Dynamic susceptibility MR perfusion in diagnosing recurrent brain metastases after radiotherapy: A systematic review and meta‐analysis

• Published in: Journal of magnetic resonance imaging Vol. 51; no. 2; pp. 524 - 534
• Main Authors: Kwee, Robert M., Kwee, Thomas C.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.02.2020; Wiley Subscription Services, Inc
• Subjects: Accuracy; Bivariate analysis; Blood volume; Brain; Brain cancer; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - radiotherapy; Cerebral blood flow; Confidence intervals; Diagnostic software; Diagnostic systems; Field strength; Heterogeneity; Humans; Magnetic Resonance Imaging; Meta-analysis; Metastases; Metastasis; neoplasm metastasis; Neoplasm Recurrence, Local - diagnostic imaging; Neuroimaging; Original Research; Perfusion; Quality assessment; Quality control; Radiation therapy; recurrence; Reviews; Sensitivity analysis; Sensitivity and Specificity; Statistical analysis; Statistical tests; Studies; Subgroups; Systematic review; recurrence; neoplasm metastasis; magnetic resonance imaging; perfusion; brain
• ISSN: 1053-1807; 1522-2586; 1522-2586
• DOI: 10.1002/jmri.26812

Background The diagnostic performance of dynamic susceptibility contrast (DSC) MR perfusion in discriminating treatment‐related changes from recurrence in irradiated brain metastases is currently not completely clear. Purpose To systematically review the accuracy of DSC MR perfusion in diagnosing recurrent brain metastases after radiotherapy. Study Type Systematic review and meta‐analysis. Subjects MEDLINE and Embase were searched for original studies investigating the accuracy of DSC MR perfusion in diagnosing recurrent brain metastases after radiotherapy. Ten studies, comprising a total of more than 271 metastases, were included. Field Strength/Sequence 1.5T or 3.0T, DSC MR perfusion. Assessment Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. Statistical Tests Sensitivity and specificity were pooled with a bivariate random‐effects model. Heterogeneity was assessed by a chi‐squared test. Potential sources for heterogeneity were explored by subgroup analyses. Results In seven studies the diagnostic criterion was not prespecified. In eight studies it was unclear whether the reference standard was interpreted blindly. In seven studies it was unclear whether DSC MR perfusion results influenced which reference standard was used. Pooled sensitivity and specificity were 81.6% (95% confidence interval [CI]: 70.6%, 89.1%) and 80.6% (95% CI: 64.2%, 90.6%), respectively. There was significant heterogeneity in both sensitivity (P = 0.005) and specificity (P < 0.001). There were no significant differences in relative diagnostic odds ratio according to publication year, country of origin, study size, and DSC MR perfusion interpretation method (visual analysis of cerebral blood volume [CBV] map vs. relative CBV measurement) (P > 0.2). Due to insufficiently detailed reporting, it was not possible to investigate the influence of primary tumor origin on accuracy. Data Conclusion Our results suggest that the accuracy of DSC MR perfusion in diagnosing recurrent brain metastases after radiotherapy is fairly high. However, these findings should be interpreted with caution because of methodological quality concerns and heterogeneity between studies. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:524–534.