TPW 7.11 The Impact of PET-CT and Selective Liver MRI on Patient Pathways and Resectability in Pancreatic Ductal Adenocarcinoma: A Single-Centre Experience
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ID: 324044
2026
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Abstract
Abstract Introduction Accurate staging of pancreatic ductal adenocarcinoma (PDAC) is essential to guide treatment decisions and avoid futile surgery. NICE guidance recommends pancreas-protocol computed tomography (CT) and positron emission tomography–computed tomography (PET–CT) for staging. The additional role of liver magnetic resonance imaging (MRI) in detecting occult liver metastases remains uncertain. Methods A retrospective observational cohort study of patients with suspected PDAC (2023-25) explored the impact of PET-CT and selective MRI on patient pathways and resectability. Results 195 patients underwent CT and were included. PET–CT was performed in 148 patients (75.9%), PET–CT with selective liver MRI in 30 (15.4%), and liver MRI alone in 17 (8.7%). PET–CT identified distant metastatic disease in 22 (12.4%) patients. When performed, selective liver MRI detected liver metastases in 19 (40.4%) patients. Twelve patients underwent liver MRI prompted by PET–CT findings, confirming metastases in three, indeterminate lesions in three, and benign or resolving lesions in six. Among patients undergoing upfront surgery (n=34), the futile laparotomy rate was 14.7%; 80% were unresectable due to liver metastases, and none had undergone preoperative liver MRI. Median time from initial MDT discussion to upfront surgery was 53 days (i.q.r. 42.5–68) for PET–CT alone and 84.8 days (i.q.r. 100.5–118.5) for PET–CT with selective liver MRI. Conclusion Preoperative PET–CT upstaged 12.4% of patients to unresectable disease. Selective liver MRI may improve liver metastases detection, particularly prior to upfront resection, but may prolong diagnostic pathways.
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| Authors | Oscar Edginton, Iestyn Shapey, Andrew Smith, Raneem Albazaz, Samir Pathak |
| Journal | the british journal of surgery |
| Year | 2026 |
| DOI |
10.1093/bjs/znag087.380
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| Keywords | Keywords not found |
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