The diagnostic performance of [18F]FET PET/MRI versus [18F]FDG PET/MRI for recurrent glioma: a systematic review and meta-analysis

PurposeOur systematic review and meta-analysis aimed to evaluate the diagnostic performance of [F-18]FDG PET/MRI vs. [F-18]FET PET/MRI for recurrent glioma.MethodsWe searched for relevant articles in PubMed, Embase, and Web of Science until February 2023. Studies regarding the diagnostic performance of [F-18]FET PET/MRI or [F-18]FDG PET/MRI in recurrent glioma were included. The quality of each study was assessed using the Quality Assessment of Diagnostic Performance Studies-2 (QUADAS-2) tool.ResultsA total of nine studies with 310 patients were included in the analysis, the pooled sensitivity, specificity of [F-18]FDG PET/MRI in detecting recurrent glioma after definitive treatment were 0.99 (95% CI 0.75-1.00) and 0.62 (95% CI 0.37-0.83), [F-18]FET PET/MRI were 0.94 (95% CI 0.81-0.98) and 0.87 (95% CI 0.70-0.95), respectively. The area under curve (AUC) for [F-18]FDG PET/MRI and [F-18]FET PET/MRI were 0.92 (95% CI 0.89-0.94) and 0.96 (95% CI 0.94-0.97) and there is a statistical difference between the two imaging modalities (Z = 12.433, P < 0.001). Fagan nomogram indicated that when the pre-test probability was set at 50%, the post-test probability for [F-18]FDG PET/MRI and [F-18]FET PET/MRI could increase to 72 and 88%.Conclusions[F-18]FET PET/MRI has a higher AUC compared to [F-18]FDG PET/MRI in the detection of tumor recurrence in glioma. However, the results of the meta-analysis were drawn from studies with small samples. Further larger prospective studies in this setting are warranted.