Diagnostic Accuracy of MRI for Differentiation of Benign and Malignant Pancreatic Cystic Lesions Compared to CT and Endoscopic Ultrasound: Systematic Review and Meta‐analysis

Abstract

Background Differentiation of benign and malignant pancreatic cystic lesions on MRI, computed tomography (CT), and endoscopic ultrasound (EUS) is critical for determining management. Purpose To perform a systematic review evaluating the diagnostic accuracy of MRI for diagnosing malignant pancreatic cystic lesions, and to compare the accuracy of MRI to CT and EUS. Study Type Systematic review and meta‐analysis. Data Sources MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched until February 2020 for studies reporting MRI accuracy for assessing pancreatic cystic lesions. Field Strength 1.5T or 3.0T. Assessment Methodologic and outcome data were extracted by two reviewers (AU and MA, 2 years of experience each). All studies of pancreatic cystic lesions on MRI were identified. Studies with incomplete MRI technique were excluded. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)‐2 tool. Statistical Tests Sensitivity/specificity was pooled using bivariate random‐effects meta‐analysis with 95% confidence intervals (95%CI). Pairwise‐comparison of MRI to CT and EUS was performed. The impact of gadolinium‐based contrast agents, mucinous lesions, and risk of bias were explored using meta‐regression. Results MRI pooled sensitivity was 76% (95%CI 67% to 84%) and specificity was 80% (95%CI 74% to 85%) for distinguishing benign and malignant lesions. MRI and CT had similar sensitivity (P = 0.822) and specificity (P = 0.096), but MRI was more specific than EUS (80% vs. 75%, P < 0.05). Studies including only contrast‐enhanced MRI were more sensitive than those including unenhanced exams (P < 0.05). MRI sensitivity and specificity did not differ for mucinous lesions (P = 0.537 and P = 0.384, respectively) or for studies at risk of bias (P = 0.789 and P = 0.791, respectively). Data Conclusion MRI and CT demonstrate comparable accuracy for diagnosing malignant pancreatic cystic lesions. EUS is less specific than MRI, which suggests that, in some cases, management should be guided by MRI findings rather than EUS. Level of Evidence 3 Technical Efficacy Stage 2

Pancreatic Cystic Lesions on MRI: What Is The Likelihood of a Present or Future Diagnosis of Pancreatic Carcinoma?

“…34 MRI is also relatively accurate at characterizing PCL morphology. 35 Studies with recruitment dates from the same time frame (prior to approximately 2010) often included many PCLs detected without MRI, possibly due to more limited availability of MRI at that time, which may have contributed towards selection bias by capturing proportionately more patients with symptomatic PCLs or with other aggressive features. 36,37 In a recent study limited exclusively to abdominal MRI, Nakhaei et al compared 267 patients with a PCL ≥5 mm to <20 mm, to 1459 patients without a PCL and found that the incidence rate of pancreatic cancer did not differ, 0.9 (95% CI: 0.1, 3.1) cases per 1000 person-years vs 1.8 (95% CI: 1.2, 3.1) cases per 1000 person-years respectively.…”

Advances in the Diagnosis of Pancreatic Cystic Lesions

“…MRI/MRCP has very good sensitivity of 91.4–100.0% and specificity of 89.7%, when assessing main pancreatic duct (MPD) communication. In a more recent meta-analysis, MRI had a sensitivity of 76% (95% CI 67% to 84%) and specificity of 80% (95% CI 74% to 85%) for distinguishing benign from malignant lesions, which is similar to the performances of CT scanning [ 29 ]. By combining MDCT and MRI, the accuracy of predicting malignancy of a PCL increased from 61% (MDCT alone) to 81% [ 30 ].…”

Application of Artificial Intelligence in the Management of Pancreatic Cystic Lesions

“…This has led researchers to explore the capabilities of MRI-based radiomics for the identification and prognostication of PCLs. Udare et al recently published a comparative analysis between CT- and MRI-based quantitative imaging to distinguish between benign and malignant PCLs that revealed comparable sensitivities and specificities [ 60 ].…”