确定弥散加权成像 (DWI) 在预测胰腺癌新辅助治疗 (NAT) 反应中的作用。在 MEDLINE、EMBASE 和 Cochrane 图书馆数据库中检索了评估表观弥散系数 (ADC) 性能的研究，以评估反应到 NAT。提取的数据包括 NAT 前后的 ADC，用于预测影像学、组织病理学或临床参考标准定义的反应。将 ADC 值与标准化平均差进行比较。使用诊断研究质量评估 (QUADAS-2) 评估偏倚风险。在 337 项研究中，7 项纳入分析（161 名患者）。 NAT 前后评估报告的 ADC 值在响应者和非响应者之间重叠。一项研究报告 NAT 后 ADC 的增加无法区分有反应者和无反应者。 4 项研究报告了 NAT 前和后 ADC 与组织病理学反应的相关性。三项研究报告称 DWI 的诊断性能很高，敏感性为 91.6-100%，特异性为 62.5-94.7%。最后，研究中发现了异质性和高偏倚风险，影响了患者选择、指标测试、参考标准以及流程和时间等领域。DWI 可能有助于确定胰腺癌对 NAT 的反应。然而，关于这个问题的研究仍然太少，而且异构性也很大，存在较高的偏倚风险。需要对数据采集标准化程序和准确的参考标准进行进一步的研究。弥散加权 MRI 可能有助于评估胰腺癌新辅助治疗的反应。然而，需要进一步的研究和可靠的数据来为临床实践提供具体的建议。•DWI 和 ADC 测量在评估胰腺癌新辅助治疗反应中的作用仍不清楚。 •新辅助治疗前后ADC值在有反应者和无反应者之间重叠。 •据报道，在使用组织病理学或临床参考标准时，DWI 具有确定反应的高诊断性能；然而，研究仍然很少，而且存在很高的偏倚风险。© 2023。作者。

To determine the role of diffusion-weighted imaging (DWI) for predicting response to neoadjuvant therapy (NAT) in pancreatic cancer.MEDLINE, EMBASE, and Cochrane Library databases were searched for studies evaluating the performance of apparent diffusion coefficient (ADC) to assess response to NAT. Data extracted included ADC pre- and post-NAT, for predicting response as defined by imaging, histopathology, or clinical reference standards. ADC values were compared with standardized mean differences. Risk of bias was assessed using the Quality Assessment of Diagnostic Studies (QUADAS-2).Of 337 studies, 7 were included in the analysis (161 patients). ADC values reported for the pre- and post-NAT assessments overlapped between responders and non-responders. One study reported inability of ADC increase after NAT for distinguishing responders and non-responders. A correlation with histopathological response was reported for pre- and post-NAT ADC in 4 studies. DWI's diagnostic performance was reported to be high in three studies, with a 91.6-100% sensitivity and 62.5-94.7% specificity. Finally, heterogeneity and high risk of bias were identified across studies, affecting the domains of patient selection, index test, reference standard, and flow and timing.DWI might be useful for determining response to NAT in pancreatic cancer. However, there are still too few studies on this matter, which are also heterogeneous and at high risk for bias. Further studies with standardized procedures for data acquisition and accurate reference standards are needed.Diffusion-weighted MRI might be useful for assessing response to neoadjuvant therapy in pancreatic cancer. However, further studies with robust data are needed to provide specific recommendations for clinical practice.•The role of DWI with ADC measurements for assessing response to neoadjuvant therapy in pancreatic cancer is still unclear. •Pre- and post-neoadjuvant therapy ADC values overlap between responders and non-responders. •DWI has a reported high diagnostic performance for determining response when using histopathological or clinical reference standards; however, studies are still few and at high risk for bias.© 2023. The Author(s).