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Meta-Analysis
. 2017 Oct;27(10):4129-4144.
doi: 10.1007/s00330-017-4789-9. Epub 2017 Mar 22.

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

Bart R J van Dijken  1 , Peter Jan van Laar  1   2 , Gea A Holtman  3 , Anouk van der Hoorn  4   5
Affiliations
Meta-Analysis

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

Bart R J van Dijken et al. Eur Radiol. 2017 Oct.

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 high-grade 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). DSC-perfusion (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 high-grade gliomas.

Key points: • Treatment response assessment in high-grade gliomas with anatomical MRI is unreliable • Novel advanced MRI techniques have been studied, but diagnostic accuracy is unknown • Meta-analysis demonstrates that advanced MRI showed higher diagnostic accuracy than anatomical MRI • Highest diagnostic accuracy for spectroscopy and perfusion MRI • Supports the incorporation of advanced MRI in high-grade glioma treatment response assessment.

Keywords: Glioma; Magnetic resonance imaging; Magnetic resonance spectroscopy; Meta-analysis; Treatment response.

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Conflict of interest statement

Guarantor

The scientific guarantor of this publication is Anouk van der Hoorn, MD PhD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has received funding by a Mandema stipendium from the University of Groningen (AH).

Statistics and biometry

One of the authors, Gea A. Holtman, MSc of the department of general practice, University Medical Centre Groningen, has significant statistical expertise.

Ethical approval

Institutional Review Board approval was not required as this is not applicable for meta-analyses.

Informed consent

Written informed consent was not required for this study as this is not applicable for meta-analyses.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

Figures

Fig. 1
Fig. 1
Flow chart of included studies. Flow chart of included studies. Abbreviations: ADC = apparent diffusion coefficient; ASL = arterial spin labelling; DCE = dynamic contrast enhanced; DSC = dynamic susceptibility contrast; MRI = magnetic resonance imaging; MRS = magnetic resonance spectroscopy
Fig. 2
Fig. 2
Quality assessment of included studies. The risk of bias in four different domains and concerns about applicability are shown for the included studies. High risk (formula image), unclear risk (formula image) and low risk (formula image)
Fig. 3
Fig. 3
Forest plots with diagnostic accuracy of different MRI techniques. Diagnostic accuracy and the 2x2 table are displayed with true positives (TP), false positives (FP), false negatives (FN) and true negative (TN). Sensitivity and specificity with the 95% Confidence intervals (CI) are given
See this image and copyright information in PMC

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