Objective: The purpose of the present study was to investigate the diagnostic performance of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the differentiation of benign and malignant vertebral compression fractures (VCFxs) through a systematic review and meta-analysis.
Methods: MEDLINE via PubMed, Cochrane, Scopus, and Embase database, from the earliest available date of indexing through September 30, 2019, were searched for studies evaluating the diagnostic performance of F-18 FDG PET or PET/CT for the differentiation of malignant VCFxs. We determined the sensitivities and specificities across the studies, calculated the positive and negative likelihood ratios (LR+ and LR-, respectively), and constructed summary receiver operating characteristic curves.
Results: For the 5 studies (274 patients), the pooled sensitivity was 0.96 (95% confidence interval [CI], 0.82-0.99) without heterogeneity (I2, 50.6) and 0.77 (95% CI, 0.56-0.89) with heterogeneity (I2, 76.1). LR syntheses gave an overall LR+ of 4.1 (95% CI, 2.1-8.0) and LR- of 0.05 (95% CI, 0.01-0.23). The pooled diagnostic odds ratio (DOR) was 78 (95% CI, 19-316). The hierarchical summary receiver operating characteristic curve indicates that the areas under the curve was 0.94 (95% CI, 0.92-0.96).
Conclusions: The results of the present meta-analysis have shown high sensitivity and moderate specificity for F-18 FDG PET and PET/CT for differentiation of malignant VCFxs. At present, the reported data regarding the use of F-18 FDG PET for differentiation of malignant VCFxs remain limited; thus, further large multicenter studies are necessary to substantiate the diagnostic accuracy of F-18 FDG PET for the differentiation of malignant VCFxs.
Keywords: F-18 FDG; Malignant fracture; PET/CT; Vertebral fracture.
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