Prognostic Value of MTV, SUVmax and the T/N Ratio of PET/CT in Patients with Glioma: A Systematic Review and Meta-Analysis

Abstract

Background: In the past decade, positron emission tomography/computed tomography (PET/CT) has become an important imaging tool for clinical assessment of tumor patients. Our meta-analysis aimed to compare the predictive value of PET/CT parameters regard to overall survival (OS) and progression-free survival (PFS) outcomes in glioma. Methods: Relevant articles were systematically searched in PMC, PubMed, EMBASE and WEB of science. Studies involving the prognostic roles of PET/CT parameters with OS and PFS in glioma patients were evaluated. The impact of metabolic tumor volume (MTV), maximal standard uptake value (SUVmax), and the ratio of uptake in tumor to normal (T/N ratio) on survival was measured by calculating combined hazard ratios (HRs) and 95% confidence intervals (CIs). Results: A total of 32 articles with 1715 patients were included. The combined HRs of higher MTV, higher SUVmax and higher T/N ratio for OS were 1.14 (95% CI: 0.98-1.32, P heterogeneity<0.001), 1.69 (95% CI: 1.18-2.41, P heterogeneity<0.001) and 1.68 (95% CI: 1.40-2.01, P heterogeneity< 0.001), respectively. Regarding PFS, the combined HRs were 1.04 (95% CI: 0.97-1.11, P heterogeneity=0.002) with higher MTV, 1.45 (95% CI: 1.11-1.90, P heterogeneity<0.001) with higher SUVmax and 2.07 (95% CI: 1.45-2.95, P heterogeneity<0.001) with higher T/N ratio. Results remained similar in the sub-group analyses. Conclusion: PET/CT parameters T/N ratio may be a significant prognostic factor in patients with glioma. Evidence of SUVmax and MTV needed more large-scale studies performed to validate. PET/CT scan could be a promising technique to provide prognostic information for these patients.

Diagnostic Performance and Prognostic Value of PET/CT with Different Tracers for Brain Tumors: A Systematic Review of Published Meta-Analyses

“…Twenty-four meta-analyses on the use of PET or PET/CT with different tracers in brain tumors, published from 2012, were selected through the comprehensive computer literature search (Figure 1) [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31]. The characteristics of the selected meta-analyses on the diagnostic performance are presented in Table 1.…”

“…Beyond the diagnostic accuracy, PET/CT parameters, and particularly the TBR, may be significant prognostic factors in patients with glioma. A recent meta-analysis demonstrated that increased TBR at 18 F-FDG PET, 11 C-methionine PET and 18 F-FET PET could indicate poor overall survival (pooled hazard ratios were 3.05 for 18 F-FDG PET, 1.59 for 11 C-methionine PET, and 1.15 for 18 F-FET PET) [10]. Another meta-analysis showed that the TBR and metabolic tumor volume at 11 C-methionine PET are significant prognostic parameters for patients with gliomas.…”

Diagnostic Performance of PET and Perfusion-Weighted Imaging in Differentiating Tumor Recurrence or Progression from Radiation Necrosis in Posttreatment Gliomas: A Review of Literature

“…Higher T/N ratios are found associated with poor prognosis for overall survival and progression-free survival in patients with brain tumors. 65 Dynamic imaging is increasingly used in PET/CT to evaluate brain tumors. After dynamic acquisition, tumors are delineated by using region of interest or volume of interest on all time frames of the dynamic PET data, and time-activity curves are extracted.…”

“…48,74 Despite inherent technical and biologic differences between these 2 imaging modalities, several authors have claimed that the diagnostic information provided by amino acid PET is comparable with or even superior to that obtained by PWI and vice versa. 65 The increasing use of advanced MR imaging techniques and the availability of hybrid PET/MR imaging systems will facilitate the optimal use of both modalities in neuro-oncologic applications. Multiparametric analysis of both modalities may improve the overall diagnostic accuracy in the posttreatment evaluation of gliomas.…”

Evidence-Based PET for Brain Tumours

“…Beyond the diagnostic accuracy, PET/CT parameters, and particularly the TBR, may be significant prognostic factors in patients with glioma. A recent meta-analysis demonstrated that increased TBR at 18 F-FDG PET, 11 C-methionine PET and 18 F-FET PET could indicate poor overall survival (pooled hazard ratios were 3.05 for 18 F-FDG PET, 1.59 for 11 C-methionine PET and 1.15 for 18 F-FET PET) [5]. Another meta-analysis showed that the TBR and metabolic tumour volume at 11 C-methionine PET are significant prognostic parameters for patients with gliomas.…”