Pancreatic cystic lesion by xiu
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  • Comparison of soft-tissue contrast capabilities of CT and MR imaging. (1a) Axial contrast-enhanced CT image obtained in a 35-year-old man with acute pancreatitis depicts a fluid collection without internal complexity (arrow) in the left anterior pararenal space. (1b) Axial T2-weighted MR image obtained within 24 hours shows markedly complicated internal fluid signal within the collection ( * ), a finding indicative of complexity. MR images obtained after the administration of a gadolinium-based contrast material did not show internal enhancement. The diagnosis was pseudocyst. (2a) Axial contrast-enhanced CT image (5-mm section) obtained in a 68-year-old man demonstrates a focal cystic lesion in the body of the pancreas (arrow). Poor depiction of the internal architecture of the lesion limited further characterization. (2b) Axial single-shot MR cholangiopancreatographic image (8-mm section) clearly shows a cluster of many small cysts (arrow), findings in keeping with benign serous cystadenoma.
  • Pancreatic pseudocyst. (a) Axial T2-weighted single-shot MR image obtained in a 45-year-old woman demonstrates a well-circumscribed, unilocular cyst in the pancreatic head. The cyst has internal signal intensity indicative of a simple fluid collection. (b) Delayed contrast-enhanced 3D GRE MR image shows chronic fibrotic changes in the pancreatic parenchyma (arrows), features suggestive of chronic pancreatitis. Surgical resection revealed a benign pseudocyst.
  • Pancreatic pseudocyst. (a) Axial T2WI obtained in a 70-year-old woman shows a complex cyst with a fluid-debris level (arrowhead) in the pancreatic head, a finding suggestive of a pseudocyst. (b) Axial T2-weighted MR image obtained 2 months later demonstrates resolution of the pseudocyst.
  • Pancreatic pseudocyst. Axial unenhanced 3D T1-weighted GRE (a) and coronal T2-weighted (b) MR images obtained in a 45-year-old man depict a large cyst along the anterior pancreatic margin (arrows in a) with increased T1 signal intensity that may be secondary to hemorrhage, protein deposition, or both, common findings in pancreatic pseudocysts. Contrast-enhanced MR images showed no internal enhancement of the pseudocyst.
  • Axial single-shot MR cholangiopancreatographic image (8-mm section) clearly shows a cluster of many small cysts (arrow), findings in keeping with benign serous cystadenoma.
  • Serous cystadenomas. Axial T2-weighted MR images obtained in a 66-year-old man (6a) and a 66-year-old woman (7a) show well-marginated pancreatic lesions, each consisting of a cluster of many small cysts separated by thin septa. In 6a, the central focal region of T2 signal hypointensity (arrowhead) from which the thin septa radiate is in keeping with a calcified scar. (6b, 7b) Axial delayed contrast-enhanced 3D GRE MR images obtained in the same two patients demonstrate thin enhancement of the internal septa (arrows), a finding suggestive of fibrous tissue. These are all features of benign serous cystadenomas.
  • Serous cystadenomas. Axial T2-weighted MR images obtained in a 66-year-old man (6a) and a 66-year-old woman (7a) show well-marginated pancreatic lesions, each consisting of a cluster of many small cysts separated by thin septa. In 6a, the central focal region of T2 signal hypointensity (arrowhead) from which the thin septa radiate is in keeping with a calcified scar. (6b, 7b) Axial delayed contrast-enhanced 3D GRE MR images obtained in the same two patients demonstrate thin enhancement of the internal septa (arrows), a finding suggestive of fibrous tissue. These are all features of benign serous cystadenomas.
  • Oligocystic serous cystadenoma. Axial T2-weighted (a) and delayed contrast-enhanced 3D GRE (b) MR images obtained in a 26-year-old woman show a cystic pancreatic lesion (arrow) that consists of several large cysts and lacks internal enhancing soft-tissue components. This oligocystic variant of serous cystadenoma (a diagnosis confirmed with surgical resection) has imaging features that overlap with those of mucinous cystadenom ฟ
  • Mucinous nonneoplastic pancreatic cyst in a 56-year-old woman. Axial T2-weighted MR image demonstrates a bilobed, smoothly marginated cyst (arrowhead) with simple fluid content. (b) Axial contrastenhanced 3D GRE MR image shows no enhancing soft-tissue elements or thickening of the cyst wall. The benign imaging features correlate with the histopathologic diagnosis of a mucinous nonneoplastic cyst.
  • Mucinous cystadenoma. (10a) Axial T2-weighted fat-saturated MR image obtained in a 56-yearold woman depicts a single large lobulated cyst (arrow) in the pancreatic neck, a finding suggestive of mucinous cystadenoma. (10b) Coronal contrast-enhanced T1-weighted MR image shows no internal enhancing soft-tissue elements suggestive of carcinoma. (11a) Axial T2-weighted MR image obtained in a 48-year-old woman shows a rounded thick-walled cystic structure (arrow) in the pancreatic tail. (11b) Contrast-enhanced 3D GRE MR image shows multiple thickened enhancing septa along the posterior margin of the cyst (arrowheads).
  • Mucinous cystadenoma. (10a) Axial T2-weighted fat-saturated MR image obtained in a 56-yearold woman depicts a single large lobulated cyst (arrow) in the pancreatic neck, a finding suggestive of mucinous cystadenoma. (10b) Coronal contrast-enhanced T1-weighted MR image shows no internal enhancing soft-tissue elements suggestive of carcinoma. (11a) Axial T2-weighted MR image obtained in a 48-year-old woman shows a rounded thick-walled cystic structure (arrow) in the pancreatic tail. (11b) Contrast-enhanced 3D GRE MR image shows multiple thickened enhancing septa along the posterior margin of the cyst (arrowheads).
  • Mucinous cystadenocarcinoma. (a) Axial T2-weighted MR image obtained in a 55-year-old man shows a large, complex cystic lesion (arrow) in the pancreatic head. (b, c) u nenhanced (b) and contrast-enhanced (c) 3D GRE MR images show enhancing mural soft-tissue elements (arrowheads in c ) projecting toward the cyst center, features that represent carcinomatous components.
  • IPMN with involvement of the main pancreatic duct. Axial T2-weighted MR images obtained in a 70-year-old man ( a at a lower level than b ) show diffuse dilatation of the main pancreatic duct with a focal cystic lesion in the pancreatic head. The lesion communicates with the distended main pancreatic duct (arrowhead in a ). These findings represent an IPMN with involvement of the main pancreatic duct.
  • IPMN. Axial T2-weighted MR image obtained in a 72-year-old man demonstrates focal dilatation of ductal side-branches in the pancreatic head (arrow), findings that represent a small side-branch IPMN.
  • Invasive adenocarcinoma in association with an IPMN. Axial T2-weighted (a) and contrast-enhanced 3D GRE (b) MR images obtained in a 62-year-old woman show a complex cystic lesion (arrow in a ) in the pancreatic head with ductal communication and an enhancing posterior margin of soft tissue (arrowheads in b ).
  • Ductal adenocarcinoma with cystic changes. (16) Coronal T2-weighted (a) and contrastenhanced 3D GRE (b) MR images obtained in a 62-year-old woman show an infiltrative poorly vascularized tumor in the pancreatic head (arrows) with a central accumulation of complex fluid (arrowhead in a), a finding indicative of necrosis. Dilatation of the pancreatic duct and delayed uptake of contrast material in the pancreatic tail (arrowhead in b) are suggestive of chronic pancreatitis due to ductal obstruction by the tumor. A pseudocyst (* in b) dissects along the undersurface of the left hepatic lobe. (17a) Coronal single-shot thicksection MR cholangiopancreatographic image obtained in a 76-year-old woman shows a severe obstruction of both the pancreatic duct and the biliary system. (17b) Axial T2-weighted MR image shows the obstructing adenocarcinoma in the pancreatic head (arrowheads) with a focal cystic lesion along the medial margin (arrow), a finding indicative of distention of the pancreatic duct side-branches in the uncinate process.
  • (17a) Coronal single-shot thick section MR cholangiopancreatographic image obtained in a 76-year-old woman shows a severe obstruction of both the pancreatic duct and the biliary system. (17b) Axial T2-weighted MR image shows the obstructing adenocarcinoma in the pancreatic head (arrowheads) with a focal cystic lesion along the medial margin (arrow), a finding indicative of distention of the pancreatic duct side-branches in the uncinate process.
  • Solid pseudopapillary tumor of the pancreas. Axial T2-weighted MR image obtained in a 38-year-old man shows a large, predominantly solid tumor in the pancreatic head, with a central focus of T2 signal hypointensity (arrowhead) that appeared hyperintense on T1-weighted unenhanced images and correlated with a focal hemorrhage at histologic analysis. (b, c) Axial contrast-enhanced GRE MR images from arterial (b) and delayed (c) phases show a gradual accumulation of contrast material in the tumor (arrow).
  • (20) Axial (a, b) and coronal (c) T2-weighted MR images obtained in three patients depict solid pseudopapillary tumors with varying degrees of cystic degeneration: one predominantly solid (arrow in a ), one mixed solid and cystic (arrow in b ), and one predominantly cystic (arrow in c ).
  • Cystic neuroendocrine tumor. Axial T2-weighted MR image obtained in a 72-year-old man shows a well-circumscribed cystic lesion (arrow). (b) Arterial phase 3D GRE MR image shows a slightly thickened rim of well-vascularized enhancing tissue (arrowheads) around the tumor.
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Pancreatic cystic lesion by xiu Pancreatic cystic lesion by xiu Presentation Transcript

  • MR Imaging of Cystic Lesion of the Pancreas Present by : Ekksit Srithammasit, MD Kalb et al : Departments of Radiology , Surgery, and Pathology, Emory University School of Medicine, Atlanta. 2009;
  • Introduction
    • Pancreatic cyst
    • A common incidental finding in cross-sectional imaging.
    • Neoplastic VS Nonneoplastic processes.
    • Require surgical intervention VS follow-up.
  • Introduction
    • The role of pancreatic cyst biopsy is debated.
    • Biopsy of a malignant fluid-containing lesion may lead to spread of malignant cells.
    • Histological analysis and chemical analysis produce a questionable diagnostic yield.
  • Introduction
    • Imaging detailed of pancreatic cyst :
    • Cyst morphology
    • Fluid content
    • Communication with the pancreatic ductal system.
    • Entire pancreatic parenchyma
    MRI = best suited for evaluating these features.
  • Imaging Modalities
    • Ultrasound
    • Lack of spatial resolution.
    • Lack of soft-tissue contrast resolution.
    • Limited in large patients.
    • Endoscopic US is invasive.
    Presence or absence of calcification : not critical factor in the differentiation of pancreatic cyst.
    • CT
    • Can depict small pancreatic cysts.
    • Limited to evaluated internal septa of the cyst.
    • Better demonstrated Calcification.
  • Imaging Modalities
    • MRI
    • Good soft-tissue contrast.
    • Clearer depiction of septa and other cyst contents.
    • Good to depiction of pancreatic ductal system.
    MRI = best suited for evaluating these features.
  •  
  • Table of Contents
    • MRI Technique
    • Overview of lesions
      • Pseudocyst
      • Serous Cysadenomas
      • Mucin Containing Cyst
      • Lymphoepithelial Cyst
      • Solid Pancreatic Tumor with Cystic Degeneration
  • MR Imaging Techniques
    • T2W sequences.
      • Fat saturation.
      • MR cholangiopancreatography.
    • Dynamic 3D contrast enhanced T1W GRE sequences.
  • MR Imaging Techniques
    • T2WI : coronal and axial planes
    • Cyst contents (fluid, septa)
    • Pancreatic duct system.
    • Fat saturation.
      • Allows the identification of acute inflammatory changes.
      • Improve depiction of the internal architecture of a cyst.
  • MR Imaging Techniques
    • MR cholangiopancreatography (heavilyT2-weighted sequences)
      • Depiction of the ductal system
      • Small communications between cystic lesions and the pancreatic duct.
  • MR Imaging Techniques
    • Unenhanced and contrast - enhanced T1-weighted images .
    • Enhancing soft - tissue components .
    • The surrounding pancreatic parenchyma
    • The pancreatic duct .
    • Unenhanced T1WI :
      • Internal hemorrhage.
      • Protein deposits .
  • Table of Contents
    • MRI Technique
    • Overview of lesions
      • Pseudocyst
      • Serous Cysadenomas
      • Mucin Containing Cyst
      • Lymphoepithelial Cyst
      • Solid Pancreatic Tumor with Cystic Degeneration
  • Table of Contents
    • MRI Technique
    • Overview of lesions
      • Pseudocyst
      • Serous Cysadenomas
      • Mucin Containing Cyst
      • Lymphoepithelial Cyst
      • Solid Pancreatic Tumor with Cystic Degeneration
  • Pseudocysts
    • M/C cystic lesions of the pancreas.
    • Occur in the setting of pancreatitis :
      • Hemorrhagic fat necrosis and encapsulation by granulation tissue and a fibrous capsule.
  • Pseudocysts
    • Irregularly marginated -> Well circumscribed, with a thickened.
    • Blood products and necrotic or proteinaceous debris.
      • Intrinsically increased T1 signal intensity.
    • Acute or chronic pancreatitis.
  • Pseudocysts
    • Inflammation:
      • Increased SI surrounding a complicated pseudocyst on T2FS.
      • Cause of inflammation is more likely to be chemical irritation than infection
      • Impossible to differentiate between an infectious process and other possible causes on the basis of imaging features alone.
    • Dissect along abdominopelvic fascial planes to sites remote from the pancreas
      • eg, liver, pleura, or mediastinum
    • Fistulation may occur between a pseudocyst and one or more vascular structures.
  • Pseudocysts No vascularized soft-tissue elements are present within pseudocysts, and if vascularized elements are seen within a cystic lesion on contrast-enhanced MR images, the lesion is not a pseudocyst.
  • Pseudocysts
    • DDx with Mucinous cystadenoma
    • Mucinous cystadenomas often persist without a significant interval change on F/U images.
    • Evidence of acute or chronic pancreatitis almost always found in pancreatic pseudocyst, not in mucinous cystadenoma.
  • Pancreatic pseudocyst. (a) a simple fluid collection. (b) with chronic pancreatitis.
  • Pancreatic pseudocyst with F/U 2 months (a) Complex cyst with a fluid-debris level (b) Resolution of the pseudocyst.
  • Pancreatic pseudocyst Common findings in pancreatic pseudocysts: hemorrhage, protein deposition.
  • Table of Contents
    • MRI Technique
    • Overview of lesions
      • Pseudocyst
      • Serous Cysadenomas
      • Mucin Containing Cyst
      • Lymphoepithelial Cyst
      • Solid Pancreatic Tumor with Cystic Degeneration
  • Serous Cystadenomas
    • Benign cystic neoplasms
    • Occur frequently in older women (median age, 65 years).
    • Usually discovered incidentally.
    • Large cyst may cause abdominal pain or, more rarely, jaundice.
    • Multiple serous cystadenomas may occur in von Hippel–Lindau disease.
  • Serous Cystadenomas
    • Composed of numerous small cysts: honeycomb like formation.
    • Size typically less than 1 cm ( 0.1-2 cm ).
    • Lined by glycogen-rich epithelium.
    • Fibrous septa that radiate from a central scar.
    • Central scar may be calcified.
  • Serous Cystadenomas
    • MR imaging: Classic type - microcystic form
    • A cluster of small cysts of simple fluid SI.
    • No visible communication between the cysts and the pancreatic duct.
    • Delayed enhance of thin fibrous septa between small cysts.
    • Central scar : with or without coarse calcification.
    • Progressive enlargement ≥ 4 cm may be seen at serial follow-up over a period of months.
  • Serous Cystadenomas
    • MR imaging: Less common types:
    • Oligocystic variant:
    • Cysts are larger and fewer.
    • May mimic that of a mucinous cystadenoma .
    • Solid variant:
    • Composed of microscopic serous cysts that too small to be reliably depicted on MR images.
    • MRI: solid, well-circumscribed, well-vascularized mass.
    • Features that overlap with those of pancreatic neuroendocrine tumors .
  • C luster of many small cysts
  • Serous cystadenomas. Calcified scar and enhancement of the internal septa
  • Serous cystadenomas. Enhancement of the internal septa
  • Oligocystic serous cystadenoma. Large cysts and lacks internal enhancing soft-tissue components. Imaging features overlap with mucinous cystadenoma
  • Table of Contents
    • MRI Technique
    • Overview of lesions
      • Pseudocyst
      • Serous Cysadenomas
      • Mucin Containing Cyst
      • Lymphoepithelial Cyst
      • Solid Pancreatic Tumor with Cystic Degeneration
  • Table of Contents
    • MRI Technique
    • Overview of lesions
      • Pseudocyst
      • Serous Cysadenomas
      • Mucin Containing Cyst
      • Lymphoepithelial Cyst
      • Solid Pancreatic Tumor with Cystic Degeneration
    • Mucinous Nonneoplastic Cysts .
    • Mucinous Cystadenomas .
    • Mucinous Cystadenocarcinoma .
    • Pancreatic IPMNs .
  • Mucinous Nonneoplastic Cysts
    • Nonneoplastic cysts.
    • No neoplastic potential.
    Mucin Containing Cyst
    • Mucinous differentiation of the epithelial lining cyst.
    • No ductal communication.
    • Lack the surrounding ovarian stroma .
    • No cellular atypia, or the papillary projections.
  • Mucinous Nonneoplastic Cysts
    • MRI Findings
    • Typically small and unilocular or thinly septate.
    • Internal SI of simple fluid.
    • No enhancing soft-tissue components.
    Mucin Containing Cyst
  • Mucinous Nonneoplastic Cysts Mucin Containing Cyst DDx with mucinous cystadenomas. May be indistinguishable, especially if the cyst is large and has a thick wall. Mucinous cystadenomas Mucinous Nonneoplastic Cysts
  • Mucin Containing Cyst Mucinous nonneoplastic pancreatic cyst . Bi-lobed, smoothly marginated cyst No enhancing soft-tissue elements.
  • Mucinous Cystadenomas
    • 10% of pancreatic cystic neoplasms.
    • Majority (>95%) found in women (mean age, 47 years).
    • Malignant potential cyst .
    Mucin Containing Cyst sampling of the cyst lining must be performed
  • Mucinous Cystadenomas
    • Typically involve body or tail of the pancreas.
    • Thickened walls, lined by mucin-producing columnar epithelium.
    • Presence of a surrounding ovarian-type stroma.
    • No communicate with the pancreatic ductal system.
    Mucin Containing Cyst
  • Mucinous Cystadenomas
    • MRI Findings
    • Unilocular or mildly septate cystic lesion.
    • Thicked and delayed enhanced wall.
    • Contained fluid : typically mucin filled
      • More common - simple fluid SI
      • Less common - Increased T1 SI
    • Often internal septal enhancement.
      • Presence of internal enhancing soft tissue elements is indicative of carcinoma.
    Mucin Containing Cyst
  • Mucin Containing Cyst Mucinous cystadenoma. A single large lobulated cyst without internal enhancing soft-tissue elements.
  • Mucin Containing Cyst Mucinous cystadenoma. A rounded thick-walled cystic structure with thickened enhancing septa.
  • Mucinous Cystadenocarcinomas
    • Older on average than those with diagnosis of mucinous cystadenoma
    • Progression from cystadenoma to cystadenocarcinoma
    • Mucinus cyst with surrouding ovarian type stoma.
    • Invasive carcinomatous elements.
    Mucin Containing Cyst
    • MRI Findings:
    • Large complex cysts.
    • Intracystic enhancing soft tissue.
  • Mucinous Cystadenocarcinomas
    • In a retrospective review of 163 resected mucinous cysts with surrounding ovarian-type stroma
    • 17.5% of the cysts contained elements of invasive carcinoma at histologic analysis.
    • All of the lesions with an invasive carcinomatous component had a size of 4 cm or more and demonstrated soft-tissue nodularity.
    • Hence, any enhancing soft tissue within a cystic neoplasm depicted on MR images is considered an indication for resection.
    Mucin Containing Cyst
  • Mucin Containing Cyst Mucinous cystadenocarcinoma. A large, complex cystic lesion with enhancing mural soft-tissue elements .
  • Pancreatic IPMNs
    • Intraductal papillary mucinous neoplasms
    • Most frequently in men (mean age, 65 years).
      • Noninvasive neoplasms with varying degrees of epithelial dysplasia.
      • Foci of carcinoma in situ.
      • Frank invasive adenocarcinoma.
    Mucin Containing Cyst
  • Pancreatic IPMNs
    • Mucinous transformation of the pancreatic ductal epithelium.
    • Usually demonstrates papillary projections.
    • Involves the main pancreatic duct or isolated side branches.
      • Main duct: 60%–70% invasive carcinoma
      • Side branches: 22% foci of carcinoma.
    • Frequently multifocal, and 5%–10% involve the entire pancreas
    Mucin Containing Cyst
  • Pancreatic IPMNs
    • ERCP
    • Excessive mucin production results in cystic dilatation of the pancreatic duct.
    • Possibly,spillage of mucin from the ampulla of Vater : a classic finding at endoscopic retrograde cholangiopancreatography.
    Mucin Containing Cyst
  • Pancreatic IPMNs
    • MRI finding: Modality of choice
    • Cyst with ductal communication.
    • Main pancreatic duct dilatation or dilatation of multiple side branches.
    • Adenocarcinoma in association with an IPMN.
      • Enhancing soft-tissue nodularity
      • Size more than 3.5 cm
      • Thick walls.
    Mucin Containing Cyst
  • Mucin Containing Cyst IPMN with involvement of the main pancreatic duct. . D iffuse dilatation of the main pancreatic duct with a focal cystic lesion . The lesion communicates with the distended main pancreatic duct .
  • Mucin Containing Cyst IPMN with involvement of the side-branches. F ocal dilatation of ductal side-branches in the pancreatic head .
  • Mucin Containing Cyst Invasive adenocarcinoma in association with an IPMN. A complex cystic lesion with ductal communication and enhancing soft tissue component.
  • Table of Contents
    • MRI Technique
    • Overview of lesions
      • Pseudocyst
      • Serous Cysadenomas
      • Mucin Containing Cyst
      • Lymphoepithelial Cyst
      • Solid Pancreatic Tumor with Cystic Degeneration
    • Mucinous Nonneoplastic Cysts .
    • Mucinous Cystadenomas .
    • Mucinous Cystadenocarcinoma .
    • Pancreatic IPMNs .
  • Table of Contents
    • MRI Technique
    • Overview of lesions
      • Pseudocyst
      • Serous Cysadenomas
      • Mucin Containing Cyst
      • Lymphoepithelial Cyst
      • Solid Pancreatic Tumor with Cystic Degeneration
  • Lymphoepithelial Cysts
    • Rare benign pancreatic cysts.
    • The imaging findings are not well described in the literature.
    • Most common: in men (mean age, 55 years)
    • The cysts are lined by squamous epithelium and surrounded by dense lymphoid tissue.
    • Their MR appearances vary: unilocular or multilocular.
  • Table of Contents
    • MRI Technique
    • Overview of lesions
      • Pseudocyst
      • Serous Cysadenomas
      • Mucin Containing Cyst
      • Lymphoepithelial Cyst
      • Solid Pancreatic Tumor with Cystic Degeneration
  • Table of Contents
    • MRI Technique
    • Overview of lesions
      • Pseudocyst
      • Serous Cysadenomas
      • Mucin Containing Cyst
      • Lymphoepithelial Cyst
      • Solid Pancreatic Tumor with Cystic Degeneration
    • Ductal adenocarcinoma with cystic features
    • Pseudopapillary tumors of the pancreas
    • Cystic neuroendocrine tumors
  • Ductal adenocarcinoma with cystic features
    • The most common pancreatic neoplasms. (90%)
    • The most lethal tumor of the pancreas. (5-year survival of less than 3%).
    • Predominantly solid.
    • 8% cyst like features:
      • cystic degeneration, retention cysts, and attached pseudocysts.
    Solid Pancreatic Tumor with Cystic Degeneration
  • Ductal adenocarcinoma with cystic features
    • Usually infiltrative growth pattern.
    • Obstruction of the pancreatic duct or CBD.
    • Invasion of adjacent vasculature.
    Solid Pancreatic Tumor with Cystic Degeneration
  • Ductal adenocarcinoma with cystic features
    • MRI Findings:
    • Infiltrative soft-tissue lesion.
    • Delayed enhancement (contrast material gradually seeps into the tumor interstitium)
    • Ductal obstruction.
    • Complex cystic areas within or adjacent to the primary soft-tissue lesion
      • Pseudocysts, internal tumor necrosis, or side-branch ductal obstruction.
    Solid Pancreatic Tumor with Cystic Degeneration
  • Ductal adenocarcinoma with cystic features
    • DDx Contain enhancing soft tissue and cystic components:
    • Ductal Adenocarcinomas with Cystic Features.
      • Infiltrative pattern of the primary tumor.
      • Combined with ductal obstruction and vascular invasion
    • Cystic neoplasms such as solid pseudopapillary tumor and mucinous cystadenocarcinoma.
    Solid Pancreatic Tumor with Cystic Degeneration
  • Solid Pancreatic Tumor with Cystic Degeneration Ductal adenocarcinoma with cystic changes. A poorly vascularized infiltrative tumor with a central necrosis and pseudocyst.
  • Solid Pancreatic Tumor with Cystic Degeneration Ductal adenocarcinoma with cystic changes. A pancreatic tumor obstructed pancreatic and common bile duct with distention of the pancreatic duct side-branches.
  • Solid Pseudopapillary Tumors
    • Solid and cystic papillary epithelial neoplasm of the pancreas.
    • Papillary cystic neoplasm.
    • Uncommon lesions.
    • Predominantly in women (mean age, 28 years).
    • Low-grade malignant potential .
    • The cellular lineage remains uncertain: Epithelial VS neuroendocrine.
    Solid Pancreatic Tumor with Cystic Degeneration
  • Solid Pseudopapillary Tumors
    • MRI Findings:
    • Predominantly solid.
    • Well circumscribed increased T2 signal intensity.
    • Gradual uniformly enhancing soft-tissue.
    • Cystic components - secondary to tumor degeneration.
    • Hemorrhage - common
    Solid Pancreatic Tumor with Cystic Degeneration
  • Solid Pseudopapillary Tumors
    • DDx
    • Neuroendocrine tumor
    • Mucinous cystadenocarcinoma.
    Solid Pancreatic Tumor with Cystic Degeneration However, because all three entities require surgical resection, their preoperative differentiation may not be important in the clinical setting.
  • Solid pseudopapillary tumor of the pancreas. A gradual enhancing solid tumor with internal hemorrhage. Solid Pancreatic Tumor with Cystic Degeneration
  • Solid pseudopapillary tumor of the pancreas. varying degrees of cystic degeneration Solid Pancreatic Tumor with Cystic Degeneration
  • Cystic Neuroendocrine Tumors
    • Occur in adults (mean age, 53 years) without sex predilection.
    • Neuroendocrine tumors - Typically solid and well vascularized.
    • Cystic change - Uncommon.
      • Secondary to tumor degeneration
    Solid Pancreatic Tumor with Cystic Degeneration
  • Cystic Neuroendocrine Tumors
    • Neoplastic neuroendocrine cells lining the cyst periphery
    Solid Pancreatic Tumor with Cystic Degeneration
  • Cystic Neuroendocrine Tumors
    • MRI Findings:
    • Well circumscribed
    • Avidly rim enhacement in arterial phase.
    Solid Pancreatic Tumor with Cystic Degeneration A patient with a cystic neuroendocrine tumor is significantly more likely to have an underlying multiple endocrine neoplasia syndrome than a patient with a uniformly solid neuroendocrine tumor.
  • Cystic neuroendocrine tumor. A well define cyst with avidly enhancing thickening rim on arterial phase image. Solid Pancreatic Tumor with Cystic Degeneration
  • Table of Contents
    • MRI Technique
    • Overview of lesions
      • Pseudocyst
      • Serous Cysadenomas
      • Mucin Containing Cyst
      • Lymphoepithelial Cyst
      • Solid Pancreatic Tumor with Cystic Degeneration
    • Ductal adenocarcinoma with cystic features
    • Pseudopapillary tumors of the pancreas
    • Cystic neuroendocrine tumors
  • Table of Contents
    • MRI Technique
    • Overview of lesions
      • Pseudocyst
      • Serous Cysadenomas
      • Mucin Containing Cyst
      • Lymphoepithelial Cyst
      • Solid Pancreatic Tumor with Cystic Degeneration
  • Conclusions
    • Common incidental finding in cross-sectional imaging.
    • Neoplastic VS Nonneoplastic processes.
    • MRI is the best modality for evaluating pancreatic cyst.
      • Good soft-tissue contrast and good to depiction of pancreatic ductal system.
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    • Which of the following modalities is optimal for depicting internal complexity of a pseudocyst?
    • A) MR imaging.
    • B) Radiography.
    • C) Multidetector CT.
    • D) Endoscopic retrograde cholangiopancreatography.
    • Which of the following cystic lesions of the pancreas is the most common overall?
    • A ) Solid pseudopapillary tumor. B ) Mucinous cystadenoma. C ) Pseudocyst. D ) Lymphoepithelial cyst.
    • Which of the following imaging methods best depicts vascularized soft tissue within a pancreatic cystic lesion?
    • A) Unenhanced and contrast-enhanced 3D MR imaging with T1-weighted sequences.
    • B) Axial thin-section 3D MR cholangiopancreatography.
    • C) Axial single-shot T2-weighted MR imaging.
    • D) Coronal thick-slab MR cholangiopancreatography.
    • Which of the following clinical or demographic characteristics is most common among patients with mucinous cystadenomas?
    • A) Presence of chronic or recurrent pancreatitis.
    • B) Presence of von Hippel-Lindau disease.
    • C) Age of less than 20 years.
    • D) Female sex.
    • Which of the following pancreatic cystic lesions may occur in the setting of von Hippel - Lindau disease?
    • A ) Mucinous cystadenoma. B ) Serous cystadenoma. C ) Ductal adenocarcinoma with cystic features. D ) IPMN.
    • Which of the following characteristics of an IPMN is most commonly associated with invasive carcinoma?
    • A) Localization to a pancreatic duct side branch.
    • B) Involvement of the main pancreatic duct.
    • C) Absence of soft-tissue nodularity.
    • D) Size of less than 3 cm.
    • Which of the following pancreatic cystic lesions does not include a vascularized soft - tissue component?
    • A ) Mucinous cystadenocarcinoma .
    • B ) Solid pseudopapillary tumor .
    • C ) Mucinous nonneoplastic cyst of the pancreas .
    • D ) Ductal adenocarcinoma with cystic features .
    • Which of the following statements does not accurately characterize cystic pancreatic neuroendocrine tumors?
    • A ) They are rarer than solid neuroendocrine tumors. B ) They are more commonly associated with multiple endocrine neoplasia than are solid neuroendocrine tumors. C ) They may include a vascularized soft-tissue component. D ) They usually demonstrate poor margination and an infiltrative growth pattern.
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