Kim Seong-Jang, Lee Sang-Woo, Pak Kyoungjune, Kim In-Ju, Kim Keunyoung
1 Department of Nuclear Medicine, Pusan National University Yangsan Hospital , Yangsan , South Korea.
2 BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , South Korea.
Br J Radiol. 2018 Jun;91(1086):20170520. doi: 10.1259/bjr.20170520. Epub 2018 Feb 5.
We aimed to explore the role of the diagnostic accuracy of F fluodeoxyglucose PET (F-FDG PET) or PET/CT for characterization of adrenal lesions through a systematic review and meta-analysis.
The MEDLINE, EMBASE, and Cochrane Library database, from the earliest available date of indexing through 30 April 2017, were searched for studies evaluating the diagnostic performance of F-FDG PET or PET/CT for characterization of adrenal lesions. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR + and LR-), and constructed summary receiver operating characteristic curves.
Across 29 studies (2421 patients), the pooled sensitivity for F-FDG PET or PET/CT was 0.91 [95% CI (0.88-0.94)] with heterogeneity (χ = 141.8, p = 0.00) and a pooled specificity of 0.91 [95% CI (0.87-0.93)] with heterogeneity (χ = 113.7, p = 0.00). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 9.9 [95% CI (7.1-13.7)] and negative likelihood ratio (LR-) of 0.09 [95% CI (0.07-0.13)]. The pooled diagnostic odds ratio was 105 [95% CI (63-176)]. In metaregression analysis, study design, publication year, study location (western vs others), interpretation criteria of PET or PET/CT images, quantification of PET or PET/CT [SUV (maximum standardized uptake value) vs SUV (standardized uptake value) ratio], patient group, and analysis method (patient-based vs lesion-based) were the sources of the study heterogeneity. However, in multivariate metaregression, no definite variable was the source of the study heterogeneity.
F-FDG PET or PET/CT demonstrated good sensitivity and specificity for the characterization of adrenal masses. At present, the literature regarding the use of F-FDG PET or PET/CT for the characterization of adrenal masses remains still limited; thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of F-FDG PET or PET/CT characterization of adrenal masses. Advances in knowledge: F- FDG PET or PET/CT showed good sensitivity and specificity for the characterization of adrenal masses and could provide additional information for that purpose.
我们旨在通过系统评价和荟萃分析，探讨氟脱氧葡萄糖正电子发射断层显像（F-FDG PET）或PET/CT对肾上腺病变特征的诊断准确性的作用。
检索MEDLINE、EMBASE和Cochrane图书馆数据库，检索时间从最早可检索日期至2017年4月30日，以查找评估F-FDG PET或PET/CT对肾上腺病变特征诊断性能的研究。我们确定了各项研究的敏感性和特异性，计算了阳性和阴性似然比（LR+和LR-），并构建了汇总的受试者工作特征曲线。
在29项研究（2421例患者）中，F-FDG PET或PET/CT的汇总敏感性为0.91 [95%可信区间（CI）（0.88 - 0.94）]，存在异质性（χ² = 141.8，p = 0.00），汇总特异性为0.91 [95% CI（0.87 - 0.93）]，存在异质性（χ² = 113.7，p = 0.00）。似然比（LR）综合分析得出总体阳性似然比（LR+）为9.9 [95% CI（7.1 - 13.7）]，阴性似然比（LR-）为0.09 [95% CI（0.07 - 0.13）]。汇总诊断比值比为105 [95% CI（63 - 176）]。在Meta回归分析中，研究设计、发表年份、研究地点（西方与其他地区）、PET或PET/CT图像的解读标准、PET或PET/CT的定量分析[SUV（最大标准化摄取值）与SUV（标准化摄取值）比值]、患者组以及分析方法（基于患者与基于病变）是研究异质性的来源。然而，在多变量Meta回归中，没有明确的变量是研究异质性的来源。
F-FDG PET或PET/CT对肾上腺肿块特征的显示具有良好的敏感性和特异性。目前，关于使用F-FDG PET或PET/CT对肾上腺肿块进行特征分析的文献仍然有限；因此，需要进一步开展大型多中心研究来证实F-FDG PET或PET/CT对肾上腺肿块特征分析的诊断准确性。知识进展：F-FDG PET或PET/CT对肾上腺肿块特征的显示具有良好的敏感性和特异性，并可为该目的提供额外信息。
