Posttreatment high-grade gliomas are usually monitored with contrast-enhanced MRI, but its diagnostic accuracy is limited as it cannot adequately distinguish between true tumor progression and treatment-related changes. According to recent Response Assessment in Neuro-Oncology recommendations, PET overcomes this limitation. However, it is currently unknown which tracer yields the best results. Therefore, a systematic review and metaanalysis were performed to compare the diagnostic accuracy of the different PET tracers in differentiating tumor progression from treatment-related changes in high-grade glioma patients. Methods: PubMed, Web of Science, and Embase were searched systematically. Study selection, data extraction, and quality assessment were performed independently by 2 authors. Metaanalysis was performed using a bivariate random-effects model when at least 5 studies were included. Results: The systematic review included 39 studies (11 tracers). ¹⁸F-FDG (12 studies, 171 lesions) showed a pooled sensitivity and specificity of 84% (95% confidence interval, 72%–92%) and 84% (95% confidence interval, 69%–93%), respectively. O-(2-¹⁸F-fluoroethyl)-l-tyrosine (¹⁸F-FET) (7 studies, 172 lesions) demonstrated a sensitivity of 90% (95% confidence interval, 81%–95%) and specificity of 85% (95% confidence interval, 71%–93%). For S-¹¹C-methyl)-l-methionine (¹¹C-MET) (8 studies, 151 lesions), sensitivity was 93% (95% confidence interval, 80%–98%) and specificity was 82% (95% confidence interval, 68%–91%). The numbers of included studies for the other tracers were too low to combine, but sensitivity and specificity ranged between 93%–100% and 0%–100%, respectively, for ¹⁸F-FLT; 85%–100% and 72%–100%, respectively, for 3,4-dihydroxy-6-¹⁸F-fluoro-l-phenylalanine (¹⁸F-FDOPA); and 100% and 70%–88%, respectively, for ¹¹C-choline. Conclusion: ¹⁸F-FET and ¹¹C-MET, both amino-acid tracers, showed a comparably higher sensitivity than ¹⁸F-FDG in the differentiation between tumor progression and treatment-related changes in high-grade glioma patients. The evidence for other tracers is limited; thus, ¹⁸F-FET and ¹¹C-MET are preferred when available. Our results support the incorporation of amino-acid PET tracers for the treatment evaluation of high-grade gliomas.

治疗后的高级别神经胶质瘤通常使用对比增强的MRI进行监测，但其诊断准确性受到限制，因为它无法充分地区分真正的肿瘤进展和治疗相关变化。根据最近在神经肿瘤学中的反应评估建议，PET克服了这一限制。但是，目前未知哪种示踪剂可产生最佳结果。因此，进行了系统的综述和荟萃分析，以比较不同PET示踪剂在区分高级别神经胶质瘤患者的肿瘤进展与治疗相关变化方面的诊断准确性。方法：系统搜索了PubMed，Web of Science和Embase。两名作者独立进行研究选择，数据提取和质量评估。当纳入至少5项研究时，使用双变量随机效应模型进行荟萃分析。结果：系统评价包括39项研究（11项示踪剂）。¹⁸ F-FDG（12个研究，171个病灶）的综合敏感性和特异性分别为84％（95％置信区间，72％–92％）和84％（95％置信区间，69％–93％）。O-（2- ¹⁸ F-氟乙基）-1-酪氨酸（¹⁸F-FET（7个研究，172个病灶）显示出90％的敏感性（95％的置信区间，81％–95％）和85％的特异性（95％的置信区间，71％–93％）。对于S - ¹¹ C-甲基）-1-甲硫氨酸（¹¹ C-MET）（8个研究，151个病变），敏感性为93％（95％置信区间，80％–98％），特异性为82％（95％）。置信区间为68％–91％）。其他示踪剂的纳入研究数量太少而无法合并，但对¹⁸ F-FLT的敏感性和特异性分别在93％–100％和0％–100％之间。85％-100％和72％-100％，分别为3,4-二羟基-6- ¹⁸ F-氟升-苯丙氨酸（¹⁸F-FDOPA）；¹¹ C-胆碱分别为100％和70％–88％。结论： ¹⁸ F-FET和¹¹ C-MET都是氨基酸示踪剂，在区分高级别神经胶质瘤患者的肿瘤进展和治疗相关变化方面，其敏感性高于¹⁸ F-FDG。其他示踪剂的证据有限；因此，如果有的话，最好使用¹⁸ F-FET和¹¹ C-MET。我们的研究结果支持将氨基酸PET示踪剂用于高级神经胶质瘤的治疗评估。