Introduction
Methods
Search strategy
Selection criteria
Study selection, data extraction, and quality assessment
Statistical analysis
Reference |
N
| Study type | Age (years) mean ± SD (range) | % male | Histology | Selection | Reference standard | Field strength; MRI technique, orientation, slice thickness/ gap in mm (TR/TE/TI in ms); b values | Time point MRI | Diagnostic accuracy (cut-off if provided in the paper) | TP | FP | TN | FN |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Al Sayyari et al. [14] | 16 | Pros | 54 (30-92) | 50 | WHO III: 6 WHO IV: 10 | HGG with new enhan-cement after treatment | Histology (N = 4), radioclinical (N = 12) | 1.5/3 T. T1 tra 5/- (500-600/7.4-11); T1C tra 5/- (500-600/7.4-11); SWI 3D (49-27/20-40); DWI tra (3900-4500/84-91) b 0 1000. | 5.6 and 8.1 mo (1-26) after end treatment | ADC (ROI based on SWI) ADC (ROI based on T1C) | 9 4 | 0 2 | 5 4 | 2 7 |
Alexiou et al. [15] | 30 | Pros | 62 ± 11.1 | 70 | WHO III: 3 WHO IV: 27 | HGG with suspected recurrence on cMRI. | Histology (N = 2), radioclinical (N = 28) | 1.5 T. T1 3D 1/0 (25/4.6); T1C tra, sag, cor 1/0 (25/4.6); T2 tra 6/0.6 (3000/90); FLAIR tra 6/0.6 (6300/120/2150); DWI tra 3/0 (9807/131) b 0, 700; DSC tra 7/0 (702/30). | 1 mo after end RT with follow-up every 3 mo | rCBV (2.2) ADC (1.27) FA (0.47) | 24 16 14 | 0 0 0 | 6 6 6 | 0 8 10 |
Baek et al. [16] | 79 | Retro | 51 (19-83) | 58 | WHO IV: 79 | GBM with new or enlarged enhan-cement after treatment | Histology (N = 22), radioclinical (N = 57) | 3 T. T1 tra 5/- (475/10); T1C tra, cor, sag 5/- (450-495/10); T2 tra 5/- (3000/80); DWI tra 5/- (3804/48), b-; DSC tra 5/- (1407/40). | <4 w after end CCRT 4-8 w after first follow-up | Histogram: max (3.1) mode (1.6) range (2.5) %Δ skew (1.17) %Δ kurtosis (5.14) Histogram pattern (3) | 39 31 33 36 26 36 | 10 6 6 8 10 4 | 27 31 31 29 27 33 | 3 11 9 6 16 6 |
Barajas et al. [17] | 57 | Retro | 54 ± 10.2 | 58 | WHO IV: 57 | GBM after treatment | Histology (N = 55), imaging (N = 2) | 1.5 T. T1 sag -/- (600/17); T1C sag -/- (1000/54); T1C 3D -/- (34/8); T2 3D -/- (3000/102); FLAIR tra -/- (10000/148/2200); DSC 5/- (1250/54) | 1.7–50.2 mo after end RT | PH (1.38) rCBV (1.75) PSR (87.3%) | 41 36 36 | 4 6 5 | 16 14 15 | 5 10 10 |
Bisdas et al. [18] | 18 | Pros | - | 56 | WHO III + IV: 56 | HGG with suspected recurrence after treatment | Histology (N = 5), imaging (N = 13) | 3 T. T1 - -/- (279/2.5); T1C - -/- (279/2.5); T1C 3D (1300/2.6); DCE 4/-(3.4/1.4). | 7.8-13 mo after end CCRT, follow-up with 2-mo intervals | Ktrans (0.19) AUC (15.35) | 12 9 | 1 2 | 5 4 | 0 3 |
Cha et al. [19] | 35 | Retro | 49 (24-70) | 51 | WHO IV: 35 | GBM with new or enlarged enhan-cement <180 d after treatment | Histology (N = 3), imaging (N = 32), | 3 T. T1C tra 5/- (500/10); DWI tra 5/- (3000/75) b 0, 1000; DSC tra 5/- (1720/35). | 124 ± 34.7 d (79-204) after surgery | Size enhan-cement rCBV (1.80) CBV mode (1.60) | 8 9 9 | 4 4 0 | 20 20 24 | 3 2 2 |
Choi et al. [20] | 62 | Retro | 49 (22-79) | 60 | WHO IV: 62 | GBM with new enhan-cement <4 w after treatment | Histology (N = 43), imaging (N = 19) | - T. T1 tra 5/- (475/10); T1C tra, cor, sag 5/- (450-495/10); T2 tra 5/- (3000/80); DWI tra 5/- (3804/46); DSC tra -/-(1407/40); ASL tra 6/- (3000/13). ASL: | MRI follow-up intervals of 2-3 mo | ASL AUC (0.774) DSC | 27 28 | 10 9 | 18 19 | 7 6 |
Chung et al. [21] | 57 | Retro | 51 (25-69) | 53 | WHO IV: 57 | GBM after treatment. | Histology (N = 57) | 3 T. DCE 4/0 (6.4/3.1) | 40 mo after end CCRT |
mAUCR 0.23)
90thAUCR (0.32) | 30 29 | 3 3 | 22 22 | 2 3 |
D’Souza et al. [22] | 27 | Pros | 43 (18-61) | 74 | WHO III: 16 WHO IV: 11 | HGG after therapy | Histology (N = 20), radioclinical (N = 7) | 3 T. T1C tra -/- (2000/12); T2 tra -/- (5600/100 ms); FLAIR tra, cor -/- (9000/81/2500); DSC 4/- (1600/30); MRS single voxel 8-12 x 8-12 x8-12 (2000/30), Cho, Cr, NAA; MRS multi voxel 10 x 10 x 15 (1700/30), Cho, Cr NAA. | 10 mo (7-19) after treatment | rCBV Cho/Cre (2.00) | 14 14 | 0 1 | 10 9 | 3 3 |
Dandois et al. [23] | 7 | Retro | 51 (25-74) | 57* | WHO III: 1 WHO IV: 6 | HGG after treatment | Histology (N = 2), imaging (N = 4), clinical (N = 1) | 1.5 T. T1C tra 5/1 (30/3); T1C 3D 1.2/0 (30/3); T2 tra 5/1 (4390/90); FLAIR tra 5/1 (10000/120/2100); DWI tra 5/1(3312/93), b 0, 1000; DSC tra 5/1 mm (1500/35 ms).CE-T1: | - | T1C FLAIR rCBV (182%) | 2 3 5 | 0 0 0 | 2 2 2 | 2 2 0 |
Di Constanzo et al. [24] | 29 | Pros | 63 (38-74) | 62 | WHO IV: 29 | GBM with new enhan-cement after treatment | Imaging (N = 29) | 3 T. T1 sag 5/1 (225/ 2.5); T1C 3D 1.4/0 (225/3.2); T2 tra 5/1 (5000/85); FLAIR tra 5/1(11000/140/2250); DWI tra 5/1 mm (11000/66.6),b 0 1000; DSC 5/1 mm (1700/48 ms); MRS multivoxel 7.5 x 7.5 x 10 (1500/144); | 8 w after end CCRT and with 3-mo intervals during 1st year and 3-6-mo intervals thereafter | ADC rCBV Cho NAA Cr Cho/Cr Cho/NAA | 17 18 15 13 12 17 10 | 1 1 2 2 0 2 0 | 7 7 6 6 8 6 8 | 4 3 6 8 9 4 11 |
Goenka et al. [25] (abstract) | 32 | Pros | - | - | WHO III + IV: 32 | HGG after treatment | Histology and/or radioclinical | 1.5 T. DWI; PWI; MRS multivoxel Cho, NAA, Cho/Cr, NAA/Cr. | - | rCBV (2.30) DWI | 15 10 | 6 1 | 15 14 | 0 11 |
Heidemans- Hazelaar et al. [26] (abstract) | 32 | Retro | - | - | WHO IV: 32 | GBM with new lesion on cMRI after treatment | Histology or imaging | - T. PWI | - | rCBV (2.12) | 25 | 1 | 5 | 3 |
Hu et al. [27] | 13 | Pros | 48 (31-62) | 85 | WHO III: 4 WHO IV: 9 | HGG with new enhan-cement after treatment undergoing re-resection | Histology (N = 13) | 3 T. T1C fs 3D 2/0 (6.8/2.8/300); DSC 5/0 mm (2000/20). | - | rCBV (0.71) | 22 | 2 | 16 | 0 |
Hu et al. [28] | 11 | Pros | 47 | 91 | WHO III: 3 WHO IV: 8 | HGG with suspected recurrence after treatment undergoing re-resection | Histology (N = 11) | 3 T. T1C fs 3D 2/0 (6.8/2.8/300); DSC 5/0 mm (2000/20). | - | rCBV without BLS/PLD (0.92-0.96) rCBV with BLS/PLD (1.02-1.03) | 13 19 | 0 0 | 15 15 | 8 2 |
Jora et al. [29] | 7 | Pros | 43 ± 14.9* | 61* | WHO III + IV: 7 | PHGG with suspected residual or recurrence after treatment | Histology (N = 7) | 1.5 T. T1 tra, sag 3-5/- (400-550/14); T1C tra, cor, sag 3/- (400/15); T2 3/- (4000/126-130). | - | cMRI | 3 | 1 | 2 | 1 |
Kim et al. [30] | 51 | Retro | 52 (35-72) | 49 | WHO IV: 51 | GBM with new or enlarged enhan-cement after treatment undergoing re-resection | Histology (N = 51) | 3 T. DWI - -/- (-/-) b 0, 10, 20, 40, 60, 80, 100, 120, 140, 160, 180, 200, 300, 500, 700 and 900; DSC - -/-(1407/40). | 12.5 d before re-resection; 44 w post CCRT | f90(0.056) D10 (0.970) nCBV90
(2.892) ADC10
(0.995) | 27 22 26 21 | 1 5 1 5 | 19 15 19 15 | 4 9 5 10 |
Kong et al. [31] | 90 | Pros | 50 (25-74) | 83 | WHO IV: 90 | GBM with new or enlarged enhan-cement after treatment | Histology (N = 4), imaging (N = 86) | 3 T. T1 - 5/1.5 (500/10); T2 - 5/1.5 (3000/80); FLAIR - 5/1.5 (11000/ 125/-); DSC - 5/2 (1500/35). | 4 w after end treatment and with 2-mo intervals | rCBV (1.49) | 27 | 6 | 51 | 6 |
Larsen et al. [32] | 13 | Pros | 58 (38-75) | 85 | WHO III: 4 WHO IV: 9 | HGG with unclear cMRI after treatment | Histology (N = 9), imaging (N = 2), clinical (N = 2) | 3 T. DCE - 8/1.5 (3.9/1.9). | 16 ± 13 mo (3-48) after end RT | DCE | 11 | 0 | 2 | 0 |
Lee et al. [33] | 22 | Retro | 49 (18-69) | 64 | WHO III: 3 WHO IV: 19 | GBM with new enhan-cement after treatment | Imaging (N = 22) | - T. T1 - 5/1 (558-650/8-20); T2 - 5/1 (4500-5160/91-106.3); FLAIR 5/1 (9000-9900/97-162.9/-); DWI tra 3/1 (6900-10000/55-70) b 0, 1000. | 24 d; (11-60) after end CCRT | ADC (1200x10-6)
| 8 | 2 | 10 | 2 |
Nakajima et al. [34] | 12 | Retro | 50 (23-67) | 33 | WHO III: 5 WHO IV: 7 | HGG with new lesion on cMRI after treatment | Histology (N = 11), radioclinical (N = 1) | 1.5 T. MRS single voxel 12-20 x 12-20 x 16-20 (2000/272). | 24.2 mo (4-80) after end RT | Cho/Cre (2.50) Lac/Cho (1.05) | 5 5 | 1 0 | 6 7 | 0 0 |
Palumbo et al. [35] | 24 | Pros | 53 ± 13.7 (25-76) | 73* | WHO III: 8 WHO IV: 16 | HGG with unclear cMRI after treatment | Histology (N = 24) | 1.5 T. T1 sag 5/0.5 (540/18); T2 cor 5/0.5 (4000/100 ms); FLAIR tra 5/0.5 (8000/120/2000); 1MRS single voxel 4-6 cc (144/2500). | 6-12 mo after surgery | MRS | 16 | 0 | 7 | 1 |
Peca et al. [36] | 15 | Pros | 53 (28-72) | 45 | WHO IV: 15 | GBM after treatment | Histology (N = 10), imaging (N = 5) | - T. MRS | 4 w after end RT | MRS | 11 | 3 | 1 | 0 |
Pica et al. [37] (abstract) | 26 | Pros | - | - | WHO III: 10 WHO IV: 16 | HGG with clinical symptoms after treatment | Histology (N = 8), imaging (N = 18) | - T. DSC | - | rCBV (3.70) | 10 | 6 | 10 | 1 |
Pugliese et al. [38] (abstract) | 24 | Retro | - | - | WHO IV: 24 | GBM after treatment | Histology or imaging | - T. DSC | <4 mo after surgery | rCBV (2.30) | 8 | 3 | 9 | 3 |
Reddy et al. [39] | 51 | Retro | 47 (22-71) | 65 | WHO III: 16 WHO IV: 35 | GBM after treatment undergoing re-resection | Histology (N = 51) | - T. T1 tra, cor and/or sag - -/- (-/-); T1C tra, cor and/or sag - -/- (-/ -); T2 and/or FLAIR - /-/ (-/-). | 2-11 d before re-resection; 7.3 mo after initial surgery | cMRI | 17 | 1 | 17 | 3 |
Seeger et al. [40] | 40 | Retro | 54 ± 13.6 | 60 | WHO III + IV: 40 | HGG with new enhan-cement after treatment | Imaging (N = 40) | 1.5 T. DSC - 5/- (1610/30); DCE 3D 5/- (4/1.16); ASL - 5/- (2600/16); MRS multivoxel 10 x 10 x 15 (1570/135). | - | ASL rCBF (2.18) DCE Ktrans
K(0.058) DSC rCBF r(2.24) DSC rCBV (2.15) Cho/Cr (1.07) | 12 14 18 19 16 | 3 3 3 4 4 | 14 14 14 13 13 | 11 9 5 4 7 |
Song et al. [41] | 20 | Retro | 51 ± 13.5 (24-68) | 50 | WHO IV: 20 | GBM with enhan-cement after treatment | Imaging (N = 20) | - T. T1 tra 5/1 (558-650/8-20); T2 tra 5/1 (4500-5160/91-106.3); FLAIR tra 5/1 (9000-9900/97-162.9); DWI tra 3/1 (6900-10000/55-70) b 0, 1000; DSC tra 5/1 (1500/30-40) | 22 d (11-34) after end CCRT | ADC ROC curve Observer 1 Observer 2 | 9 8 | 1 2 | 9 8 | 1 2 |
Suh et al. [42] | 79 | Retro | 51 (25-69) | 46 | WHO IV: 79 | GBM with new or enlarged enhan-cement after treatment | Histology (N = 24), imaging with clinical progression (N = 55) | 3 T. DCE 3D 4/0 (6.4/3.1). | <4-5 w after end CCRT | mAUCR (0.31) AUCR50
(0.19) | 38 37 | 6 6 | 31 31 | 4 5 |
Sundgren et al. [43] | 13 | Retro | 46 (31-64) | 54 | WHO III: 9 WHO IV: 4 | HGG with new enhan-cement after treatment | Histology (N = 5), imaging (N = 8) | 1.5 T. T1 tra, sag 6/1.5 (470/min.); T1C tra, sag 6/1 · 5 (470/min.); T2 f. 6/1.5 mm (3000-5000/98); FLAIR tra 6/1.5 (10000/95/2200); DWI tra, cor, sag 6/0 (10000/min) b 0, 1000; DTI 4/0 (9300/min ms) b 0, 1000; MRS. | 3-6 mo intervals; 28 mo after initial surgery | MRS (1.60-1.80) | 7 | 0 | 6 | 0 |
Tie et al. [44] | 19 | Pros | 51 (25-78) | 63 | WHO III: 12 WHO IV: 7 | HGG with clinical or imaging suspicion of recurrence after treatment | Histology (N = 9), radioclinical (N = 10) | 1.5 T. T1 tra -/- (-/-); T2 tra -/- (-/-); FLAIR tra -/- (-/-). | - | cMRI | 11 | 1 | 3 | 6 |
Tsien et al. [45] | 27 | Pros | 52 ± 3.1 | - | WHO III: 4 WHO IV: 23 | HGG after STR with min. 4 mL of residual tumour | Imaging (N = 27) | 1.5-3 T. DSC - 4-6/0 (1500-2000/50-60). | Prior, 1 w after, 3 w after RT | rCBV | 8 | 6 | 6 | 7 |
Yaman et al. [46] | 17 | Retro | 45 (23-74) | 65 | WHO III: 2 WHO IV: 15 | HGG with clinical or imaging suspicion of recurrence after treatment | Histology (N = 3), imaging (N = 14) | 1.5 T. MRS multivoxel (-/35-135). | 1 mo after CCRT + every 3 cycles of TMZ; 75% >6 mo post CCRT | MRS | 13 | 0 | 4 | 0 |
Young et al. [47] | 93 | Retro | 59 (9-84) | 62 | WHO IV: 93 | GBM with new or enlarged enhan-cement after treatment | Histology (N = 28), imaging (N = 65) | 1.5-3 T. T1C tra, cor, sag 5/0 (500/10); T2 tra 5/0 (4000-9000/100-125); FLAIR tra 5/0 (9000-10000/125-160/2200-2250). | 4 weeks after end RT and with 1-2 mo intervals 1 | cMRI | 32 | 18 | 12 | 31 |
Zeng et al. [48] | 26 | Retro | 40 ± 9.8 (23-65) | 64 | WHO III: 18 WHO IV: 6 WHO III/IV:4 | HGG with new enhan-cement after treatment | Histology (N = 21), radioclinical (N = 5) | - T. T1 tra 6/- (-/-); T1C tra, cor, sag 6/- (-/-); T2 tra 6/- (-/-); FLAIR tra 6/- (-/-); MRS 3D 8 x 8 x 20-60 (1000/144). | 6 w after RT end for MRI and 3-4 mo intervals | Cho/Cr (1.71) Cho/NAA (1.71) | 16 15 | 0 0 | 9 9 | 1 2 |
Results
Reference |
N
| Study type | Age (years) mean ± SD (range) | % male | Histology | Selection | Reference standard | Field strength; MRI techniques, orientation, slice thickness/ gap in mm (TR/TE/TI in ms); b values | Time point MRI | Diagnostic accuracy (cut-off) | TP | FP | TN | FN |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Abel et al. [50] (abstract) | 14 | Retro | - | - | WHO IV: 14 | GBM with new or enlarged enhan-cement fafter treatment | Imaging (N = 14) | - T. FLAIR | 6-8 mo | Change in FLAIR volume | ||||
Agerwal et al. [51] | 46 | Retro | 57* | 18* | WHO III: 6 WHO IV: 40 | HGG with new or enlarged enhan-cement fafter treatment | Imaging (N = 46) | 3 T. T1 tra 5/0 (3000/min); T2 tra 5/0 (3000/102); FLAIR tra 5/0 (10 · 000/120/2250); DTI 5/0 (8000-10000/84.3) b 0, 1000. | - | - | ||||
Amin et al. [52] | 19 | Pros | 55* (17-70) | 54* | WHO III: 12 WHO IV: 7 | HGG routine follow-up or with unclear cMRI or CT | Imaging (N = 19) | 1.5 T. T1 tra, cor, sag 10-20/- (-/-); T1C tra, cor, sag10-20/- (-/-); T2 f. tra 10-20/- (-/-); FLAIR tra 10-20/- (-/-/-); MRS single voxel 4-8 cm3 (1500/30). | 4-6 w after end of therapy | Cho/Cr Cho/NAA | ||||
Fink et al. [53] | 38 | Retro | 48 (28-70) | 53 | WHO III: 10 WHO IV: 12 | HGG with suspected recurrence after treatment | Histology (N = 14), radioclinical (N = 26) | 3 T. T1 tra 5/0 (400/10); T1C tra 5/0 (400/10); T2 tra 5/0 (3000/90); FLAIR tra (11.000/125/2800); DWI - 4/1 (5210/53), b 0, 1000; DSC tra 3/-(16/24); MRS multivoxel 10 x 10 x 12 (2000/144-288). | MRI after CCRT | CBV (2.08) ADC (1.28) Cho/Cr peak area (1.54) Cho/NAA peak height (1.05) | ||||
Galldiks et al. [54] | 25 | Pros | 54 (36-73) | 60 | WHO IV: 25 | GBM patients undergoing surgery + CCRT | Imaging (N = 25) | 1.5 T. T1 - 1/- (-/-); T2 - 1/- (-/-); FLAIR - 1/- (-/-). | 11-20 d after surgery,7-10 d after end CCRT and 6-8 w after end CCRT | - | ||||
Prat et al. [55] | 20 | Retro | - | 58* | WHO III: 9 WHO IV: 11 | HGG with new enhan-cement fafter treatment | Histology or multi-disciplinary consensus with imaging | - T. PWI - -/- (-/-); MRS - -/- (-/-). | After end CCRT | NAA/Cho (0.70) | ||||
Shin et al. [56] | 27 | Retro | 55* (27-72) | 55* | WHO III: 7 WHO IV: 20 | HGG with increased enhan-cement fafter treatment | Histology (N = 24), radioclinical (N = 7) | 3 T. T1 - 5/- (250/3.5); T2 - 5/- (5500/93); FLAIR - 5/- (9000/95/ 2500); DCE - 4/- (4.3-5.1/1.5-1.8); DSC - 1.5/- (1880/30). | - | rCBV (2.33) rKtrans (2.1) AUC (2.29) | ||||
Xu et al. [57] | 31 | Pros | 45 (21-65) | 54 | WHO III: 14 WHO IV: 17 | HGG with new enhan-cement fafter treatment | Histology (N = 23), imaging (N = 12) | 3 T. T1 tra 5/1 (400/ 15);T2 tra 5/1 (3500/ 105); FLAIR tra 5/1 (10000/175/2200); DTI tra 5/1 (5000/97), b 0, 1000. | <72 h before re-resection or fbiopsy | ADC ratio (1.65) FA ratio (0.36) | ||||
Xu et al. [58] | 31 | Pros | 45 (21-65) | 54 | WHO III: 14 WHO IV: 17 | HGG with new enhan-cement fafter treatment | Histology (N = 23), imaging (N = 12) | 3 T. T1 tra 5/1 (400/ 15);T2 tra 5/1 (3500/ 105); FLAIR tra 5/1 (10000/175/2200); DSC tra 5/1 (1400/32). | - | rCBVmax (2.15) | ||||
Zeng et al. [59] | 55 | Pros | 44 (23-67) | 55 | WHO III: 36 WHO IV: 19 | HGG with new enhan-cement fafter treatment | Histology (N = 39), imaging (N = 16) | 3 T. T1 tra 6/- (500/8 ms); T1C tra, cor, sag 6/- (-/-); T2 tra 6/- (4500/102); FLAIR tra 6/- (9000/120/2250); DWI tra, cor, sag 6/- (5000/64 · 9), b 0, 1000; MRS multivoxel 10 x 10 x 10 (1500/144). | <6 w after end RT and with 2 mo intervals | Cho/Cr Cho/NAA ADC ratio |
Patients (N) | 1174 |
Mean age (years) | 51.6 |
% Male | 61.3 |
Histology | |
- WHO III | 124 |
- WHO IV | 951 |
- WHO III or IV (not specified) | 99 |
Follow-up | |
- Histology | 502 |
- Imaging | 406 |
- Clinical | 3 |
- Combination | 263 |
Methodological quality of included studies
Main findings
Studies |
N
| Sensitivity(95% CI) | Specificity(95% CI) | Positive LR (95% CI) | Negative LR (95% CI) | |
---|---|---|---|---|---|---|
Anatomical MRI | 5 | 166 | 68 (51-81) | 77 (45-93) | 2.9 (0.86-9.82) | 0.42 (0.21-0.85) |
ADC | 7 | 204 | 71 (60-80) | 87 (77-93) | 5.4 (3.0-9.7) | 0.33 (0.23-0.47) |
DSC | 18 | 708 | 87 (82-91) | 86 (77-91) | 6.1 (3.6-10.1) | 0.15 (0.10-0.22) |
DCE | 5 | 207 | 92 (73-98) | 85 (76-92) | 6.4 (3.6-11.3) | 0.09 (0.02-0.36) |
MRS | 9 | 203 | 91 (79-97) | 95 (65-99) | 17.2 (2.0-151.7) | 0.09 (0.03-0.24) |