Dynamic susceptibility contrast perfusion in differentiation between recurrence and pseudoprogression in glioblastoma: a systematic review and meta-analysis.

Background: Dynamic susceptibility contrast (DSC) perfusion has emerged as a valuable imaging technique for distinguishing pseudoprogression (PP) from recurrent tumor (RT) in patients with gliomas. However, its diagnostic accuracy, specifically in glioblastoma, remains less clearly defined. This systematic review aimed to evaluate and clarify the diagnostic performance of DSC perfusion in differentiating PP from RT in glioblastoma patients. Methods: A comprehensive search of the PubMed, Cochrane Library, and Wanfang databases was conducted for relevant articles published up to October 2024. Eligible studies were screened, and data about patient diagnoses were systematically extracted and synthesized. Results: A total of 13 studies comprising 487 patients met the inclusion criteria, with 318 categorized as RT and 178 as PP. In three studies, both relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) were assessed, whereas the remaining studies relied solely on rCBV. Pooled analyses of rCBV demonstrated a sensitivity of 87% [95% confidence interval (CI): 0.82-0.91], specificity of 83% (95% CI: 0.75-0.89), positive likelihood ratio of 5.14 (95% CI: 3.35-7.89), and negative likelihood ratio of 0.16 (95% CI: 0.11-0.23). None of these measures showed significant heterogeneity (I2=18.92%, 11.76%, 0%, and 0.35%, respectively). The pooled area under the curve (AUC) was 0.92 (95% CI: 0.89-0.94), indicating excellent diagnostic accuracy, with only minimal evidence of publication bias (P=0.051). Due to the limited number of studies (n=3) reporting rCBF-related outcomes, a pooled diagnostic analysis for rCBF could not be performed. Conclusions: These findings demonstrate that DSC perfusion provides a reliable and effective method for distinguishing PP from RT in the diagnostic evaluation of glioblastoma patients.