Comparing PET/CT and PET/MRI for pancreatic cancer diagnosis: a systematic review and meta-analysis

The diagnosis and staging of pancreatic cancer are critical for effective treatment, with positron emission tomography/computed tomography (PET/CT) and PET/magnetic resonance imaging (MRI) emerging as key imaging modalities. This study compared their diagnostic accuracy, focusing on tumor resectability, staging, and standardized uptake values (SUV).

A systematic review was conducted in October 2024, searching PubMed, Embase, Web of Science, and Scopus. Nine studies comparing PET/CT and PET/MRI in pancreatic cancer were included. Data on sensitivity, specificity, and diagnostic odds ratio (DOR) were pooled using random-effects models. Study quality was assessed with the Newcastle–Ottawa Scale and QUADAS‑2 tool. Heterogeneity was evaluated using the I² statistic, and publication bias was assessed with Egger’s test.

Nine studies were included following screening. A pooled sensitivity of 81.95% (95% CI: 62.31–92.57%) and specificity of 78.19% (95% CIs: 41.64–94.74%) was found for PET/CT, with a pooled DOR of 13.85 (95% CI: 1.72–111.76; I² = 0%). For PET/MRI, a pooled sensitivity of 83.16% (95% CI: 12.30–99.43%) and specificity of 77.74% (95% CI: 10.71–99.03%) were found. Excellent results in detecting solid tumors and local invasion were achieved with PET/MRI. Both modalities influenced clinical management, but high heterogeneity was observed (I² > 80% for sensitivity and specificity).

Both PET/CT and PET/MRI demonstrate comparable diagnostic performance for pancreatic cancer, with PET/MRI offering advantages in soft tissue characterization. The DOR for PET/CT indicates reliable diagnostic accuracy, although the variability across studies underscores the need for standardized, prospective trials to optimize their use in clinical practice.