@article {de Zwart498, author = {Paul L. de Zwart and Bart R.J. van Dijken and Gea A. Holtman and Gilles N. Stormezand and Rudi A.J.O. Dierckx and Peter Jan van Laar and Anouk van der Hoorn}, title = {Diagnostic Accuracy of PET Tracers for the Differentiation of Tumor Progression from Treatment-Related Changes in High-Grade Glioma: A Systematic Review and Metaanalysis}, volume = {61}, number = {4}, pages = {498--504}, year = {2020}, doi = {10.2967/jnumed.119.233809}, publisher = {Society of Nuclear Medicine}, abstract = {Posttreatment high-grade gliomas are usually monitored with contrast-enhanced MRI, but its diagnostic accuracy is limited as it cannot adequately distinguish between true tumor progression and treatment-related changes. According to recent Response Assessment in Neuro-Oncology recommendations, PET overcomes this limitation. However, it is currently unknown which tracer yields the best results. Therefore, a systematic review and metaanalysis were performed to compare the diagnostic accuracy of the different PET tracers in differentiating tumor progression from treatment-related changes in high-grade glioma patients. Methods: PubMed, Web of Science, and Embase were searched systematically. Study selection, data extraction, and quality assessment were performed independently by 2 authors. Metaanalysis was performed using a bivariate random-effects model when at least 5 studies were included. Results: The systematic review included 39 studies (11 tracers). 18F-FDG (12 studies, 171 lesions) showed a pooled sensitivity and specificity of 84\% (95\% confidence interval, 72\%{\textendash}92\%) and 84\% (95\% confidence interval, 69\%{\textendash}93\%), respectively. O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) (7 studies, 172 lesions) demonstrated a sensitivity of 90\% (95\% confidence interval, 81\%{\textendash}95\%) and specificity of 85\% (95\% confidence interval, 71\%{\textendash}93\%). For S-11C-methyl)-l-methionine (11C-MET) (8 studies, 151 lesions), sensitivity was 93\% (95\% confidence interval, 80\%{\textendash}98\%) and specificity was 82\% (95\% confidence interval, 68\%{\textendash}91\%). The numbers of included studies for the other tracers were too low to combine, but sensitivity and specificity ranged between 93\%{\textendash}100\% and 0\%{\textendash}100\%, respectively, for 18F-FLT; 85\%{\textendash}100\% and 72\%{\textendash}100\%, respectively, for 3,4-dihydroxy-6-18F-fluoro-l-phenylalanine (18F-FDOPA); and 100\% and 70\%{\textendash}88\%, respectively, for 11C-choline. Conclusion: 18F-FET and 11C-MET, both amino-acid tracers, showed a comparably higher sensitivity than 18F-FDG in the differentiation between tumor progression and treatment-related changes in high-grade glioma patients. The evidence for other tracers is limited; thus, 18F-FET and 11C-MET are preferred when available. Our results support the incorporation of amino-acid PET tracers for the treatment evaluation of high-grade gliomas.}, issn = {0161-5505}, URL = {https://jnm.snmjournals.org/content/61/4/498}, eprint = {https://jnm.snmjournals.org/content/61/4/498.full.pdf}, journal = {Journal of Nuclear Medicine} }