Diagnostic Value of Seven Different Imaging Modalities for Patients with Neuroblastic Tumors: A Network Meta-Analysis

Abstract

Objective. We performed a systematic review and network meta-analysis (NMA) to compare the diagnostic value of seven different imaging modalities for the detection of neuroblastic tumors in diverse clinical settings. Methods. PubMed, Embase, Medline, and the Cochrane Library were searched to identify eligible studies from inception to Sep 29, 2020. Quality assessment of included studies was appraised with Quality Assessment of Diagnostic Accuracy Studies. Firstly, direct pairwise meta-analysis was conducted to calculate the pooled estimates of odds ratio (OR) and 95% confidence interval (CI) of the sensitivity, specificity, NPV, PPV, and DR. Next, NMA using Bayesian methods was performed. The superiority index was assessed to quantify the rank probability of a diagnostic test. The studies performed SPECT/CT or SPECT were analyzed separately from the ones only performed planar imaging. Results. A total of 1135 patients from 32 studies, including 7 different imaging modalities, were eligible for this NMA. In the pairwise meta-analysis, 18F-FDOPA PET/CT had a relatively high value of all the outcomes (sensitivity: 10.195 [5.332–19.493]; specificity: 17.906 [5.950–53.884]; NPV: 16.819 [7.033–40.218]; PPV: 11.154 [4.216–29.512]; and DR 5.616 [3.609–8.739]). In the NMA, 18F-FDOPA PET/CT exhibited relatively high sensitivity in all subgroups (all data: 0.94 [0.87–0.98]; primary tumor: 0.89 [0.53–1]; bone/bone marrow metastases: 0.96 [0.83–1]; and primary tumor and metastases (P + M): 0.92 [0.80–0.97]), the highest specificity in the subgroup of P + M (0.85 [0.61–0.97]), and achieved the highest superiority index in the subgroups of all data (8.57 [1–15]) and P + M (7.25 [1–13]). Conclusion. 18F-FDOPA PET/CT exhibited the best diagnostic performance in the comprehensive detection of primary tumor and metastases for neuroblastic tumors, followed by 68Ga-somatostatin analogs, 123I-meta-iodobenzylguanidine (MIBG), 18F-FDG, and 131I-MIBG tomographic imaging.

Comparing the diagnostic value of 18F-FDG PET/CT scan and bone marrow biopsy in newly diagnosed pediatric neuroblastoma and ganglioneuroblastoma

“…18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET)/computed tomography (CT) ( 18 F-FDG PET/CT) is commonly used to complete the staging and prognosis prediction of malignant tumors and can also be used to evaluate marrow infiltration. Compared with 123 I-MIBG scintigraphy imaging, the superiorities of PET are high 18 F-FDG avidity of the BM and better identification of FDG abnormalities in the BM and bone ( 6 , 7 ). Moreover, an important advantage of PET/CT over BMB is that PET/CT can assess all BM sites at once and find unintended BMI in areas where biopsies are not usually performed ( 8 ), thus avoiding the sampling limitation of BMB.…”

Leptomeningeal Metastasis From Neuroblastoma Revealed by 123I-MIBG SPECT/CT

“…12 MIBG scintigraphy is a relatively sensitive modality for the detection of neuroblastoma. 13,14 However, accurate anatomical localization may not be possible by MIBG study, thus making differentiation of meningeal, skull, and brain metastases difficult. Although SPECT/CT can enhance the diagnostic performance of the MIBG study, [15][16][17][18][19] our case indicates that it is insufficient to distinguish whether the metastasis was from leptomeninges or brain.…”

“…Different nuclear medicine methods have been used in the diagnosis of leptomeningeal metastasis, including 18 F-FDG PET/CT, 8–10 18 F-DOPA PET/MRI, 11 and 68 Ga-DOTATATE PET/CT 12 . MIBG scintigraphy is a relatively sensitive modality for the detection of neuroblastoma 13,14 . However, accurate anatomical localization may not be possible by MIBG study, thus making differentiation of meningeal, skull, and brain metastases difficult.…”