A meta-analysis of 18F-Fluoride positron emission tomography for assessment of metastatic bone tumor

Purpose

The aim of this study was to assess the diagnostic performance of ¹⁸F-Fluoride positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) compared with bone scintigraphy (BS) planar or BS planar and single photon emission computed tomography (SPECT) in evaluating patients with metastatic bone tumor.

Materials and methods

We performed a meta-analysis of all available studies addressing the diagnostic accuracy of ¹⁸F-Fluoride PET, ¹⁸F-Fluoride PET/CT, BS planar, and BS planar and SPECT for detecting the metastatic bone tumor. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios, and drew summary receiver operating characteristic curves using hierarchical regression models. We also compared the effective dose and cost-effectiveness estimated by data from the enrolled studies between ¹⁸F-Fluoride PET or PET/CT and BS planar or BS planar and SPECT.

Results

When comparing all studies with data on ¹⁸F-Fluoride PET or PET/CT, sensitivity and specificity were 96.2% 95% confidence interval (CI) 93.5–98.9%] and 98.5% (95% CI 97.0–100%), respectively, on a patient basis and 96.9% (95% CI 95.9–98.0%) and 98.0% (95% CI 97.1–98.9%), respectively, on a lesion basis. The Az values of ¹⁸F-Fluoride PET or PET/CT were 0.986 for the patient basis and 0.905 for the lesion basis, whereas those of BS or BS and SPECT were 0.866 for the patient basis and 0.854 for the lesion basis. However, the estimated effective dose and average cost-effective ratio were poorer for ¹⁸F-Fluoride PET or PET/CT than those of BS planar or BS planar and SPECT.

Conclusion

¹⁸F-Fluoride PET or PET/CT has excellent diagnostic performance for the detection of metastatic bone tumor, but the estimated effective dose and average cost-effective ratio are at a disadvantage compared with BS planar or BS planar and SPECT.