Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Department of Radiology and Epidemiology, Ottawa Hospital Research Institute Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada.
J Magn Reson Imaging. 2021 Oct;54(4):1126-1137. doi: 10.1002/jmri.27606. Epub 2021 Apr 13.
Differentiation of benign and malignant pancreatic cystic lesions on MRI, computed tomography (CT), and endoscopic ultrasound (EUS) is critical for determining management.
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.
Systematic review and meta-analysis.
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.
1.5T or 3.0T.
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.
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.
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).
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.
3 TECHNICAL EFFICACY STAGE: 2.
MRI、计算机断层扫描（CT）和内镜超声（EUS）对胰腺囊性病变良恶性的鉴别诊断至关重要，这决定了后续的处理方案。
对 MRI 诊断胰腺囊性病变恶性的准确性进行系统评价，并比较 MRI 与 CT 和 EUS 的准确性。
系统评价和荟萃分析。
检索 MEDLINE、EMBASE、Cochrane 对照试验中心注册库、Web of Science 和 Scopus，截至 2020 年 2 月，以获取报告 MRI 对胰腺囊性病变评估准确性的研究。
1.5T 或 3.0T。
两名审核员（AU 和 MA，均有 2 年的工作经验）提取方法学和结果数据。识别出所有关于 MRI 胰腺囊性病变的研究。排除了 MRI 技术不完整的研究。使用诊断准确性研究质量评估工具（QUADAS-2）评估偏倚风险。
使用二变量随机效应荟萃分析，采用 95%置信区间（95%CI）汇总敏感度/特异性。对 MRI 与 CT 和 EUS 进行两两比较。使用元回归探索钆基造影剂、黏液性病变和偏倚风险的影响。
MRI 鉴别良恶性病变的汇总敏感度为 76%（95%CI 67%84%），特异性为 80%（95%CI 74%85%）。MRI 和 CT 的敏感度（P=0.822）和特异性（P=0.096）相当，但 MRI 的特异性优于 EUS（80%比 75%，P<0.05）。仅包括增强 MRI 的研究比包括非增强检查的研究更敏感（P<0.05）。MRI 敏感度和特异性在黏液性病变中无差异（P=0.537 和 P=0.384），在有偏倚风险的研究中也无差异（P=0.789 和 P=0.791）。
MRI 和 CT 对诊断胰腺囊性病变恶性的准确性相当。EUS 的特异性低于 MRI，这表明在某些情况下，应根据 MRI 结果而非 EUS 结果来指导治疗。
3 级技术效能。
