Abdlkadir Ahmed Saad, Al-Adhami Dhuha, Allouzi Sudqi, Badarneh Mohannad, Shahait Mohammed, Abdulrahman Marwa, Ruzzeh Saad, Moghrabi Serin, Al-Ibraheem Akram
Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Queen Rania Street, Al Jubeiha, Amman, 11941, Jordan.
Department of Surgery, Clemenceau Medical Center, Dubai, UAE.
Discov Oncol. 2025 Jul 1;16(1):1241. doi: 10.1007/s12672-025-03020-1.
This systematic review and meta-analysis aims to evaluate the diagnostic utility of [F]Fluorodeoxyglucose ([F]FDG) PET/CT and [F]FDG PET/MRI in preoperative locoregional staging of bladder cancer (BC).
A comprehensive search of PubMed and Scopus databases was conducted up to February 26, 2025, to collect and analyze diagnostic accuracy parameters. Statistical analyses, including publication bias assessment, interstudy heterogeneity evaluation, and effect size adjustment, were performed using Stata software, with a significance threshold set at p < 0.05.
A total of 25 eligible studies were identified. Among these, three studies utilized [F]FDG PET/MRI for primary tumor detection, yielding a pooled sensitivity of 90%. In contrast, five studies employing [F]FDG PET/CT for the same purpose reported a pooled sensitivity of 69%. Notably, [F]FDG PET/MRI demonstrated threefold greater effectiveness in primary tumor detection compared to [F]FDG PET/CT based on results of indirect comparison of true positive odds ratio between the two modalities. For lymph node staging, 18 studies employed [F]FDG PET/CT, with pooled sensitivity and specificity estimates of 50% and 91%, respectively. Significant interstudy heterogeneity was observed in lymph node staging, primarily attributed to variations in PET/CT protocols. Studies incorporating bladder priming strategies, dual-time-point imaging, and contrast-enhanced CT protocols achieved superior sensitivity and specificity compared to traditional PET/CT approaches.
The findings highlight the compelling potential of [F]FDG PET/MRI for primary tumor staging in BC. Further research is warranted to explore this innovative modality's role in locoregional BC evaluation. Additionally, substantial heterogeneity in [F]FDG PET/CT protocols underscores the need for standardization to improve sensitivity. Thus, Future studies should focus on addressing these limitations by adopting optimized PET/CT protocols.
本系统评价和荟萃分析旨在评估[F]氟脱氧葡萄糖（[F]FDG）PET/CT和[F]FDG PET/MRI在膀胱癌（BC）术前局部区域分期中的诊断效用。
截至2025年2月26日，对PubMed和Scopus数据库进行了全面检索，以收集和分析诊断准确性参数。使用Stata软件进行统计分析，包括发表偏倚评估、研究间异质性评估和效应量调整，显著性阈值设定为p < 0.05。
共确定了25项符合条件的研究。其中，三项研究使用[F]FDG PET/MRI检测原发性肿瘤，汇总敏感性为90%。相比之下，五项采用[F]FDG PET/CT进行相同目的研究报告的汇总敏感性为69%。值得注意的是，基于两种模式之间真阳性比值比的间接比较结果，[F]FDG PET/MRI在原发性肿瘤检测中的有效性比[F]FDG PET/CT高三倍。对于淋巴结分期，18项研究采用了[F]FDG PET/CT，汇总敏感性和特异性估计分别为50%和91%。在淋巴结分期中观察到显著的研究间异质性，主要归因于PET/CT方案的差异。与传统PET/CT方法相比，纳入膀胱充盈策略、双时相成像和对比增强CT方案的研究实现了更高的敏感性和特异性。
研究结果突出了[F]FDG PET/MRI在BC原发性肿瘤分期中的巨大潜力。有必要进一步研究探索这种创新模式在BC局部区域评估中的作用。此外，[F]FDG PET/CT方案存在大量异质性，强调了标准化以提高敏感性的必要性。因此，未来的研究应侧重于通过采用优化的PET/CT方案来解决这些局限性。
