Fluorine 18-FDG PET/CT and Diffusion-weighted MRI for Malignant versus Benign Pulmonary Lesions: A Meta-Analysis.
Radiology. 2019 Feb;290(2):525-534. doi: 10.1148/radiol.2018181159. Epub 2018 Nov 27.
Basso Dias A1, Zanon M1, Altmayer S1, Sartori Pacini G1, Henz Concatto N1, Watte G1, Garcez A1, Mohammed TL1, Verma N1, Medeiros T1, Marchiori E1, Irion K1, Hochhegger B1.
Purpose To perform a meta-analysis of the literature to compare the diagnostic performance of fluorine 18 fluorodeoxyglucose PET/CT and diffusion-weighted (DW) MRI in the differentiation of malignant and benign pulmonary nodules and masses. Materials and Methods Published English-language studies on the diagnostic accuracy of PET/CT and/or DW MRI in the characterization of pulmonary lesions were searched in relevant databases through December 2017. The primary focus was on studies in which joint DW MRI and PET/CT were performed in the entire study population, to reduce interstudy heterogeneity. For DW MRI, lesion-to-spinal cord signal intensity ratio and apparent diffusion coefficient were evaluated; for PET/CT, maximum standard uptake value was evaluated. The pooled sensitivities, specificities, diagnostic odds ratios, and areas under the receiver operating characteristic curve (AUCs) for PET/CT and DW MRI were determined along with 95% confidence intervals (CIs). Results Thirty-seven studies met the inclusion criteria, with a total of 4224 participants and 4463 lesions (3090 malignant lesions [69.2%]). In the primary analysis of joint DW MRI and PET/CT studies (n = 6), DW MRI had a pooled sensitivity and specificity of 83% (95% CI: 75%, 89%) and 91% (95% CI: 80%, 96%), respectively, compared with 78% (95% CI: 70%, 84%) (P = .01 vs DW MRI) and 81% (95% CI: 72%, 88%) (P = .056 vs DW MRI) for PET/CT. DW MRI yielded an AUC of 0.93 (95% CI: 0.90, 0.95), versus 0.86 (95% CI: 0.83, 0.89) for PET/CT (P = .001). The diagnostic odds ratio of DW MRI (50 [95% CI: 19, 132]) was superior to that of PET/CT (15 [95% CI: 7, 32]) (P = .006). Conclusion The diagnostic performance of diffusion-weighted MRI is comparable or superior to that of fluorine 18 fluorodeoxyglucose PET/CT in the differentiation of malignant and benign pulmonary lesions. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Schiebler in this issue.