title: The diagnostic performance of magnetic resonance spectroscopy in differentiating high-from low-grade gliomas: A systematic review and meta-analysis.
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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Air Force General Hospital of the Chinese PLA, 30 Fucheng Road, Haidian District, Beijing, 100142, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
authors.forename: JiaShu
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery, General Hospital, Ji'nan Military Area Command, Ji'nan, 250032, China.
authors.forename: WeiJie
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
authors.forename: FangYe
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China. cxl73@msn.com.
authors.forename: XiaoLei
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China. bn_xu@yahoo.com.
authors.forename: BaiNan
authors.initials: B
authors.lastname: Xu
mesh_terms: D019540:Area Under Curve; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D016208:Databases, Factual; D005910:Glioma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D060787:Neoplasm Grading; D012372:ROC Curve
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline
keywords: Differentiation; Glioma; Magnetic resonance spectroscopy; Meta-analysis; Systematic review