[18F]FDG PET imaging in the differentiation of cardiac masses: an updated systematic review and dual Meta-Analysis of diagnostic performance and parameter variability

Abstract

Introduction

Cardiac masses (CMs) encompass a heterogeneous group of benign, malignant, and pseudotumoural lesions, posing diagnostic challenges due to their rarity and varied aetiologies. Given the limitations of conventional imaging modalities in differentiating benign from malignant masses, [¹⁸F]FDG PET/CT has emerged as a promising technique by providing metabolic information. This systematic review and meta-analysis aimed to evaluate the diagnostic performance of [¹⁸F]FDG PET/CT in characterising CMs and assess semi-quantitative parameters’ role in distinguishing malignant from benign lesions.

Methods

A systematic review and meta-analysis were conducted, including studies evaluating the diagnostic accuracy of [¹⁸F]FDG PET/CT in CMs. Sensitivity and specificity were pooled using a random-effects model, and a secondary analysis examined differences in SUVmax between malignant and benign lesions.

Results

Fifteen studies enrolling 1114 patients met inclusion criteria. The pooled sensitivity and specificity of [¹⁸F]FDG PET/CT in detecting malignant CMs were 89.2% (95% CI: 85–92%) and 82.8% (95% CI: 78–87%), respectively. Malignant lesions exhibited significantly higher SUVmax values (range: 5.6–14.3) than benign masses (range: 1.1–5.3, p < 0.001). PET/CT proved particularly effective in cases with inconclusive findings from echocardiography, cardiac magnetic resonance, or CT, contributing to biopsy guidance and treatment planning.

Conclusions

[¹⁸F]FDG PET/CT demonstrates robust diagnostic accuracy in differentiating benign from malignant cardiac masses, with SUVmax as a valuable malignancy marker. Its integration into multimodal imaging strategies enhances diagnostic certainty and optimises patient management. Despite these advantages, standardised imaging protocols and further multicentre prospective studies are warranted to refine its clinical application and validate its prognostic potential.