Comparative diagnostic performance of 68Ga-PSMA-11 PET/CT and 68Ga-PSMA-11 PET/MRI in detecting biochemical recurrent bone metastasis in prostate cancer: a systematic review and meta-analysis

The comparative diagnostic performance of 68Gallium (Ga)-PSMA-11 PET/CT and 68Ga-PSMA-11 PET/MRI in detecting bone metastases in prostate cancer (PCa) remains unclear. To systematically evaluate the early detection rate of biochemical recurrent (BCR) bone metastasis in PCa utilizing 68Ga-PSMA-11 PET/CT and 68Ga-PSMA-11 PET/MRI. We searched PubMed, Embase, and Web of Science for relevant articles up to April 2023 and extracted studies that examined the positivity rate of both 68Ga-PSMA-11 PET/CT and 68Ga-PSMA-11 PET/MRI in the context of the BCR bone metastasis of PCa patients. Random-effects model was used to compare positivity rates for two imaging modalities. Heterogeneity among studies was assessed using the I2 statistic. To evaluate the methodological quality of studies, we employed Quality Assessment of Diagnostic Performance Studies method. The study protocol was registered in PROSPERO (CRD42023454118). A total of 1670 publications were originally identified; 58 studies, encompassing a cohort of 8037 patients, met the inclusion criteria. Regarding the evaluation of BCR bone metastasis, results suggest no statistically significant difference in the utilization of 68Ga-PSMA-11 PET/CT versus 68Ga-PSMA-11 PET/MRI in 58 non-head-to-head studies (0.21, 95% CI=0.19-0.24 and 0.17, 95% CI=0.11-0.23; P = 0.19) and four head-to-head studies (0.16, 95% CI=0.08-0.27 and 0.16, 95% CI=0.08-0.27; P = 1.00). Meta-regression showed the study design of influenced the heterogeneity in the PET/MRI group (P < 0.01); but analysis of PET/CT did not identify the potential reason for heterogeneity. There was no statistically significant difference in identifying BCR bone metastasis in PCa patients between 68Ga-PSMA-11 PET/CT and 68Ga-PSMA-11 PET/MRI.