Glymphatic system dysfunction in gliomas: A systematic review and meta-analysis of DTI-ALPS index - 26/08/26
, Amirsaman Soleimani Nasab a , Narges Arabi a , Iraj Abedi b, ⁎ Graphical abstract |
Abstract |
Background |
The glymphatic system's role in brain waste clearance is increasingly recognized in glioma pathophysiology. This study synthesizes evidence on DTI-ALPS index variations across glioma grades, molecular subtypes, and clinical outcomes to evaluate its diagnostic and prognostic utility.
Methods |
: Following PRISMA 2020, major databases were searched up to December 20, 2025, for studies of adults with histologically confirmed gliomas who underwent DTI-ALPS assessment. Risk of bias was evaluated using ROBINS-E, and reporting quality using the STROBE checklist. Random-effects meta-analyses examined ALPS differences for six different outcome comparisons.
Results |
: Fourteen studies were included. ROBINS-E revealed very high risk of bias in 14% of studies and some concerns in 64%; mean STROBE compliance was 92.2%. High-grade gliomas exhibited lower ALPS indices than low-grade tumors (MD=0.14, 95% CI: 0.11–0.16; I 2 =0%). IDH wild-type gliomas showed lower ALPS indices than IDH-mutant tumors (MD=0.14, 95% CI: 0.10–0.18; I 2 =38%). Multivariate Cox regression demonstrated that lower ALPS index is associated with worse overall survival (HR=0.73, 95% CI: 0.49–1.10; I 2 =57%).
Conclusion |
: DTI-ALPS index reliably detects glymphatic dysfunction in gliomas and provides prognostic information, supporting its use as a non-invasive biomarker for glioma assessment. However, methodological standardization and prospective multicenter studies are needed for clinical integration.
Le texte complet de cet article est disponible en PDF.Keywords : Glioma, Glymphatic system, Diffusion tensor imaging, Magnetic resonance imaging, Prognosis
Abbreviations : AQP4, ALPS, AUC, CI, CSF, DKI, DTI, DTI-ALPS, GBM, GRADE, HGG, HR, IDH, ISF, LGG, MD, MMSE, MRI, OS, PICO, PRISMA, ROBINS-E, ROI, SNR, STROBE, WHO
Plan
Vol 53 - N° 5
Article 101572- septembre 2026 Retour au numéro
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