Relationship Between Diabetic Chorea and Timing of MRI Findings: A Systematic Review with Case Reports

Figures & data

Figure 1 Magnetic resonance imaging (MRI) on the day of examination (a) and 14 days later (b).

Figure 2 Study screening and selection flow chart.

Table 1 Basic Information of All Patients

Case No	Sex	Age (Year)	Duration of Diabetes Mellitus	Glucose (mg/dL)	HbA1c	Plasma Osmolality (mOsm/L)	Side of Involuntary Movement (L,R,Bi)	Time to First MRI (After Onset or Consultation)	First MRI Lesion (T1 Hyperintense) (R/L,P,C,G,B)	Time to Follow-Up MRI	F/U MRI Lesion (T1 Hyperintense) (R/L,P,C,G,B)	Course	Study
1	F	77	0	NA	NA	NA	R	3 months	Bi,P	11 months	Resolution	Improved	Nagai et al (1995)^Citation6
2	M	69	Unknown	597	NA	NA	L	4 days	R,C	3 weeks	R,P,C,G, more clear	Worse	Broderick et al (1995)^Citation7)
3	M	66	2 years	300	NA	310	R	6 days	L,C	6 months	Diminished	Improved	Lai et al (1996)^Citation8
4	M	78	3 years	245	NA	296	Bi	7 days	Bi,P,C,G	6 months	Diminished	Improved
5	M	67	NA	337	NA	302	R	NA	L,P	6 months	Diminished	Improved
6	NA	62	NA	688	NA	NA	L→Bi	1 month	R,P,C,G, Cerebral peduncle, internal capsule	26 months	Diminished	Improved	Shan et al (1998)^Citation9
7	M	64	1 year	567	17.3%	301	L	11 days	R,P,C	58 days	More clear	Worse	Iwata et al (1999)^Citation10
8	M	90	20 years	144	8.3%	NA	L	NA	R,B	5 months	Diminished	Improved	Free et al (1999)^Citation11
9	F	22	NA	527	11.1%	299	L	4 days	R,P,C	4 months	More clear	Worse	Oerlemans et al (1999)^Citation12
10	M	92	Unknown	320	17.4%	NA	L	24 days	R,P,G	71 days	Diminished	Improved	Ohara et al (2001)^Citation13
11	F	60	Unknown	365	NA	NA	R	NA	L,P	6 months	Normal	Improved	Lin et al (2001)^Citation14
12	F	69	7 years	348	9.5%	NA	L	4 days	R,P,C,G	17 days	Unchanged	Unchanged	Chu et al (2002)^Citation15
13	F	74	15 years	264	9.7%	NA	L	NA	R,P	2 months	Diminished	Improved	Leeet al (2002)^Citation16
14	F	63	10 years	1080	NA	375	Bi	NA	Bi,P	4 months	Diminished	Improved	Higa et al (2004)^Citation17
15	F	28	6 years	481	12.2%	NA	L	NA	Bi,P,C	3 months	Unchanged	Unchanged	Kang et al (2005)^Citation18
16	M	65	3 years	96	10.9%	NA	R	NA	L,P,C	3 months	Diminished	Improved	Nakano et al (2005)^Citation19
17	F	81	0	505	13.3%	334.3	Bi	NA	Normal	5 months	Normal	Unchanged	Branca et al (2005)^Citation20
18	M	81	Unknown	NA	NA	NA	L	4 weeks	R,P	6 months	Resolution	Improved	Pisani et al (2005)^Citation21
19	F	72	Unknown	507	NA	NA	R→Bi	NA	Bi(R>L),P	6 months	Diminished	Improved
20	F	78	8 years	473	18%	NA	L	12 days	Bi,B	25 days	More clear	Worse	Chung et al (2005)^Citation22
21	F	85	30 years	324	14.8%	NA	L→Bi	6 days	R,P	1.5 months	Diminished	Improved	Ohmori et al (2005)^Citation23
22	M	70	0	560	6.6%	332	L	NA	R,P	9 months	Resolution	Improved	Felicio et al (2008)^Citation24
23	F	78	0	463	10%	NA	L	3 days	R,P	1 year	Resolution	Improved	Battisti et al (2009)^Citation25
24	F	80	0	121	8%	NA	L	33 days	R,P,G	4 months	Diminished	Improved
25	F	82	0	445	NA	NA	L	14 days	R,G	1 month	R,P,G	Worse	Wang et al (2009)^Citation26
26	F	77	0	459	NA	NA	R	2 days	L,P	13 months	Resolution	Improved
27	M	37	Unknown	NA	NA	NA	R	NA	L,P	3 months	Unchanged	Unchanged	Duker et al (2010)^Citation27
28	F	63	10 years	1067	14.5	388	Bi	1 year	Bi,G	4 months	R more clear, L diminished	Improved	Higa et al (2010)^Citation28
29	F	98	3 years	589	11.4	314	L	NA	R,G	3 months	Unchanged	Improved
30	F	82	0	220	14.5%	320	Bi	NA	Bi,P,G	2 weeks	Resolution	Improved	Massaro et al (2012)^Citation29
31	F	77	NA	632	19%	NA	L	4 days	R,P,C	19 days	More clear	Worse	Hashimoto et al (2012)^Citation30
32	F	78	NA	455	14.4%	NA	L	3 days	Bi, P,C,G	35 days	More clear	Worse
33	F	76	0	439.6	17.3%	NA	R	NA	L,P,C,G	2 months	More clear	Worse	Padmanabhan et al (2013)^Citation31
34	F	78	NA	567	13.90%	NA	L	5 days	R,B	3 months	More clear	Worse	Kaseda et al (2013)^Citation32
35	F	74	20 years	180	10.7%	299	L	NA	R,P	1 year	Diminished	Improved	Guo et al (2014)^Citation33
36	F	82	0	239	9.5%	313	R	NA	L,P,C	18 months	diminished	Improved
37	F	85	Unknown	500	16.2%	NA	Bi	NA	Bi,P	4 months	Resolution	Improved	Lin et al (2014)^Citation34
38	M	82	NA	374	11.5%	NA	L	NA	R,P,C	1 month	Diminished	Improved	Nagai et al (2015)^Citation35
39	F	14	0	349	NA	313.2	L	1 month	R,P,C	4 years	Diminished	Improved	Aquino et al (2015)^Citation36
40	F	55	Unknown	540	NA	NA	L	NA	R,B	NA	Diminished	Improved	Patel et al (2015)^Citation37
41	M	61	0	527	10.3%	NA	L→Bi	NA	R,P	2 months	Unchanged	Unchanged	Ray et al (2015)^Citation38
42	F	68	Unknown	500	15.8%	NA	Bi(L>R)	9 days	R,P,C,G	13 months	Diminished	Improved	Teodoro et al (2015)^Citation39
43	M	86	Unknown	306	11.9%	303.3	L	NA	R,P,C	9 months	Unchanged	Unchanged	Lancellotti et al (2015)^Citation40
44	F	57	NA	NA	15.9%	NA	L	2 days	R,B	1 month	More clear	Worse	Suárez-Vega et al (2016)^Citation41
45	M	52	0	356	16.2%	291	L	NA	R,P,C	6 months	Resolution	Improved	Roy et al (2016)^Citation42
46	F	71	Unknown	822	16.0%	343	Bi	NA	Bi,P,G	1 month	Resolution	Improved	Yu et al (2017)^Citation43
47	M	85	9 years	102	8.1%	NA	R	1 month	L,P,G	2 months	More clear	Worse	Kitagawa et al (2017)^Citation44
48	M	58	0	549	16.1%	311	No involuntary movement	7 days	L,P,C	24 days	Unchanged	Unchanged	Sato et al (2017)^Citation45
49	F	46	11 years	536	15.7%	335	L	NA	R,P,G	16 months	Diminished	Improved	Son et al (2017)^Citation46
50	F	57	NA	NA	14%	NA	L	1 month	R,C,B	5 years	Resolution	Improved	Lucassen et al (2017)^Citation47
51	F	76	20 years	558.6	10.5%	NA	R	NA	Bi,P	5 months	Diminished	Improved	Fong et al (2019)^Citation48
52	F	69	15 years	NA	NA	NA	R	40 days	L,B	3.5 months	Diminished	Improved	Lin et al (2019)^Citation49
53	M	83	NA	505	15.7%	NA	L	7 days	Bi,P,C	3 weeks	Diminished	Improved	Marinelli et al (2019)^Citation50
54	F	58	>20 years	219	14.5%	NA	R	2 months	L,P,G	14 days	More clear	Worse	Zheng et al (2020)^Citation51
55	F	65	10 years	270	16.8%	NA	L	3 months	R,B	6 months	Unchanged	Unchanged	Wang et al (2020)^Citation52
56	M	61	15 years	414	NA	NA	R	NA	L,P,C	3 weeks	Unchanged	Unchanged	Kammeyer et al (2020)^Citation53
57	M	78	Unknown	167	11.1%	NA	L	NA	R,B	NA	More clear	Worse	Chakales et al (2020)^Citation54
58	F	70	0	428	15.2%	NA	L	4 months	R,P,C	6 months	Diminished	Improved	Currò et al (2021)^Citation55
59	F	54	Recent	416	9%	NA	R→Bi	NA	L,B	4 months	More clear	Worse	Zhao et al (2021)^Citation56
60	F	56	Recent	167	14%	NA	L	NA	R,P,C	4 months	Diminished	Improved	Scamarcia et al (2021)^Citation57
61	F	85	6 weeks	1035	14.60%	311 (6 weeks before onset)	NA	NA	R,P	6 months	Normal	Improved	Kataja Knight et al (2021)^Citation58
62	F	62	3 years	776	15.8%	NA	L	4 days	Normal	1 month	R,P,C,G	Worse	Rupp et al (2021)^Citation59
63	F	54	Unknown	416	18%	NA	L	1 month	R,B	1 month later during current hospitalization	More clear	Worse	Nelson et al (2021)^Citation60
64	F	91	Unknown	460	14%	NA	L	NA	R,P,G	6 months	Resolution	Improved	Maia et al (2021)^Citation61

Abbreviations: M, male; F, female; NA, not available; L, left; R, right; Bi, bilateral; P, putamen; C, caudate; G, globus pallidus; B, basal ganglia.

Table 2 Charceristics of Patients Between Unchanged, Worsened and Improved Groups

	Unchanged	Worsened	Improved	Significance
	n=10	n=16	n=37
Age (years)	64.4 (21.2)	67.0 (15.9)	71.2 (14.9)	0.425
Sex	M 5, F 5	M 4, F 12	M 11, F 25	0.392*
Duration of diabetes mellitus (years)	5.2 (5.4)	7.5 (7.2)	6.6 (9.0)	0.852
Glucose	443 (114)	453 (180)	426 (232)	0.904
HbA1c (%)	12.7 (2.6)	14.5 (3.5)	12.9 (3.1)	0.263
Side of involuntary movement (n)	Bi 2, L 5, R 2	Bi 1, L 12, R 3	Bi 9, L 18, R 9	0.490*
Time to first MRI (days)	33.7 (48.8)	14.1 (16.8)	29.1 (32.7)	0.323
Time to follow-up MRI (months)	3.3 (2.7)	1.8 (1.2)	9.4 (12.3)	0.023

Note: *Statistical analyses were performed using Chi square test and others were using ANOVA.

Abbreviations: Bi, bilateral; L, left; R, right.

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