Korean J Radiol.  2019 Apr;20(4):542-557. 10.3348/kjr.2018.0640.

Diagnosis and Surveillance of Incidental Pancreatic Cystic Lesions: 2017 Consensus Recommendations of the Korean Society of Abdominal Radiology

• Lee ES
• Kim JH
• Yu MH
• Choi SY
• Kang HJ
• Park HJ
• Park YS
• Byun JH
• Shin SS
• Lee CH
• Korean Society of Abdominal Radiology

• KMID: 2440478
• DOI: http://doi.org/10.3348/kjr.2018.0640

Abstract

The occurrence of incidentally detected pancreatic cystic lesions (PCLs) is continuously increasing. Radiologic examinations including computed tomography and magnetic resonance imaging with magnetic resonance cholangiopancreatography have been widely used as the main diagnostic and surveillance methods for patients with incidental PCLs. Although most incidentally detected PCLs are considered benign, they have the potential to become malignant. Currently, we have several guidelines for the management of incidental PCLs. However, there is still debate over proper management, in terms of accurate diagnosis, optimal follow-up interval, and imaging tools. Because imaging studies play a crucial role in the management of incidental PCLs, the 2017 consensus recommendations of the Korean Society of Abdominal Radiology for the diagnosis and surveillance of incidental PCLs approved 11 out of 16 recommendations. Although several challenges remain in terms of optimization and standardization, these consensus recommendations might serve as useful tools to provide a more standardized approach and to optimize care of patients with incidental PCLs.

Keyword

Pancreas; Cysts; Consensus; Magnetic resonance imaging; Computed tomography

MeSH Terms

Cholangiopancreatography, Magnetic Resonance
Consensus*
Diagnosis*
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Pancreas
Pancreatic Cyst*

Figure

• 

  Fig. 1 69-year-old woman with incidental pancreatic cystic lesion.MRCP (A), coronal T2-weighted image (B), and contrast-enhanced axial T1-weighted image (C) show pleomorphic cystic lesion in pancreas head. Lesion is measured as 30.62 mm on MRCP (A), 27.74 mm on coronal T2-weighted image (B), and 14.02 mm on contrast-enhanced axial T1-weighted image (C), reflecting high variability of size measurement in different sequences and planes. On contrast-enhanced CT obtained after 1 year, size of lesion is measured as 27.76 mm on coronal image (D) and 14.27 mm on axial image (E). In each of same plane, size of pancreatic cystic lesion remains stable without significant interval growth to initial MR. It is important to measure size of pancreatic cystic lesions in cross-sectional image in same direction at least in same plane, and with same imaging modality, if possible. MR = magnetic resonance, MRCP = MR cholangiopancreatography

• 

  Fig. 2 54-year-old man with incidental pancreatic cystic lesion.Coronal T2-weighted image (A), contrast-enhanced coronal T1-weighted image (B), MRCP with thin section (C), and maximal intensity projection reconstruction image (D) show 48 mm pleomorphic cystic lesion (arrowheads) in pancreas body. Lesion shows direct communication with main pancreatic duct (arrows) without septum between cyst and duct. In this case, MRI with MRCP directly shows continuity between pancreatic cyst and main pancreatic duct. MRI = magnetic resonance imaging

• 

  Fig. 3 56-year-old man with pathologically confirmed IPMN associated with invasive carcinoma.Precontrast CT (A), contrast-enhanced portal phase CT (B), coronal T2-weighted image (C), precontrast (D), contrast-enhanced portal phase axial (E), and coronal (F) T1-weighted image show 7 cm pleomorphic cystic lesion in pancreas head. Contrast-enhanced CT and MRI clearly depict 23 mm enhancing mural nodule (arrows) within cystic lesion. IPMN = intraductal papillary mucinous neoplasm G. Cut section of gross specimen shows solid mural nodules (arrows) within cyst. Histopathology confirmed IPMN with invasive carcinoma. IPMN = intraductal papillary mucinous neoplasm

• 

  Fig. 4 76-year-old man with incidental pancreatic cystic lesion.Initial two-dimensional MRCP (A), coronal T2-weighted image (B), and contrast-enhanced axial T1-weighted image (C) show 16 mm pleomorphic cystic lesion (arrows) in pancreas head without enhancing mural nodule. Follow-up three-dimensional MRCP (D), coronal T2-weighted image (E), and axial non-contrast T1-weighted image (F) obtained after 1 year demonstrate same cyst (arrows) without significant interval growth. There were no worrisome features on follow-up non-contrast MRI.

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