Yoon Seung Bae, Jeon Tae Yeon, Moon Sung-Hoon, Lee Sang Min, Kim Myung-Hwan
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Eur Radiol. 2022 Oct;32(10):6691-6701. doi: 10.1007/s00330-022-08816-1. Epub 2022 Apr 29.
To identify reliable MRI features for differentiating autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC) and to summarize their diagnostic accuracy.
We conducted a systematic literature review and meta-analysis using PubMed, EMBASE, and the Cochrane Library to identify original articles published between January 2006 and July 2021. The pooled diagnostic accuracy, including the diagnostic odds ratios (DORs) with 95% confidence intervals (CIs) of the identified features, was calculated using a bivariate random effects model.
Twelve studies were included, and 92 overlapping descriptors were subsumed under 16 MRI features. Ten features favoring AIP were diffuse enlargement (DOR, 75; 95% CI, 9-594), capsule-like rim (DOR, 52; 95% CI, 20-131), multiple main pancreatic duct (MPD) strictures (DOR, 47; 95% CI, 17-129), homogeneous delayed enhancement (DOR, 46; 95% CI, 21-104), low apparent diffusion coefficient value (DOR, 30), speckled enhancement (DOR, 30), multiple pancreatic masses (DOR, 29), tapered narrowing of MPD (DOR, 15), penetrating duct sign (DOR, 14), and delayed enhancement (DOR, 13). Six features favoring PDAC were target type enhancement (DOR, 41; 95% CI, 11-158), discrete pancreatic mass (DOR, 35; 95% CI, 15-80), upstream MPD dilatation (DOR, 13), peripancreatic fat infiltration (DOR, 10), upstream parenchymal atrophy (DOR, 5), and vascular involvement (DOR, 3).
This study identified 16 informative MRI features to differentiate AIP from PDAC. Among them, diffuse enlargement, capsule-like rim, multiple MPD strictures, and homogeneous delayed enhancement favored AIP with the highest DORs, whereas discrete mass and target type enhancement favored PDAC.
• The MRI features with the highest pooled diagnostic odds ratios (DORs) for autoimmune pancreatitis were diffuse enlargement of the pancreas (75), capsule-like rim (52), multiple strictures of the main pancreatic duct (47), and homogeneous delayed enhancement (46). • The MRI features with the highest pooled DORs for pancreatic ductal adenocarcinoma were target type enhancement (41) and discrete pancreatic mass (35).
确定用于鉴别自身免疫性胰腺炎（AIP）与胰腺导管腺癌（PDAC）的可靠MRI特征，并总结其诊断准确性。
我们使用PubMed、EMBASE和Cochrane图书馆进行了系统的文献综述和荟萃分析，以识别2006年1月至2021年7月期间发表的原始文章。使用双变量随机效应模型计算汇总诊断准确性，包括所识别特征的诊断比值比（DOR）及其95%置信区间（CI）。
纳入12项研究，92个重叠描述符归入16个MRI特征。有利于AIP的10个特征为弥漫性肿大（DOR，75；95%CI，9 - 594）、包膜样边缘（DOR，52；95%CI，20 - 131）、多条主胰管（MPD）狭窄（DOR，47；95%CI，17 - 129）、均匀延迟强化（DOR，46；95%CI，21 - 104）、低表观扩散系数值（DOR，30）、斑点状强化（DOR，30）、多个胰腺肿块（DOR，29）、MPD逐渐变细狭窄（DOR，15）、穿入导管征（DOR，14）和延迟强化（DOR，13）。有利于PDAC的6个特征为靶样强化（DOR，41；95%CI，11 - 158）、孤立性胰腺肿块（DOR，35；95%CI，15 - 80）、MPD上游扩张（DOR，13）、胰周脂肪浸润（DOR，10）、上游实质萎缩（DOR，5）和血管受累（DOR，3）。
本研究确定了16个有助于鉴别AIP与PDAC的MRI特征。其中，弥漫性肿大、包膜样边缘、多条MPD狭窄和均匀延迟强化有利于AIP，DOR最高；而孤立性肿块和靶样强化有利于PDAC。
• 自身免疫性胰腺炎汇总诊断比值比（DOR）最高的MRI特征为胰腺弥漫性肿大（75）、包膜样边缘（52）、主胰管多处狭窄（47）和均匀延迟强化（46）。• 胰腺导管腺癌汇总DOR最高的MRI特征为靶样强化（41）和孤立性胰腺肿块（35）。
