Brain Incidentalomas in Positron Emission Tomography: A Systematic Literature Review and Meta‐Analysis

ABSTRACT Background and Purpose Over the past decades, whole‐body PET‐CT scanning has undergone considerable innovation, with a considerable increase in clinical indications becoming a key diagnostic imaging method. Subsequently PET is contributing to the growth in imaging incidentaloma rates, including those of the brain, a critical functional tissue. Investigation of etiologies and prevalence of PET incidentalomas, notably of brain, is crucial in order to enhance their recognition and managing by concerned physicians. Thus, for educational purposes, we have chosen to collect and analyze cases of cerebral PET incidentalomas that are published in relevant international literature. Methods Following PRISMA checklist guidelines, a systematic review and a meta‐analysis were executed. Literature was searched through several engines including PubMed and Cochrane Library. Data extracted from selected studies were qualitatively and quantitatively analyzed. Results Among a total of 2211 studies collected, only 18 retrospective observational studies, using different kind of radiotracers, were eligible. Descriptive analysis revealed that the most frequent brain PET incidentalomas were meningiomas (30%), metastatic tumors (23.1%), and pituitary adenomas (9.2%). The meta‐analyses concluded a pooled prevalence rate of 1.2% (95% CI: 0.7%–2%; p ‐value < 0.0001) and 3.5% (95% CI: 1.6%–7.5%; p ‐value < 0.0001) of incidentalomas as disclosed by 18F‐FDG and 68Ga‐DOTA‐peptides respectively. Conclusions This review is the first to have summarized findings available in the literature on the identification of brain incidentalomas using PET‐CT techniques with different kinds of radiotracers. It fulfilled its main objective by presenting the compiled findings and deducing a pooled prevalence rate along with a description of their etiologies. Results undeniably solicit more research for better management of these entities whose etiologies are quite diverse.