Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2015; 21(20): 6374-6380
Published online May 28, 2015. doi: 10.3748/wjg.v21.i20.6374
Differential diagnosis of pancreatic cancer by single-shot echo-planar imaging diffusion-weighted imaging
Ben-Zu Hong, Xin-Feng Li, Jian-Qing Lin
Ben-Zu Hong, Xin-Feng Li, Department of General Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
Jian-Qing Lin, Department of Oncological Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
Author contributions: Hong BZ designed the study, analyzed the data and wrote the manuscript; Li XF contributed to the discussion; Hong BZ and Lin JQ revised the manuscript; and Lin JQ designed the study, contributed to the discussion and revised the manuscript as the corresponding author.
Supported by Key Program of Scientific Research of Fujian Medical University, FMU 09ZD014.
Conflict-of-interest: We declare that we have no conflict of interest.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Jian-Qing Lin, Department of Oncological Surgery, Second Affiliated Hospital of Fujian Medical University, No. 34 Zhongshan North Road, Quanzhou 362000, Fujian Province, China. gianty2005@yahoo.com
Telephone: +86-59-522768937 Fax: +86-59-522768937
Received: October 10, 2014
Peer-review started: October 17, 2014
First decision: October 29, 2014
Revised: November 26, 2014
Accepted: December 19, 2014
Article in press: January 5, 2015
Published online: May 28, 2015
Abstract

AIM: To investigate the diagnostic ability of single-shot echo-planar imaging (EPI) diffusion-weighted imaging (DWI) to differentiate between malignant and benign pancreatic lesions.

METHODS: A computerized search was performed on PubMed, MEDLINE and EMBASE up to August 2014. Nine studies (10 sets of data) with a total of 304 malignant pancreatic lesions and 188 benign pancreatic lesions were included. The characteristics of each study included the study name, year of publication, magnetic resonance modalities used, patient population, strength of field, pulse time, repetition time, echo time (TE), maximum b factor, mean age, mean body weight, fat suppression, number of benign and malignant lesions, and true positive, true negative, false positive and false negative results. All analyses were performed using Meta-DiSc and Stata 11.0.

RESULTS: The pooled sensitivity and specificity of single-shot EPI DWI were 0.83 (95%CI: 0.79-0.87) and 0.77 (95%CI: 0.70-0.83), respectively. The positive likelihood ratio and negative likelihood ratio were 5.09 (95%CI: 2.19-11.84) and 0.23 (95%CI: 0.15-0.36), respectively. The P value for the χ2 heterogeneity for all pooled estimates was < 0.05. From the fitted summary receiver operating characteristic curve, the area under the curve and Q* index were 0.89 and 0.82, respectively. Publication bias was not present (t = 0.58, P = 0.58). Meta-regression analysis indicated that fat suppression, mean age, TE, and maximum b factor were not sources of heterogeneity (all P > 0.05).

CONCLUSION: Single-shot EPI DWI is useful to differentiate between malignant and benign pancreatic lesions. Lesion size ≥ 2 cm is the limit for the diagnosis of early lesions.

Keywords: Meta-analysis, Single-shot echo-planar imaging, Diffusion-weighted imaging, Pancreatic cancer, Differential diagnosis

Core tip: We performed a meta-analysis to investigate the diagnostic capability of single-shot echo-planar imaging (EPI) diffusion-weighted imaging (DWI) to differentiate between malignant and benign pancreatic lesions. Single-shot EPI DWI was useful to differentiate between malignant and benign pancreatic lesions. Lesion size ≥ 2 cm was the limit for the diagnosis of early lesions.