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Imaging Pancreatic Cysts with CT and MRI

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Abstract

CT and MRI are the imaging modalities of choice to guide the clinical management of incidentally discovered pancreatic cysts. Most of these lesions are mucinous cysts with varying degrees of malignant potential. This article reviews the CT and MRI findings that help differentiate a potentially aggressive lesion that requires EUS or surgery from a lesion of low malignant potential that is appropriate for imaging surveillance. The imaging-based societal guidelines for these cysts are reviewed.

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References

  1. Zaheer A, Pokharel SS, Wolfgang C, Fishman EK, Horton KM. Incidentally detected cystic lesions of the pancreas on CT: review of literature and management suggestions. Abdom Imaging. 2013;38:331–341.

    Article  PubMed  Google Scholar 

  2. Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol. 2008;191:802–807.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lee KS, Sekhar A, Rofsky NM, Pedrosa I. Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol. 2010;105:2079–2084.

    Article  PubMed  Google Scholar 

  4. Yoon WJ, Brugge WR. Pancreatic cystic neoplasms: diagnosis and management. Gastroenterol Clin North Am. 2012;41:103–118.

    Article  PubMed  Google Scholar 

  5. Kimura W, Nagai H, Kuroda A, et al. Analysis of small cystic lesions of the pancreas. Int J Pancreatol. 1995;18:197–206.

    CAS  PubMed  Google Scholar 

  6. Scheiman JM, Hwang JH, Moayyedi P. American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148:824–848.

    Article  PubMed  Google Scholar 

  7. Gardner TB, Glass LM, Smith KD, et al. Pancreatic cyst prevalence and the risk of mucin-producing adenocarcinoma in US adults. Am J Gastroenterol. 2013;108:1546–1550.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee, American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148:819–822.

    Article  PubMed  Google Scholar 

  9. Lee HJ, Kim MJ, Choi JY, Hong HS, Kim KA. Relative accuracy of CT and MRI in the differentiation of benign from malignant pancreatic cystic lesions. Clin Radiol. 2011;66:315–321.

    Article  PubMed  Google Scholar 

  10. Sandrasegaran K, Lin C, Akisik FM, Tann M. State-of-the-art pancreatic MRI. AJR Am J Roentgenol. 2010;195:42–53.

    Article  PubMed  Google Scholar 

  11. Avanesov M, Weinrich JM, Kraus T, et al. MDCT of acute pancreatitis: intraindividual comparison of single-phase versus dual-phase MDCT for initial assessment of acute pancreatitis using different CT scoring systems. Eur J Radiol. 2016;85:2014–2022.

    Article  PubMed  Google Scholar 

  12. Anand N, Sampath K, Wu BU. Cyst features and risk of malignancy in intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Clin Gastroenterol Hepatol. 2013;11:913–921.

    Article  PubMed  Google Scholar 

  13. Manfredi R, Pozzi Mucelli R. Secretin-enhanced MR imaging of the pancreas. Radiology. 2016;279:29–43.

    Article  PubMed  Google Scholar 

  14. Greffier J, Macri F, Larbi A, et al. Dose reduction with iterative reconstruction: optimization of CT protocols in clinical practice. Diagn Interv Imaging. 2015;96:477–486.

    Article  CAS  PubMed  Google Scholar 

  15. Kwon RS, Larson A, Enchakalody B, Wang N, Wang S, Su GL. 937 analytic morphomics accurately identifies serous and mucinous cystic neoplasms. Gastroenterology. 2015;148:180.

    Article  Google Scholar 

  16. Sainani NI, Saokar A, Deshpande V, Fernández-del Castillo C, Hahn P, Sahani DV. Comparative performance of MDCT and MRI with MR cholangiopancreatography in characterizing small pancreatic cysts. AJR Am J Roentgenol. 2009;193:722–731.

    Article  PubMed  Google Scholar 

  17. Brugge WR. Diagnosis and management of cystic lesions of the pancreas. J Gastrointest Oncol. 2015;6:375–388.

    PubMed  PubMed Central  Google Scholar 

  18. Chu LC, Singhi AD, Haroun RR, Hruban RH, Fishman EK. The many faces of pancreatic serous cystadenoma: Radiologic and pathologic correlation. Diagn Interv Imaging. 2016. doi:10.1016/j.diii.2016.08.005.

    PubMed  Google Scholar 

  19. Di Paola V, Manfredi R, Mehrabi S, et al. Pancreatic mucinous cystoadenomas and cystoadenocarcinomas: differential diagnosis by means of MRI. Br J Radiol. 1057;2016:20150536.

    Google Scholar 

  20. Kucera JN, Kucera S, Perrin SD, Caracciolo JT, Schmulewitz N, Kedar RP. Cystic lesions of the pancreas: radiologic-endosonographic correlation. Radiographics. 2012;32:E283–E301.

    Article  PubMed  Google Scholar 

  21. Lv P, Mahyoub R, Lin X, Chen K, Chai W, Xie J. Differentiating pancreatic ductal adenocarcinoma from pancreatic serous cystadenoma, mucinous cystadenoma, and a pseudocyst with detailed analysis of cystic features on CT scans: a preliminary study. Korean J Radiol. 2011;12:187–195.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Jeffrey RB. Pancreatic Cancer: radiologic imaging. Gastroenterol Clin North Am. 2012;41:159–177.

    Article  PubMed  Google Scholar 

  23. Berland LL, Silverman SG, Gore RM, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol. 2010;7:754–773.

    Article  PubMed  Google Scholar 

  24. Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32.

    Article  PubMed  Google Scholar 

  25. Tanaka M, Fernández-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–197.

    Article  PubMed  Google Scholar 

  26. Kaimakliotis P, Riff B, Pourmand K, et al. Sendai and Fukuoka consensus guidelines identify advanced neoplasia in patients with suspected mucinous cystic neoplasms of the pancreas. Clin Gastroenterol Hepatol. 2015;13:1808–1815.

    Article  PubMed  Google Scholar 

  27. Tanaka M. International consensus on the management of intraductal papillary mucinous neoplasm of the pancreas. Ann Transl Med. 2015;3:286.

    PubMed  PubMed Central  Google Scholar 

  28. Allen PJ, D’Angelica M, Gonen M, et al. A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients. Ann Surg. 2006;244:572–582.

    PubMed  PubMed Central  Google Scholar 

  29. Kalb B, Sarmiento JM, Kooby DA, Adsay NV, Martin DR. MR imaging of cystic lesions of the pancreas. Radiographics. 2009;29:1749–1765.

    Article  PubMed  Google Scholar 

  30. Kauhanen S, Rinta-Kiikka I, Kemppainen J, et al. Accuracy of 18F-FDG PET/CT, multidetector CT, and MR imaging in the diagnosis of pancreatic cysts: a prospective single-center study. J Nucl Med. 2015;56:1163–1168.

    Article  CAS  PubMed  Google Scholar 

  31. Sato T, Ito K, Tamada T, et al. Age-related changes in normal adult pancreas: MR imaging evaluation. Eur J Radiol. 2012;81:2093–2098.

    Article  PubMed  Google Scholar 

  32. Kang HJ, Lee JM, Joo I, et al. Assessment of malignant potential in intraductal papillary mucinous neoplasms of the pancreas: comparison between multidetector CT and MR imaging with MR cholangiopancreatography. Radiology. 2016;279:128–139.

    Article  PubMed  Google Scholar 

  33. Paroder V, Flusberg M, Kobi M, Rozenblit AM, Chernyak V. Pancreatic cysts: what imaging characteristics are associated with development of pancreatic ductal adenocarcinoma? Eur J Radiol. 2016;85:1622–1626.

    Article  PubMed  Google Scholar 

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Correspondence to R. Brooke Jeffrey.

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Jeffrey, R.B. Imaging Pancreatic Cysts with CT and MRI. Dig Dis Sci 62, 1787–1795 (2017). https://doi.org/10.1007/s10620-017-4501-6

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