Online link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544812/

Systematic review/meta-analysis

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.

–          This systematic review included a total of 43 studies and had a total population size of 3460 patients.

–          This study’s main focus was to compare imaging modalities for chronic pancreatitis (Endoscopic ultrasound, ERCP, MRCP and CT).

–          The age of the patients ranged from 36 to 65 years.

–          When it came to diagnostic sensitivity, MRCP has an 82% sensitivity rate for chronic pancreatitis while the sensitivity of CT for chronic pancreatitis rages between 80-90%.

–          Both these modalities were able to outperform ultrasound which had a sensitivity of only 60%.

–          ERCP had a sensitivity rate of 82% and specificity rate of 94%, however it had a relatively high risk of complications, such as post-ERCP pancreatitis

–          In conclusion: CT was better in detecting parenchymal calcifications and intraductal calcifications compared to MRCP. On the other hand, MRCP was more often able to detect significant abnormalities of the pancreatic duct (dilatation and strictures) and slight changes of the pancreatic parenchyma, which can be attributed to early signs chronic pancreatitis.

–          In conclusion MRCP and CT had comparable diagnostic accuracy for chronic pancreatitis and the choice between the two should be made based on invasiveness, local availability, and costs. It more of a clinical preference.