Diagnostic Performance and Prognostic Value of PET/CT with Different Tracers for Brain Tumors: A Systematic Review of Published Meta-Analyses

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Abstract

Background: Several meta-analyses reporting data on the diagnostic performance or prognostic value of positron emission tomography (PET) with different tracers in detecting brain tumors have been published so far. This review article was written to summarize the evidence-based data in these settings. Methods: We have performed a comprehensive literature search of meta-analyses published in the Cochrane library and PubMed/Medline databases (from inception through July 2019) about the diagnostic performance or prognostic value of PET with different tracers in patients with brain tumors. Results: We have summarized the results of 24 retrieved meta-analyses on the use of PET or PET/computed tomography (CT) with different tracers in brain tumors. The tracers included were: fluorine-18 fluorodeoxyglucose ( ¹⁸F-FDG), carbon-11 methionine ( ¹¹C-methionine), fluorine-18 fluoroethyltyrosine ( ¹⁸F-FET), fluorine-18 dihydroxyphenylalanine ( ¹⁸F-FDOPA), fluorine-18 fluorothymidine ( ¹⁸F-FLT), and carbon-11 choline ( ¹¹C-choline). Evidence-based data demonstrated good diagnostic performance of PET with different tracers in detecting brain tumors, in particular, radiolabelled amino acid tracers showed the highest diagnostic performance values. All the PET tracers evaluated had significant prognostic value in patients with glioma. Conclusions: Evidence-based data showed a good diagnostic performance for some PET tracers in specific indications and significant prognostic value in brain tumors.

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Joint EANM/EANO/RANO practice guidelines/SNMMI procedure standards for imaging of gliomas using PET with radiolabelled amino acids and [ 18 F]FDG: version 1.0

Ian Law, Nathalie L. Albert, Javier Arbizu … (2018)

These joint practice guidelines, or procedure standards, were developed collaboratively by the European Association of Nuclear Medicine (EANM), the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the European Association of Neurooncology (EANO), and the working group for Response Assessment in Neurooncology with PET (PET-RANO). Brain PET imaging is being increasingly used to supplement MRI in the clinical management of glioma. The aim of these standards/guidelines is to assist nuclear medicine practitioners in recommending, performing, interpreting and reporting the results of brain PET imaging in patients with glioma to achieve a high-quality imaging standard for PET using FDG and the radiolabelled amino acids MET, FET and FDOPA. This will help promote the appropriate use of PET imaging and contribute to evidence-based medicine that may improve the diagnostic impact of this technique in neurooncological practice. The present document replaces a former version of the guidelines published in 2006 (Vander Borght et al. Eur J Nucl Med Mol Imaging. 33:1374–80, 2006), and supplements a recent evidence-based recommendation by the PET-RANO working group and EANO on the clinical use of PET imaging in patients with glioma (Albert et al. Neuro Oncol. 18:1199–208, 2016). The information provided should be taken in the context of local conditions and regulations.

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Diagnostic accuracy of PET for recurrent glioma diagnosis: a meta-analysis.

T Nihashi, I.J. Dahabreh, T Terasawa (2013)

Studies have assessed PET by using various tracers to diagnose disease recurrence in patients with previously treated glioma; however, the accuracy of these methods, particularly compared with alternative imaging modalities, remains unclear. We conducted a meta-analysis to quantitatively synthesize the diagnostic accuracy of PET and compare it with alternative imaging modalities.

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Performance of 18F-fluoro-ethyl-tyrosine (18F-FET) PET for the differential diagnosis of primary brain tumor: a systematic review and Metaanalysis.

Roger Stupp, Vincent Dunet, John O Prior … (2012)

For the past decade, PET with (18)F-fluoro-ethyl-tyrosine ((18)F-FET) has been used in the evaluation of patients with primary brain tumors (PBTs), but so far series have reported only a limited number of patients. The purpose of this systematic review and metaanalysis was to assess the diagnostic performance of (18)F-FET PET in patients with suspicion of PBT. We examined studies published in the literature using MEDLINE and EMBASE databases. Inclusion criteria were use of (18)F-FET PET for initial assessment of patients with a newly diagnosed brain lesion; patients who had no radiotherapy, surgery, or chemotherapy before (18)F-FET PET; and use of histology as a gold standard. Metaanalysis was performed on a per-patient basis. We secondarily performed receiver-operating-characteristic analysis of pooled patients to determine tumor-to-background ratio (TBR) of (18)F-FET uptake and best diagnostic value. Thirteen studies totaling 462 patients were included. For the diagnosis of PBT, (18)F-FET PET demonstrated a pooled sensitivity of 0.82 (95% confidence interval [CI], 0.74-0.88), specificity of 0.76 (95% CI, 0.44-0.92), area under the curve of 0.84 (95% CI, 0.80-0.87), positive likelihood ratio of 3.4 (95% CI, 1.2-9.5), and negative likelihood ratio of 0.24 (95% CI, 0.14-0.39). Receiver-operating-characteristic analysis indicated that a mean TBR threshold of at least 1.6 and a maximum TBR of at least 2.1 had the best diagnostic value for differentiating PBTs from nontumoral lesions. (18)F-FET PET demonstrated excellent performance for diagnosing PBTs. Strict standardization of PET acquisition protocols and prospective, multicenter studies investigating the added value over current MRI are now needed to establish (18)F-FET PET as a highly relevant tool for patient management.

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Journal

Journal ID (nlm-ta): Int J Mol Sci

Journal ID (iso-abbrev): Int J Mol Sci

Journal ID (publisher-id): ijms

Title: International Journal of Molecular Sciences

Publisher: MDPI

ISSN (Electronic): 1422-0067

Publication date (Electronic): 20 September 2019

Publication date Collection: October 2019

Volume: 20

Issue: 19

Electronic Location Identifier: 4669

Affiliations

[1 ]Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland; luca.giovanella@ 123456eoc.ch

[2 ]Health Technology Assessment Unit, Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland

[3 ]Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland

[4 ]Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland; barbara.muoio@ 123456eoc.ch

[5 ]Neurosurgical Unit, Presidio Ospedaliero Santo Spirito, IT-65124 Pescara, Italy; trevisi.gianluca@ 123456gmail.com

[6 ]Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” University, IT-66100 Chieti, Italy; mvittoriamattoli@ 123456yahoo.it

[7 ]Department of Nuclear Medicine, Spedali Civili of Brescia and University of Brescia, IT-25123 Brescia, Italy; doalba87@ 123456libero.it (D.A.); francesco.bertagna@ 123456unibs.it (F.B.)

[8 ]Department of Nuclear Medicine, University Hospital Zurich and University of Zurich, CH-8091 Zurich, Switzerland

Author notes

[* ]Correspondence: giorgio.treglia@ 123456eoc.ch ; Tel.: +41-91-811-1415

[†]

These authors contributed equally to this work.

[‡]

These authors contributed equally to this work.

Author information

Giorgio Treglia https://orcid.org/0000-0001-9808-780X

Luca Giovanella https://orcid.org/0000-0003-0230-0974

Article

Publisher ID: ijms-20-04669

DOI: 10.3390/ijms20194669

PMC ID: 6802483

PubMed ID: 31547109

SO-VID: c3f79ba1-3204-4962-9fac-0dd569d81b48

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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Diagnostic Performance and Prognostic Value of PET/CT with Different Tracers for Brain Tumors: A Systematic Review of Published Meta-Analyses

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Most cited references 34

Joint EANM/EANO/RANO practice guidelines/SNMMI procedure standards for imaging of gliomas using PET with radiolabelled amino acids and [ 18 F]FDG: version 1.0

Diagnostic accuracy of PET for recurrent glioma diagnosis: a meta-analysis.

Performance of 18F-fluoro-ethyl-tyrosine (18F-FET) PET for the differential diagnosis of primary brain tumor: a systematic review and Metaanalysis.

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