An evidence-based approach to evaluate the accuracy of amide proton transfer-weighted MRI in characterization of gliomas

BACKGROUD: To perform a meta-analysis to evaluate the diagnostic accuracy of the amide proton transfer (APT) technique in differentiating high-grade gliomas (HGGs) from low grade gliomas (LGGs). METHODS: Medical literature databases were searched for studies that evaluated the diagnostic accuracy of APT in patients suspected of brain tumor who underwent APT MRI and surgery. Only English language studies and published before September 2018 were considered to be included in this project. Homogeneity was assessed by the inconsistency index. Mean difference (MD) at 95% confidence interval (CI) of all parameters derived from APT was calculated. Publication bias was explored by Egger's funnel plot. RESULTS: Six eligible studies were included in the meta-analysis, comprising 144 HGGs and 122 LGGs. The APT-related parameter signal intensity (SI) was significantly higher in the HGG than the LGG (WMD = 0.86 (0.61–1.1), P < .0001); A significant difference was also found between grade II and grade III (WMD = 0.6 (0.4–0.8), P < .0001), and between grade II and grade IV (WMD = 1.07 (0.65–1.49), P < .0001). CONCLUSIONS: APT imaging may be a useful imaging biomarker for discriminating between LGGs and HGGs. However, large randomized control trials (RCT) were necessary to evaluate its clinical value.