title: Magnetic resonance cholangiopancreatography in the diagnosis of pancreas divisum: a systematic review and meta-analysis.
abstract: OBJECTIVE
  This study aimed to perform a structured meta-analysis of all eligible studies to assess the overall diagnostic use of magnetic resonance cholangiopancreatography (MRCP) alone or with secretin enhancement (secretin-enhanced MRCP [S-MRCP]) in the detection of pancreas divisum.
  
  
  METHODS
  Two authors independently performed a comprehensive search of PubMed, MEDLINE, and the Cochrane Library from inception to September 2013. Studies were included if they allowed construction of 2 × 2 contingency tables of MRCP and/or S-MRCP compared with criterion standard. DerSimonian-Laird random effect models were used to estimate the pooled sensitivity, specificity, specificity, and quantitative receiver operating characteristics.
  
  
  RESULTS
  Of 51 citations, 10 studies with 1474 patients were included. Secretin-enhanced MRCP had a higher overall diagnostic performance than MRCP (S-MRCP: pooled sensitivity, 86% [95% confidence interval (CI), 77%-93%]; specificity, 97% [95% CI, 94%-99%]; and area under the curve, 0.93 ± 0.056 compared with MRCP: sensitivity, 52% [95% CI, 45%-59%]; specificity, 97% [95% CI, 94%-99%]; and area under the curve, 0.76 ± 0.104). Pooled diagnostic odds ratios were 72.19 (95% CI, 5.66-938.8) and 23.39 (95% CI, 7.93-69.02) for S-MRCP and MRCP, respectively. Visual inspection of the funnel plot showed low potential for publication bias.
  
  
  CONCLUSIONS
  Secretin-enhanced MRCP has a much higher diagnostic accuracy than MRCP and should be preferred for diagnosis of pancreas divisum.
authors.affiliation: From the *Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven; and †Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT.
authors.forename: Tarun
authors.initials: T
authors.lastname: Rustagi
authors.forename: Basile
authors.initials: B
authors.lastname: Njei
mesh_terms: D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D006801:Humans; D010179:Pancreas / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D011859:Radiography; D015203:Reproducibility of Results; D012633:Secretin; D012680:Sensitivity and Specificity
chemical_list: D012633:Secretin