System Review Of Diagnostic Tests Of WB-DWI For Bone Metastases In Malignant Tumor Patients

Objective:To systematically evaluate the bone metastases'diagnostic accuracy of WB-DWI in malignant tumor patients.Materials and Methods:Relevant articles were identified from Pubmed, OVID, CBM, CNKI, Chinainfo, Cqvip (January 2004 to January 2010), hand searching of Journal of GE China MR Academy(2008 spring) and reference lists from primary articles and reviews. After screening according to inclusion and exclusion criteria,data was extracted for study characteristics and quality, and then system review was processed.Results:6 studies met the inclusion criteria, including 2 types of evaluation types:4 for per-patient basis,5 for per-site basis. The former included 240 patients, and the latter included 299 patients and 1450 metastasises.3 studies were not blind, in which the golden tests based on the diagnostic tests' results, and the results of other quality assrssment items were good Because the number of studies, patients and lesions were fewer, and types of cancers, number of patients,and the distribution of lesions were not proporational, it was not appropriate to continue quantitative(meta-analysisi) but qualitative system review, and the scope was expanded. The results between these studies were quite different. This research showed the sensitivity for per-patient basis and per-site basis respectively was 89.47%-100%,86.67%-95.68%, and the mean sensitivity respectively was 94.45%,91.43%.The specificity for per-patient basis and per-site basis respectively was 78.89%-100%,60.00%-99.07%, and the mean specificity respectively was 88.71%,86.11%. The accuracy for per-patient basis and per-site basis respectively was 82.61%-100%,82.14%-95.39%, and the mean specificity respectively is 91.26%,88.35%. The combined experiment studies indicated that WB-MRI had better results in detection of metastasises with WB-DWI, and the diagnostic efficacy was similar or slightly superior to radioisotope bone scan or PET-CT. Overall,WB-DWI was not superior obviously to radioisotope bone sca,PET or PET-CT. But they can complement with each other with their advantages.Conclusion:Because the number of studies, patients and lesions were fewer, and types of cancers, number of patients,and the distribution of lesions were not proporational, the meta-analysis was not adopted, and at the moment we cann't make a precise and comprehensive assessment of the diagnostic ability for bone metastasizes. But these studies had a consensus that WB-DWI had high sensitivity, specificity and accuracy, the clinical application value is high,and the feasibility is good. WB-DWI should be a routine techniques in diagnosing metastasises in malignant tumor patients, especially in osteolytic metastasizes,and can be used in management of metastasises.Compared with other whole body imaging techniques, such as radioisotope bone scan,PET,PET-CT, they, they agreed well with each other, they either has its own advantages and disadvantages, and they were complementary to each other in diagnostic efficacy. Moreover, WB-DWI has comprehensive application foreground and spread value for its veritable whole body not only skeleton system. In future, quantitative system review (meta-analysis) can be accomplished when more large sample and blind diagnostic tests with different size, types'lesions and perfect diagnostic criterion are published, and it's a must.