Diagnostic Value of Seven Different Imaging Modalities for Patients with Neuroblastic Tumors: A Network Meta-Analysis

Objective. We performed a systematic review and network meta-analysis (NMA) to compare the diagnostic value of seven different imaging modalities for the detection of neuroblastic tumors in diverse clinical settings. Methods. PubMed, Embase, Medline, and the Cochrane Library were searched to identify eligible studies from inception to Sep 29, 2020. Quality assessment of included studies was appraised with Quality Assessment of Diagnostic Accuracy Studies. Firstly, direct pairwise meta-analysis was conducted to calculate the pooled estimates of odds ratio (OR) and 95% confidence interval (CI) of the sensitivity, specificity, NPV, PPV, and DR. Next, NMA using Bayesian methods was performed. The superiority index was assessed to quantify the rank probability of a diagnostic test. The studies performed SPECT/CT or SPECT were analyzed separately from the ones only performed planar imaging. Results. A total of 1135 patients from 32 studies, including 7 different imaging modalities, were eligible for this NMA. In the pairwise meta-analysis, F-18-FDOPA PET/CT had a relatively high value of all the outcomes (sensitivity: 10.195 [5.332-19.493]; specificity: 17.906 [5.950-53.884]; NPV: 16.819 [7.033-40.218]; PPV: 11.154 [4.216-29.512]; and DR 5.616 [3.609-8.739]). In the NMA, F-18-FDOPA PET/CT exhibited relatively high sensitivity in all subgroups (all data: 0.94 [0.87-0.98]; primary tumor: 0.89 [0.53-1]; bone/bone marrow metastases: 0.96 [0.83-1]; and primary tumor and metastases (P + M): 0.92 [0.80-0.97]), the highest specificity in the subgroup of P + M (0.85 [0.61-0.97]), and achieved the highest superiority index in the subgroups of all data (8.57 [1-15]) and P + M (7.25 [1-13]). Conclusion. F-18-FDOPA PET/CT exhibited the best diagnostic performance in the comprehensive detection of primary tumor and metastases for neuroblastic tumors, followed by Ga-68-somatostatin analogs, I-123-meta-iodobenzylguanidine (MIBG), F-18-FDG, and I-131-MIBG tomographic imaging.