J Korean Soc Radiol.  2019 May;80(3):412-424. 10.3348/jksr.2019.80.3.412.

Imaging Diagnosis and Management of Pancreatic Cystic Neoplasms

• Choi IW
• Shin SS
• Heo SH
• Jeong YY

• KMID: 2454023
• DOI: http://doi.org/10.3348/jksr.2019.80.3.412

Abstract

Incidental pancreatic cysts may show various clinical courses, from benign to invasive malignant lesions. To adequately treat asymptomatic pancreatic cystic tumors, accurate diagnosis is needed. However, in many cases, clinical and imaging findings do not provide a definitive diagnosis. Therefore, if there is any evidence suggestive of a malignant lesion, the lesion should be removed surgically. If not, follow-up should be done continuously. To date, several academic societies have issued guidelines that suggest malignant features and follow-up strategies for incidental pancreatic cysts. These guidelines ultimately aim to increase the cure rate by surgical resection and reduce the likelihood of unnecessary surgery by early and efficient screening of high-risk cases. The purpose of this study is to review the relevant findings for the definitive diagnosis of relatively common pancreatic cystic neoplasms and to discuss guidelines for the management of incidental pancreatic cystic neoplasms.

MeSH Terms

Cystadenoma, Mucinous
Cystadenoma, Serous
Diagnosis*
Endosonography
Follow-Up Studies
Magnetic Resonance Imaging
Mass Screening
Pancreatic Cyst*
Unnecessary Procedures

Figure

• 

  Fig. 1 Serous cystadenoma in a 51-year-old woman. A. Axial contrast-enhanced CT image shows a heterogeneously enhancing mass (arrow) with both cystic and solid components in the head of the pancreas. B. Coronal T2-weighted MRI clearly depicts that this lesion (arrow) is cystic in nature with multiple septations and a hypointense central scar (arrowhead). C. Axial contrast-enhanced MRI demonstrates that central stellate scar (arrowhead) and septa within the mass (arrow) are enhanced.

• 

  Fig. 2 Mucinous cystadenocarcinoma in a 61-year-old woman. A–C. Axial precontrast (A), contrast-enhanced arterial (B), and delayed (C) phase CT images show a well-defined round cystic mass (arrows) in the tail of the pancreas, accompanied by thick enhancing septa and septal calcification (arrowheads).

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  Fig. 3 Invasive mucinous cystadenocarcinoma in a 49-year-old woman. A–C. Axial T1 (A), T2-weighted (B), and contrast-enhanced (C) MRIs show a round cystic mass (arrows) in the tail of the pancreas, which has multiple irregular septa and solid enhancing components.

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  Fig. 4 Branch-duct intraductal papillary mucinous neoplasm in a 77-year-old man. A. Coronal T2-weighted MRI demonstrates a pleomorphic and septated cystic mass (arrow) in the pancreatic head. B. Axial T2-weighted MRI shows that this cystic mass (arrow) abuts the main pancreatic duct (arrowhead), implying that there would be a communication between the cystic lesion and the main pancreatic duct.

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  Fig. 5 Fig. 5. Mixed intraductal papillary mucinous neoplasm in a 74-year-old woman. A. Contrast-enhanced axial CT image shows that the main pancreatic duct is markedly dilated in the body of the pancreas (arrows). B. Magnetic resonance cholangiopancreatographic image depicts a markedly dilated main pancreatic duct (arrows). Several cystic lesions (arrowheads) are additionally seen along the main pancreatic duct, which represent the dilated branch ducts. The pancreas divisum is also noted.

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  Fig. 6 Solid pseudopapillary neoplasm in a 31-year-old woman. A. Axial contrast-enhanced CT image shows a cystic mass (arrow) in the head of the pancreas, which contains solid enhancing portions and peripheral calcification (arrowhead). B. Precontrast T1-weighted MRI demonstrates that there are amorphic areas with high signal intensity within the mass (arrow), which represent hemorrhagic degeneration.

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