Zhou Chenchen, Kou Yunpeng, Zhou Wenqian, Zhao Wenjian, Fan Zhicheng, Jiao Yang, Zhai Yulong, Liu Jinghui, Guo Shaochun, Ji Peigang, Wang Liang
From the Department of Neurosurgery (C.Z.), Xi'an Medical University, Xi'an, China.
Department of Neurosurgery (C.Z., Y.K., W.Zhao, Z.F., Y.J., Y.Z., J.L., S.G., P.J., L.W.), Tangdu Hospital, Air Force Military Medical University, Xi'an, China.
AJNR Am J Neuroradiol. 2025 Apr 2;46(4):758-765. doi: 10.3174/ajnr.A8565.
It is often difficult to identify treatment-related changes (TRC) from tumor progression (TP) in patients with glioma, and the current application of PET scanning is expected to improve the diagnosis.
We used a systematic review and meta-analysis to reveal diagnostically more promising tracers by comparing the diagnostic accuracy of different PET tracers in identifying TRC and TP in patients with glioma.
We searched PubMed, Web of Science, and EMBASE databases, and we selected studies that used PET scans to identify TP and TRC in patients with glioma.
Twenty-eight studies were identified based on the set criteria. The studies involved a total of 10 different tracers and 1405 patients. TP occurred in 67.4% (947) of patients, while TRC occurred in 32.6% (458) of patients.
The sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio of various PET tracers were calculated and summarized. Moreover, the diagnostic value of various tracers was compared.
This systematic review included 28 studies comparing 10 different PET tracers, including F-fluoro-deoxy-glucose FDG (F-FDG), C methionine (C -MET), F-fuoroethyl-L-tyrosine (F-FET), 3,4-dihydroxy-6-18F-fluoro-L-phenylalanine (F-FDOPA), F-fluorothymidine (F-FLT), F-PSMA-1007, Ga-PSMA-11, F-choline (F-CHO), F-fluciclovine, and []C-Alpha-Methyl-Tryptophan(C-AMT). The results revealed that C-MET exhibited the highest diagnostic value, with an overall sensitivity and specificity of 0.89 [0.85, 0.93] and 0.91 [0.84, 0.99], respectively. Although the number of F-FDOPA studies is limited, it exhibited high diagnostic value, with an overall sensitivity and specificity of 1.00 [0.91, 1.00] and 0.92 [0.75, 0.99], respectively.
Most studies consisted of small sample sizes; however, the included studies differed to some extent regarding the reference standard for the final diagnosis and the standard of care. Additionally, most selected studies were retrospective.
Amino acid-based tracers exhibited the highest diagnostic value in identifying TRC and TP in gliomas, with C-MET and F-FDOPA having the most notable advantages. Research on other new tracers is limited, therefore, further studies are needed to prove their diagnostic value.
在胶质瘤患者中，区分治疗相关变化（TRC）和肿瘤进展（TP）往往很困难，目前正期待通过正电子发射断层扫描（PET）来改善诊断。
我们通过系统评价和荟萃分析，比较不同PET示踪剂在识别胶质瘤患者TRC和TP方面的诊断准确性，以揭示诊断前景更广阔的示踪剂。
我们检索了PubMed、科学网和EMBASE数据库，并选择了使用PET扫描识别胶质瘤患者TP和TRC的研究。
根据既定标准确定了28项研究。这些研究共涉及10种不同的示踪剂和1405例患者。67.4%（947例）的患者出现了TP，而32.6%（458例）的患者出现了TRC。
计算并汇总了各种PET示踪剂的敏感性、特异性、诊断比值比、阳性似然比和阴性似然比。此外，还比较了各种示踪剂的诊断价值。
本系统评价纳入了28项比较10种不同PET示踪剂的研究，包括氟代脱氧葡萄糖（F-FDG）、碳-蛋氨酸（C-MET）、氟代乙基-L-酪氨酸（F-FET）、3,4-二羟基-6-18F-氟-L-苯丙氨酸（F-FDOPA）、氟代胸苷（F-FLT）、F-PSMA-1007、镓-PSMA-11、氟代胆碱（F-CHO）、氟代环胞苷和碳-α-甲基色氨酸（C-AMT）。结果显示，C-MET的诊断价值最高，总体敏感性和特异性分别为0.89[0.85，0.93]和0.91[0.84，0.99]。虽然F-FDOPA的研究数量有限，但其诊断价值较高，总体敏感性和特异性分别为1.00[0.91，1.00]和0.92[0.75，0.99]。
大多数研究样本量较小；然而，纳入的研究在最终诊断的参考标准和护理标准方面存在一定差异。此外，大多数入选研究为回顾性研究。
基于氨基酸的示踪剂在识别胶质瘤的TRC和TP方面具有最高的诊断价值，C-MET和F-FDOPA优势最为显著。对其他新型示踪剂的研究有限，因此需要进一步研究以证实其诊断价值。
