Affiliation:
1. Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London , London , UK
2. Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, King Abdulaziz University (KAU) , Jeddah , Saudi Arabia
3. University College London Hospitals NHS Foundation Trust , London , UK
4. Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust , London , UK
Abstract
Abstract
Background
The distinction between viable tumor and therapy-induced changes is crucial for the clinical management of patients with gliomas. This study aims to quantitatively assess the efficacy of arterial spin labeling (ASL) biomarkers, including relative cerebral blood flow (rCBF) and absolute cerebral blood flow (CBF), for the discrimination of progressive disease (PD) and treatment-related effects.
Methods
Eight articles were included in the synthesis after searching the literature systematically. Data have been extracted and a meta-analysis using the random-effect model was subsequently carried out. Diagnostic accuracy assessment was also performed.
Results
This study revealed that there is a significant difference in perfusion measurements between groups with PD and therapy-induced changes. The rCBF yielded a standardized mean difference (SMD) of 1.25 [95% CI 0.75, 1.75] (p < .00001). The maximum perfusion indices (rCBFmax and CBFmax) both showed equivalent discriminatory ability, with SMD of 1.35 [95% CI 0.78, 1.91] (p < .00001) and 1.56 [95% CI 0.79, 2.33] (p < .0001), respectively. Similarly, accuracy estimates were comparable among ASL-derived metrices. Pooled sensitivities [95% CI] were 0.85 [0.67, 0.94], 0.88 [0.71, 0.96], and 0.93 [0.73, 0.98], and pooled specificities [95% CI] were 0.83 [0.71, 0.91], 0.83 [0.67, 0.92], 0.84 [0.67, 0.93], for rCBF, rCBFmax and CBFmax, respectively. Corresponding HSROC area under curve (AUC) [95% CI] were 0.90 [0.87, 0.92], 0.92 [0.89, 0.94], and 0.93 [0.90, 0.95].
Conclusion
These results suggest that ASL quantitative biomarkers, particularly rCBFmax and CBFmax, have the potential to discriminate between glioma progression and therapy-induced changes.
Funder
UCLH NIHR Biomedical Research Centre
Wellcome Trust
Publisher
Oxford University Press (OUP)
Subject
Surgery,Oncology,Neurology (clinical)
Reference57 articles.
1. Brain cancer in the world: an epidemiological review;Farmanfarma;World Cancer Res J,2019
2. The epidemiology of glioma in adults: A state of the science review;Ostrom;Neuro Oncol,2014
3. Diagnostic accuracy of arterial spin labeling in comparison with dynamic susceptibility contrast-enhanced perfusion for brain tumor surveillance at 3T MRI;Lavrova;Front Oncol.,2022
4. Imaging biomarkers of glioblastoma treatment response: a systematic review and meta-analysis of recent machine learning studies;Booth;Front Oncol.,2022
5. Advanced MRI and PET imaging for assessment of treatment response in patients with gliomas;Dhermain;Lancet Neurol.,2010