Accuracy of MR imaging for staging prostate cancer: A meta-analysis to examine the effect of technologic change

Rationale and Objectives. The purpose of this study was to summarize the ac curacy of magnetic resonance (MR) imaging for staging prostate cancer and t o determine the effect of high magnetic field strength, use of the endorect al coil, use of fast spin-echo (SE) imaging, and study size on staging accu racy. Materials and Methods. A literature search and review yielded 27 studies co mparing MR imaging to a pathologic standard in patients with clinically lim ited prostate cancer. Subgroup analyses examined magnetic field strength, u se of an endorectal coil, use of fast SE imaging, publication date, and stu dy size. Results. A summary receiver operating characteristic curve for all studies had a maximum joint sensitivity and specificity of 74%. At a specificity of 80% on this curve, sensitivity was 69%. Subgroup analyses showed that fast SE imaging was statistically significantly more accurate than conventional SE techniques (P < .001). Unexpectedly, studies employing higher magnetic field strength and those employing an endorectal coil were less accurate. Conclusion, Seemingly small technologic advances may influence test accurac y. Early and small studies, however, may overstate accuracy because of publ ication bias, bias in small samples, or earlier studies being performed by the experts who developed the technology itself.