Pancreatic diseases are diagnostically challenging due to overlapping imaging features and variable lesion vascularity. While contrast-enhanced harmonic EUS (CH-EUS) improves microvascular visualization, its use is limited by cost and contraindications. Detective flow imaging EUS (DFI-EUS) is a novel, contrast-free Doppler technique with enhanced sensitivity for detecting fine vascular structures and slow blood flow. However, current evidence is limited to small, single-center studies with methodological variability, and its role relative to CH-EUS remains unclear. This meta-analysis aims to evaluate the diagnostic performance of DFI-EUS in pancreatic lesions.

we have conducted a systematic review and meta-analysis including MEDLINE (via PubMed), Scopus, and the Cochrane Library (Central Register of Controlled Trials), covering all available records up to 30 September 2025 (protocol registered on PROSPERO; registration number CRD420251086026). 

At the end of the selection process, four studies comprising a total of 267 patients were included in the meta-analysis. DFI demonstrated a pooled sensitivity of 0.93 (95% CI: 0.83–0.98) and a pooled specificity of 0.91 (95% CI: 0.47–0.99). Among these, two studies evaluated CE-EUS and eFLOW, reporting pooled sensitivity and specificity estimates of 0.96 and 0.94 for CE-EUS, and 0.84 and 0.69 for eFLOW, respectively.

This meta-analysis supports the diagnostic value of DFI-EUS for pancreatic lesions. These findings indicate that DFI shows robust discriminatory performance across the included datasets, although further validation with additional data would strengthen the generalizability of these results