MRI vs. CT for the Detection of Liver Metastases in Patients With Pancreatic Carcinoma: A Comparative Diagnostic Test Accuracy Systematic Review and Meta‐Analysis

Abstract

Background: The detection of liver metastases is important for pancreatic cancer curative treatment eligibility. The data suggest that magnetic resonance imaging (MRI) is more sensitive than computed tomography (CT) for the diagnosis of pancreatic cancer liver metastases. However, MRI is not currently recommended in multiple published guidelines. Purpose: To perform a comparative diagnostic test accuracy systematic review and meta-analysis comparing CT and MRI for pancreatic cancer liver metastases detection. Study Type: Systematic review and meta-analysis. Data Sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and multiple radiology society meeting archives were searched until November 2018. Comparative design studies reporting on liver CT and MRI accuracy for detection of pancreatic cancer liver metastases in the same cohort were included. Field Strength: 1.5T or 3.0T. Assessment: Demographic, methodologic, and diagnostic test accuracy data were extracted. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. Statistical Tests: Accuracy metrics were obtained using bivariate random-effects meta-analysis. The impact of different covariates on accuracy estimates was assessed using a meta-regression model. Covariates included modality, study design, tumor characteristics, risk of bias, and imaging protocols. Results: Fourteen studies including 987 patients with pancreatic cancer (205 with liver metastases) were included. Sensitivity for CT and MRI was 45% (confidence intervals [95% CI] 21-71%) and 83% (95% CI 74-88%), respectively. Specificity for CT and MRI was 94% (95% CI 84-98%) and 96% (95% CI 93-97%), respectively. The greater observed sensitivity of MRI was preserved in the meta-regression model (P = 0.01), while no difference in specificity was detected (P = 0.16). CT sensitivity was highest for triphasic and quadriphasic examinations compared to single phase or biphasic protocols (P = 0.03). Most studies were at high risk of bias.

Impact of 68Ga-FAPI PET/CT Imaging on the Therapeutic Management of Primary and Recurrent Pancreatic Ductal Adenocarcinomas

“…Standard of care imaging techniques for PDAC include transabdominal ultrasonography (2), computed tomography (3), magnetic resonance imaging (4,5) and endoscopic ultrasonography (6), with contrast enhanced CT considered the gold standard for TNM staging in pre-operative and follow-up settings (7,8). Positron Emission Tomography with 18 F-Fluorodeoxyglucose (FDG) is not part of the clinical routine, but is sensitive for initial TNM-staging (9), evaluation of treatment response (10) and detection of recurrence (11).…”

Diagnostic accuracy of contrast-enhanced diffusion-weighted MRI for liver metastases of pancreatic cancer: towards adequate staging and follow-up of pancreatic cancer – DIA-PANC study: study protocol for an international, multicenter, diagnostic trial

“…Despite the good diagnostic performance of MRI for liver metastases, the benefits of MRI remain unclear, mostly because of low level of evidence, heterogeneity, and bias in the performed studies. Two recently published meta-analyses have suggested the results should be confirmed by performing a well-designed and sufficiently powered study directly comparing liver CT and MRI in the same cohort [37,38].…”

Can preoperative liver MRI with gadoxetic acid help reduce open-close laparotomies for curative intent pancreatic cancer surgery?

“…Ito et al demonstrated that a significant predictor of LM was the identification of possible lesions on EOB-MRI, while other preoperative clinical factors, such as tumor markers and CECT findings were not predictive of LM [ 10 ]. Recently, a systematic review [ 23 ] reported that MRI was more sensitive than CT in detecting pancreatic cancer LM. This study supports our results; however, not all reviewed studies compared EOB-MRI with CECT in patients with PDAC while only two included studies performed MRI with a liver-specific agent in PDAC.…”