• Charalampos Tsakiris, Timoleon Siempis, George A Alexiou, Anastasia Zikou, Chrissa Sioka, Spyridon Voulgaris, and Maria I Argyropoulou.
• Department of Neurosurgery, Medical School, University of Ioannina, Ioannina, Greece.
• World Neurosurg. 2020 Dec 1; 144: e100-e109.

BackgroundOn brain magnetic resonance imaging, both diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) are used to evaluate cerebral tumors. The purpose of this meta-analysis was to evaluate and compare the diagnostic performance of DWI and PWI in differentiating between pseudoprogression and true tumor progression of glioblastoma.MethodsWe performed a systematic review of the PubMed database from January 2000 to December 2019 for relevant studies. After application of specific inclusion and exclusion criteria, the eligible articles were evaluated for methodologic quality and risk of bias using the updated Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool. From the published study results, the pooled sensitivity, pooled specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio and their corresponding confidence intervals (% CI), and the area under the curve, were calculated individually for DWI and PWI.ResultsThe meta-analysis included 24 studies, with a total of 900 patients. DWI was found to be slightly superior in terms of sensitivity and specificity, 0.88 (% CI 0.83-0.92) and 0.85 (% CI 0.78-0.91), respectively, compared with the respective values of PWI, 0.85 (% CI 0.81-0.89) and 0.79 (% CI 0.74-0.84). On comparison of the overall diagnostic accuracy of the MRI modalities using their respective area under the curve values (0.9156 for DWI, 0.9072 for PWI), no significant difference was demonstrated between the 2.ConclusionsBoth DWI and PWI provided optimal diagnostic performance in differentiating pseudoprogression from true tumor progression in cerebral glioblastoma, and neither technique proved to be superior.Copyright © 2020 Elsevier Inc. All rights reserved.

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