Abstract：
OBJECTIVE: Differentiating true progression or recurrence (TP/TR) from therapy-related changes (TRC) is complex in brain tumours. Amide proton transfer-weighted (APT) imaging is a chemical exchange saturation transfer (CEST) MRI technique that may improve diagnostic accuracy during radiological follow-up. This systematic review and meta-analysis elucidated the level of evidence and details of state-of-the-art imaging for APT-CEST in glioma and brain metastasis surveillance.
METHODS: PubMed, EMBASE, Web of Science, and Cochrane Library were systematically searched for original articles about glioma and metastasis patients who received APT-CEST imaging for suspected TP/TR within 2 years after (chemo)radiotherapy completion. Modified Quality Assessment of Diagnostic Accuracy Studies-2 criteria were applied. A meta-analysis was performed to pool results and to compare subgroups.
RESULTS: Fifteen studies were included for a narrative synthesis, twelve of which (500 patients) were deemed sufficiently homogeneous for a meta-analysis. Magnetisation transfer ratio asymmetry performed well in gliomas (sensitivity 0.88 [0.82-0.92], specificity 0.84 [0.72-0.91]) but not in metastases (sensitivity 0.64 [0.38-0.84], specificity 0.56 [0.33-0.77]). APT-CEST combined with conventional/advanced MRI rendered 0.92 [0.86-0.96] and 0.88 [0.72-0.95] in gliomas. Tumour type, TR prevalence, sex, and acquisition protocol were sources of significant inter-study heterogeneity in sensitivity (I2 = 62.25%; p < 0.01) and specificity (I2 = 66.31%; p < 0.001).
CONCLUSIONS: A growing body of literature suggests that APT-CEST is a promising technique for improving the discrimination of TP/TR from TRC in gliomas, with limited data on metastases.
CONCLUSIONS: This meta-analysis identified a utility for APT-CEST imaging regarding the non-invasive discrimination of brain tumour progression from therapy-related changes, providing a critical evaluation of sequence parameters and cut-off values, which can be used to improve response assessment and patient outcome.
CONCLUSIONS: Therapy-related changes mimicking progression complicate brain tumour treatment. Amide proton imaging improves the non-invasive discrimination of glioma progression from therapy-related changes. Magnetisation transfer ratio asymmetry measurement seems not to have added value in brain metastases.
METHODS: PubMed, EMBASE, Web of Science, and Cochrane Library were systematically searched for original articles about glioma and metastasis patients who received APT-CEST imaging for suspected TP/TR within 2 years after (chemo)radiotherapy completion. Modified Quality Assessment of Diagnostic Accuracy Studies-2 criteria were applied. A meta-analysis was performed to pool results and to compare subgroups.
RESULTS: Fifteen studies were included for a narrative synthesis, twelve of which (500 patients) were deemed sufficiently homogeneous for a meta-analysis. Magnetisation transfer ratio asymmetry performed well in gliomas (sensitivity 0.88 [0.82-0.92], specificity 0.84 [0.72-0.91]) but not in metastases (sensitivity 0.64 [0.38-0.84], specificity 0.56 [0.33-0.77]). APT-CEST combined with conventional/advanced MRI rendered 0.92 [0.86-0.96] and 0.88 [0.72-0.95] in gliomas. Tumour type, TR prevalence, sex, and acquisition protocol were sources of significant inter-study heterogeneity in sensitivity (I2 = 62.25%; p < 0.01) and specificity (I2 = 66.31%; p < 0.001).
CONCLUSIONS: A growing body of literature suggests that APT-CEST is a promising technique for improving the discrimination of TP/TR from TRC in gliomas, with limited data on metastases.
CONCLUSIONS: This meta-analysis identified a utility for APT-CEST imaging regarding the non-invasive discrimination of brain tumour progression from therapy-related changes, providing a critical evaluation of sequence parameters and cut-off values, which can be used to improve response assessment and patient outcome.
CONCLUSIONS: Therapy-related changes mimicking progression complicate brain tumour treatment. Amide proton imaging improves the non-invasive discrimination of glioma progression from therapy-related changes. Magnetisation transfer ratio asymmetry measurement seems not to have added value in brain metastases.
摘要：
目的：区分脑肿瘤的真实进展或复发（TP/TR）与治疗相关变化（TRC）是复杂的。酰胺质子转移加权（APT）成像是一种化学交换饱和转移（CEST）MRI技术，可以在放射学随访期间提高诊断准确性。这项系统评价和荟萃分析阐明了APT-CEST在神经胶质瘤和脑转移监测中的最新成像的证据水平和细节。
方法：PubMed，EMBASE,WebofScience,和CochraneLibrary系统检索有关胶质瘤和转移患者的原始文章，这些患者在（化学）放疗完成后2年内接受了APT-CEST成像的可疑TP/TR。应用改良的诊断准确性研究质量评估-2标准。进行荟萃分析以汇总结果并比较亚组。
结果：15项研究被纳入叙事综合，其中12例(500例)被认为在荟萃分析中足够同质。磁化转移比不对称性在胶质瘤中表现良好（灵敏度0.88[0.82-0.92]，特异性0.84[0.72-0.91]），但不在转移中（敏感性0.64[0.38-0.84]，特异性0.56[0.33-0.77]）。APT-CEST联合常规/高级MRI在胶质瘤中表现为0.92[0.86-0.96]和0.88[0.72-0.95]。肿瘤类型,TR患病率,性别,和获取方案在敏感性(I2=62.25%;p<0.01)和特异性(I2=66.31%;p<0.001)方面是研究间显著异质性的来源。
结论：越来越多的文献表明，APT-CEST是一种有前途的技术，可以改善神经胶质瘤中TP/TR与TRC的区别，关于转移的数据有限。
结论：这项荟萃分析确定了APT-CEST成像在非侵入性区分脑肿瘤进展与治疗相关变化方面的实用性，提供序列参数和截止值的关键评估，可用于改善反应评估和患者预后。
结论：模仿进展的治疗相关变化使脑肿瘤治疗复杂化。酰胺质子成像可改善神经胶质瘤进展与治疗相关变化的非侵入性区分。磁化转移比不对称性测量似乎在脑转移中没有附加值。
方法：PubMed，EMBASE,WebofScience,和CochraneLibrary系统检索有关胶质瘤和转移患者的原始文章，这些患者在（化学）放疗完成后2年内接受了APT-CEST成像的可疑TP/TR。应用改良的诊断准确性研究质量评估-2标准。进行荟萃分析以汇总结果并比较亚组。
结果：15项研究被纳入叙事综合，其中12例(500例)被认为在荟萃分析中足够同质。磁化转移比不对称性在胶质瘤中表现良好（灵敏度0.88[0.82-0.92]，特异性0.84[0.72-0.91]），但不在转移中（敏感性0.64[0.38-0.84]，特异性0.56[0.33-0.77]）。APT-CEST联合常规/高级MRI在胶质瘤中表现为0.92[0.86-0.96]和0.88[0.72-0.95]。肿瘤类型,TR患病率,性别,和获取方案在敏感性(I2=62.25%;p<0.01)和特异性(I2=66.31%;p<0.001)方面是研究间显著异质性的来源。
结论：越来越多的文献表明，APT-CEST是一种有前途的技术，可以改善神经胶质瘤中TP/TR与TRC的区别，关于转移的数据有限。
结论：这项荟萃分析确定了APT-CEST成像在非侵入性区分脑肿瘤进展与治疗相关变化方面的实用性，提供序列参数和截止值的关键评估，可用于改善反应评估和患者预后。
结论：模仿进展的治疗相关变化使脑肿瘤治疗复杂化。酰胺质子成像可改善神经胶质瘤进展与治疗相关变化的非侵入性区分。磁化转移比不对称性测量似乎在脑转移中没有附加值。
