A meta-analysis of fluorodeoxyglucose-positron emission tomography versus scintigraphy in the evaluation of suspected osteomyelitis.

AIM: Functional nuclear medicine imaging techniques have become particularly important in the diagnosis of osteomyelitis. The aim of our study was to perform a meta-analysis to obtain a reliable estimate of the diagnostic performance of fluorodeoxyglucose-positron emission tomography (FDG-PET), three-phase bone scintigraphy, leukocyte scintigraphy, and monoclonal antigranulocyte antibody (MOAB) scintigraphy in the assessment of suspected osteomyelitis and to perform pairwise comparisons of the diagnostic accuracy between these different imaging modalities.

PATIENTS AND METHODS: A total of 23 studies representing 851 examinations that were published from January 1980 to October 2010 were reviewed. These studies evaluated the role of FDG-PET, three-phase bone scintigraphy, leukocyte scintigraphy, and MOAB scintigraphy in the assessment of suspected osteomyelitis. Systematic methods were used to identify, select, and evaluate the methodological quality of the studies and to summarize the overall findings of sensitivity and specificity. Two-sample Z-tests were conducted to evaluate for differences in sensitivity, specificity, area under the curve (AUC), and the Q* index between any two diagnostic modalities.

RESULTS: The FDG-PET had a pooled sensitivity of 0.923, specificity of 0.920, and AUC of 0.9666, whereas for bone scintigraphy, the corresponding values were 0.827, 0.446, and 0.6514, respectively, for leukocyte scintigraphy, the corresponding values were 0.742, 0.881, and 0.9139, respectively, and for MOAB, the corresponding values were 0.883, 0.705, and 0.8897, respectively. Our meta-analysis did not find statistically significant differences in the sensitivity, specificity, AUC, and Q* index between FDG-PET and leukocyte scintigraphy.

CONCLUSION: Leukocyte scintigraphy can be used with satisfactory diagnostic accuracy for detecting osteomyelitis when positron emission tomography systems are not available. The FDG-PET appears to be superior in terms of accuracy compared with other radionuclide imaging modalities.