MRI Abdomen with MRCP The risk of malignant transformation of a pancreatic cyst is approximately 0.24% per year [9]. Once a pancreatic cyst has been characterized on a dedicated baseline examination, subsequent follow-up may be performed with either CT or MRI. There is no evidence to suggest that MRI is superior to CT for detection of new or developing worrisome features or pancreatic ductal adenocarcinoma [7], although modality concordance between baseline and follow-up examinations may facilitate comparison. The issue of whether IV contrast is necessary for MRI follow-up of pancreatic cysts remains controversial. Noncontrast MRI is associated with shorter scan times, with some sources citing little difference in the ability to detect evolving dysplastic changes compared with a contrast-enhanced study [7,33,34]. However, the use of IV contrast may permit detection of high-risk stigmata such as enhancing mural nodules. An abbreviated protocol MRI, including T2-weighted sequences and dual-phase (late arterial and portal venous phase) contrast-enhanced acquisitions, has been shown to be equivalent to standard pancreatic protocol MRI for detection of evolving dysplasia [7,34]. The frequency and duration of follow-up is controversial and depends on multiple factors, including patient age, family history of pancreatic ductal adenocarcinoma, cyst size, and whether or not there has been prior surgical resection of a pancreatic cyst. For patients with a nonspecific pancreatic cyst without a history of prior surgery, the surveillance plan will depend upon patient age and the cyst size. Follow-up intervals are generally in the range of 6 months to every 2 years for a minimum of 5 to 10 years [7-9]. Development of high-risk stigmata or worrisome features during the surveillance period should prompt EUS-FNA or surgical evaluation [8,9,14,26].
Pancreatic Cyst. MRI Abdomen with MRCP The risk of malignant transformation of a pancreatic cyst is approximately 0.24% per year [9]. Once a pancreatic cyst has been characterized on a dedicated baseline examination, subsequent follow-up may be performed with either CT or MRI. There is no evidence to suggest that MRI is superior to CT for detection of new or developing worrisome features or pancreatic ductal adenocarcinoma [7], although modality concordance between baseline and follow-up examinations may facilitate comparison. The issue of whether IV contrast is necessary for MRI follow-up of pancreatic cysts remains controversial. Noncontrast MRI is associated with shorter scan times, with some sources citing little difference in the ability to detect evolving dysplastic changes compared with a contrast-enhanced study [7,33,34]. However, the use of IV contrast may permit detection of high-risk stigmata such as enhancing mural nodules. An abbreviated protocol MRI, including T2-weighted sequences and dual-phase (late arterial and portal venous phase) contrast-enhanced acquisitions, has been shown to be equivalent to standard pancreatic protocol MRI for detection of evolving dysplasia [7,34]. The frequency and duration of follow-up is controversial and depends on multiple factors, including patient age, family history of pancreatic ductal adenocarcinoma, cyst size, and whether or not there has been prior surgical resection of a pancreatic cyst. For patients with a nonspecific pancreatic cyst without a history of prior surgery, the surveillance plan will depend upon patient age and the cyst size. Follow-up intervals are generally in the range of 6 months to every 2 years for a minimum of 5 to 10 years [7-9]. Development of high-risk stigmata or worrisome features during the surveillance period should prompt EUS-FNA or surgical evaluation [8,9,14,26].