The performance of 11C-Methionine PET in the differential diagnosis of glioma recurrence

Abstract

Despite the advancement of neuroimaging techniques, it often remains a diagnostic challenge to distinguish recurrent glioma from lesions representing treatment effect. Preliminary reports suggest that 11C-methionine Positron emission tomography (PET) can assist in diagnosing true glioma recurrence. We present here a meta-analysis to assess the accuracy of 11C-methionine PET in identifying recurrent glioma in patients who had undergone prior therapy. A comprehensive search of the PubMed, Embase and Chinese Biomedical (CBM) databases yielded 23 eligible articles comprising 29 studies listed prior to November 20, 2016, representing 891 patients. In this report, we assess the methodological quality of each article individually and perform a meta-analysis to obtain the summary diagnostic accuracy of 11C-methionine PET in correctly identifying recurrent glioma. The pooled sensitivity and specificity are 0.88 (95% CI: 0.85, 0.91) and 0.85 (95% CI: 0.80, 0.89), respectively, with an area under the curve (AUC) for the summary receiver-operating characteristic curve (SROC) of 0.9352. We conclude that 11C-methionine PET has excellent diagnostic performance for differentiating glioma recurrence from treatment effect.

Keywords: PET; glioma; meta-analysis; methionine; recurrence.

Figure 1. Flow diagram of the study selection process

Figure 2. Methodological quality analysis of the 23 eligible articles using QUADAS-2 tool

Figure 3. Forest plot showing the sensitivity and specificity for the differentiation of glioma recurrence

Figure 4. Summary receiver-operating characteristic curve (SROC)

Figure 5. Funnel plot of publication bias