Purpose: This study aimed to evaluate the diagnostic accuracy of F-fluoride PET or PET/CT compared with Tc-MDP bone scintigraphy and F-FDG PET/CT in the detection of bone metastases.
Patients and methods: An electronic search was conducted using PubMed/MEDLINE and EMBASE. The methodological quality of the included studies was assessed with Quality Assessment of Diagnostic Accuracy Studies 2. All analyses were performed on Stata version 12.0 and Meta-DiSc version 1.4.
Results: Twenty articles containing 1170 patients were identified. On a patient basis, the pooled sensitivity, specificity, and the area under the summary receiver operating characteristic curve of F-fluoride PET or PET/CT were 92% (95% confidence interval [CI], 89%-95%), 93% (95% CI, 91%-95%), and 0.985, respectively. On a lesion basis, the pooled sensitivity, specificity, and area under the summary receiver operating characteristic curve of F-fluoride PET or PET/CT were 87% (95% CI, 85%-88%), 95% (95% CI, 94%-96%), and 0.979, respectively. When compared with Tc-MDP bone scintigraphy, F-fluoride PET or PET/CT showed both higher sensitivity (96% vs. 88%, P = 0.002) and specificity (91% vs. 80%, P = 0.001). When compared with F-FDG PET/CT, F-fluoride PET/CT showed higher sensitivity (94% vs. 73%, P = 0.003), whereas no significant difference was observed in specificity (88% vs. 98%, P = 0.06).
Conclusions: F-fluoride PET or PET/CT has an excellent diagnostic capacity for the detection of bone metastases and shows advantages when compared with Tc-MDP bone scintigraphy and F-FDG PET/CT.