TY - JOUR
T1 - Diagnostic accuracy of MRI techniques for treatment response evaluation in patients with brain metastasis
T2 - A systematic review and meta-analysis
AU - Teunissen, Wouter H.T.
AU - Govaerts, Chris W.
AU - Kramer, Miranda C.A.
AU - Labrecque, Jeremy A.
AU - Smits, Marion
AU - Dirven, Linda
AU - van der Hoorn, Anouk
N1 - Funding Information:
The authors wish to thank the Erasmus MC medical library for their excellent support. This research was funded by “Leading the Change” (80-85009-98-2008-NVvR).
Funding Information:
The authors wish to thank the Erasmus MC medical library for their excellent support. This research was funded by “Leading the Change” (80-85009-98-2008-NVvR). The scientific guarantor of this publication is dr. Anouk van der Hoorn. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Jeremy Labrecque kindly provided statistical advice for this manuscript. No complex statistical methods were necessary for this paper. Only if the study is on human subjects:, Written informed consent was obtained from all subjects (patients) in this study, if still alive during the study (validation cohort). Written informed consent was not required for this study because some patients were deceased at the time of this study, so no informed consent was possible (validation cohort). Only if the study is on animals:, Approval from the institutional animal care committee was obtained. (not applicable). Institutional Review Board approval was obtained (for independent validation cohort). Some study subjects or cohorts have been previously reported: An independent cohort was used for external validation. 16 of the 39 patients used for this cohort have been studied in another study which is published in https://doi.org/10.3389/fonc.2022.849657 Frontiers Oncology. That study has a different aim (comparison between ASL and DSC perfusion), so we do not indicate this as overlap. • prospective and retrospective (differs per included study, validation cohort retrospective). • meta-analysis (with independent validation cohort). • performed at one institution.
Publisher Copyright:
© 2022 The Author(s)
PY - 2022/12
Y1 - 2022/12
N2 - Background: Treatment response assessment in patients with brain metastasis uses contrast enhanced T1-weighted MRI. Advanced MRI techniques have been studied, but the diagnostic accuracy is not well known. Therefore, we performed a metaanalysis to assess the diagnostic accuracy of the currently available MRI techniques for treatment response.Methods: A systematic literature search was done. Study selection and data extraction were done by two authors independently. Meta-analysis was performed using a bivariate random effects model. An independent cohort was used for DSC perfusion external validation of diagnostic accuracy.Results: Anatomical MRI (16 studies, 726 lesions) showed a pooled sensitivity of 79% and a specificity of 76%. DCE perfusion (4 studies, 114 lesions) showed a pooled sensitivity of 74% and a specificity of 92%. DSC perfusion (12 studies, 418 lesions) showed a pooled sensitivity was 83% with a specificity of 78%. Diffusion weighted imaging (7 studies, 288 lesions) showed a pooled sensitivity of 67% and a specificity of 79%. MRS (4 studies, 54 lesions) showed a pooled sensitivity of 80% and a specificity of 78%. Combined techniques (6 studies, 375 lesions) showed a pooled sensitivity of 84% and a specificity of 88%. External validation of DSC showed a lower sensitivity and a higher specificity for the reported cut-off values included in this metaanalysis.Conclusion: A combination of techniques shows the highest diagnostic accuracy differentiating tumor progression from treatment induced abnormalities. External validation of imaging results is important to better define the reliability of imaging results with the different techniques.
AB - Background: Treatment response assessment in patients with brain metastasis uses contrast enhanced T1-weighted MRI. Advanced MRI techniques have been studied, but the diagnostic accuracy is not well known. Therefore, we performed a metaanalysis to assess the diagnostic accuracy of the currently available MRI techniques for treatment response.Methods: A systematic literature search was done. Study selection and data extraction were done by two authors independently. Meta-analysis was performed using a bivariate random effects model. An independent cohort was used for DSC perfusion external validation of diagnostic accuracy.Results: Anatomical MRI (16 studies, 726 lesions) showed a pooled sensitivity of 79% and a specificity of 76%. DCE perfusion (4 studies, 114 lesions) showed a pooled sensitivity of 74% and a specificity of 92%. DSC perfusion (12 studies, 418 lesions) showed a pooled sensitivity was 83% with a specificity of 78%. Diffusion weighted imaging (7 studies, 288 lesions) showed a pooled sensitivity of 67% and a specificity of 79%. MRS (4 studies, 54 lesions) showed a pooled sensitivity of 80% and a specificity of 78%. Combined techniques (6 studies, 375 lesions) showed a pooled sensitivity of 84% and a specificity of 88%. External validation of DSC showed a lower sensitivity and a higher specificity for the reported cut-off values included in this metaanalysis.Conclusion: A combination of techniques shows the highest diagnostic accuracy differentiating tumor progression from treatment induced abnormalities. External validation of imaging results is important to better define the reliability of imaging results with the different techniques.
KW - Brain metastasis
KW - Meta-analysis
KW - MRI
KW - Pseudoprogression
KW - Treatment response
U2 - 10.1016/j.radonc.2022.10.026
DO - 10.1016/j.radonc.2022.10.026
M3 - Article
AN - SCOPUS:85141764455
SN - 0167-8140
VL - 177
SP - 121
EP - 133
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -