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Review
. 2022 Oct 4;13(1):158.
doi: 10.1186/s13244-022-01295-4.

Diffusion imaging could aid to differentiate between glioma progression and treatment-related abnormalities: a meta-analysis

Rik van den Elshout  1 , Tom W J Scheenen  1 , Chantal M L Driessen  2 , Robert J Smeenk  3 , Frederick J A Meijer  1 , Dylan Henssen  4
Affiliations
Review

Diffusion imaging could aid to differentiate between glioma progression and treatment-related abnormalities: a meta-analysis

Rik van den Elshout et al. Insights Imaging. .

Abstract

Background: In a considerable subgroup of glioma patients treated with (chemo) radiation new lesions develop either representing tumor progression (TP) or treatment-related abnormalities (TRA). Quantitative diffusion imaging metrics such as the Apparent Diffusion Coefficient (ADC) and Fractional Anisotropy (FA) have been reported as potential metrics to noninvasively differentiate between these two phenomena. Variability in performance scores of these metrics and absence of a critical overview of the literature contribute to the lack of clinical implementation. This meta-analysis therefore critically reviewed the literature and meta-analyzed the performance scores.

Methods: Systematic searching was carried out in PubMed, EMBASE and The Cochrane Library. Using predefined criteria, papers were reviewed. Diagnostic accuracy values of suitable papers were meta-analyzed quantitatively.

Results: Of 1252 identified papers, 10 ADC papers, totaling 414 patients, and 4 FA papers, with 154 patients were eligible for meta-analysis. Mean ADC values of the patients in the TP/TRA groups were 1.13 × 10-3mm2/s (95% CI 0.912 × 10-3-1.32 × 10-3mm2/s) and 1.38 × 10-3mm2/s (95% CI 1.33 × 10-3-1.45 × 10-3mm2/s, respectively. Mean FA values of TP/TRA was 0.19 (95% CI 0.189-0.194) and 0.14 (95% CI 0.137-0.143) respectively. A significant mean difference between ADC and FA values in TP versus TRA was observed (p = 0.005).

Conclusions: Quantitative ADC and FA values could be useful for distinguishing TP from TRA on a meta-level. Further studies using serial imaging of individual patients are warranted to determine the role of diffusion imaging in glioma patients.

Keywords: Apparent diffusion coefficient; Fractional anisotropy; Glioblastoma; Treatment-related abnormalities; Tumor progression.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA 2020 Flow Diagram
Fig. 2
Fig. 2
a Barplot of risk of bias and applicability concerns across all ADC studies assessed by QUADAS2. b Barplot of risk of bias and applicability concerns across all FA studies assessed by QUADAS2
Fig. 3
Fig. 3
Forest plot of included studies on ADC metrics
Fig. 4
Fig. 4
Summary receiver operator characteristics plot of sensitivity and 1-specificity ratios of the included studies
Fig. 5
Fig. 5
Forest plot of included studies on FA metrics
Fig. 6
Fig. 6
Summary receiver operator characteristics plot of sensitivity and 1-specificity ratios of the included studies
See this image and copyright information in PMC

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