Contrast enhancement potential of food-based imaging agents in cholangiopancreatography and digestive tract investigations using MRI: A systematic literature review and meta-analysis.

Abstract

Objective To evaluate the contrast enhancement potential of food-based substances (FBS) as clinical imaging agents in MR cholangiopancreatography (MRCP) and digestive tract investigations. Methods A systematic literature search was conducted using a pre-defined strategy and inclusion criteria to identify relevant articles. Two review authors independently screened and selected papers for inclusion, conducted risk of bias assessment using ROBINS-I (Risk of Bias In Non-randomised Studies of Interventions) tool and assessed certainty of evidence using the Cochrane’s GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Areas of disagreement were resolved through consensus and the involvement of a third reviewer. The data obtained were meta-analysed using both random and fixed effects models with inverse variance methods, depending on the included studies’ methodological heterogeneity, to estimate the pooled mean difference and odds ratio. Results 16 studies (1360 participants) were included in this review. Eight studies each examined the effectiveness of FBS for contrast enhancement in MRCP and MRE, respectively. The pooled mean differences between MRCP with pineapple juice and non-contrast MRCP were 1.04 (95 % CI: 0.23, 1.84; I2 = 96 %, p < 0.01) for bile duct visibility and 0.95 (95 % CI: 0.04, 1.85; I2 = 95 %, p < 0.01) for pancreatic duct visibility. Compared to non-contrast MRCP, MRCP with pineapple juice showed improved pancreaticobiliary duct visibility (Combined odds ratio, 5.01; 95 % CI: 2.34, 10.64; p < 0.0001). However, when compared with synthetic contrast agents, there is a lower likelihood of obtaining excellent quality MRE images with food-based contrast agents (FBCAs) (odds ratio, 0.36; 95 % CI: 0.18, 0.73, 0.73; p = 0.004). A generally high safety and acceptance profile was reported across the included studies for FBCAs. The certainty of the evidence obtained was considered moderate across all outcomes. Conclusion Oral administration of pineapple juice improves the diagnostic quality of MRCP investigations, while the contrast enhancement potential of FBS is limited in MRE studies. The high heterogeneity of results and moderate certainty of the evidence, however, require a cautious admission of results. Therefore, further research is necessary to gain a comprehensive understanding of the reliability of FBS in these MRI investigations, as well as in other imaging modalities that are yet to be explored.