• N Verburg, F W A Hoefnagels, F Barkhof, R Boellaard, S Goldman, J Guo, J J Heimans, O S Hoekstra, R Jain, M Kinoshita, Pouwels P J W PJW http://orcid.org/0000-0001-8430-0606 Physics and Medical Technology (P.J.W.P.)., S J Price, J C Reijneveld, A Stadlbauer, W P Vandertop, P Wesseling, A H Zwinderman, and P C De Witt Hamer.
• From the Neurosurgical Center Amsterdam (N.V., F.W.A.H., W.P.V., P.C.D.W.H.).
• AJNR Am J Neuroradiol. 2017 Oct 1; 38 (10): 1884-1891.

BackgroundBrain imaging in diffuse glioma is used for diagnosis, treatment planning, and follow-up.PurposeIn this meta-analysis, we address the diagnostic accuracy of imaging to delineate diffuse glioma.Data SourcesWe systematically searched studies of adults with diffuse gliomas and correlation of imaging with histopathology.Study SelectionStudy inclusion was based on quality criteria. Individual patient data were used, if available.Data AnalysisA hierarchic summary receiver operating characteristic method was applied. Low- and high-grade gliomas were analyzed in subgroups.Data SynthesisSixty-one studies described 3532 samples in 1309 patients. The mean Standard for Reporting of Diagnostic Accuracy score (13/25) indicated suboptimal reporting quality. For diffuse gliomas as a whole, the diagnostic accuracy was best with T2-weighted imaging, measured as area under the curve, false-positive rate, true-positive rate, and diagnostic odds ratio of 95.6%, 3.3%, 82%, and 152. For low-grade gliomas, the diagnostic accuracy of T2-weighted imaging as a reference was 89.0%, 0.4%, 44.7%, and 205; and for high-grade gliomas, with T1-weighted gadolinium-enhanced MR imaging as a reference, it was 80.7%, 16.8%, 73.3%, and 14.8. In high-grade gliomas, MR spectroscopy (85.7%, 35.0%, 85.7%, and 12.4) and 11C methionine-PET (85.1%, 38.7%, 93.7%, and 26.6) performed better than the reference imaging.LimitationsTrue-negative samples were underrepresented in these data, so false-positive rates are probably less reliable than true-positive rates. Multimodality imaging data were unavailable.ConclusionsThe diagnostic accuracy of commonly used imaging is better for delineation of low-grade gliomas than high-grade gliomas on the basis of limited evidence. Improvement is indicated from advanced techniques, such as MR spectroscopy and PET.© 2017 by American Journal of Neuroradiology.

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