For management recommendations please refer to the ACR White Paper on Management of Incidental Pancreatic Cysts [7]. The following recommendations refer to the initial imaging evaluation of pancreatic cysts incidentally detected and incompletely evaluated on imaging studies performed for unrelated indications. The recommendations below apply Reprint requests to: publications@acr.org Pancreatic Cyst irrespective of the imaging modality in which the cyst was initially detected. CT abdomen, MRI abdomen with MRCP, and US abdomen endoscopic are included in the discussion. These are the three conventional imaging modalities used in the workup of pancreatic cysts. Although we acknowledge the added value of US (especially contrast-enhanced US) in select cases in which workup with conventional imaging is inconclusive or incomplete, US has been omitted from the discussion because it is not routinely used in this setting. Discussion of Procedures by Variant Variant 1: Incidentally detected pancreatic cyst less than or equal to 2.5 cm in size. Initial evaluation. CT Abdomen MRI is preferred over contrast-enhanced CT in this setting. The sensitivity and specificity of CT for distinguishing IPMN from other cystic pancreatic lesions is 80.6% and 86.4% compared with 96.8% and 90.8% for MRI [3,18]. Advantages of CT include its ease of implementation and excellent spatial resolution. Multidetector CT provides critical diagnostic information pertaining to the presence or absence of calcifications (both in the background parenchyma and in the cyst proper), ductal dilation, intralesional septations, mural nodules, and pancreatic duct communication [6,15]. MRI Abdomen with MRCP Contrast-enhanced MRI with MR cholangiopancreatography (MRCP) is considered the procedure of choice in this setting because of its superior soft-tissue contrast and superior ability to demonstrate ductal communication [6-10].
Pancreatic Cyst. For management recommendations please refer to the ACR White Paper on Management of Incidental Pancreatic Cysts [7]. The following recommendations refer to the initial imaging evaluation of pancreatic cysts incidentally detected and incompletely evaluated on imaging studies performed for unrelated indications. The recommendations below apply Reprint requests to: publications@acr.org Pancreatic Cyst irrespective of the imaging modality in which the cyst was initially detected. CT abdomen, MRI abdomen with MRCP, and US abdomen endoscopic are included in the discussion. These are the three conventional imaging modalities used in the workup of pancreatic cysts. Although we acknowledge the added value of US (especially contrast-enhanced US) in select cases in which workup with conventional imaging is inconclusive or incomplete, US has been omitted from the discussion because it is not routinely used in this setting. Discussion of Procedures by Variant Variant 1: Incidentally detected pancreatic cyst less than or equal to 2.5 cm in size. Initial evaluation. CT Abdomen MRI is preferred over contrast-enhanced CT in this setting. The sensitivity and specificity of CT for distinguishing IPMN from other cystic pancreatic lesions is 80.6% and 86.4% compared with 96.8% and 90.8% for MRI [3,18]. Advantages of CT include its ease of implementation and excellent spatial resolution. Multidetector CT provides critical diagnostic information pertaining to the presence or absence of calcifications (both in the background parenchyma and in the cyst proper), ductal dilation, intralesional septations, mural nodules, and pancreatic duct communication [6,15]. MRI Abdomen with MRCP Contrast-enhanced MRI with MR cholangiopancreatography (MRCP) is considered the procedure of choice in this setting because of its superior soft-tissue contrast and superior ability to demonstrate ductal communication [6-10].