Clinical Significance of Magnetic Resonance Cholangiopancreatography for the Diagnosis of Cystic Tumor of the Pancreas Compared with Endoscopic Retrograde Cholangiopancreatography and Computed Tomography

Abstract

Background: Cystic tumor of the pancreas has been investigated by a variety of imaging techniques. Magnetic resonance cholangiopancreatography (MRCP) is being widely used as a non-invasive diagnostic modality for investigation of the biliary tree and pancreatic duct system. The purpose of this study was to compare MRCP images with those of endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) in order to clarify the diagnostic efficacy of MRCP for cystic tumor of the pancreas. Methods:We retrospectively studied 15 patients with cystic tumor of the pancreas that had been surgically resected and histopathologically confirmed. There were five cases of intraductal papillary adenocarcinoma, five of intraductal papillary adenoma, two of serous cyst adenoma,two of retention cyst associated with invasive ductal adenocarcinoma and one of solid cystic tumor. Results:In all cases MRCP correctly identified the main pancreatic duct (MPD) and showed the entire cystic tumor and the communication between the tumor and the MPD. On the other hand, the detection rate by ERCP of the cystic tumor and the communication between the cystic tumor and the MPD was only 60%. Although the detection rates by CT for the septum and solid components inside the cystic tumor were 100 and 90.0%, respectively, those of MRCP for each were 58.3 and 20.0%. Conclusion: MRCP is capable of providing diagnostic information superior to ERCP for the diagnosis of cystic tumor of the pancreas. Although MRCP may provide complementary information about the whole lesion of interest, the characteristic internal features of cystic tumor of the pancreas should be carefully diagnosed in combination with CT.

Additional value of FDG PET/CT to contrast-enhanced CT in the differentiation between benign and malignant intraductal papillary mucinous neoplasms of the pancreas with mural nodules

“…Sahani et al [25] have reported that CT and MRI are reasonably and similarly accurate in both detection and characterization of cystic pancreatic lesions. Furthermore, Mera et al [26] have reported that CT is superior to MRCP for the detection of the internal features of cystic tumor of the pancreas: detection rate of the septum and solid components inside the cystic tumor of the pancreas were 100 and 90% for CT, and 58.3 and 20.0% for MRCP, respectively. They discussed that one of the limiting factors for the MRCP image is a maximum intensity projection algorithm to create three-dimensional images of the pancreatic duct system.…”

Cystic lesions in the pancreas: When to watch, when to resect

“…Occasionally, however, mucinous cystic neoplasms may show this characteristic; and, of course, intraductal papillary mucinous tumors (IPMTs) by definition show ectatic changes in the pancreatic duct which may include cystic dilatation of the branch ducts [3,7,8]. Magnetic resonance cholangiopancreatography (MRCP) is a relatively new technique that has shown promise in better defining the relationship between cystic lesions and the pancreatic duct, but until there is further refinement, its clinical use should probably be corroborated with other imaging studies such as CT [9]. Endoscopic ultrasound is emerging as another powerful tool in the differential diagnosis of pancreatic cystic lesions.…”

An Illustrative Review of Solid Pancreatic Masses: Differential Diagnostic Features of CT and MRI Findings

“…In most cases, T2WI show typical lobular and marked hyperintense mass lesions. On MRCP, SCT is marked by strong hyperintensity, reflecting its cystic nature [21]. Thus, diagnosis of most cases is not difficult.…”