Zhang Jun, Wang Yulin, Wang Yan, Xiao Huafeng, Chen Xinjing, Lei Yifei, Feng Zhebin, Ma Xiaodong, Ma Lin
Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
Department of Radiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China.
Quant Imaging Med Surg. 2022 Oct;12(10):4805-4822. doi: 10.21037/qims-22-32.
Tumor recurrence and pseudoprogression (PsP) have similar imaging manifestations in conventional magnetic resonance imaging (MRI), although the subsequent treatments are completely different. This study aimed to evaluate the value of perfusion-weighted imaging (PWI) in differentiating PsP from glioma recurrence.
A comprehensive literature search was performed to evaluate clinical studies focused on differentiating recurrent glioma from PsP using PWI, including dynamic susceptibility contrast MRI (DSC-MRI), dynamic contrast enhanced MRI (DCE-MRI), and arterial spin labeling (ASL). Study selection and data extraction were independently completed by two reviewers. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was applied to evaluate the quality of the included studies. The software Stata 16.0 and Meta-Disc 1.4 were used for the meta-analysis. Meta-regression and subgroup analyses were applied to identify the sources of heterogeneity in the studies. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) prior to initiation (CRD42022304404).
A total of 40 studies were included, including 27 English studies and 13 Chinese studies. There were 1,341 patients with glioma recurrence and 876 patients with PsP. The pooled sensitivity and specificity of DSC-MRI for differentiating glioma recurrence from PsP were 0.82 [95% confidence interval (CI): 0.78 to 0.86] and 0.87 (95% CI: 0.80 to 0.92), respectively. The pooled sensitivity and specificity of DCE-MRI were 0.83 (95% CI: 0.76 to 0.89) and 0.83 (95% CI: 0.78 to 0.87), respectively. The pooled sensitivity and specificity of ASL were 0.80 (95% CI: 0.73 to 0.86) and 0.86 (95% CI: 0.76 to 0.92), respectively.
The DSC-MRI, DCE-MRI, and ASL perfusion techniques displayed high accuracy in distinguishing glioma recurrence from PsP, and DSC-MRI had a higher diagnostic performance than the other two techniques. However, due to the diversity of the parameters and threshold differences, further investigation and standardization are needed.
肿瘤复发和假性进展（PsP）在传统磁共振成像（MRI）中具有相似的影像学表现，尽管后续治疗完全不同。本研究旨在评估灌注加权成像（PWI）在鉴别PsP与胶质瘤复发中的价值。
进行全面的文献检索，以评估使用PWI鉴别复发性胶质瘤与PsP的临床研究，包括动态磁敏感对比增强MRI（DSC-MRI）、动态对比增强MRI（DCE-MRI）和动脉自旋标记（ASL）。研究选择和数据提取由两名审阅者独立完成。应用诊断准确性研究质量评估2（QUADAS-2）工具评估纳入研究的质量。使用Stata 16.0软件和Meta-Disc 1.4进行荟萃分析。应用Meta回归和亚组分析确定研究中的异质性来源。本研究在启动前已在国际系统评价前瞻性注册库（PROSPERO）注册（CRD42022304404）。
共纳入40项研究，其中英文研究27项，中文研究13项。有1341例胶质瘤复发患者和876例PsP患者。DSC-MRI鉴别胶质瘤复发与PsP的合并敏感性和特异性分别为0.82[95%置信区间（CI）：0.78至0.86]和0.87（95%CI：0.80至0.92）。DCE-MRI的合并敏感性和特异性分别为0.83（95%CI：0.76至0.89）和0.83（95%CI：0.78至0.87）。ASL的合并敏感性和特异性分别为0.80（95%CI：0.73至0.86）和0.86（95%CI：0.76至0.92）。
DSC-MRI、DCE-MRI和ASL灌注技术在鉴别胶质瘤复发与PsP方面显示出较高的准确性，且DSC-MRI的诊断性能高于其他两种技术。然而，由于参数的多样性和阈值差异，需要进一步研究和标准化。
