MRI of mucinous pancreatic cystic lesions: a new updated morphological approach for the differential diagnosis
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REVIEW ARTICLE
MRI of mucinous pancreatic cystic lesions: a new updated morphological approach for the differential diagnosis Giuseppe Mamone1 · Luca Barresi2 · Alessandro Tropea3 · Ambra Di Piazza1 · Roberto Miraglia1 Received: 28 February 2020 / Accepted: 12 May 2020 © Italian Society of Surgery (SIC) 2020
Abstract Pancreatic cystic lesions (PCLs) have been increasingly identified over the past 2 decades due to the widespread use of highresolution non-invasive abdominal imaging. They cover a vast spectrum, from benign to malignant and invasive lesions, thus they constitute a significant clinical entity. Among PCLs, mucin-producing lesions are those at risk of progression to malignancy. They include mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPMN). The diagnosis and management of these cystic lesions are a dilemma since there is a significant overlap in the morphology of benign and premalignant lesions. At the moment, there is no single test that will allow a correct diagnosis in all cases. Magnetic resonance (MR) and endoscopic ultrasound (EUS) morphology, with cyst fluid analysis and cytohistology done with EUS-guided procedure are the best techniques that can narrow the differential diagnosis and identify potentially malignant lesions requiring resection from those requiring follow-up only. The purpose of this paper is to present an updated review of MR imaging findings of mucinous PCLs and to provide a new morphological approach that can serve as a practical guide for the diagnosis of these lesions, allowing a more confident characterization and avoiding relevant misdiagnosis. Furthermore, we provide some information about EUS and cystic fluid analysis and cytohistology, since they are diagnostic modalities that radiologists and surgeons should be familiar with. Keywords Mucinous pancreatic cystic lesions · Magnetic resonance imaging (MRI) · Magnetic resonance cholangiopancreatography (MRCP) · Differential diagnosis
Introduction Pancreatic cystic lesions (PCLs) are diagnosed with increasing frequency, often incidentally, and have been reported in 2–49% of individuals undergoing computed tomography (CT) or magnetic resonance imaging (MRI) [1, 2], * Giuseppe Mamone [email protected] 1
Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127 Palermo, Italy
2
Endoscopic Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
3
Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
in particular in older patients. PCLs are a heterogeneous group of varying entities, with a wide variability of biological behavior, from benign to borderline to malignant. They include mucinous cystic ne
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