Magnetic Resonance Cholangiopancreatography in the Diagnosis of Pancreas Divisum: A Meta-Analysis of Test Performance

Abstract

Purpose: Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosing pancreas divisum (PD). Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive test that can be used to identify PD. However, several epidemiological studies on the diagnostic accuracy of MRCP have yielded conflicting results. The aim of this meta-analysis was to precisely estimate the overall sensitivity and specificity of MRCP alone or with secretin enhancement (S-MRCP) in diagnosing PD. Methods: Two authors independently conducted a comprehensive search of the Cochrane library PUBMED, MEDLINE, and published proceedings from major gastroenterology meetings from January 1980 to June 2012. The reference lists of eligible studies were reviewed for additional studies on the subject. Studies were included if they allowed construction of 2 x 2 contingency tables of MRCP and/or S-MRCP compared with gold standard. Mixed-effect models were used to estimate sensitivity, specificity and quantitative receiver-operating characteristics. Logistic regression was used to examine the influence of publication bias. All analyses were performed using REVMAN 5.1 and IBM SPSS 20. Results: Nine studies involving 1,429 patients were included in the analysis. S-MRCP had a higher overall pooled sensitivity (87%; 95% CI: 84% to 90%; Figure 1) and specificity (97%; 95% CI: 91% to 99%) compared to MRCP (sensitivity [64%; 95% CI: 60% to 67%] and specificity [90%; 85% CI: 84% to 94%]). Table 1 summarizes the diagnostic performance of S-MRCP and MRCP. No major side effects of secretin were noted in these studies.Figure 1: Forest plot of sensitivity of S-MRCP in diagnosing Pancreas Divisum.Table 1: Diagnostic yield of MRCP and S-MRCP in detecting Pancreas DivisumConclusion: The pooled data suggests improved visualization of pancreatic ductal anatomy for detection of PD with secretin stimulation leading to higher overall sensitivity and specificity of S-MRCP. Given its high negative predictive value (NPV) it might be considered as diagnostic test of choice for excluding PD without exposing patients to discomfort and risk associated with ERCP.