Diagnostic value of whole-body diffusion-weighted magnetic resonance imaging for detection of primary and metastatic malignancies: a meta-analysis

Abstract

Purpose: To perform a meta-analysis to evaluate the diagnostic performance of whole-body diffusion-weighted magnetic resonance imaging (WB-DWI) technique in detection of primary and metastatic malignancies compared with that of whole-body positron emission tomography/computed tomography (WB-PET/CT).

Materials and methods: Search Pubmed, MEDLINE, EMBASE and Cochrane Library database from January 1984 to July 2013 for studies comparing WB-DWI with WB-PET/CT for detection of primary and metastatic malignancies. Methodological quality was assessed by the quality assessment of diagnostic studies (QUADAS) instrument. Sensitivities, specificities, predictive values, diagnostic odds ratio (DOR) and areas under the summary receiver operator characteristic curve (AUC) were calculated. Potential threshold effect, heterogeneity and publication bias were investigated.

Result: Thirteen eligible studies were included, with a total of 1067 patients. There was no significant threshold effect. WB-DWI had a similar AUC (0.966 (95% CI, 0.940-0.992) versus 0.984 (95% CI, 0.965-0.999)) with WB-PET/CT. No significant difference was detected between AUC of WB-DWI and WB-PET/CT. WB-DWI had a pooled sensitivity of 0.897 (95% CI, 0.876-0.916) and a pooled specificity of 0.954 (95% CI, 0.944-0.962). WB-PET/CT had a pooled sensitivity of 0.895 (95% CI, 0.865-0.920) and a pooled specificity of 0.975 (95% CI, 0.966-0.981). Heterogeneity was found to stem primarily from data type (per lesion versus per patient), MR sequence (DWIBS only and DWIBS with other sequence), and primary lesion type (single type and multiple type). The Deeks's funnel plots suggested the absence of publication bias.

Conclusion: WB-DWI has similar, good diagnostic performance for the detection of primary and metastatic malignancies compared with WB-PET/CT. DWIBS with other MR sequences could further improve the diagnostic performance. More high-quality studies regarding comparison of WB-DWI and WB-PET/CT and combination of them in detecting malignancies are still needed to be conducted.

Keywords: Computed tomography; Diagnostic value; Malignancies; Meta-analysis; Positron emission tomography; Whole-body DWI.