Umbrella review and network meta-analysis of diagnostic imaging test accuracy studies in Differentiating between brain tumor progression versus pseudoprogression and radionecrosis

Affiliations

¹ Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA.
² Diagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
³ Tiradentes University Medical School, Maceió, AL, Brazil.
⁴ SUNY Downstate HSC and University, Brooklyn, NY, USA.
⁵ Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
⁶ Radiology Department, Fortaleza General Hospital, Fortaleza, Brazil.
⁷ The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA.
⁸ Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA. lluna6@jhmi.edu.

PMID: 38212574
DOI: 10.1007/s11060-023-04528-8

Umbrella review and network meta-analysis of diagnostic imaging test accuracy studies in Differentiating between brain tumor progression versus pseudoprogression and radionecrosis

Richard Dagher et al. J Neurooncol. 2024 Jan.

. 2024 Jan;166(1):1-15.

doi: 10.1007/s11060-023-04528-8. Epub 2024 Jan 11.

Affiliations

¹ Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA.
² Diagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
³ Tiradentes University Medical School, Maceió, AL, Brazil.
⁴ SUNY Downstate HSC and University, Brooklyn, NY, USA.
⁵ Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
⁶ Radiology Department, Fortaleza General Hospital, Fortaleza, Brazil.
⁷ The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA.
⁸ Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA. lluna6@jhmi.edu.

PMID: 38212574
DOI: 10.1007/s11060-023-04528-8

Erratum in

Correction to: Umbrella review and network meta-analysis of diagnostic imaging test accuracy studies in differentiating between brain tumor progression versus pseudoprogression and radionecrosis.
Dagher R, Gad M, da Silva de Santana P, Sadeghi MA, Yewedalsew SF, Gujar SK, Yedavalli V, Köhler CA, Khan M, Fernandes Tavora DG, Olayinka Kamson D, Sair HI, Luna LP. Dagher R, et al. J Neurooncol. 2024 Aug;169(1):219. doi: 10.1007/s11060-024-04718-y. J Neurooncol. 2024. PMID: 38858340 No abstract available.

Abstract

Purpose: In this study we gathered and analyzed the available evidence regarding 17 different imaging modalities and performed network meta-analysis to find the most effective modality for the differentiation between brain tumor recurrence and post-treatment radiation effects.

Methods: We conducted a comprehensive systematic search on PubMed and Embase. The quality of eligible studies was assessed using the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) instrument. For each meta-analysis, we recalculated the effect size, sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio from the individual study data provided in the original meta-analysis using a random-effects model. Imaging technique comparisons were then assessed using NMA. Ranking was assessed using the multidimensional scaling approach and by visually assessing surface under the cumulative ranking curves.

Results: We identified 32 eligible studies. High confidence in the results was found in only one of them, with a substantial heterogeneity and small study effect in 21% and 9% of included meta-analysis respectively. Comparisons between MRS Cho/NAA, Cho/Cr, DWI, and DSC were most studied. Our analysis showed MRS (Cho/NAA) and 18F-DOPA PET displayed the highest sensitivity and negative likelihood ratios. 18-FET PET was ranked highest among the 17 studied techniques with statistical significance. APT MRI was the only non-nuclear imaging modality to rank higher than DSC, with statistical insignificance, however.

Conclusion: The evidence regarding which imaging modality is best for the differentiation between radiation necrosis and post-treatment radiation effects is still inconclusive. Using NMA, our analysis ranked FET PET to be the best for such a task based on the available evidence. APT MRI showed promising results as a non-nuclear alternative.

Keywords: Network meta-analysis; Pseudoprogression; Radiation necrosis; Radionecrosis; Tumor recurrence.

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References

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Umbrella review and network meta-analysis of diagnostic imaging test accuracy studies in Differentiating between brain tumor progression versus pseudoprogression and radionecrosis

Affiliations

Umbrella review and network meta-analysis of diagnostic imaging test accuracy studies in Differentiating between brain tumor progression versus pseudoprogression and radionecrosis

Authors

Affiliations

Erratum in

Abstract

References

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LinkOut - more resources

Full Text Sources

Medical