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European Radiology

, Volume 26, Issue 8, pp 2670–2684 | Cite as

The diagnostic performance of magnetic resonance spectroscopy in differentiating high-from low-grade gliomas: A systematic review and meta-analysis

  • Qun Wang
  • Hui Zhang
  • JiaShu Zhang
  • Chen Wu
  • WeiJie Zhu
  • FangYe Li
  • XiaoLei ChenEmail author
  • BaiNan XuEmail author
Magnetic Resonance

Abstract

Objective

Magnetic resonance spectroscopy (MRS) is a powerful tool for preoperative grading of gliomas. We performed a meta-analysis to evaluate the diagnostic performance of MRS in differentiating high-grade gliomas (HGGs) from low-grade gliomas (LGGs).

Methods

PubMed and Embase databases were systematically searched for relevant studies of glioma grading assessed by MRS through 27 March 2015. Based on the data from eligible studies, pooled sensitivity, specificity, diagnostic odds ratio and areas under summary receiver operating characteristic curve (SROC) of different metabolite ratios were obtained.

Results

Thirty articles comprising a total sample size of 1228 patients were included in our meta-analysis. Quantitative synthesis of studies showed that the pooled sensitivity/specificity of Cho/Cr, Cho/NAA and NAA/Cr ratios was 0.75/0.60, 0.80/0.76 and 0.71/0.70, respectively. The area under the curve (AUC) of the SROC was 0.83, 0.87 and 0.78, respectively.

Conclusions

MRS demonstrated moderate diagnostic performance in distinguishing HGGs from LGGs using tumoural metabolite ratios including Cho/Cr, Cho/NAA and NAA/Cr. Although there was no significant difference in AUC between Cho/Cr and Cho/NAA groups, Cho/NAA ratio showed higher sensitivity and specificity than Cho/Cr ratio and NAA/Cr ratio. We suggest that MRS should combine other advanced imaging techniques to improve diagnostic accuracy in differentiating HGGs from LGGs.

Key points

MRS has moderate diagnostic performance in distinguishing HGGs from LGGs.

There is no significant difference in AUC between Cho/Cr and Cho/NAA ratios.

Cho/NAA ratio is superior to NAA/Cr ratio.

Cho/NAA ratio shows higher sensitivity and specificity than Cho/Cr and NAA/Cr ratios.

MRS should combine other advanced imaging techniques to improve diagnostic accuracy.

Keywords

Magnetic resonance spectroscopy Glioma Differentiation Systematic review Meta-analysis 

Abbreviations

AUC

Area under the curve

Cho

Choline

CI

Confidence intervals

Cr

Creatine

DOR

Diagnostic odds ratio

DTI

Diffusion tensor imaging

DWI

Diffusion-weighted imaging

FN

False negative

FP

False positive

HGGs

High-grade gliomas

I2

Inconsistency index

Lac

Lactate

LGGs

Low-grade gliomas

LL

Lipids and lactate

LR+

Positive likelihood ratio

LR−

Negative likelihood ratio

LTE

Long echo time

MI

Myo-inositol

MRI

Magnetic resonance imaging

MRS

Magnetic resonance spectroscopy

MVS

Multi-voxel spectroscopy

NAA

N-acetyl-aspartate

nCho

Normalized choline

nCr

Normalized creatine

Pcr

Phosphocreatine

PET

Positron-emission tomography

QUADAS-2

Quality Assessment Tool for Diagnostic Accuracy Studies version 2

SEN

Sensitivity

SPE

Specificity

SPECT

Single photon mission computed tomography

SROC

Summary receiver-operating characteristic curve

STE

Short echo time

SVS

Single-voxel spectroscopy

TN

True negative

TP

True positive

Notes

Acknowledgments

The scientific guarantor of this publication is Hui Zhang, PHD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (Hui Zhang) has significant statistical expertise. Neither institutional review board approval nor written informed consent were required, because of the nature of our study, which was a systemic review and meta-analysis. Methodology: Meta-analysis, performed at one institution.

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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  1. 1.Department of NeurosurgeryChinese PLA General HospitalBeijingChina
  2. 2.Department of NeurosurgeryAir Force General Hospital of the Chinese PLABeijingChina
  3. 3.Department of Neurosurgery, General HospitalJi’nan Military Area CommandJi’nanChina

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