Nowadays, CPLs can be detected with most imaging techniques (ultrasound-US, multidetector computed tomography-MDCT, magnetic resonance imaging with magnetic resonance cholangiopancreatography-MRI with MRCP), but for a correct characterization MDCT and MRI are needed. CPLs communicating with MPD are further divided in non-neoplastic (pseudocyst and WON) and neoplastic (IPMN). Neoplastic non-communicating cysts include mucinous (MCN) and non-mucinous neoplasms (SCN, SPN, ACCN, CPNET and ductal adenocarcinoma with cystic degeneration). ClassificationĪccording to data extrapolated from WHO classification, CPLs are classified in epithelial and non-epithelial and each of these categories is further subdivided in non-neoplastic and neoplastic (CPNs) (Table 1) ĬPLs non-communicating with MPD include non-neoplastic (walled-off necrosis-WON, simple or congenital cyst and retention cyst) as well as neoplastic cysts. Differential diagnosis among different CPLs is also emphasized. Scope of this review is to offer a practical approach to the diagnosis of CPLs using mainly MR imaging findings, location and demographic data and thus drive their correct management. The role of Imaging is to differentiate benign from malignant or potentially malignant CPLs avoiding unnecessary surgery and, in potentially malignant CPLs, to early detect morphological changes related to malignant transformations in order to offer more chance of survival to these patients. Follow-up strategies rise a really challenging issue for radiologists, due to the high number of patients to be submitted. The vast majority of these lesions will never threat the life of affected subjects, but due to their malignant potential will cause affected subjects to become patients, and followed up even for many years. Most CPLs can be considered “technopathies,” as they are more frequently detected in the last decades due to the widespread use and advancement in diagnostic imaging. Moreover, the frequent incidental detection of CPLs, in the absence of any symptoms, makes the diagnosis even more difficult. However, difficulties in differential diagnosis of CPLs still exist because of the lack of specific clinical and laboratoristic signs and the overlap of imaging findings, and thus, the management of patients with CPLs remains complex. A precise characterization is fundamental for the correct management of these lesions, as they have heterogeneous biological behavior and different prognosis (according to histological type and differentiation), thus requiring different therapeutic options. As some CPLs with different pathologic backgrounds can show the same morphological findings, differential diagnosis can be difficult, and thus, the final diagnosis can require other techniques, such as endoscopic ultrasound, endoscopic ultrasound-fine needle aspiration and endoscopic ultrasound-through the needle biopsy, and multidisciplinary management is important for a correct management.Ĭystic pancreatic lesions (CPLs) are quite common: Their frequency of detection ranges from 2.4 to 19.6%, and their prevalence as well as size and number increases with age (from 7.9 below 70 years to 40.2 over 70 years).

Age, sex and a history of previous pancreatic pathologies are important information to be used in the differential diagnosis.

The first step for a correct characterization is to look for a communication between the CPLs and the main pancreatic duct, and then, it is essential to evaluate the morphology of the lesions.

Radiologist plays a key role in the diagnosis and management of these lesions as imaging is able to correctly characterize most of them and thus address to a correct management. As they require different management according to their histological nature, differential diagnosis is essential. Cystic pancreatic lesions (CPLs) are frequently casual findings in radiological examinations performed for other reasons in patients with unrelated symptoms.

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