content="ajnr;ajnr.A8440v2" />
<meta name="citation_id" content="ajnr.A8440v2" />
<meta name="citation_public_url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/12/26/ajnr.A8440" />
<meta name="citation_abstract_html_url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/12/26/ajnr.A8440.abstract" />
<meta name="citation_full_html_url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/12/26/ajnr.A8440.full" />
<meta name="citation_pdf_url" content="http://ajnr-stage2.stage.highwire.org/content/ajnr/early/2024/12/26/ajnr.A8440.full.pdf" />
<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A8440" />
<meta name="citation_pmid" content="39134374" />
<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="NEUROPSYCHIATRIC IMAGING" />
<meta name="citation_author" content="Richard Dagher" />
<meta name="citation_author_institution" content="aFrom the Department of Neuroradiology (R.D., B.B.O., M.W.), MD Anderson Cancer Center, Houston, Texas" />
<meta name="citation_author_orcid" content="https://orcid.org/0009-0001-7666-2989" />
<meta name="citation_author" content="Parisa Arjmand" />
<meta name="citation_author_institution" content="bMashhad University of Medical Sciences (P.A.), Mashhad, Iran" />
<meta name="citation_author" content="Burak Berksu Ozkara" />
<meta name="citation_author_institution" content="aFrom the Department of Neuroradiology (R.D., B.B.O., M.W.), MD Anderson Cancer Center, Houston, Texas" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0002-8769-3342" />
<meta name="citation_author" content="Mahla Radmard" />
<meta name="citation_author_institution" content="cRussell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, Maryland" />
<meta name="citation_author" content="Mona Gad" />
<meta name="citation_author_institution" content="dDiagnostic Radiology Department (M.G.), Faculty of Medicine, Mansoura University, Egypt" />
<meta name="citation_author" content="Ali Sheikhy" />
<meta name="citation_author_institution" content="eRadiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0002-0358-4406" />
<meta name="citation_author" content="Max Wintermark" />
<meta name="citation_author_institution" content="aFrom the Department of Neuroradiology (R.D., B.B.O., M.W.), MD Anderson Cancer Center, Houston, Texas" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0002-6726-3951" />
<meta name="citation_author" content="Vivek Yedavalli" />
<meta name="citation_author_institution" content="cRussell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, Maryland" />
<meta name="citation_author" content="Haris I. Sair" />
<meta name="citation_author_institution" content="cRussell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, Maryland" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0002-5077-0471" />
<meta name="citation_author" content="Licia P. Luna" />
<meta name="citation_author_institution" content="cRussell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, Maryland" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0003-3539-4831" />
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<meta name="twitter:title" content="Diagnostic Performance of ASL-MRI and FDG-PET in Frontotemporal Dementia: A Systematic Review and Meta-Analysis" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND: While the diagnosis of frontotemporal dementia (FTD) is based mostly on clinical features, [18F]-FDG-PET has been investigated as a potential imaging standard in ambiguous cases, with arterial spin-labeling (ASL) MRI gaining recent interest.

PURPOSE: The purpose of this study is to conduct a systematic review and meta-analysis on the diagnostic performance of ASL MRI in patients with FTD and compare it with that of [18F]-FDG-PET.

DATA SOURCES: A systematic search of PubMed, Scopus, and Embase was conducted until March 13, 2024.

STUDY SELECTION: Inclusion criteria were original articles, patients with FTD and/or its variants, use of ASL MR perfusion imaging with or without [18F]-FDG-PET, and presence of sufficient diagnostic performance data. Exclusion criteria were meeting abstracts, comments, summaries, protocols, letters and guidelines, longitudinal studies, and overlapping cohorts.

DATA ANALYSIS: The quality of eligible studies was assessed by using the Quality Assessment of Diagnostic Accuracy Studies-2. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) for [18F]-FDG-PET and ASL MRI were calculated, and a summary receiver operating characteristic curve was plotted.

DATA SYNTHESIS: Seven eligible studies were identified, which included a total of 102 patients with FTD. Aside from some of the studies showing, at worst, an unclear risk of bias in patient selection, index test, flow, and timing, all studies showed low risk of bias and applicability concerns in all categories. Data from 4 studies were included in our meta-analysis for ASL MRI and 3 studies for [18F]-FDG-PET. Pooled sensitivity, specificity, and DOR were 0.70 (95% CI: 0.59–0.79), 0.81 (95% CI: 0.71–0.88), and 8.00 (95% CI: 3.74–17.13) for ASL MRI and 0.88 (95% CI: 0.71–0.96), 0.89 (95% CI: 0.43–0.99), and 47.18 (95% CI: 10.77–206.75) for [18F]-FDG-PET.

LIMITATIONS: The number of studies was relatively small, with a small sample size. The studies used different scanning protocols as well as a mix of diagnostic metrics, all of which might have introduced heterogeneity in the data.

CONCLUSIONS: While ASL MRI performed worse than [18F]-FDG-PET in the diagnosis of FTD, it exhibited a decent diagnostic performance to justify its further investigation as a quicker and more convenient alternative.

3DPCASL
:   3D pseudocontinuous ASL
AD
:   Alzheimer disease
ASL
:   arterial spin-labeling
bvFTD
:   behavioral variant of frontotemporal dementia
DOR
:   diagnostic odds ratio
FN
:   false-negative
FP
:   false-positive
FTD
:   frontotemporal dementia
NLR
:   negative likelihood ratio
PASL
:   pulsed ASL
PLD
:   postlabel delay
PLR
:   positive likelihood ratio
PRISMA
:   Preferred Reporting Items for Systematic Reviews and Meta-Analysis
QUADAS-2
:   Quality Assessment of Diagnostic Accuracy Studies-2
SROC
:   summary receiver operative characteristic
TN
:   true-negative
TP
:   true-positive" />
<meta name="og-title" property="og:title" content="Diagnostic Performance of ASL-MRI and FDG-PET in Frontotemporal Dementia: A Systematic Review and Meta-Analysis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/12/26/ajnr.A8440" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND: While the diagnosis of frontotemporal dementia (FTD) is based mostly on clinical features, [18F]-FDG-PET has been investigated as a potential imaging standard in ambiguous cases, with arterial spin-labeling (ASL) MRI gaining recent interest.

PURPOSE: The purpose of this study is to conduct a systematic review and meta-analysis on the diagnostic performance of ASL MRI in patients with FTD and compare it with that of [18F]-FDG-PET.

DATA SOURCES: A systematic search of PubMed, Scopus, and Embase was conducted until March 13, 2024.

STUDY SELECTION: Inclusion criteria were original articles, patients with FTD and/or its variants, use of ASL MR perfusion imaging with or without [18F]-FDG-PET, and presence of sufficient diagnostic performance data. Exclusion criteria were meeting abstracts, comments, summaries, protocols, letters and guidelines, longitudinal studies, and overlapping cohorts.

DATA ANALYSIS: The quality of eligible studies was assessed by using the Quality Assessment of Diagnostic Accuracy Studies-2. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) for [18F]-FDG-PET and ASL MRI were calculated, and a summary receiver operating characteristic curve was plotted.

DATA SYNTHESIS: Seven eligible studies were identified, which included a total of 102 patients with FTD. Aside from some of the studies showing, at worst, an unclear risk of bias in patient selection, index test, flow, and timing, all studies showed low risk of bias and applicability concerns in all categories. Data from 4 studies were included in our meta-analysis for ASL MRI and 3 studies for [18F]-FDG-PET. Pooled sensitivity, specificity, and DOR were 0.70 (95% CI: 0.59–0.79), 0.81 (95% CI: 0.71–0.88), and 8.00 (95% CI: 3.74–17.13) for ASL MRI and 0.88 (95% CI: 0.71–0.96), 0.89 (95% CI: 0.43–0.99), and 47.18 (95% CI: 10.77–206.75) for [18F]-FDG-PET.

LIMITATIONS: The number of studies was relatively small, with a small sample size. The studies used different scanning protocols as well as a mix of diagnostic metrics, all of which might have introduced heterogeneity in the data.

CONCLUSIONS: While ASL MRI performed worse than [18F]-FDG-PET in the diagnosis of FTD, it exhibited a decent diagnostic performance to justify its further investigation as a quicker and more convenient alternative.

3DPCASL
:   3D pseudocontinuous ASL
AD
:   Alzheimer disease
ASL
:   arterial spin-labeling
bvFTD
:   behavioral variant of frontotemporal dementia
DOR
:   diagnostic odds ratio
FN
:   false-negative
FP
:   false-positive
FTD
:   frontotemporal dementia
NLR
:   negative likelihood ratio
PASL
:   pulsed ASL
PLD
:   postlabel delay
PLR
:   positive likelihood ratio
PRISMA
:   Preferred Reporting Items for Systematic Reviews and Meta-Analysis
QUADAS-2
:   Quality Assessment of Diagnostic Accuracy Studies-2
SROC
:   summary receiver operative characteristic
TN
:   true-negative
TP
:   true-positive" />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Richard Dagher</span>, <span class="highwire-citation-author" data-delta="1">Parisa Arjmand</span>, <span class="highwire-citation-author" data-delta="2">Burak Berksu Ozkara</span>, <span class="highwire-citation-author" data-delta="3">Mahla Radmard</span>, <span class="highwire-citation-author" data-delta="4">Mona Gad</span>, <span class="highwire-citation-author" data-delta="5">Ali Sheikhy</span>, <span class="highwire-citation-author" data-delta="6">Max Wintermark</span>, <span class="highwire-citation-author" data-delta="7">Vivek Yedavalli</span>, <span class="highwire-citation-author" data-delta="8">Haris I. Sair</span> and <span class="highwire-citation-author" data-delta="9">Licia P. Luna</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">December 2024,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8440 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-112506--6542798435" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Richard Dagher </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neuroradiology (R.D., B.B.O., M.W.), MD Anderson Cancer Center, Houston, Texas</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Richard%2BDagher%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Dagher%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3ARichard%2BDagher%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0009-0001-7666-2989" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Richard Dagher</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Parisa Arjmand </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Mashhad University of Medical Sciences (P.A.), Mashhad, Iran</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Parisa%2BArjmand%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Arjmand%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AParisa%2BArjmand%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Burak Berksu Ozkara </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neuroradiology (R.D., B.B.O., M.W.), MD Anderson Cancer Center, Houston, Texas</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Burak%2BBerksu%2BOzkara%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ozkara%20BB&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3ABurak%2BBerksu%2BOzkara%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8769-3342" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Burak Berksu Ozkara</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Mahla Radmard </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Russell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, Maryland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Mahla%2BRadmard%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Radmard%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AMahla%2BRadmard%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Mona Gad </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Diagnostic Radiology Department (M.G.), Faculty of Medicine, Mansoura University, Egypt</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Mona%2BGad%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gad%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AMona%2BGad%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Ali Sheikhy </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Ali%2BSheikhy%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sheikhy%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AAli%2BSheikhy%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-0358-4406" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Ali Sheikhy</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">Max Wintermark </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neuroradiology (R.D., B.B.O., M.W.), MD Anderson Cancer Center, Houston, Texas</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Max%2BWintermark%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wintermark%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AMax%2BWintermark%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6726-3951" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Max Wintermark</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">Vivek Yedavalli </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Russell H. Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, Maryland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Vivek%2BYedavalli%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yedavalli%20V&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AVivek%2BYedavalli%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">Haris I. 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Morgan Department of Radiology and Radiological Science (M.R., V.Y., H.I.S., L.P.L.), Johns Hopkins Hospital, Baltimore, Maryland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Haris%2BI.%2BSair%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sair%20HI&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AHaris%2BI.%2BSair%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-5077-0471" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Haris I. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND:</strong> While the diagnosis of frontotemporal dementia (FTD) is based mostly on clinical features, [<sup>18</sup>F]-FDG-PET has been investigated as a potential imaging standard in ambiguous cases, with arterial spin-labeling (ASL) MRI gaining recent interest.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>PURPOSE:</strong> The purpose of this study is to conduct a systematic review and meta-analysis on the diagnostic performance of ASL MRI in patients with FTD and compare it with that of [<sup>18</sup>F]-FDG-PET.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>DATA SOURCES:</strong> A systematic search of PubMed, Scopus, and Embase was conducted until March 13, 2024.</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>STUDY SELECTION:</strong> Inclusion criteria were original articles, patients with FTD and/or its variants, use of ASL MR perfusion imaging with or without [<sup>18</sup>F]-FDG-PET, and presence of sufficient diagnostic performance data. Exclusion criteria were meeting abstracts, comments, summaries, protocols, letters and guidelines, longitudinal studies, and overlapping cohorts.</p></div><div id="sec-5" class="subsection"><p id="p-5"><strong>DATA ANALYSIS:</strong> The quality of eligible studies was assessed by using the Quality Assessment of Diagnostic Accuracy Studies-2. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) for [<sup>18</sup>F]-FDG-PET and ASL MRI were calculated, and a summary receiver operating characteristic curve was plotted.</p></div><div id="sec-6" class="subsection"><p id="p-6"><strong>DATA SYNTHESIS:</strong> Seven eligible studies were identified, which included a total of 102 patients with FTD. Aside from some of the studies showing, at worst, an unclear risk of bias in patient selection, index test, flow, and timing, all studies showed low risk of bias and applicability concerns in all categories. Data from 4 studies were included in our meta-analysis for ASL MRI and 3 studies for [<sup>18</sup>F]-FDG-PET. Pooled sensitivity, specificity, and DOR were 0.70 (95% CI: 0.59–0.79), 0.81 (95% CI: 0.71–0.88), and 8.00 (95% CI: 3.74–17.13) for ASL MRI and 0.88 (95% CI: 0.71–0.96), 0.89 (95% CI: 0.43–0.99), and 47.18 (95% CI: 10.77–206.75) for [<sup>18</sup>F]-FDG-PET.</p></div><div id="sec-7" class="subsection"><p id="p-7"><strong>LIMITATIONS:</strong> The number of studies was relatively small, with a small sample size. The studies used different scanning protocols as well as a mix of diagnostic metrics, all of which might have introduced heterogeneity in the data.</p></div><div id="sec-8" class="subsection"><p id="p-8"><strong>CONCLUSIONS:</strong> While ASL MRI performed worse than [<sup>18</sup>F]-FDG-PET in the diagnosis of FTD, it exhibited a decent diagnostic performance to justify its further investigation as a quicker and more convenient alternative.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">3DPCASL<span class="def-item-dt-sep"></span></dt><dd>3D pseudocontinuous ASL<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">AD<span class="def-item-dt-sep"></span></dt><dd>Alzheimer disease<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">ASL<span class="def-item-dt-sep"></span></dt><dd>arterial spin-labeling<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">bvFTD<span class="def-item-dt-sep"></span></dt><dd>behavioral variant of frontotemporal dementia<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">DOR<span class="def-item-dt-sep"></span></dt><dd>diagnostic odds ratio<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">FN<span class="def-item-dt-sep"></span></dt><dd>false-negative<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">FP<span class="def-item-dt-sep"></span></dt><dd>false-positive<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">FTD<span class="def-item-dt-sep"></span></dt><dd>frontotemporal dementia<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">NLR<span class="def-item-dt-sep"></span></dt><dd>negative likelihood ratio<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">PASL<span class="def-item-dt-sep"></span></dt><dd>pulsed ASL<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">PLD<span class="def-item-dt-sep"></span></dt><dd>postlabel delay<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">PLR<span class="def-item-dt-sep"></span></dt><dd>positive likelihood ratio<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">PRISMA<span class="def-item-dt-sep"></span></dt><dd>Preferred Reporting Items for Systematic Reviews and Meta-Analysis<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">QUADAS-2<span class="def-item-dt-sep"></span></dt><dd>Quality Assessment of Diagnostic Accuracy Studies-2<span class="def-item-dd-sep"></span></dd><dt id="def-item-15">SROC<span class="def-item-dt-sep"></span></dt><dd>summary receiver operative characteristic<span class="def-item-dd-sep"></span></dd><dt id="def-item-16">TN<span class="def-item-dt-sep"></span></dt><dd>true-negative<span class="def-item-dd-sep"></span></dd><dt id="def-item-17">TP<span class="def-item-dt-sep"></span></dt><dd>true-positive</dd></dl></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-financial-disclosure" id="fn-1"><p id="p-54"><a href="https://www.ajnr.org/sites/default/files/additional-assets/Disclosures/February%202025/0533.pdf">Disclosure forms</a> provided by the authors are available with the full text and PDF of this article at <a href="http://www.ajnr.org">www.ajnr.org</a>.</p></li></ul></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2025 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/early/2024/12/26/ajnr.A8440.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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