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Quantitative MR imaging biomarkers for distinguishing inflammatory pancreatic mass and pancreatic cancer—a systematic review and meta-analysis

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Abstract

Objectives

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.

Clinical relevance statement

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.

Key Points

• 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.

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Abbreviations

ADC:

Apparent diffusion coefficient

AIP:

Autoimmune pancreatitis

CI:

Confidence interval

CP:

Chronic pancreatitis

D fast :

Fast component of diffusion

dMPD:

Maximal diameter of upstream main pancreatic duct (dMPD)

D slow :

Slow component of diffusion

DWI:

Diffusion-weighted imaging

f :

Perfusion fraction

IPM:

Inflammatory pancreatic mass

IVIM:

Intravoxel incoherent motion

MFP:

Mass-forming pancreatitis

MR:

Magnetic resonance

MRE:

Magnetic resonance elastography

PC:

Pancreatic cancer

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Funding

This study was funded by the National Natural Science Foundation of China (82371950 to L. Zhu), and National High Level Hospital Clinical Research Funding (2022-PUMCH-B-069 to H. Xue).

National Natural Science Foundation of China,82371950,Liang Zhu ,National High Level Hospital Clinical Research Funding ,2022-PUMCH-B-069,Hua-dan Xue

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Author notes

  1. Zi-he Wang, Liang Zhu contributed equally to this work.

Authors and Affiliations

  1. School of Medicine, Anhui Medical University, Hefei, China

    Zi-he Wang

  2. Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China

    Liang Zhu, Hua-dan Xue & Zheng-yu Jin

Authors
  1. Zi-he Wang
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  2. Liang Zhu
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Correspondence to Liang Zhu or Hua-dan Xue.

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The scientific guarantor of this publication is Professor Hua-dan Xue from Department of Radiology, Peking Union Medical College Hospital, Beijing, China.

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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

No complex statistical methods were necessary for this paper.

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

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Institutional Review Board approval was not required because this study was a systematic and meta-analysis.

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  • retrospective

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Hua-dan Xue and Liang Zhu are co-corresponding authors.

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Wang, Zh., Zhu, L., Xue, Hd. et al. Quantitative MR imaging biomarkers for distinguishing inflammatory pancreatic mass and pancreatic cancer—a systematic review and meta-analysis. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10720-9

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