Pancreatic MRI Findings in High-Risk Individuals Compared With Matched Average-Risk Individuals

Pancreatic ductal adenocarcinoma (PDAC) screening is recommended for high-risk individuals (HRI) with familial pancreatic cancer (FPC) or certain pathogenic germline variants (PGVs). Screening MRI commonly identifies pancreatic cystic lesions (PCLs), but comparative data between HRI and average-risk individuals (ARI) are limited. We aimed to quantify and characterize PCL differences between these groups.

In this retrospective study, 317 HRI were age-, sex-, and race-matched to 634 ARI undergoing MRI/MRCP between July 2018-2019 and 2024. Demographics, genetic factors, and baseline MRI/MRCP outcomes were analyzed. HRI was classified as FPC or PGV±PDAC family history. Statistical analysis compared: all HRI versus all ARI; single HRI subgroups versus matched ARI; and single HRI subgroups versus other HRI.

HRIs were more likely to have PCLs than ARIs (50.8% vs. 25.7%, P <0.001). FPC HRI were more likely to have PCLs (54.1% vs. 44.4%, P =0.049) than PGV HRI. However, PCLs in HRI were smaller than in ARI (7.4±5.7 vs. 10.8±12.6 mm; P =0.002). HRI and ARI did not differ regarding worrisome feature prevalence. No solid lesions were observed.

PCLs are significantly more common among HRI than matched ARI, although typically small and low-risk. Future longitudinal studies should determine whether the higher prevalence of PCLs among HRI translates into an increased risk of PCL-derived malignancy or reflects heightened detection on MRI.