Impact of Canadian Association of Radiologists and Fukuoka Recommendations on MRI Utilization for Surveillance of Incidental Pancreatic Cysts
Serguei Medvedev, Matthew D. F. McInnes, Eric Lam, Christopher I. Fung, Christian B. van der Pol, Kelly HarperObjectives:
To evaluate the impact of the Canadian Association of Radiologists (CAR) guidelines on MRI surveillance burden for incidental pancreatic cystic lesions compared with Fukuoka guidelines.
Methods:
This retrospective single-center study included 1000 asymptomatic patients aged ≥40 years with incidental pancreatic cystic lesions identified on abdominal MRI between January 2010 and March 2025. Patients with high-risk features, cysts ≥3 cm, or a history of pancreatic cancer were excluded. Surveillance recommendations were retrospectively simulated according to CAR and Fukuoka guidelines. The primary outcome was the mean number of recommended MRI examinations over 5- and 10-year follow-up periods. Comparisons were performed using paired
Results:
A total of 1205 consecutive patients were reviewed between January 1, 2010 and March 31, 2025. Of these, 205 patients were excluded based on study criteria, yielding a final cohort of 1000 patients for analysis. At 5 years, the mean number of recommended MRI examinations was lower under CAR guidelines compared with Fukuoka guidelines (1.45 ± 1.5 vs 3.89 ± 0.99;
Conclusion:
Application of CAR guidelines is associated with a reduction in MRI surveillance utilization over 5- and 10-year follow-up periods compared with Fukuoka guidelines. These findings have important implications in the setting of MRI resource constraints within the Canadian healthcare system.