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Umbrella review and network meta-analysis of diagnostic imaging test accuracy studies in Differentiating between brain tumor progression versus pseudoprogression and radionecrosis

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Abstract

Purpose

In this study we gathered and analyzed the available evidence regarding 17 different imaging modalities and performed network meta-analysis to find the most effective modality for the differentiation between brain tumor recurrence and post-treatment radiation effects.

Methods

We conducted a comprehensive systematic search on PubMed and Embase. The quality of eligible studies was assessed using the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) instrument. For each meta-analysis, we recalculated the effect size, sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio from the individual study data provided in the original meta-analysis using a random-effects model. Imaging technique comparisons were then assessed using NMA. Ranking was assessed using the multidimensional scaling approach and by visually assessing surface under the cumulative ranking curves.

Results

We identified 32 eligible studies. High confidence in the results was found in only one of them, with a substantial heterogeneity and small study effect in 21% and 9% of included meta-analysis respectively. Comparisons between MRS Cho/NAA, Cho/Cr, DWI, and DSC were most studied. Our analysis showed MRS (Cho/NAA) and 18F-DOPA PET displayed the highest sensitivity and negative likelihood ratios. 18-FET PET was ranked highest among the 17 studied techniques with statistical significance. APT MRI was the only non-nuclear imaging modality to rank higher than DSC, with statistical insignificance, however.

Conclusion

The evidence regarding which imaging modality is best for the differentiation between radiation necrosis and post-treatment radiation effects is still inconclusive. Using NMA, our analysis ranked FET PET to be the best for such a task based on the available evidence. APT MRI showed promising results as a non-nuclear alternative.

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Data Availability

The data used for the current study was compiled from existing studies that were found as detailed in the methods section and the search strategy. The condensed and final list is available from the corresponding author on reasonable request.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA

    Richard Dagher, Haris I. Sair & Licia P. Luna

  2. Diagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Mona Gad

  3. Tiradentes University Medical School, Maceió, AL, Brazil

    Paloma da Silva de Santana

  4. SUNY Downstate HSC and University, Brooklyn, NY, USA

    Mohammad Amin Sadeghi & Selome F. Yewedalsew

  5. Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil

    Sachin K. Gujar, Vivek Yedavalli & Cristiano André Köhler

  6. Radiology Department, Fortaleza General Hospital, Fortaleza, Brazil

    Majid Khan & Daniel Gurgel Fernandes Tavora

  7. The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA

    David Olayinka Kamson

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Richard Dagher, Paloma da Silva de Santana, Mona Gad, Mohammad Amin Sadeghi and Licia P. Luna. The first draft of the manuscript was written by Richard Dagher and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Licia P. Luna.

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Dagher, R., Gad, M., da Silva de Santana, P. et al. Umbrella review and network meta-analysis of diagnostic imaging test accuracy studies in Differentiating between brain tumor progression versus pseudoprogression and radionecrosis. J Neurooncol 166, 1–15 (2024). https://doi.org/10.1007/s11060-023-04528-8

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