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

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.