Shorter, Faster, and Effective? Evaluating Abbreviated MRI for Branch-Duct Intraductal Papillary Mucinous Neoplasm

Shorter, Faster, and Effective? 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Evaluating Abbreviated MRI for Branch-Duct Intraductal Papillary Mucinous Neoplasm Sevde Nur Emir, Görkem Karamustafao, Gülbanu Güner, Servet Emir, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5968545/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background With the advancements in imaging technologies and the widespread use of magnetic resonance imaging (MRI), the detection rates of pancreatic cystic lesions (PCLs) have significantly increased. While most of these lesions are benign, branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) pose a potential risk for malignant transformation, necessitating regular clinical and radiological follow-up. However, conventional MRI protocols are time-consuming and resource-intensive, prompting the need for shorter, cost-effective alternatives without compromising diagnostic accuracy. This study aims to evaluate the diagnostic performance and clinical feasibility of abbreviated MRI (A-MRI) protocols for BD-IPMN surveillance compared to standard MRI (S-MRI). Methods This was a single-center, retrospective study including patients with BD-IPMN who underwent follow-up MRI between January 2022 and December 2024. Three MRI protocols were analyzed: (1) S-MRI, comprising T2-weighted imaging, dynamic contrast-enhanced (DCE) T1-weighted imaging, 3D MR cholangiopancreatography (MRCP), and diffusion-weighted imaging (DWI); (2) A-MRI protocol 1 (A-MRI-1), including MRCP and T2-weighted sequences; and (3) A-MRI protocol 2 (A-MRI-2), incorporating MRCP, T2-weighted, and DWI sequences. The images are evaluated for lesion size progression (≥ 5 mm in 2 years), mural nodules, cyst wall thickening, main pancreatic duct dilation, and parenchymal atrophy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for A-MRI protocols in detecting degeneration signs. Results A total of 124 patients (mean age: 64 years, 55.6% female) and 124 lesions were analyzed. The detection rates of key degeneration markers were similar between S-MRI and A-MRI protocols, except for contrast-enhanced mural nodules, which were not identifiable with A-MRI due to the lack of DCE sequences. The overall sensitivity, specificity, PPV, and NPV for A-MRI in detecting BD-IPMN degeneration markers were 100%, 98.3%, 71.4%, and 100%, respectively. A-MRI protocols demonstrated a comparable diagnostic performance to S-MRI while significantly reducing scan time (from ~ 40–50 min to 7–12 min). However, false-positive mural nodule detection was higher with A-MRI, potentially leading to unnecessary follow-up imaging. The addition of DWI in A-MRI-2 did not provide a significant diagnostic advantage over A-MRI-1. Conclusions A-MRI is a viable alternative for BD-IPMN follow-up, offering substantial reductions in imaging duration and costs while maintaining high diagnostic accuracy. However, the absence of DCE sequences may lead to false-positive mural nodule detection, necessitating further evaluation in selected cases. Figures Figure 1 Figure 2 Introduction Advancements in imaging technologies and the widespread use of magnetic resonance imaging (MRI) have significantly increased the detection rates of pancreatic cystic lesions. According to the literature, these lesions are identified in approximately 2–3% of the general population through abdominal computed tomography (CT) and in up to 40% of cases in magnetic resonance cholangiopancreatography (MRCP) studies. Most pancreatic cystic lesions are incidentally detected, and while the majority are benign, certain types, such as intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN), carry a potential risk of malignancy, necessitating regular clinical and radiological follow-up [ 1 – 3 ]. IPMNs are classified into three subtypes: main duct, branch duct, and mixed-type. Main duct IPMNs have been reported to exhibit invasive characteristics in approximately 62% of cases following resection. Similarly, although branch duct IPMNs carry a lower risk, they still present a notable potential for malignancy. Studies have shown that 10–15% of branch duct IPMNs progress over a 3–5 year follow-up period, with an annual malignancy development risk of 0.24%. Additionally, high-grade dysplasia or invasive malignancy has been identified in 31% of resected branch duct IPMNs. Therefore, regular radiological surveillance of small, asymptomatic branch duct IPMNs that are not associated with suspicious imaging findings or clinical/biochemical indicators is crucial for the early detection of malignant transformation[ 4 , 5 ]. Various guidelines have been developed for the surveillance of IPMNs and similar lesions; however, they differ in terms of follow-up duration and methodology. The American Gastroenterological Association recommends follow-up for up to five years, whereas European guidelines emphasize the necessity of lifelong surveillance. Despite these discrepancies, there is a consensus on the importance of evaluating critical imaging findings, such as cyst size, the presence of mural nodules, and the enlargement of the main pancreatic duct, in guiding clinical management [ 6 , 7 ]. For the routine surveillance of IPMNs and other pancreatic cystic lesions, the standard upper abdominal MRI protocol is commonly preferred. This protocol includes comprehensive sequences such as T2-weighted imaging, dynamic contrast-enhanced T1-weighted imaging, and diffusion-weighted imaging (DWI). However, this approach poses challenges, particularly for patients requiring frequent imaging, due to prolonged scan times (30–50 minutes), the additional costs associated with contrast administration, and reduced patient comfort. Furthermore, the need for intravenous contrast injection can be an added source of stress, especially for claustrophobic or elderly patients[ 8 , 9 ]. Therefore, abbreviated MRI (A-MRI) protocols, which aim to reduce scan time and cost while maintaining diagnostic accuracy, have emerged as a valuable alternative. In recent years, there has been growing interest in A-MRI protocols designed to shorten imaging duration without compromising diagnostic performance. These protocols achieve time efficiency by omitting time-consuming components such as dynamic contrast-enhanced sequences and/or diffusion-weighted imaging (DWI). While studies on abbreviated MRI protocols for organs such as the liver and prostate have shown promising results, their effectiveness in the surveillance of pancreatic cystic lesions has been evaluated in only a limited number of studies. This raises concerns regarding the potential risk of missing critical malignant features, such as mural nodules, cyst enlargement, and main pancreatic duct dilation[ 10 – 14 ] This study aims to compare the diagnostic accuracy and clinical feasibility of two different abbreviated MRI (A-MRI) protocols with the standard MRI protocol (S-MRI) in the surveillance of IPMNs. Materials and Methods This study is a retrospective, single-center study. Patients diagnosed with branch-duct IPMN who underwent follow-up abdominal MRI between January 2022 and December 2024 at our institution were included in the analysis. Patient Selection The diagnosis of branch-duct IPMN was based on the presence of cystic lesions with a clear connection to the pancreatic duct on initial MRI examinations. Patients were included in the study if they met the following criteria: Had a baseline (initial) abdominal MRI and at least one follow-up MRI using the standard protocol (S-MRI). Had a minimum interval of six months between follow-up MRI scans. In cases where multiple MRI examinations were available, the scan with the least artifacts was selected for analysis. Patients were excluded from the study if: Contrast agent was not administered during follow-up MRI. They had a history of pancreatic surgery. Image quality was compromised due to motion artifacts or metallic artifacts. MRI Acquisition All MRI examinations were performed using a 1.5 Tesla system (Magnetom Aera®, Siemens Healthineers, Erlangen, Germany). Three different MRI protocols were defined for the study: Standard Protocol (S-MRI): Included axial and coronal T2-weighted imaging, dynamic contrast-enhanced T1-weighted imaging (pre- and post-contrast), 3D MR cholangiopancreatography (MRCP), and diffusion-weighted imaging (DWI). The total scan time was approximately 40–50 minutes. Abbreviated Protocol 1 (A-MRI-1): Included 3D MRCP and T2-weighted imaging sequences. The estimated scan time was approximately 7–8 minutes. Abbreviated Protocol 2 (A-MRI-2): Included all sequences in A-MRI-1 with the addition of DWI. The estimated scan time was approximately 10–12 minutes. All abbreviated protocol images were extracted from the existing S-MRI datasets and analyzed separately. Imaging Analysis MRI images were evaluated by a radiology resident with three years of experience. The radiologist conducted the assessments in a blinded manner, without access to clinical information such as symptoms, surgical history, or histopathological findings. The imaging analysis was performed in four stages: Baseline Evaluation: The initial MRI of each patient was reviewed by a second radiologist with 11 years of experience to confirm the diagnosis of branch-duct IPMN. S-MRI Evaluation: The most recent follow-up MRI images were compared with the baseline MRI to assess for degeneration markers, including lesion size changes, mural nodules, cyst wall thickening, and main pancreatic duct dilation. A-MRI-2 Evaluation: The images extracted for A-MRI-2 (MRCP + DWI) were independently analyzed. A-MRI-1 Evaluation: The images extracted for A-MRI-1 (MRCP only) were analyzed and compared with S-MRI. A three-week interval was maintained between each evaluation to minimize recall bias. Figures 1 and 2 shows MR images of leisons. Evaluation Criteria Degeneration markers were assessed based on the 2017 Fukuoka guidelines, considering the following criteria: Lesion size ≥ 3 cm Increase in lesion size ≥ 5 mm within 2 years Presence of contrast-enhancing mural nodules Thickening of the cyst wall Main pancreatic duct dilation (≥ 5 mm) Sudden change in pancreatic duct diameter with distal atrophy Results This study evaluated the diagnostic performance of abbreviated MRI (A-MRI) protocols in detecting degeneration markers in patients with branch-duct IPMN (BD-IPMN). A total of 124 patients were included, with a mean age of 64 years; 55.6% were female, and 44.4% were male. In total, 124 lesions were analyzed. The lesion size distribution was as follows: 44.4% measured 5–10 mm, 40.3% were 10–20 mm, 12.9% were 20–30 mm, and 2.4% were >30 mm. The most common lesion locations were the pancreatic body (19.4%) and tail (11.3%)(as shown in table 1). The study compared the performance of abbreviated MRI protocols (A-MRI-1 and A-MRI-2) with the standard protocol (S-MRI) in detecting degeneration markers in BD-IPMNs. A significant increase in lesion size (≥5 mm over 2 years) was identified at equal rates (7.3%) across all protocols (S-MRI, A-MRI-1, and A-MRI-2). Mural nodules were detected in 4.0% of cases using S-MRI, whereas A-MRI-1 and A-MRI-2 yielded a slightly higher detection rate (5.6%). However, contrast-enhancing mural nodules were identified only with S-MRI (1.6%), as A-MRI protocols lacked dynamic contrast-enhanced sequences. The detection rates for cyst wall thickening were identical across all protocols (1.6% for both S-MRI and A-MRI protocols). Main pancreatic duct dilation and parenchymal atrophy were observed in 0.8% of cases across all three protocols (as shown in Table 2). Regarding overall degeneration marker detection, positive findings were identified in 15.3% (19/124) of cases with S-MRI, compared to 16.9% (21/124) with both A-MRI-1 and A-MRI-2. The slightly higher detection rate in A-MRI protocols was attributed to differences in mural nodule evaluation. Additional mural nodules identified in A-MRI protocols were determined to be false positives, likely due to the absence of contrast-enhanced sequences. The false-positive rate for mural nodule detection in A-MRI was 1.6% (2/124), while the false-negative rate was 0%. Based on these findings, the diagnostic performance metrics for A-MRI were calculated as follows: Sensitivity: 100% Specificity: 98.3% Positive Predictive Value (PPV): 71.4% Negative Predictive Value (NPV): 100% Accuracy: 98.4% These results demonstrate that A-MRI protocols exhibit comparable performance to S-MRI in detecting degeneration markers, with the exception of mural nodules. However, the higher false-positive rate for mural nodule detection in A-MRI suggests that the lack of dynamic contrast-enhanced sequences negatively impacts specificity and PPV. Nonetheless, the high sensitivity and accuracy of A-MRI in identifying degeneration markers overall support its potential utility in clinical practice as an efficient alternative for BD-IPMN surveillance. Table 1. Baseline Characteristics of the Study Population Characteristics Number (%) Age (years) 64.0 Males 54 (44.4) Females 69 (55.6) Location of lesions Head 7 (5.6) Uncinate 14 (11.3) Isthmus 15 (12.1) Body 24 (19.4) Tail 14 (11.3) Demographic and anatomical distribution of pancreatic cystic lesions in the study cohort. Data are presented as median (interquartile range) for age and as number (percentage) for categorical variables. Table 2 . Comparison of Degeneration Markers Detected by Standard and Abbreviated MRI Protocols Parameter Standard Protocol (S-MRI) Abbreviated Protocol 1 (A-MRI-1) Abbreviated Protocol 2 (A-MRI-2) Significant Increase in Size (≥5 mm/2Y) Present: 9 (7.3%) Present: 9 (7.3%) Present: 9 (7.3%) Absent: 115 (92.7%) Absent: 115 (92.7%) Absent: 115 (92.7%) Mural Nodule Present: 5 (4.0%) Present: 7 (5.6%) Present: 7 (5.6%) Absent: 119 (96.0%) Absent: 117 (94.4%) Absent: 117 (94.4%) Contrast-Enhancing Mural Nodule Present: 2 (1.6%) - - Absent: 122 (98.4%) Absent: 124 (100%) Absent: 124 (100%) Thickened Cyst Wall Present: 2 (1.6%) Present: 2 (1.6%) Present: 2 (1.6%) Absent: 122 (98.4%) Absent: 122 (98.4%) Absent: 122 (98.4%) Main Pancreatic Duct Dilation and Parenchymal Atrophy Present: 1 (0.8%) Present: 1 (0.8%) Present: 1 (0.8%) Absent: 123 (99.2%) Absent: 123 (99.2%) Absent: 123 (99.2%) Degeneration Signs Present: 19 (15.3%) Present: 21 (16.9%) Present: 21 (16.9%) Absent: 105 (84.7%) Absent: 103 (83.1%) Absent: 103 (83.1%) Detection rates of key degeneration markers in branch-duct IPMN using the standard MRI protocol (S-MRI), abbreviated protocol 1 (A-MRI-1), and abbreviated protocol 2 (A-MRI-2). Discussion This study evaluated the diagnostic efficacy of abbreviated MRI (A-MRI) protocols in detecting degeneration markers in BD-IPMN patients and demonstrated comparable results to the standard protocol. The incidental detection rate of pancreatic cystic lesions on MRI ranges between 20% and 44%, with some of these lesions carrying malignant potential. BD-IPMNs, in particular, are known to have a low but clinically significant risk of malignancy. Our findings indicate that A-MRI protocols facilitate the surveillance of these lesions while maintaining diagnostic accuracy [ 15 ]. The high-risk stigmata criteria outlined in the 2017 Fukuoka guidelines by Tanaka et al. were effectively identified using the abbreviated MRI protocol in our study [ 5 ]. Similarly, the study by D'Onofrio et al. compared the diagnostic efficacy of different abbreviated MRI protocols, including T1-weighted, T2-weighted, MRCP sequences, a DWI-enhanced abbreviated protocol, and post-contrast T1-weighted sequences. The impact of these protocols on clinical decision-making was also evaluated. Their findings reported that the DWI-enhanced protocol and the post-contrast T1-weighted protocol demonstrated a higher concordance with clinical decisions[ 16 ]. In our study, abbreviated MRI (A-MRI) protocols were shown to maintain their effectiveness in detecting key degeneration markers indicative of malignancy, such as lesion size increase, the presence of mural nodules, and pancreatic duct dilation, while significantly reducing scan times. A comparison between A-MRI-1 (MRCP) and A-MRI-2 (MRCP + DWI) demonstrated that both protocols had a 100% sensitivity and negative predictive value (NPV) in detecting these degeneration markers. Similarly, Johansson et al. evaluated the diagnostic accuracy of ultrashort MRI protocols in identifying worrisome features (WF) and high-risk stigmata (HRS), reporting comparable results to standard protocols. Their study found that the detection rate of WF/HRS was 92.4% with ultrashort protocols (USP) and 96.4% with longer protocols. Consistent with these findings, our study also demonstrated that abbreviated MRI protocols provide similar diagnostic accuracy to standard protocols in identifying degeneration markers. Notably, Johansson’s study emphasized that ultrashort protocols were most suitable for patients who did not initially present with WF or HRS findings [ 17 ]. In the study by Pozzi-Mucelli et al., the diagnostic efficacy of an abbreviated protocol was compared with a comprehensive protocol for the surveillance of pancreatic cystic neoplasms. Their findings demonstrated that the abbreviated protocol provided equivalent diagnostic information to the standard protocol in clinical decision-making while also offering significant advantages in terms of time efficiency and cost reduction [ 13 ]. These findings are largely consistent with the study by Delaney et al., which evaluated the use of abbreviated MRI (A-MRI) in the surveillance of pancreatic cystic lesions [ 12 ]. However, the absence of contrast-enhanced sequences led to false-positive identification of mural nodules in these studies, subsequently reducing the positive predictive value (PPV). Similarly, in our study, mural nodules were overestimated in the abbreviated MRI (A-MRI) protocols, contributing to a lower PPV. This finding suggests that A-MRI may be more suitable for the surveillance of patients without high-risk features at baseline. A key contribution of our study was the comparison between MRCP + T2-weighted imaging (A-MRI-1) and MRCP + T2 + DWI (A-MRI-2), demonstrating that the addition of DWI did not improve diagnostic accuracy. This finding aligns with the study by Malekzadeh et al., which evaluated the diagnostic value of an abbreviated MRI protocol in BD-IPMN patients. Their study reported that DWI did not provide additional value in detecting degeneration markers and that A-MRI showed comparable sensitivity and specificity to the standard protocol. Specifically, they found that A-MRI had 100% sensitivity, 93.5% specificity, 83.3% PPV, and 100% negative predictive value (NPV) for assessing degeneration criteria in BD-IPMNs [ 18 ]. These results are highly consistent with our study, where we observed high NPV but an increased false-positive detection of mural nodules in non-contrast A-MRI protocols. These findings suggest that mural nodule assessment may require contrast-enhanced imaging and that additional imaging might be necessary in selected cases. Both Malekzadeh et al. and our study indicate that some mural nodules identified in non-contrast A-MRI protocols were, in fact, mucinous content rather than true nodules when verified with contrast-enhanced imaging. This highlights the potential for increased false-positive rates in non-contrast protocols, emphasizing the need for further evaluation in patients at higher risk. Similarly, Nougaret et al. conducted a long-term study on the surveillance of incidentally detected pancreatic cystic lesions and reported that gadolinium injection did not provide additional value in the follow-up process. In this study, 301 patients and 1,174 cystic lesions were analyzed, with significant changes observed in only 12% of cases during follow-up. Notably, lesions with an initial size of less than 2 cm did not undergo malignant transformation, suggesting that gadolinium-enhanced imaging offers limited benefit in the surveillance protocols for such lesions [ 19 ]. Abbreviated MRI protocols not only enhance patient comfort but also provide significant economic benefits. The reduction in imaging costs could contribute substantially to both individual healthcare expenses and long-term healthcare system sustainability, particularly in younger populations requiring prolonged surveillance. Additionally, the omission of contrast agents eliminates the risk of nephrogenic systemic fibrosis (NSF) and other contrast-related complications, offering a crucial advantage for patients with impaired renal function [ 20 ]. Our study has several limitations. First, as a retrospective study, there is a potential risk of selection bias. Additionally, since imaging evaluations were performed three weeks apart, the possibility of recall bias cannot be excluded. Second, being a single-center study, our sample size is limited. The median follow-up duration for lesions was 564 days. Third, only a small subset of patients had a histopathological diagnosis, as most were followed without surgical intervention. Finally, all images were evaluated by a single reader, and interobserver agreement was not assessed. However, the literature already contains multiple studies evaluating interobserver variability in this context. To further validate our findings, multi-center, prospective studies with longer follow-up periods are warranted. The higher false-positive detection rate of mural nodules in abbreviated MRI (A-MRI) protocols underscores the need for careful clinical decision-making. In cases where mural nodules—a key malignancy indicator—are reported, further evaluation with a standard contrast-enhanced protocol may be warranted. This represents one of the key limitations of abbreviated protocols, potentially restricting their use in selected patient groups. However, the impact of false-positive results due to the absence of contrast-enhanced sequences can be minimized through technical optimization and improved artifact management. Conclusion Our study demonstrates that abbreviated MRI (A-MRI) protocols can be a safe and effective alternative for the surveillance of branch-duct IPMNs (BD-IPMNs). Particularly in patients with no degeneration markers on initial MRI, A-MRI may serve as a time- and cost-efficient follow-up strategy. However, contrast-enhanced imaging may still be necessary for the accurate assessment of mural nodules in certain patient groups. Additionally, our findings indicate that diffusion-weighted imaging (DWI) does not provide additional diagnostic benefit and only prolongs the imaging process. Based on these findings, A-MRI appears to be a viable follow-up method for selected patients, though it cannot entirely replace standard protocols. Future studies should further define the patient groups for whom A-MRI is sufficient and determine specific cases where contrast-enhanced imaging remains essential, ultimately refining its role in clinical practice. Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Sağlık Bilimleri University Ümraniye Training and Research Hospital (Approval code: pending). The requirement for informed consent was waived. Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. Funding The author did not receive support from any organization for the submitted work. Author Contribution All authors made significant contributions to the conception and design of the study, as well as the acquisition, analysis, and interpretation of data. Material preparation, data collection, and statistical analysis were conducted by SNE, GK, and GG, ensuring methodological rigor and accuracy in the findings. The first draft of the manuscript was written by SNE, GG, and YÖ, incorporating key insights from the study. All authors provided critical revisions and intellectual input on earlier versions of the manuscript, refining the content for clarity, coherence, and scientific accuracy. The final revisions were completed collaboratively, integrating feedback and ensuring the manuscript met the highest academic standards. All authors have reviewed and approved the final version of the manuscript and take responsibility for its integrity and accuracy. Acknowledgements Not applicable Availability of data and materials The datasets analyzed during the current study are not publicly available due to patient confidentiality but are available from the corresponding author on reasonable request. References Canellas R, Rosenkrantz AB, Taouli B, et al. Abbreviated MRI protocols for the abdomen. Radiographics. 2019;39:744-58. Crippa S, Capurso G, Camma C, Fave GD, Castillo CF, Falconi M. Risk of pancreatic malignancy and mortality in branch-duct IPMNs undergoing surveillance: a systematic review and meta-analysis. Dig Liver Dis. 2016;48:473-79. Nilsson LN, Keane MG, Shamali A, et al. Nature and management of pancreatic mucinous cystic neoplasm (MCN): a systematic review of the literature. Pancreatology. 2016;16:1028-36. Zaheer A, Pokharel SS, Wolfgang C, Fishman EK, Horton KM. Incidentally detected cystic lesions of the pancreas on CT: review of literature and management suggestions. Abdom Imaging . 2013;38:331-41. Tanaka M, Fernández-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology . 2017;17:738-53. European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut . 2018;67:789-804. Vege SS, Ziring B, Jain R, Moayyedi P; Clinical Guidelines Committee, American Gastroenterology Association. American Gastroenterological Association Institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology . 2015;148:819-22. Zanini N, Giordano M, Smerieri E, et al. Estimation of the prevalence of asymptomatic pancreatic cysts in the population of San Marino. Pancreatology . 2015;15:417-22. Girometti R, Intini S, Brondani G, et al. Incidental pancreatic cysts on 3D turbo spin echo magnetic resonance cholangiopancreatography: prevalence and relation with clinical and imaging features. Abdom Imaging . 2011;36:196-205. Carbonell G, Taouli B. Abbreviated MR protocols for chronic liver disease and liver cancer. Magn Reson Imaging Clin N Am . 2021;29(3):321-7. doi:10.1016/j.mric.2021.05.003. Kuhl CK, Bruhn R, Krämer N, Nebelung S, Heidenreich A, Schrading S. Abbreviated biparametric prostate MR imaging in men with elevated prostate-specific antigen. Radiology . 2017;285:493-505. Delaney FT, Fenlon HM, Cronin CG. An abbreviated MRI protocol for surveillance of cystic pancreatic lesions. Abdom Radiol (NY) . 2021;46(7):3253-9. doi:10.1007/s00261-021-02987-z. Pozzi-Mucelli RM, Rinta-Kiikka I, Wünsche K, et al. Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol. Eur Radiol . 2017;27(1):41-50. doi:10.1007/s00330-016-4377-4. Emir SN, Gürsu M, Dereli Bulut SS. Evaluating the potential of abbreviated MRI protocols for liver metastasis detection: a study in colorectal cancer patients. Pol J Radiol . 2025;90:19-25. doi:10.5114/pjr/196906. Seo N, Byun JH, Kim JH, et al. Validation of the 2012 International Consensus Guidelines using computed tomography and magnetic resonance imaging: branch duct and main duct intraductal papillary mucinous neoplasms of the pancreas. Ann Surg. 2016;263(3):557-64. doi:10.1097/SLA.0000000000001217. D'Onofrio M, Geraci L, De Robertis RL, et al. Magnetic resonance imaging short protocols for intraductal papillary mucinous neoplasm (IPMN) surveillance: the time has come. Dig Liver Dis. 2024;56(9):1551-6. doi:10.1016/j.dld.2024.03.005. Johansson K, Mustonen H, Nieminen H, Haglund C, Lehtimäki TE, Seppänen H. MRI follow-up for pancreatic intraductal papillary mucinous neoplasm: an ultrashort versus long protocol. Abdom Radiol (NY). 2022;47(2):727-37. doi:10.1007/s00261-021-03382-4. Malekzadeh S, Cannella R, Fournier I, et al. The diagnostic value of abbreviated MRI protocol in the surveillance of branch-duct intraductal papillary mucinous neoplasm. Eur J Radiol. 2024;175:111455. doi:10.1016/j.ejrad.2024.111455. Nougaret S, Reinhold C, Chong J, et al. Incidental pancreatic cysts: natural history and diagnostic accuracy of a limited serial pancreatic cyst MRI protocol. Eur Radiol. 2014;24(5):1020-9. doi:10.1007/s00330-014-3112-2. Khawaja AZ, Cassidy DB, Al Shakarchi J, McGrogan DG, Inston NG, Jones RG. Revisiting the risks of MRI with gadolinium-based contrast agents: review of literature and guidelines. Insights Imaging. 2015;6:553-8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Emir","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYDCCAyCCDcpJYLABkoyNB0jRkgbS0kCCFgaGwwhBXIDv9vGHj3nKbPIMbh8+uuHhnvN2a9sPA22psYnGpUXyXI6xMc+5tGKDc2lpNxKe3U7ediYRqOVYWm4DDi0GZ3jYJGe2HU7ccIbH7EbCgdvJZgeAWhgbDuPRwv7858y2/0At/N+AWs4lm51/SEgLgxnDx7YDIFvYgFoO2JndIGCL5BkeY4kP55ITZ55hAzksOcHsBtCWBDx+4TvD/vBDQpldYt8Z5mc3fxywszc7n/7wwYcaG5xaMEAiWGUCscpBwJ4UxaNgFIyCUTAyAABgqW2TK8XTFQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Health Sciences, Umraniye Training and Research Hospital, Department of Radiology","correspondingAuthor":true,"prefix":"","firstName":"Sevde","middleName":"Nur","lastName":"Emir","suffix":""},{"id":415828720,"identity":"5dba7942-542c-4f71-b0e6-d63719df6873","order_by":1,"name":"Görkem Karamustafao","email":"","orcid":"","institution":"University of Health Sciences, Umraniye Training and Research Hospital, Department of Radiology","correspondingAuthor":false,"prefix":"","firstName":"Görkem","middleName":"","lastName":"Karamustafao","suffix":""},{"id":415828721,"identity":"14e4de22-b113-4f8c-bdf0-fb61fbaea1cb","order_by":2,"name":"Gülbanu Güner","email":"","orcid":"","institution":"University of Health Sciences, Umraniye Training and Research Hospital, Department of Radiology","correspondingAuthor":false,"prefix":"","firstName":"Gülbanu","middleName":"","lastName":"Güner","suffix":""},{"id":415828722,"identity":"9bcd10af-8613-421a-9b90-c2b6d54eb01b","order_by":3,"name":"Servet Emir","email":"","orcid":"","institution":"University of Health Sciences, Umraniye Training and Research Hospital, Department of Internal Medicine","correspondingAuthor":false,"prefix":"","firstName":"Servet","middleName":"","lastName":"Emir","suffix":""},{"id":415828723,"identity":"4c51989b-095d-4862-9129-511964b61459","order_by":4,"name":"Yahya Özel","email":"","orcid":"","institution":"Dogus University, VM Medical Park Pendik Hospital, Department of General Surgery","correspondingAuthor":false,"prefix":"","firstName":"Yahya","middleName":"","lastName":"Özel","suffix":""},{"id":415828724,"identity":"a1590def-e420-4300-84de-8574365c3db5","order_by":5,"name":"Fatma Kulalı","email":"","orcid":"","institution":"University of Health Sciences, Umraniye Training and Research Hospital, Department of Radiology","correspondingAuthor":false,"prefix":"","firstName":"Fatma","middleName":"","lastName":"Kulalı","suffix":""}],"badges":[],"createdAt":"2025-02-05 21:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5968545/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5968545/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76740580,"identity":"d57b1a4c-8675-4a10-a5b5-d5d8b7ac10c9","added_by":"auto","created_at":"2025-02-20 08:11:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":264130,"visible":true,"origin":"","legend":"\u003cp\u003e(a) Axial T2-weighted imaging demonstrates a lobulated cystic lesion with thin septations at the level of the pancreatic head.\u003cbr\u003e\n(b) Dynamic post-contrast venous phase imaging reveals mild enhancement of the cyst septa.\u003cbr\u003e\n(c) 3D MRCP (coronal view) visualizes the cyst structure and its relationship with the pancreatic duct.\u003cbr\u003e\n(d) ADC mapping shows a hyperintense signal, indicative of a T2 shine-through effect rather than true diffusion restriction.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5968545/v1/e2e5605628b14a085ca65192.png"},{"id":76740576,"identity":"3593be33-9ddb-47c7-a897-c14844e9c4ff","added_by":"auto","created_at":"2025-02-20 08:11:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":272866,"visible":true,"origin":"","legend":"\u003cp\u003e(a) T2-weighted axial imaging shows a thick-walled cystic lesion in the pancreatic tail, with a millimetric nodular appearance on the left lateral wall.\u003cbr\u003e\n(b) Post-contrast venous phase imaging demonstrates enhancement of the mural nodule within the lesion.\u003cbr\u003e\n(c) Diffusion-weighted imaging (DWI) shows no diffusion restriction within the lesion.\u003cbr\u003e\n(d) Post-contrast coronal imaging reveals the thick cyst wall.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5968545/v1/0ba4c5256194a15a5066d544.png"},{"id":79553742,"identity":"fdc11228-2bd8-4cc7-8982-e655e5172e15","added_by":"auto","created_at":"2025-03-31 07:02:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1228100,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5968545/v1/fe1e512d-6cb2-4895-82a0-2c770656ea9c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Shorter, Faster, and Effective? Evaluating Abbreviated MRI for Branch-Duct Intraductal Papillary Mucinous Neoplasm","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAdvancements in imaging technologies and the widespread use of magnetic resonance imaging (MRI) have significantly increased the detection rates of pancreatic cystic lesions. According to the literature, these lesions are identified in approximately 2\u0026ndash;3% of the general population through abdominal computed tomography (CT) and in up to 40% of cases in magnetic resonance cholangiopancreatography (MRCP) studies. Most pancreatic cystic lesions are incidentally detected, and while the majority are benign, certain types, such as intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN), carry a potential risk of malignancy, necessitating regular clinical and radiological follow-up [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIPMNs are classified into three subtypes: main duct, branch duct, and mixed-type. Main duct IPMNs have been reported to exhibit invasive characteristics in approximately 62% of cases following resection. Similarly, although branch duct IPMNs carry a lower risk, they still present a notable potential for malignancy. Studies have shown that 10\u0026ndash;15% of branch duct IPMNs progress over a 3\u0026ndash;5 year follow-up period, with an annual malignancy development risk of 0.24%. Additionally, high-grade dysplasia or invasive malignancy has been identified in 31% of resected branch duct IPMNs. Therefore, regular radiological surveillance of small, asymptomatic branch duct IPMNs that are not associated with suspicious imaging findings or clinical/biochemical indicators is crucial for the early detection of malignant transformation[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Various guidelines have been developed for the surveillance of IPMNs and similar lesions; however, they differ in terms of follow-up duration and methodology. The American Gastroenterological Association recommends follow-up for up to five years, whereas European guidelines emphasize the necessity of lifelong surveillance. Despite these discrepancies, there is a consensus on the importance of evaluating critical imaging findings, such as cyst size, the presence of mural nodules, and the enlargement of the main pancreatic duct, in guiding clinical management [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor the routine surveillance of IPMNs and other pancreatic cystic lesions, the standard upper abdominal MRI protocol is commonly preferred. This protocol includes comprehensive sequences such as T2-weighted imaging, dynamic contrast-enhanced T1-weighted imaging, and diffusion-weighted imaging (DWI). However, this approach poses challenges, particularly for patients requiring frequent imaging, due to prolonged scan times (30\u0026ndash;50 minutes), the additional costs associated with contrast administration, and reduced patient comfort. Furthermore, the need for intravenous contrast injection can be an added source of stress, especially for claustrophobic or elderly patients[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, abbreviated MRI (A-MRI) protocols, which aim to reduce scan time and cost while maintaining diagnostic accuracy, have emerged as a valuable alternative. In recent years, there has been growing interest in A-MRI protocols designed to shorten imaging duration without compromising diagnostic performance. These protocols achieve time efficiency by omitting time-consuming components such as dynamic contrast-enhanced sequences and/or diffusion-weighted imaging (DWI). While studies on abbreviated MRI protocols for organs such as the liver and prostate have shown promising results, their effectiveness in the surveillance of pancreatic cystic lesions has been evaluated in only a limited number of studies. This raises concerns regarding the potential risk of missing critical malignant features, such as mural nodules, cyst enlargement, and main pancreatic duct dilation[\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThis study aims to compare the diagnostic accuracy and clinical feasibility of two different abbreviated MRI (A-MRI) protocols with the standard MRI protocol (S-MRI) in the surveillance of IPMNs.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis study is a retrospective, single-center study. Patients diagnosed with branch-duct IPMN who underwent follow-up abdominal MRI between January 2022 and December 2024 at our institution were included in the analysis.\u003c/p\u003e\n\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003ePatient Selection\u003c/h2\u003e\n \u003cp\u003eThe diagnosis of branch-duct IPMN was based on the presence of cystic lesions with a clear connection to the pancreatic duct on initial MRI examinations. Patients were included in the study if they met the following criteria:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eHad a baseline (initial) abdominal MRI and at least one follow-up MRI using the standard protocol (S-MRI).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eHad a minimum interval of six months between follow-up MRI scans.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eIn cases where multiple MRI examinations were available, the scan with the least artifacts was selected for analysis.\u003c/p\u003e\n \u003cp\u003ePatients were excluded from the study if:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eContrast agent was not administered during follow-up MRI.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eThey had a history of pancreatic surgery.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eImage quality was compromised due to motion artifacts or metallic artifacts.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n\u003c/div\u003e\n\u003ch3\u003eMRI Acquisition\u003c/h3\u003e\n\u003cp\u003eAll MRI examinations were performed using a 1.5 Tesla system (Magnetom Aera\u0026reg;, Siemens Healthineers, Erlangen, Germany). Three different MRI protocols were defined for the study:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eStandard Protocol (S-MRI): Included axial and coronal T2-weighted imaging, dynamic contrast-enhanced T1-weighted imaging (pre- and post-contrast), 3D MR cholangiopancreatography (MRCP), and diffusion-weighted imaging (DWI). The total scan time was approximately 40\u0026ndash;50 minutes.\u003c/li\u003e\n \u003cli\u003eAbbreviated Protocol 1 (A-MRI-1): Included 3D MRCP and T2-weighted imaging sequences. The estimated scan time was approximately 7\u0026ndash;8 minutes.\u003c/li\u003e\n \u003cli\u003eAbbreviated Protocol 2 (A-MRI-2): Included all sequences in A-MRI-1 with the addition of DWI. The estimated scan time was approximately 10\u0026ndash;12 minutes.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eAll abbreviated protocol images were extracted from the existing S-MRI datasets and analyzed separately.\u003c/p\u003e\n\u003ch3\u003eImaging Analysis\u003c/h3\u003e\n\u003cp\u003eMRI images were evaluated by a radiology resident with three years of experience. The radiologist conducted the assessments in a blinded manner, without access to clinical information such as symptoms, surgical history, or histopathological findings. The imaging analysis was performed in four stages:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\n \u003cp\u003eBaseline Evaluation: The initial MRI of each patient was reviewed by a second radiologist with 11 years of experience to confirm the diagnosis of branch-duct IPMN.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eS-MRI Evaluation: The most recent follow-up MRI images were compared with the baseline MRI to assess for degeneration markers, including lesion size changes, mural nodules, cyst wall thickening, and main pancreatic duct dilation.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eA-MRI-2 Evaluation: The images extracted for A-MRI-2 (MRCP\u0026thinsp;+\u0026thinsp;DWI) were independently analyzed.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eA-MRI-1 Evaluation: The images extracted for A-MRI-1 (MRCP only) were analyzed and compared with S-MRI.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eA three-week interval was maintained between each evaluation to minimize recall bias.\u003c/p\u003e\n\u003cp\u003eFigures 1 and 2 shows MR images of leisons.\u003c/p\u003e\n\u003ch3\u003eEvaluation Criteria\u003c/h3\u003e\n\u003cp\u003eDegeneration markers were assessed based on the 2017 Fukuoka guidelines, considering the following criteria:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eLesion size\u0026thinsp;\u0026ge;\u0026thinsp;3 cm\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eIncrease in lesion size\u0026thinsp;\u0026ge;\u0026thinsp;5 mm within 2 years\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ePresence of contrast-enhancing mural nodules\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eThickening of the cyst wall\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eMain pancreatic duct dilation (\u0026ge;\u0026thinsp;5 mm)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eSudden change in pancreatic duct diameter with distal atrophy\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Results","content":"\u003cp\u003eThis study evaluated the diagnostic performance of abbreviated MRI (A-MRI) protocols in detecting degeneration markers in patients with branch-duct IPMN (BD-IPMN). A total of 124 patients were included, with a mean age of 64 years; 55.6% were female, and 44.4% were male.\u003c/p\u003e\n\u003cp\u003eIn total, 124 lesions were analyzed. The lesion size distribution was as follows: 44.4% measured 5\u0026ndash;10 mm, 40.3% were 10\u0026ndash;20 mm, 12.9% were 20\u0026ndash;30 mm, and 2.4% were \u0026gt;30 mm. The most common lesion locations were the pancreatic body (19.4%) and tail (11.3%)(as shown in table 1).\u003c/p\u003e\n\u003cp\u003eThe study compared the performance of abbreviated MRI protocols (A-MRI-1 and A-MRI-2) with the standard protocol (S-MRI) in detecting degeneration markers in BD-IPMNs. A significant increase in lesion size (\u0026ge;5 mm over 2 years) was identified at equal rates (7.3%) across all protocols (S-MRI, A-MRI-1, and A-MRI-2). Mural nodules were detected in 4.0% of cases using S-MRI, whereas A-MRI-1 and A-MRI-2 yielded a slightly higher detection rate (5.6%). However, contrast-enhancing mural nodules were identified only with S-MRI (1.6%), as A-MRI protocols lacked dynamic contrast-enhanced sequences. The detection rates for cyst wall thickening were identical across all protocols (1.6% for both S-MRI and A-MRI protocols). Main pancreatic duct dilation and parenchymal atrophy were observed in 0.8% of cases across all three protocols (as shown in Table 2).\u003c/p\u003e\n\u003cp\u003eRegarding overall degeneration marker detection, positive findings were identified in 15.3% (19/124) of cases with S-MRI, compared to 16.9% (21/124) with both A-MRI-1 and A-MRI-2. The slightly higher detection rate in A-MRI protocols was attributed to differences in mural nodule evaluation. Additional mural nodules identified in A-MRI protocols were determined to be false positives, likely due to the absence of contrast-enhanced sequences. The false-positive rate for mural nodule detection in A-MRI was 1.6% (2/124), while the false-negative rate was 0%.\u003c/p\u003e\n\u003cp\u003eBased on these findings, the diagnostic performance metrics for A-MRI were calculated as follows:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eSensitivity: 100%\u003c/li\u003e\n \u003cli\u003eSpecificity: 98.3%\u003c/li\u003e\n \u003cli\u003ePositive Predictive Value (PPV): 71.4%\u003c/li\u003e\n \u003cli\u003eNegative Predictive Value (NPV): 100%\u003c/li\u003e\n \u003cli\u003eAccuracy: 98.4%\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThese results demonstrate that A-MRI protocols exhibit comparable performance to S-MRI in detecting degeneration markers, with the exception of mural nodules. However, the higher false-positive rate for mural nodule detection in A-MRI suggests that the lack of dynamic contrast-enhanced sequences negatively impacts specificity and PPV. Nonetheless, the high sensitivity and accuracy of A-MRI in identifying degeneration markers overall support its potential utility in clinical practice as an efficient alternative for BD-IPMN surveillance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Baseline Characteristics of the Study Population\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eNumber (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e64.0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e54 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e69 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eLocation of lesions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eHead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e7 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eUncinate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e14 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eIsthmus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e15 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eBody\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e24 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eTail\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e14 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eDemographic and anatomical distribution of pancreatic cystic lesions in the study cohort. Data are presented as median (interquartile range) for age and as number (percentage) for categorical variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. Comparison of Degeneration Markers Detected by Standard and Abbreviated MRI Protocols\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eParameter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eStandard Protocol (S-MRI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbbreviated Protocol 1 (A-MRI-1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbbreviated Protocol 2 (A-MRI-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eSignificant Increase in Size (\u0026ge;5 mm/2Y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 9 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 9 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 9 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 115 (92.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 115 (92.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 115 (92.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eMural Nodule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 5 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 7 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 7 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 119 (96.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 117 (94.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 117 (94.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eContrast-Enhancing Mural Nodule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 2 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 122 (98.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 124 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 124 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eThickened Cyst Wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 2 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 2 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 2 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 122 (98.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 122 (98.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 122 (98.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eMain Pancreatic Duct Dilation and Parenchymal Atrophy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 123 (99.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 123 (99.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 123 (99.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eDegeneration Signs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 19 (15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 21 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePresent: 21 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 105 (84.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 103 (83.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAbsent: 103 (83.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eDetection rates of key degeneration markers in branch-duct IPMN using the standard MRI protocol (S-MRI), abbreviated protocol 1 (A-MRI-1), and abbreviated protocol 2 (A-MRI-2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the diagnostic efficacy of abbreviated MRI (A-MRI) protocols in detecting degeneration markers in BD-IPMN patients and demonstrated comparable results to the standard protocol. The incidental detection rate of pancreatic cystic lesions on MRI ranges between 20% and 44%, with some of these lesions carrying malignant potential. BD-IPMNs, in particular, are known to have a low but clinically significant risk of malignancy. Our findings indicate that A-MRI protocols facilitate the surveillance of these lesions while maintaining diagnostic accuracy [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e The high-risk stigmata criteria outlined in the 2017 Fukuoka guidelines by Tanaka et al. were effectively identified using the abbreviated MRI protocol in our study [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSimilarly, the study by D'Onofrio et al. compared the diagnostic efficacy of different abbreviated MRI protocols, including T1-weighted, T2-weighted, MRCP sequences, a DWI-enhanced abbreviated protocol, and post-contrast T1-weighted sequences. The impact of these protocols on clinical decision-making was also evaluated. Their findings reported that the DWI-enhanced protocol and the post-contrast T1-weighted protocol demonstrated a higher concordance with clinical decisions[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, abbreviated MRI (A-MRI) protocols were shown to maintain their effectiveness in detecting key degeneration markers indicative of malignancy, such as lesion size increase, the presence of mural nodules, and pancreatic duct dilation, while significantly reducing scan times. A comparison between A-MRI-1 (MRCP) and A-MRI-2 (MRCP\u0026thinsp;+\u0026thinsp;DWI) demonstrated that both protocols had a 100% sensitivity and negative predictive value (NPV) in detecting these degeneration markers.\u003c/p\u003e \u003cp\u003eSimilarly, Johansson et al. evaluated the diagnostic accuracy of ultrashort MRI protocols in identifying worrisome features (WF) and high-risk stigmata (HRS), reporting comparable results to standard protocols. Their study found that the detection rate of WF/HRS was 92.4% with ultrashort protocols (USP) and 96.4% with longer protocols. Consistent with these findings, our study also demonstrated that abbreviated MRI protocols provide similar diagnostic accuracy to standard protocols in identifying degeneration markers. Notably, Johansson\u0026rsquo;s study emphasized that ultrashort protocols were most suitable for patients who did not initially present with WF or HRS findings [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the study by Pozzi-Mucelli et al., the diagnostic efficacy of an abbreviated protocol was compared with a comprehensive protocol for the surveillance of pancreatic cystic neoplasms. Their findings demonstrated that the abbreviated protocol provided equivalent diagnostic information to the standard protocol in clinical decision-making while also offering significant advantages in terms of time efficiency and cost reduction [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese findings are largely consistent with the study by Delaney et al., which evaluated the use of abbreviated MRI (A-MRI) in the surveillance of pancreatic cystic lesions [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the absence of contrast-enhanced sequences led to false-positive identification of mural nodules in these studies, subsequently reducing the positive predictive value (PPV). Similarly, in our study, mural nodules were overestimated in the abbreviated MRI (A-MRI) protocols, contributing to a lower PPV. This finding suggests that A-MRI may be more suitable for the surveillance of patients without high-risk features at baseline.\u003c/p\u003e \u003cp\u003eA key contribution of our study was the comparison between MRCP\u0026thinsp;+\u0026thinsp;T2-weighted imaging (A-MRI-1) and MRCP\u0026thinsp;+\u0026thinsp;T2\u0026thinsp;+\u0026thinsp;DWI (A-MRI-2), demonstrating that the addition of DWI did not improve diagnostic accuracy.\u003c/p\u003e \u003cp\u003eThis finding aligns with the study by Malekzadeh et al., which evaluated the diagnostic value of an abbreviated MRI protocol in BD-IPMN patients. Their study reported that DWI did not provide additional value in detecting degeneration markers and that A-MRI showed comparable sensitivity and specificity to the standard protocol. Specifically, they found that A-MRI had 100% sensitivity, 93.5% specificity, 83.3% PPV, and 100% negative predictive value (NPV) for assessing degeneration criteria in BD-IPMNs [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. These results are highly consistent with our study, where we observed high NPV but an increased false-positive detection of mural nodules in non-contrast A-MRI protocols.\u003c/p\u003e \u003cp\u003eThese findings suggest that mural nodule assessment may require contrast-enhanced imaging and that additional imaging might be necessary in selected cases. Both Malekzadeh et al. and our study indicate that some mural nodules identified in non-contrast A-MRI protocols were, in fact, mucinous content rather than true nodules when verified with contrast-enhanced imaging. This highlights the potential for increased false-positive rates in non-contrast protocols, emphasizing the need for further evaluation in patients at higher risk.\u003c/p\u003e \u003cp\u003eSimilarly, Nougaret et al. conducted a long-term study on the surveillance of incidentally detected pancreatic cystic lesions and reported that gadolinium injection did not provide additional value in the follow-up process. In this study, 301 patients and 1,174 cystic lesions were analyzed, with significant changes observed in only 12% of cases during follow-up. Notably, lesions with an initial size of less than 2 cm did not undergo malignant transformation, suggesting that gadolinium-enhanced imaging offers limited benefit in the surveillance protocols for such lesions [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAbbreviated MRI protocols not only enhance patient comfort but also provide significant economic benefits. The reduction in imaging costs could contribute substantially to both individual healthcare expenses and long-term healthcare system sustainability, particularly in younger populations requiring prolonged surveillance. Additionally, the omission of contrast agents eliminates the risk of nephrogenic systemic fibrosis (NSF) and other contrast-related complications, offering a crucial advantage for patients with impaired renal function [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study has several limitations. First, as a retrospective study, there is a potential risk of selection bias. Additionally, since imaging evaluations were performed three weeks apart, the possibility of recall bias cannot be excluded. Second, being a single-center study, our sample size is limited. The median follow-up duration for lesions was 564 days. Third, only a small subset of patients had a histopathological diagnosis, as most were followed without surgical intervention. Finally, all images were evaluated by a single reader, and interobserver agreement was not assessed. However, the literature already contains multiple studies evaluating interobserver variability in this context.\u003c/p\u003e \u003cp\u003eTo further validate our findings, multi-center, prospective studies with longer follow-up periods are warranted.\u003c/p\u003e \u003cp\u003eThe higher false-positive detection rate of mural nodules in abbreviated MRI (A-MRI) protocols underscores the need for careful clinical decision-making. In cases where mural nodules\u0026mdash;a key malignancy indicator\u0026mdash;are reported, further evaluation with a standard contrast-enhanced protocol may be warranted. This represents one of the key limitations of abbreviated protocols, potentially restricting their use in selected patient groups. However, the impact of false-positive results due to the absence of contrast-enhanced sequences can be minimized through technical optimization and improved artifact management.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study demonstrates that abbreviated MRI (A-MRI) protocols can be a safe and effective alternative for the surveillance of branch-duct IPMNs (BD-IPMNs). Particularly in patients with no degeneration markers on initial MRI, A-MRI may serve as a time- and cost-efficient follow-up strategy. However, contrast-enhanced imaging may still be necessary for the accurate assessment of mural nodules in certain patient groups. Additionally, our findings indicate that diffusion-weighted imaging (DWI) does not provide additional diagnostic benefit and only prolongs the imaging process.\u003c/p\u003e \u003cp\u003eBased on these findings, A-MRI appears to be a viable follow-up method for selected patients, though it cannot entirely replace standard protocols. Future studies should further define the patient groups for whom A-MRI is sufficient and determine specific cases where contrast-enhanced imaging remains essential, ultimately refining its role in clinical practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was approved by the Ethics Committee of Sağlık Bilimleri University \u0026Uuml;mraniye Training and Research Hospital (Approval code: pending). The requirement for informed consent was waived.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe author did not receive support from any organization for the submitted work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors made significant contributions to the conception and design of the study, as well as the acquisition, analysis, and interpretation of data. Material preparation, data collection, and statistical analysis were conducted by SNE, GK, and GG, ensuring methodological rigor and accuracy in the findings. The first draft of the manuscript was written by SNE, GG, and Y\u0026Ouml;, incorporating key insights from the study. All authors provided critical revisions and intellectual input on earlier versions of the manuscript, refining the content for clarity, coherence, and scientific accuracy. The final revisions were completed collaboratively, integrating feedback and ensuring the manuscript met the highest academic standards. All authors have reviewed and approved the final version of the manuscript and take responsibility for its integrity and accuracy.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe datasets analyzed during the current study are not publicly available due to patient confidentiality but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCanellas R, Rosenkrantz AB, Taouli B, et al. Abbreviated MRI protocols for the abdomen. Radiographics. 2019;39:744-58.\u003c/li\u003e\n\u003cli\u003eCrippa S, Capurso G, Camma C, Fave GD, Castillo CF, Falconi M. Risk of pancreatic malignancy and mortality in branch-duct IPMNs undergoing surveillance: a systematic review and meta-analysis. Dig Liver Dis. 2016;48:473-79.\u003c/li\u003e\n\u003cli\u003eNilsson LN, Keane MG, Shamali A, et al. Nature and management of pancreatic mucinous cystic neoplasm (MCN): a systematic review of the literature. Pancreatology. 2016;16:1028-36.\u003c/li\u003e\n\u003cli\u003eZaheer A, Pokharel SS, Wolfgang C, Fishman EK, Horton KM. Incidentally detected cystic lesions of the pancreas on CT: review of literature and management suggestions. \u003cstrong\u003eAbdom Imaging\u003c/strong\u003e. 2013;38:331-41.\u003c/li\u003e\n\u003cli\u003eTanaka M, Fern\u0026aacute;ndez-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. \u003cstrong\u003ePancreatology\u003c/strong\u003e. 2017;17:738-53.\u003c/li\u003e\n\u003cli\u003eEuropean Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. \u003cstrong\u003eGut\u003c/strong\u003e. 2018;67:789-804.\u003c/li\u003e\n\u003cli\u003eVege SS, Ziring B, Jain R, Moayyedi P; Clinical Guidelines Committee, American Gastroenterology Association. American Gastroenterological Association Institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. \u003cstrong\u003eGastroenterology\u003c/strong\u003e. 2015;148:819-22.\u003c/li\u003e\n\u003cli\u003eZanini N, Giordano M, Smerieri E, et al. Estimation of the prevalence of asymptomatic pancreatic cysts in the population of San Marino. \u003cstrong\u003ePancreatology\u003c/strong\u003e. 2015;15:417-22.\u003c/li\u003e\n\u003cli\u003eGirometti R, Intini S, Brondani G, et al. Incidental pancreatic cysts on 3D turbo spin echo magnetic resonance cholangiopancreatography: prevalence and relation with clinical and imaging features. \u003cstrong\u003eAbdom Imaging\u003c/strong\u003e. 2011;36:196-205.\u003c/li\u003e\n\u003cli\u003eCarbonell G, Taouli B. Abbreviated MR protocols for chronic liver disease and liver cancer. \u003cstrong\u003eMagn Reson Imaging Clin N Am\u003c/strong\u003e. 2021;29(3):321-7. doi:10.1016/j.mric.2021.05.003.\u003c/li\u003e\n\u003cli\u003eKuhl CK, Bruhn R, Kr\u0026auml;mer N, Nebelung S, Heidenreich A, Schrading S. Abbreviated biparametric prostate MR imaging in men with elevated prostate-specific antigen. \u003cstrong\u003eRadiology\u003c/strong\u003e. 2017;285:493-505.\u003c/li\u003e\n\u003cli\u003eDelaney FT, Fenlon HM, Cronin CG. An abbreviated MRI protocol for surveillance of cystic pancreatic lesions. \u003cstrong\u003eAbdom Radiol (NY)\u003c/strong\u003e. 2021;46(7):3253-9. doi:10.1007/s00261-021-02987-z.\u003c/li\u003e\n\u003cli\u003ePozzi-Mucelli RM, Rinta-Kiikka I, W\u0026uuml;nsche K, et al. Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol. \u003cstrong\u003eEur Radiol\u003c/strong\u003e. 2017;27(1):41-50. doi:10.1007/s00330-016-4377-4.\u003c/li\u003e\n\u003cli\u003eEmir SN, G\u0026uuml;rsu M, Dereli Bulut SS. Evaluating the potential of abbreviated MRI protocols for liver metastasis detection: a study in colorectal cancer patients. \u003cstrong\u003ePol J Radiol\u003c/strong\u003e. 2025;90:19-25. doi:10.5114/pjr/196906.\u003c/li\u003e\n\u003cli\u003eSeo N, Byun JH, Kim JH, et al. Validation of the 2012 International Consensus Guidelines using computed tomography and magnetic resonance imaging: branch duct and main duct intraductal papillary mucinous neoplasms of the pancreas. Ann Surg. 2016;263(3):557-64. doi:10.1097/SLA.0000000000001217.\u003c/li\u003e\n\u003cli\u003eD\u0026apos;Onofrio M, Geraci L, De Robertis RL, et al. Magnetic resonance imaging short protocols for intraductal papillary mucinous neoplasm (IPMN) surveillance: the time has come. Dig Liver Dis. 2024;56(9):1551-6. doi:10.1016/j.dld.2024.03.005.\u003c/li\u003e\n\u003cli\u003eJohansson K, Mustonen H, Nieminen H, Haglund C, Lehtim\u0026auml;ki TE, Sepp\u0026auml;nen H. MRI follow-up for pancreatic intraductal papillary mucinous neoplasm: an ultrashort versus long protocol. Abdom Radiol (NY). 2022;47(2):727-37. doi:10.1007/s00261-021-03382-4.\u003c/li\u003e\n\u003cli\u003eMalekzadeh S, Cannella R, Fournier I, et al. The diagnostic value of abbreviated MRI protocol in the surveillance of branch-duct intraductal papillary mucinous neoplasm. Eur J Radiol. 2024;175:111455. doi:10.1016/j.ejrad.2024.111455.\u003c/li\u003e\n\u003cli\u003eNougaret S, Reinhold C, Chong J, et al. Incidental pancreatic cysts: natural history and diagnostic accuracy of a limited serial pancreatic cyst MRI protocol. Eur Radiol. 2014;24(5):1020-9. doi:10.1007/s00330-014-3112-2.\u003c/li\u003e\n\u003cli\u003eKhawaja AZ, Cassidy DB, Al Shakarchi J, McGrogan DG, Inston NG, Jones RG. Revisiting the risks of MRI with gadolinium-based contrast agents: review of literature and guidelines. Insights Imaging. 2015;6:553-8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5968545/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5968545/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWith the advancements in imaging technologies and the widespread use of magnetic resonance imaging (MRI), the detection rates of pancreatic cystic lesions (PCLs) have significantly increased. While most of these lesions are benign, branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) pose a potential risk for malignant transformation, necessitating regular clinical and radiological follow-up. However, conventional MRI protocols are time-consuming and resource-intensive, prompting the need for shorter, cost-effective alternatives without compromising diagnostic accuracy. This study aims to evaluate the diagnostic performance and clinical feasibility of abbreviated MRI (A-MRI) protocols for BD-IPMN surveillance compared to standard MRI (S-MRI).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a single-center, retrospective study including patients with BD-IPMN who underwent follow-up MRI between January 2022 and December 2024. Three MRI protocols were analyzed: (1) S-MRI, comprising T2-weighted imaging, dynamic contrast-enhanced (DCE) T1-weighted imaging, 3D MR cholangiopancreatography (MRCP), and diffusion-weighted imaging (DWI); (2) A-MRI protocol 1 (A-MRI-1), including MRCP and T2-weighted sequences; and (3) A-MRI protocol 2 (A-MRI-2), incorporating MRCP, T2-weighted, and DWI sequences. The images are evaluated for lesion size progression (\u0026ge;\u0026thinsp;5 mm in 2 years), mural nodules, cyst wall thickening, main pancreatic duct dilation, and parenchymal atrophy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for A-MRI protocols in detecting degeneration signs.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 124 patients (mean age: 64 years, 55.6% female) and 124 lesions were analyzed. The detection rates of key degeneration markers were similar between S-MRI and A-MRI protocols, except for contrast-enhanced mural nodules, which were not identifiable with A-MRI due to the lack of DCE sequences. The overall sensitivity, specificity, PPV, and NPV for A-MRI in detecting BD-IPMN degeneration markers were 100%, 98.3%, 71.4%, and 100%, respectively. A-MRI protocols demonstrated a comparable diagnostic performance to S-MRI while significantly reducing scan time (from ~\u0026thinsp;40\u0026ndash;50 min to 7\u0026ndash;12 min). However, false-positive mural nodule detection was higher with A-MRI, potentially leading to unnecessary follow-up imaging. The addition of DWI in A-MRI-2 did not provide a significant diagnostic advantage over A-MRI-1.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eA-MRI is a viable alternative for BD-IPMN follow-up, offering substantial reductions in imaging duration and costs while maintaining high diagnostic accuracy. However, the absence of DCE sequences may lead to false-positive mural nodule detection, necessitating further evaluation in selected cases.\u003c/p\u003e","manuscriptTitle":"Shorter, Faster, and Effective? Evaluating Abbreviated MRI for Branch-Duct Intraductal Papillary Mucinous Neoplasm","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-20 08:11:41","doi":"10.21203/rs.3.rs-5968545/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e872c636-7d58-4a59-96df-f0e559969d32","owner":[],"postedDate":"February 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-31T06:54:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-20 08:11:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5968545","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5968545","identity":"rs-5968545","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}