Fu Rongwei, Szidonya Laszlo, Barajas Ramon F, Ambady Prakash, Varallyay Csanad, Neuwelt Edward A
Oregon Health & Science University-Portland State University, School of Public Health, Portland, Oregon, USA.
Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA.
Neurooncol Adv. 2022 Mar 1;4(1):vdac027. doi: 10.1093/noajnl/vdac027. eCollection 2022 Jan-Dec.
In patients with high-grade glioma (HGG), true disease progression and treatment-related changes often appear similar on magnetic resonance imaging (MRI), making it challenging to evaluate therapeutic response. Dynamic susceptibility contrast (DSC) MRI has been extensively studied to differentiate between disease progression and treatment-related changes. This systematic review evaluated and synthesized the evidence for using DSC MRI to distinguish true progression from treatment-related changes.
We searched Ovid MEDLINE and the Ovid MEDLINE in-process file (January 2005-October 2019) and the reference lists. Studies on test performance of DSC MRI using relative cerebral blood volume in HGG patients were included. One investigator abstracted data, and a second investigator confirmed them; two investigators independently assessed study quality. Meta-analyses were conducted to quantitatively synthesize area under the receiver operating curve (AUROC), sensitivity, and specificity.
We screened 1177 citations and included 28 studies with 638 patients with true tumor progression, and 430 patients with treatment-related changes. Nineteen studies reported AUROC and the combined AUROC is 0.85 (95% CI, 0.81-0.90). All studies contributed data for sensitivity and specificity, and the pooled sensitivity and specificity are 0.84 (95% CI, 0.80-0.88), and 0.78 (95% CI, 0.72-0.83). Extensive subgroup analyses based on study, treatment, and imaging characteristics generally showed similar results.
There is moderate strength of evidence that relative cerebral blood volume obtained from DSC imaging demonstrated "excellent" ability to discriminate true tumor progression from treatment-related changes, with robust sensitivity and specificity.
在高级别胶质瘤（HGG）患者中，真正的疾病进展和治疗相关变化在磁共振成像（MRI）上往往表现相似，这使得评估治疗反应具有挑战性。动态磁敏感对比增强（DSC）MRI已被广泛研究，以区分疾病进展和治疗相关变化。本系统评价评估并综合了使用DSC MRI区分真正进展与治疗相关变化的证据。
我们检索了Ovid MEDLINE及Ovid MEDLINE在研文献数据库（2005年1月至2019年10月）以及参考文献列表。纳入了关于使用相对脑血容量的DSC MRI在HGG患者中的测试性能的研究。一名研究人员提取数据，另一名研究人员进行确认；两名研究人员独立评估研究质量。进行荟萃分析以定量合成受试者工作特征曲线下面积（AUROC）、敏感性和特异性。
我们筛选了1177篇引文，纳入了28项研究，其中638例患者有真正的肿瘤进展，430例患者有治疗相关变化。19项研究报告了AUROC，合并后的AUROC为0.85（95%CI，0.81 - 0.90）。所有研究都提供了敏感性和特异性的数据，汇总后的敏感性和特异性分别为0.84（95%CI，0.80 - 0.88）和0.78（95%CI，0.72 - 0.83）。基于研究、治疗和影像学特征的广泛亚组分析总体显示了相似的结果。
有中等强度的证据表明，从DSC成像获得的相对脑血容量具有“出色”的能力来区分真正的肿瘤进展与治疗相关变化，具有较强的敏感性和特异性。
