The diagnostic performance of ¹⁸F-fluoride PET/CT in bone metastases detection: a meta-analysis

Aim: To assess the diagnostic performance of combined ¹⁸F-fluoride positron-emission tomography (PET)/computed tomography (CT) in bone metastases (BM) and explore whether there is an added value when compared with ^99mTc- methylene diphosphonate (MDP) planar bone scintigraphy (BS).

Materials and methods: PubMed, EMBASE, Web of Science, and the Cochrane Library were searched to December 2017. Studies evaluating the performance of ¹⁸F-fluoride PET/CT in BM detection and using histopathology or clinical/imaging follow-up for ≥6 months as the reference standard were included. All analyses were performed on Stata/SE 12.0 and MetaDisc 1.4.

Results: Twenty articles comprising 1,349 patients were included. On the patient basis, the pooled sensitivity and specificity of ¹⁸F-fluoride PET/CT were 93% (95% confidence interval [CI], 91-96%) and 95% (95% CI, 93-96%) when equivocal results were considered as negative for BM; and 96% (95% CI, 93-97%) and 93% (95% CI, 91-95%) when equivocal results were considered as positive. On the lesion basis, the pooled sensitivity and specificity were 93% (95% CI, 92-94%) and 96% (95% CI, 95-97%) when equivocal results were considered as negative; and 94% (95% CI, 92-95%) and 95% (95% CI, 94-96%) when equivocal results were considered as positive. Seven articles reported the comparison between ¹⁸F-fluoride PET/CT and ^99mTc-MDP BS. ¹⁸F-fluoride PET/CT showed both higher sensitivity (p<0.005) and specificity (p<0.05) when equivocal results were considered as positive. When the equivocal results were considered as negative, ¹⁸F-fluoride PET/CT showed higher sensitivity (p<0.005), but no significant difference in specificity (p=0.08).

Conclusions: ¹⁸F-fluoride PET/CT showed superior diagnostic performance in BM detection and had higher accuracy when compared with ^99mTc-MDP BS.