What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Cardiac masses (n=408). Intervention: 18F-FDG PET vs. Conventional imaging (MRI, CT, echocardiography). Primary outcome: Area Under the Curve (AUC) for diagnostic accuracy (95% CI 0.92-0.96, p=0.7977).

What does this research mean for the field?

18F-FDG PET demonstrates comparable diagnostic accuracy to conventional imaging techniques (MRI, echocardiography, and CT) for the characterization of cardiac masses. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 25, 2022Open Access

Diagnostic test accuracies of F-18 FDG PET for characterisation of cardiac masses compared to conventional imaging techniques: systematic review and meta-analysis

KKKeunyoung KimUniversity of San Diego WKWoo Seog KoInje University SKSeong‐Jang KimPusan National University Yangsan Hospital

Key Result

18F-FDG PET demonstrated comparable diagnostic accuracy to conventional imaging for the characterization of cardiac masses, with an AUC of 0.95 versus 0.92 (p=0.7977).

Study Design

Type

Meta-Analysis (n=408)

Structured PICO

Does 18F-FDG PET improve diagnostic accuracy for the characterization of cardiac masses compared to conventional imaging techniques?

Population

408 patients presenting with cardiac masses across 6 studies (235 male, 173 female, age 20-83 years)

Intervention

F-18 fludeoxyglucose positron emission tomography (18F-FDG PET or PET/CT)

Comparator

Conventional imaging techniques including MRI, CT, and transesophageal echocardiography

Outcome

Diagnostic accuracy (sensitivity, specificity, likelihood ratios, diagnostic odds ratio, and AUC) for characterization of cardiac masses using histopathology as the reference standardsurrogate

18F-FDG PET provides comparable diagnostic accuracy to conventional imaging modalities like MRI and CT for characterizing cardiac masses, with high sensitivity and specificity.

Main Result

Absolute Event Rate: 0.95% vs 0.92%

p-value: p=0.7977

Limitations

Considerable heterogeneity in the interpretation criteria for defining a positive 18F-FDG PET scan across included studies.
Potential for publication bias due to the small number of included studies.
Not useful for tumors that do not take up 18F-FDG, such as well-differentiated neuroendocrine tumors.

Abstract

Objective: The present systematic review and meta-analysis compared the diagnostic performance of F-18 fludeoxyglucose positron emission tomography ( 18 F-FDG PET) and conventional imaging, including MRI, echocardiography, and CT, in characterising cardiac masses. Methods: A literature search of the PubMed, Cochrane, and EMBASE databases for studies comparing the diagnostic accuracies of 18 F-FDG PET and conventional imaging in characterising cardiac masses, from inception of indexing to 31 July 2020, was performed. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess study quality. Sensitivity and specificity across the studies were determined, positive and negative likelihood ratios (LR+ and LR-, respectively) were calculated, and summary receiver operating characteristic curves were constructed. Results: Of six included studies (n = 212 patients), 18 F-FDG PET demonstrated a pooled sensitivity of 0.89 (95% confidence interval CI 0.81–0.94) and a pooled specificity of 0.89 (95% CI 0.80–0.94). LR syntheses yielded an overall LR+ of 7.9 (95% CI 4.3–14.6) and LR- of 0.12 (95% CI 0.07–0.22). The calculated pooled diagnostic odds ratio (DOR) was 64 (95% CI 23–181). For conventional imaging, the pooled sensitivity was 0.70 (95% CI 0.57–0.81) and the pooled specificity was 0.96 (95% CI 0.88–0.98). LR syntheses yielded an overall LR+ of 16.1 (95% CI 5.8–44.5) and LR- of 0.31 (95% CI 0.21–0.46). The evaluated pooled DOR was 52 (95% CI 17–155). Conclusion: 18 F-FDG PET and conventional imaging demonstrated comparable diagnostic accuracies for the characterisation of cardiac masses. Further large multicentre studies are, however, required to corroborate the diagnostic performances of 18 F-FDG PET and conventional imaging for the characterisation of cardiac masses. Advances in knowledge: No previous studies have comprehensively analysed the diagnostic performance of 18 F-FDG PET/CT compared with conventional imaging techniques including echocardiography, CT, and MRI. According to the current study, 18 F-FDG PET/CT yielded a pooled DOR of 64, whereas other conventional imaging techniques demonstrated a DOR of 52. As such, 18 F-FDG PET/CT demonstrated sensitivity and specificity, with a high pooled DOR comparable with other conventional imaging modalities.

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