Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada.
Sunnybrook Health Sciences Center, Toronto, Canada.
Eur J Nucl Med Mol Imaging. 2022 Oct;49(12):4205-4217. doi: 10.1007/s00259-022-05871-0. Epub 2022 Jun 16.
To calculate the diagnostic performance of [F]-FDG PET/MR in colorectal cancer (CRC).
This study was designed following the PRISMA-DTA guidelines. To be included, published original articles (until December 31, 2021) that met the following criteria were considered eligible: (1) evaluated [F]-FDG PET/MR as the diagnostic method to detect CRC; (2) compared [F]-FDG PET/MR with histopathology as the reference standard, or clinical/imaging composite follow-up when pathology was not available; (3) provided adequate crude data for meta-analysis. The diagnostic pooled measurements were calculated at patient and lesion levels. Regarding sub-group analysis, diagnostic measurements were calculated in "TNM staging," "T staging," "N staging," "M staging," and "liver metastasis" sub-groups. Additionally, we calculated the pooled performances in "rectal cancer: patient-level" and "rectal cancer: lesion-level" sub-groups. A hierarchical method was used to pool the performances. The bivariate model was conducted to find the summary points. Analyses were performed using STATA 16.
A total of 1534 patients from 18 studies were entered. The pooled sensitivities in CRC lesion detection (tumor, lymph nodes, and metastases) were 0.94 (95%CI: 0.89-0.97) and 0.93 (95%CI: 0.82-0.98) at patient-level and lesion-level, respectively. The pooled specificities were 0.89 (95%CI: 0.84-0.93) and 0.95 (95%CI: 0.90-0.98) at patient-level and lesion-level, respectively. In sub-groups, the highest sensitivity (0.97, 95%CI: 0.86-0.99) and specificity (0.99, 95%CI: 0.84-1.00) were calculated for "M staging" and "rectal cancer: lesion-level," respectively. The lowest sensitivity (0.81, 95%CI: 0.65-0.91) and specificity (0.79, 95%CI: 0.52-0.93) were calculated for "N staging" and "T staging," respectively.
This meta-analysis showed an overall high diagnostic performance for [F]-FDG PET/MR in detecting CRC lesions/metastases. Thus, this modality can play a significant role in several clinical scenarios in CRC staging and restaging. Specifically, one of the main strengths of this modality is ruling out the existence of CRC lesions/metastases. Finally, the overall diagnostic performance was not found to be affected in the post-treatment setting.
计算 [F]-FDG PET/MR 在结直肠癌（CRC）中的诊断性能。
本研究遵循 PRISMA-DTA 指南进行设计。符合以下标准的已发表的原始文章（截至 2021 年 12 月 31 日）被认为符合入选条件：（1）评估 [F]-FDG PET/MR 作为检测 CRC 的诊断方法；（2）将 [F]-FDG PET/MR 与组织病理学作为参考标准进行比较，或者在无法获得病理结果时与临床/影像学综合随访进行比较；（3）提供足够的粗数据进行荟萃分析。在患者和病变水平上计算诊断汇总测量值。关于亚组分析，在“TNM 分期”、“T 分期”、“N 分期”、“M 分期”和“肝转移”亚组中计算了诊断测量值。此外，我们还在“直肠癌：患者水平”和“直肠癌：病变水平”亚组中计算了汇总表现。使用分层方法对表现进行汇总。使用二元模型找到汇总点。使用 STATA 16 进行分析。
共纳入了来自 18 项研究的 1534 名患者。在 CRC 病变检测（肿瘤、淋巴结和转移）的患者水平和病变水平的汇总敏感性分别为 0.94（95%CI：0.89-0.97）和 0.93（95%CI：0.82-0.98）。汇总特异性分别为 0.89（95%CI：0.84-0.93）和 0.95（95%CI：0.90-0.98）。在亚组中，“M 分期”和“直肠癌：病变水平”的敏感性最高（0.97，95%CI：0.86-0.99）和特异性最高（0.99，95%CI：0.84-1.00）。“N 分期”和“T 分期”的敏感性最低（0.81，95%CI：0.65-0.91）和特异性最低（0.79，95%CI：0.52-0.93）。
这项荟萃分析表明，[F]-FDG PET/MR 在检测 CRC 病变/转移方面总体具有较高的诊断性能。因此，这种方法可以在 CRC 分期和再分期的多个临床情况下发挥重要作用。具体来说，这种方法的主要优势之一是排除 CRC 病变/转移的存在。最后，在治疗后环境中未发现总体诊断性能受到影响。
