Suh Chong Hyun, Park Ji Eun, Jung Seung Chai, Choi Choong Gon, Kim Sang Joon, Kim Ho Sung
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-ro 88, Songpa-Gu, Seoul, 05505, South Korea.
Neuroradiology. 2019 May;61(5):525-534. doi: 10.1007/s00234-018-02152-2. Epub 2019 Jan 21.
Grading of brain gliomas is of clinical importance, and noninvasive molecular imaging may help differentiate low- and high-grade gliomas. We aimed to evaluate the diagnostic performance of amide proton transfer-weighted (APTw) MRI for differentiating low- and high-grade gliomas on 3-T scanners.
A systematic literature search of Ovid-MEDLINE and EMBASE was performed up to March 28, 2018. Original articles evaluating the diagnostic performance of APTw MRI for differentiating low- and high-grade gliomas were selected. The pooled sensitivity and specificity were calculated using a bivariate random-effects model. A coupled forest plot and a hierarchical summary receiver operating characteristic curve were obtained. Heterogeneity was investigated using Higgins inconsistency index (I) test. Meta-regression was performed.
Ten original articles with a total of 353 patients were included. High-grade gliomas showed significantly higher APT signal intensity than low-grade gliomas. The pooled sensitivity and specificity for the diagnostic performance of APTw MRI for differentiating low-grade and high-grade gliomas were 88% (95% CI, 77-94%) and 91% (95% CI, 82-96%), respectively. Higgins I statistic demonstrated heterogeneity in the sensitivity (I = 68.17%), whereas no heterogeneity was noted in the specificity (I = 44.84%). In meta-regression, RF saturation power was associated with study heterogeneity. Correlation coefficients between APT signal intensity and Ki-67 cellular proliferation index ranged from 0.430 to 0.597, indicating moderate correlation. All studies showed excellent interobserver agreement.
Although heterogeneous protocols were used, APTw MRI demonstrated excellent diagnostic performance for differentiating low- and high-grade gliomas. APTw MRI could be a reliable technique for glioma grading in clinical practice.
脑胶质瘤分级具有临床重要性，非侵入性分子成像可能有助于区分低级别和高级别胶质瘤。我们旨在评估酰胺质子转移加权（APTw）MRI在3-T扫描仪上区分低级别和高级别胶质瘤的诊断性能。
截至2018年3月28日，对Ovid-MEDLINE和EMBASE进行了系统的文献检索。选择评估APTw MRI区分低级别和高级别胶质瘤诊断性能的原始文章。使用双变量随机效应模型计算合并敏感性和特异性。获得耦合森林图和分层汇总接收器操作特征曲线。使用希金斯不一致指数（I）检验研究异质性。进行了Meta回归。
纳入10篇原始文章，共353例患者。高级别胶质瘤的APT信号强度明显高于低级别胶质瘤。APTw MRI区分低级别和高级别胶质瘤诊断性能的合并敏感性和特异性分别为88%（95%CI，77-94%）和91%（95%CI，82-96%）。希金斯I统计量显示敏感性存在异质性（I = 68.17%），而特异性未发现异质性（I = 44.84%）。在Meta回归中，射频饱和功率与研究异质性相关。APT信号强度与Ki-67细胞增殖指数之间的相关系数范围为0.430至0.597，表明存在中度相关性。所有研究均显示出良好的观察者间一致性。
尽管使用了不同的方案，但APTw MRI在区分低级别和高级别胶质瘤方面表现出优异的诊断性能。APTw MRI可能是临床实践中胶质瘤分级的可靠技术。
