The reported sensitivity of thin-slice 3-D MRCP acquisitions for demonstrating communication of a cyst with the pancreatic duct is as high as 100% [6,22]. Communication with the main pancreatic duct is suggestive of IPMN, although this may also be seen in the setting of pseudocysts [6]. The sensitivity of MRI for detection of internal septations is 91% [6,22], and its diagnostic accuracy for distinguishing between malignant and nonmalignant lesions ranges between 73.2% and 91% [6,23,24]. In distinguishing IPMN from other cystic lesions, studies have reported a sensitivity of 96.8% and a specificity of 90.8% [3,18]. Pancreatic Cyst MRI Abdomen with MRCP Because of its superior soft-tissue resolution and noninvasive approach, contrast-enhanced MRI with MRCP is generally favored over CT or EUS-FNA in this setting [6-10]. The diagnostic accuracy of MRI for distinguishing between malignant and nonmalignant lesions ranges from 73.2% to 91% [6,23,24]. Its accuracy at diagnosing the specific type of cyst is slightly lower at 50% [23]. However, an exception may be the distinction of IPMN from other cystic lesions, in which studies have reported a sensitivity of 96.8% and specificity of 90.8% [3,18]. In a study of over 300 patients with pancreatic cysts, the addition of EUS-FNA to the diagnostic workup significantly altered the management strategy in nearly 72% of patients [28]. Management algorithms integrating clinical data, imaging, and fluid analysis have reported cyst classification sensitivities of 90% to 100% and specificities of 92% to 98% [7,25]. The addition of EUS-FNA to management algorithms combining clinical history and imaging may also reduce unnecessary surgeries by 91% [7]. Variant 3: Incidentally detected pancreatic cyst greater than 2.5 cm in size. High-risk stigmata or worrisome features. Initial evaluation.
Pancreatic Cyst. The reported sensitivity of thin-slice 3-D MRCP acquisitions for demonstrating communication of a cyst with the pancreatic duct is as high as 100% [6,22]. Communication with the main pancreatic duct is suggestive of IPMN, although this may also be seen in the setting of pseudocysts [6]. The sensitivity of MRI for detection of internal septations is 91% [6,22], and its diagnostic accuracy for distinguishing between malignant and nonmalignant lesions ranges between 73.2% and 91% [6,23,24]. In distinguishing IPMN from other cystic lesions, studies have reported a sensitivity of 96.8% and a specificity of 90.8% [3,18]. Pancreatic Cyst MRI Abdomen with MRCP Because of its superior soft-tissue resolution and noninvasive approach, contrast-enhanced MRI with MRCP is generally favored over CT or EUS-FNA in this setting [6-10]. The diagnostic accuracy of MRI for distinguishing between malignant and nonmalignant lesions ranges from 73.2% to 91% [6,23,24]. Its accuracy at diagnosing the specific type of cyst is slightly lower at 50% [23]. However, an exception may be the distinction of IPMN from other cystic lesions, in which studies have reported a sensitivity of 96.8% and specificity of 90.8% [3,18]. In a study of over 300 patients with pancreatic cysts, the addition of EUS-FNA to the diagnostic workup significantly altered the management strategy in nearly 72% of patients [28]. Management algorithms integrating clinical data, imaging, and fluid analysis have reported cyst classification sensitivities of 90% to 100% and specificities of 92% to 98% [7,25]. The addition of EUS-FNA to management algorithms combining clinical history and imaging may also reduce unnecessary surgeries by 91% [7]. Variant 3: Incidentally detected pancreatic cyst greater than 2.5 cm in size. High-risk stigmata or worrisome features. Initial evaluation.