Henssen Dylan, Leijten Lars, Meijer Frederick J A, van der Kolk Anja, Arens Anne I J, Ter Laan Mark, Smeenk Robert J, Gijtenbeek Anja, van de Giessen Elsmarieke M, Tolboom Nelleke, Oprea-Lager Daniela E, Smits Marion, Nagarajah James
Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
Radboudumc Center of Expertise Neuro-Oncology, 6525 GA Nijmegen, The Netherlands.
Cancers (Basel). 2023 May 5;15(9):2631. doi: 10.3390/cancers15092631.
The post-treatment imaging surveillance of gliomas is challenged by distinguishing tumor progression (TP) from treatment-related abnormalities (TRA). Sophisticated imaging techniques, such as perfusion-weighted magnetic resonance imaging (MRI PWI) and positron-emission tomography (PET) with a variety of radiotracers, have been suggested as being more reliable than standard imaging for distinguishing TP from TRA. However, it remains unclear if any technique holds diagnostic superiority. This meta-analysis provides a head-to-head comparison of the diagnostic accuracy of the aforementioned imaging techniques. Systematic literature searches on the use of PWI and PET imaging techniques were carried out in PubMed, Embase, the Cochrane Library, ClinicalTrials.gov and the reference lists of relevant papers. After the extraction of data on imaging technique specifications and diagnostic accuracy, a meta-analysis was carried out. The quality of the included papers was assessed using the QUADAS-2 checklist. Nineteen articles, totaling 697 treated patients with glioma (431 males; mean age ± standard deviation 50.5 ± 5.1 years) were included. The investigated PWI techniques included dynamic susceptibility contrast (DSC), dynamic contrast enhancement (DCE) and arterial spin labeling (ASL). The PET-tracers studied concerned [S-methyl-C]methionine, 2-deoxy-2-[F]fluoro-D-glucose ([F]FDG), O-(2-[F]fluoroethyl)-L-tyrosine ([F]FET) and 6-[F]-fluoro-3,4-dihydroxy-L-phenylalanine ([F]FDOPA). The meta-analysis of all data showed no diagnostic superior imaging technique. The included literature showed a low risk of bias. As no technique was found to be diagnostically superior, the local level of expertise is hypothesized to be the most important factor for diagnostically accurate results in post-treatment glioma patients regarding the distinction of TRA from TP.
胶质瘤治疗后的影像监测面临着区分肿瘤进展（TP）和治疗相关异常（TRA）的挑战。复杂的成像技术，如灌注加权磁共振成像（MRI PWI）和使用各种放射性示踪剂的正电子发射断层扫描（PET），被认为在区分TP和TRA方面比标准成像更可靠。然而，尚不清楚是否有任何技术具有诊断优势。这项荟萃分析对上述成像技术的诊断准确性进行了直接比较。在PubMed、Embase、Cochrane图书馆、ClinicalTrials.gov以及相关论文的参考文献列表中，对PWI和PET成像技术的使用进行了系统的文献检索。在提取关于成像技术规格和诊断准确性的数据后，进行了荟萃分析。使用QUADAS-2清单评估纳入论文的质量。纳入了19篇文章，共697例接受治疗的胶质瘤患者（431例男性；平均年龄±标准差50.5±5.1岁）。研究的PWI技术包括动态磁敏感对比增强（DSC）、动态对比增强（DCE）和动脉自旋标记（ASL）。研究的PET示踪剂包括[S-甲基-C]蛋氨酸、2-脱氧-2-[F]氟-D-葡萄糖（[F]FDG）、O-（2-[F]氟乙基）-L-酪氨酸（[F]FET）和6-[F]-氟-3,4-二羟基-L-苯丙氨酸（[F]FDOPA）。对所有数据的荟萃分析显示，没有诊断优势的成像技术。纳入的文献显示偏倚风险较低。由于未发现任何技术具有诊断优势，因此推测在区分TRA和TP方面，当地的专业水平是治疗后胶质瘤患者获得诊断准确结果的最重要因素。
