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MRI of mucinous pancreatic cystic lesions: a new updated morphological approach for the differential diagnosis

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Abstract

Pancreatic cystic lesions (PCLs) have been increasingly identified over the past 2 decades due to the widespread use of high-resolution non-invasive abdominal imaging. They cover a vast spectrum, from benign to malignant and invasive lesions, thus they constitute a significant clinical entity. Among PCLs, mucin-producing lesions are those at risk of progression to malignancy. They include mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPMN). The diagnosis and management of these cystic lesions are a dilemma since there is a significant overlap in the morphology of benign and premalignant lesions. At the moment, there is no single test that will allow a correct diagnosis in all cases. Magnetic resonance (MR) and endoscopic ultrasound (EUS) morphology, with cyst fluid analysis and cytohistology done with EUS-guided procedure are the best techniques that can narrow the differential diagnosis and identify potentially malignant lesions requiring resection from those requiring follow-up only. The purpose of this paper is to present an updated review of MR imaging findings of mucinous PCLs and to provide a new morphological approach that can serve as a practical guide for the diagnosis of these lesions, allowing a more confident characterization and avoiding relevant misdiagnosis. Furthermore, we provide some information about EUS and cystic fluid analysis and cytohistology, since they are diagnostic modalities that radiologists and surgeons should be familiar with.

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We declare no financial support.

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Authors and Affiliations

  1. Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy

    Giuseppe Mamone, Ambra Di Piazza & Roberto Miraglia

  2. Endoscopic Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy

    Luca Barresi

  3. Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy

    Alessandro Tropea

Authors
  1. Giuseppe Mamone
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  2. Luca Barresi
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  3. Alessandro Tropea
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  4. Ambra Di Piazza
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  5. Roberto Miraglia
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Correspondence to Giuseppe Mamone.

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Our study doesn’t involve animals. The Institutional Research Review Board reviewed and approved this article, with waiver of the informed consent.

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A written informed consent to the imaging procedure was obtained after a full explanation of the purpose and nature of the procedure.

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Mamone, G., Barresi, L., Tropea, A. et al. MRI of mucinous pancreatic cystic lesions: a new updated morphological approach for the differential diagnosis. Updates Surg 72, 617–637 (2020). https://doi.org/10.1007/s13304-020-00800-y

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  • DOI: https://doi.org/10.1007/s13304-020-00800-y

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