目的:总结18F-FET-PET在处理高级别脑胶质瘤或颅外原发性恶性肿瘤转移患者中的诊断性能。
方法:MEDLINE,EMBASE,和Cochrane数据库的系统评价数据库被搜索的研究报告的诊断测试参数在放射治疗计划,反应评估,和肿瘤复发/治疗相关的变化分化。放射学研究被排除。使用诊断准确性研究质量评估(QUADAS-2)工具和分级方法进行质量评估。一个双变量,随机效应模型用于产生敏感性和特异性的汇总估计.
结果:分析中纳入了26项研究,共1206例患者/病变。对于神经胶质瘤的放射治疗计划,来自3项研究的18F-FET摄取超过标准MRI钆增强20mm边缘的患者的合并比例为39%(95%CI,10-73%).在3项研究中,18F-FET-PET也被证明可以预测治疗的早期反应者,而MRI未能显示任何预后价值。对于胶质瘤复发与治疗相关变化的区别,来自6项研究的TBRmax1.9-2.3的合并敏感性和特异性分别为91%(95%CI,74-97%)和84%(95%CI,69-93%),分别。使用TBRmax2.15-3.11,来自4项研究的脑转移的相应值分别为82%(95%CI,74-88%)和82%(95%CI,74-88%)。
结论:虽然18F-FET有望作为标准MRI治疗原发性和转移性脑恶性肿瘤的补充方式,在精心设计的前瞻性研究中,有必要使用标准化图像判读方法进行进一步验证.
OBJECTIVE: To provide a summary of the diagnostic performance of 18F-FET-PET in the management of patients with high-grade brain gliomas or metastases from extracranial primary malignancies.
METHODS: MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews databases were searched for studies that reported on diagnostic test parameters in radiotherapy planning, response assessment, and tumour recurrence/treatment-related changes differentiation. Radiomic studies were excluded. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool and the GRADE approach. A bivariate, random-effects model was used to produce summary estimates of sensitivity and specificity.
RESULTS: Twenty-six studies with a total of 1206 patients/lesions were included in the analysis. For radiotherapy planning of glioma, the pooled proportion of patients from 3 studies with 18F-FET uptake extending beyond the 20 mm margin from the gadolinium enhancement on standard MRI was 39% (95% CI, 10-73%). In 3 studies, 18F-FET-PET was also shown to be predictive of early responders to treatment, whereas MRI failed to show any prognostic value. For the differentiation of glioma recurrence from treatment-related changes, the pooled sensitivity and specificity of TBRmax 1.9-2.3 from 6 studies were 91% (95% CI, 74-97%) and 84% (95% CI, 69-93%), respectively. The respective values for brain metastases from 4 studies were 82% (95% CI, 74-88%) and 82% (95% CI, 74-88%) using TBRmax 2.15-3.11.
CONCLUSIONS: While 18F-FET shows promise as a complementary modality to standard-of-care MRI for the management of primary and metastatic brain malignancies, further validation with standardized image interpretation methods in well-designed prospective studies are warranted.