Abstract
SUMMARY: 18F-FDG-PET has been widely used in patients with brain tumors. However, the reported sensitivity and specificity of 18F-FDG-PET for brain tumor differentiation varied greatly. We performed this meta-analysis to systematically assess the diagnostic performance of 18F-FDG-PET in differentiating brain tumors. The diagnostic performance of 11C-methionine PET was assessed for comparison. Relevant studies were searched in PubMed/MEDLINE, Scopus, and China National Knowledge Infrastructure (until February 2013). The methodologic quality of eligible studies was evaluated, and a meta-analysis was performed to obtain the combined diagnostic performance of 18F-FDG and 11C-methionine PET with a bivariate model. Thirty eligible studies, including 5 studies with both 18F-FDG and 11C-methionine PET data were enrolled. Pooled sensitivity, pooled specificity, and area under the receiver operating characteristic curve of 18F-FDG-PET (n = 24) for differentiating brain tumors were 0.71 (95% CI, 0.63–0.78), 0.77 (95% CI, 0.67–0.85), and 0.80. Heterogeneity was found among 18F-FDG studies. Subsequent subgroup analysis revealed that the disease status was a statistically significant source of the heterogeneity and that the sensitivity in the patients with recurrent brain tumor was markedly higher than those with suspected primary brain tumors. Pooled sensitivity, pooled specificity, and area under the receiver operating characteristic of 11C-methionine PET (n = 11) were 0.91 (95% CI, 0.85–0.94), 0.86 (95% CI, 0.78–0.92), and 0.94. No significant statistical heterogeneity was found among 11C-methionine studies. This meta-analysis suggested that 18F-FDG-PET has limited diagnostic performance in brain tumor differentiation, though its performance may vary according to the status of brain tumor, whereas 11C-methionine PET has excellent diagnostic accuracy in brain tumor differentiation.
Abbreviations
- AUC
- area under receiver operating characteristic curve
- 18F-FDOPA
- 3,4-dihydroxy-6-18F-fluoro-L-phenylalanine
- 18F-FET
- O-(2−[18F]fluoroethyl)-L-tyrosine
- 18F-FLT
- 3’-deoxy-3’-18F-fluorothymidine
- HSROC
- hierarchic summary receiver operating characteristics
- LR
- likelihood ratio
- MET
- methionine
- SPBT
- suspected primary brain tumor
- SRBT
- suspected recurrence of brain tumor after treatment
- © 2014 American Society of Neuroradiology