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<meta name="DC.Title" content="Arterial Spin-Labeling in Children with Brain Tumor: A Meta-Analysis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5727" />
<meta name="DC.Date" content="2018-08-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2018 by American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND: The value of arterial spin-labeling in a pediatric population has not been assessed in a meta-analysis.

PURPOSE: Our aim was to assess the diagnostic accuracy of arterial spin-labeling–derived cerebral blood flow to discriminate low- and high-grade tumors.

DATA SOURCES: MEDLINE, EMBASE, the Web of Science Core Collection, and the Cochrane Library were used.

STUDY SELECTION: Pediatric patients with arterial spin-labeling MR imaging with verified neuropathologic diagnoses were included.

DATA ANALYSIS: Relative CBF and absolute CBF and tumor grade were extracted, including sequence-specific information. Mean differences in CBF between low- and high-grade tumors were calculated. Study quality was assessed.

DATA SYNTHESIS: Data were aggregated using the bivariate summary receiver operating characteristic curve model. Heterogeneity was explored with meta-regression and subgroup analyses. The study protocol was published at PROSPERO (CRD42017075055). Eight studies encompassing 286 pediatric patients were included. The mean differences in absolute CBF were 29.62 mL/min/100 g (95% CI, 10.43–48.82 mL/min/100 g), I2 = 74, P = .002, and 1.34 mL/min/100 g (95% CI, 0.95–1.74 mL/min/100 g), P &lt; .001, I2 = 38 for relative CBF. Pooled sensitivity for relative CBF ranged from 0.75 to 0.90, and specificity, from 0.77 to 0.92 with an area under curve = 0.92. Meta-regression showed no moderating effect of sequence parameters TE, TR, acquisition time, or ROI method.

LIMITATIONS: Included tumor types, analysis method, and original data varied among included studies.

CONCLUSIONS: Arterial spin-labeling–derived CBF measures showed high diagnostic accuracy for discriminating low- and high-grade tumors in pediatric patients with brain tumors. The relative CBF showed less variation among studies than the absolute CBF.

aCBF
:   absolute CBF
ASL
:   arterial spin-labeling
HGT
:   high-grade tumor
LGT
:   low-grade tumor
rCBF
:   relative CBF
QUADAS-2
:   Quality Assessment of Diagnostic Accuracy Studies
WHO
:   World Health Organization" />
<meta name="DC.Contributor" content="A.F. Delgado" />
<meta name="DC.Contributor" content="F. De Luca" />
<meta name="DC.Contributor" content="P. Hanagandi" />
<meta name="DC.Contributor" content="D. van Westen" />
<meta name="DC.Contributor" content="A.F. Delgado" />
<meta name="article:published_time" content="2018-08-01" />
<meta name="article:section" content="Pediatrics" />
<meta name="citation_title" content="Arterial Spin-Labeling in Children with Brain Tumor: A Meta-Analysis" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND:&lt;/h3&gt;
&lt;p&gt;The value of arterial spin-labeling in a pediatric population has not been assessed in a meta-analysis.&lt;/p&gt;&lt;h3&gt;PURPOSE:&lt;/h3&gt;
&lt;p&gt;Our aim was to assess the diagnostic accuracy of arterial spin-labeling–derived cerebral blood flow to discriminate low- and high-grade tumors.&lt;/p&gt;&lt;h3&gt;DATA SOURCES:&lt;/h3&gt;
&lt;p&gt;MEDLINE, EMBASE, the Web of Science Core Collection, and the Cochrane Library were used.&lt;/p&gt;&lt;h3&gt;STUDY SELECTION:&lt;/h3&gt;
&lt;p&gt;Pediatric patients with arterial spin-labeling MR imaging with verified neuropathologic diagnoses were included.&lt;/p&gt;&lt;h3&gt;DATA ANALYSIS:&lt;/h3&gt;
&lt;p&gt;Relative CBF and absolute CBF and tumor grade were extracted, including sequence-specific information. Mean differences in CBF between low- and high-grade tumors were calculated. Study quality was assessed.&lt;/p&gt;&lt;h3&gt;DATA SYNTHESIS:&lt;/h3&gt;
&lt;p&gt;Data were aggregated using the bivariate summary receiver operating characteristic curve model. Heterogeneity was explored with meta-regression and subgroup analyses. The study protocol was published at PROSPERO (CRD42017075055). Eight studies encompassing 286 pediatric patients were included. The mean differences in absolute CBF were 29.62 mL/min/100 g (95% CI, 10.43–48.82 mL/min/100 g), I&lt;sup&gt;2&lt;/sup&gt; = 74, &lt;i&gt;P&lt;/i&gt; = .002, and 1.34 mL/min/100 g (95% CI, 0.95–1.74 mL/min/100 g), &lt;i&gt;P&lt;/i&gt; &amp;lt; .001, I&lt;sup&gt;2&lt;/sup&gt; = 38 for relative CBF. Pooled sensitivity for relative CBF ranged from 0.75 to 0.90, and specificity, from 0.77 to 0.92 with an area under curve = 0.92. Meta-regression showed no moderating effect of sequence parameters TE, TR, acquisition time, or ROI method.&lt;/p&gt;&lt;h3&gt;LIMITATIONS:&lt;/h3&gt;
&lt;p&gt;Included tumor types, analysis method, and original data varied among included studies.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Arterial spin-labeling–derived CBF measures showed high diagnostic accuracy for discriminating low- and high-grade tumors in pediatric patients with brain tumors. The relative CBF showed less variation among studies than the absolute CBF.&lt;/p&gt;" />
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<meta name="twitter:title" content="Arterial Spin-Labeling in Children with Brain Tumor: A Meta-Analysis" />
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<meta name="twitter:description" content="BACKGROUND: The value of arterial spin-labeling in a pediatric population has not been assessed in a meta-analysis.

PURPOSE: Our aim was to assess the diagnostic accuracy of arterial spin-labeling–derived cerebral blood flow to discriminate low- and high-grade tumors.

DATA SOURCES: MEDLINE, EMBASE, the Web of Science Core Collection, and the Cochrane Library were used.

STUDY SELECTION: Pediatric patients with arterial spin-labeling MR imaging with verified neuropathologic diagnoses were included.

DATA ANALYSIS: Relative CBF and absolute CBF and tumor grade were extracted, including sequence-specific information. Mean differences in CBF between low- and high-grade tumors were calculated. Study quality was assessed.

DATA SYNTHESIS: Data were aggregated using the bivariate summary receiver operating characteristic curve model. Heterogeneity was explored with meta-regression and subgroup analyses. The study protocol was published at PROSPERO (CRD42017075055). Eight studies encompassing 286 pediatric patients were included. The mean differences in absolute CBF were 29.62 mL/min/100 g (95% CI, 10.43–48.82 mL/min/100 g), I2 = 74, P = .002, and 1.34 mL/min/100 g (95% CI, 0.95–1.74 mL/min/100 g), P &lt; .001, I2 = 38 for relative CBF. Pooled sensitivity for relative CBF ranged from 0.75 to 0.90, and specificity, from 0.77 to 0.92 with an area under curve = 0.92. Meta-regression showed no moderating effect of sequence parameters TE, TR, acquisition time, or ROI method.

LIMITATIONS: Included tumor types, analysis method, and original data varied among included studies.

CONCLUSIONS: Arterial spin-labeling–derived CBF measures showed high diagnostic accuracy for discriminating low- and high-grade tumors in pediatric patients with brain tumors. The relative CBF showed less variation among studies than the absolute CBF.

aCBF
:   absolute CBF
ASL
:   arterial spin-labeling
HGT
:   high-grade tumor
LGT
:   low-grade tumor
rCBF
:   relative CBF
QUADAS-2
:   Quality Assessment of Diagnostic Accuracy Studies
WHO
:   World Health Organization" />
<meta name="og-title" property="og:title" content="Arterial Spin-Labeling in Children with Brain Tumor: A Meta-Analysis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/39/8/1536" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND: The value of arterial spin-labeling in a pediatric population has not been assessed in a meta-analysis.

PURPOSE: Our aim was to assess the diagnostic accuracy of arterial spin-labeling–derived cerebral blood flow to discriminate low- and high-grade tumors.

DATA SOURCES: MEDLINE, EMBASE, the Web of Science Core Collection, and the Cochrane Library were used.

STUDY SELECTION: Pediatric patients with arterial spin-labeling MR imaging with verified neuropathologic diagnoses were included.

DATA ANALYSIS: Relative CBF and absolute CBF and tumor grade were extracted, including sequence-specific information. Mean differences in CBF between low- and high-grade tumors were calculated. Study quality was assessed.

DATA SYNTHESIS: Data were aggregated using the bivariate summary receiver operating characteristic curve model. Heterogeneity was explored with meta-regression and subgroup analyses. The study protocol was published at PROSPERO (CRD42017075055). Eight studies encompassing 286 pediatric patients were included. The mean differences in absolute CBF were 29.62 mL/min/100 g (95% CI, 10.43–48.82 mL/min/100 g), I2 = 74, P = .002, and 1.34 mL/min/100 g (95% CI, 0.95–1.74 mL/min/100 g), P &lt; .001, I2 = 38 for relative CBF. Pooled sensitivity for relative CBF ranged from 0.75 to 0.90, and specificity, from 0.77 to 0.92 with an area under curve = 0.92. Meta-regression showed no moderating effect of sequence parameters TE, TR, acquisition time, or ROI method.

LIMITATIONS: Included tumor types, analysis method, and original data varied among included studies.

CONCLUSIONS: Arterial spin-labeling–derived CBF measures showed high diagnostic accuracy for discriminating low- and high-grade tumors in pediatric patients with brain tumors. The relative CBF showed less variation among studies than the absolute CBF.

aCBF
:   absolute CBF
ASL
:   arterial spin-labeling
HGT
:   high-grade tumor
LGT
:   low-grade tumor
rCBF
:   relative CBF
QUADAS-2
:   Quality Assessment of Diagnostic Accuracy Studies
WHO
:   World Health Organization" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node62136--5" data-node-nid="62136" id="top-node-62136--6359388836" data-pisa="ajnr;39/8/1536" data-pisa-master="ajnr;ajnr.A5727" data-apath="/ajnr/39/8/1536.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Pediatrics</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="ajnr;ajnr.A5727" data-atom-uri="/ajnr/39/8/1536.atom" data-request-view="full"></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Arterial Spin-Labeling in Children with Brain Tumor: A Meta-Analysis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">A.F. Delgado</span>, <span class="highwire-citation-author" data-delta="1">F. De Luca</span>, <span class="highwire-citation-author" data-delta="2">P. Hanagandi</span>, <span class="highwire-citation-author" data-delta="3">D. van Westen</span> and <span class="highwire-citation-author" data-delta="4">A.F. Delgado</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2018,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1536-1542; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5727 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-62136--6359388836" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">A.F. Delgado </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Clinical Neuroscience (Anna F.D.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.F.%2BDelgado%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Delgado%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.F.%2BDelgado%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4389-5089" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.F. Delgado</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">F. De Luca </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Faculty of Medicine and Surgery (F.D.L.), School of Medicine and Health Sciences, University “G. d'Annunzio,” Chieti, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.%2BDe%2BLuca%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=De%20Luca%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AF.%2BDe%2BLuca%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7131-3248" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F. De Luca</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">P. Hanagandi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neuroradiology (P.H.), Karolinska Institute, Stockholm, Sweden</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BHanagandi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hanagandi%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AP.%2BHanagandi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-3654-8329" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P. Hanagandi</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">D. van Westen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Faculty of Medicine (D.v.W.), Clinical Sciences, Lund University, Sweden</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.%2Bvan%2BWesten%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=van%20Westen%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.%2Bvan%2BWesten%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8649-9874" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D. van Westen</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">A.F. Delgado </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Surgical Sciences (Alberto F.D.), Uppsala University, Uppsala, Sweden.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.F.%2BDelgado%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Delgado%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.F.%2BDelgado%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-9107-5814" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.F. Delgado</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-39.8.1536.1" data-doi="10.1007/s00381-013-2307-1"><div class="cit-metadata"><ol class="cit-auth-list"><li>
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 39</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 8 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Aug 2018 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">A.F.</span> <span class="nlm-surname">Delgado</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">F.</span> <span class="nlm-surname">De Luca</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Hanagandi</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.</span> <span class="nlm-surname">van Westen</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.F.</span> <span class="nlm-surname">Delgado</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1536-1542; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5727 </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">A.F.</span> <span class="nlm-surname">Delgado</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">F.</span> <span class="nlm-surname">De Luca</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Hanagandi</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.</span> <span class="nlm-surname">van Westen</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.F.</span> <span class="nlm-surname">Delgado</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1536-1542; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5727 </span></div>
  
  
  
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