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Published online before print January 30, 2008, 10.1148/radiol.2463062148
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(Radiology 2008;246:772-782.)
© RSNA, 2008

Evidence-based Practice

Solitary Pulmonary Nodules: Meta-analytic Comparison of Cross-sectional Imaging Modalities for Diagnosis of Malignancy1

Paul Cronin, MD, MS, Ben A. Dwamena, MD, Aine Marie Kelly, MD, MS, and Ruth C. Carlos, MD, MS

1 From the Department of Radiology, Divisions of Cardiothoracic Radiology (P.C., A.M.K.), Nuclear Medicine (B.A.D.), and Magnetic Resonance Imaging (R.C.C.), University of Michigan Medical Center, B1 132F Taubman Center/0302, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0030; and Veterans Administration Ann Arbor Healthcare System Nuclear Medicine Service, Ann Arbor, Mich (B.A.D.). Received December 20, 2006; revision requested February 13, 2007; revision received May 23; accepted June 13; final version accepted August 29. Funded in part by National Institutes of Health/National Cancer Institute grant 1 K07 CA108664 01A1 and a GE-AUR Radiology Research Academic Fellowship. Address correspondence to P.C. (e-mail: pcronin{at}med.umich.edu).

Purpose: To perform a meta-analysis to estimate the diagnostic accuracy of dynamic contrast material–enhanced computed tomography (CT) and magnetic resonance (MR) imaging, fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET), and technetium 99m (99mTc) depreotide single photon emission computed tomography (SPECT) for evaluation of solitary pulmonary nodules (SPNs).

Materials and Methods: Data sources were studies published in PubMed between January 1990 and December 2005. The selected investigations were comparative and noncomparative diagnostic cohort studies to examine the operating characteristics of the four imaging modalities for evaluation of SPNs, involving at least 10 enrolled participants with histologic confirmation and having sufficient data to calculate contingency tables. A random coefficient binary regression model with disease probability conditioned on test results was used to summarize test performance and construct summary receiver operating characteristic (ROC) curves. Sensitivities, specificities, predictive values, diagnostic odds ratios, and areas under the ROC curve were calculated.

Results: Forty-four studies—10 dynamic CT, six dynamic MR, 22 FDG PET, and seven 99mTc-depreotide SPECT—met the inclusion criteria. (One study was included in both the FDG PET and SPECT groups.) Sensitivities, specificities, positive predictive values, negative predictive values, diagnostic odds ratios, and areas under the ROC curve were, respectively, 0.93 (95% confidence interval [CI]: 0.88, 0.97), 0.76 (95% CI: 0.68, 0.97), 0.80 (95% CI: 0.74, 0.86), 0.95 (95% CI: 0.93, 0.98), 39.91 (95% CI: 1.21, 81.04), and 0.93 (95% CI: 0.81, 0.97) for dynamic CT; 0.94 (95% CI: 0.91, 0.97), 0.79 (95% CI: 0.73, 0.86), 0.86 (95% CI: 0.83, 0.89), 0.93 (95% CI: 0.90, 0.96), 60.59 (95% CI: 5.56, 115.62), and 0.94 (95% CI: 0.83, 0.98) for dynamic MR; 0.95 (95% CI: 0.93, 0.98), 0.82 (95% CI: 0.77, 0.88), 0.91 (95% CI: 0.88, 0.93), 0.90 (95% CI: 0.85, 0.94), 97.31 (95% CI: 6.26, 188.37), and 0.94 (95% CI: 0.83, 0.98) for FDG PET; and 0.95 (95% CI: 0.93, 0.97), 0.82 (95% CI: 0.78, 0.85), 0.90 (95% CI: 0.83, 0.97), 0.91 (95% CI: 0.84, 0.98), 84.50 (95% CI: 34.28, 134.73), and 0.94 (95% CI: 0.83, 0.98) for 99mTc-depreotide SPECT.

Conclusion: Dynamic CT and MR, FDG PET, and 99mTc-depreotide SPECT are noninvasive and accurate in distinguishing malignant from benign SPNs; differences among these tests are nonsignificant.

Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/2463062148/DC1

© RSNA, 2008