The value of arterial spin labelling in adults glioma grading: systematic review and meta-analysis

Abstract

This study aimed to evaluate the diagnostic performance of arterial spin labelling (ASL) in grading of adult gliomas. Eighteen studies matched the inclusion criteria and were included after systematic searches through EMBASE and MEDLINE databases. The quality of the included studies was assessed utilizing Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The quantitative values were extracted and a meta-analysis was subsequently based on a random-effect model with forest plot and joint sensitivity and specificity modelling. Hierarchical summary receiver operating characteristic (HROC) curve analysis was also conducted. The absolute tumour blood flow (TBF) values can differentiate high-grade gliomas (HGGs) from low-grade gliomas (LGGs) and grade II from grade IV tumours. However, it lacked the capacity to differentiate grade II from grade III tumours and grade III from grade IV tumours. In contrast, the relative TBF (rTBF) is effective in differentiating HGG from LGG and in glioma grading. The maximum rTBF (rTBFmax) demonstrated the best results in glioma grading. These results were also reflected in the sensitivity/specificity analysis in which the rTBFmax showed the highest discrimination performance in glioma grading. The estimated effect size for the rTBF was approximately similar between HGGs and LGGs, and grade II and grade III tumours, (–1.46 (–2.00, –0.91), p-value < 0.001), (–1.39 (–1.89, –0.89), p-value < 0.001), respectively; while it exhibited smaller effect size between grade III and grade IV (–1.05 (–1.82, –0.27)), p < 0.05). Sensitivity and specificity analysis replicate these results as well. This meta-analysis suggests that ASL is useful for glioma grading, especially when considering the rTBFmax parameter.

ASL-Perfusion for Intrinsic Brain Tumor Diagnosis. Analysis of 253 Patients.

“…Studies using small-size ROI and VOI demonstrated higher sensitivity and speci city in distinguishing LGG and HGG. According to meta-analysis performed by Alsaedi et al (2019) maxTBF was proved to be more informative rather than meanTBF in differentiating cerebral glioma grades.…”

3D pCASL-perfusion in preoperative assessment of brain gliomas in large cohort of patients

“…All studies with small-size ROI and VOI demonstrated higher sensitivity and specificity in distinguishing of low- and high-grade gliomas. According to a meta-analysis performed by Alsaedi et al 33 , maxTBF has been proven to be more informative than mean TBF in differentiating between cerebral glioma grades. We have acquired the same results in our study as well.…”

The Added Value of Inflow-Based Vascular-Space-Occupancy and Diffusion-Weighted Imaging in Preoperative Grading of Gliomas

“…Endothelial neovascularization is an important histopathologic feature that reflects glioma malignancy [27] and increased vascularity is typically associated with a higher tumor grade and aggressiveness [5,7,[28][29][30]. PWI techniques, such as DSC-MRI and ASL-MRI, have been widely used for the assessment of tumoral vascularity in vivo [31] and help to preoperatively predict grading of gliomas [1,7,25,[32][33][34][35][36][37]. Maia et al [30] found that quantitative perfusion measurements predicted tumor biologic activity and survival better than histopathologic grade did.…”