Abstract
The value of arterial spin-labeling in a pediatric population has not been assessed in a meta-analysis. Our aim was to assess the diagnostic accuracy of arterial spin-labeling-derived cerebral blood flow to discriminate low- and high-grade tumors. MEDLINE, EMBASE, the Web of Science Core Collection, and the Cochrane Library were used. Pediatric patients with arterial spin-labeling MR imaging with verified neuropathologic diagnoses were included. Relative CBF and absolute CBF and tumor grade were extracted, including sequence-specific information. Mean differences in CBF between low- and high-grade tumors were calculated. Study quality was assessed. Data were aggregated using the bivariate summary receiver operating characteristic curve model. Heterogeneity was explored with meta-regression and subgroup analyses. The study protocol was published at PROSPERO (CRD42017075055). Eight studies encompassing 286 pediatric patients were included. The mean differences in absolute CBF were 29.62 mL/min/100 g (95% CI, 10.43-48.82 mL/min/100 g), I2 = 74, P = .002, and 1.34 mL/min/100 g (95% CI, 0.95-1.74 mL/min/100 g), P < .001, I2 = 38 for relative CBF. Pooled sensitivity for relative CBF ranged from 0.75 to 0.90, and specificity, from 0.77 to 0.92 with an area under curve = 0.92. Meta-regression showed no moderating effect of sequence parameters TE, TR, acquisition time, or ROI method. Included tumor types, analysis method, and original data varied among included studies. Arterial spin-labeling-derived CBF measures showed high diagnostic accuracy for discriminating low- and high-grade tumors in pediatric patients with brain tumors. The relative CBF showed less variation among studies than the absolute CBF.
Highlights
The value of arterial spin-labeling in a pediatric population has not been assessed in a meta-analysis.PURPOSE: Our aim was to assess the diagnostic accuracy of arterial spin-labeling– derived cerebral blood flow to discriminate low- and high-grade tumors.DATA SOURCES: MEDLINE, EMBASE, the Web of Science Core Collection, and the Cochrane Library were used.STUDY SELECTION: Pediatric patients with arterial spin-labeling MR imaging with verified neuropathologic diagnoses were included.DATA ANALYSIS: Relative CBF and absolute CBF and tumor grade were extracted, including sequence-specific information
The study selection is presented in the On-line Figure 1
Bivariate meta-regression found no moderating effect on the outcome by TE, TR, or acquisition time (P Ͼ .05). This meta-analysis found an aggregated high diagnostic accuracy for cerebral blood flow measurements derived from arterial spin-labeling (ASL) MR imaging to discriminate low-grade tumors (LGTs) and high-grade tumors (HGTs) in pediatric patients
Summary
The value of arterial spin-labeling in a pediatric population has not been assessed in a meta-analysis.PURPOSE: Our aim was to assess the diagnostic accuracy of arterial spin-labeling– derived cerebral blood flow to discriminate low- and high-grade tumors.DATA SOURCES: MEDLINE, EMBASE, the Web of Science Core Collection, and the Cochrane Library were used.STUDY SELECTION: Pediatric patients with arterial spin-labeling MR imaging with verified neuropathologic diagnoses were included.DATA ANALYSIS: Relative CBF and absolute CBF and tumor grade were extracted, including sequence-specific information. The value of arterial spin-labeling in a pediatric population has not been assessed in a meta-analysis. PURPOSE: Our aim was to assess the diagnostic accuracy of arterial spin-labeling– derived cerebral blood flow to discriminate low- and high-grade tumors. DATA SOURCES: MEDLINE, EMBASE, the Web of Science Core Collection, and the Cochrane Library were used. STUDY SELECTION: Pediatric patients with arterial spin-labeling MR imaging with verified neuropathologic diagnoses were included. DATA ANALYSIS: Relative CBF and absolute CBF and tumor grade were extracted, including sequence-specific information. Mean differences in CBF between low- and high-grade tumors were calculated.
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