Abstract
(18)F-FDG-PET has been widely used in patients with brain tumors. However, the reported sensitivity and specificity of (18)F-FDG-PET for brain tumor differentiation varied greatly. We performed this meta-analysis to systematically assess the diagnostic performance of (18)F-FDG-PET in differentiating brain tumors. The diagnostic performance of (11)C-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 (18)F-FDG and (11)C-methionine PET with a bivariate model. Thirty eligible studies, including 5 studies with both (18)F-FDG and (11)C-methionine PET data were enrolled. Pooled sensitivity, pooled specificity, and area under the receiver operating characteristic curve of (18)F-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 (18)F-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 (11)C-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 (11)C-methionine studies. This meta-analysis suggested that (18)F-FDG-PET has limited diagnostic performance in brain tumor differentiation, though its performance may vary according to the status of brain tumor, whereas (11)C-methionine PET has excellent diagnostic accuracy in brain tumor differentiation.
Highlights
Inclusion criteria were the following: 1) the purpose of the study was to differentiate suspected primary brain tumor (SPBT) or suspected recurrence of brain tumors after treatment (SRBT), 2) the study population consisted of a minimum of 10 patients, 3) histology or clinical follow-up was used as a reference standard, and 4) the reported primary data were sufficient to calculate both sensitivity and specificity
Diagnostic Values and hierarchic summary receiver operating characteristic (HSROC) Curve of 11C-MET PET Studies When all eleven 11C-MET studies were pooled, the sensitivity, specificity, and area under receiver operating characteristic curve (AUC) for differentiating brain tumors were 0.91, 0.86, and 0.94
We found that the sensitivity of 18F-FDG-PET was the worst (0.43; 95% CI, 0.3– 0.58) when applied to the patients with SPBT
Summary
Inclusion criteria were the following: 1) the purpose of the study was to differentiate SPBT or SRBT, 2) the study population consisted of a minimum of 10 patients, 3) histology or clinical follow-up was used as a reference standard, and 4) the reported primary data were sufficient to calculate both sensitivity and specificity
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