435 Impact of MRI on Real-World Staging Pathways and Management Timelines in Pancreatic Cancer: A Systematic Review

Abstract Aim Effective patient pathways are essential to optimising outcomes in pancreatic adenocarcinoma (PDAC). Contrast-enhanced CT (CE-CT) is the standard imaging modality in the UK, however new evidence suggests that Magnetic Resonance Imaging (MRI) improves detection of liver metastases and reduces futile surgery. The effect of adding MRI to patient pathways remains unclear. This systematic review investigated the effect of MRI on PDAC patient pathways. Method A systematic review was conducted according to PRISMA guidelines. MEDLINE, Embase, Web of Science, and the Cochrane Library were searched from January 2005 to January 2025 for studies comparing preoperative pathways with MRI plus CE-CT or Positron Emission Tomography and Computed Tomography (PET-CT) versus CE-CT or PET-CT alone in adults with PDAC. Outcomes included detection of occult disease, time to treatment, and changes in management/cost. Results Eighteen studies (seventeen retrospective and one prospective), comprising 7,526 patients, were included. Twelve used a within-subject design; five were between-group comparisons. Adding MRI upstaged 5–23% of patients by detecting occult liver metastases or subtle vascular invasion not seen on CT, thereby reducing futile surgery. Between-group studies showed MRI can extend time to surgery, but centres integrating MRI early reported similar or shorter intervals. In within-subject studies, the mean interval between CE-CT and MRI ranged from 3.2 to15 days. No studies provided empirical cost-effectiveness data. Conclusions Adding MRI improves detection of occult metastases and can influence staging and surgical decisions without consistent evidence of delay when integrated efficiently. Future research should prioritise optimised pathway design and robust economic evaluation.