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

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.

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.

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.

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.