Systematic review of the diagnostic accuracy of 201Tl single photon emission computed tomography in the detection of recurrent glioma.

Objective: To determine the diagnostic accuracy of 201Tl SPECT in the detection of tumour recurrence in patients with previous radiotherapy for supratentorial glioma.

Methods: The databases of PubMed and Embase were searched for relevant studies. Two reviewers independently selected and extracted data on study characteristics, quality and accuracy of studies. Studies were included if they comprised at least six eligible patients who underwent 201Tl SPECT (index test) and in whom (histo)pathological confirmation (reference test) of the suspected brain lesion was obtained. Because of the methodological and statistical heterogeneity of the included studies, a quantitative meta-analysis was not performed. Instead, for every individual study, the sensitivity, specificity and diagnostic odds ratio of 201Tl SPECT was calculated.

Results: Eight studies met the inclusion criteria. Only one was considered of high methodological quality. Methodological limitations referred most notably to blinding and patient selection. The diagnostic odds ratio was greater than 1 in all studies included, with a broad range (2-351), and relatively wide 95% confidence intervals. The sensitivity of 201Tl SPECT ranged from 0.43 to 1.00, and the specificity from 0.25 to 1.00.

Conclusion: 201Tl SPECT seems a valuable method in the detection of tumour recurrence in patients treated with radiotherapy for supratentorial glioma. However, the evidence is not very robust because of the low quality and high heterogeneity of the studies included. Future studies are warranted to further explore the diagnostic potential of 201Tl SPECT, and to determine optimum thresholds for the detection of glioma recurrence.