A narrative review: key evidence from meta-analyses in nuclear medicine

Recent progress in nuclear medicine has been driven by continuous advances in radiotracers, imaging technologies, and radiopharmaceutical therapies, leading to an expansion of clinical applications supported by an increasing body of evidence. In particular, systematic reviews and meta-analyses have played an important role in quantitatively evaluating the clinical value of these developments. This narrative review provides an overview of recent meta-analytic evidence in nuclear medicine, with a primary focus on oncologic applications, while briefly addressing developments in cardiology and neurology. In oncology, positron emission tomography (PET)/computed tomography (CT) using fluorodeoxyglucose (FDG) has become an established imaging modality for post-treatment assessment across various malignancies. Meta-analyses indicate that volumetric metabolic parameters, such as metabolic tumor volume and total lesion glycolysis, are more consistently associated with clinical outcomes than conventional single-voxel metrics. In addition, the interim and post-therapy metabolic response, assessed by FDG PET/CT, provides clinically relevant prognostic information and may contribute to treatment monitoring. Beyond FDG, tumor-targeted PET tracers, including prostate-specific membrane antigen and somatostatin receptor ligands, have demonstrated improved diagnostic performance in specific malignancies, and emerging tracers such as fibroblast activation protein inhibitors represent promising future directions. Radiopharmaceutical therapy has also shown notable progress, with meta-analytic evidence supporting the effectiveness and acceptable safety of peptide receptor radionuclide therapy for neuroendocrine tumors, as well as for advanced prostate cancer. In nuclear cardiology and neurology, advances in PET and single photon emission CT technologies have enabled more precise disease characterization, although their clinical roles continue to evolve. Overall, accumulating meta-analytic evidence supports the growing clinical importance of nuclear medicine. Continued methodological refinement and further evidence generation will be essential to optimize patient management in routine clinical practice.