title: Diagnostic accuracy of PET for recurrent glioma diagnosis: a meta-analysis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  We searched PubMed and Scopus (until June 2011), bibliographies, and review articles. Two reviewers extracted study characteristics, validity items, and quantitative data on diagnostic accuracy. We performed meta-analysis when ≥5 studies were available.
  
  
  RESULTS
  Twenty-six studies were eligible. Studies were heterogeneous in treatment strategies and diagnostic criteria of PET; recurrence was typically suspected by CT or MR imaging. The diagnostic accuracies of (18)F-FDG (n = 16) and (11)C-MET PET (n = 7) were heterogeneous across studies. (18)F-FDG PET had a summary sensitivity of 0.77 (95% CI, 0.66-0.85) and specificity of 0.78 (95% CI, 0.54-0.91) for any glioma histology; (11)C-methionine PET had a summary sensitivity of 0.70 (95% CI, 0.50-0.84) and specificity of 0.93 (95% CI, 0.44-1.0) for high-grade glioma. These estimates were stable in subgroup and sensitivity analyses. Data were limited on (18)F-FET (n = 4), (18)F-FLT (n = 2), and (18)F-boronophenylalanine (n = 1). Few studies performed direct comparisons between different PET tracers or between PET and other imaging modalities.
  
  
  CONCLUSIONS
  (18)F-FDG and (11)C-MET PET appear to have moderately good accuracy as add-on tests for diagnosing recurrent glioma suspected by CT or MR imaging. Studies comparing alternative tracers or PET versus other imaging modalities are scarce. Prospective studies performing head-to-head comparisons between alternative imaging modalities are needed.
authors.affiliation: Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nihashi
authors.forename: I J
authors.initials: IJ
authors.lastname: Dahabreh
authors.forename: T
authors.initials: T
authors.lastname: Terasawa
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005910:Glioma / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity