Impact of Canadian Association of Radiologists and Fukuoka Recommendations on MRI Utilization for Surveillance of Incidental Pancreatic Cysts

Objectives: 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 t -tests. 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; P < .001). At 10 years, the difference further increased (1.45 ± 1.5 vs 6.23 ± 1.64; P < .001). 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.