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Diagnostic performance of diffusion MRI for pancreatic ductal adenocarcinoma characterisation: A meta-analysis
Jing Chen1, Shuxue Liu1, Yude Tang1
1Department of Radiology, Zhongshan Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Zhongshan, 528400, PR China.
Purpose:
To assess the diagnostic performance of intravoxel incoherent motion (IVIM) and diffusion-weighted imaging (DWI) for characterising pancreatic ductal adenocarcinoma (PDAC).
Method:
A literature search was performed through PubMed, Web of Science, the Cochrane Library, and Embase databases. The search date was updated to extend until 28 October 2020, with no starting time limitation. The pooled sensitivity and specificity were calculated using a bivariate random effects model. Summary receiver operating characteristic curves were constructed, and area under the curve (AUC) of each diffusion parameter was calculated. Subgroup and meta-regression analyses were performed to assess for heterogeneity. Study quality was assessed.
Results:
Twenty-nine studies involving 1579 participants were included, of which 26 evaluated the apparent diffusion coefficient (ADC) and eight evaluated IVIM, with five evaluating both ADC and IVIM. Pooled sensitivity and specificity of ADC were 83 % (95 % CI, 76 %-88 %, I2 = 86 %) and 85 % (95 % CI, 79 %-90 %, I2 = 77 %), respectively, and AUC was 0.91 (95 % CI, 0.88-0.93). The perfusion fraction had the highest diagnostic accuracy in the IVIM model; the pooled sensitivity, specificity, and AUC were 87 % (95 % CI, 81 %-92 %, I2 = 45 %), 88 % (95 % CI, 77 %-94 %, I2 = 57 %), and 0.93 (95 % CI, 0.91-0.95), respectively. The pooled sensitivity, specificity and AUC for the tissue diffusion coefficient were 74 % (95 % CI, 55 %-87 %, I2 = 87 %), 69 % (95 % CI, 52 %-82 %, I2 = 73 %), and 0.77 (95 % CI, 0.73-0.81), respectively. And the pooled sensitivity, specificity, and AUC for the pseudodiffusion coefficient were 89 % (95 % CI, 77 %-96 %, I2 = 79 %), 74 % (95 % CI, 60 %-84 %, I2 = 78 %), and 0.88(95 %CI,0.85-0.91), respectively. Meta-regression analyses revealed that study design (specificity, P＜0.01), region-of-interest delineation (sensitivity, P = 0.02;specificity, P = 0.03), field strength (sensitivity, P＜0.01), and thickness (sensitivity, P＜0.01; specificity, P = 0.01) were sources of ADC heterogeneity.
Conclusions:
DWI and IVIM have comparable diagnostic power and good diagnostic performance for characterising PDAC.
Insights
Diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) show similar, good diagnostic performance for characterizing pancreatic ductal adenocarcinoma (PDAC). These advanced MRI techniques aid in distinguishing PDAC from other pancreatic conditions.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Pancreatic ductal adenocarcinoma (PDAC) is a challenging diagnosis.
- Accurate characterization of PDAC is crucial for effective treatment planning.
- Diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) are advanced MRI techniques with potential for tissue characterization.
Purpose of the Study:
- To evaluate the diagnostic performance of DWI and IVIM in characterizing PDAC.
- To compare the diagnostic accuracy of different diffusion parameters derived from DWI and IVIM.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Web of Science, Cochrane Library, Embase) up to October 2020.
- Bivariate random-effects models were used to calculate pooled sensitivity, specificity, and area under the curve (AUC).
- Subgroup and meta-regression analyses were performed to investigate heterogeneity.
Main Results:
- Twenty-nine studies including 1579 participants were analyzed.
- Apparent diffusion coefficient (ADC) from DWI showed pooled sensitivity of 83% and specificity of 85% (AUC=0.91).
- IVIM parameters, particularly the perfusion fraction, demonstrated high diagnostic accuracy (sensitivity 87%, specificity 88%, AUC=0.93). The pseudodiffusion coefficient also showed good performance (AUC=0.88).
Conclusions:
- DWI and IVIM offer comparable and good diagnostic performance for PDAC characterization.
- IVIM parameters, especially the perfusion fraction, show promising accuracy.
- These imaging techniques can aid in the non-invasive diagnosis and characterization of PDAC.
