Preoperative vascular evaluation with computed tomography and magnetic resonance imaging for pancreatic cancer: a meta-analysis.
OBJECTIVE
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.
Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, United Kingdom.
Yaojun
Y
Zhang
Jia
J
Huang
MinShan
M
Chen
Long R
LR
Jiao
D019540:Area Under Curve; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000098:blood supply* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed