Diagnostic value of diffusion‐weighted magnetic resonance imaging compared with fluorodeoxyglucose positron emission tomography/computed tomography for pancreatic malignancy: A meta‐analysis using a hierarchical regression model

Abstract

Background and Aim: To obtain diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the detection of pancreatic malignancy. Methods: We performed a meta-analysis of all available studies of the diagnostic performance of DWI and PET/CT for pancreatic malignancy. MEDLINE, EMBASE, Cochrane library and some other databases were searched for initial studies. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves (SROC) using hierarchical regression models. Results: Across 16 studies with 804 patients, PET/CT sensitivity was 0.87 (95% confidence interval [CI], 0.82, 0.81) and specificity was 0.83 (95% CI, 0.71, 0.91). Overall, LR+ was 5.84 (95% CI, 4.59, 7.42) and LR-was 0.24 (95% CI, 0.17, 0.33). DWI sensitivity was 0.85 (95% CI, 0.74, 0.92) and specificity was 0.91 (95% CI, 0.71, 0.98). LR+ was 9.53 (95% CI, 2.41, 37.65) and LR-was 0.17 (95% CI, 0.09, 0.32). In subgroup analysis, the sensitivity of enhanced versus unenhanced PET/CT in the detection of pancreatic cancer was 0.91 (95% CI, 0.86, 0.96) versus 0.84 (95% CI, 0.78, 0.90) (P > 0.05), the specificity 0.88 (95% CI, 0.73, 1.00) versus 0.81 (95% CI, 0.69, 0.94) (P > 0.05). Conclusion: Positron emission tomography/computed tomography (PET/CT) was highly sensitive and DWI was a highly specific modality in diagnosing patients with pancreatic malignancy. PET/CT and DWI could play different roles in diagnosing pancreatic carcinoma. Enhanced PET/CT seems to be superior to unenhanced PET/CT. Further larger prospective studies are needed to establish its value for diagnosis in pancreatic cancer.

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

“…Five meta-analyses have compared PET with PET/CT and a variety of other imaging modalities. 24,41,44,45,77 The sensitivities and specificities in these meta-analyses are provided in Table 63. The sensitivity and specificity of 92.7% and 75.8% for PET/CT from the PET-PANC study are similar to those found in the latest meta-analysis by Rijkers et al 41 There is a lack of comparison between PET/CT and MDCT in these meta-analyses.…”

Multiparametric MR Imaging in Abdominal Malignancies

“…38 Most commonly, PA shows high SI on high b-value imaging and lower ADC values than normal pancreas, related to dense fibrosis and increased cellular elements 39 (Fig. 8).…”

Pancreatic Adenocarcinoma

“…According to some authors, the improvement in PET-CT devices (and particularly the use of iodated contrast media) allows better results [8]. In conclusion, imaging has shown significant improvements in the assessment of pancreatic cancer, particularly in view of pancreatic surgery.…”