Original articlePreoperative vascular evaluation with computed tomography and magnetic resonance imaging for pancreatic cancer: A meta-analysis
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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2018, Magnetic Resonance Imaging Clinics of North AmericaStaging Computed Tomography in Patients With Noncurative Laparotomy for Periampullary Cancer: Does Nonstructured Reporting Adequately Communicate Resectability?
2018, Canadian Association of Radiologists JournalCitation Excerpt :We found that in patients who underwent NCL for PC, structured reinterpretation of preoperative CT frequently showed evidence of borderline resectable or unresectable disease. However, the sensitivity and specificity of determining local vascular invasion was lower in this population than previously reported values by about 10%-20% and 30%-50%, respectively [15–19]. One possible explanation is that previous publications included all patients with PC, including those with R0 resections, those with NCLs, and those who were treated nonoperatively.
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2017, Journal of the American College of RadiologyCitation Excerpt :A study comparing 64-detector row MDCT versus 3-T MRI showed for MRI a sensitivity for vascular infiltration of 50% to 80% and a specificity of 96% to 98% [11]. These findings are similar to those found on a meta-analysis of eight studies published between 1997 and 2004 that showed a pooled sensitivity of 67% and pooled specificity of 94%, which was not significantly different from CT [33]. Therefore, MRI and CT can be considered likely comparable with regard to assessment of vascular involvement by tumor.
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2016, The LancetCitation Excerpt :However, contrast-enhanced ultrasonography has a higher sensitivity than MDCT for small or medium lesions.55 MDCT with contrast medium is now routinely performed for the diagnosis of suspicious pancreatic lesions, assessment of resectability, assessment of vascular invasion,56 and diagnosis of metastatic lesions (figure 3). The following CT findings aid in the diagnosis of pancreatic cancer: hypoattenuation (sensitivity 75% and specificity 84%); ductal dilatation (50% and 78%); ductal interruption (45% and 82%); distal pancreatic atrophy (45% and 96%); pancreatic contour anomalies (15% and 92%); and common bile duct dilation (5% and 92%).57
Justifying vein resection with pancreatoduodenectomy
2016, The Lancet OncologyCitation Excerpt :The best chance of achieving no direct invasion of the vein wall is problematic because there is no accurate and available way to verify whether there is actual invasion of the vein wall before committing to synchronous vein resection. Standard staging modalities (CT scanning and MRI) for pancreatic cancer7 tend to under-report venous invasion.53 More accurate reporting might occur if other imaging features were routinely considered, including the degree of circumferential contact by the tumour, length of contact, and degree of venous deformity.54
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These two authors contribute to this work equally.