European Radiology

, Volume 28, Issue 6, pp 2628–2638 | Cite as

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

  • Chong Hyun Suh
  • Ho Sung KimEmail author
  • Seung Chai Jung
  • Choong Gon Choi
  • Sang Joon Kim



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.

Key Points

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.


Glioblastoma 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


Diffusion-weighted imaging


Hierarchical summary receiver operating characteristic


Initial area under the curve


Magnetic resonance imaging


MR spectroscopy


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).

Informed consent

Written informed consent was not required for this study because of the nature of our study, which was a systemic review and meta-analysis.

Ethical approval

Institutional Review Board approval was not required because of the nature of our study, which was a systemic review and meta-analysis.


• systematic review

• meta-analysis

• performed at one institution

Supplementary material

330_2017_5262_MOESM1_ESM.docx (5.4 mb)
Supplementary Fig. 1 (DOCX 5501 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulRepublic of Korea

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