Department of Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230036, China.
Department of Radiation Oncology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230036, China.
Chin Med J (Engl). 2021 Oct 14;134(21):2535-2543. doi: 10.1097/CM9.0000000000001445.
It is crucial to differentiate accurately glioma recurrence and pseudoprogression which have entirely different prognosis and require different treatment strategies. This study aimed to assess the diagnostic accuracy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as a tool for distinguishing glioma recurrence and pseudoprogression.
According to particular criteria of inclusion and exclusion, related studies up to May 1, 2019, were thoroughly searched from several databases including PubMed, Embase, Cochrane Library, and Chinese biomedical databases. The quality assessment of diagnostic accuracy studies was applied to evaluate the quality of the included studies. By using the "mada" package in R, the heterogeneity, overall sensitivity, specificity, and diagnostic odds ratio were calculated. Moreover, funnel plots were used to visualize and estimate the publication bias in this study. The area under the summary receiver operating characteristic (SROC) curve was computed to display the diagnostic efficiency of DCE-MRI.
In the present meta-analysis, a total of 11 studies covering 616 patients were included. The results showed that the pooled sensitivity, specificity, and diagnostic odds ratio were 0.792 (95% confidence interval [CI] 0.707-0.857), 0.779 (95% CI 0.715-0.832), and 16.219 (97.5% CI 9.123-28.833), respectively. The value of the area under the SROC curve was 0.846. In addition, the SROC curve showed high sensitivities (>0.6) and low false positive rates (<0.5) from most of the included studies, which suggest that the results of our study were reliable. Furthermore, the funnel plot suggested the existence of publication bias.
While the DCE-MRI is not the perfect diagnostic tool for distinguishing glioma recurrence and pseudoprogression, it was capable of improving diagnostic accuracy. Hence, further investigations combining DCE-MRI with other imaging modalities are required to establish an efficient diagnostic method for glioma patients.
准确区分具有完全不同预后且需要不同治疗策略的胶质瘤复发和假性进展至关重要。本研究旨在评估动态对比增强磁共振成像（DCE-MRI）作为区分胶质瘤复发和假性进展的诊断准确性的工具。
根据纳入和排除的特定标准，从几个数据库（包括 PubMed、Embase、Cochrane Library 和中国生物医学数据库）全面搜索截至 2019 年 5 月 1 日的相关研究。应用诊断准确性研究的质量评估来评估纳入研究的质量。使用 R 中的“mada”包计算异质性、总敏感性、特异性和诊断优势比。此外，漏斗图用于可视化和估计本研究中的发表偏倚。计算汇总受试者工作特征（SROC）曲线下面积以显示 DCE-MRI 的诊断效率。
在本荟萃分析中，共纳入了 11 项涵盖 616 名患者的研究。结果表明，合并的敏感性、特异性和诊断优势比分别为 0.792（95%置信区间 [CI] 0.707-0.857）、0.779（95% CI 0.715-0.832）和 16.219（97.5% CI 9.123-28.833）。SROC 曲线下面积值为 0.846。此外，SROC 曲线显示大多数纳入研究的灵敏度较高（>0.6）和假阳性率较低（<0.5），这表明本研究的结果是可靠的。此外，漏斗图表明存在发表偏倚。
虽然 DCE-MRI 不是区分胶质瘤复发和假性进展的完美诊断工具，但它能够提高诊断准确性。因此，需要进一步结合 DCE-MRI 与其他成像模式的研究来建立一种有效的胶质瘤患者诊断方法。
