评估灌注 MRI 对胶质瘤放疗后肿瘤进展评估的价值：系统评价和荟萃分析。
Evaluation of perfusion MRI value for tumor progression assessment after glioma radiotherapy: A systematic review and meta-analysis.
机构信息
Department of radiology, Ninth Hospital of Xi'an.
Department of neurosurgery, Xijing hospital, Fourth military medical university.
出版信息
Medicine (Baltimore). 2020 Dec 24;99(52):e23766. doi: 10.1097/MD.0000000000023766.
OBJECTIVES
This study aimed to evaluate the diagnostic performance of magnetic resonance perfusion-weighted imaging (PWI) as a noninvasive method to assess post-treatment radiation effect and tumor progression in patients with glioma.
METHODS
A systematic literature search was performed in the PubMed, Cochrane Library, and Embase databases up to March 2020. The quality of the included studies was assessed by the quality assessment of diagnostic accuracy studies 2. Data were extracted to calculate sensitivity, specificity, and diagnostic odds ratio (DOR), 95% Confidence interval (CI) and analyze the heterogeneity of the studies (Spearman correlation coefficient, I2 test). We performed meta-regression and subgroup analyses to identify the impact of study heterogeneity.
RESULTS
Twenty studies were included, with available data for analysis on 939 patients and 968 lesions. All included studies used dynamic susceptibility contrast (DSC) PWI, four also used dynamic contrast-enhanced PWI, and three also used arterial spin marker imaging PWI. When DSC was considered, the pooled sensitivity and specificity were 0.83 (95% CI, 0.79 to 0.86) and 0.83 (95% CI, 0.78 to 0.87), respectively; pooled DOR, 21.31 (95% CI, 13.07 to 34.73); area under the curve (AUC), 0.887; Q∗, 0.8176. In studies using dynamic contrast-enhanced, the pooled sensitivity and specificity were 0.73 (95% CI, 0.66 to 0.80) and 0.80 (95% CI, 0.69 to 0.88), respectively; pooled DOR, 10.83 (95% CI, 2.01 to 58.43); AUC, 0.9416; Q∗, 0.8795. In studies using arterial spin labeling, the pooled sensitivity and specificity were 0.79 (95% CI, 0.69 to 0.87) and 0.78 (95% CI, 0.67 to 0.87), respectively; pooled DOR, 15.63 (95% CI, 4.61 to 53.02); AUC, 0.8786; Q∗, 0.809.
CONCLUSIONS
Perfusion magnetic resonance imaging displays moderate overall accuracy in identifying post-treatment radiation effect and tumor progression in patients with glioma. Based on the current evidence, DSC-PWI is a relatively reliable option for assessing tumor progression after glioma radiotherapy.
目的
本研究旨在评估磁共振灌注加权成像（PWI）作为一种非侵入性方法，用于评估脑胶质瘤患者治疗后辐射效应和肿瘤进展的诊断性能。
方法
系统检索 PubMed、Cochrane 图书馆和 Embase 数据库，检索时间截至 2020 年 3 月。使用诊断准确性研究质量评估工具 2 评估纳入研究的质量。提取数据以计算敏感度、特异度和诊断比值比（DOR）、95%置信区间（CI），并分析研究的异质性（Spearman 相关系数，I2 检验）。我们进行了荟萃回归和亚组分析，以确定研究异质性的影响。
结果
共纳入 20 项研究，其中 939 例患者和 968 个病灶的数据可用于分析。所有纳入的研究均使用动态对比增强磁共振 PWI，4 项研究还使用动态对比增强磁共振 PWI，3 项研究还使用动脉自旋标记磁共振 PWI。当仅考虑 DSC 时，汇总的敏感度和特异度分别为 0.83（95%CI，0.79 至 0.86）和 0.83（95%CI，0.78 至 0.87）；汇总的 DOR 为 21.31（95%CI，13.07 至 34.73）；曲线下面积（AUC）为 0.887；Q为 0.8176。使用动态对比增强时，汇总的敏感度和特异度分别为 0.73（95%CI，0.66 至 0.80）和 0.80（95%CI，0.69 至 0.88）；汇总的 DOR 为 10.83（95%CI，2.01 至 58.43）；AUC 为 0.9416；Q为 0.8795。使用动脉自旋标记时，汇总的敏感度和特异度分别为 0.79（95%CI，0.69 至 0.87）和 0.78（95%CI，0.67 至 0.87）；汇总的 DOR 为 15.63（95%CI，4.61 至 53.02）；AUC 为 0.8786；Q*为 0.809。
结论
灌注磁共振成像在识别脑胶质瘤患者治疗后辐射效应和肿瘤进展方面具有中等总体准确性。基于现有证据，DSC-PWI 是评估脑胶质瘤放疗后肿瘤进展的一种相对可靠的选择。
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