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18F-FDG PET/MRI in Detection of Pulmonary Malignancies: A Systematic Review and Meta-Analysis
Seyed Ali Mirshahvalad1, Ur Metser1, Adriano Basso Dias1
1From the Joint Department of Medical Imaging (S.A.M., U.R., A.B.D., C.O., P.V.H.) and Division of Thoracic Surgery, Department of Surgery (J.Y.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2.
Abstract:
Background There have been conflicting results regarding fluorine 18-labeled fluorodeoxyglucose (18F-FDG) PET/MRI diagnostic performance in lung malignant neoplasms. Purpose To evaluate the diagnostic performance of 18F-FDG PET/MRI for the detection of pulmonary malignant neoplasms. Materials and Methods A systematic search was conducted within the Scopus, Web of Science, and PubMed databases until December 31, 2021. Published original articles that met the following criteria were considered eligible for meta-analysis: (a) detecting malignant lesions in the lung, (b) comparing 18F-FDG PET/MRI with a valid reference standard, and (c) providing data for the meta-analytic calculations. A hierarchical method was used to pool the performances. The bivariate model was used to find the summary points and 95% CIs. The hierarchical summary receiver operating characteristic model was used to draw the summary receiver operating characteristic curve and calculate the area under the curve. The Higgins I2 statistic and Cochran Q test were used for heterogeneity assessment. Results A total of 43 studies involving 1278 patients met the inclusion criteria and were included in the meta-analysis. 18F-FDG PET/MRI had a pooled sensitivity and specificity of 96% (95% CI: 84, 99) and 100% (95% CI: 98, 100), respectively. 18F-FDG PET/CT had a pooled sensitivity and specificity of 99% (95% CI: 61, 100) and 99% (95% CI: 94, 100), respectively, which were comparable with those of 18F-FDG PET/MRI. At meta-regression, studies in which contrast media (P = .03) and diffusion-weighted imaging (P = .04) were used as a part of a pulmonary 18F-FDG PET/MRI protocol showed significantly higher sensitivities. Conclusion Fluorine 18-labeled fluorodeoxyglucose (18F-FDG) PET/MRI was found to be accurate and comparable with 18F-FDG PET/CT in the detection of malignant pulmonary lesions, with significantly improved sensitivity when advanced acquisition protocols were used. © RSNA, 2023 Supplemental material is available for this article.
Insights
Fluorine 18-labeled fluorodeoxyglucose (18F-FDG) PET/MRI accurately detects lung cancers, showing comparable performance to PET/CT. Advanced protocols enhance diagnostic sensitivity for pulmonary malignant neoplasms.
Area of Science:
- Nuclear Medicine
- Radiology
- Oncology
Background:
- Conflicting data exists on the diagnostic utility of 18F-FDG PET/MRI for lung malignant neoplasms.
- This study aimed to systematically evaluate the diagnostic performance of 18F-FDG PET/MRI in detecting pulmonary malignant lesions.
Approach:
- A comprehensive meta-analysis was performed on studies published until December 31, 2021, sourced from Scopus, Web of Science, and PubMed.
- Included studies compared 18F-FDG PET/MRI against a reference standard for detecting malignant lung lesions.
- Hierarchical and bivariate models were employed for performance pooling and heterogeneity assessment.
Key Points:
- The meta-analysis included 43 studies with 1278 patients.
- 18F-FDG PET/MRI demonstrated a pooled sensitivity of 96% and specificity of 100%.
- Performance was comparable to 18F-FDG PET/CT (sensitivity 99%, specificity 99%).
- Use of contrast media and diffusion-weighted imaging in PET/MRI protocols significantly improved sensitivity.
Conclusions:
- 18F-FDG PET/MRI is an accurate imaging modality for detecting malignant pulmonary lesions.
- Its diagnostic performance is comparable to 18F-FDG PET/CT.
- Advanced PET/MRI acquisition protocols, including contrast and DWI, enhance sensitivity for lung cancer detection.
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