Systematic review and meta-analysis of arterial spin-labeling imaging to distinguish between glioma recurrence and post-treatment radiation effect

Background: At present, the use of arterial spin-labeling (ASL) imaging to assess the recurrence of gliomas and post-treatment radiation effect (PTRE) is limited, and the results of studies on ASL are quite different. To date, no multi-center, large-scale studies have been conducted to confirm its diagnostic efficacy. This study sought to systematically evaluate the diagnostic value of ASL imaging in distinguishing between glioma recurrence and PTRE. Methods: Databases, including Medline, Cochrane Library, Pub Med, Web of Science, Embase, China National Knowledge Infrastructure, Wan Fang, were searched to retrieve studies that used ASL imaging to diagnose glioma recurrence and radiation-induced brain injury. The search deadline was August 31, 2021. Two reviewers independently screened the literature according to set literature inclusion and exclusion criteria, extracted basic data from the literature, and evaluated the quality of the literature. Revman 5.3 software was used to analyze the included research data. Results: Ten studies, comprising 216 patients with glioma recurrence and 152 patients with PTRE, were included in the meta-analysis. The results showed that cerebral blood flow [mean difference (MD) =1.67, 95% confidence interval (CI): 0.89-2.46, P=0.000], relative cerebral blood flow (MD =1.20, 95% CI: 0.91-1.49, P=0.000), and relative cerebral blood volume (MD =1.29, 95% CI: 0.98-1.59, P=0.000); this 3 indicators between glioma recurrence and PTRE were significantly different. Discussion: ASL imaging has high diagnostic value in distinguishing between glioma recurrence and PTRE.