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 7/2018-9/2024. Demographics, genetic factors, and baseline MRI/MRCP outcomes were analyzed. HRI were classified as FPC or PGV±PDAC family history. Statistical analysis compared: all HRI vs. all ARI; single HRI subgroups vs. matched ARI; single HRI subgroups vs. 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 increased risk of PCL-derived malignancy or reflects heighted detection on MRI.