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Perfusion MRI as a diagnostic biomarker for differentiating glioma from brain metastasis: a systematic review and
Chong Hyun Suh1, Ho Sung Kim2, Seung Chai Jung1
1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.
Objectives:
Differentiation of glioma from brain metastasis is clinically crucial because it affects the clinical outcome of patients and alters patient management. Here, we present a systematic review and meta-analysis of the currently available data on perfusion magnetic resonance imaging (MRI) for differentiating glioma from brain metastasis, assessing MRI protocols and parameters.
Methods:
A computerised search of Ovid-MEDLINE and EMBASE databases was performed up to 3 October 2017, to find studies on the diagnostic performance of perfusion MRI for differentiating glioma from brain metastasis. Pooled summary estimates of sensitivity and specificity were obtained using hierarchical logistic regression modelling. We conducted meta-regression and subgroup analyses to explain the effects of the study heterogeneity.
Results:
Eighteen studies with 900 patients were included. The pooled sensitivity and specificity were 90% (95% CI, 84-94%) and 91% (95% CI, 84-95%), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.96 (95% CI, 0.94-0.98). The meta-regression showed that the percentage of glioma in the study population and the study design were significant factors affecting study heterogeneity. In a subgroup analysis including patients with glioblastoma only, the pooled sensitivity was 92% (95% CI, 84-97%) and the pooled specificity was 94% (95% CI, 85-98%).
Conclusions:
Although various perfusion MRI techniques were used, the current evidence supports the use of perfusion MRI to differentiate glioma from brain metastasis. In particular, perfusion MRI showed excellent diagnostic performance for differentiating glioblastoma from brain metastasis.
Key Points:
• Perfusion MRI shows high diagnostic performance for differentiating glioma from brain metastasis. • The pooled sensitivity was 90% and pooled specificity was 91%. • Peritumoral rCBV derived from DSC is a relatively well-validated.
Insights
Perfusion magnetic resonance imaging (MRI) effectively differentiates glioma from brain metastasis, with 90% sensitivity and 91% specificity. This technique is crucial for accurate patient management and treatment planning in neuro-oncology.
Area of Science:
- Neuroimaging
- Oncology
- Radiology
Background:
- Differentiating glioma from brain metastasis is critical for patient outcomes and management.
- Perfusion magnetic resonance imaging (MRI) offers potential for non-invasive tissue characterization.
Purpose of the Study:
- To systematically review and meta-analyze the diagnostic performance of perfusion MRI in distinguishing glioma from brain metastasis.
- To assess various MRI protocols and parameters used in perfusion imaging for this differentiation.
Main Methods:
- A comprehensive literature search of Ovid-MEDLINE and EMBASE databases was conducted.
- Hierarchical logistic regression modeling was used to pool sensitivity and specificity estimates.
- Meta-regression and subgroup analyses were performed to investigate sources of heterogeneity.
Main Results:
- Eighteen studies including 900 patients were analyzed.
- Pooled sensitivity was 90% (95% CI, 84-94%) and pooled specificity was 91% (95% CI, 84-95%).
- The area under the ROC curve was 0.96, indicating excellent diagnostic performance.
Conclusions:
- Perfusion MRI demonstrates high accuracy in differentiating glioma from brain metastasis.
- Diagnostic performance is particularly strong for distinguishing glioblastoma from brain metastasis.
- The findings support the clinical utility of perfusion MRI in neuro-oncology.
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