Neuro-Oncology Advances 4(1), 1–16, 2022 | https://doi.org/10.1093/noajnl/vdac027 | Advance Access date 01 March 2022 1 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com © The Author(s) 2022. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology. Rongwei Fu, Laszlo Szidonya, Ramon F. Barajas Jr., Prakash Ambady, Csanad Varallyay, and Edward A. Neuwelt Oregon Health & Science University-Portland State University, School of Public Health, Portland, Oregon, USA (R.F.); Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA (R.F.); Department of Radiology, Oregon Health & Science University, Portland, Oregon, USA (L.S., R.F.B.); Neuro-Oncology Program, Oregon Health & Science University, Portland, Oregon, USA (L.S., P.A., E.A.N.); Heart and Vascular Center, Diagnostic Radiology, Semmelweis University, Budapest, Hungary (L.S.); Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA (R.F.B.); Knight Cancer Institute Translational Oncology Program, Oregon Health & Science University, Portland, Oregon, USA (R.F.B.); Department of Radiology, EPIC Imaging, Portland, Oregon, USA (C.V.); Department of Neurosurgery, Oregon Health and Sciences University, Portland, Oregon, USA (E.A.N.); Office of Research and Development, Department of Veterans Affairs Medical Center, Portland, Oregon, USA (E.A.N.) Corresponding Author: Edward A. Neuwelt, MD, Oregon Health and Science University, Mail code L 603, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA (neuwelte@ohsu.edu). Abstract Background. In patients with high-grade glioma (HGG), true disease progression and treatment-related changes often appear similar on magnetic resonance imaging (MRI), making it challenging to evaluate therapeutic response. Dynamic susceptibility contrast (DSC) MRI has been extensively studied to differentiate between disease progres- sion and treatment-related changes. This systematic review evaluated and synthesized the evidence for using DSC MRI to distinguish true progression from treatment-related changes. Methods. We searched Ovid MEDLINE and the Ovid MEDLINE in-process fle (January 2005–October 2019) and the reference lists. Studies on test performance of DSC MRI using relative cerebral blood volume in HGG patients were included. One investigator abstracted data, and a second investigator confrmed them; two investigators independ- ently assessed study quality. Meta-analyses were conducted to quantitatively synthesize area under the receiver operating curve (AUROC), sensitivity, and specifcity. Results. We screened 1177 citations and included 28 studies with 638 patients with true tumor progression, and 430 patients with treatment-related changes. Nineteen studies reported AUROC and the combined AUROC is 0.85 (95% CI, 0.81–0.90). All studies contributed data for sensitivity and specifcity, and the pooled sensitivity and speci- fcity are 0.84 (95% CI, 0.80–0.88), and 0.78 (95% CI, 0.72–0.83). Extensive subgroup analyses based on study, treat- ment, and imaging characteristics generally showed similar results. Conclusions. There is moderate strength of evidence that relative cerebral blood volume obtained from DSC im- aging demonstrated “excellent” ability to discriminate true tumor progression from treatment-related changes, with robust sensitivity and specifcity. Keywords: diagnostic performance | dynamic susceptibility contrast (DSC) MRI | high-grade glioma | meta-analysis | treatment-related changes Diagnostic performance of DSC perfusion MRI to distinguish tumor progression and treatment-related changes: a systematic review and meta-analysis Downloaded from https://academic.oup.com/noa/article/4/1/vdac027/6540485 by guest on 13 December 2022