Diagnostic Performance of Magnetic Resonance Imaging for the Detection of Bone Metastasis in Prostate Cancer: A Systematic Review and Meta-analysis

Abstract

Context: Magnetic resonance imaging (MRI) has been tested for detecting bone metastasis and has shown promising results. Yet, consensus has not been reached regarding whether it can replace the role of bone scintigraphy in this clinical setting or not.

Objective: To review the diagnostic performance of contemporary (≥1.5 T) MRI for the detection of bone metastasis in patients with prostate cancer.

Evidence acquisition: MEDLINE and EMBASE were searched up to January 22, 2017. We included studies that used MRI using ≥1.5-T scanners for the detection of bone metastasis in patients with prostate cancer, using histopathology or best value comparator as the reference standard. Two independent reviewers assessed the methodological quality using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Per-patient sensitivity and specificity of included studies were calculated, and pooled and plotted in a hierarchical summary receiver operating characteristic plot. Meta-regression and sensitivity analyses were performed.

Evidence synthesis: Ten studies (1031 patients) were included. Pooled sensitivity was 0.96 (95% confidence interval [CI] 0.87-0.99) with a specificity of 0.98 (95% CI 0.93-0.99). At meta-regression analysis, only the number of imaging planes (≥2 vs 1) was a significant factor affecting heterogeneity (p<0.01). Sensitivity analyses showed that specificity estimates were comparable and consistently high across all subgroups, but sensitivity estimates demonstrated some differences. Studies using two or more planes (n=4) had the highest sensitivity (0.99 [95% CI 0.98-1.00]).

Conclusions: Contemporary MRI shows excellent sensitivity and specificity for detection of bone metastasis in patients with prostate cancer. Using two or more imaging planes may further improve sensitivity. However, caution is needed in applying our results due to the heterogeneity among the included studies.

Patient summary: We reviewed studies using contemporary magnetic resonance imaging (MRI) for the detection of bone metastasis in prostate cancer patients. MRI shows excellent diagnostic performance in finding patients with bone metastasis.

Keywords: Bone metastasis; Magnetic resonance imaging; Meta-analysis; Prostate cancer; Systematic review.