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The diagnostic role of CT, MRI/MRCP, PET/CT, EUS and DWI in the differentiation of benign and malignant IPMN: A meta-analysis

Published:December 02, 2020DOI:https://doi.org/10.1016/j.clinimag.2020.11.018

      Highlights

      • A new table summarized clinical features that characterized the IPMN as malignant.
      • Meta-analysis compares the diagnostic performance of all possible imaging modalities for differentiation of malignant IPMNs.
      • Both PET/CT and DWI performed better diagnostic accuracy in the detection of malignant IPMN.
      • It is the first meta-analysis to investigate the different imaging modalities in benign and malignant diagnosis of IPMN.

      Abstract

      Purpose

      The objective of this study was to assess the diagnostic properties of computed tomography (CT), magnetic resonance imaging (MRI/MRCP) /Magnetic Resonance Cholangiopancreatography (MRCP), positron emission tomography/computed tomography (PET/CT), endoscopic ultrasound (EUS) and diffusion-weighted magnetic resonance imaging (DWI) in distinguishing benign and malignant intraductal papillary mucinous neoplasm (IPMN).

      Materials and methods

      Eligible databases were searched for eligible studies, published through July 2020 on the diagnostic accuracy of these modalities. Diagnostic accuracy parameters, including sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic curves (SROC) were calculated. Meta-regression was performed to identify the source of heterogeneity.

      Results

      In total, 28 studies were included. Pooled sensitivities for CT, MRI/MRCP, PET/CT, EUS and DWI were 0.7, 0.76, 0.8, 0.6 and 0.72, respectively. Pooled specificities were 0.78, 0.83, 0.9, 0.8 and 0.97. The DORs were 8, 16, 35, 6 and 88. The areas under the curve (AUC) of SROC for CT, MRI/MRCP/MRCP, PET/CT, EUS and DW were 0.8, 0.87, 0.92, 0.79 and 0.82, respectively.

      Conclusion

      PET/CT showed the highest AUC and the overall diagnostic accuracy results support the use of MRI/MRCP, PET/CT interchangeably as a first-line examination in the diagnosis of malignant IPMN. With regard to DWI, EUS and CT, each techniques have their advantages and supportive to MRI/MRCP.

      Abbreviations:

      AUC (area under the curve), BD (branch-duct), CI (confidence intervals), CT (computed tomography), DOR (diagnostic odds ratios), CNKI (China National Knowledge Infrastructure), DWI (diffusion-weighted magnetic resonance imaging), EUS (endoscopic ultrasound), FPs (false-positives), FNs (false-negatives), IPMN (intraductal papillary mucinous neoplasm), MD (main-duct), MPD (main pancreatic duct), MRCP (magnetic resonance cholangiopancreatography), MRI/MRCP (magnetic resonance imaging), PET/CT (positron emission tomography with computed tomography), QUADAS-2 (quality assessment for diagnostic accuracy study form), SROCs (summary receiver operating characteristic curves), TPs (true-positives), TNs (true-negatives)

      Keywords

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