Prevalence and Size-Based Risk Categorization of Pancreatic Cysts Among Asymptomatic Individuals With Screening MRI

TL;DR

This study finds that pancreatic cysts are common in asymptomatic adults, especially older individuals, but most are small and likely low-risk.

Contribution

The study provides the first large-scale prevalence data on pancreatic cysts in asymptomatic individuals using whole-body MRI screening.

Findings

The overall prevalence of pancreatic cystic lesions was 6.3% in the study population.

98.9% of pancreatic cysts were less than 3 cm, indicating low malignant potential.

Older age, female sex, and certain ethnicities were associated with higher cyst prevalence.

Abstract

What is the prevalence of clinically relevant pancreatic cystic lesions (PCLs) among asymptomatic adults who undergo screening with whole-body magnetic resonance imaging (MRI)?

In this cross-sectional study of 21 651 North American individuals with whole-body MRI screening, the standardized prevalence of PCLs was 6% overall and 21% in individuals 80 years and older. Older age, female sex, history of pancreatitis and pancreatic ductal adenocarcinoma, family history of pancreatic ductal adenocarcinoma, alcohol use, and Latin American or Middle Eastern ethnicity were associated with higher likelihood of cyst development; 99% of lesions fell below the size threshold associated with a worrisome feature of increased malignant potential (3 cm).

These findings suggest that most incidental PCLs, while common, may be very low risk based on size-based risk categorization alone.

This cross-sectional study assesses the prevalence of pancreatic cystic lesions in a North American cohort of asymptomatic patients undergoing screening with whole-body magnetic resonance imaging, estimates risk using size-based categorization, and identifies associated demographic factors and exposures.

Subsets of pancreatic cystic lesions (PCLs) are the only radiographically evident precursors to pancreatic cancer. Guidelines prioritize cyst size and high-risk features to determine the need for resection. However, the true prevalence of PCLs and risk factors for their development in the general population remain unknown, as available data are often biased by imaging performed in symptomatic patients.

To determine prevalence of PCLs in an asymptomatic North American cohort using size-based risk categorization and identify associated demographic factors and exposures.

This cross-sectional study included asymptomatic individuals who underwent rapid whole-body magnetic resonance imaging using a commercially available 1.5T device for general preventive screening between January 1, 2020, and May 31, 2023. Scans were interpreted by certified radiologists using standardized synoptic reporting templates. Diagnostic free-text reports were analyzed, and positive reports underwent independent additional review. Data were analyzed from February 4, 2024, to March 6, 2025.

Participant demographic information and lifestyle exposures.

Prevalence of PCLs based on size-based risk categorization.

Among 21 651 individuals undergoing screening MRI (11 050 [51.0%] male; median age, 51 [IQR, 42-61] years), 1509 (7.0%) had an incidental PCL (776 [51.4%] female), and age- and sex-standardized prevalence was 6.3%. The median age was higher in individuals with PCLs (61 [IQR, 51-69] vs 50 [IQR, 41-60] years). Prevalence increased with age, from 86 of 4223 (2.0%) 39 years or younger to 229 of 5720 (4.0%) aged 40 to 49 years, 390 of 5586 (7.0%) aged 50 to 59 years, 467 of 4049 (11.5%) aged 60 to 65 years, 268 of 1741 (15.4%) aged 70 to 79 years, and 69 of 332 (20.8%) 80 years or older (P < .001). Most cysts (1449 [96.0%]) were less than 2 cm, 1200 (79.5%) were less than 1 cm, and 17 (1.1%) were 3 cm or larger (0.08% of all scans). Independent factors associated with PCLs included being 65 years or older (odds ratio [OR], 3.03; 95% CI, 2.67-3.45), female sex (OR, 1.13; 95% CI, 1.002-1.27), personal history of pancreatitis (OR, 2.65; 95% CI, 1.66-4.08) or pancreatic ductal adenocarcinoma (PDAC) (OR, 20.98; 95% CI 3.70-161.45), family history of PDAC (OR, 1.40; 95% CI, 1.04-1.86), alcohol consumption (OR, 1.15; 95% CI, 1.01-1.31), and Latin American (OR, 1.79; 95% CI, 1.43-2.23) or Middle Eastern (OR, 1.40; 95% CI, 1.03-1.86) ethnicity. Asian ethnicity (OR, 0.79; 95% CI, 0.66-0.95) was associated with lower PCL prevalence.

In this cross-sectional study of 21 651 individuals, incidental PCLs were common (6.3%) and found in as many as 20.8% of older individuals undergoing whole-body MRI screening, with 1492 PCLs (98.9%) of all PCLs being less than 3 cm.

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