The diagnostic role of diffusional kurtosis imaging in glioma grading and differentiation of gliomas from other intra-axial brain tumours: a systematic review with critical appraisal and meta-analysis
Gehad Abdalla, Luke Dixon, Eser Sanverdi, Pedro Machado, Joey S.W. Kwong, Jasmina Panovska‐Griffiths, Antonio Rojas‐García, Daisuke Yoneoka, Jelle Veraart, Sofie Van Cauter, Ahmed M. Abdel‐Khalek, Magdy Settein, Tarek Yousry, Sotirios Bisdas
Abstract
Abstract Purpose We aim to illustrate the diagnostic performance of diffusional kurtosis imaging (DKI) in the diagnosis of gliomas. Methods A review protocol was developed according to the (PRISMA-P) checklist, registered in the international prospective register of systematic reviews (PROSPERO) and published. A literature search in 4 databases was performed using the keywords ‘glioma’ and ‘diffusional kurtosis’. After applying a robust inclusion/exclusion criteria, included articles were independently evaluated according to the QUADAS-2 tool and data extraction was done. Reported sensitivities and specificities were used to construct 2 × 2 tables and paired forest plots using the Review Manager (RevMan®) software. A random-effect model was pursued using the hierarchical summary receiver operator characteristics. Results A total of 216 hits were retrieved. Considering duplicates and inclusion criteria, 23 articles were eligible for full-text reading. Ultimately, 19 studies were eligible for final inclusion. The quality assessment revealed 9 studies with low risk of bias in the 4 domains. Using a bivariate random-effect model for data synthesis, summary ROC curve showed a pooled area under the curve (AUC) of 0.92 and estimated sensitivity of 0.87 (95% CI 0.78–0.92) in high-/low-grade gliomas’ differentiation. A mean difference in mean kurtosis (MK) value between HGG and LGG of 0.22 (95% CI 0.25–0.19) was illustrated ( p value = 0.0014) with moderate heterogeneity ( I 2 = 73.8%). Conclusion DKI shows good diagnostic accuracy in the differentiation of high- and low-grade gliomas further supporting its potential role in clinical practice. Further exploration of DKI in differentiating IDH status and in characterising non-glioma CNS tumours is however needed.