Meningioma grading based on positron emission tomography: A systematic review and meta-analysis

Panagiotis Filis; George A Alexiou; Andreas Zigouris; Chrissa Sioka; Nikolaos Filis; Spyridon Voulgaris

doi:10.1016/j.wnsx.2023.100167

Meningioma grading based on positron emission tomography: A systematic review and meta-analysis

World Neurosurg X. 2023 Feb 3:18:100167. doi: 10.1016/j.wnsx.2023.100167. eCollection 2023 Apr.

Authors

Panagiotis Filis^{1

2}, George A Alexiou¹, Andreas Zigouris¹, Chrissa Sioka³, Nikolaos Filis¹, Spyridon Voulgaris¹

Affiliations

¹ Department of Neurosurgery, University of Ioannina, School of Medicine, Greece.
² Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Greece.
³ Department of Nuclear Medicine, University of Ioannina, Greece.

Abstract

Introduction: Meningiomas are the most common central nervous system tumor in adults. Knowledge of the tumor grade can guide optimal treatment timing and shape personalized follow-up strategies. Positron emission tomography (PET) has been utilized for the metabolic assessment of various intracranial space-occupying lesions. Herewith, we set out to evaluate the diagnostic accuracy of PET for the noninvasive assessment of meningioma's grade.

Materials and methods: The Medline, Scopus and Cochrane databases were systematically searched in March 2022 for studies that evaluated the sensitivity and specificity of PET compared to the gold standard of histological diagnosis in the grading of meningiomas. Summary statistics will be calculated and scatter plots, summary curve from the HSROC model and posterior predictions by empirical Bayes estimates will be presented.

Results: Five studies consisting of 242 patients with a total of 196 low-grade (Grade 1) and 46 high grade (Grade 2/3) meningiomas were included in our analysis. Three of the included studies used ¹⁸F-FDG, one study used ¹⁸F-FLT and one used(Whiting et al., 2011) 18 F-FET as PET tracers. The pooled sensitivity was 76% (95% CI: 52%-91%) and the pooled specificity was 89% (95% CI: 83%-93%). The diagnostic odds ratio was 27.17 (95% CI: 9.22-80.06), the positive likelihood ratio was 7.18 (95% CI: 4.54-11.34) and the negative likelihood ratio was 0.26 (95% CI: 0.11-0.61).

Conclusion: PET is a promising and viable option as a noninvasive imaging tool to differentiate the meningioma grades. However, currently it cannot overtake the gold standard of histological grade confirmation. More studies are required for further validation and refinement of this imaging technique and assessment of other radiotracers as well.

Keywords: 1/LR-, inverse of the negative likelihood ratio; 11C-MET, 11C-methionine; 18F-FDG, fluorine-18 fluorodeoxyglucose; 18F-FET, O-(2-[18F]Fluoroethyl)-l-tyrosine; CIs, 95% confidence intervals; CT, computerized tomography; DOR, diagnostic odds ratio; HSROC, hierarchical summary receiver operating characteristic; LR+, positive likelihood ratios; LR−, negative likelihood ratios; MRI, magnetic resonance imaging; Mendingioma; Meta-analysis; PET; PET, positron emission tomography; SPECT, single-photon emission computerized tomography; SUV, standardized uptake value; SUVmax, maximum standardized uptake value; TBR, tumour-to-brain ratios; TGR, tumor-to-contralateral gray matter ratios; WHO, World Health Organization; [18F]FLT, 3′-deoxy-3′-[18F]fluorothymidine.