Evaluation of the efficiency of diffusion weighted imaging in the diagnosis and staging of Pancreatic ductal adenocarcinoma in adult patients: A structured literature review.

Abstract

Abstract Aim. This Structured literature review (SLR) aims to evaluate the efficiency and validity of diffusion-weighted imaging (DWI) in the diagnosis and staging of PDAC in adult patients, critically appraising the available evidence on the value of DWI to assess the reliability and feasibility of DWI for its implementation in clinical practice. Background. Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers of the 21st century. Many pancreatic lesions remain silent and undetectable until the tumour can no longer be surgically restricted. Early detection followed by chemotherapy and surgical involvement is considered the only solution to increase the 5-year survival rate to 20% (Garces-Descovich et al., 2019). Therefore, DWI has emerged as a practical technique for the diagnosis and evaluation of treatment for PDAC, as it offers higher tumour complicity and excellent contrast resolution which are invaluable for enhancing clinical outcomes. Methods. A structured literature review (SLR) was undertaken, and a PIO framework was employed to frame the review question. Several electronic databases were extensively searched for quantitative primary studies related to the review question which met the exclusion and inclusion criteria. The Quality Assessment Tool for Quantitative Studies (QualSyst) (Kmet et al., 2004) was used to evaluate the quality of the included literatures. Results. Four studies which met the inclusion criteria were included in this review. Three studies used Receiver Operating Characteristic (ROC) curve analysis to measure the accuracy (sensitivity and specificity), whereas the fourth study used basic descriptive statistics for the calculation of continuous variables (mean and median). The sensitivity rates varied between 78.6% and 96.2%, with similar rates of specificity between 33% and 100%. All studies reported that the diagnosis performed by DWI provided better findings, thereby justifying its implementation in clinical practice. The major limitation of this research was the low validity and reproducibility of the included studies, hence, DWI cannot be recommended for use in clinical practice despite their favourable results. Conclusion. Further research is required to assess the efficiency of DWI in the diagnosis of PDAC and its validity to evaluate treatment progression, as the included studies were not robust enough to serve as evidence for implementing the findings of this review. Future reviews should use uniform b-values and methods and emphasis the importance of MRI-safety to improve the reliability of the results and ensure that radiologists and medical professionals can use DWI to provide excellent outcome for PDAC patients and reduce the risk of future clinical challenges.