Accuracy of quantitative diffusion-weighted imaging for differentiating benign and malignant pancreatic lesions: a systematic review and meta-analysis.

backgroundA variety of imaging techniques can be used to evaluate diffusion characteristics to differentiate malignant and benign pancreatic lesions. The diagnostic performance of diffusion parameters has not been systematic assessed. PURPOSE: We aimed to investigate the diagnostic efficacy of quantitative diffusion-weighted imaging (DWI) for pancreatic lesions.

methodsA literature search was conducted using the PubMed, Embase, and Cochrane Library databases for studies from inception to March 30, 2020, which involves the quantitative diagnostic performance of diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) in the pancreas. Studies were reviewed according to inclusion and exclusion criteria. The quality of articles was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUATAS-2). A bivariate random-effects model was used to evaluate pooled sensitivities and specificities. Univariable meta-regression analysis was used to test the effects of factors that contributed to the heterogeneity.

resultsA total of 31 studies involving 1558 patients were ultimately eligible for data extraction. The lowest heterogeneity was found in specificity of perfusion fraction (f) with the I

conclusionQuantitative DWI and IVIM have a good diagnostic performance for differentiating malignant and benign pancreatic lesions. KEY POINTS: • IVIM has high sensitivity and specificity (84% and 83%, respectively) for differential diagnosis of pancreatic lesions, which is comparable to that of the ADC (83% and 87%, respectively). • The ADC has an excellent diagnostic performance for differentiating malignant from benign IPMNs (sensitivity, 0.83; specificity, 0.92); the f has the best diagnostic performance for differentiating pancreatic carcinoma from PNET (sensitivity, 0.85; specificity, 0.85). • For the ADC, using a maximal b value < 800 s/mm