ArticleAbdominal radiology (New York)2026
Incidental findings during pancreatic cyst surveillance: clinical relevance and implications for MRI protocol design.
Article in Abdominal radiology (New York), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate the prevalence and clinical relevance of incidental findings detected during pancreatic cyst surveillance and explore their implications for pancreas-focused imaging protocols.
methodsThis single-center retrospective study analyzed abdominal MRI and CT reports for pancreatic cyst surveillance (2005-2025) using a large language model (LLM). Incidental findings were findings unrelated to the clinical indication. Only the earliest surveillance examination per patient was included. Patients were stratified into cyst-only surveillance (cyst-only), cyst surveillance with high-risk pancreatic screening (cyst-HRI), or cyst surveillance with additional clinical indications (cyst-other). Electronic health record (EHR) review evaluated suspected extrapancreatic neoplastic incidental findings and incidental intrapancreatic hyperenhancing lesions. LLM performance was validated against two reviewers in 100 sampled reports. Multivariable logistic regression adjusted for age and sex.
results6174 patients (mean age, 70.6 ± 12.3 years; 65.7% women) were included; 94.8% underwent MRI. LLM-reviewer agreement was high (Cohen κ = 0.857 and 0.882). Incidental findings were identified in 43.0% of examinations and were predominantly nonneoplastic (98.7%), with most not requiring further action (70.2%). EHR targeted review confirmed 19 extrapancreatic neoplasms, most commonly renal neoplasms (n = 14). Extrapancreatic neoplasms were more frequent in cyst-other than cyst-only patients (14/906 [1.55%] vs. 5/4,822 [0.10%]; aOR, 14.20; 95% CI 5.09-39.61; p < 0.001). No extrapancreatic neoplasms were identified in cyst-HRI patients (0/446; 95% CI 0.00-0.82%). Incidentally detected intrapancreatic hyperenhancing lesions were uncommon (31/6,174, 0.50%); final diagnoses included 25 neuroendocrine tumors and four intrapancreatic splenules.
conclusionClinically significant extrapancreatic neoplasms were rare during pancreatic cyst surveillance, particularly among cyst-only and cyst-HRI patients. While this study did not directly assess the diagnostic performance of reduced field-of-view or non-contrast MRI, the low burden of extrapancreatic neoplasms suggests these protocol strategies warrant further evaluation in selected populations.
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