Update in Imaging of Cystic Pancreatic Masses for Gastroenterologists Alec J. Megibow  Clinical Gastroenterology and Hepatology  Volume 6, Issue 11, Pages 1194-1197 (November 2008) DOI: 10.1016/j.cgh.2008.08.026 Copyright © 2008 AGA Institute Terms and Conditions

Figure 1 MDCT appearance of serous cystadenoma. The lesion is predominantly fibrous tissue delimiting tiny cysts. The largest cysts are seen at the periphery. A small central calcification is seen. This morphology is characteristic; if the patient is asymptomatic, the lesion can be followed up. Clinical Gastroenterology and Hepatology 2008 6, 1194-1197DOI: (10.1016/j.cgh.2008.08.026) Copyright © 2008 AGA Institute Terms and Conditions

Figure 2 MCT by T2-weighted MR imaging. A large mass with bright central fluid is seen in the left upper quadrant. A thick central septum is present. A hazy area of decreased signal can be seen in the dependent portion of the cyst representing inspissated mucin (arrow). This lesion will be resected. Clinical Gastroenterology and Hepatology 2008 6, 1194-1197DOI: (10.1016/j.cgh.2008.08.026) Copyright © 2008 AGA Institute Terms and Conditions

Figure 3 Main duct IPMT by computed tomography. The entire pancreatic duct is distended (arrows). Calcifications along the wall of the pancreatic duct occur in the papillary malignant projections that produce the abundant mucin distending the main pancreatic duct. The mass effect of the distended pancreatic duct has compressed the biliary tree resulting in dilatation of the intrahepatic biliary tree (curved arrow). Clinical Gastroenterology and Hepatology 2008 6, 1194-1197DOI: (10.1016/j.cgh.2008.08.026) Copyright © 2008 AGA Institute Terms and Conditions

Figure 4 Branch duct IPMT by computed tomography and MR. A cystic mass is seen in the uncinate process of the pancreas on a 3-dimensional computed tomography image from September 2005 (9-05). Note the thin neck connecting the cyst to the main pancreatic duct. The computed tomography findings are definitive, and, because the cyst is less than 3 cm and has no solid elements, clinical and imaging follow-up were recommended. An MR cholangiopancreatography in April 2008 (4-08) shows the stability of the lesion. MR is preferred for follow-up evaluation to minimize radiation exposure. Clinical Gastroenterology and Hepatology 2008 6, 1194-1197DOI: (10.1016/j.cgh.2008.08.026) Copyright © 2008 AGA Institute Terms and Conditions

Figure 5 Solid and pseudopapillary epithelial neoplasm tumor by computed tomography. A computed tomography image from a 26-year-old woman reveals a heterogeneous cyst in the pancreatic tail. The variable appearance in the cyst reflects the solid and cystic components of the lesion. A small calcification is present in the wall of the lesion. The lesion was resected and was benign. Clinical Gastroenterology and Hepatology 2008 6, 1194-1197DOI: (10.1016/j.cgh.2008.08.026) Copyright © 2008 AGA Institute Terms and Conditions