EURURO Vol. 73 No. 1

Platinum Priority – Prostatic Disease

Editorial by Alex P. Hoyle and Noel W. Clarke on pp. 92–93 of this issue

Diagnostic Performance of Magnetic Resonance Imaging for the

Detection of Bone Metastasis in Prostate Cancer: A Systematic

Review and Meta-analysis

Sungmin Woo

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, 1

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Chong Hyun Suh

b , c , 1

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Sang Youn Kim

a , * ,

Jeong Yeon Cho

a , d ,

Seung Hyup Kim

a , d

Department of Radiology, Seoul National University College of Medicine, Seoul, Korea;

Department of Radiology and Research Institute of Radiology,

University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea;

Department of Radiology, Namwon Medical Center, Jeollabuk-do,

Republic of Korea;

Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Korea

E U R O P E A N U R O L O G Y 7 3 ( 2 0 1 8 ) 8 1 – 9 1

ava ilable at

www.sciencedirect.com

journal homepage:

www.eu ropeanurology.com

Article info

Article history:

Accepted March 28, 2017

Associate Editor:

Giacomo Novara

Keywords:

Magnetic resonance imaging

Prostate cancer

Bone metastasis

Systematic review

Meta-analysis

Abstract

Context:

Magnetic resonance imaging (MRI) has been tested for detecting bone metas-

tasis 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 com-

parator as the reference standard. Two independent reviewers assessed the methodo-

logical 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.

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Meta-regres-

sion 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

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meta-regression analysis, only the number of imaging planes ( 2

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vs 1) was a

significant factor affecting heterogeneity (

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

(

= 4) had the highest sensitivity (0.99 [95% CI 0.98–1.00]).

Conclusions:

Contemporary MRI shows excellent sensitivity and specificity for detec-

tion 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 im-

aging (MRI) for the detection of bone metastasis in prostate cancer patients. MRI shows

excellent diagnostic performance in finding patients with bone metastasis.

These authors contributed equally.

* Corresponding author. Department of Radiology, Seoul National University Hospital, 101 Daehak-

ro, Jongno-gu, Seoul 110-744, Korea. Tel. +82 2 2072 4897; Fax: +82 2 743 6385.

E-mail address:

iwishluv@empas.com

(S.Y. Kim).

http://dx.doi.org/10.1016/j.eururo.2017.03.042

0302-2838/