Pancreatic Cysts: Comprehensive Radiological Evaluation and Diagnostic Strategy

Abstract

Abstract
Background:
Pancreatic cystic lesions are frequently encountered in abdominal imaging, presenting a
broad range of diagnostic and management challenges. With the increasing use of cross-sectional
imaging techniques, especially CT and MRI, incidental detection of pancreatic cysts has become
common. These cysts may be benign, premalignant, or malignant, requiring precise radiological
evaluation for appropriate clinical decision-making.
Purpose:
To provide a comprehensive review of radiological modalities used in the evaluation of
pancreatic cysts, including their diagnostic accuracy, characteristic imaging features, and roles in
risk stratification. The article also discusses guideline-based recommendations for follow-up and
management.
Methods:
A literature-based synthesis of comparative studies and guideline documents was
performed, examining the diagnostic performance of CT, MRI, MRCP, and EUS (with FNA) in
identifying key features such as mural nodules, septations, ductal communication, and malignant
stigmata.
Results:
MRI with MRCP demonstrated the highest sensitivity for ductal evaluation and internal
cyst structure. CT was useful for detecting calcifications and local invasion. EUS-FNA provided
additional diagnostic information via fluid analysis and cytology. Combining MRI and EUS
yielded the highest overall diagnostic accuracy (>90%).
Conclusion:
Radiology plays a pivotal role in the management of pancreatic cysts. A structured
approach utilizing MRI/MRCP as the primary modality, complemented by CT and EUS when
indicated, ensures accurate diagnosis and optimized patient outcomes. Multidisciplinary collaboration and adherence to international guidelines are essential in tailoring patient-specific
management strategies.