Performance of SPECT in the differential diagnosis of glioma recurrence from radiation necrosis

Radiation necrosis (RN) may be a confounder in the diagnosis of glioma recurrence. Several functional imaging techniques, including single photon emission computed tomography (SPECT) and positron emission tomography (PET), have been used to differentiate RN from glioma recurrence. However, to our knowledge the efficacy of SPECT has not been evaluated quantitatively. This meta-analysis evaluated the diagnostic ability of SPECT in differentiating glioma recurrence from RN. PubMed and EMBASE were systematically searched for studies published up to 1 March 2014 that evaluated SPECT in the differential diagnosis of glioma recurrence from RN. The data from eligible studies were evaluated by heterogeneity and threshold effect tests, and the sensitivity, specificity, and areas under the summary receiver-operating characteristic curve (SROC) were calculated. Twenty-eight studies in 24 articles, which included 893 patients (1163 scans) with suspected glioma recurrence after radiotherapy, met all inclusion and exclusion criteria, and were included in the meta-analysis. Their pooled sensitivity and specificity were 0.89 (95% confidence interval [CI]: 0.87, 0.91) and 0.88 (95% CI: 0.84, 0.91), respectively, and the area under the SROC was 0.9403. This meta-analysis showed that SPECT had good diagnostic performance for differentiating glioma recurrence from RN.