Diagnostic Performance of F-18 Fluorodeoxyglucose Positron Emission Tomography or Positron Emission Tomography/Computed Tomography for Differentiation of Benign and Malignant Vertebral Compression Fractures: A Meta-Analysis

Abstract

The purpose of the present study was to investigate the diagnostic performance of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the differentiation of benign and malignant vertebral compression fractures (VCFxs) through a systematic review and meta-analysis. MEDLINE via PubMed, Cochrane, Scopus, and Embase database, from the earliest available date of indexing through September 30, 2019, were searched for studies evaluating the diagnostic performance of F-18 FDG PET or PET/CT for the differentiation of malignant VCFxs. We determined the sensitivities and specificities across the studies, calculated the positive and negative likelihood ratios (LR+ and LR-, respectively), and constructed summary receiver operating characteristic curves. For the 5 studies (274 patients), the pooled sensitivity was 0.96 (95% confidence interval [CI], 0.82-0.99) without heterogeneity (I2, 50.6) and 0.77 (95% CI, 0.56-0.89) with heterogeneity (I2, 76.1). LR syntheses gave an overall LR+ of 4.1 (95% CI, 2.1-8.0) and LR- of 0.05 (95% CI, 0.01-0.23). The pooled diagnostic odds ratio (DOR) was 78 (95% CI, 19-316). The hierarchical summary receiver operating characteristic curve indicates that the areas under the curve was 0.94 (95% CI, 0.92-0.96). The results of the present meta-analysis have shown high sensitivity and moderate specificity for F-18 FDG PET and PET/CT for differentiation of malignant VCFxs. At present, the reported data regarding the use of F-18 FDG PET for differentiation of malignant VCFxs remain limited; thus, further large multicenter studies are necessary to substantiate the diagnostic accuracy of F-18 FDG PET for the differentiation of malignant VCFxs.