The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: a systematic review and metaanalysis including the Ontario experience.

Cardiac Sarcoidosis: There Is No Instant Replay

We aimed to explore the role of the diagnostic accuracy of 18F fluodeoxyglucose PET (18F-FDG PET) or PET/CT for characterization of adrenal lesions through a systematic review and meta-analysis. The MEDLINE, EMBASE, and Cochrane Library database, from the earliest available date of indexing through 30 April 2017, were searched for studies evaluating the diagnostic performance of 18F-FDG PET or PET/CT for characterization of adrenal lesions. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR + and LR-), and constructed summary receiver operating characteristic curves. Across 29 studies (2421 patients), the pooled sensitivity for 18F-FDG PET or PET/CT was 0.91 [95% CI (0.88-0.94)] with heterogeneity (χ2 = 141.8, p = 0.00) and a pooled specificity of 0.91 [95% CI (0.87-0.93)] with heterogeneity (χ2 = 113.7, p = 0.00). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 9.9 [95% CI (7.1-13.7)] and negative likelihood ratio (LR-) of 0.09 [95% CI (0.07-0.13)]. The pooled diagnostic odds ratio was 105 [95% CI (63-176)]. In metaregression analysis, study design, publication year, study location (western vs others), interpretation criteria of PET or PET/CT images, quantification of PET or PET/CT [SUVmax (maximum standardized uptake value) vs SUV (standardized uptake value) ratio], patient group, and analysis method (patient-based vs lesion-based) were the sources of the study heterogeneity. However, in multivariate metaregression, no definite variable was the source of the study heterogeneity. 18F-FDG PET or PET/CT demonstrated good sensitivity and specificity for the characterization of adrenal masses. At present, the literature regarding the use of 18F-FDG PET or PET/CT for the characterization of adrenal masses remains still limited; thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of 18F-FDG PET or PET/CT characterization of adrenal masses. Advances in knowledge: 18F- FDG PET or PET/CT showed good sensitivity and specificity for the characterization of adrenal masses and could provide additional information for that purpose.

Improving 18F-FDG PET Imaging Using Canola Oil For Evaluation Of Cardiac Sarcoidosis

A meta-analysis was performed to compare the diagnostic performance of gallium-68 (18Ga) somatostatin receptor positron emission tomography (68Ga-SSTR PET) and fluorine-18-fluorodeoxyglucose (18F-FDG) PET in patients with neuroendocrine tumours (NET) and whether the two imaging modalities can be mutually substituted in clinical work. We performed electronic literature searches of the MEDLINE, PubMed, Embase and Cochrane Library databases for English-language articles from the earliest available date of indexing through 30 July 2019. We calculated the pooled sensitivity, specificity and diagnostic odds ratios (DOR) with 95% confidence intervals (95% CI) of 68Ga-SSTR PET and 18F-FDG PET in NET. We drew a summary receiver operator characteristic (SROC) curve and calculated the area under the curve (AUC) to measure the accuracy of 68Ga-SSTR PET and 18F-FDG PET in patients or lesions with NET. Thirty studies comprising 3401 patients and 5793 lesions with NET were included in this meta-analysis. The pooled sensitivity, sensitivity, DOR and AUC for 68Ga-SSTR PET or PET/computed tomography (CT) in the diagnosis of NET, based on lesion patient, were 0.92(0.89-0.95), 0.91(0.83-0.95),119(51-282) and 0.96(0.94-0.98), and based on lesion, were 0.95(0.86-0.98), 0.93(0.83-0.97), 229(43-1205) and 0.98(0.96-0.99), respectively. The pooled sensitivity, sensitivity, DOR and AUC for 18F-FDG PET or PET/CT in NET were 0.70(0.41-0.89), 0.97(0.70-1.00), 67(7-612) and 0.94(0.92-0.96), respectively, when analyzed on a per-patient basis.The pooled sensitivities of 68Ga-SSTR PET/CT were 0.923 (95% CI: 0.884-0.952), 0.902 (0.862-0.934) and 0.578 (0.482-0.669) in the G1(ki67,≤2%), G2(ki67,>3%,≤20% and G3(ki67,>20%) groups based on patients with NET, respectively. The pooled sensitivities of 18F-FDG PET/CT were 0.378 (0.319-0.440), 0.554 (0.492-0.615) and 0.712 (0.633-0.783) in the G1, G2 and G3 groups based on patients with NET, respectively. The 68Ga-SSTR PET has highly sensitive and had a greater diagnostic value than 18F-FDG PET for patients with NET. Fluorine-18-FDG PET, however, had significant specificity than 68Ga-SSTR PET. The 68Ga-SSTR has high sensitivity in G1/G2 NET, while 18F-FDG has a low positive rate. In G3 NET, however, the opposite is true. Therefore, the 68Ga-SSTR PET and 18F-FDG PET modalities are complementary rather than substitutive in clinical practice.

The soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is a promising diagnostic marker for many types of infections. A bivariate meta-analysis was performed to evaluate its diagnostic value for lower respiratory tract infections (LRTI). We searched PubMed, Cochrane Library and Web of Science (from January 1966 to August 2013) for all trials assessing diagnostic value of sTREM-1 for LRTI. The pooled sensitivity, specificity, positive likelihood ratio(PLR), negative likelihood ratio(NLR), diagnostic odds ratio (DOR), the area under summary receiver operator characteristic (SROC) curve and the Q* were calculated. Thirteen studies with 1138 patients were included in our meta-analysis. The pooled sensitivity and specificity of sTREM-1 for diagnosis of LRTI was 0.84 and 0.77. The PLR, NLR and DOR were 3.6, 0.21 and 17. The area under SROC curve was 0.88 and the Q* was 0.82. The univariate meta-regression analysis demonstrated that the assay method for sTREM-1 significantly affected sensitivity for LRTI. The Q* of sTREM-1 for diagnosis of community-acquired LRTI was 0.82, and the area under SROC curve was 0.88. The Q* of sTREM-1 in diagnosis of hospital-acquired LRTI was 0.83, and the area under SROC curve was 0.90. The Q* of sTREM-1 for distinguishing culture-positive LRTI from culture-negative diseases was 0.79, and the area under SROC curve was 0.86. Current evidence suggests that sTREM-1 is an accurate marker of LRTI. The overall diagnostic value of sTREM-1 for LRTI, community-acquired LRTI and hospital-acquired LRTI is similar.

Meta-analysis of the diagnostic performance of 18F-FDG PET in renal cell carcinoma

The purpose of this systematic meta-analysis was to evaluate the diagnostic accuracy of 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) PET for the assessment of glioma recurrence and compare it with that of (18)F-fluorodeoxyglucose ((18)F-FDG) PET. The authors electronically and manually searched for studies from 1948 to 2014 that evaluated the diagnostic accuracy of (18)F-FDG or (18)F-FLT PET for glioma recurrence. The primary results of sensitivity, specificity, and diagnostic odds ratio (DOR) were summarized using the random-effects model. Summary receiver operating characteristic (ROC) curves and its area under the curve (AUC were used to summarize the overall diagnostic accuracy. Statistical analysis was performed with the software STATA (version 11.0). Twenty-four studies that included a total of 799 patients were included in the meta-analysis. The pooled sensitivity, specificity, DOR, and summary ROC AUC for the overall diagnostic accuracy of (18)F-FDG PET were 0.78 (95% CI 0.69-0.85), 0.77 (95% CI 0.66-0.85), 12 (95% CI 6-22), and 0.84 (95% CI 0.81-0.87), respectively. The pooled sensitivity, specificity, DOR, and summary ROC AUC for the overall diagnostic accuracy of (18)F-FLT PET were 0.82 (95% CI 0.51-0.95), 0.76 (95% CI 0.50-0.91), 15 (95% CI 4-56), and 0.85 (95% CI 0.81-0.88), respectively. Metaregression analysis showed that year of publication, male proportion, average age, and blinding review did not affect the test performance statistically significantly (all P > 0.05). This meta-analysis indicates that PET by using (18)F-FLT has a moderately better overall accuracy for diagnosing glioma recurrence compared with that by using (18)F-FDG. Video abstract: http://links.lww.com/NMC/A41.

BackgroundThe aim of this study was to evaluate the diagnostic performance of microRNA-1 in the diagnosis of acute myocardial infarction (AMI).MethodsPubMed, Embase, Cochrane, Web of science and CNKI databases were searched by computer to collect English literature evaluating the diagnostic value of microRNA-1 in AMI patients. The retrieval period is from the establishment of the database to September 2023. Two researchers independently screened the literature according to inclusion and exclusion criteria, extracted data, and evaluated the risk of bias in the included studies using QUADAS-2 tools. Stata15.0 software was used for meta-analysis. The combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operator characteristic (SROC) curve were calculated.ResultsThis study included 11 pieces of literature, which included 894 patients with AMI and 600 controls. The main results of meta-analysis were as follows: The pooled sensitivity and specificity of microRNA-1 for the diagnosis of AMI were 78% (95% CI: 0.69–0.85) and 85% (95% CI: 0.76–0.91), respectively, the positive likelihood ratio was 5.1 (95%CI: 3.0–8.6), the negative likelihood ratio was 0.26 (95% CI: 0.17–0.38), the diagnostic odds ratio was 20 (95% CI: 9–47), and the area under the SROC curve (AUC) was 88% (95% CI: 0.85–0.91).ConclusionsPlasma microRNA-1 has high sensitivity and specificity for early AMI, and has certain diagnostic value, which can help distinguish AMI from patients with other systemic diseases, and can be combined with other biomarkers to diagnose AMI.

In recent years, fluorine-18-fluorodeoxyglucose (F-FDG) PET or PET/computed tomography (PET/CT) has emerged as a valuable method for restaging of cancer. The aim of this study was to evaluate its diagnostic performance for detecting metastatic or recurrent lesions in patients with renal cell carcinoma (RCC). Several databases were searched for relevant articles on F-FDG PET or PET/CT for the restaging of RCC. Two researchers independently selected studies, extracted data, and assessed the methodological quality according to the QUADAS-2 tool. On a per-patient basis, we determined the pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio. Summary receiver-operating characteristic curves were also constructed with the area under the curve and Q* index obtained. A total of 15 studies involving 1168 patients fulfilled the inclusion criteria. After excluding one study on the basis of the sensitivity analysis, the pooled estimates of 14 studies were 0.86 [95% confidence interval (CI), 0.88-0.93] for sensitivity, 0.88 (95% CI, 0.84-0.91) for specificity, 5.85 (95% CI, 4.27-8.03) for positive likelihood ratio, 0.18 (95% CI, 0.12-0.26) for negative likelihood ratio, and 42.12 (95% CI, 21.56-82.28) for diagnostic odds ratio. The area under the curve and Q* estimates were 0.9310 and 0.8663, respectively. Current evidence suggests that F-FDG PET or PET/CT is a valuable tool in the detection of metastatic or recurrent lesions in patients with RCC. More prospective studies on PET or PET/CT in the restaging of RCC are still needed.

The skeleton is one of the favorable sites for the metastasis of almost all human malignant neoplasms. An accurate diagnosis of bone metastasis is crucial for the patient's staging and management. To investigate and compare diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and bone scintigraphy (BS) for detection of bone metastasis in malignancies using meta-analysis. PubMed (Medline included) was searched for relevant articles. We assessed the methodological quality with Quality Assessment of Diagnosis Accuracy Studies (QUADAS) score tool, and used statistical software to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver-operating characteristic (SROC) curve. Six studies met inclusion criteria. For 18F-FDG PET/CT, the pooled sensitivity and specificity were 0.934 and 0.975, respectively. The pooled positive likelihood ratio (LR+), negative likelihood ratio (LR-) and diagnostic odds ratio (DOR) were 34.990, 0.068 and 559.02, respectively. The area under the SROC curve was 0.9854. For BS, the pooled sensitivity, specificity, LR + , LR- and DOR were 0.706 (0.642-0.764), 0.911 (0.896-0.926), 13.982 (2.419-80.817), 0.319 (0.143-0.712), and 60.420 (21.393-170.64), respectively. The area under the SROC curve was 0.9386. The results indicate that 18F-FDG PET/CT do have both higher sensitivity and specificity than bone scintigraphy for detecting metastatic bone tumor. However, further research is needed to evaluate the diagnostic performance of 18F-FDG PET/CT and BS in each common malignancy.

This systematic review highlights the need for the following: Further studies needs to investigate the diagnostic accuracy of already existing nutritional screening tools in the context of colorectal cancer patients. If new screenings tools are developed, they should be developed and validated in the specific clinical context within the same patient population (colorectal cancer patients).

Objective markers of disease activity are crucial for clinical decision making in patients with chronic inflammatory bowel diseases (IBD). We aimed to perform an updated systematic review on the clinical role of 18F-FDG PET in evaluating disease activity in patients with IBD and a bivariate meta-analysis on its accuracy in this setting. A comprehensive computer literature search of studies published through December 2016 about the clinical role of 18F-FDG PET in patients with IBD was performed using the following search algorithm: A) PET OR positron emission tomography OR FDG AND B) inflammatory bowel OR Crohn OR ulcerative colitis OR IBD. All included articles were reviewed. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−) and diagnostic odds ratio (DOR) of 18F-FDG PET in evaluating disease activity in patients with IBD on a per-segment-based analysis were calculated. Furthermore, the summary receiver operating characteristic (sROC) curve has been evaluated. Twenty-three studies on the use of 18F-FDG PET in evaluating disease activity in patients with IBD (584 cases) were discussed in the systematic review. The meta-analysis of nine selected studies provided the following results on a per-segment-based analysis: sensitivity was 85.6% [95% confidence interval (95% CI) 76–92%], specificity 85.5% (95% CI 75–92%), LR+ 5.59 (95% CI 3.29–9.5), LR− 0.15 (95% CI 0.07–0.32), DOR 34.64 (95% CI 13.03–92.08). Heterogeneity among the selected studies was found. 18F-FDG PET demonstrated good accuracy in evaluating the disease activity in patients with IBD and this method could have a clinical impact in patients with IBD. Large multicenter studies and cost-effectiveness analyses are needed to confirm the role of this functional imaging method in this setting.

Diagnostic Performance of Bronchoalveolar Lavage Fluid CD4/CD8 Ratio for Sarcoidosis: A Meta-analysis

Objective We sought to perform a systemic review and meta-analysis of the diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (computed tomography) (PET(CT)) in detection of bone and/or bone marrow involvement (BMI) in pediatric neuroblastoma (NB). Materials and Methods We searched electronic databases Pubmed and Embase to retrieve relevant references. We calculated pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−), diagnostic odds ratio (DOR), and the area under the curve (AUC). Moreover, a summary receiver operating characteristic (SROC) curve and likelihood ratio dot plot were plotted. Study-between statistical heterogeneity was evaluated via I-square index (I2). Subgroup analyses were used to explore heterogeneity. Results Seven studies including 127 patients were involved in this meta-analysis. The overall sensitivity and specificity were 0.87 (95% CI: 0.65–0.96) with heterogeneity I2 = 88.1% (p < 0.001) and 0.96 (95% CI: 0.67–1.00) with heterogeneity I2 = 77.8% (p < 0.001), respectively. The pooled LR+, LR−, and DOR were 21.3 (95% CI: 2.1–213.9), 0.14 (95% CI: 0.05–0.40), and 157 (95% CI: 16–1532), respectively. The area under the SROC curve was 0.97 (95% CI: 0.95–0.98). Conclusions Through a meta-analysis, this study suggested that 18F-FDG PET(CT) has a good overall diagnostic accuracy in the detection of bone/BMI in pediatric neuroblastoma.

Lung cancer (LC) is one of the most prevalent causes of cancer death with a high mortality rate worldwide. While various sets of microRNAs (miRNAs) have been found to be highly sensitive and specific biomarkers for the early diagnosis of LC (the first word of abstract), conflicting results on their diagnostic accuracy are still present in individual studies. Thus, we aimed to conduct a systematic review and meta-analysis of the published literature to comprehensively assess the diagnostic value of miRNAs for predicting LC. The sensitivity and specificity of each included study were used to plot the summary receiver operator characteristic (SROC) curve and to calculate the area under the SROC curve (AUC). All analyses were performed using the Stata 12.0 software. Twenty-six articles were involved in our meta-analysis, 18 of which focused on single miRNA assays and 15 on multiple miRNA assays. For single miRNA profiling, the pooled parameters calculated from all studies are as follows: sensitivity (SEN), 0.72; specificity (SPE), 0.74; positive likelihood ratio (PLR), 2.7; negative likelihood ratio (NLR), 0.39; and diagnostic odds ratio (DOR), 7. For multiple miRNA profiling, the pooled estimates for the overall studies are as follows: SEN, 0.81; SPE, 0.84; PLR, 4.9; NLR, 0.23; and DOR, 22, which are significantly better than the diagnostic performance of the single miRNA profiling. In addition, subgroup analyses based on sample types suggested that blood-based multiple miRNA assays were more accurate than non-blood-based studies. In conclusion, the current meta-analysis shows that multiple miRNA assays were more accurate in diagnosing LC than single miRNA assays. However, further large-scale investigations are urgently needed to confirm our results and verify the feasibility of routine clinical utilization.