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Review
. 2022 Jul 8;12(7):1665.
doi: 10.3390/diagnostics12071665.

Diagnostic Accuracy of PET/CT or PET/MRI Using PSMA-Targeting Radiopharmaceuticals in High-Grade Gliomas: A Systematic Review and a Bivariate Meta-Analysis

Barbara Muoio  1   2 , Domenico Albano  3 , Francesco Dondi  3 , Francesco Bertagna  3 , Valentina Garibotto  4 , Jolanta Kunikowska  5 , Arnoldo Piccardo  6 , Salvatore Annunziata  7 , Vittoria Espeli  1 , Denis Migliorini  2 , Giorgio Treglia  8   9   10
Affiliations
Review

Diagnostic Accuracy of PET/CT or PET/MRI Using PSMA-Targeting Radiopharmaceuticals in High-Grade Gliomas: A Systematic Review and a Bivariate Meta-Analysis

Barbara Muoio et al. Diagnostics (Basel). .

Abstract

Background: Several studies proposed the use of positron emission tomography (PET) with Prostate Specific Membrane Antigen (PSMA)-targeting radiopharmaceuticals in brain tumors. Our aim is to calculate the diagnostic accuracy of these methods in high-grade gliomas (HGG) with a bivariate meta-analysis.

Methods: A comprehensive literature search of studies on the diagnostic accuracy of PET/CT or PET/MRI with PSMA-targeting radiopharmaceuticals in HGG was performed. Original articles evaluating these imaging methods both in the differential diagnosis between HGG and low-grade gliomas (LGG) and in the assessment of suspicious HGG recurrence were included. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), and diagnostic odds ratio (DOR) including 95% confidence intervals (95% CI) were calculated. Statistical heterogeneity was also assessed using the I2 test.

Results: The meta-analysis of six selected studies (157 patients) provided the following results about PET/CT or PET/MRI with PSMA-targeting radiopharmaceuticals in the diagnosis of HGG: sensitivity 98.2% (95% CI: 75.3-99.9%), specificity 91.2% (95% CI: 68.4-98.1%), LR+ 4.5 (95% CI: 2.2-9.3), LR- 0.07 (95% CI: 0.04-0.15), and DOR 70.1 (95% CI: 19.6-250.9). No significant statistical heterogeneity among the included studies was found (I2 = 0%).

Conclusions: the quantitative data provided demonstrate the high diagnostic accuracy of PET/CT or PET/MRI with PSMA-targeting radiopharmaceuticals for HGG detection. However, more studies are needed to confirm the promising role of PSMA-targeted PET in this clinical setting.

Keywords: PET; PSMA; brain tumors; glioblastoma; glioma; meta-analysis; neuro-oncology; nuclear medicine; positron emission tomography.

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Conflict of interest statement

Outside the submitted work: JK reports an unrestricted grant from Janssen, consulting fees from Telix and Novartis. The other coauthors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Summary of study selection process for the systematic review and meta-analysis.
Figure 2
Figure 2
Summary of quality assessment according to QUADAS-2 tool. Studies included in the systematic review are classified as low-risk or high-risk of bias or applicability concerns for different domains (reported in the vertical axis). The horizontal axis indicates the percentage of studies. The graph indicates that for the reference standard more than half of the studies show potential high risk of bias.
Figure 3
Figure 3
Summary ROC curve of diagnostic accuracy of the index test in high-grade glioma.
Figure 4
Figure 4
Positive likelihood ratio of the index test in high-grade glioma. Legend: 95% C.I. = 95% confidence interval; TP = true positive; TN = true negative; FP = false positive; FN = false negative.
Figure 5
Figure 5
Negative likelihood ratio of the index test in high-grade glioma. Legend: 95% C.I. = 95% confidence interval; TP = true positive; TN = true negative; FP = false positive; FN = false negative.
Figure 6
Figure 6
Diagnostic Odds ratio of the index test in high-grade glioma. Legend: 95% C.I. = 95% confidence interval; TP = true positive; TN = true negative; FP = false positive; FN = false negative.
See this image and copyright information in PMC

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