Diagnostic and grading accuracy of 18F-FDOPA PET and PET/CT in patients with gliomas: a systematic review and meta-analysis

Jiarui Xiao,Fukun Chen,Xuelei Ma,Yizi Jin,Ji Nie

doi:10.1186/s12885-019-5938-0

Jiarui Xiao, Fukun Chen + Show 3 more

Open Access

https://doi.org/10.1186/s12885-019-5938-0

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Abstract

BackgroundPositron emission tomography (PET) and PET/computed tomography (PET/CT) imaging with 3,4-dihydroxy-6-[18F] fluoro-L-phenylalanine (18F-FDOPA) has been used in the evaluation of gliomas. We performed a meta-analysis to obtain the diagnostic and grading accuracy of 18F-FDOPA PET and PET/CT in patients with gliomas.MethodsPubMed, Embase, Cochrane Library and Web of Science were searched through 13 May 2019. We included studies reporting the diagnostic performance of 18F-FDOPA PET or PET/CT in glioma patients. Pooled sensitivity, specificity, and area under the summary receiver operating characteristic (SROC) curve were calculated from eligible studies on a per-lesion basis.ResultsEventually, 19 studies were included. Across 13 studies (370 patients) for glioma diagnosis, the pooled sensitivity and specificity of 18F-FDOPA PET and PET/CT were 0.90 (95%CI: 0.86–0.93) and 0.75 (95%CI: 0.65–0.83). Across 7 studies (219 patients) for glioma grading, 18F-FDOPA PET and PET/CT showed a pooled sensitivity of 0.88 (95%CI: 0.81–0.93) and a pooled specificity of 0.73 (95%CI: 0.64–0.81).Conclusions18F-FDOPA PET and PET/CT demonstrated good performance for diagnosing gliomas and differentiating high-grade gliomas (HGGs) from low-grade gliomas (LGGs). Further studies implementing standardized PET protocols and investigating the grading parameters are needed.

Highlights

Positron emission tomography (PET) and PET/computed tomography (PET/CT) imaging with 3,4-dihydroxy-6-[18F] fluoro-L-phenylalanine (18F-FDOPA) has been used in the evaluation of gliomas
According to the World Health Organization (WHO) 2007 classification, grade I and II tumors are together referred to as low-grade gliomas (LGGs), while grade III and IV tumors are categorized into high-grade gliomas
The inclusion criteria were: (1) Original studies investigating the diagnostic or grading capacity of 18F-FDOPA PET or PET/CT in patients with gliomas; (2) Studies with histopathology and/or clinical and imaging follow-up as reference standards; (3) Certain numbers of true-positive (TP), false-positive (FP), false-negative (FN) and true-negative (TN) results in diagnostic or grading tests can be derived from sufficient data

Summary

Introduction

Positron emission tomography (PET) and PET/computed tomography (PET/CT) imaging with 3,4-dihydroxy-6-[18F] fluoro-L-phenylalanine (18F-FDOPA) has been used in the evaluation of gliomas. We performed a meta-analysis to obtain the diagnostic and grading accuracy of 18F-FDOPA PET and PET/CT in patients with gliomas. Appropriate surgical or radiotherapy regimen is highly dependent on the delineation and grade of tumors, and imaging assessment is critical to the clinical management of affected patients. For the past few decades, conventional magnetic resonance imaging (MRI) has been the method of choice for glioma diagnosis. It lacks sensitivity in non-enhancing gliomas and cannot reliably provide the differentiation between tumor recurrence and radiation-induced changes (e.g., pseudoprogression and radionecrosis) [3, 4].

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