Update on Diagnostic Performance of PET/MRI in Gynecological Malignancies: A Systematic Review and Meta-Analysis

Objective: The aim of this study was to assess the diagnostic performance of F-18-fluorodeoxyglucose (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. Patients and Methods: A systematic literature search for original diagnostic studies was performed using PubMed/MEDLINE, the Cochrane Library, Embase and Web of Science. The methodological quality of each study was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Data necessary for entry in 2 x 2 contingency tables were obtained, and patients, study, and imaging characteristics were extracted from the selected articles. Statistical analysis included data pooling, heterogeneity testing, sensitivity analyses, forest plotting, and summary receiver operating characteristic curve construction. Result: Twelve studies met our predefined inclusion criteria and were included in this study. Patient-based analysis, the pooled sensitivity rate, specificity rate, diagnostic odds ratio, and area under the receiver operating characteristic curve for F-18-FDG PET/MRI in diagnosis of gynecological malignancies were 74.2% (95% confidence interval, 66.2-80.8%), 89.8% (95% CI, 82.2-94.3%), 26 (95% CI, 10-67), and 0.834, respectively. On lesion-based analysis, the pooled sensitivity rate, specificity rate, diagnostic odds ratio, and area under the curve were 87.5% (95% CI, 75.8-94.0%), 88.2% (95% CI, 84.2-91.3%), 50 (95% CI, 23-111), and 0.922, respectively. Conclusions: Our meta-analysis demonstrated that F-18-FDG PET/MRI is a promising diagnostic method for primary tumors, nodal staging, and recurrence in patients with gynecological malignancies of the pelvis.