Radiomics for differentiating radiation-induced brain injury from recurrence in gliomas: systematic review, meta-analysis, and methodological quality evaluation using METRICS and RQS.

Abstract

Objective: To systematically evaluate glioma radiomics literature on differentiating between radiation-induced brain injury and tumor recurrence.

Methods: Literature was searched on PubMed and Web of Science (end date: May 7, 2024). Quality of eligible papers was assessed using METhodological RadiomICs Score (METRICS) and Radiomics Quality Score (RQS). Reliability of quality scoring tools were analyzed. Meta-analysis, meta-regression, and subgroup analysis were performed.

Results: Twenty-seven papers were included in the qualitative assessment. Mean average METRICS score and RQS percentage score across three readers was 57% (SD, 14%) and 16% (SD, 12%), respectively. Score-wise inter-rater agreement for METRICS ranged from poor to excellent, while RQS demonstrated moderate to excellent agreement. Item-wise agreement was moderate for both tools. Meta-analysis of 11 eligible studies yielded an estimated area under the receiver operating characteristic curve of 0.832 (95% CI, 0.757-0.908), with significant heterogeneity (I² = 91%) and no statistical publication bias (p = 0.051). Meta-regression did not identify potential sources of heterogeneity. Subgroup analysis revealed high heterogeneity across all subgroups, with the lowest I² at 68% in studies with proper validation and higher quality scores. Statistical publication bias was generally not significant, except in the subgroup with the lowest heterogeneity (p = 0.044). However, most studies in both qualitative analysis (26/27; 96%) and primary meta-analysis (10/11; 91%) reported positive effects of radiomics, indicating high non-statistical publication bias.

Conclusion: While a good performance was noted for radiomics, results should be interpreted cautiously due to heterogeneity, publication bias, and quality issues thoroughly examined in this study.

Key points: Question Radiomic literature on distinguishing radiation-induced brain injury from glioma recurrence lacks systematic reviews and meta-analyses that assess methodological quality using radiomics-specific tools. Findings While the results are encouraging, there was substantial heterogeneity, publication bias toward positive findings, and notable concerns regarding methodological quality. Clinical relevance Meta-analysis results need cautious interpretation due to significant problems detected during the analysis (e.g., suboptimal quality, heterogeneity, bias), which may help explain why radiomics has not yet been translated into clinical practice.