Multiparametric MRI as a potential surrogate endpoint for decision-making in early treatment response following concurrent chemoradiotherapy in patients with newly diagnosed glioblastoma: a systematic review and meta-analysis
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To evaluate the value of multiparametric MRI for determination of early treatment response following concurrent chemoradiotherapy in patients with newly diagnosed glioblastoma.
A computerized search of Ovid-MEDLINE and EMBASE up to 1 October 2017 was performed to find studies on the diagnostic performance of multiparametric MRI for differentiating true progression from pseudoprogression. The beginning search date was not specified. Pooled estimates of sensitivity and specificity were obtained using hierarchical logistic regression modeling. We performed meta-regression and sensitivity analyses to explain the effects of the study heterogeneity.
Nine studies including 456 patients were included. Pooled sensitivity and specificity were 84 % (95 % CI 74–91) and 95 % (95 % CI 83–99), respectively. Area under the hierarchical summary receiver operating characteristic curve was 0.95 (95 % CI 0.92–0.96). Meta-regression showed true progression in the study population, the mean age and the reference standard were significant factors affecting heterogeneity.
Multiparametric MRI may be used as a potential surrogate endpoint for assessment of early treatment response, especially in the differentiation of true progression from pseudoprogression. However, based on the current evidence, monoparametric and multiparametric MRI perform equally in the clinical context. Further evaluation will be needed.
• Multiparametric MRI shows high diagnostic performance for early treatment response in glioblastoma.
• Multiparametric MRI could differentiate true progression from pseudoprogression in newly diagnosed glioblastoma.
• The normalized rCBV derived from DSC was the most commonly used parameter.
KeywordsGlioblastoma Magnetic resonance imaging Perfusion Diagnosis Standardization
Apparent diffusion coefficient
Arterial spin labeling
Area under the receiver operating characteristic curve
Cerebral blood flow
Dynamic contrast-enhanced imaging
Dynamic susceptibility-weighted contrast-enhanced imaging
Diffusion tensor imaging
Hierarchical summary receiver operating characteristic
Initial area under the curve
Magnetic resonance imaging
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Quality Assessment of Diagnostic Accuracy Studies-2
Response assessment in neuro-oncology
Relative cerebral blood volume
This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1720030)
Compliance with ethical standards
The scientific guarantor of this publication is Ho Sung Kim.
Conflict of interest
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.
Statistics and biometry
One of the authors (Chong Hyun Suh) has significant statistical expertise (4 years of experience in a systematic review and meta-analysis).
Written informed consent was not required for this study because of the nature of our study, which was a systemic review and meta-analysis.
Institutional Review Board approval was not required because of the nature of our study, which was a systemic review and meta-analysis.
• systematic review
• performed at one institution
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