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

Abstract

Objective: The present systematic review and meta-analysis compared the diagnostic performance of F-18 fludeoxyglucose positron emission tomography (18F-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 18F-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), 18F-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: 18F-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 18F-FDG PET and conventional imaging for the characterisation of cardiac masses. Advances in knowledge: No previous studies have comprehensively analysed the diagnostic performance of 18F-FDG PET/CT compared with conventional imaging techniques including echocardiography, CT, and MRI. According to the current study, 18F-FDG PET/CT yielded a pooled DOR of 64, whereas other conventional imaging techniques demonstrated a DOR of 52. As such, 18F-FDG PET/CT demonstrated sensitivity and specificity, with a high pooled DOR comparable with other conventional imaging modalities.