MRI as a diagnostic biomarker for differentiating primary central nervous system lymphoma from glioblastoma: A systematic review and meta‐analysis

Background Accurate preoperative differentiation of primary central nervous system lymphoma (PCNSL) and glioblastoma is clinically crucial because the treatment strategies differ substantially. Purpose To evaluate the diagnostic performance of MRI for differentiating PCNSL from glioblastoma. Study Type Systematic review and meta‐analysis. Subjects Ovid‐MEDLINE and EMBASE databases were searched to find relevant original articles up to November 25, 2018. The search term combined synonyms for "lymphoma," "glioblastoma," and "MRI." Field Strength/Sequence Patients underwent at least one MRI sequence including diffusion‐weighted imaging (DWI), dynamic susceptibility‐weighted contrast‐enhanced imaging (DSC), dynamic contrast‐enhanced imaging (DCE), arterial spin labeling (ASL), susceptibility‐weighted imaging (SWI), intravoxel incoherent motion (IVIM), and magnetic resonance spectroscopy (MRS) using 1.5 or 3 T. Assessment Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. Statistical Tests Hierarchical logistic regression modeling was used to obtain pooled sensitivity and specificity. Meta‐regression was performed. Results Twenty‐two studies with 1182 patients were included. MRI sequences demonstrated high overall diagnostic performance with pooled sensitivity of 91% (95% confidence interval [CI], 87–93%) and specificity of 89% (95% CI, 85–93%). The area under the hierarchical summary receiver operating characteristic curve was 0.92 (95% CI, 0.90–0.94). Studies using DSC or ASL showed high diagnostic performance (sensitivity of 93% [95% CI, 89–97%] and specificity of 91% [95% CI, 86–96%]). Heterogeneity was only detected in specificity (I2 = 66.84%) and magnetic field strength was revealed to be a significant factor affecting study heterogeneity. Data Conclusion MRI showed overall high diagnostic performance for differentiating PCNSL from glioblastoma, with studies using DSC or ASL showing high diagnostic performance. Therefore, MRI sequences including DSC or ASL is a potential diagnostic tool for differentiating PCNSL from glioblastoma. Level of Evidence: 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:560–572.