Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol

The study aims were to evaluate: (1) whether a short-protocol (SP) MRI for the surveillance of pancreatic cystic neoplasms (PCN) provides equivalent clinical information as a comprehensive-protocol (CP), and (2) the cost reduction from substituting CP with SP for patient surveillance. This retrospective study included 154 consecutive patients (median age: 66, 52 % men) with working-diagnosis of PCN and available contrast-enhanced MRI/MRCP. Three radiologists evaluated independently two imaging sets (SP/CP) per patient. The CP included: T2-weighted (HASTE/MRCP), DWI and T1-weighted (chemical-shift/pre-/post-contrast) images [acquisition time (AT) ae 35 min], whereas the SP included: T2-weighted HASTE and T1-weighted pre-contrast images (AT ae 8 min). Mean values of largest cyst/main pancreatic duct diameter (D-C/D-MPD) were compared. Agreement regarding presence/absence of cystic/MPD mural nodules (MNC/MNMPD), inter-observer agreement and cost differences between SP/CP were calculated. For D-C and D-MPD, mean values with SP/CP were 21.4/21.7 mm and 3.52/3.58 mm, while mean differences SP-CP were 0.3 mm (p = 0.02) and 0.06 mm (p = 0.12), respectively. For presence/absence of MNC and MNMPD, SP/CP coincided in 93 % and 98 % of cases, respectively. Inter-observer agreement was strong for SP/CP. SP-cost was 25 % of CP-cost. For the surveillance of PCN, short-protocol MRI provides information equivalent to the more time-consuming and costly comprehensive-protocol. aEuro cent Pancreatic cystic neoplasms (PCN) are increasingly diagnosed in the general population. aEuro cent Multiple imaging controls are recommended for the surveillance of patients with PCN. aEuro cent Short and comprehensive MRI-protocols are equivalent for decision-making in PCN under surveillance. aEuro cent Evaluation of imaging risk factors in PCNs is comparable with both MRI-protocols. aEuro cent Use of the short MRI-protocol may rationalise healthcare resources.