The diagnostic performance of perfusion MRI for differentiating glioma recurrence from pseudoprogression

Abstract

Background:The purpose of this meta-analysis was to evaluate the diagnostic accuracy of perfusion magnetic resonance imaging (MRI) as a method for differentiating glioma recurrence from pseudoprogression.Methods:The PubMed, Embase, Cochrane Library, and Chinese Biomedical databases were searched comprehensively for relevant studies up to August 3, 2016 according to specific inclusion and exclusion criteria. The quality of the included studies was assessed according to the quality assessment of diagnostic accuracy studies (QUADAS-2). After performing heterogeneity and threshold effect tests, pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated. Publication bias was evaluated visually by a funnel plot and quantitatively using Deek funnel plot asymmetry test. The area under the summary receiver operating characteristic curve was calculated to demonstrate the diagnostic performance of perfusion MRI.Results:Eleven studies covering 416 patients and 418 lesions were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.88 (95% confidence interval [CI] 0.84–0.92), 0.77 (95% CI 0.69–0.84), 3.93 (95% CI 2.83–5.46), 0.16 (95% CI 0.11–0.22), and 27.17 (95% CI 14.96–49.35), respectively. The area under the summary receiver operating characteristic curve was 0.8899. There was no notable publication bias. Sensitivity analysis showed that the meta-analysis results were stable and credible.Conclusion:While perfusion MRI is not the ideal diagnostic method for differentiating glioma recurrence from pseudoprogression, it could improve diagnostic accuracy. Therefore, further research on combining perfusion MRI with other imaging modalities is warranted.

Advanced ADC Histogram, Perfusion, and Permeability Metrics Show an Association with Survival and Pseudoprogression in Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium

“…While most previous studies have retrospectively compared diffusion and perfusion properties of pseudoprogression and true progression groups at the time of radiologic progression, 7,9,36,38,39 our results show post-RT changes in ADC histograms that precede radiologic progression and could be used to predict pseudoprogression. A recent report by Calmon et al 37 found differences in post-RT changes in DSC perfusion between pseudoprogression and true progression groups, confirming the usefulness of looking at post-RT changes in DIPG as a predictive radiologic marker of pseudoprogression.…”

“…Poly (adenosine diphospate ribose) polymerase (PARP) inhibitors such as veliparib have been shown to overcome TMZ resistance while also increasing radiosensitivity. 4,5 Advanced ADC histogram metrics have been shown to correlate with survival 6 in DIPG, whereas perfusion and permeability metrics have shown associations with survival as well as pseudoprogression [7][8][9] in pediatric and adult gliomas. We therefore explored the utility of these imaging metrics to predict pseudoprogression versus early true progression.…”

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.…”

“…2). 30,32,33 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).…”

Neuroimaging of Brain Tumors: Pseudoprogression, Pseudoresponse, and Delayed Effects of Chemotherapy and Radiation

“…12 Advanced imaging modalities (e.g., perfusion MRI, diffusion tensor imaging, and dynamic susceptibility contrast MRI) are currently under clinical investigation in an attempt to improve the diagnostic accuracy of identifying pseudoprogression. [53][54][55] Taken together, pseudoprogression likely represents a unique scenario encountered in patients with malignant glioma treated with radiation and chemotherapy. The pathophysiology of pseudoprogression is not well understood, and the clinical and radiographic course may be different from what is described for delayed onset of cerebral radiation necrosis.…”