Learning objectives
In this educational exhibit we propose to achieve these objectives:
- To describe the most common pancreatic cystic lesions and the most adequate diagnostic tools for their characterization.
- To provide brief notes about the clinical and pathophysiological correlation of the radiological findings.
Background
Cystic lesions of pancreas are increasingly recognized because of the improvement of imaging techniques during the last decades.
Pancreatic cysts form a heterogeneous group of tumours.
While some show benign behaviour,
others have an unequivocal malignant potential and,
in addition,
are precursors of pancreatic ductal adenocarcinoma [1].
Cystic pancreatic lesions not only have diverse histologic and imaging appearances,
but also differ in clinical presentation,
biologic behavior,
growth pattern,
and risk of malignancy [2].
In fact,
they encompass a varied group of pancreatic abnormalities,
including inflammatory...
Findings and procedure details
Imaging features that help to make a specific imaging diagnosis of a cyst include its location along the length of the pancreas,
presence and density of septae,
cyst communication with the pancreatic duct,
internal debris within a cystic lesion,
or internal hemorrhage (sometimes present in solid pseudopapillary tumor).
Furthermore,
some morphologic elements (eg,
mural nodules and/or irregularity,
peripheral calcification,
soft-tissue attenuation or signal components) will identify an individual cyst as worrisome.
Patient-related features,
including the age,
sex and syntoms,
can help to narrow the differential...
Conclusion
Radiologists should be familiarized with the radiological features of the most frequent pancreatic cystic lesions; CT and MR imaging are excellent modalities for the initial detection and characterization.
When an adequate characterization cannot be achieved,
radiologists can play a role in the management of the patient,
suggesting the next diagnostic or therapeutic step,
such as the performance of EUS with FNA (endoscopic ultrasound-guided fine needle aspiration),
lesion’s follow-up or surgical resection.
References
1.Marco Del Chiaro,
Caroline Verbeke,
Roberto Salvia,
Gunter Klöppel,
Jens Werner,Colin McKay,
Helmut Friess,
Riccardo Manfredi,
Eric VanCutsem,
Matthias Löhr,
Ralf Segersvärd,the European Study Group on Cystic Tumours of the Pancreas.European experts consensus statement on cystic tumours of the pancreas.Digestive and Liver Disease 45 (2013) 703– 711.
2.Dushyant V.
Sahani,Avinash Kambadakone,
Michael Macari,
Noaki Takahashi,
Suresh Chari,
Carlos Fernandez-del Castillo.Diagnosis and Managementof Cystic Pancreatic Lesions.
AJR 2013; 200:343–354.
3.Michael Macari,Alec J.
Megibow.Focal Cystic Pancreatic Lesions:Variability in Radiologists’ Recommendations for Follow-up Imaging.Radiology 2011; 259:20–23.
4.Young H....