title: The diagnostic performance of perfusion MRI for differentiating glioma recurrence from pseudoprogression: A meta-analysis.
abstract: BACKGROUND
  The purpose of this meta-analysis was to evaluate the diagnostic accuracy of perfusion magnetic resonance imaging (MRI) as a method for differentiating glioma recurrence from pseudoprogression.
  
  
  METHODS
  The PubMed, Embase, Cochrane Library, and Chinese Biomedical databases were searched comprehensively for relevant studies up to August 3, 2016 according to specific inclusion and exclusion criteria. The quality of the included studies was assessed according to the quality assessment of diagnostic accuracy studies (QUADAS-2). After performing heterogeneity and threshold effect tests, pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated. Publication bias was evaluated visually by a funnel plot and quantitatively using Deek funnel plot asymmetry test. The area under the summary receiver operating characteristic curve was calculated to demonstrate the diagnostic performance of perfusion MRI.
  
  
  RESULTS
  Eleven studies covering 416 patients and 418 lesions were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.88 (95% confidence interval [CI] 0.84-0.92), 0.77 (95% CI 0.69-0.84), 3.93 (95% CI 2.83-5.46), 0.16 (95% CI 0.11-0.22), and 27.17 (95% CI 14.96-49.35), respectively. The area under the summary receiver operating characteristic curve was 0.8899. There was no notable publication bias. Sensitivity analysis showed that the meta-analysis results were stable and credible.
  
  
  CONCLUSIONS
  While perfusion MRI is not the ideal diagnostic method for differentiating glioma recurrence from pseudoprogression, it could improve diagnostic accuracy. Therefore, further research on combining perfusion MRI with other imaging modalities is warranted.
authors.affiliation: Department of Radiology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Wan
authors.forename: Siqi
authors.initials: S
authors.lastname: Wang
authors.forename: Mengqi
authors.initials: M
authors.lastname: Tu
authors.forename: Bo
authors.initials: B
authors.lastname: Wu
authors.forename: Ping
authors.initials: P
authors.lastname: Han
authors.forename: Haibo
authors.initials: H
authors.lastname: Xu
mesh_terms: D005910:Glioma / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000592:standards*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology*; D012680:Sensitivity and Specificity