Magnetic resonance imaging in the assessment of cystic pancreatic lesions: differentiation of benign and malignant lesion status.
OBJECTIVE
To characterize cystic pancreatic lesions and tumors with magnetic resonance imaging (MRI), and to assess the value of morphological criteria in differentiating pseudocysts versus cystic tumors and benign versus malignant cystic tumors.


METHODS
Twenty-three patients with cystic pancreatic tumors or lesions underwent plain and contrast-material-enhanced MRI, including magnetic resonance cholangiopancreatography (MRCP). The MR findings were characterized and analyzed by two readers, and the role of various imaging criteria and combinations thereof for final lesion assignment were assessed. Final diagnoses were obtained from the results of open surgery (n = 19) and/or biopsy (n = 4).


RESULTS
Final diagnoses included cystic tumors (n = 11) and pseudocysts (n = 12). The lesions were located in the head (56%) and body or tail (44%). Lesion diameters ranged from 7 to 50 mm. Various lesion contrast enhancement patterns were observed for both benign and malignant lesions. Serous cystadenomas were located in the head, they were lobulated, and had wall diameters < or = 2 mm; with the combination of these characteristics all patients with serous cystadenoma could be identified, whereas in no other patient was this constellation observed.


CONCLUSIONS
MRI facilitated the diagnosis of serous cystadenomas, although no definite morphologic criterion for the differentiation between pseudocysts and mucinous cystadenomas was identified. In consideration of the substantial therapeutic consequences, either diagnostics in unclear cystic pancreatic lesions should comprise cyst fluid analysis if necessary, or eligible patients should be referred for surgical resection.
Lopez Hänninen
E
E
Department of Radiology, Charité Medical University Center, Campus Virchow Clinic, Berlin, Germany. elh@charite.de
Pech
M
M
Ricke
J
J
Denecke
T
T
Amthauer
H
H
Lehmkuhl
L
L
Böhmig
M
M
Röttgen
R
R
Pinkernelle
J
J
Felix
R
R
Langrehr
J
J
D000328:Adult; D000368:Aged; D049448:Cholangiopancreatography, Magnetic Resonance; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000175:diagnosis*; D010190:Pancreatic Neoplasms / Q000175:diagnosis*
D003287:Contrast Media