Glymphatic System Dysfunction in Gliomas: A Systematic Review and Meta-Analysis of Dti-Alps Index Publisher Pubmed

Summary: Could MRI reflect brain waste clearance in glioma? A meta-analysis linked lower DTI-ALPS scores to tumor features; standardized, prospective studies are still needed. #Glioma #Neuroimaging

Dehaghi F T ; Nasab A S ; Arabi N ; Abedi I
Source: Journal of Neuroradiology Published:2026

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; I2=0%). IDH wild-type gliomas showed lower ALPS indices than IDH-mutant tumors (MD=0.14, 95% CI: 0.10–0.18; I2=38%). Multivariate Cox regression demonstrated that lower ALPS index is associated with worse overall survival (HR=0.73, 95% CI: 0.49–1.10; I2=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. © 2026 Elsevier Masson SAS