Diagnostic accuracy of dynamic contrast‐enhanced perfusion MRI in stratifying gliomas: A systematic review and meta‐analysis

Abstract

Background T1‐weighted dynamic contrast‐enhanced (DCE) perfusion magnetic resonance imaging (MRI) has been broadly utilized in the evaluation of brain tumors. We aimed at assessing the diagnostic accuracy of DCE‐MRI in discriminating between low‐grade gliomas (LGGs) and high‐grade gliomas (HGGs), between tumor recurrence and treatment‐related changes, and between primary central nervous system lymphomas (PCNSLs) and HGGs. Methods We performed this study based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis of Diagnostic Test Accuracy Studies criteria. We systematically surveyed studies evaluating the diagnostic accuracy of DCE‐MRI for the aforementioned entities. Meta‐analysis was conducted with the use of a random effects model. Results Twenty‐seven studies were included after screening of 2945 possible entries. We categorized the eligible studies into three groups: those utilizing DCE‐MRI to differentiate between HGGs and LGGs (14 studies, 546 patients), between recurrence and treatment‐related changes (9 studies, 298 patients) and between PCNSLs and HGGs (5 studies, 224 patients). The pooled sensitivity, specificity, and area under the curve for differentiating HGGs from LGGs were 0.93, 0.90, and 0.96, for differentiating tumor relapse from treatment‐related changes were 0.88, 0.86, and 0.89, and for differentiating PCNSLs from HGGs were 0.78, 0.81, and 0.86, respectively. Conclusions Dynamic contrast‐enhanced‐Magnetic resonance imaging is a promising noninvasive imaging method that has moderate or high accuracy in stratifying gliomas. DCE‐MRI shows high diagnostic accuracy in discriminating between HGGs and their low‐grade counterparts, and moderate diagnostic accuracy in discriminating recurrent lesions and treatment‐related changes as well as PCNSLs and HGGs.

Hemodynamic Imaging in Cerebral Diffuse Glioma—Part B: Molecular Correlates, Treatment Effect Monitoring, Prognosis, and Future Directions

“…Okuchi et al meta-analyzed nine studies for a total of 179 TR and 119 treatment-related changes. They found there to be a pooled sensitivity and specificity of 0.88 and 0.86, respectively, and an AUC of 0.89 [ 108 ]. ASL has been less investigated.…”

High-Grade Glioma Treatment Response Monitoring Biomarkers: A Position Statement on the Evidence Supporting the Use of Advanced MRI Techniques in the Clinic, and the Latest Bench-to-Bedside Developments. Part 1: Perfusion and Diffusion Techniques

“…Supplementary Table S2 shows studies of diagnostic accuracy for differentiating disease progression related and treatment-related effects. Two partially overlapping meta-analyses ( 56 , 88 ) calculated pooled sensitivity and specificity of 88–89% and 85–86%, respectively, based in combination on a total of 10 studies published from 2011 to 2015 including 371 patients. It is noteworthy that the diagnostic accuracy was higher in studies with model independent analysis ( 88 ) than in studies with two- or three-parameter models, while most recent studies (and clinical practice) typically employ three-parameter models.…”

MRI biomarkers in neuro-oncology

“…The QIBA claim for K trans in the brain is that a longitudinal change of 21.3% of more can be attributed to true change rather than measurement error, noting that this is based on very limited literature 70,71 . This can also been seen from table 2, where only few DCE studies were identified in various meta-analyses, not allowing for reliable quantitative analyses and/or determination of thresholds 72 .…”