Diagnostic role of 18F-FDG PET/MRI in patients with gynecological malignancies of the pelvis: A systematic review and meta-analysis

PURPOSE: The aim of this study was to assess the diagnostic performance of 18F-FDG Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) for gynecological cancers of the pelvis, based on a systematic review and meta-analysis of published data. METHODS: We performed a comprehensive literature search of Pubmed and Embase for studies that evaluated the diagnosis of 18F-FDG PET/MRI for gynecological malignancies in the pelvis. Quality Assessment for Studies of Diagnostic Accuracy 2 (QUADAS 2) tool was used to access the quality of included studies. After testing heterogeneity of the pooled studies with I^2 and H^2 (calculated using metaan in Stata12.0) we treated the data that extracted and transformation from the studies, based on DerSimonian-Laird method(Random-effects models),then back-transformation them to percentages and plotting to get the pooled sensitivity, specificity, likelihood ratios, and constructed summary receiver operating characteristics (SROC) curve. RESULTS: Eventually, 7 studies fulfilled our predefined inclusion criteria were included in our research. On patient-based assessment, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of 18F-FDG PET/MRI for diagnosis of gynecological malignancies were 0.95 (95%CI 0.86–0.99), 0.95 (95% CI 0.74–1.00), 7.51 (95% CI 2.29–24.59), 0.12 (95% CI 0.05–0.29) and 116.27 (95% CI 17.07–791.74), respectively. On lesion-based assessment, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and the summary DOR were 0.89 (95%CI 0.84–0.93), 0.87 (95%CI 0.74–0.95), 6.99 (95%CI 3.30–14.79), 0.12 (95%CI 0.06–0.25) and 55.82 (95%CI 20.91–149.05), respectively. CONCLUSIONS: Our meta-analysis indicated that 18F-FDG PET/MRI, combined the advantages of MRI and PET, may be a very promising diagnostic method to assess the primary tumor and nodal staging in patients with gynecological malignancies of the pelvis.