Prediction of Meningioma WHO Grade Using PET Findings: A Systematic Review and Meta‐Analysis

BACKGROUND AND PURPOSE: World Health Organization (WHO) grading of meningiomas reflects recurrence rate and prognosis. Positron emission tomography (PET) investigates metabolic activity, allowing for distinction between low‐ and high‐grade tumors. As preoperative suspicion for malignant meningioma will influence surgical strategy in terms of timing, extent of resection, and risks taken to achieve a total resection, we systematically reviewed the literature on PET‐imaging in meningiomas and relate these findings to histopathological analysis. METHODS: Searches in PubMed, EMBASE, and The Cochrane Library, from inception to September 2019, included studies of patients who had undergone surgery for a histologically verified intracranial meningioma, with a PET‐scan prior to surgery and description of (semi)quantitative PET values for meningiomas from two different WHO groups. Studies comparing more than 1 patient per WHO group were included in the meta‐analysis. RESULTS: Twenty‐two studies (432 patients) were included. 18fluor‐fluorodesoxyglucose (18F‐FDG) PET was mostly described to differentiate benign from malignant meningiomas. Pooled data showed differences in mean (95% CI) Standardized Uptake Value (SUV) for WHO II/III compared to WHO I of 2.51 (1.36, 3.66), and in tumor‐to‐normal (T/N) ratio (T/N ratio) for WHO II/III versus WHO I of .42 (.12, .73). CONCLUSIONS: We found that SUV and T/N ratio in 18F‐FDG PET may be useful to noninvasively differentiate benign from malignant meningiomas. T/N ratio seems to have a high specificity for the detection of high‐grade meningiomas. Other PET tracers were studied too infrequently to draw definitive conclusions. Before treatment strategies can be adapted based on 18F‐FDG PET, prospective studies in larger cohorts are warranted to validate the optimal T/N ratio cutoff point.