目的:评估定量磁共振(MR)成像生物标志物在区分炎性胰腺肿块(IPM)和胰腺癌(PC)中的诊断性能。
方法:使用PubMed进行了文献检索,Embase,Cochrane图书馆,和WebofScience到2023年8月。诊断准确性研究2(QUADAS-2)的质量评估用于评估研究的偏倚风险和适用性。汇集的敏感性,特异性,正似然比,负似然比,和诊断比值比使用DerSimonian-Laird方法计算。使用单因素荟萃回归分析来确定异质性的潜在因素。
结果:本荟萃分析包括24项研究。IPM的两种主要类型,肿块型胰腺炎(MFP)和自身免疫性胰腺炎(AIP),它们的表观扩散系数(ADC)值不同。与PC相比,MFP的ADC值较高,但AIP值较低。ADC的合并敏感性/特异性为0.80/0.85用于区分MFP和PC和0.82/0.84用于区分AIP和PC。上游主胰管最大直径(dMPD)的合并敏感性/特异性为0.86/0.74,截止dMPD≤4mm,和0.97/0.52,截止dMPD≤5mm。灌注分数(f)的合并敏感性/特异性为0.82/0.68,质量刚度值为0.82/0.77。
结论:定量MR成像生物标志物可用于区分IPM和PC。MFP和AIP之间的ADC值不同,他们应该分开考虑在未来的研究。
结论:定量MR参数可作为非侵入性成像生物标志物,用于区分恶性胰腺肿瘤和胰腺炎性肿块,因此有助于避免不必要的手术。
结论:•几种定量MR成像生物标志物在炎性胰腺肿块和胰腺癌的鉴别诊断中表现良好。•ADC值可以辨别胰腺癌与肿块型胰腺炎或自身免疫性胰腺炎,如果两种炎性肿块类型没有合并。•主胰管的直径对于区分自身免疫性胰腺炎和胰腺癌具有最高的特异性。
OBJECTIVE: To evaluate the diagnostic performance of quantitative magnetic resonance (MR) imaging biomarkers in distinguishing between inflammatory pancreatic masses (IPM) and pancreatic cancer (PC).
METHODS: A literature search was conducted using PubMed, Embase, the Cochrane Library, and Web of Science through August 2023. Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) was used to evaluate the risk of bias and applicability of the studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated using the DerSimonian-Laird method. Univariate meta-regression analysis was used to identify the potential factors of heterogeneity.
RESULTS: Twenty-four studies were included in this meta-analysis. The two main types of IPM, mass-forming pancreatitis (MFP) and autoimmune pancreatitis (AIP), differ in their apparent diffusion coefficient (ADC) values. Compared with PC, the ADC value was higher in MFP but lower in AIP. The pooled sensitivity/specificity of ADC were 0.80/0.85 for distinguishing MFP from PC and 0.82/0.84 for distinguishing AIP from PC. The pooled sensitivity/specificity for the maximal diameter of the upstream main pancreatic duct (dMPD) was 0.86/0.74, with a cutoff of dMPD ≤ 4 mm, and 0.97/0.52, with a cutoff of dMPD ≤ 5 mm. The pooled sensitivity/specificity for perfusion fraction (f) was 0.82/0.68, and 0.82/0.77 for mass stiffness values.
CONCLUSIONS: Quantitative MR imaging biomarkers are useful in distinguishing between IPM and PC. ADC values differ between MFP and AIP, and they should be separated for consideration in future studies.
CONCLUSIONS: Quantitative MR parameters could serve as non-invasive imaging biomarkers for differentiating malignant pancreatic neoplasms from inflammatory masses of the pancreas, and hence help to avoid unnecessary surgery.
CONCLUSIONS: • Several quantitative MR imaging biomarkers performed well in
differential diagnosis between inflammatory pancreatic mass and pancreatic cancer. • The ADC value could discern pancreatic cancer from mass-forming pancreatitis or autoimmune pancreatitis, if the two inflammatory mass types are not combined. • The diameter of main pancreatic duct had the highest specificity for differentiating autoimmune pancreatitis from pancreatic cancer.