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Reliability and validity of the total cerebral small vessel disease score: a systematic review and meta-analysis
Guilherme Diogo Silva1, João Paulo Mota Telles1, Carolina de Medeiros Rimkus2
1Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Insights
The total cerebral small vessel disease (tSVD) score shows good reliability for research on stroke and dementia. Its use is supported, though rater and patient factors may influence results.
Area of Science:
- Neurology
- Radiology
- Medical Research
Background:
- Cerebral small vessel disease (CSVD) is a key research area for reducing stroke and dementia.
- The total CSVD score (tSVD) offers a comprehensive measure of CSVD burden.
- Previous reviews have not systematically assessed the tSVD score's reliability and validity.
Purpose of the Study:
- To systematically review the inter-rater and intra-rater reliability of the tSVD score and its components.
- To examine the associations between the tSVD score and demographic/clinical factors like age, hypertension, stroke, and cognitive impairment.
Main Methods:
- Systematic literature search of PubMed/MEDLINE, Embase, and Scopus databases.
- Inclusion of studies reporting reliability metrics or associations with clinical factors for the tSVD score.
- Meta-analysis of Cohen's kappa coefficients for reliability and summarization of association studies.
Main Results:
- High inter-rater reliability (kappa 0.79-0.82) and intra-rater reliability (kappa 0.78-0.84) were found for tSVD features.
- Significant heterogeneity was observed in inter-rater reliability, potentially due to rater, age, and median tSVD score.
- Numerous studies confirmed associations between tSVD scores and age, hypertension, stroke, and cognitive impairment.
Conclusions:
- The tSVD score demonstrates reliable intra-rater and inter-rater performance, supporting its use in CSVD research.
- Factors such as rater characteristics, participant age, and median tSVD score may impact inter-rater reliability.
- The tSVD score's validity is supported by its associations with key clinical outcomes and risk factors.
Introduction:
Cerebral small vessel disease (CSVD) is a research priority to reduce the burden of stroke and dementia. The total cerebral small vessel disease (tSVD) score provides a global view of CSVD burden combining lacunes of presumed vascular origin, cerebral microbleeds, enlarged perivascular spaces, and white matter hyperintensities of presumed vascular origin. While its use in research is expanding, a systematic review of the tSVD score's reliability and validity had not yet been undertaken. We reviewed the inter-rater and intra-rater reliability for the tSVD score and its features. We also examined the associations between the tSVD score and age, hypertension, stroke and cognitive impairment.
Methods:
We performed a systematic review of studies on Pubmed/MEDLINE, Embase, and Scopus databases from inception until June 21st, 2024. We included manuscripts that reported at least one of the following metrics for the tSVD or for its components: inter-rater reliability, intra-rater reliability, or associations with age, hypertension, stroke, and/or cognitive impairment. We provided summary Cohen's kappa coefficients for inter and intra-rater reliability for each feature of the tSVD score. Subgroup analysis and meta-regression models were used to evaluate the impact of raters, MRI fields, age, and median tSVD score values in inter-rater reliability. We summarized studies reporting associations between the tSVD score, stroke and cognitive impairment.
Results:
The summary Cohen's kappa values for inter-rater reliability ranged from 0.79 to 0.82 for each CSVD feature (13 studies, 8,177 participants). We found a high heterogeneity between studies (I2 = 94%), which may be explained by differences in rater, age, and median tSVD score. The summary Cohen's kappa values for intra-rater reliability ranged from 0.78 to 0.84 (four studies, 250 cases were randomized from 3,654 participants). Heterogeneity was low. Seven studies (6,022 participants) reported associations between tSVD scores and either age or hypertension. Fifteen studies (6,941 participants) reported associations between tSVD scores and either stroke or cognitive impairment.
Conclusion:
The intra-rater reliability, inter-rater reliability, and construct validity of each feature of the tSVD support the use of this scale in CSVD research. However, inter-rater reliability might be influenced by rater characteristics, the median tSVD score, and participant age.
Systematic Review Registration:
https://www.crd.york.ac.uk/prospero/, identifier CRD42022372599.
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