Diagnostic accuracy of magnetic resonance imaging techniques for treatment response evaluation in patients with high-grade glioma, a systematic review and meta-analysis

Abstract

Objective Treatment response assessment in high-grade gliomas uses contrast enhanced T1-weighted MRI, but is unreliable. Novel advanced MRI techniques have been studied, but the accuracy is not well known. Therefore, we performed a systematic meta-analysis to assess the diagnostic accuracy of anatomical and advanced MRI for treatment response in highgrade gliomas. Methods Databases were searched systematically. Study selection and data extraction were done by two authors independently. Meta-analysis was performed using a bivariate random effects model when ≥5 studies were included. Results Anatomical MRI (five studies, 166 patients) showed a pooled sensitivity and specificity of 68% (95%CI 51-81) and 77% (45-93), respectively. Pooled apparent diffusion coefficients (seven studies, 204 patients) demonstrated a sensitivity of 71% (60-80) and specificity of 87% (77-93). DSCperfusion (18 studies, 708 patients) sensitivity was 87% (82-91) with a specificity of 86% (77-91). DCE-perfusion (five studies, 207 patients) sensitivity was 92% (73-98) and specificity was 85% (76-92). The sensitivity of spectroscopy (nine studies, 203 patients) was 91% (79-97) and specificity was 95% (65-99). Conclusion Advanced techniques showed higher diagnostic accuracy than anatomical MRI, the highest for spectroscopy, supporting the use in treatment response assessment in highgrade gliomas.

Perfusion MRI in treatment evaluation of glioblastomas: Clinical relevance of current and future techniques

“…) than treatment effects (Fig. ) . rCBV is high in tumor, as it is reflective of the tumor hyperperfusion volume.…”

“…Other DSC‐derived parameters such as peak height and percentage of signal recovery were significantly higher in tumor progression than pseudoprogression . However, these parameters were all outperformed by rCBV …”

“…Perfusion MRI is more reliable than conventional MRI in the differentiation between pseudoprogression and tumor progression. A recent meta‐analysis demonstrated a pooled sensitivity and specificity of 87% (95% CI 82–91) and 86% (77–91) for DSC and 92% (73–98) and 85% (76–92) for DCE, respectively . The limited studies available for ASL to differentiate tumor progression from pseudoprogression showed a sensitivity ranging from 52–79% and a specificity ranging from 64–82% .…”

“…A recent meta‐analysis demonstrated a pooled sensitivity and specificity of 87% (95% CI 82–91) and 86% (77–91) for DSC and 92% (73–98) and 85% (76–92) for DCE, respectively . The limited studies available for ASL to differentiate tumor progression from pseudoprogression showed a sensitivity ranging from 52–79% and a specificity ranging from 64–82% . A table listing key information of included clinical studies/surveys such as authors, study design including MRI techniques and patient population, major findings, and year of publication can be found in our recent meta‐analysis …”

“…rCBV is high in tumor, as it is reflective of the tumor hyperperfusion volume. However, the optimum rCBV threshold for differentiating between tumor and treatment effects varies significantly between studies (range 0.71–3.7) . rCBF can also be collected with DSC imaging but is not often applied in neuro‐oncology treatment evaluation.…”