CT 和 MRI 对自身免疫性胰腺炎与胰腺腺癌鉴别诊断的荟萃分析。
Meta-analysis of CT and MRI for differentiation of autoimmune pancreatitis from pancreatic adenocarcinoma.
机构信息
Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, South Korea.
出版信息
Eur Radiol. 2021 May;31(5):3427-3438. doi: 10.1007/s00330-020-07416-1. Epub 2020 Nov 4.
OBJECTIVES
To systematically determine the diagnostic performance of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiating autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC), with a comparison between the two imaging modalities.
METHODS
Literature search was conducted using PubMed and EMBASE databases to identify original articles published between 2009 and 2019 reporting the diagnostic performance of CT and MRI for differentiating AIP from PDAC. The meta-analytic sensitivity and specificity of CT and MRI were calculated, and compared using a bivariate random effects model. Subgroup analysis for differentiating focal AIP from PDAC was performed.
RESULTS
Of the 856 articles screened, 11 eligible articles are remained, i.e., five studies for CT, four for MRI, and two for both. The meta-analytic summary sensitivity and specificity of CT were 59% (95% confidence interval [CI], 41-75%) and 99% (95% CI, 88-100%), respectively, while those of MRI were 84% (95% CI, 68-93%) and 97% (95% CI, 87-99%). MRI had a significantly higher meta-analytic summary sensitivity than CT (84% vs. 59%, p = 0.02) but a similar specificity (97% vs. 99%, p = 0.18). In the subgroup analysis for focal AIP, the sensitivity for distinguishing between focal AIP and PDAC was lower than that for the overall analysis. MRI had a higher sensitivity than CT (76% vs. 50%, p = 0.28) but a similar specificity (97% vs. 98%, p = 0.07).
CONCLUSION
MRI might be clinically more useful to evaluate patients with AIP, particularly for differentiating AIP from PDAC.
KEY POINTS
• MRI had an overall good diagnostic performance to differentiate AIP from PDAC with a meta-analytic summary estimate of 83% for sensitivity and of 97% for specificity. • CT had a very high specificity (99%), but a suboptimal sensitivity (59%) for differentiating AIP from PDAC. • Compared with CT, MRI had a higher sensitivity, but a similar specificity.
目的
系统评估计算机断层扫描（CT）和磁共振成像（MRI）在鉴别自身免疫性胰腺炎（AIP）与胰腺导管腺癌（PDAC）方面的诊断性能，并比较两种影像学方法的表现。
方法
使用 PubMed 和 EMBASE 数据库检索 2009 年至 2019 年间发表的关于 CT 和 MRI 鉴别 AIP 与 PDAC 的原始文章，以评估其诊断性能。采用双变量随机效应模型计算并比较 CT 和 MRI 的汇总敏感性和特异性。对鉴别局灶性 AIP 与 PDAC 的亚组分析进行了评估。
结果
在筛选出的 856 篇文章中，最终纳入 11 项符合条件的研究，其中 5 项为 CT 研究，4 项为 MRI 研究，2 项同时采用了 CT 和 MRI。CT 的汇总敏感性和特异性分别为 59%（95%置信区间 [CI]，41-75%）和 99%（95% CI，88-100%），MRI 则分别为 84%（95% CI，68-93%）和 97%（95% CI，87-99%）。MRI 的汇总敏感性显著高于 CT（84% vs. 59%，p=0.02），但特异性相似（97% vs. 99%，p=0.18）。在鉴别局灶性 AIP 的亚组分析中，鉴别局灶性 AIP 与 PDAC 的敏感性低于整体分析。MRI 的敏感性高于 CT（76% vs. 50%，p=0.28），但特异性相似（97% vs. 98%，p=0.07）。
结论
MRI 可能在评估 AIP 患者方面具有更高的临床应用价值，尤其是在鉴别 AIP 与 PDAC 方面。
关键要点
MRI 总体上具有良好的鉴别诊断性能，其鉴别 AIP 与 PDAC 的汇总敏感性为 83%，特异性为 97%。
CT 鉴别 AIP 与 PDAC 的特异性很高（99%），但敏感性欠佳（59%）。
与 CT 相比，MRI 的敏感性更高，特异性相似。
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