Advancing Ocular Disease Diagnosis through FDG-PET Imaging Techniques

Introduction: ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) represents a significant advancement in medical imaging. While its utility in oncology and neurology is well-established, its potential in ophthalmology remains underexplored. This review focuses on the application of FDG-PET in early disease detection, specifically in conditions like uveal melanoma, diabetic retinopathy, and age-related macular degeneration (AMD). FDG-PET's ability to detect early metabolic changes before structural damage offers a promising avenue for enhancing diagnostic accuracy and timely intervention in ophthalmic care.

Methods: A comprehensive literature search of PubMed, Scopus, and Web of Science databases from 2000 to 2023 yielded 43 independent studies. Inclusion criteria were predicated on study design, FDG-PET application, and reported outcomes. We employed a random-effects meta-analysis to calculate pooled diagnostic odds ratios, sensitivity, specificity, and heterogeneity (I²). Quality assessment and bias evaluation were conducted using the quality assessment tool for diagnostic accuracy studies (QUADAS)-2 tool.

Results: Our meta-analysis indicates that FDG-PET has a significantly higher diagnostic odds ratio in early detection of uveal melanoma compared to conventional methods (pooled OR = 4.25, 95% CI [2.67, 6.78], p<0.001), surpassing traditional imaging methods (including B-scan ultrasonography and slit-lamp biomicroscopy) in differentiating between malignant and benign lesions and in identifying metastatic spread. For diabetic retinopathy and AMD, FDG-PET showed increased sensitivity in identifying pre-clinical pathological changes compared to optical coherence tomography (OCT) and fluorescein angiography, with moderate heterogeneity among studies (I² < 50%). These findings suggest that FDG-PET can notably improve the early detection and staging of ocular diseases, differentiate between malignant and benign ocular lesions, and potentially forecast disease progression, thereby facilitating personalized treatment planning.

Conclusions: Integrating FDG-PET into ophthalmic imaging marks a significant advancement in the early detection and management of ocular diseases. Its unique ability to detect subtle metabolic changes offers a diagnostic advantage over conventional methods. These findings across various ocular diseases underscore the urgent need for more research to validate these applications and establish standardized protocols for FDG-PET in ophthalmology. The broader implications of this integration could be transformative, potentially improving patient outcomes, optimizing treatment approaches, and impacting overall healthcare practices in ophthalmic care.

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