Dear Doctor: My doctors want MRIs every 6 months and I’m overwhelmed by the surveillance

Key Points:

• A patient with small pancreatic cysts suspected to be branch-duct intraductal papillary mucinous neoplasms (IPMNs) and a mildly enlarged main pancreatic duct seeks advice on the necessity of frequent MRI monitoring.
• Dr. Roach explains that due to the dilated duct, the patient has about a 10% risk of developing pancreatic cancer in five years, justifying careful follow-up with MRI/MRCP scans every six months to two years.
• CT scans are less accurate and involve radiation, making MRI the preferred, safer method despite being time-consuming and noisy; blood testing for CA19-9 and monitoring duct enlargement are also recommended.
• In a separate discussion, Dr. Roach differentiates between benign paroxysmal positional vertigo (BPPV) and Meniere’s disease, highlighting differences in vertigo triggers, duration, and associated symptoms like hearing loss and tinnitus.
• He advises that when diagnosis is uncertain, audiology tests or referrals to specialists such as neurologists or ENT physicians can help ensure proper treatment for dizziness-related conditions.