Comparison of arterial spin labelling and dynamic susceptibility contrast perfusion MR imaging in paediatric brain tumours : a systematic review and meta-analysis

Abstract

Background: Brain tumours are a leading cause of mortality in children. Accurate tumour grading is essential to plan treatment and for prognostication. Perfusion imaging has been shown to correlate well with tumour grade in adults. However, there are fewer studies in paediatric patients. Moreover, there is no consensus regarding which MR perfusion technique demonstrates the highest accuracy in the latter population. Aim: To compare the diagnostic test accuracy of dynamic-susceptibility contrast and arterial spin-labelling, in their ability to differentiate between low- and high-grade paediatric brain tumours at first presentation. Methods: A systematic review of the literature and metanalysis of the extracted data was performed. PRISMA guidelines were followed. Results: 10 studies (7 ASL and 5 DSC) comprising 477 patients were included. The area under the curve (AUC) for the summary ROC of the combined studies was 0.866. The pooled AUC for ASL was 0.88, whilst that for DSC was 0.86. Pooled sensitivity was 0.824, 95% CI [0.757 - 0.876] for ASL and 0.789, 95% CI [0.552 - 0.919] for DSC. Pooled false positive rate was 0.204, 95% CI [0.142 0.285] for ASL and 0.203, 95% CI [0.081 - 0.425] for DSC. ASL appeared to perform better than DSC however the difference between the two studies was not statistically significant. Conclusion: Whilst DSC has been used more frequently than ASL in this field, the application of ASL is increasing. ASL is a contrast-free, non-invasive technique. As the diagnostic accuracy of ASL has been shown to be comparable and not inferior to DSC, its use in the diagnostic assessment of these patients should continue to be supported, however further studies with larger numbers and standardised practice are needed.