Delgado Anna F, Delgado Alberto F
From the Department of Clinical Neuroscience (Anna F.D.), Karolinska Institute, Stockholm, Sweden.
Department of Surgical Sciences (Alberto F.D.), Uppsala University, Uppsala, Sweden.
AJNR Am J Neuroradiol. 2017 Jul;38(7):1348-1355. doi: 10.3174/ajnr.A5218. Epub 2017 May 18.
DSC perfusion has been evaluated in the discrimination between low-grade and high-grade glioma but the diagnostic potential to discriminate beween glioma grades II and III remains unclear.
Our aim was to evaluate the diagnostic accuracy of relative maximal CBV from DSC perfusion MR imaging to discriminate glioma grades II and III.
A systematic literature search was performed in PubMed/MEDLINE, Embase, Web of Science, and ClinicalTrials.gov.
Eligible studies reported on patients evaluated with relative maximal CBV derived from DSC with a confirmed neuropathologic diagnosis of glioma World Health Organization grades II and III. Studies reporting on mean or individual patient data were considered for inclusion.
Data were analyzed by using inverse variance with the random-effects model and receiver operating characteristic curves describing optimal cutoffs and areas under the curve. Bivariate diagnostic random-effects meta-analysis was used to calculate diagnostic accuracy.
Twenty-eight studies evaluating 727 individuals were included in the meta-analysis. Individual data were available from 10 studies comprising 190 individuals. The mean difference of relative maximal CBV between glioma grades II and III ( = 727) was 1.76 (95% CI, 1.27-2.24; < .001). Individual patient data ( = 190) had an area under the curve of 0.77 for discriminating glioma grades II and III at an optimal cutoff of 2.02. When we analyzed astrocytomas separately, the area under the curve increased to 0.86 but decreased to 0.61 when we analyzed oligodendrogliomas.
A substantial heterogeneity was found among included studies.
Glioma grade III had higher relative maximal CBV compared with glioma grade II. A high diagnostic accuracy was found for all patients and astrocytomas; however, the diagnostic accuracy was substantially reduced when discriminating oligodendroglioma grades II and III.
动态对比增强（DSC）灌注成像已用于鉴别低级别和高级别胶质瘤，但鉴别Ⅱ级和Ⅲ级胶质瘤的诊断潜力仍不明确。
我们的目的是评估DSC灌注磁共振成像中相对最大脑血容量（CBV）鉴别Ⅱ级和Ⅲ级胶质瘤的诊断准确性。
在PubMed/MEDLINE、Embase、Web of Science和ClinicalTrials.gov上进行了系统的文献检索。
符合条件的研究报告了经DSC获得相对最大CBV评估且经病理确诊为世界卫生组织Ⅱ级和Ⅲ级胶质瘤的患者情况。报告均值或个体患者数据的研究被纳入。
采用随机效应模型的逆方差分析以及描述最佳截断值和曲线下面积的受试者工作特征曲线进行数据分析。采用双变量诊断随机效应荟萃分析计算诊断准确性。
荟萃分析纳入了评估727例个体的28项研究。10项研究提供了190例个体的个体数据。Ⅱ级和Ⅲ级胶质瘤之间相对最大CBV的平均差异（n = 727）为1.76（95%CI，1.27 - 2.24；P <.001）。个体患者数据（n = 190）在最佳截断值为2.02时，鉴别Ⅱ级和Ⅲ级胶质瘤的曲线下面积为0.77。当我们分别分析星形细胞瘤时，曲线下面积增至0.86，但分析少突胶质细胞瘤时降至0.61。
纳入研究间存在显著异质性。
与Ⅱ级胶质瘤相比，Ⅲ级胶质瘤的相对最大CBV更高。对所有患者和星形细胞瘤均发现较高的诊断准确性；然而，在鉴别Ⅱ级和Ⅲ级少突胶质细胞瘤时，诊断准确性大幅降低。
