The diagnostic accuracy of magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) for detecting local recurrence of nasopharyngeal carcinoma: A meta-analysis

Objective This study aimed to carry out an integrated meta-analytical review to fully assess the diagnostic value of magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) for local relapse risk in nasopharyngeal carcinoma (NPC). Methods The relevant published literature was retrieved comprehensively from online databases, specifically PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Chinese Journal Service Platform. The diagnostic efficacy of MRI and PET/CT examinations with the reference standard of pathological results or clinical follow-up data, was evaluated in this meta-analysis. The methodological quality and potential bias of included literature were evaluated via the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Comprehensive statistical analyses covering overall sensitivity, overall specificity, positive and negative likelihood ratios, diagnostic odds ratio, as well as the area under the summary receiver operating characteristic curve (AUC) were completed with the aid of RevMan 5.4 and Stata 18.0 software. Results Ultimately, a total of nine eligible clinical investigations (PET/CT and MRI) involving 1941 enrolled participants were included in the final quantitative synthesis. PET/CT presented excellent diagnostic efficacy in identifying local recurrence, with an overall sensitivity of 0.93 (95% CI: 0.90-0.95), an overall specificity of 0.87 (95% CI: 0.78-0.93), a diagnostic odds ratio of 91, and an SROC-derived AUC of 0.94 (95% CI: 0.92-0.96). Meanwhile, MRI also displayed satisfactory diagnostic capability for this clinical endpoint, with an overall sensitivity of 0.89 (95% CI: 0.79-0.95), an overall specificity of 0.68 (95% CI: 0.33-0.91), a diagnostic odds ratio of 18, and a pooled AUC value of 0.90 (95% CI: 0.87-0.92). The results of the meta-regression analysis showed that the study design type was the main factor influencing the sensitivity of PET/CT for diagnosing local recurrence of nasopharyngeal carcinoma (sensitivity 0.80, 95% CI: 0.58–0.92, P = 0.04). Funnel plot-based statistical examination revealed no obvious publication bias among the included research literature ( P = 0.10). Conclusion Both MRI and PET/CT afforded a high degree of diagnostic accuracy when diagnosing local recurrence of NPC, though PET/CT might present relatively superior overall performance, particularly regarding its specificity and its ability to differentiate between recurrence and non-recurrence. However, clinical decision-making requires going beyond a single diagnostic accuracy metric. MRI has distinct advantages in terms of accessibility, convenience, and cost, making it still valuable for routine follow-up and specific clinical scenarios.