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Performance of 18F-FDG, 11C-Methionine, and 18F-FET PET for Glioma Grading

A Meta-analysis

Katsanos, Aristeidis H. MD, PhD*,†; Alexiou, George A. MD, PhD†,‡; Fotopoulos, Andreas D. MD, PhD§; Jabbour, Pascal MD; Kyritsis, Athanasios P. MD, PhD†,¶; Sioka, Chrissa MD, PhD†,∥

doi: 10.1097/RLU.0000000000002654
Original Articles

Purpose Gliomas constitute the most frequent primary brain tumors. Glioblastoma, the most common and malignant glioma in adults, has dismal prognosis with any current therapy. On the other hand, low-grade gliomas, the second most common type of gliomas, are potentially curative with appropriate treatment.

Methods We conducted a meta-analysis to assess the performance of PET tracers with the best available evidence, namely, fluorodeoxyglucose (FDG), 11C-methionine (MET), and 18F-fluoroethyltyrosine (FET), in differentiating low- from high-grade gliomas.

Results Twenty-three studies with a total of 994 participants were included in this meta-analysis. The pooled sensitivities of both MET PET and FET PET were found to be significantly higher than of FDG PET (94%, 88%, and 63% respectively, P < 0.001). The pooled specificity of FDG PET was found to be significantly greater compared with both MET PET and FET PET (89%, 55%, and 57%, respectively; P = 0.002). Fluorodeoxyglucose PET was superior in terms of higher positive likelihood ratio values compared with both FET PET and MET PET.

Conclusions This meta-analysis indicated that both MET and FET were superior to FDG in terms of sensitivity for identifying glioma grade.

From the *Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Bochum, Germany

Neurosurgical Research Institute, University of Ioannina

Departments of Neurosurgery

§Nuclear Medicine, University of Ioannina School of Medicine, Ioannina, Greece

Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA

Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece.

Received for publication April 3, 2019; revision accepted April 23, 2019.

Conflicts of interest and sources of funding: none declared.

This article does not contain any studies with human participants or animals performed by any of the authors.

Correspondence to: George A. Alexiou, MD, PhD, Department of Neurosurgery, University of Ioannina School of Medicine, Ioannina 45500, Greece. E-mail:;

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Online date: June 14, 2019

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