Perfusion magnetic resonance imaging in the differentiation between glioma recurrence and pseudoprogression: a systematic review, meta-analysis and meta-regression

Abstract

Background: 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.Methods: 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).Results: 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.

Dynamic Susceptibility Contrast-Enhanced Perfusion-Weighted Imaging in Differentiation Between Recurrence and Pseudoprogression in High-Grade Glioma: A Meta-analysis

“…35 In prior meta-analyses, DSC-PWI has been suggested to exhibit greater diagnostic utility when differentiating between PsP and RT in HGG patients relative to individuals with low-grade glioma. 1,2 Cerebral blood volume and CBF are the primary DSC-PWI indices, and the present results suggest that the diagnostic performance of these indices is comparable when distinguishing between PsP and RT while analyzing patients with HGG. Importantly, the high AUC values for both CBV and CBF suggest that both are associated with a high degree of diagnostic accuracy.…”

“…Notably, subgroup and meta-regression analysis results suggested that study design, blinding situation, MRI field strength, and CBV type did not affect diagnostic accuracy, in line with prior meta-analyses. 1,2 Contrast-enhanced PWI strategies primarily consist of DSC-PWI and dynamic contrast-enhanced MRI. 1,3,37 Dynamic contrast-enhanced MRI exhibits a higher level of spatial resolution than that afforded by DSC-PWI, offering more insight regarding tumor perfusion while better reflecting vascular permeability.…”

“…4 The recurrence and mortality risks facing glioma patients rise with World Health Organization (WHO) grade, 5 with WHO grade 4 glioblastoma patients exhibiting a median 14-to 15-month survival duration and a 5-year survival rate below 5%. 6,7 Magnetic resonance imaging (MRI) is a key imaging technique used for both the preoperative diagnosis and postoperative monitoring of glioma patients, [1][2][3] but abnormal MRI signals after treatment have the potential to correspond to either pseudoprogression (PsP) or a recurrent tumor (RT). [1][2][3] Pseudoprogression is generally the result of radiation necrosis and associated radiotherapy-related damage.…”

“…6,7 Magnetic resonance imaging (MRI) is a key imaging technique used for both the preoperative diagnosis and postoperative monitoring of glioma patients, [1][2][3] but abnormal MRI signals after treatment have the potential to correspond to either pseudoprogression (PsP) or a recurrent tumor (RT). [1][2][3] Pseudoprogression is generally the result of radiation necrosis and associated radiotherapy-related damage. 8 As the approaches to treating PsP and RT are distinct, it is vital that clinicians be able to reliably differentiate between the two.…”

A Rapid Late Enhancement MRI Protocol Improves Differentiation between Brain Tumor Recurrence and Treatment-Related Contrast Enhancement of Brain Parenchyma

“…There are several larger, population-based studies that support MR perfusion imaging as a basic diagnostic tool for identifying suspect lesions. Regarding DCE-MRI, Zhang et al in their meta-analysis of 40 studies including 876 cases showed a pooled sensitivity and specificity of 0.83 each in differentiation between tumor recurrence and pseudo progression [ 28 ].…”