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- Title
Differentiating radiation necrosis from tumor recurrence: a systematic review and diagnostic meta-analysis comparing imaging modalities.
- Authors
Smith, Emily J.; Naik, Anant; Shaffer, Annabelle; Goel, Mahima; Krist, David T.; Liang, Edward; Furey, Charuta G.; Miller, William K.; Lawton, Michael T.; Barnett, Daniel H.; Weis, Blake; Rizk, Ahmed; Smith, Ron S.; Hassaneen, Wael
- Abstract
Purpsose: Cerebral radiation necrosis (RN) is often a delayed phenomenon occurring several months to years after the completion of radiation treatment. Differentiating RN from tumor recurrence presents a diagnostic challenge on standard MRI. To date, no evidence-based guidelines exist regarding imaging modalities best suited for this purpose. We aim to review the current literature and perform a diagnostic meta-analysis comparing various imaging modalities that have been studied to differentiate tumor recurrence and RN. Methods: A systematic search adherent to PRISMA guidelines was performed using Scopus, PubMed/MEDLINE, and Embase. Pooled sensitivities and specificities were determined using a random-effects or fixed-effects proportional meta-analysis based on heterogeneity. Using diagnostic odds ratios, a diagnostic frequentist random-effects network meta-analysis was performed, and studies were ranked using P-score hierarchical ranking. Results: The analysis included 127 studies with a total of 220 imaging datasets, including the following imaging modalities: MRI (n = 10), MR Spectroscopy (MRS) (n = 28), dynamic contrast-enhanced MRI (n = 7), dynamic susceptibility contrast MRI (n = 36), MR arterial spin labeling (n = 5), diffusion-weighted imaging (n = 13), diffusion tensor imaging (DTI) (n = 2), PET (n = 89), and single photon emission computed tomography (SPECT) (n = 30). MRS had the highest pooled sensitivity (90.7%). DTI had the highest pooled specificity (90.5%). Our hierarchical ranking ranked SPECT and MRS as most preferable, and MRI was ranked as least preferable. Conclusion: These findings suggest SPECT and MRS carry greater utility than standard MRI in distinguishing RN from tumor recurrence.
- Subjects
SINGLE-photon emission computed tomography; DISEASE relapse; CONTRAST-enhanced magnetic resonance imaging; DIFFUSION tensor imaging; DIFFUSION magnetic resonance imaging
- Publication
Journal of Neuro-Oncology, 2023, Vol 162, Issue 1, p15
- ISSN
0167-594X
- Publication type
Article
- DOI
10.1007/s11060-023-04262-1