Alsaedi Amirah, Doniselli Fabio, Jäger Hans Rolf, Panovska-Griffiths Jasmina, Rojas-Garcia Antonio, Golay Xavier, Bisdas Sotirios
Department of Radiology Technology, Taibah University, Medina, KSA.
Department of Brain Repair & Rehabilitation, Queen Square Institute of Neurology, University College London, London, UK.
Oncotarget. 2019 Feb 22;10(16):1589-1601. doi: 10.18632/oncotarget.26674.
This study aimed to evaluate the diagnostic performance of arterial spin labelling (ASL) in grading of adult gliomas. Eighteen studies matched the inclusion criteria and were included after systematic searches through EMBASE and MEDLINE databases. The quality of the included studies was assessed utilizing Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The quantitative values were extracted and a meta-analysis was subsequently based on a random-effect model with forest plot and joint sensitivity and specificity modelling. Hierarchical summary receiver operating characteristic (HROC) curve analysis was also conducted. The absolute tumour blood flow (TBF) values can differentiate high-grade gliomas (HGGs) from low-grade gliomas (LGGs) and grade II from grade IV tumours. However, it lacked the capacity to differentiate grade II from grade III tumours and grade III from grade IV tumours. In contrast, the relative TBF (rTBF) is effective in differentiating HGG from LGG and in glioma grading. The maximum rTBF (rTBFmax) demonstrated the best results in glioma grading. These results were also reflected in the sensitivity/specificity analysis in which the rTBFmax showed the highest discrimination performance in glioma grading. The estimated effect size for the rTBF was approximately similar between HGGs and LGGs, and grade II and grade III tumours, (-1.46 (-2.00, -0.91), -value < 0.001), (-1.39 (-1.89, -0.89), -value < 0.001), respectively; while it exhibited smaller effect size between grade III and grade IV (-1.05 (-1.82, -0.27)), < 0.05). Sensitivity and specificity analysis replicate these results as well. This meta-analysis suggests that ASL is useful for glioma grading, especially when considering the rTBFmax parameter.
本研究旨在评估动脉自旋标记（ASL）在成人胶质瘤分级中的诊断性能。通过对EMBASE和MEDLINE数据库进行系统检索，有18项研究符合纳入标准并被纳入。使用诊断准确性研究质量评估-2（QUADAS-2）对纳入研究的质量进行评估。提取定量值，随后基于随机效应模型进行荟萃分析，并绘制森林图以及联合敏感性和特异性模型。还进行了分层汇总接受者操作特征（HROC）曲线分析。绝对肿瘤血流量（TBF）值可区分高级别胶质瘤（HGG）与低级别胶质瘤（LGG），以及II级与IV级肿瘤。然而，它缺乏区分II级与III级肿瘤以及III级与IV级肿瘤的能力。相比之下，相对TBF（rTBF）在区分HGG与LGG以及胶质瘤分级方面有效。最大rTBF（rTBFmax）在胶质瘤分级中显示出最佳结果。这些结果也反映在敏感性/特异性分析中，其中rTBFmax在胶质瘤分级中表现出最高的辨别性能。rTBF的估计效应大小在HGG与LGG以及II级与III级肿瘤之间大致相似，分别为（-1.46（-2.00，-0.91），P值<0.001）以及（-1.39（-1.89，-0.89），P值<0.001）；而在III级与IV级之间其效应大小较小（-1.05（-1.82，-0.27）），P<0.05）。敏感性和特异性分析也重复了这些结果。这项荟萃分析表明，ASL对胶质瘤分级有用，尤其是考虑rTBFmax参数时。
