Medline ® Abstract for Reference 45
of 'Pancreas divisum: Clinical manifestations and diagnosis'
Magnetic resonance cholangiopancreatography in the diagnosis of pancreas divisum: a systematic review and meta-analysis.
Rustagi T, Njei B
Pancreas. 2014 Aug;43(6):823-8.
OBJECTIVE: This study aimed to perform a structured meta-analysis of all eligible studies to assess the overall diagnostic use of magnetic resonance cholangiopancreatography (MRCP) alone or with secretin enhancement (secretin-enhanced MRCP [S-MRCP]) in the detection of pancreas divisum.
METHODS: Two authors independently performed a comprehensive search of PubMed, MEDLINE, and the Cochrane Library from inception to September 2013. Studies were included if they allowed construction of 2×2 contingency tables of MRCP and/or S-MRCP compared with criterion standard. DerSimonian-Laird random effect models were used to estimate the pooled sensitivity, specificity, specificity, and quantitative receiver operating characteristics.
RESULTS: Of 51 citations, 10 studies with 1474 patients were included. Secretin-enhanced MRCP had a higher overall diagnostic performance than MRCP (S-MRCP: pooled sensitivity, 86% [95% confidence interval (CI), 77%-93%]; specificity, 97% [95% CI, 94%-99%]; and area under the curve, 0.93±0.056 compared with MRCP: sensitivity, 52% [95% CI, 45%-59%]; specificity, 97% [95% CI, 94%-99%]; and area under the curve, 0.76±0.104). Pooled diagnostic odds ratios were 72.19 (95% CI, 5.66-938.8) and 23.39 (95% CI, 7.93-69.02) for S-MRCP and MRCP, respectively. Visual inspection of the funnel plot showed low potential for publication bias.
CONCLUSIONS: Secretin-enhanced MRCP has a much higher diagnostic accuracy than MRCP and should be preferred for diagnosis of pancreas divisum.
From the *Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven; and†Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT.