Department of Radiology, Stanford University, 300 Pasteur Drive, Suite H1330, Stanford, USA.
Faculdade de Medicina, Universidade Federal de Minas Gerais, 190 Prof Alfredo Balena Ave, Belo Horizonte, Brazil.
Eur Radiol. 2024 Jan;34(1):106-114. doi: 10.1007/s00330-023-10069-5. Epub 2023 Aug 11.
To perform a systematic review and meta-analysis to evaluate if magnetic resonance imaging (MRI) with diffusion weighted imaging (DWI) adds value compared to contrast-enhanced computed tomography (CECT) alone in the preoperative evaluation of pancreatic cancer.
MEDLINE, EMBASE, and Cochrane databases were searched for relevant published studies through October 2022. Studies met eligibility criteria if they evaluated the per-patient diagnostic performance of MRI with DWI in the preoperative evaluation of newly diagnosed pancreatic cancer compared to CECT. Our primary outcome was the number needed to treat (NNT) to prevent one futile surgery using MRI with DWI, defined as those in which CECT was negative and MRI with DWI was positive for liver metastasis (i.e., surgical intervention in metastatic disease missed by CECT). The secondary outcomes were to determine the diagnostic performance and the NNT of MRI with DWI to change management in pancreatic cancer.
Nine studies met the inclusion criteria with a total of 1121 patients, of whom 172 had liver metastasis (15.3%). The proportion of futile surgeries reduced by MRI with DWI was 6.0% (95% CI, 3.0-11.6%), yielding an NNT of 16.6. The proportion of cases that MRI with DWI changed management was 18.1% (95% CI, 9.9-30.7), corresponding to an NNT of 5.5. The per-patient sensitivity and specificity of MRI were 92.4% (95% CI, 87.4-95.6%) and 97.3% (95% CI, 96.0-98.1).
MRI with DWI may prevent futile surgeries in pancreatic cancer by improving the detection of occult liver metastasis on preoperative CECT with an NNT of 16.6.
MRI with DWI complements the standard preoperative CECT evaluation for liver metastasis in pancreatic cancer, improving the selection of surgical candidates and preventing unnecessary surgeries.
• The NNT of MRI with DWI to prevent potential futile surgeries due to occult liver metastasis on CECT, defined as those in which CECT was negative and MRI with DWI was positive for liver metastasis, in patients with pancreatic cancer was 16.6. • The higher performance of MRI with DWI to detect liver metastasis occult on CECT can be attributed to an increased detection of subcentimeter liver metastasis.
进行系统评价和荟萃分析，以评估磁共振成像（MRI）联合弥散加权成像（DWI）与单独增强计算机断层扫描（CECT）相比，在术前评估胰腺癌中的附加价值。
通过 2022 年 10 月检索 MEDLINE、EMBASE 和 Cochrane 数据库中相关已发表的研究。如果研究评估了新诊断胰腺癌患者术前 MRI 联合 DWI 相对于 CECT 的个体诊断性能，则符合入选标准。我们的主要结局是使用 MRI 联合 DWI 预防因 CECT 阴性而 MRI 联合 DWI 阳性（即 CECT 漏诊的转移性疾病的手术干预）导致的无效手术所需的治疗人数（NNT）。次要结局是确定 MRI 联合 DWI 改变胰腺癌管理的诊断性能和 NNT。
共有 9 项研究符合纳入标准，共纳入 1121 例患者，其中 172 例患者有肝转移（15.3%）。MRI 联合 DWI 降低无效手术的比例为 6.0%（95%可信区间，3.0-11.6%），NNT 为 16.6。MRI 联合 DWI 改变管理的病例比例为 18.1%（95%可信区间，9.9-30.7%），NNT 为 5.5。MRI 联合 DWI 的个体敏感性和特异性分别为 92.4%（95%可信区间，87.4-95.6%）和 97.3%（95%可信区间，96.0-98.1%）。
MRI 联合 DWI 通过提高术前 CECT 对隐匿性肝转移的检测能力，从而预防胰腺癌的无效手术，NNT 为 16.6。
MRI 联合 DWI 补充了胰腺癌标准术前 CECT 对肝转移的评估，改善了手术候选者的选择，避免了不必要的手术。
• 对于因 CECT 阴性而 MRI 联合 DWI 阳性（即 CECT 漏诊的转移性疾病的手术干预）导致的隐匿性肝转移的潜在无效手术，MRI 联合 DWI 的 NNT 为 16.6。• MRI 联合 DWI 检测 CECT 上隐匿性肝转移的性能更高，可能归因于对亚厘米级肝转移的检测增加。
