What is the purpose of performing a Magnetic Resonance Imaging (MRI) of the abdomen on a 77-year-old female to follow up on pancreatic lesions found on Computed Tomography (CT)?

From the Guidelines

I strongly recommend proceeding with an MRI of the abdomen to follow up on the pancreatic lesions previously identified on CT in this 77-year-old female patient. The MRI should be performed with and without contrast (gadolinium) using pancreatic protocol sequences, including T1-weighted, T2-weighted, diffusion-weighted imaging, and dynamic contrast enhancement. This imaging modality is superior to CT for characterizing pancreatic lesions as it provides better soft tissue contrast and can better differentiate between cystic and solid components 1.

The patient should fast for 4-6 hours prior to the examination to reduce bowel motility and improve image quality. If the patient has any metallic implants or devices, these should be screened for MRI compatibility beforehand. Additionally, renal function should be assessed with recent creatinine levels (within 30 days) to ensure safe administration of contrast. Following the MRI, a comparison with the previous CT findings should be performed to assess for any interval changes in size, number, or characteristics of the lesions, which will help determine if these are likely benign (such as serous cystadenomas) or potentially malignant lesions requiring further intervention.

Some key points to consider when performing the MRI include:

• The use of MRCP sequences to evaluate the biliary and pancreatic ducts 1
• The potential for MRI to detect liver metastases from pancreaticobiliary malignancies 1
• The importance of assessing renal function before administering contrast 1
• The need to screen for MRI compatibility of any metallic implants or devices 1

Overall, the MRI is a valuable tool for characterizing pancreatic lesions and guiding further management, and its use is supported by recent evidence 1.

From the Research

MRI Abdomen for Pancreatic Lesions

• The use of MRI abdomen to follow up on pancreatic lesions found on CT is a common practice, as MRI can provide more detailed images of the pancreas and surrounding tissues 2.
• Pancreatic cystic lesions (PCLs) are being increasingly identified, and their diagnosis and discrimination are crucial due to the risk of concurrent or later development of malignancy 2.
• MRI can be used to characterize PCLs, but its ability to differentiate between benign and malignant lesions is limited 2, 3.

Diagnostic Options

• Endoscopic US may be more helpful for the diagnosis and differentiation of PCLs due to its high resolution and better imaging characteristics than cross-sectional imaging modalities 2.
• Fine-needle aspiration (FNA) of cystic lesions for biochemical, cytological, and DNA analysis can provide further diagnostic information 2.
• Other imaging modalities, such as CT, MRCP, and 18-FDG PET, can also be used to characterize PCLs and determine their malignant potential 3.

Management Options

• The management options for PCLs include observation, endoscopic treatment, or surgical resection 2.
• The decision for management is sometimes hampered by limitations in current diagnostic and tissue sampling techniques 2.
• Radiation therapy, including stereotactic ablative body radiotherapy, may be beneficial in certain circumstances, such as locally advanced pancreatic cancer 4, 5.
• Chemoradiation and chemotherapy are also used in the treatment of pancreatic cancer, and their efficacy and safety are being studied in clinical trials 4, 6, 5.