Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Feb 22, 2019; 7(2): 51-65
Published online Feb 22, 2019. doi: 10.13105/wjma.v7.i2.51
Evaluation of tumor response to antiangiogenic therapy in patients with recurrent gliomas using contrast-enhanced perfusion-weighted magnetic resonance imaging techniques: A meta-analysis
Akanganyira Kasenene, Aju Baidya, Salman Shams, Hai-Bo Xu
Akanganyira Kasenene, Aju Baidya, Salman Shams, Hai-Bo Xu, Department of Radiology and Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430071, Hubei Province, China
Author contributions: Kasenene A and Baidya A contributed equally to this work; Kasenene A and Xu HB designed this study; Kasenene A and Baidya A analyzed the data; Kasenene A, Baidya A, Shams S, and Xu HB drafted the paper.
Conflict-of-interest statement: There is no conflict of interest.
PRISMA 2009 Checklist statement: The current manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hai-Bo Xu, MD, PhD, Director, Doctor, Professor, Teacher, Department of Radiology and Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China. xuhaibo1120@hotmail.com
Telephone: +86-27-67812533 Fax: +86-27-67812533
Received: January 16, 2019
Peer-review started: January 16, 2019
First decision: January 30, 2019
Revised: February 7, 2019
Accepted: February 13, 2019
Article in press: February 14, 2019
Published online: February 22, 2019
Processing time: 35 Days and 20.7 Hours
Abstract
BACKGROUND

It is of vital importance to find radiologic biomarkers that can accurately predict treatment response. Usually, the initiation of antiangiogenic therapy causes a rapid decrease in the contrast enhancing tumor. However, the treatment response is observed only in a fraction of patients due to the partial radiological response secondary to stabilization of abnormal vessels which does not essentially indicate a true antitumor effect. Perfusion-weighted magnetic resonance imaging (PW-MRI) techniques have shown implicitness as a strong imaging biomarker for gliomas since they give hemodynamic information of blood vessels. Hence, there is a rapid expansion of PW-MRI related studies and clinical applications.

AIM

To determine the diagnostic performance of PW-MRI techniques including: (A) dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI); and (B) dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) for evaluating response to antiangiogenic therapy in patients with recurrent gliomas.

METHODS

Databases such as PubMed (MEDLINE included), EMBASE, and Google Scholar were searched for relevant original articles. The included studies were assessed for methodological quality with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Medical imaging follow-up or histopathological analysis was used as the reference standard. The data were extracted by two reviewers independently, and then the sensitivity, specificity, summary receiver operating characteristic curve, area under the curve (AUC), and heterogeneity were calculated using Meta-Disc 1.4 software.

RESULTS

This study analyzed a total of six articles. The overall sensitivity for DCE-MRI and DSC-MRI was 0.69 [95% confidence interval (CI): 0.53-0.82], and the specificity was 0.99 (95%CI: 0.93-1) by a random effects model (DerSimonianee-Laird model). The likelihood ratio (LR) +, LR-, and diagnostic odds ratio (DOR) were 12.84 (4.54-36.28), 0.35 (0.22-0.53), and 24.44 (7.19-83.06), respectively. The AUC (± SE) was 0.9921 (± 0.0120), and the Q* index (± SE) was 0.9640 (± 0.0323). For DSC-MRI, the sensitivity was 0.73, the specificity was 0.98, the LR+ was 7.82, the LR- was 0.32, the DOR was 31.65, the AUC (± SE) was 0.9925 (± 0.0132), and the Q* index was 0.9649 (± 0.0363). For DCE-MRI, the sensitivity was 0.41, the specificity was 0.97, the LR+ was 5.34, the LR- was 0.71, the DOR was 8.76, the AUC (± SE) was 0.9922 (± 0.2218), and the Q* index was 0.8935 (± 0.3037).

CONCLUSION

This meta-analysis demonstrated a beneficial value of PW-MRI (DSC-MRI and DCE-MRI) in monitoring the response of recurrent gliomas to antiangiogenic therapy, with reasonable sensitivity, specificity, +LR, and -LR.

Keywords: Glioma; Perfusion-weighted magnetic resonance imaging; Dynamic contrast-enhanced magnetic resonance imaging; Dynamic susceptibility contrast magnetic resonance imaging; Anti-vascular endothelial growth factor; Antiangiogenic; Meta-analysis

Core tip: Perfusion-weighted magnetic resonance imaging is one of the advanced magnetic resonance (MR) techniques which offer non-invasive and effective ways of grading, differentiating, and assessing therapeutic response and prognosis of brain tumors. This meta-analysis evaluates the clinical applicability of this MR technique in the assessment of the response of recurrent gliomas to antiangiogenic therapy.