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Diagnostic accuracy of dynamic contrast-enhanced perfusion MRI in stratifying gliomas: A systematic review and
Sachi Okuchi1, Antonio Rojas-Garcia2, Agne Ulyte3
1Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.
Background:
T1-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.
Methods:
We 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.
Results:
Twenty-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.
Conclusions:
Dynamic 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.
Insights
Dynamic contrast-enhanced MRI accurately distinguishes high-grade from low-grade gliomas. This imaging technique also shows moderate accuracy in differentiating tumor recurrence from treatment effects and primary CNS lymphomas from high-grade gliomas.
Area of Science:
- Neuroimaging
- Oncology
- Radiology
Background:
- T1-weighted dynamic contrast-enhanced (DCE) perfusion MRI is widely used for brain tumor evaluation.
- Accurate differentiation of brain tumor types and treatment effects is crucial for patient management.
Purpose of the Study:
- To assess the diagnostic accuracy of DCE-MRI in differentiating low-grade gliomas (LGGs) from high-grade gliomas (HGGs).
- To evaluate DCE-MRI's accuracy in distinguishing tumor recurrence from treatment-related changes.
- To determine the accuracy of DCE-MRI in differentiating primary central nervous system lymphomas (PCNSLs) from HGGs.
Main Methods:
- Systematic review and meta-analysis of diagnostic test accuracy studies.
- Studies were selected based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis of Diagnostic Test Accuracy Studies (PRISMA) criteria.
- Random effects model was used for meta-analysis.
Main Results:
- Twenty-seven studies involving 1068 patients were included.
- DCE-MRI showed high accuracy in differentiating HGGs from LGGs (sensitivity 0.93, specificity 0.90, AUC 0.96).
- Moderate accuracy was found for differentiating tumor recurrence from treatment changes (sensitivity 0.88, specificity 0.86, AUC 0.89) and PCNSLs from HGGs (sensitivity 0.78, specificity 0.81, AUC 0.86).
Conclusions:
- DCE-MRI is a valuable noninvasive tool for brain tumor stratification.
- The technique demonstrates high diagnostic accuracy for distinguishing HGGs from LGGs.
- DCE-MRI offers moderate accuracy for differentiating tumor recurrence from treatment effects and for distinguishing PCNSLs from HGGs.
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