title: [Diagnostic strategy and differential therapeutic approach for cystic lesions of the pancreas].
abstract: OBJECTIVE
  Cystic pancreatic lesions (CPL) are diagnosed with increasing frequency. Because up to 60% of CPL are classified as malignant or premalignant, every CPL should be fully investigated and clarified. Serous CPL with low risk of malignancy must be differentiated from mucinous CPL with relevant potential malignancy (intraductal papillary mucinous neoplasm IPMN) and mucinous cystic neoplasm (MCN) as well as from harmless pseudocysts.
  
  
  METHODS
  Cross-sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI) plays a crucial role in the diagnostics of CPL.
  
  
  METHODS
  An algorithm for the differential diagnostic classification of CPL is presented.
  
  
  METHODS
  The connection to the pancreatic duct is the key diagnostic criterion to differentiate IPMN from all other CPL. An exception to this rule is that pseudocysts can also show a connection to the pancreatic duct. A further classification of CPL with no connection to the pancreatic duct can be made by morphological criteria and correlation of the radiological findings with patient age, sex, history and symptoms.
  
  
  CONCLUSIONS
  Depending on the diagnosis and hence the malignant potential the indications for surgery or watch and wait have to be discussed in an interdisciplinary cooperation. Due to its higher soft tissue contrast MRI is often superior to CT for depiction of CPL morphology.
authors.affiliation: Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Mayer
authors.affiliation: Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Tjaden
authors.affiliation: Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. Miriam.Klauss@med.uni-heidelberg.de.
authors.forename: M
authors.initials: M
authors.lastname: Klauß
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D064847:Multimodal Imaging / Q000379:methods; D010180:Pancreatectomy / Q000379:methods*; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy*; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: Differential diagnostic classification; Duct connection; Intraductal papillary mucinous neoplasms; Magnetic resonance imaging; Mucinous cystic neoplasms