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

Background: The comparative diagnostic performance of (68)Gallium (Ga)-PSMA-11 PET/CT and Ga-68-PSMA-11 PET/MRI in detecting bone metastases in prostate cancer (PCa) remains unclear. Purpose: To systematically evaluate the early detection rate of biochemical recurrent (BCR) bone metastasis in PCa utilizing Ga-68-PSMA-11 PET/CT and Ga-68-PSMA-11 PET/MRI. Material and Methods: 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 Ga-68-PSMA-11 PET/CT and Ga-68-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 I-2 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). Results: 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 Ga-68-PSMA-11 PET/CT versus Ga-68-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. Conclusion: There was no statistically significant difference in identifying BCR bone metastasis in PCa patients between Ga-68-PSMA-11 PET/CT and Ga-68-PSMA-11 PET/MRI.