Abstract
Objectives
To perform a systematic review comparing the diagnostic accuracy of MRI vs. CT for assessing pancreatic ductal adenocarcinoma (PDAC) vascular invasion.
Methods
MEDLINE, EMBASE, Cochrane Central, and Scopus were searched until December 2021 for diagnostic accuracy studies comparing MRI vs. CT to evaluate vascular invasion of pathologically confirmed PDAC in the same patients. Findings on resection or exploratory laparotomy were the preferred reference standard. Data extraction, risk of bias, and applicability assessment were performed by two authors using the Quality Assessment of Diagnostic Accuracy Studies-Comparative Tool. Bivariate random-effects meta-analysis and meta-regression were performed with 95% confidence intervals (95% CI).
Results
Three studies were included assessing 474 vessels without vascular invasion and 65 with vascular invasion in 107 patients. All patients were imaged using MRI at ≥ 1.5 T and a pancreatic protocol CT. No difference was shown between MRI and CT for diagnosing PDAC vascular invasion: MRI/CT sensitivity (95% CI) were 71% (47–87%)/74% (56–86%), and specificity were 97% (94–99%)/97% (94–98%). Sources of bias included selection bias from only a subset of CT patients undergoing MRI and verification bias from patients with unresectable disease not confirmed on surgery. No patients received neoadjuvant therapy prior to staging.
Conclusions
Based on limited data, no difference was observed between MRI and pancreatic protocol CT for PDAC vascular invasion assessment. MRI may be an adequate substitute for pancreatic protocol CT in some patients, particularly those who have already had a single-phase CT. Larger and more recent cohort studies at low risk of bias, including patients who have received neoadjuvant therapy, are needed.
Clinical relevance statement
Abdominal MRI performed similarly to pancreatic protocol CT at assessing pancreatic ductal adenocarcinoma vascular invasion, suggesting local staging is adequate in some patients using MRI. More data are needed using larger, more recent cohorts including patients with neoadjuvant treatment.
Key Points
• Based on limited data, no difference was found between MRI and pancreatic protocol CT sensitivity and specificity for diagnosing PDAC vascular invasion (p = 0.81, 0.73 respectively).
• Risk of bias could be reduced in future PDAC MRI vs CT comparative diagnostic test accuracy research by ensuring all enrolled patients undergo both imaging modalities being compared in random order and regardless of the findings on either modality.
• More studies are needed that directly compare the diagnostic performance of MRI and CT for PDAC staging after neoadjuvant therapy.
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Abbreviations
- AUC:
-
Area under the curve
- DTA:
-
Diagnostic test accuracy
- EUS:
-
Endoscopic ultrasound
- MRCP:
-
Magnetic resonance cholangiopancreatography
- PDAC:
-
Pancreatic ductal adenocarcinoma
- PRISMA-DTA:
-
Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies
- QUADAS-C:
-
Quality Assessment of Diagnostic Accuracy Studies-Comparative tool
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Acknowledgements
The authors would like to acknowledge Sadaf Ullah and Rachel Couban for their assistance in develo** the literature search.
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The scientific guarantor of this publication is Christian B. van der Pol.
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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors, Dr. Mostafa Alabousi, has significant statistical expertise.
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Written informed consent was not required for this study because it was based exclusively on data available in the public domain.
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Institutional Review Board approval was not required because this study was based exclusively on data available in the public domain.
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Study subjects in this systematic review were previously reported in their primary publications.
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• multicenter study
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Ankush Jajodia and Ashley Wang are co-first authors with equal contribution.
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Jajodia, A., Wang, A., Alabousi, M. et al. MRI vs. CT for pancreatic adenocarcinoma vascular invasion: comparative diagnostic test accuracy systematic review and meta-analysis. Eur Radiol 33, 6883–6891 (2023). https://doi.org/10.1007/s00330-023-09659-0
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DOI: https://doi.org/10.1007/s00330-023-09659-0