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Review
. 2023 May 5;15(9):2631.
doi: 10.3390/cancers15092631.

Head-To-Head Comparison of PET and Perfusion Weighted MRI Techniques to Distinguish Treatment Related Abnormalities from Tumor Progression in Glioma

Dylan Henssen  1   2 , Lars Leijten  1 , Frederick J A Meijer  1   2 , Anja van der Kolk  1   2   3 , Anne I J Arens  1 , Mark Ter Laan  2   4 , Robert J Smeenk  2   5 , Anja Gijtenbeek  2   6 , Elsmarieke M van de Giessen  7 , Nelleke Tolboom  3 , Daniela E Oprea-Lager  7 , Marion Smits  8   9   10 , James Nagarajah  1
Affiliations
Review

Head-To-Head Comparison of PET and Perfusion Weighted MRI Techniques to Distinguish Treatment Related Abnormalities from Tumor Progression in Glioma

Dylan Henssen et al. Cancers (Basel). .

Abstract

The post-treatment imaging surveillance of gliomas is challenged by distinguishing tumor progression (TP) from treatment-related abnormalities (TRA). Sophisticated imaging techniques, such as perfusion-weighted magnetic resonance imaging (MRI PWI) and positron-emission tomography (PET) with a variety of radiotracers, have been suggested as being more reliable than standard imaging for distinguishing TP from TRA. However, it remains unclear if any technique holds diagnostic superiority. This meta-analysis provides a head-to-head comparison of the diagnostic accuracy of the aforementioned imaging techniques. Systematic literature searches on the use of PWI and PET imaging techniques were carried out in PubMed, Embase, the Cochrane Library, ClinicalTrials.gov and the reference lists of relevant papers. After the extraction of data on imaging technique specifications and diagnostic accuracy, a meta-analysis was carried out. The quality of the included papers was assessed using the QUADAS-2 checklist. Nineteen articles, totaling 697 treated patients with glioma (431 males; mean age ± standard deviation 50.5 ± 5.1 years) were included. The investigated PWI techniques included dynamic susceptibility contrast (DSC), dynamic contrast enhancement (DCE) and arterial spin labeling (ASL). The PET-tracers studied concerned [S-methyl-11C]methionine, 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG), O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET) and 6-[18F]-fluoro-3,4-dihydroxy-L-phenylalanine ([18F]FDOPA). The meta-analysis of all data showed no diagnostic superior imaging technique. The included literature showed a low risk of bias. As no technique was found to be diagnostically superior, the local level of expertise is hypothesized to be the most important factor for diagnostically accurate results in post-treatment glioma patients regarding the distinction of TRA from TP.

Keywords: MR–perfusion; PET/CT; PET/MR; molecular imaging–cancer; neuro-oncology.

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Conflict of interest statement

Smits declares that she received speaker fees from GE Healthcare with regard to the use of perfusion weighted magnetic resonance imaging. The other authors declare that they have had no conflict of interest in the conduction of this research.

Figures

Figure 1
Figure 1
PRISMA flow chart.
Figure 2
Figure 2
Forest plot and summary receiver operating curves (SROCs) of [18F]FDG PET imaging and DCE PW imaging with regard to the differentiation of TP from TRA. [18F]FDG, 2-deoxy-2-[18F]fluoro-D-glucose; DCE PW imaging, dynamic contrast enhancement perfusion weighted imaging; TP, tumor progression. Forest plot displaying the individual effect sizes from each study for the diagnostic accuracy of [18F]FDG PET imaging and DCE PW imaging with regard to the differentiation of TP from TRA. SROC of [18F]FDG PET imaging (black line) and DCE PW imaging (red line) with regard to the differentiation of TP from TRA shows greater potential for DCE PW imaging. However, the difference in the diagnostic accuracy of the techniques was not statistically significant [27,28,29,30].
Figure 3
Figure 3
Forest plot and summary receiver operating curves (SROCs) of [18F]FDG PET imaging and DSC PW imaging with regard to the differentiation of TP from TRA. [18F]FDG, 2-deoxy-2-[18F]fluoro-D-glucose; DSC PW imaging, dynamic susceptibility contrast perfusion weighted imaging; TP, tumor progression. Forest plot displaying the individual effect sizes from each study for the diagnostic accuracy of [18F]FDG PET imaging and DSC PW imaging with regard to the differentiation of TP from TRA. SROC of [18F]FDG PET imaging (black line) and DSC PW imaging (red line) with regard to the differentiation of TP from TRA shows greater potential for [18F]FDG PET imaging. However, the difference in the diagnostic accuracy of the techniques was not statistically significant [24,25,26].
Figure 4
Figure 4
Forest plot and summary receiver operating curves (SROCs) of [11C]MET PET imaging and DSC PW imaging with regard to the differentiation of TP from TRA. [C1-11C]MET, [S-methyl-11C]methionine; DSC PW imaging, dynamic susceptibility contrast perfusion weighted imaging; TP, tumor progression. Forest plot displaying the individual effect sizes from each study for the diagnostic accuracy of [C1-11C]MET PET imaging and DSC PW imaging with regard to the differentiation of TP from TRA. SROC of [C1-11C]MET PET imaging (black line) and DSC PW imaging (red line) with regard to the differentiation of TP from TRA shows no superiority of either technique. Additionally, the difference in the diagnostic accuracy of the techniques was not statistically significant [20,21,22,23,38].
Figure 5
Figure 5
Forest plot and summary receiver operating curves (SROCs) of [18F]FET PET imaging and DSC PW imaging with regard to the differentiation of TP from TRA. [18F]FET, O-(2-[18F]fluoroethyl)-L-tyrosine; DSC PW imaging, dynamic susceptibility contrast perfusion weighted imaging; TP, tumor progression. Forest plot displaying the individual effect sizes from each study for the diagnostic accuracy of [18F]FET PET imaging and DSC PW imaging with regard to the differentiation of TP from TRA. SROC of [18F]FET PET imaging (black line) and DSC PW imaging (red line) with regard to the differentiation of TP from TRA shows greater potential for the DSC PW imaging. However, the difference in the diagnostic accuracy of the techniques was not statistically significant [31,32,33,34,35].
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