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J Magn Reson Imaging. 2019 Jan 14. doi: 10.1002/jmri.26602. [Epub ahead of print]

MRI as a diagnostic biomarker for differentiating primary central nervous system lymphoma from glioblastoma: A systematic review and meta-analysis.

Author information

1
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

Abstract

BACKGROUND:

Accurate preoperative differentiation of primary central nervous system lymphoma (PCNSL) and glioblastoma is clinically crucial because the treatment strategies differ substantially.

PURPOSE:

To evaluate the diagnostic performance of MRI for differentiating PCNSL from glioblastoma.

STUDY TYPE:

Systematic review and meta-analysis.

SUBJECTS:

Ovid-MEDLINE and EMBASE databases were searched to find relevant original articles up to November 25, 2018. The search term combined synonyms for "lymphoma," "glioblastoma," and "MRI."

FIELD STRENGTH/SEQUENCE:

Patients underwent at least one MRI sequence including diffusion-weighted imaging (DWI), dynamic susceptibility-weighted contrast-enhanced imaging (DSC), dynamic contrast-enhanced imaging (DCE), arterial spin labeling (ASL), susceptibility-weighted imaging (SWI), intravoxel incoherent motion (IVIM), and magnetic resonance spectroscopy (MRS) using 1.5 or 3 T.

ASSESSMENT:

Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

STATISTICAL TESTS:

Hierarchical logistic regression modeling was used to obtain pooled sensitivity and specificity. Meta-regression was performed.

RESULTS:

Twenty-two studies with 1182 patients were included. MRI sequences demonstrated high overall diagnostic performance with pooled sensitivity of 91% (95% confidence interval [CI], 87-93%) and specificity of 89% (95% CI, 85-93%). The area under the hierarchical summary receiver operating characteristic curve was 0.92 (95% CI, 0.90-0.94). Studies using DSC or ASL showed high diagnostic performance (sensitivity of 93% [95% CI, 89-97%] and specificity of 91% [95% CI, 86-96%]). Heterogeneity was only detected in specificity (I2 = 66.84%) and magnetic field strength was revealed to be a significant factor affecting study heterogeneity.

DATA CONCLUSION:

MRI showed overall high diagnostic performance for differentiating PCNSL from glioblastoma, with studies using DSC or ASL showing high diagnostic performance. Therefore, MRI sequences including DSC or ASL is a potential diagnostic tool for differentiating PCNSL from glioblastoma.

LEVEL OF EVIDENCE:

3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019.

KEYWORDS:

diffusion; glioblastoma; lymphoma; magnetic resonance imaging; perfusion

PMID:
30637843
DOI:
10.1002/jmri.26602

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