Pancreatic cancer has a poor prognosis, with a 5-year survival rate of just 8%. Surgery is the only potential cure, but only 20% of patients are eligible due to metastases at diagnosis. Moreover, pancreatic surgery carries a 30-50% complication risk and a 2-3% fatality rate. Thus, it’s crucial to avoid unnecessary resections that delay chemotherapy for patients who will not benefit.

Surgical eligibility depends on tumor involvement with major vessels and the absence of liver or lung metastases, which preclude surgery. While CT is commonly used to assess resectability, it has a sensitivity of only 75% for detecting liver metastases, which can lead to futile surgeries. MRI, in contrast, is superior for detecting small liver metastases, with a sensitivity of around 90%, especially when combined with diffusion-weighted imaging and liver-specific contrast.

Some studies show that MRI detects liver metastases not visible on CT, suggesting it may help better select candidates for surgery. One study found liver metastases in 25% of patients not identified by CT, while another found that preoperative MRI was associated with a longer time to recurrence. Despite promising results, more research is needed to confirm whether routine MRI could improve treatment decisions and survival outcomes in pancreatic cancer patients.