Elsevier

Pancreatology

Volume 12, Issue 3, May–June 2012, Pages 227-233
Pancreatology

Original article
Preoperative vascular evaluation with computed tomography and magnetic resonance imaging for pancreatic cancer: A meta-analysis

https://doi.org/10.1016/j.pan.2012.03.057Get rights and content

Abstract

Objectives

Vascular invasion (VI) is the most important factor in assessing operability for pancreatic cancer. The accuracy of preoperative vascular staging with computed tomography (CT) and magnetic resonance imaging (MRI) was examined using meta-analysis.

Methods

Published articles in pancreatic cancer comparing diagnostic accuracy of CT with MRI for VI confirmed on histology were searched from MEDLINE, EMBASE and ISI Web of Science databases. Pooled sensitivity, specificity, likelihood ratio, summary receiver operating characteristic (SROC) curve and area under curve (AUC) were analysed by SPSS 13.0 and Revmen 5.1.

Results

Eight studies (n = 296) met the inclusion criteria. The pooled sensitivity of CT and MRI in diagnosing VI was 71% (95% CI, 64–78) and 67% (95% CI, 59–74), pooled specificity 92% (95% CI, 89–95) and 94% (95% CI, 91–96), positive likelihood ratio 6.33 (95% CI, 4.51–8.87) and 6.58 (95% CI, 4.62–9.37), negative likelihood ratio 0.34 (95% CI, 0.27–0.43) and 0.38 (95% CI, 0.30–0.47), and AUCs 0.87 and 0.76 (p = 0.63), respectively. There was no significant difference between CT and MRI for preoperative diagnosis of VI. Subgroup analysis of 4 studies (n = 143) showed no significant difference between CT and MRI in preoperative diagnosis of venous or arterial invasion (p = 0.73 and p = 0.81, respectively). When CT was compared with MRA in 3 studies (n = 110), again there was no significant difference for preoperative staging of VI (p = 0.54).

Conclusions

Both CT and MRI are underreporting vascular invasion preoperatively in pancreatic cancer. MRA does not add any additional information on vascular staging when compared with CT and MRI.

Introduction

Pancreatic cancer ranks the sixth most common cancer and forth cause of death from cancer in the western world, with a poor 5-year survival rate [1], [2]. Surgical resection remains the only chance for cure with the best 5-year survival rate ranging from 25% to 5% for pancreatic adenocarcinoma [3], [4], [5]. Besides metastatic disease, vascular invasion is the most important and frequent factor precluding surgical resection, present in 21%–64% of cases [5], [6], [7]. Furthermore, vascular invasion is also an important predictor for poor prognosis after local resection [8], [9]. To increase the number of cases for surgery, vascular resection and reconstitution are commonly performed in major pancreatic centres [8], [9], [10], [11]. As a result, an accurate diagnosis of vascular invasion preoperatively is crucial in determining treatment modalities.

Computed tomography (CT) and magnetic resonance imaging (MRI) are the most commonly used image modalities for preoperative staging of pancreatic cancer. There remains controversial in selection of either CT or MRI as an optimal imaging tool to decide vascular invasion in pancreatic cancer [11]. The aim of this meta-analysis is to compare CT with MRI in preoperative evaluation of vascular invasion in patients with pancreatic cancer.

Section snippets

Materials and methods

The MEDLINE (via PubMed), EMBASE (via Ovid), and ISI Web of Science were searched systematically for all articles published between January 1990 and December 2010 using terms, computed tomography, CT, magnetic resonance imaging, MRI, pancreatic cancer, vascular, vessel, sensitivity and specificity. The “related articles” function was used to broaden the search, as well as performing the search using truncated search terms utilizing the wildcard (“*”) character, and articles were also identified

Search results and study selection

A total of 77 relevant articles were extracted and reviewed by 2 independent reviewers. Eight studies [13], [14], [15], [16], [17], [18], [19], [20] (n = 296), including 4 prospective and 4 retrospective studies, that met the inclusion criteria were included in this analysis. The methodological qualities of these studies were of moderate quality, and all of them fulfilled at least 8 of the 13 items (Fig. 1). All studies used surgical and/or histological finding as a “gold standard” diagnosis of

Disscusion

There was no evidence-based consensus on the optimal preoperative imaging technique in patients with suspected pancreatic cancer [2], [6], [7]. To our knowledge, this study is the first meta-analysis comparing CT with MRI and MRA on preoperative evaluation of vascular invasion in pancreatic cancer. To minimize the population bias, only the studies with both CT and MRI/MRA as a preoperative diagnostic tool for vascular invasion in same population (direct “head-to-head” studies) were included in

Conflict of interest

None.

Financial disclosure

None.

Acknowledgement

None.

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    These two authors contribute to this work equally.

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