[18F]FDG PET/CT versus Dynamic Contrast-Enhanced CT for the diagnosis of solitary pulmonary Nodule: A Head-to-Head comparative Meta-Analysis

Abstract

Purpose

This head-to-head comparative meta-analysis aimed to evaluate the comparative diagnostic efficacy of [¹⁸F]FDG PET/CT and dynamic contrast-enhanced CT(DCE-CT) for the differentiation between malignant and benign pulmonary nodules.

Methods

An extensive search was conducted in the PubMed, Embase, and Web of Science to identify available publications up to March 23, 2024. Studies were included if they evaluated the diagnostic efficacy of [¹⁸F]FDG PET/CT and DCE-CT for the characterization of pulmonary nodules. Sensitivity and specificity were assessed using the inverse variance method, followed by transformation via the Freeman-Tukey double inverse sine transformation. The quality of the included studies utilizing the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.

Results

Seven articles involving 1,183 patients were included in the meta-analysis. The sensitivity of [¹⁸F]FDG PET/CT was comparable to that of DCE-CT (0.88 vs. 0.87, P = 0.95). Similarly, the specificity of [¹⁸F]FDG PET/CT was not significantly different from that of DCE-CT (0.63 vs. 0.54, P = 0.47). No significant publication bias was detected for any outcome (Egger’s test: all P > 0.05). For DCE-CT, meta-regression analysis identified the mean lesion size of pulmonary nodules (<20 mm vs. ≥ 20 mm, P = 0.01) as a potential source of heterogeneity. Meanwhile, the number of patients (<100 vs. ≥ 100, P < 0.01) for PET/CT may also contribute to the heterogeneity.

Conclusions

Our meta-analysis indicates that [¹⁸F]FDG PET/CT demonstrates similar sensitivity and specificity to DCE-CT for the diagnosis of pulmonary nodules. However, the number of the head-to-head studies were relatively small, further larger sample prospective research is required to confirm these findings.