The diagnostic performance of18F-FDG PET/CT, CT and MRI in the treatment evaluation of ablation therapy for colorectal liver metastases: A systematic review and meta-analysis.
Uncertainty exists regarding the optimal imaging modality for timely detection of disease progression (DP) after ablation therapy for colorectal liver metastases. We evaluated the diagnostic accuracy of18F-FDG PET(/CT), CT and MRI for detection of DP following ablation therapy.



A systematic search was performed on May 18, 2016. The analysis included studies that reported on the diagnostic accuracy of18F-FDG PET(/CT), CT and/or MRI for post-ablative evaluation of patients with liver metastases. Primary outcome was the diagnostic accuracy of the imaging modalities for detection of DP. Methodological quality was assessed using the QUADAS-2 tool. Pooled sensitivities and specificities were estimated using bivariate random-effects models.



Ten studies were included in the meta-analysis, including seven comparative studies. Nine reported data on diagnostic accuracy of18F-FDG PET(/CT), seven on CT imaging. Only two studies reported the diagnostic accuracy of MRI, hence not included in the meta-analysis. Quality assessment raised concerns about the risk of bias regarding the use of the reference standard, blinding of the index tests and the follow-up time. Pooled sensitivity was respectively 84.6% (75.0-90.6) and 53.4% (29.0-76.4) for18F-FDG PET(/CT) and CT (P = 0.005). Pooled specificity was respectively 92.4% (86.5-95.9) and 95.7% (87.5-98.6) (P = 0.392).



18F-FDG PET/(CT) yields a higher sensitivity for detecting DP after ablation therapy compared with CT and has a comparably high specificity. These findings indicate that the use of18F-FDG PET(/CT) in this setting particularly allows for minimization of the false-negative rate compared with CT without compromising the low false-positive rate.
Dept. Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508GA, Utrecht, The Netherlands. Electronic address: M.Samim-3@umcutrecht.nl.
M
M
Samim
Dept. Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508GA, Utrecht, The Netherlands.
I Q
IQ
Molenaar
Dept. Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508GA, Utrecht, The Netherlands.
M F J
MFJ
Seesing
Dept. Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508GA, Utrecht, The Netherlands; Dept. Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508GA, Utrecht, The Netherlands.
P S N
PSN
van Rossum
Dept. Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3508GA, Utrecht, The Netherlands.
M A A J
MAAJ
van den Bosch
Dept. Surgical Oncology, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1006BE, Amsterdam, The Netherlands.
T J M
TJM
Ruers
Dept. Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508GA, Utrecht, The Netherlands.
I H M
IHM
Borel Rinkes
Dept. Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508GA, Utrecht, The Netherlands.
R
R
van Hillegersberg
Dept. Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3508GA, Utrecht, The Netherlands.
M G E H
MGEH
Lam
Dept. Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3508GA, Utrecht, The Netherlands.
H M
HM
Verkooijen
D017115:Catheter Ablation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D064847:Multimodal Imaging / Q000379:methods*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed / Q000379:methods*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
Accuracy; Hepatic metastases; Nuclear imaging; RFA