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This article was conducted to review the diagnostic performance of 18F-fluoride PET or PET/CT compared with planar bone scintigraphy (BS) or planar BS plus SPECT with 99mTc-labeled methylene diphosphonate in evaluating patients with metastatic bone tumor, updating a previous meta-analysis on this topic. We performed an updated meta-analysis of all available studies addressing the diagnostic accuracy of 18F-fluoride PET, 18F-fluoride PET/CT, planar BS, and planar BS plus SPECT for detecting metastatic bone tumor. The Medline (from 1966 to November, 2012), SCOPUS, and Biological Abstracts databases were searched using a search algorithm based on combinations of the terms: (1) 18F-fluoride, 18F- fluoride PET, or 18F-fluoride PET/CT, (2) bone scintigraphy, (3) bone metastasis, metastatic bone tumor, without language restriction. We constructed summary receiver operating characteristic curves using hierarchical regression models. Effective dose and cost-effectiveness, estimated from the data of the enrolled studies, were also compared between 18F-fluoride PET or PET/CT and planar BS or planar BS plus SPECT. Comparison of all the studies with data on 18F-fluoride PET or PET/CT showed sensitivity and specificity values of 91.9- and 97.1 % on patient-based analyses and 83.3 and 86.8 % on lesion-based analyses. The Az values of 18F-fluoride PET or PET/CT were 0.987 on a patient basis and 0.894 on a lesion basis, whereas those of BS or BS plus SPECT were 0.867 on a patient basis and 0.854 on a lesion basis. However, 18F-fluoride PET or PET/CT showed poorer estimated effective dose and average cost-effectiveness ratio when compared with the values recorded for planar BS or planar BS plus SPECT. 18F-fluoride PET or PET/CT showed excellent diagnostic performance for the detection of metastatic bone tumor, but the estimated effective dose and the average cost-effectiveness ratio were poorer than the values recorded with planar BS or planar BS plus SPECT. The question of whether there is an incremental diagnostic improvement with 18F-fluoride PET or PET/CT for bone metastasis should be addressed, as should the issues of radiation dose, cost-effectiveness, and potential complications against the yield of information.

Diagnostic accuracy of 18F-fluoride PET and PET/CT in patients with bone metastases: a systematic review and meta-analysis update