Clinical value of diffusion-weighted MRI for differentiation between benign and malignant gallbladder disease: a systematic review and meta-analysis

Abstract

Background Radiological differentiation between benign and malignant gallbladder disease is important but remains challenging. Furthermore, the clinical value of diffusion-weighted imaging (DWI) remains unclear. Purpose To determine the value of DWI in discriminating benign from malignant gallbladder disease by conducting a systematic review and meta-analysis. Material and Methods The literature was systematically searched. Studies analyzing diagnostic value of DWI in gallbladder disease with histopathology or follow-up as reference standard were included. Study selection and data extraction were done by two reviewers independently. Methodological quality was assessed using the QUADAS-2 tool. Sensitivity and specificity were calculated and displayed in a forest plot. A sensitivity analysis was performed in case of outliers. Pooled sensitivity and specificity of DWI were plotted on a hierarchical summary receiver operating characteristic curve. If available, the added value of DWI to conventional magnetic resonance imaging (MRI) sequences was analyzed. Results Out of 2456 articles, eight studies fulfilled the inclusion criteria; 592 patients with 221 malignant lesions were included. Pooled sensitivity and specificity rates were 0.87 and 0.84, respectively. In two studies, diagnostic accuracy rates improved after adding DWI to conventional MRI (64% and 75% for conventional MRI vs. 89% and 94% after combining conventional MRI with DWI). In another study, the area under the curve increased from 0.92 to 0.95. Conclusion DWI appears to be an accurate imaging technique in discriminating benign from malignant gallbladder disease. To achieve optimal patient care, it should be part of multiparametric MRI and should be combined with other imaging modalities.

Magnetic Resonance Diffusion-Weighted Imaging for Detecting Fundal Intracholecystic Papillary Neoplasm inside Rokitansky-Aschoff Sinuses: A Comparison of Two Cases and a Literature Review

“…In addition, the results from a recent meta-analysis [20] further supported the role of MR-DWI to discriminate malignant from benign gallbladder lesions. In this article, the reported pooled sensitivity/specificity values were 0.87/0.84 across studies.…”

“…Future studies with a higher sample size may better evaluate the incidence of MR-DWI restriction within RAS and the degree of correlation between this radiological sign and histopathology-defined malignancies. In addition, future literature may further explore the differences in ADC measurements between benign and malignant gallbladder lesions in order to better validate the cutoff values of ADC proposed in the recent meta-analysis by Kuipers and colleagues [20].…”

“…Multiple articles advocate for the diagnostic value of MR-DWI in discriminating malignant and benign gallbladder lesions [18][19][20].…”

The Role of Fine Needle Aspiration Cytology in the Diagnosis of Gallbladder Cancer: A Systematic Review

“…Diagnostic accuracy for gallbladder carcinoma slightly improved after adding DWI to regular MRI, from 92% to 95% with overall statistical significance, indicating that DWI can improve diagnostic accuracy for gallbladder cancer [36]. Moreover, in a meta-analysis of 8 studies including a total number of 592 patients, performed by Kuipers et al in 2020, pooled sensitivity and specificity rates were found to be 0.87 and 0.84, respectively [37].…”

Diffusion-Weighted Magnetic Resonance Imaging: Clinical Potential and Applications

“…DWI has been widely used in cancer imaging to detect, characterize, and stage malignant lesions, or even assess the response to therapy, in various anatomical districts besides the brain [ 11 ], such as the breast [ 12 , 13 ], lung [ 14 , 15 ], liver [ 16 ], pancreas [ 17 ], kidney [ 18 ], gallbladder [ 19 ], thyroid [ 20 ], head and neck [ 21 , 22 ], prostate [ 23 , 24 ], vertebral bone marrow [ 25 ], musculoskeletal soft tissue [ 26 ], nasopharynx [ 27 ], ovaries [ 28 ], cervix [ 29 ], and rectum [ 30 ], as well as in the whole body [ 31 ].…”