Thirteen articles that reported 23 data sets (2,115 participants) were included in the review. Most studies did not use the same reference standard in all participants and did not interpret the reference standard without knowledge of the index test results.
18FDG-PET:
The per patient estimates of sensitivity, specificity and DOR were 83.3% (95% CI 78.2% to 90.8%), 94.5% (95% CI 88.5% to 98.0%) and 82.1 (95% CI 17.4 to 387.5), and the estimated Q* index was 0.922, based on 3 studies and 184 patients. The per lesion estimates of sensitivity, specificity and DOR were 52.7% (95% CI 47.0% to 58.4%), 99.6% (95% CI 98.9% to 99.9%) and 283.3 (95% CI 96.0 to 835.5), and the estimated Q* index was 0.941, based on 3 studies and 1,214 lesions.
MRI:
The per patient estimates of sensitivity, specificity and DOR were 97.1% (95% CI 90.1% to 99.7%), 97.0% (95% CI 89.5% to 99.6%) and 298.5 (95% CI 48.5 to 1,836.9), and the estimated Q* index was 0.935, based on 3 studies and 136 patients.
Bone scintigraphy:
The per patient estimates of sensitivity, specificity and DOR were 87.0% (95% CI 82.1% to 90.9%), 88.1% (95% CI 84.6% to 91.0%) and 49.3 (95% CI 17.2 to 141.5), and the estimated Q* index was 0.872, based on 10 studies and 678 patients. The per lesion estimates of sensitivity, specificity and DOR were 87.8% (95% CI 83.9% to 91.1%), 96.1% (95% CI 94.7% to 97.2%) and 66.8 (95% CI 4.9–903.6), and the estimated Q* index was 0.893, based on 4 studies and 1,303 lesions.
On a per patient basis, the pooled sensitivity estimates for MRI were significantlyhigher than those for 18FDG-PET and bone scintigraphy; there was no significant difference between 18FDG-PET and bone scintigraphy. The pooled specificity estimates for 18FDG-PET and MRI were both significantlyhigher than those for bone scintigraphy; there was no significant difference between 18FDG-PET and MRI.
On a per lesion basis, the pooled sensitivity estimates for bone scintigraphy were significantly higher than those for 18FDG-PET, and the pooled specificity estimates for 18FDG-PET were significantly higher than those for bone scintigraphy.