Data_Sheet_1_Diagnostic Accuracy of PET for Differentiating True Glioma Progression From Post Treatment-Related Changes: A Systematic Review and Meta-Analysis.DOC

Purpose: To evaluate the diagnostic accuracy of PET with different radiotracers and parameters in differentiating between true glioma progression (TPR) and post treatment-related change (PTRC).
Methods: Studies on using PET to differentiate between TPR and PTRC were screened from the PubMed and Embase databases. By following the PRISMA checklist, the quality assessment of included studies was performed, the true positive and negative values (TP and TN), false positive and negative values (FP and FN), and general characteristics of all the included studies were extracted. Results of PET consistent with reference standard were defined as TP or TN. The pooled sensitivity (Sen), specificity (Spe), and hierarchical summary receiver operating characteristic curves (HSROC) were generated to evaluate the diagnostic accuracy.
Results: The 33 included studies had 1,734 patients with 1,811 lesions suspected of glioma recurrence. Fifteen studies tested the accuracy of 18F-FET PET, 12 tested 18F-FDG PET, seven tested 11C-MET PET, and three tested 18F-DOPA PET. 18F-FET PET showed a pooled Sen and Spe of 0.88 (95% CI: 0.80, 0.93) and 0.78 (0.69, 0.85), respectively. In the subgroup analysis of FET-PET, diagnostic accuracy of high-grade gliomas (HGGs) was higher than that of mixed-grade gliomas (Pinteraction = 0.04). 18F-FDG PET showed a pooled Sen and Spe of 0.78 (95% CI: 0.71, 0.83) and 0.87 (0.80, 0.92), the Spe of the HGGs group was lower than that of the low-grade gliomas group (0.82 vs. 0.90, P = 0.02). 11C-MET PET had a pooled Sen and Spe of 0.92 (95% CI: 0.83, 0.96) and 0.78 (0.69, 0.86). 18F-DOPA PET had a pooled Sen and Spe of 0.85 (95% CI: 0.80, 0.89) and 0.70 (0.60, 0.79). FET-PET combined with MRI had a pooled Sen and Spe of 0.88 (95% CI: 0.78, 0.94) and 0.76 (0.57, 0.88). Multi-parameters analysis of FET-PET had pooled Sen and Spe values of 0.88 (95% CI: 0.81, 0.92) and 0.79 (0.63, 0.89).
Conclusion: PET has a moderate diagnostic accuracy in differentiating between TPR and PTRC. The high Sen of amino acid PET and high Spe of FDG-PET suggest that the combination of commonly used FET-PET and FDG-PET may be more accurate and promising, especially for low-grade glioma.

研究目的：评估采用不同放射性示踪剂与参数的正电子发射断层扫描（Positron Emission Tomography, PET）在鉴别真性胶质瘤进展（True Glioma Progression, TPR）与治疗后相关改变（Post Treatment-related Change, PTRC）中的诊断效能。
研究方法：从PubMed与Embase数据库中检索筛选应用PET鉴别TPR与PTRC的相关研究。按照PRISMA声明清单（PRISMA checklist）对纳入研究开展质量评价，提取所有纳入研究的真阳性（True Positive, TP）、真阴性（True Negative, TN）值，假阳性（False Positive, FP）、假阴性（False Negative, FN）值以及基本研究特征。将与参考标准相符的PET检测结果定义为真阳性或真阴性。通过合并灵敏度（Sensitivity, Sen）、特异度（Specificity, Spe）以及分层汇总受试者工作特征曲线（Hierarchical Summary Receiver Operating Characteristic Curve, HSROC）以评估诊断效能。
研究结果：共纳入33项研究，涉及1734名患者，共计1811个疑似胶质瘤复发的病灶。其中15项研究评估了18F-FET PET的诊断效能，12项评估了18F-FDG PET，7项评估了11C-MET PET，3项评估了18F-DOPA PET。18F-FET PET的合并灵敏度与特异度分别为0.88（95%置信区间：0.80, 0.93）与0.78（95%置信区间：0.69, 0.85）。在FET-PET的亚组分析中，高级别胶质瘤（High-grade Gliomas, HGGs）组的诊断效能优于混合级别胶质瘤组（交互P值=0.04）。18F-FDG PET的合并灵敏度与特异度分别为0.78（95%置信区间：0.71, 0.83）与0.87（95%置信区间：0.80, 0.92），高级别胶质瘤组的特异度低于低级别胶质瘤组（0.82 vs. 0.90，P=0.02）。11C-MET PET的合并灵敏度与特异度分别为0.92（95%置信区间：0.83, 0.96）与0.78（95%置信区间：0.69, 0.86）。18F-DOPA PET的合并灵敏度与特异度分别为0.85（95%置信区间：0.80, 0.89）与0.70（95%置信区间：0.60, 0.79）。联合MRI的FET-PET检测的合并灵敏度与特异度分别为0.88（95%置信区间：0.78, 0.94）与0.76（95%置信区间：0.57, 0.88）。FET-PET多参数分析的合并灵敏度与特异度分别为0.88（95%置信区间：0.81, 0.92）与0.79（95%置信区间：0.63, 0.89）。
研究结论：PET在鉴别TPR与PTRC中具备中等程度的诊断效能。氨基酸类PET的高灵敏度与FDG-PET的高特异度提示，联合应用临床常用的FET-PET与FDG-PET可获得更优的诊断准确性与应用前景，尤其适用于低级别胶质瘤患者。