Diagnostic value of FDG-PET versus magnetic resonance imaging for detecting spondylitis: a systematic review and meta-analysis

Abstract

Background context: Spondylitis is a rare infection in bone requiring multiple diagnostic strategies for verification.

Purpose: This study aimed to compare the diagnostic values of ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) and magnetic resonance imaging (MRI) in detecting spondylitis.

Methods: Online PubMed, Embase, and Cochrane Library databases were systematically searched through September 2017 for studies comparing the diagnostic values of ¹⁸F-FDG-PET and MRI. The summary sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve were calculated using Stata software. The ratio of these indexes between ¹⁸F-FDG-PET and MRI was also determined.

Results: The summary results for ¹⁸F-FDG-PET were as follows: sensitivity=0.96 [95% confidence intervals (CI), 0.84-0.99]; specificity=0.90 (95% CI, 0.79-0.96); PLR=9.83 (95% CI, 4.39-22.03); NLR=0.05 (95% CI, 0.01-0.19); DOR=124.08 (95% CI, 39.04-394.34); and area under the SROC=0.97 (95% CI, 0.95-0.98). The summary sensitivity, specificity, PLR, NLR, DOR, and area under the SROC for MRI were 0.76 (95% CI, 0.65-0.84), 0.62 (95% CI, 0.45-0.77), 2.01 (95% CI, 1.36-2.98), 0.39 (95% CI, 0.27-0.56), 5.08 (95% CI, 2.66-9.69), and 0.77 (95% CI, 0.73-0.80), respectively. The summary results of sensitivity (p=.034), specificity (p=.006), PLR (p<.001), DOR (p<.001), and area under the SROC (p<.001) were higher in ¹⁸F-FDG-PET than in MRI. However, NLR (p=.003) was lower in ¹⁸F-FDG-PET than in MRI.

Conclusions: ¹⁸F-FDG-PET had a higher diagnostic value compared with MRI in detecting spondylitis.

Keywords: (18)F-fluorodeoxyglucose positron emission tomography; Diagnostic value; FDG-PET; MRI; Magnetic resonance imaging; Spondylitis.