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

Sachi Okuchi,Antonio Rojas‐Garcia,Eser Sanverdi,Jurgita Ušinskienė,Sotirios Bisdas,Stefanie Thust,Sara M Hassanein,Jasmina Panovska‐Griffiths,Martin Lewis,Ingeborg Lopez,Xavier Golay,Agne Ulyte

doi:10.1002/cam4.2369

Abstract

BackgroundT1‐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.MethodsWe 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.ResultsTwenty‐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.ConclusionsDynamic 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.

Highlights

Gliomas account for approximately 28% of all central nervous system tumors and 80% of all malignant brain tumors.[1]
We have explored whether using dynamic contrast‐enhanced (DCE) measurements can successfully differentiate low‐grade glioma (LGG) from high‐grade glioma (HGG), tumor recurrence from treatment‐related changes, and Primary central nervous system lymphoma (PCNSL) from HGGs
* One study was categorized into both HGGs vs LGGs and PCNSLs vs HGGs subgroups

Summary

Introduction

Gliomas account for approximately 28% of all central nervous system tumors and 80% of all malignant brain tumors.[1]. The present standard therapy of HGGs is surgical resection and concomitant chemoradiation.[4] Chemoradiation may knowingly result in radiation necrosis and pseudoprogression, which may notoriously resemble recurrence and tumor progression.[5] it is crucially important to utilize a noninvasive imaging technique that can differentiate them for the patient management. 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 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

Methods

Results

Conclusion