title: Diagnostic performance of imaging modalities in chronic pancreatitis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Obtain summary estimates of sensitivity and specificity for imaging modalities for chronic pancreatitis (CP) assessment.
  
  
  METHODS
  A systematic search was performed in Cochrane Library, MEDLINE, Embase and CINAHL databases for studies evaluating imaging modalities for the diagnosis of CP up to September 2016. A bivariate random-effects modeling was used to obtain summary estimates of sensitivity and specificity.
  
  
  RESULTS
  We included 43 studies evaluating 3460 patients. Sensitivity of endoscopic retrograde cholangiopancreatography (ERCP) (82%; 95%CI: 76%-87%) was significant higher than that of abdominal ultrasonography (US) (67%; 95%CI: 53%-78%; P=0.018). The sensitivity estimates of endoscopic ultrasonography (EUS), magnetic resonance imaging (MRI), and computed tomography (CT) were 81% (95%CI: 70%-89%), 78% (95%CI: 69%-85%), and 75% (95%CI: 66%-83%), respectively, and did not differ significantly from each other. Estimates of specificity were comparable for EUS (90%; 95%CI: 82%-95%), ERCP (94%; 95%CI: 87%-98%), CT (91%; 95% CI: 81%-96%), MRI (96%; 95%CI: 90%-98%), and US (98%; 95%CI: 89%-100%).
  
  
  CONCLUSIONS
  EUS, ERCP, MRI and CT all have comparable high diagnostic accuracy in the initial diagnosis of CP. EUS and ERCP are outperformers and US has the lowest accuracy. The choice of imaging modality can therefore be made based on invasiveness, local availability, experience and costs.
  
  
  CONCLUSIONS
  • EUS, ERCP, MRI and CT have high diagnostic sensitivity for chronic pancreatitis • Diagnostic specificity is comparable for all imaging modalities • EUS and ERCP are outperformers and US has the lowest accuracy • The choice of imaging can be made based on clinical considerations.
authors.affiliation: Department of Surgery, Academic Medical Centre, Meibergdreef 9, 1100DD, Amsterdam, The Netherlands.
authors.forename: Y
authors.initials: Y
authors.lastname: Issa
authors.affiliation: Department of Surgery, Academic Medical Centre, Meibergdreef 9, 1100DD, Amsterdam, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Kempeneers
authors.affiliation: Department of Surgery, Academic Medical Centre, Meibergdreef 9, 1100DD, Amsterdam, The Netherlands.
authors.forename: H C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Department of Radiology, St Antonius Ziekenhuis, Koekoekslaan 1, 3430EM, Nieuwegein, The Netherlands.
authors.forename: T L
authors.initials: TL
authors.lastname: Bollen
authors.affiliation: Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1100DD, Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Bipat
authors.affiliation: Department of Surgery, Academic Medical Centre, Meibergdreef 9, 1100DD, Amsterdam, The Netherlands. m.a.boermeester@amc.uva.nl.
authors.forename: M A
authors.initials: MA
authors.lastname: Boermeester
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D003952:Diagnostic Imaging / Q000379:methods* / Q000592:standards*; D019160:Endosonography; D006801:Humans; D008279:Magnetic Resonance Imaging; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
keywords: Chronic pancreatitis; Diagnostic accuracy; Diagnostic imaging; Meta-analysis