title: A pooled analysis of MRI in the detection of bone marrow infiltration in patients with malignant lymphoma.
abstract: OBJECTIVE
  To explore the role of magnetic resonance imaging (MRI) in detecting bone marrow infiltration of malignant lymphoma through a systematic review and meta-analysis.
  
  
  METHODS
  Studies that evaluated the diagnostic performance of MRI in detecting bone marrow infiltration of malignant lymphoma were acquired from the MEDLINE, EMBASE, Cancerlit, and Cochrane Library database, from February 1987 to May 2012. Pooled estimation and subgroup analysis data were obtained by statistical analysis.
  
  
  RESULTS
  A total of 13 studies involving 634 patients who fulfilled all of the inclusion criteria were considered for the analysis. No publication bias was found (p = 0.70). The pooled sensitivity of MRI was 0.82 [95% confidence intervals (CI): 0.70-0.90] and the pooled specificity was 0.79 (95% CI: 0.72-0.84). Overall, positive likelihood ratios (LR+) was 3.9 (95% CI: 2.8-5.4) and negative likelihood ratios (LR-) was 0.23 (95% CI: 0.13-0.41). In patients with high pre-test probabilities, MRI enabled confirmation of bone marrow involvement; in patients with low pre-test probabilities, MRI enabled exclusion of bone marrow involvement. Worst-case-scenario (pre-test probability, 50%) post-test probabilities were 80% and 18% for positive and negative MRI results, respectively. In subgroup analysis, MRI performed with 1.5 T devices had higher pooled specificity (0.80, 95% CI: 0.71-0.88) than the MRI with ≤1 T (0.78, 95% CI: 0.71-0.85; p < 0.05). The pooled sensitivity of MRI with diffusion-weighted imaging (DWI) was 0.65 (95% CI: 0.39-0.92) and the pooled specificity was 0.83 (95% CI: 0.69-0.97). The sensitivity and specificity of MRI without DWI was 0.85 (95% CI: 0.76-0.94) and 0.79 (95% CI: 0.72-0.85), respectively.
  
  
  CONCLUSIONS
  A limited number of small studies indicate that MRI can serve as a valuable tool for detecting bone marrow infiltration of malignant lymphoma. Results were most promising when performing MRI using high field strength devices. MRI with DWI is shown to be more specific than conventional MRI techniques. This deserves further investigation in future studies.
authors.affiliation: State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: X-X
authors.initials: XX
authors.lastname: Jiang
authors.forename: Z-X
authors.initials: ZX
authors.lastname: Yan
authors.forename: Y-Y
authors.initials: YY
authors.lastname: Song
authors.forename: W-L
authors.initials: WL
authors.lastname: Zhao
mesh_terms: D001853:Bone Marrow / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D006801:Humans; D008223:Lymphoma / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D012680:Sensitivity and Specificity