Enhanced Staging of Extrahepatic Hepatocellular Carcinoma Metastasis Through Dual-Tracer Pet/Computed Tomography: A Systematic Review and Meta-Analysis Publisher Pubmed



Mohebbi A¹ ; Kiani I¹ ; Mohammadzadeh S¹ ; Mirzaaghazadehattari M² ; Mohammadi A³ ; Tavangar SM⁴ Show Affiliations
Source: Nuclear Medicine Communications Published:2024

Abstract

The aim of this study was to quantify the diagnostic value of dual-Tracer PET/computed tomography (CT) with 11C-Acetate and fluorodeoxyglucose (FDG) in per-lesion and per-patient and its effect on clinical decision-making for choosing the most appropriate management. The study protocol is registered a priori at https://osf.io/rvm75/. PubMed, Web of Science, Embase, and Cochrane Library were searched for relevant studies until 1 June 2023. Studies regarding the review question were included. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to assess bias risk. Per-lesion and per-patient diagnostic performance were calculated for: (1) 11C-Acetate alone; (2) FDG alone; and (3) dual tracer of 11C-Acetate and FDG. A direct comparison of these three combinations was made. The possible sources of statistical heterogeneity were also examined. We also calculated the percentage change in clinical decision-making when dual-Tracer PET/CT was added to conventional imaging routinely used for metastatic evaluation (CT/MRI). Grading of Recommendations, Assessment, Development, and Evaluations tool was used to evaluate the certainty of evidence. Eight studies including 521 patients and 672 metastatic lesions were included. Dual-Tracer PET/CT had a per-lesion sensitivity of 96.3% [95% confidence interval (CI), 91.8-98.4%] and per-patient sensitivity of 95.5% (95% CI, 89.1-98.2%) which were highly superior to either of tracers alone. Per-patient specificity was 98.5% (84.1-99.9%) which was similar to either of tracers alone. Overall, 9.3% (95% CI, 4.7-13.9%) of the patients had their management beneficially altered by adding dual-Tracer PET/CT to their conventional CT/MRI results. Dual-Tracer PET/CT substantially outperforms single-Tracer methods in detecting extrahepatic hepatocellular carcinoma metastases, evidencing its reliability and significant role in refining clinical management strategies based on robust diagnostic performance. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.