Common cystic pancreatic neoplasms: A comprehensive magnetic resonance imaging-based review of typical and atypical imaging features

Table 1 Differential diagnosis of cystic pancreatic neoplasms based on magnetic resonance imaging findings

Key imaging feature	Most suggestive diagnosis	Recommended clinical action
Ductal communication on magnetic resonance cholangiopancreatography	IPMN	Surveillance or EUS-FNA depending on risk features
Microcystic lesion with central scar	Serous cystic neoplasm	Surveillance (typically benign, no intervention unless symptomatic)
Thick-walled cyst in body/tail, no ductal communication	MCN	Surgical referral (especially in fit patients due to malignant potential)
Mixed solid-cystic lesion with hemorrhage in young female	Solid pseudopapillary tumor	Surgical referral (generally recommended due to malignant potential)
Enhancing mural nodule	IPMN or malignant MCN	EUS-FNA and strong consideration for surgical referral
Main pancreatic duct dilatation > 10 mm	Main duct IPMN	Surgical referral (high-risk stigmata)

EUS-FNA: Endoscopic ultrasound-guided fine-needle aspiration; IPMN: Intraductal papillary mucinous neoplasm; MCN: Mucinous cystic neoplasm.

Table 2 Imaging features associated with increased malignant risk

Imaging finding	Clinical implication
Enhancing mural nodules	Increased risk of malignancy
Main pancreatic duct dilatation	High-risk intraductal papillary mucinous neoplasm
Solid enhancing components	Suggestive of invasive disease
Restricted diffusion	Possible high-grade dysplasia or malignancy
Irregular cyst walls	Suspicion of malignant transformation