To determine the pooled diagnostic accuracy of radiomics features derived from Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography(^18F-FDG PET (in predicting the conversion from mild cognitive impairment (MCI)to Alzheimer’s disease (AD)

Radiomics applied to ^18F-FDG PET provides a new way to detect subtle brain changes linked to AD, as it reflects regional cerebral glucose metabolism and can reveal characteristic metabolic patterns in patients suspected of having AD. Predicting which individuals with MCI will progress to AD is still challenging

We conducted a comprehensive search of PubMed, Embase, Scopus, and Web of Science up to July 2025. We included observational studies assessing radiomic features extracted from ^18F-FDG PET in adults with MCI to predict progression to AD. Methodological quality was assessed using the QUADAS-2 tool, and data were independently extracted by two reviewers. We used a bivariate random-effects model to pool sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio. I², τ², and Q statistics were used to explore heterogeneity

Eight studies were identified, including a total of 2,735 patients with MCI. The pooled sensitivity and specificity of the radiomics-based model across five independent cohorts were 0.72 (95% CI: 0.50–0.88; I² = 49.9%) and 0.94 (95% CI: 0.77–0.98; I² = 85.3%), respectively. The pooled  area under the curve (AUC) and c-index were 0.798 (95% CI: 0.745–0.851; I² = 77.9%) and 0.775 (95% CI: 0.702–0.848; I² = 98.6%) across five and six cohorts, respectively. The sensitivity analysis revealed that most of heterogeneity related to a single outlier study; its exclusion reduced I² without affecting the robustness of the results

Radiomics features extracted from ^18F-FDG PET show promising diagnostic performance in predicting the conversion from MCI to AD. The pooled estimates indicate high specificity and acceptable sensitivity, suggesting that radiomics can complement conventional imaging assessment in identifying individuals at higher risk of progression