title: Diagnostic accuracy of imaging methods for the diagnosis of skeletal malignancies: A retrospective analysis against a pathology-proven reference.
abstract: OBJECTIVE
  To examine the diagnostic accuracy of imaging modalities in skeletal tumours versus pathology reports.
  
  
  METHODS
  Pathology reports of bone biopsies were compared to diagnostic imaging with X-ray, computed tomography (CT), magnetic resonance imaging (MRI), bone scintigraphy (BS), and (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) performed within 6 months of biopsy.
  
  
  RESULTS
  A total of 409 biopsies were included. Sensitivity and specificity were significantly different among the five modalities (p<0.0001). The sensitivity of MRI and PET/CT was better than CT, but CT had a better specificity than PET/CT. In general, these methods outperformed BS and X-ray. The sensitivity for osteolytic lesions varied significantly between modalities (p<0.0001), with MRI and PET/CT being more sensitive than CT. Differences in sensitivity were also observed in mixed lesions (p=0.0002) but not in osteosclerotic lesions. In spine lesions, MRI showed the best sensitivity followed by PET/CT and CT (p<0.0005 vs. MRI). There was no significant differences among non-spine lesions.
  
  
  CONCLUSIONS
  MRI and FDG-PET/CT showed comparable diagnostic characteristics in general, in individual tumour types, and in different bone lesions and locations. Nominally, they outperformed CT in most situations. The diagnostic accuracy of X-ray and BS were notably inferior to other modalities.
authors.affiliation: Department of Radiology, Aalborg University Hospital, Aalborg, Denmark. Electronic address: bl@benedictelange.dk.
authors.forename: Mine Benedicte
authors.initials: MB
authors.lastname: Lange
authors.affiliation: Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Mads Lausen
authors.initials: ML
authors.lastname: Nielsen
authors.affiliation: Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Jeannette Demant
authors.initials: JD
authors.lastname: Andersen
authors.affiliation: Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Hanna Järnum
authors.initials: HJ
authors.lastname: Lilholt
authors.affiliation: Institute of Pathology, Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Mogens
authors.initials: M
authors.lastname: Vyberg
authors.affiliation: Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Lars Jelstrup
authors.initials: LJ
authors.lastname: Petersen
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000175:diagnosis*; D001842:Bone and Bones / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D049268:Positron-Emission Tomography; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Bone metastasis/neoplasms/tumours; Computed tomography Imaging; Diagnostic accuracy; Magnetic resonance imaging; Positron emission tomography with computed tomography; Sensitivity and specificity