E2577. Do Not Fear the Pancreas: A Comprehensive MR Approach to Cystic Pancreatic Lesions
  1. Victor Babatunde; University of Pennsylvania
  2. Nathaniel Linna; University of Pennsylvania
  3. Amr El Jack; University of Pennsylvania
Cystic pancreatic lesions are often detected incidentally. Studies have shown that cystic pancreatic lesions can be observed in 2 to 20% of patients undergoing CT or MRI. Cystic pancreatic lesions can be classified as neoplastic or nonneoplastic lesions. Neoplastic cysts include intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms, serous cystadenomas, and solid neoplasms with cystic components such as neuroendocrine tumors and solid pseudopapillary neoplasms. Nonneoplastic cysts include epithelial cysts and retention cysts. Differentiating benign lesions from those with malignant potential has important prognostic, therapeutic, and management implications.

Educational Goals / Teaching Points
Through illustrative cases, the objectives of this educational exhibit are to familiarize the radiologist with the broad spectrum of cystic lesions of the pancreas; review the overlapping imaging features of the different types of cystic pancreatic lesions; explore the diagnostic challenge and discuss the imaging findings to help identify the small minority of cystic lesions with associated invasive cancer, high grade dysplasia, or malignant potential; review published guidelines for pancreatic cyst surveillance.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
MR is the most powerful modality for imaging evaluation of the pancreas. We will review the optimal the MR technique and pulse sequences for pancreatic imaging. Normal MR appearance of the pancreas will be discussed followed by a comprehensive review of common and less common cystic lesions of the pancreas including nonneoplastic cysts, cystic non-epithelial neoplasms, cystic epithelial neoplasms, and secondarily cystic solid neoplasms.

The majority of cystic pancreatic lesions are asymptomatic and incidentally detected. These require accurate diagnosis for appropriate follow up and management. The aim of this review is to help practicing and training radiologists differentiate benign cystic pancreatic lesions from malignant or potentially malignant entities.