Accuracy of Magnetic Resonance Imaging for Local Staging of XXXX : A Diagnostic Meta-analysis.

@entity5 @entity1 @entity263 @entity3
CONTEXT: Correct assessment of @entity5 stage is crucial for @entity263 ( @entity263 ) management. OBJECTIVE: To assess the diagnostic accuracy of magnetic resonance imaging (MRI) for local @entity263 staging and explore the influence of different imaging protocols. EVIDENCE ACQUISITION: We searched the PubMed, Embase, and Cochrane databases from 2000 up to August 2014. We included studies that used MRI for detection of extracapsular extension (ECE; T3a), @entity3 ( @entity3 ; T3b), or overall stage T3 @entity263 , with prostatectomy as the reference standard. Methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool by two independent reviewers. Data necessary to complete 2*2 tables were obtained, and @entity1 , study, and imaging characteristics were extracted. Accuracy was reported for the most experienced or first reader. Results were pooled and plotted in summary receiver operating characteristics plots. EVIDENCE SYNTHESIS: A total of 75 studies (9796 @entity1 ) could be analysed. Pooled data for ECE (45 studies, 5681 @entity1 ), @entity3 (34 studies, 5677 @entity1 ), and overall stage T3 detection (38 studies, 4001 @entity1 ) showed sensitivity and specificity of 0.57 (95% confidence interval [CI] 0.49-0.64) and 0.91 (95% CI 0.88-0.93), 0.58 (95% CI 0.47-0.68) and 0.96 (95% CI 0.95-0.97), and 0.61 (95% CI 0.54-0.67) and 0.88 (95% CI 0.85-0.91), respectively. Functional imaging in addition to T2-weighted imaging and use of higher field strengths (3 T) improved sensitivity for ECE and @entity3 . ECE sensitivity was not improved by endorectal coil use. CONCLUSIONS: MRI has high specificity but poor and heterogeneous sensitivity for local @entity263 staging. An endorectal coil showed no additional benefit for ECE detection, but slightly improved sensitivity for @entity3 detection. Higher field strengths and the use of functional imaging techniques can slightly improve sensitivity. @entity1 SUMMARY: We pooled the results from all previous studies that evaluated magnetic resonance imaging (MRI) for detection of @entity5 growth outside the prostate. MRI is not sensitive enough to find all @entity5 with extraprostatic growth.
