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MRI vs. CT for pancreatic adenocarcinoma vascular invasion: comparative diagnostic test accuracy systematic review and meta-analysis

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

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 developing the literature search.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, McMaster University, Hamilton Health Sciences, Hamilton, Canada

    Ankush Jajodia,  Christopher Wilks, Ameya Kulkarni  &  Christian B. van der Pol

  2. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada

    Ashley Wang

  3. Joint Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Canada

    Mostafa Alabousi

  4. Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada

    Ameya Kulkarni  &  Christian B. van der Pol

Authors
  1. Ankush Jajodia
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  2. Ashley Wang
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  3. Mostafa Alabousi
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  4. Christopher Wilks
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  5. Ameya Kulkarni
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  6. Christian B. van der Pol
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Corresponding author

Correspondence to Christian B. van der Pol.

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Guarantor

The scientific guarantor of this publication is Christian B. van der Pol.

Conflict of interest

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.

Informed consent

Written informed consent was not required for this study because it was based exclusively on data available in the public domain.

Ethical approval

Institutional Review Board approval was not required because this study was based exclusively on data available in the public domain.

Study subjects or cohorts overlap

Study subjects in this systematic review were previously reported in their primary publications.

Methodology

• retrospective

• diagnostic or prognostic study

• 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

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