Abstract：
OBJECTIVE: 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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
目的：在这项研究中，我们收集并分析了17种不同成像方式的现有证据，并进行了网络荟萃分析，以找到区分脑肿瘤复发和治疗后放疗效应的最有效方式。
方法：我们对PubMed和Embase进行了全面系统的搜索。使用多重系统评价-2（AMSTAR-2）工具评估合格研究的质量。对于每个荟萃分析，我们重新计算了效果大小，灵敏度,特异性，正负似然比，和使用随机效应模型的原始荟萃分析中提供的个体研究数据的诊断优势比。然后使用NMA评估成像技术比较。使用多维缩放方法并通过视觉评估累积排序曲线下的表面来评估排序。
结果：我们确定了32项符合条件的研究。只有其中一个对结果有很高的信心，在纳入的荟萃分析中，分别有21%和9%的患者具有显著的异质性和较小的研究效果。MRSCho/NAA之间的比较，Cho/Cr,DWI,和DSC的研究最多。我们的分析显示MRS（Cho/NAA）和18F-DOPAPET显示出最高的敏感性和负似然比。18-FETPET在17种研究技术中排名最高，具有统计学意义。APTMRI是唯一排名高于DSC的非核成像方式，具有统计学意义，however.
结论：关于哪种成像方式最适合区分放射性坏死和治疗后辐射效应的证据仍然没有定论。使用NMA，根据现有证据,我们的分析将FETPET列为最适合此类任务的.APTMRI作为非核替代方法显示出有希望的结果。
方法：我们对PubMed和Embase进行了全面系统的搜索。使用多重系统评价-2（AMSTAR-2）工具评估合格研究的质量。对于每个荟萃分析，我们重新计算了效果大小，灵敏度,特异性，正负似然比，和使用随机效应模型的原始荟萃分析中提供的个体研究数据的诊断优势比。然后使用NMA评估成像技术比较。使用多维缩放方法并通过视觉评估累积排序曲线下的表面来评估排序。
结果：我们确定了32项符合条件的研究。只有其中一个对结果有很高的信心，在纳入的荟萃分析中，分别有21%和9%的患者具有显著的异质性和较小的研究效果。MRSCho/NAA之间的比较，Cho/Cr,DWI,和DSC的研究最多。我们的分析显示MRS（Cho/NAA）和18F-DOPAPET显示出最高的敏感性和负似然比。18-FETPET在17种研究技术中排名最高，具有统计学意义。APTMRI是唯一排名高于DSC的非核成像方式，具有统计学意义，however.
结论：关于哪种成像方式最适合区分放射性坏死和治疗后辐射效应的证据仍然没有定论。使用NMA，根据现有证据,我们的分析将FETPET列为最适合此类任务的.APTMRI作为非核替代方法显示出有希望的结果。
