Arterial Spin Labeling For Differentiating Glioma Recurrence From PTRE: A Meta-Analysis Of Diagnostic Accuracy

Background: Discriminating between tumor recurrence and treatment change has been a topic of extensive research interest spanning multiple imaging modalities.Prior systematic review and meta-analysis compared MR,CT,and nuclear medicine techniques in differentiating tumor primarily from delayed radiation necrosis.Every techniques each have their own established limitations.Arterial spin labeling(ASL)is a non-invasive and easily repeatable MRI technique to measure cerebral blood flow(CBF).Major advantages of ASL are the fact that CBF measurements are not influenced by break down of the blood–brain barrier,as well as its quantitative nature.Objective: The purpose of this meta-analysis is to assess the diagnostic value of ASL in distinguishing glioma recurrence from PTRE.Methods: Searched databases included Medline,Cochrane Library,Pub Med,Web of Science,Embase,Google Scholar,CNKI,Wan Fang Data and VIP which were comprehensive searched until December 31,2018.Studies were identified and assessed by two independent reviewers using the search strategy and selection criteria.Where there was uncertainty regarding eligibility,a third reviewer was consulted.Results: Ten studies involving 405 patients were assessed for eligibility based on their full-text review and our inclusion/ exclusion criteria.The pooled values for studies on ASL were Sen 0.790[95%CI(0.730,0.842)],Spe 0.882[95%CI(0.826,0.924)],+LR4.839[95%CI(3.220,7.272)],–LR 0.256[95%CI(0.138,0.475)],DOR 24.029[95%CI(9.727,59.355)],SROC AUC =0.9266,Q~*=0.8610(SEQ~*=0.0280.The between-study heterogeneity was assessed by Q test and I~2 statistics.P<0.05 or I~2>50% suggested significant heterogeneity.Notable heterogeneities were present in both sensitivity (I~2=79.9%;P=0.000)and specificity data(I~2=12.5%;P=32.8)in ASL studies.The presence of publication bias was evaluated by the use of funnel plots and the Begg–Mazumdar rank-correlation test(P <0.05).Conclusion: ASL shows overall moderate diagnostic performance in the discrimination of glioma recurrence from PTRE.