Whole body magnetic resonance imaging on the diagnosis of metastasis in children and adolescents : a systematic review and meta-analysis

Abstract

Background: Whole-body magnetic resonance imaging (WB-MRI) has brought the advantage of a comprehensive evaluation of pediatric patients without the risks inherent to ionizing radiation usually present in other conventional imaging methods. However, consensus regarding WB-MRI accuracy for the diagnosis of metastasis in children and adolescents is still lacking. Objective: To evaluate the diagnostic accuracy of WB-MRI in the diagnosis of metastasis in children and adolescents. Materials and methods: The following electronic databases were searched: MEDLINE, EMBASE, The Cochrane Controlled Trials Register, Scientific Electronic Library Online, Latin American Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and www.clinicaltrials.gov. Meta-analysis was performed according to the recommendations of the Cochrane handbook. All studies included children and adolescents with histopathological proof of the original tumor. All patients underwent a reference standard. Different reference standards were used, including clinical outcomes, biopsy, iliac crest biopsy, focal imaging methods follow-up and expert panel review, and the gold standard of each patient was established. Using the stablished gold standard, sensitivity, specificity and positive predictive values were calculated for eath technique. Any study have been used endovenous contrast. Results: The selected studies included 118 patients with age ranged from seven months to 19 years. The summary estimates obtained from analysis of WB-MRI were sensitivity of 0,964 (95%CI 0,944 to 0.978, I2= 0%) with specificity of 0.902 (95%CI 0.882 to 0.919, I2= 98,4%) and AUC=0.991. When the study with low robustness was excluded, heterogeneity decreased, of both tests, to zero. Conclusion: Whole Body Magnetic Resonance Imaging has a good accuracy for the diagnosis of metastasis in children and adolescents and could potentially provide a safer nonionizing alternative method for staging disease