Abstract
Background and Aims
The accurate differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic
ductal adenocarcinoma (PDAC) is clinically important. We aimed to determine significant
MRI features for differentiating AIP from PDAC, including assessment of diffusion-weighted
imaging (DWI).
Methods
We performed a systematic search using three databases. The pooled diagnostic odds
ratio was calculated using a bivariate random effects model to determine significant
MRI features for differentiating AIP from PDAC. The pooled sensitivity and specificity
were calculated. The qualitative systematic review for DWI assessment was performed.
Results
Of nine studies (775 patients), multiple main pancreatic duct (MPD) strictures, absence
of upstream marked MPD dilatation, peripancreatic rim, and duct penetration sign were
significant MRI features for differentiating AIP from PDAC. Absence of MPD dilatation
had the highest pooled sensitivity (87%, 95% CI=68–96%), whereas peripancreatic rim
had the highest pooled specificity (100%, 95% CI=88–100%). Of 12 studies evaluating
DWI, seven reported statistically significant differences in apparent diffusion coefficient
(ADC) values between AIP and PDAC; however, four reported lower ADC values in AIP
than in PDAC, but three reported the opposite result.
Conclusion
The four significant MRI features can be useful to differentiate AIP from PDAC, but
DWI assessment might be limited.
Keywords
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Article info
Publication history
Published online: December 10, 2021
Accepted:
November 15,
2021
Received:
August 30,
2021
Footnotes
Grant Support: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT; grant number: NRF-2019R1G1A1099743).
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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- ADC values from diffusion‐weighted imaging may be lower for autoimmune pancreatitis than for pancreatic ductal adenocarcinomaDigestive and Liver DiseaseVol. 54Issue 7
- PreviewWe read with great interest the article by Ha et al. [1] regarding the meta-analysis of MRI features used to differentiate autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC). The authors concluded that the interpretation of diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) values may be limited, although the four significant MRI features can be useful for differentiating AIP from PDAC. Ha et al. analyzed eight studies for ADC values [2–9] based on their eligibility criteria [1].
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