Table 1.
Summary of studies for CQ1 (conventional radiological imaging)
| References | Study Design | Patient | Exposure | Comparison | Outcome | Reference Standard |
|---|---|---|---|---|---|---|
| Dequesada 2008 [16] | Retrospective case series | 32 Mets treated with SRS | MRI lesion quotient ≤ 0.3 (retrospective) (blinded review) | AV shunt, enhancement pattern, etc. | Sensitivity: 80% Specificity: 96.4% Accuracy: 94% |
Histology for all 32 lesions (blinded review) |
| Leeman 2013 [17] | Retrospective case series | 49 Mets 52 lesions treated with SRS |
MRI edema/lesion volume ratio ≥ 10 (retrospective) (blinded review) | None | Sensitivity: 84.6% Specificity: 62.9% Accuracy: 69% |
Histology obtained by removal in all 52 lesions |
| Santra 2011 [18] | Prospective cohort study | 85 gliomas (16 GIVs, 28 GIIIs, 37GIIs, 4 GIs) | MRI Gd-enhancement (blinded review) | 99mTc-GHA-PET (blinded review) | Sensitivity: 24.1% Specificity: 94.6% Accuracy: 71% |
5 Histological and 80 clinical diagnosis (repeat imaging, F/U ≥ 6 mos) |
| Tie 2008 [19] | Retrospective case series (consecutive) | 19 gliomas (21 examinations) (7 GBMs, 7 AAs, 5 AOs) | MRI T1, T2, FLAIR, GdT1 Radiological report | 201Tl-SPECT | Sensitivity: 75% Specificity: 64.7% Accuracy: 67% |
9 Histological and 12 clinical diagnosis (clinical course) |
| Di Costanzo 2014 [20] | Retrospective case series (consecutive) | 29 GBMs | DWI ADC alone (higher) | Sensitivity: 87.5% Specificity: 81.0% Accuracy: 83% |
Clinical diagnosis (≥4 F/U MRI, 2–6-mo interval) in all 29 cases | |
| MRS Cho/Crn alone (lower) | Sensitivity: 75.0% Specificity: 81.0% Accuracy: 79% |
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| PWI rCBV alone (lower) | Sensitivity: 87.5% Specificity: 85.7% Accuracy: 86% |
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| MRS, DWI, and MRP Cho/Chon, ADC, CBV | Sensitivity: 100% Specificity: 95.2% Accuracy: 97% |
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| Cha 2013 [21] | Retrospective case series (consecutive) | 16 Mets treated with SRS | DWI 3 layer pattern of ADC | Sensitivity: 100% Specificity: 87.5% Accuracy: 94% |
Histological diagnosis by removal in all 16 cases | |
| MRP rCBV ≤ 4.1 (retrospective) | Sensitivity: 100% Specificity: 71.4% Accuracy: 88% |
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| DWI and perfusion MRI 3 layer pattern ADC with rCBV ≤ 2.6 or rCBV ≤ 4.1 (retrospective) |
Sensitivity: 100% Specificity: 100% Accuracy: 100% |
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| Amin 2012 [22] | Retrospective case series | 24 primary brain tumors (7 GBMs, 12 AAs, 5 GI-IIAs) | MRS Cho/Cr < 1.5 and Cho/NAA < 1 (prospective) | 99mTc-DMSA-PET | Sensitivity: 100% Specificity: 61.1% Accuracy: 71% |
5 Histological (5B) and 19 clinical diagnosis (clinical course and F/U image) |
| Ando 2004 [23] | Retrospective case series | 20 gliomas (10 GBMs, 2 AAs, 1 OD, 7 GI-IIAs) | MRS Cho/Cr < 1.5 (retrospective) | None | Sensitivity: 83.3% Specificity: 64.3% Accuracy: 70% |
7 Histological and 13 clinical diagnosis (MRI F/U ≥ 1 year) |
| Elias 2011 [24] | Retrospective case series | 27 intracranial neoplasms | MRS Cho/NAA < 0.92 (Retrospective) | MRS Higher NAA/Cr, lower Cho/nNAA | Sensitivity: 90% Specificity: 86.7% Accuracy: 88% |
10 Histology and15 clinical diagnosis (3–6-mo F/U imaging) |
| Huang 2011 [25] | Retrospective case series | 33 metastatic lesions | MRS 24 multivoxel MRS Cho/nCho ≤ 1.2 (retrospective) | Sensitivity: 100% Specificity: 33.3% Accuracy: 48% |
4 Histological and 29 clinical diagnosis (F/U image) | |
| MRP rCBV ≤ 2 (retrospective) | Sensitivity: 100% Specificity: 55.6% Accuracy: 70% |
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| Nakajima T 2009 [26] | Retrospective case series | 18 gliomas (8 GBMs, 6AAs, 4 DAs) | MRS Lac/Cho > 1.05 (retrospective) | MET-PET | Sensitivity: 88.9% Specificity: 100% Accuracy: 94% |
14 Histological and 4 clinical diagnosis (clinical course and F/U image ≥6 mos) |
| Peca 2009 [27] | Retrospective case series | 15 GBMs after Stupp protocol | MRS neither increased Cho nor decreased NAA | None | Sensitivity: 25% Specificity: 100% Accuracy: 80% |
10 Histological and 5 clinical diagnosis (clinical and 3-mo interval MRI F/U) |
| Zeng IJROBP 2007 [28] | Prospective cohort study | 55 HGGs (36 GIIIs, 19 GIVs) | MRS Lower Cho/Cr and lower Cho/NAA |
Sensitivity: 100% Specificity: 93.8% Accuracy: 96% |
39 Histological (10B, 29R) and 16 clinical diagnosis (MRI F/U ≤ 22 mos) | |
| Proton MRS and DWI combination of Cho/Cr, Cho/NAA, ADC ratio (higher) |
Sensitivity: 100% Specificity: 93.8% Accuracy: 96% |
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| Zeng JNO 2007 [29] | Prospective cohort study | 28 HGGs (20 GIIIs, 8 GIVs) |
proton MRS Cho/Cr < 1.71, Cho/NAA < 1.71 (retrospective) |
None | Sensitivity: 100% Specificity: 94.1% Accuracy: 96% |
21 Histological (5B, 16R) and 7 clinical diagnosis (F/U MRI) |
| Jain 2011 [30] | Retrospective case series | 38 brain tumors | PCT rCBV ≤ 1.5 PS ≤ 2.5 (retrospective) |
None | Sensitivity: 90.9, 81.8% Specificity: 81.5, 81.5% Accuracy: 84, 82% |
Histological diagnosis in all 38 cases |
| Barajas 2009 [31] | Retrospective case series | 57 GBMs (66 examinations) | MRP rPH < 1.38 (retrospective) (blinded review) | None | Sensitivity: 80% Specificity: 89.1% Accuracy: 86% |
64 Histological (62R, 2B) and 2 clinical diagnosis (MRI F/U ≥ 22 mos) |
| Bisdas 2011 [32] | Prospective cohort study | 18 HGGs | MRP Ktrans ≤ 0.19 (retrospective) |
None | Sensitivity: 83.3% Specificity: 100% Accuracy: 94% |
5 Histological and 13 clinical diagnosis (MRI F/U ≥ 6 mos) |
| Bobek-Billewicz 2011 [33] | Retrospective case series | 8 gliomas (11 lesions) (2 GBMs, 5 AAs, 1 DA) | MRP Normalized CBVmean ≤ 1.25 (retrospective) |
DWI | Sensitivity: 100% Specificity: 60% Accuracy: 82% |
8 Histological and 3 clinical diagnosis (F/U image) |
| Kim 2010 [34] | Retrospective case series | 10 HGGs (5 GBMs, 3 AAs, 2 AOs) |
MRP normalized rCBV ≤ 3.69 (retrospective) |
18F-FDG-PET, 11C-MET-PET | Sensitivity: 100% Specificity: 100% Accuracy: 100 |
3 Histological (3 R) and 7 clinical diagnosis (3-mo interval MRI F/U of 28 mos) |
| Narang J 2011 [35] | Retrospective case series | 29 brain tumors (24 PBTs, 5 Mets) | MRP nMSIVP < 0.031 (MSIVP ≤ 9.5) (retrospective) |
None | Sensitivity: 77.8% Specificity: 95% Accuracy: 90% |
20 Histological and 9 clinical diagnosis (imaging and clinical F/U ≦13 mos) |