Detection of vertebral metastases: a meta-analysis comparing MRI, CT, PET, BS and BS with SPECT

Abstract

Objective: To perform a meta-analysis to compare the diagnostic value of magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), bone scintigraphy (BS) and BS with single-photon emission computed tomography (SPECT) in detecting vertebral metastases.

Methods: Relevant original articles published from January 1995 to December 2015 were searched. Two reviewers independently extracted data. Software called "META-DiSc" was used to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and summary receiver operating characteristic (SROC) curves.

Results: Twenty-three articles consisting of 33 studies fulfilled all inclusion criteria. On per-patient basis, for sensitivity, MRI = PET = SPECT > CT = BS ("=" indicated no significant difference, P > 0.05; ">" indicated significantly higher, P < 0.05). For specificity, MRI = CT = BS > SPECT > PET. For DOR, MRI > SPECT > BS > CT = PET. SROC curves for SPECT and MRI showed better diagnostic accuracy than others. On per-lesion basis, for sensitivity, PET = SPECT = MRI > BS > CT. For specificity, MRI = CT > PET = SPECT = BS. For DOR, MRI > SPECT > CT = PET > BS. SROC curves showed MRI had the best while CT had the lowest diagnostic accuracy.

Conclusion: For diagnosis of vertebral metastases, MRI was found to be the best modality and also better than other techniques on both per-patient and per-lesion basis.

Keywords: BS; MRI; Meta-analysis; PET; Vertebral metastases.

Fig. 1

SROC curves for MRI (a), PET (b), SPECT(c) and BS (d) on per-patient basis; SROC curve for MRI and SPECT showed better diagnostic accuracy than PET and BS

Fig. 2

SROC curves for MRI (a), CT (b), PET (c), SPECT (d) and BS (e) on per-lesion basis; SROC curve for each modality showed MRI had the best diagnostic accuracy and CT had the lowest diagnostic accuracy