Diagnostic Performance of F-18 Fluorodeoxyglucose Positron Emission Tomography or Positron Emission Tomography/Computed Tomography for Differentiation of Benign and Malignant Vertebral Compression Fractures: A Meta-Analysis

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 (I, 50.6) and 0.77 (95% CI, 0.56-0.89) with heterogeneity (I, 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.