Diagnostic performance of [18F]FDG-PET/MRI for liver metastasis in patients with primary malignancy: a systematic review and meta-analysis
- 31 Downloads
To systematically determine the diagnostic accuracy of 18-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ([18F]FDG-PET/MRI) for the detection of liver metastases and evaluate the sources of heterogeneity in the reported results.
PubMed and EMBASE databases were searched up until December 31, 2017, to identify original research studies reporting the diagnostic performance (Se and Sp) of PET/MRI for liver metastases, in comparison with PET/CT. Study quality was assessed using QUADAS-2. The summary Se and Sp of the studies were estimated using hierarchical modeling methods. To determine causes of study heterogeneity, the presence of a threshold effect was analyzed, and meta-regression analysis was performed.
Of 546 articles screened, eight suitable articles were identified, with seven for per-lesion analysis, and four for per-patient analysis. The meta-analytic summary Se and Sp for per-patient-based analysis were 99.2% (95% CI, 31.4–100.0%, I2 = 89.4%) and 98.6% (95% CI, 84.0–99.9%, I2 = 0.0%), respectively, while for per-lesion-based analysis they were 95.4% (95% CI, 78.3–99.2%, I2 = 99.7%) and 99.3% (95% CI, 93.8–99.9%, I2 = 96.5%). PET/MRI showed higher Se (95.4% vs. 68.3%) and Sp (99.3% vs. 95.8%) than PET/CT. Meta-regression analysis showed five significant factors affecting study heterogeneity: study subject characteristics, study design, MRI technique (DWI, HBP after injection of liver-specific contrast media), imaging review method, and reference standard.
The diagnostic accuracy of [18F]FDG-PET/MRI for liver metastasis was high overall, but substantial heterogeneity was found. Further randomized controlled studies or prospective studies are needed to investigate the role of PET/MRI in liver metastasis in comparison with PET/CT.
• [ 18 F]FDG-PET/MRI has high meta-analytic Se and Sp for the diagnosis of liver metastasis.
• PET/MRI using DWI and HBP images significantly increased diagnostic accuracy.
• Study heterogeneity was associated with subject characteristics, study design, MRI technique, image review method, and reference standard.
KeywordsFluorodeoxyglucose F18 Positron emission tomography-computed tomography Magnetic resonance imaging Neoplasms Liver
Agency for Healthcare Research and Quality
Hierarchical summary receiver operating characteristic
Magnetic resonance imaging
Positron emission tomography
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Quality Assessment of Diagnostic Accuracy Studies
This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number HI18C2383).
Compliance with ethical standards
The scientific guarantor of this publication is Sang Hyun Choi.
Conflict of interest
The authors declare that they have no conflict of interest.
Statistics and biometry
One of the authors (Sang Hyun Choi) has significant statistical expertise.
Written informed consent was not required for this study because this study was a meta-analysis.
Institutional review board approval was not required because this study was a meta-analysis.
• Diagnostic study
• Performed at one institution
- 15.Brendle C, Schwenzer NF, Rempp H et al (2016) Assessment of metastatic colorectal cancer with hybrid imaging: comparison of reading performance using different combinations of anatomical and functional imaging techniques in PET/MRI and PET/CT in a short case series. Eur J Nucl Med Mol Imaging 43:123–132CrossRefGoogle Scholar
- 20.Trikalinos TA, Balion CM, Coleman CI et al (2012) Meta-analysis of test performance when there is a “gold standard”. In: Chang SM, Matchar DB, Smetana GW, Umscheid CA (eds) Methods Guide for Medical Test Reviews, Rockville (MD)Google Scholar