Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
J Magn Reson Imaging. 2019 Aug;50(2):560-572. doi: 10.1002/jmri.26602. Epub 2019 Jan 14.
Accurate preoperative differentiation of primary central nervous system lymphoma (PCNSL) and glioblastoma is clinically crucial because the treatment strategies differ substantially.
To evaluate the diagnostic performance of MRI for differentiating PCNSL from glioblastoma.
Systematic review and meta-analysis.
Ovid-MEDLINE and EMBASE databases were searched to find relevant original articles up to November 25, 2018. The search term combined synonyms for "lymphoma," "glioblastoma," and "MRI."
FIELD STRENGTH/SEQUENCE: Patients underwent at least one MRI sequence including diffusion-weighted imaging (DWI), dynamic susceptibility-weighted contrast-enhanced imaging (DSC), dynamic contrast-enhanced imaging (DCE), arterial spin labeling (ASL), susceptibility-weighted imaging (SWI), intravoxel incoherent motion (IVIM), and magnetic resonance spectroscopy (MRS) using 1.5 or 3 T.
Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies-2 tool.
Hierarchical logistic regression modeling was used to obtain pooled sensitivity and specificity. Meta-regression was performed.
Twenty-two studies with 1182 patients were included. MRI sequences demonstrated high overall diagnostic performance with pooled sensitivity of 91% (95% confidence interval [CI], 87-93%) and specificity of 89% (95% CI, 85-93%). The area under the hierarchical summary receiver operating characteristic curve was 0.92 (95% CI, 0.90-0.94). Studies using DSC or ASL showed high diagnostic performance (sensitivity of 93% [95% CI, 89-97%] and specificity of 91% [95% CI, 86-96%]). Heterogeneity was only detected in specificity (I = 66.84%) and magnetic field strength was revealed to be a significant factor affecting study heterogeneity.
MRI showed overall high diagnostic performance for differentiating PCNSL from glioblastoma, with studies using DSC or ASL showing high diagnostic performance. Therefore, MRI sequences including DSC or ASL is a potential diagnostic tool for differentiating PCNSL from glioblastoma.
3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:560-572.
准确区分原发性中枢神经系统淋巴瘤（PCNSL）和胶质母细胞瘤在临床上至关重要，因为两者的治疗策略有很大的不同。
评估 MRI 对 PCNSL 与胶质母细胞瘤的鉴别诊断性能。
系统评价和荟萃分析。
在 Ovid-MEDLINE 和 EMBASE 数据库中检索到 2018 年 11 月 25 日之前的相关原始文章。检索词结合了“淋巴瘤”、“胶质母细胞瘤”和“MRI”的同义词。
磁场强度/序列：患者接受了至少一种 MRI 序列检查，包括弥散加权成像（DWI）、动态磁敏感对比增强成像（DSC）、动态对比增强成像（DCE）、动脉自旋标记（ASL）、磁敏感加权成像（SWI）、体素内不相干运动（IVIM）和磁共振波谱（MRS），使用 1.5 或 3T。
根据诊断准确性研究的质量评估工具-2 进行质量评估。
采用分层逻辑回归模型获得汇总敏感性和特异性。进行了元回归分析。
纳入了 22 项研究，共 1182 例患者。MRI 序列显示出较高的总体诊断性能，汇总敏感性为 91%（95%置信区间[CI]，87%-93%），特异性为 89%（95% CI，85%-93%）。分层汇总受试者工作特征曲线下面积为 0.92（95% CI，0.90-0.94）。使用 DSC 或 ASL 的研究显示出较高的诊断性能（敏感性为 93%[95% CI，89%-97%]，特异性为 91%[95% CI，86%-96%]）。仅在特异性方面检测到异质性（I=66.84%），且磁场强度被揭示为影响研究异质性的一个重要因素。
MRI 对区分 PCNSL 和胶质母细胞瘤具有较高的总体诊断性能，使用 DSC 或 ASL 的研究显示出较高的诊断性能。因此，包括 DSC 或 ASL 的 MRI 序列是区分 PCNSL 和胶质母细胞瘤的一种潜在诊断工具。
3 技术功效阶段：2 J. Magn. Reson. Imaging 2019;50:560-572.
