Document review and Meta analysis of MRI identification of PCNSL and GBM

Clinically, it is important to accurately identify primary central nervous system lymphoma (primary central nervous system lymphoma, PCNSL) and glioblastoma (GBM) prior to surgeryBecause there is a big difference in treatment strategies between the twoFor PCNSL patients, chemotherapy based on high doses of methotrexate after stereotactic biopsy is the main treatment; however, GBM patients usually need to have an first full excision and then simultaneous chemotherapy for pyrozineTraditional MRI imaging can usually distinguish between typical PCNSL and GBM; Because the atypical necrosis-enhancing GBM is similar to PCNSL, pcNNSLs with necrosis, bleeding, or irregular edge enhancements may be similar to GBMOver the past decade, PCNSL and GBM have been differentiated on 1.5T or 3T MRI, including diffuse-weighted imaging (diffusion-weighted imaging, DWI), dynamic magnetic sensitivity-weighted contrast-enhanced imaging (dynamic ity-weighted contrast imaging, DSC)), dynamic contrast-enhanced imaging (dynamic contrast-enhanced imaging, DCE), arterial spin markers (arterial spin labeling, ASL), magnetic sensitivity-weighted imaging (appability-weighted imaging, SWI), incoherent motion inside the colloid (intravoxel incoherent motion, IVIM), And magnetic resonance spectroscopy (resonance magnetic spectroscopy, MRS) and so on, can show different diagnostic propertiesHowever, how to select the most appropriate MRI sequence to identify PCNSL and GBM? A recently published meta-analysis showed that MRI perfusion imaging had a combined sensitivity of 88% (95% CI, 85-91%) in distinguishing PCNSL from high-level gliomas, and 84% (95% CI, 78-89) However, the meta-analysis included only MRI perfusion imaging in the MRI sequence, analysis of mixed glioblastoma and intersastatic astrocytoma, and no robust meta-analysis method of stratification of the stratified logistic regression model was usedA systematic review and meta-analysis of MRI identification of PCNSL and GBM was conducted by Chong Hyun Suh of seoul University Medical Center, Ulsan University School of Medicine and Research Institute of Radiology, South Korea, and published in Journal of Magnetic Imaging in August 2019research method
authors retrieve the relevant literature in the Ovid-MEDLINE and EMBASE databases as of November 25, 2018Search terms include "lymphoma," "glioblastoma" and "MRI" and their synonymsThe literature is included in the criteria that (1) histopathology is confirmed as PCNSL or GBM; (2) patients with normal immune function and non-acquired immunodeficiency syndrome (AIDS) ;(4) have received one or more MRI sequence examinations, including DWI, DSC, DCE, ASL, SWI and IVIM, and (5) the papers provide sufficient information to assess the performance of MRIToC and PCNSExcluding conference summaries, case reports or papers with fewer than 10 cases, reviews, overlapping studies of some patients, mixed studies of brain tumor types, insufficient data on 2-by-2 table reconstruction, studies including interdestenive atomostoma, studies using only conventional MRI, and MRI sequences mentioned in the non-selection criteriaQuality evaluation is carried out using the Quality Evaluation Tool-2 (Quality Assessment of Diagnostic Accuracy Studies-2, QUADAS-2)The combined sensitivity and specificity were evaluated using the layered logistic regression model, followed by metaregression analysisresultsresults, including a total of 22 studies, including 1182 patientsUsing a variety of combinations of MRI sequences, the most commonLY USED MRI sequences are DWI, DSC, and DCE The MRI sequence showed a high overall diagnostic performance, meta-analysis suggested that the sensitivity of the merger was 91% (95% CI, 87-93%), the specificity was 89% (95% CI, 85-93%), and the area under the hierarchical summary subject's working characteristic curve was 0.92 (95% CI, 0.90-0.94) The Deeks funnel chart shows no publishing bias I2 statistics indicate that there is no heterogeneity in sensitivity (I2 s 4.81%), but heterogeneity is detected in specificity (I2 s 66.84%) In covariates, magnetic field strength is an important factor affecting the study of heterogeneity use a 3T scanner with a specific degree of 91% (95% CI, 87-95%) than the speciality of using a 1.5T scanner 84% (95% CI, 76-95%) Other factors, such as the percentage of PCNSL in the study population, DSC or ASL, DWI or IVIM, DCE or quality assessment, were not important factors affecting the study's heterogeneity Studies using DSC or ASL show higher diagnostic performance, combined sensitivity of 93% (95% CI, 89-97%), specificity 91% (95% CI, 86-96%), and study with DWI or IVIM shows combined sensitivity of 87% (95% CI), 82-93%), the specificity is 89% (95% CI, 83-95%), and the study using DCE shows that the combined sensitivity is 83% (95% CI, 73-93%) and the specificity is 86% (95% CI, 74-98%) conclusions finally, the results show that MRI imaging has high diagnostic performance in identifying PCNSL and GBM in general, and has higher combined sensitivity and specificity The use of DSC or ASL sequences has higher diagnostic performance, so MRI sequences, including DSC or ASL, are potential diagnostic tools for identifying PCNSLs and GBMs A larger sample size and prospective studies related to pathological diagnosis are recommended.