Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, PR China.
Eur J Radiol. 2012 May;81(5):1007-15. doi: 10.1016/j.ejrad.2011.01.126. Epub 2011 Feb 26.
Lung cancer is the most common cause of cancer related death among both men and women worldwide. The skeleton is the most common site of cancer metastasis. Early detection is crucial for prognosis. To evaluate and compare the capability for bone metastasis assessment of [(18)F] fluoro-2-d-glucose positron emission tomography with computed tomography ((18)FDG-PET-CT), [(18)F] fluoro-2-d-glucose positron emission tomography ((18)FDG-PET), magnetic resonance imaging (MRI) and bone scintigraphy (BS) in lung cancer patients, a meta-analysis is preformed.
We searched MEDLINE, OVID, EMBASE and the Cochrane Library for studies evaluating diagnosis validity of (18)FDG-PET-CT, (18)FDG-PET, MRI and BS between January 1990 and August 2010. Meta-analysis methods were used to pool sensitivity, specificity, diagnostic odd ratios (DORs) and to construct a summary receiver-operating characteristic curve (SROC).
A total of 17 articles (9 (18)FDG-PET-CT studies, 9 (18)FDG-PET studies, 6 MRI studies and 16 BS studies) that included 2940 patients who fulfilled all of the inclusion criteria were considered for inclusion in the analysis. The pooled sensitivity for the detection of bone metastasis in lung cancer using (18)FDG-PET-CT, (18)FDG-PET, MRI and BS were 0.92 (95% CI, 0.88-0.95), 0.87 (95% CI, 0.81-0.92), 0.77 (95% CI, 0.65-0.87) and 0.86 (95% CI, 0.82-0.89), respectively. The pooled specificity for the detection of bone metastasis from lung cancer using (18)FDG-PET-CT, (18)FDG-PET, MRI and BS were 0.98 (95% CI, 0.97-0.98), 0.94 (95% CI, 0.92-0.96), 0.92 (95% CI, 0.88-0.95), 0.88 (95% CI, 0.86-0.89), respectively. The pooled DORs estimates for (18)FDG-PET-CT 449.17 were significantly higher than for (18)FDG-PET (118.25, P<0.001), MRI (38.27, P<0.001) and BS (63.37, P<0.001). The pooled sensitivity of BS was not correlated with the prevalence of bone metastasis.
The results showed that both (18)FDG-PET-CT and (18)FDG-PET were better imaging methods for diagnosing bone metastasis from lung cancer than MRI and BS. (18)FDG-PET-CT has higher diagnostic value (sensitivity, specificity and DORs) for diagnosing bone metastasis from lung cancer than any other imaging methods.
肺癌是全世界男性和女性癌症相关死亡的最常见原因。骨骼是癌症转移最常见的部位。早期发现对预后至关重要。为了评估和比较[(18)F]氟-2-脱氧葡萄糖正电子发射断层扫描与计算机断层扫描（(18)FDG-PET-CT）、[(18)F]氟-2-脱氧葡萄糖正电子发射断层扫描（(18)FDG-PET）、磁共振成像（MRI）和骨闪烁扫描（BS）在肺癌患者中评估骨转移的能力，进行了荟萃分析。
我们在 1990 年 1 月至 2010 年 8 月期间，通过 MEDLINE、OVID、EMBASE 和 Cochrane 图书馆检索了评估 (18)FDG-PET-CT、(18)FDG-PET、MRI 和 BS 诊断有效性的研究。使用荟萃分析方法合并敏感性、特异性、诊断比值比（DORs）并构建汇总受试者工作特征曲线（SROC）。
共有 17 篇文章（9 项 (18)FDG-PET-CT 研究、9 项 (18)FDG-PET 研究、6 项 MRI 研究和 16 项 BS 研究）纳入了所有纳入标准的 2940 例患者。使用 (18)FDG-PET-CT、(18)FDG-PET、MRI 和 BS 检测肺癌骨转移的合并敏感性分别为 0.92（95%CI，0.88-0.95）、0.87（95%CI，0.81-0.92）、0.77（95%CI，0.65-0.87）和 0.86（95%CI，0.82-0.89）。使用 (18)FDG-PET-CT、(18)FDG-PET、MRI 和 BS 检测肺癌骨转移的合并特异性分别为 0.98（95%CI，0.97-0.98）、0.94（95%CI，0.92-0.96）、0.92（95%CI，0.88-0.95）和 0.88（95%CI，0.86-0.89）。(18)FDG-PET-CT 的 DORs 估计值为 449.17，明显高于 (18)FDG-PET（118.25，P<0.001）、MRI（38.27，P<0.001）和 BS（63.37，P<0.001）。BS 的合并敏感性与骨转移的患病率无相关性。
结果表明，(18)FDG-PET-CT 和 (18)FDG-PET 均优于 MRI 和 BS，是诊断肺癌骨转移的更好影像学方法。(18)FDG-PET-CT 对诊断肺癌骨转移的诊断价值（敏感性、特异性和 DORs）高于任何其他影像学方法。
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