Authors' objectives:

This expert group has based its work on the INAHTA report "Positron emission tomography: experience with PET and synthesis of the evidence", a joint project produced on behalf of INAHTA, and has supplied it with documentation published after the INAHTA report. The INAHTA report assessed the use of PET in several clinical conditions. Only when used in cancer, neurology and coronary disease and coronary disease does the evidence suggest that PET may give diagnostic advantages compared to other techniques. The expert group agrees this evaluation/prioritation. Below are the conclusions from the INAHTA report together with the concomitant conclusions from the Norwegian expert group. It is emphasised that the expert group has not directly evaluated PET as a research tool, but underlines that PET used in the clinic is important for clinical research and development.

Authors' recommendations: Diagnosing and staging non-small cell lung cancer: INAHTA: PET may be cost-effective for staging lung cancer to confirm resectability in patients with a negative mediastinum on CT. Expert group conclusions: Assessment of newer literature shows that PET gives more accurate staging of non-small cell lung cancer compared with standard diagnostic methods, for instance CT. This may result in better clinical treatment. Characterizing solitary pulmonary nodules: INAHTA: PET may have utility when other diagnostic tests are inconclusive. Expert group conclusions: PET can be used to control and possibly correct results obtained by other methods. Diagnosing brain tumor recurrence vs. radiation necrosis: INAHTA: PETs diagnostic accuracy was superior to conventional diagnostic techniques (CT, MRI) but not to SPECT. Expert group conclusions: Agrees with the INAHTA report. It is presently not documented that PET will result in a better clinical outcome compared with existing techniques. More studies are needed on this topic. Diagnosing seizure foci in intractable epilepsy: INAHTA: PET's diagnostic accuracy was comparable or superior to other functional imaging modalities used to confirm foci identified by EEG or MRI, but PET is not yet able to replace invasive EEG or structural imaging. Diagnostic contribution of all functional imaging for this indication is still questioned. Expert group conclusions: A new study shows that PET is complementary to MRI and SPECT. PET-investigations can result in patients avoiding harmful brain surgery, alternatively patients may receive surgery correcting their epileptic seizures. Diagnosing Alzheimer's dementia: INAHTA: PET's diagnostic accuracy was comparable or superior to competing technologies (CT, MRI, SPECT, EEG), but the value of improved diagnostic information to the management of AD patients or to improved clinical results was unknown. Expert group conclusions: Agrees with the INAHTA report concerning the diagnostic properties. The group emphasises the potential role of PET in differential diagnoses of Alzheimer's dementia in relation to other types of dementia, and the possibilities in future monitoring of ny drugs against Alzheimer's dementia. Assessing myocardial perfusion in patients with coronary artery disease (CAD): INAHTA: PET's diagnostic accuracy is improved over other imaging alternatives, particularly thallium-201 SPECT, but the extent of improvement is unclear. PET is more costly than all other individual noninvasive strategies. PET is unable to replace coronary angiography as the definitive standard for CAD assessment in most patients. Expert group conclusions: Agrees with INAHTA, however, the cost factor can be changed in the nearest years through introduction of cheaper PET-technology. Assessing myocardial viability: INAHTA: PET has comparable sensitivity and superior specificity to other modalities. Quality of data for evaluating the performance of SPECT, dobutamine ECHO and MRI are similarly limited. Expert group conclusions: Agrees with INAHTA, but PET investigations would be desirable in a small subset of patient under evaluation for heart transplantation or other high-risk coronary surgery.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nokc.no/

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Norway

Organisation Name: Norwegian Institute of Public Health

Contact Address: Universitetsgata 2, Postbox 7004 St. Olavs plass, NO-0310 Oslo NORWAY. Tel: +47 23 25 50 00; Fax: +47 23 25 50 10;

Contact Name: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Contact Email: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Copyright: The Norwegian Knowledge Centre for the Health Services