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Differentiation of autoimmune pancreatitis from pancreatic adenocarcinoma using CT characteristics: a systematic review and meta-analysis

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

Abstract

Objectives

To determine informational CT findings for distinguishing autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC) and to review their diagnostic accuracy.

Methods

A systematic and detailed literature review was performed through PubMed, EMBASE, and the Cochrane library. Similar descriptors to embody the identical image finding were labeled as a single CT characteristic. We calculated the pooled diagnostic odds ratios (DORs) of each CT characteristic using a bivariate random-effects model.

Results

A total of 145 various descriptors from 15 studies (including 562 AIP and 869 PDAC patients) were categorized into 16 CT characteristics. According to the pooled DOR, 16 CT characteristics were classified into three groups (suggesting AIP, suggesting PDAC, and not informational). Seven characteristics suggesting AIP were diffuse pancreatic enlargement (DOR, 48), delayed homogeneous enhancement (DOR, 46), capsule-like rim (DOR, 34), multiple pancreatic masses (DOR, 16), renal involvement (DOR, 15), retroperitoneal fibrosis (DOR, 13), and bile duct involvement (DOR, 8). Delayed homogeneous enhancement showed a pooled sensitivity of 83% and specificity of 85%. The other six characteristics showed relatively low sensitivity (12–63%) but high specificity (93–99%). Four characteristics suggesting PDAC were discrete pancreatic mass (DOR, 23), pancreatic duct cutoff (DOR, 16), upstream main pancreatic duct dilatation (DOR, 8), and upstream parenchymal atrophy (DOR, 7).

Conclusion

Eleven CT characteristics were informational to distinguish AIP from PDAC. Diffuse pancreatic enlargement, delayed homogeneous enhancement, and capsule-like rim suggested AIP with the highest DORs, whereas discrete pancreatic mass suggested PDAC. However, pooled sensitivities of informational CT characteristics were moderate.

Clinical relevance statement

This meta-analysis underscores eleven distinctive CT characteristics that aid in differentiating autoimmune pancreatitis from pancreatic adenocarcinoma, potentially preventing misdiagnoses in patients presenting with focal/diffuse pancreatic enlargement.

Key Points

• Diffuse pancreatic enlargement (pooled diagnostic odds ratio [DOR], 48), delayed homogeneous enhancement (46), and capsule-like rim (34) were CT characteristics suggesting autoimmune pancreatitis.

• The CT characteristics suggesting autoimmune pancreatitis, except delayed homogeneous enhancement, had a general tendency to show relatively low sensitivity (12–63%) but high specificity (93–99%).

• Discrete pancreatic mass (pooled diagnostic odds ratio, 23) was the CT characteristic suggesting pancreatic ductal adenocarcinoma with the highest pooled DORs.

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Abbreviations

AIP:

Autoimmune pancreatitis

CI:

Confidence interval

DOR:

Diagnostic odds ratio

ERP:

Endoscopic retrograde pancreatography

EUS:

Endoscopic ultrasonography

MPD:

Main pancreatic duct

MRCP:

Magnetic resonance cholangiopancreatography

PDAC:

Pancreatic ductal adenocarcinoma

QUADAS-2:

The quality assessment of diagnostic accuracy studies

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Acknowledgements

The review methodology for this study was preregistered on the PROSPERO database (CRD42021277517).

Funding

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

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Author notes

  1. Seung Bae Yoon and Tae Yeon Jeon contributed equally to this work as first authors.

Authors and Affiliations

  1. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Seung Bae Yoon

  2. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Tae Yeon Jeon & Ji Hye Min

  3. Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea

    Sung-Hoon Moon & Dong Woo Shin

  4. Department of Radiology, Cha Gangnam Medical Center, Seoul, South Korea

    Sang Min Lee

  5. Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Moon Hyung Choi

  6. Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea

    Min-Jeong Kim

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Correspondence to Sung-Hoon Moon.

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The scientific guarantor of this publication is Sung-Hoon Moon.

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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 (Seung Bae Yoon) has significant statistical expertise.

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Written informed consent was not required for this study because this study was a systematic review and meta-analysis.

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Institutional review board approval was not required because this study was a systematic review and meta-analysis.

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Yoon, S.B., Jeon, T.Y., Moon, SH. et al. Differentiation of autoimmune pancreatitis from pancreatic adenocarcinoma using CT characteristics: a systematic review and meta-analysis. Eur Radiol 33, 9010–9021 (2023). https://doi.org/10.1007/s00330-023-09959-5

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