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Systematic review and meta-analysis of MRI features for differentiating autoimmune pancreatitis from pancreatic adenocarcinoma



To identify reliable MRI features for differentiating autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC) and to summarize their diagnostic accuracy.


We conducted a systematic literature review and meta-analysis using PubMed, EMBASE, and the Cochrane Library to identify original articles published between January 2006 and July 2021. The pooled diagnostic accuracy, including the diagnostic odds ratios (DORs) with 95% confidence intervals (CIs) of the identified features, was calculated using a bivariate random effects model.


Twelve studies were included, and 92 overlapping descriptors were subsumed under 16 MRI features. Ten features favoring AIP were diffuse enlargement (DOR, 75; 95% CI, 9–594), capsule-like rim (DOR, 52; 95% CI, 20–131), multiple main pancreatic duct (MPD) strictures (DOR, 47; 95% CI, 17–129), homogeneous delayed enhancement (DOR, 46; 95% CI, 21–104), low apparent diffusion coefficient value (DOR, 30), speckled enhancement (DOR, 30), multiple pancreatic masses (DOR, 29), tapered narrowing of MPD (DOR, 15), penetrating duct sign (DOR, 14), and delayed enhancement (DOR, 13). Six features favoring PDAC were target type enhancement (DOR, 41; 95% CI, 11–158), discrete pancreatic mass (DOR, 35; 95% CI, 15–80), upstream MPD dilatation (DOR, 13), peripancreatic fat infiltration (DOR, 10), upstream parenchymal atrophy (DOR, 5), and vascular involvement (DOR, 3).


This study identified 16 informative MRI features to differentiate AIP from PDAC. Among them, diffuse enlargement, capsule-like rim, multiple MPD strictures, and homogeneous delayed enhancement favored AIP with the highest DORs, whereas discrete mass and target type enhancement favored PDAC.

Key Points

• The MRI features with the highest pooled diagnostic odds ratios (DORs) for autoimmune pancreatitis were diffuse enlargement of the pancreas (75), capsule-like rim (52), multiple strictures of the main pancreatic duct (47), and homogeneous delayed enhancement (46).

• The MRI features with the highest pooled DORs for pancreatic ductal adenocarcinoma were target type enhancement (41) and discrete pancreatic mass (35).

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Apparent diffusion coefficient


Autoimmune pancreatitis


Confidence interval


Diagnostic odds ratio


Diffusion-weighted imaging


Main pancreatic duct


Magnetic resonance cholangiopancreatography


Negative likelihood ratio


Pancreatic ductal adenocarcinoma


Positive likelihood ratio


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Correspondence to 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. Systematic review and meta-analysis of MRI features for differentiating autoimmune pancreatitis from pancreatic adenocarcinoma. Eur Radiol 32, 6691–6701 (2022).

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