Aseel Almusaedi, McCarthy Peter, Mohammed Alsaddi
School of Medicine, Clinical Science Institute, National University of Ireland, Galway, Galway, Ireland.
Universitair ziekenhuis, Brussel UZB, Jette, Brussels, Belgium.
J Neuroimaging. 2023 Mar;33(2):189-201. doi: 10.1111/jon.13080. Epub 2023 Jan 11.
Postradiation treatment necrosis is one of the most serious late sequelae and appears within 6 months. The magnetic resonance spectroscopy imaging (MRSI) has been used for the detection of brain tumors. The study aimed to determine the radiological accuracy and efficacy in distinguishing recurrent brain tumor from radiation-induced necrosis by identifying pseudoprogression.
The research was performed in accordance with the preferred reporting items for systematic review and meta-analysis guidelines. International electronic databases including 15 English sources were investigated. A total of 4281 papers with 2159 citations from 15 databases from 2011 to 2021 met the search strategies of magnetic resonance (MR) spectroscopy in recurrent brain tumors and postradiation necrosis.
Nine studies were enrolled in the meta-analysis with a total of 354 patients (203 male and 151 female) whose average age ranged from 4 to 74 years. Anbarloui et al., Elias et al., Nemattalla et al., Smith et al., Zeng et al., and Weybright et al. showed strong evidence of heterogeneity regarding choline/N-acetylaspartate (Cho/NAA) ratio in the evaluation of the nine studies. Elias et al., Nemattalla et al., Bobek-Billewicz et al., and Smith et al. showed a high heterogeneity in Cho/creatine (Cr) ratio. Elias et al., Nemattalla et al., Smith et al., and Weybright et al. revealed high heterogeneity in NAA/Cr ratio estimates.
MR spectroscopy is effective in distinguishing recurrent brain tumors from necrosis. Our meta-analysis revealed that Cho/NAA, Cho/Cr, and NAA/Cr ratios were significantly better predictor of detected recurrent tumor. Therefore, the MRSI is an informative tool in the distinction of tumor recurrence versus necrosis.
放射治疗后坏死是最严重的晚期后遗症之一，通常在6个月内出现。磁共振波谱成像（MRSI）已被用于脑肿瘤的检测。本研究旨在通过识别假性进展来确定区分复发性脑肿瘤与放射性坏死的放射学准确性和有效性。
本研究按照系统评价和Meta分析指南的首选报告项目进行。对包括15个英文来源的国际电子数据库进行了调查。2011年至2021年期间，来自15个数据库的4281篇论文（共2159次引用）符合复发性脑肿瘤和放射后坏死中磁共振（MR）波谱的检索策略。
9项研究纳入Meta分析，共354例患者（男性203例，女性151例），平均年龄4至74岁。在9项研究的评估中，安巴洛维等人、伊莱亚斯等人、内马塔拉等人、史密斯等人、曾等人和韦布赖特等人显示出胆碱/N-乙酰天门冬氨酸（Cho/NAA）比值存在显著异质性证据。伊莱亚斯等人、内马塔拉等人、博贝克-比利维茨等人和史密斯等人显示出Cho/肌酸（Cr）比值存在高度异质性。伊莱亚斯等人、内马塔拉等人、史密斯等人和韦布赖特等人显示出NAA/Cr比值估计存在高度异质性。
磁共振波谱在区分复发性脑肿瘤与坏死方面有效。我们的Meta分析表明，Cho/NAA、Cho/Cr和NAA/Cr比值是检测复发性肿瘤的显著更好预测指标。因此，MRSI是区分肿瘤复发与坏死的一种有用工具。
