Carle Illinois College of Medicine, Urbana, IL, USA.
Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA.
J Neurooncol. 2023 Mar;162(1):15-23. doi: 10.1007/s11060-023-04262-1. Epub 2023 Feb 28.
Cerebral radiation necrosis (RN) is often a delayed phenomenon occurring several months to years after the completion of radiation treatment. Differentiating RN from tumor recurrence presents a diagnostic challenge on standard MRI. To date, no evidence-based guidelines exist regarding imaging modalities best suited for this purpose. We aim to review the current literature and perform a diagnostic meta-analysis comparing various imaging modalities that have been studied to differentiate tumor recurrence and RN.
A systematic search adherent to PRISMA guidelines was performed using Scopus, PubMed/MEDLINE, and Embase. Pooled sensitivities and specificities were determined using a random-effects or fixed-effects proportional meta-analysis based on heterogeneity. Using diagnostic odds ratios, a diagnostic frequentist random-effects network meta-analysis was performed, and studies were ranked using P-score hierarchical ranking.
The analysis included 127 studies with a total of 220 imaging datasets, including the following imaging modalities: MRI (n = 10), MR Spectroscopy (MRS) (n = 28), dynamic contrast-enhanced MRI (n = 7), dynamic susceptibility contrast MRI (n = 36), MR arterial spin labeling (n = 5), diffusion-weighted imaging (n = 13), diffusion tensor imaging (DTI) (n = 2), PET (n = 89), and single photon emission computed tomography (SPECT) (n = 30). MRS had the highest pooled sensitivity (90.7%). DTI had the highest pooled specificity (90.5%). Our hierarchical ranking ranked SPECT and MRS as most preferable, and MRI was ranked as least preferable.
These findings suggest SPECT and MRS carry greater utility than standard MRI in distinguishing RN from tumor recurrence.
放射性脑坏死（RN）通常是在放射治疗完成后数月至数年发生的迟发性现象。在标准 MRI 上，区分 RN 与肿瘤复发具有诊断挑战性。迄今为止，尚无关于最适合此目的的成像方式的循证指南。我们旨在回顾当前文献，并进行诊断荟萃分析，比较已研究用于区分肿瘤复发和 RN 的各种成像方式。
使用 Scopus、PubMed/MEDLINE 和 Embase 进行符合 PRISMA 指南的系统搜索。根据异质性，使用随机效应或固定效应比例荟萃分析确定汇总敏感性和特异性。使用诊断优势比进行诊断似然比随机效应网络荟萃分析，并使用 P 评分层次排名对研究进行排名。
该分析包括 127 项研究，共 220 个成像数据集，包括以下成像方式：MRI（n=10）、磁共振波谱（MRS）（n=28）、动态对比增强 MRI（n=7）、动态磁敏感对比 MRI（n=36）、MR 动脉自旋标记（n=5）、扩散加权成像（n=13）、扩散张量成像（DTI）（n=2）、正电子发射断层扫描（PET）（n=89）和单光子发射计算机断层扫描（SPECT）（n=30）。MRS 的汇总敏感性最高（90.7%）。DTI 的汇总特异性最高（90.5%）。我们的层次排名将 SPECT 和 MRS 列为最优选，MRI 列为最不优选。
这些发现表明，SPECT 和 MRS 在区分 RN 与肿瘤复发方面比标准 MRI 具有更大的作用。
