Comparative Study of Different Imaging Modalities for Diagnosis of Bone Metastases of Prostate Cancer

Purpose This study aimed to compare the diagnostic performances of 8 different imaging modalities for preoperative detection of bone metastases in prostate cancer patients by performing a network meta-analysis using direct comparison studies with 2 or more imaging techniques. Patients and Methods We searched PubMed, Embase, and Cochrane Library for studies evaluating the performances of 8 different imaging modalities for the preoperative detection of bone metastases in prostate cancer patients. The network meta-analysis was performed in patient-based analysis. The consistency was evaluated by examining the agreement between direct and indirect treatment effects, and the surface under the cumulative ranking curve (SUCRA) values were obtained to calculate the probability of each imaging modality being the most effective diagnostic method. Results A total of 999 patients from 13 direct comparison studies using 8 different imaging modalities for preoperative detection or follow-up of bone metastases in prostate cancer patients were included. For the detection of bone metastases of prostate cancer, 68 Ga-PSMA-11 PET/CT showed the highest SUCRA values of sensitivity, positive predictive value, accuracy, and diagnostic odds ratio. In addition, 18 F-NaF PET/CT and SPECT/CT showed high SUCRA values. Conclusions 68 Ga-PSMA-11 PET/CT showed the highest SUCRA values. Other imaging modalities showed complementary diagnostic roles for preoperative detection of bone metastases in patients with prostate cancer, except bone scintigraphy and MRI.