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Table 1 Summary of studies for CQ1 (conventional radiological imaging)

From: Radiological diagnosis of brain radiation necrosis after cranial irradiation for brain tumor: a systematic review

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%

 
  

PWI rCBV alone (lower)

 

Sensitivity: 87.5%

Specificity: 85.7%

Accuracy: 86%

 
  

MRS, DWI, and MRP Cho/Chon, ADC, CBV

 

Sensitivity: 100%

Specificity: 95.2%

Accuracy: 97%

 

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%

 
  

DWI and perfusion MRI

3 layer pattern ADC

with rCBV ≤ 2.6 or rCBV ≤ 4.1 (retrospective)

 

Sensitivity: 100%

Specificity: 100%

Accuracy: 100%

 

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%

 

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%

 

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 â‰¤â€‰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)