1 Department 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.
AJR Am J Roentgenol. 2018 Dec;211(6):1332-1341. doi: 10.2214/AJR.18.19674. Epub 2018 Sep 21.
The purpose of this study is to compare the diagnostic performance of MRI and PET for differentiating tumor recurrence from radiation necrosis in patients with brain metastasis treated with stereotactic radiosurgery.
The Ovid-Medline and Embase databases were searched up to November 11, 2017, to find relevant studies. Pooled sensitivity and specificity from entire included studies were obtained using hierarchic logistic regression modeling. Metaregression was performed.
Twenty studies including 728 patients with 872 brain metastases were selected. MRI showed a pooled sensitivity of 84% (95% CI, 72-91%) and specificity of 88% (95% CI, 71-96%). PET showed a pooled sensitivity of 84% (95% CI, 78-88%) and specificity of 86% (95% CI, 81-90%). There were no statistically significant differences in the diagnostic performance of MRI and PET using indirect (p = 0.80) or direct (p = 0.48) comparisons. The diagnostic performance of advanced MRI was significantly higher than that of conventional MRI (p = 0.01). Advanced MRI (sensitivity, 86% [95% CI, 74-93%]; specificity, 95% [95% CI, 82-98%]) showed a significantly higher diagnostic performance than did PET (p < 0.01). All the included studies used perfusion MRI as an advanced MRI technique.
MRI and PET showed high diagnostic performance for the detection of tumor recurrence after stereotactic radiosurgery in patients with brain metastasis. There was no significant difference in the diagnostic performance between MRI and PET. Because of heterogeneity and paucity in studies, caution may be needed in applying the results.
本研究旨在比较 MRI 和 PET 对经立体定向放射外科治疗脑转移瘤患者肿瘤复发与放射性坏死的鉴别诊断性能。
检索 Ovid-Medline 和 Embase 数据库，截至 2017 年 11 月 11 日，查找相关研究。使用分层逻辑回归模型获得所有纳入研究的汇总敏感性和特异性。进行荟萃回归分析。
共纳入 20 项研究，共计 728 例患者 872 个脑转移灶。MRI 的汇总敏感性为 84%（95%CI，72-91%），特异性为 88%（95%CI，71-96%）。PET 的汇总敏感性为 84%（95%CI，78-88%），特异性为 86%（95%CI，81-90%）。间接（p = 0.80）或直接（p = 0.48）比较均未见 MRI 和 PET 诊断性能的统计学差异。高级 MRI 的诊断性能明显高于常规 MRI（p = 0.01）。高级 MRI（敏感性，86%[95%CI，74-93%]；特异性，95%[95%CI，82-98%]）的诊断性能明显高于 PET（p < 0.01）。所有纳入研究均采用灌注 MRI 作为高级 MRI 技术。
MRI 和 PET 对检测脑转移瘤患者立体定向放射外科治疗后肿瘤复发均具有较高的诊断性能。MRI 和 PET 的诊断性能无显著差异。由于研究的异质性和数量较少，在应用结果时需谨慎。
