Diagnostic performance of diffusion-weighted imaging versus 18F-FDG PET/CT in differentiating pulmonary lesions: an updated meta-analysis of comparative studies

OBJECTIVE: To compare the diagnostic accuracy of diffusion-weighted imaging (DWI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for differentiating pulmonary nodules and masses. METHODS: We systematically searched six databases, including PubMed, EMBASE, the Cochrane Library, and three Chinese databases, to identify studies that used both DWI and PET/CT to differentiate pulmonary nodules. The diagnostic performance of DWI and PET/CT was compared and pooled sensitivity and specificity were calculated along with 95% confidence intervals (CIs). The Quality Assessment of Diagnostic Accuracy Studies 2 was used to assess the quality of the included studies, and STATA 16.0 software was utilized to perform statistical analysis. RESULTS: Overall, 10 studies that enrolled a total of 871 patients with 948 pulmonary nodules were included in this meta-analysis. DWI had greater pooled sensitivity (0.85 [95% CI 0.77–0.90]) and specificity (0.91 [95% CI 0.82–0.96]) than PET/CT (sensitivity, 0.82 [95% CI 0.70–0.90]); specificity, (0.81, [95% CI 0.72–0.87]). The area under the curve of DWI and PET/CT were 0.94 (95% CI 0.91–0.96) and 0.87 (95% CI 0.84–0.90) (Z = 1.58, P > 0.05), respectively. The diagnostic odds ratio of DWI (54.46, [95% CI 17.98–164.99]) was superior to that of PET/CT (15.77, [95% CI 8.19–30.37]). The Deeks’ funnel plot asymmetry test showed no publication bias. The Spearman correlation coefficient test revealed no significant threshold effect. Lesion diameter and reference standard could be potential causes for the heterogeneity of both DWI and PET/CT studies, and quantitative or semi-quantitative parameters used would be a potential source of bias for PET/CT studies. CONCLUSION: As a radiation-free technique, DWI may have similar performance compare with PET/CT in differentiating malignant pulmonary nodules or masses from benign ones. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12880-023-00990-y.