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Evidence-based Practice |
1 From the Department of Radiology, Geneva University Hospital, Rue Micheli-du-Crest 24, CH 1211 Geneva 14, Switzerland (K.K.); Departments of Epidemiology (Y.L.), Radiology (K.K., Y.L., M.B., R.F.T.), and Surgery (R.S.W.), University of California, San Francisco; and Department of Radiology, Klinik für Diagnostische Radiologie de Christian-Albrechts-Universität zu Kiel, Germany (M.B.). Received August 10, 2001; revision requested October 9; revision received January 4, 2002; accepted January 29. Address correspondence to K.K. (e-mail: karen.kinkel@hcuge.ch).
PURPOSE: To perform a meta-analysis to compare current noninvasive imaging methods (ultrasonography [US], computed tomography [CT], magnetic resonance [MR] imaging, and 18F fluorodeoxyglucose [FDG] positron emission tomography [PET]) in the detection of hepatic metastases from colorectal, gastric, and esophageal cancers.
MATERIALS AND METHODS: A MEDLINE literature search and review of article bibliographies and our institutional charts of patients with colorectal cancer identified data with histopathologic correlation or at least 6 months of patient follow-up. Two authors independently abstracted data sets and excluded data without contingency tables or data published more than once. Summary-weighted estimates of sensitivity were obtained and stratified according to specificity of less than 85% or 85% and higher. A covariate analysis was used to evaluate the influence of patient- or study-related factors on sensitivity.
RESULTS: Among 111 data sets, nine US (509 patients), 25 CT (1,747 patients), 11 MR imaging (401 patients), and nine PET (423 patients) data sets met the inclusion criteria. In studies with a specificity higher than 85%, the mean weighted sensitivity was 55% (95% CI: 41, 68) for US, 72% (95% CI: 63, 80) for CT, 76% (95% CI: 57, 91) for MR imaging, and 90% (95% CI: 80, 97) for FDG PET. Results of pairwise comparison between imaging modalities demonstrated a greater sensitivity of FDG PET than US (P = .001), CT (P = .017), and MR imaging (P = .055).
CONCLUSION: At equivalent specificity, FDG PET is the most sensitive noninvasive imaging modality for the diagnosis of hepatic metastases from colorectal, gastric, and esophageal cancers.
© RSNA, 2002
Index terms: Computed tomography (CT), comparative studies, 70.1211 • Gastrointestinal tract, neoplasms, 78.32, 78.3327 • Liver neoplasms, metastases, 761.3327 • Magnetic resonance (MR), comparative studies, 70.1214 • Positron emission tomography (PET), comparative studies, 70.12163 • Ultrasound (US), comparative studies, 70.1298
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