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CEUS Pancreas: Cystic Lesions
Mirko D‘Onofrio, MD; Alessandro Sarno, MD; Christian Jenssen, MD
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KEY FACTS

  • Terminology

    • Clinical Implications

      • IMAGING

        TERMINOLOGY

        • Abbreviations

          • Pancreatic cystic lesion (PCL)
          • Intraductal papillary mucinous neoplasm (IPMN)
            • Branch duct type (BD)
            • Main duct type (MD)
            • Mixed type (MT)
          • Mucinous cystic neoplasm (MCN)
          • Serous cystic neoplasm (SCN)
          • Solid pseudopapillary neoplasm (SPN)
          • Pancreatic neuroendocrine tumor (PNET)
        • Definitions

          • IPMN: Exocrine, mucin-producing, cystic pancreatic neoplasm arising from pancreatic ducts
            • BD-IPMN: Neoplastic infiltration of side-branch epithelia with uni- or multilocular cystic dilation; moderate risk of malignancy
            • MD-IPMN: Neoplastic proliferation of main duct epithelia exhibiting segmental or diffuse dilation of MPD; high risk of malignancy
            • MT-IPMN: Characteristics of both main and branch duct types; high risk of malignancy
          • MCN: Nonductal, cystic, mucinous neoplasm with ovarian-type stroma affecting almost exclusively women; moderate risk of malignancy
          • SCN: Benign, cystic, serous neoplasm
          • SPN: Rare, solid-cystic neoplasm of exocrine pancreas with heterogeneous aspects due to cystic, hemorrhagic, or necrotic degeneration affecting almost exclusively young women; low risk of malignancy
          • Cystic PNET: ~ 10% of PNETs are cystic due to central necrosis
            • Further nonneoplastic cysts include broad variety of different entities, including simple dysontogenetic cysts
          • Pseudocyst: Most common cystic lesion of pancreas as consequence of necrosis in course of acute or chronic pancreatitis

        CLINICAL IMPLICATIONS

        • Clinical Importance

          IMAGING

          • General Anatomic Considerations

            • Critical Anatomic Structures

              • Role of CEUS

                Selected References

                1. European Study Group on Cystic Tumours of the Pancreas: European evidence-based guidelines on pancreatic cystic neoplasms. Gut. 67(5):789-804, 2018
                2. Vinik A et al: Pathophysiology and treatment of pancreatic neuroendocrine tumors (PNETs): New developments. https://www.ncbi.nlm.nih.gov/books/NBK279074/. Updated June 2018. Accessed November 2018
                3. Marchegiani G et al: Systematic review, meta-analysis, and a high-volume center experience supporting the new role of mural nodules proposed by the updated 2017 international guidelines on IPMN of the pancreas. Surgery. 163(6):1272-1279, 2018
                4. Dietrich CF et al: Serous pancreatic neoplasia, data and review. World J Gastroenterol. 23(30):5567-5578, 2017
                5. Tanaka M et al: Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 17(5):738-753, 2017
                6. Nilsson LN et al: Nature and management of pancreatic mucinous cystic neoplasm (MCN): A systematic review of the literature. Pancreatology. 16(6):1028-1036, 2016
                7. Tyberg A et al: Management of pancreatic fluid collections: A comprehensive review of the literature. World J Gastroenterol. 22(7):2256-70, 2016
                8. D'Onofrio M et al: Imaging and Pathology of Pancreatic Neoplasms: A Pictorial Atlas. Springer, 2015
                9. Fan Z et al: Application of contrast-enhanced ultrasound in cystic pancreatic lesions using a simplified classification diagnostic criterion. Biomed Res Int. 2015:974621, 2015
                10. Jenssen C et al: Management of incidental pancreatic cystic lesions. Viszeralmedizin. 31(1):14-24, 2015
                11. Jiang L et al: Solid pseudopapillary tumors of the pancreas: Findings from routine screening sonographic examination and the value of contrast-enhanced ultrasound. J Clin Ultrasound. 43(5):277-82, 2015
                12. D'Onofrio M: Ultrasonography of the Pancreas: Imaging and Pathologic Correlations. Springer, 2012
                13. D'Onofrio M et al: Pancreatic multicenter ultrasound study (PAMUS). Eur J Radiol. 81(4):630-8, 2012
                14. Xu M et al: The application value of contrast-enhanced ultrasound in the differential diagnosis of pancreatic solid-cystic lesions. Eur J Radiol. 81(7):1432-7, 2012
                15. Beyer-Enke SA et al: Contrast enhanced transabdominal ultrasound in the characterisation of pancreatic lesions with cystic appearance. JOP. 11(5):427-33, 2010
                16. D'Onofrio M et al: Imaging techniques in pancreatic tumors. Expert Rev Med Devices. 7(2):257-73, 2010
                17. D'Onofrio M et al: Comparison of contrast-enhanced sonography and MRI in displaying anatomic features of cystic pancreatic masses. AJR Am J Roentgenol. 189(6):1435-42, 2007
                18. Sahani DV et al: Cystic pancreatic lesions: a simple imaging-based classification system for guiding management. Radiographics. 25(6):1471-84, 2005
                Related Anatomy
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                References
                Tables

                Tables

                KEY FACTS

                • Terminology

                  • Clinical Implications

                    • IMAGING

                      TERMINOLOGY

                      • Abbreviations

                        • Pancreatic cystic lesion (PCL)
                        • Intraductal papillary mucinous neoplasm (IPMN)
                          • Branch duct type (BD)
                          • Main duct type (MD)
                          • Mixed type (MT)
                        • Mucinous cystic neoplasm (MCN)
                        • Serous cystic neoplasm (SCN)
                        • Solid pseudopapillary neoplasm (SPN)
                        • Pancreatic neuroendocrine tumor (PNET)
                      • Definitions

                        • IPMN: Exocrine, mucin-producing, cystic pancreatic neoplasm arising from pancreatic ducts
                          • BD-IPMN: Neoplastic infiltration of side-branch epithelia with uni- or multilocular cystic dilation; moderate risk of malignancy
                          • MD-IPMN: Neoplastic proliferation of main duct epithelia exhibiting segmental or diffuse dilation of MPD; high risk of malignancy
                          • MT-IPMN: Characteristics of both main and branch duct types; high risk of malignancy
                        • MCN: Nonductal, cystic, mucinous neoplasm with ovarian-type stroma affecting almost exclusively women; moderate risk of malignancy
                        • SCN: Benign, cystic, serous neoplasm
                        • SPN: Rare, solid-cystic neoplasm of exocrine pancreas with heterogeneous aspects due to cystic, hemorrhagic, or necrotic degeneration affecting almost exclusively young women; low risk of malignancy
                        • Cystic PNET: ~ 10% of PNETs are cystic due to central necrosis
                          • Further nonneoplastic cysts include broad variety of different entities, including simple dysontogenetic cysts
                        • Pseudocyst: Most common cystic lesion of pancreas as consequence of necrosis in course of acute or chronic pancreatitis

                      CLINICAL IMPLICATIONS

                      • Clinical Importance

                        IMAGING

                        • General Anatomic Considerations

                          • Critical Anatomic Structures

                            • Role of CEUS

                              Selected References

                              1. European Study Group on Cystic Tumours of the Pancreas: European evidence-based guidelines on pancreatic cystic neoplasms. Gut. 67(5):789-804, 2018
                              2. Vinik A et al: Pathophysiology and treatment of pancreatic neuroendocrine tumors (PNETs): New developments. https://www.ncbi.nlm.nih.gov/books/NBK279074/. Updated June 2018. Accessed November 2018
                              3. Marchegiani G et al: Systematic review, meta-analysis, and a high-volume center experience supporting the new role of mural nodules proposed by the updated 2017 international guidelines on IPMN of the pancreas. Surgery. 163(6):1272-1279, 2018
                              4. Dietrich CF et al: Serous pancreatic neoplasia, data and review. World J Gastroenterol. 23(30):5567-5578, 2017
                              5. Tanaka M et al: Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 17(5):738-753, 2017
                              6. Nilsson LN et al: Nature and management of pancreatic mucinous cystic neoplasm (MCN): A systematic review of the literature. Pancreatology. 16(6):1028-1036, 2016
                              7. Tyberg A et al: Management of pancreatic fluid collections: A comprehensive review of the literature. World J Gastroenterol. 22(7):2256-70, 2016
                              8. D'Onofrio M et al: Imaging and Pathology of Pancreatic Neoplasms: A Pictorial Atlas. Springer, 2015
                              9. Fan Z et al: Application of contrast-enhanced ultrasound in cystic pancreatic lesions using a simplified classification diagnostic criterion. Biomed Res Int. 2015:974621, 2015
                              10. Jenssen C et al: Management of incidental pancreatic cystic lesions. Viszeralmedizin. 31(1):14-24, 2015
                              11. Jiang L et al: Solid pseudopapillary tumors of the pancreas: Findings from routine screening sonographic examination and the value of contrast-enhanced ultrasound. J Clin Ultrasound. 43(5):277-82, 2015
                              12. D'Onofrio M: Ultrasonography of the Pancreas: Imaging and Pathologic Correlations. Springer, 2012
                              13. D'Onofrio M et al: Pancreatic multicenter ultrasound study (PAMUS). Eur J Radiol. 81(4):630-8, 2012
                              14. Xu M et al: The application value of contrast-enhanced ultrasound in the differential diagnosis of pancreatic solid-cystic lesions. Eur J Radiol. 81(7):1432-7, 2012
                              15. Beyer-Enke SA et al: Contrast enhanced transabdominal ultrasound in the characterisation of pancreatic lesions with cystic appearance. JOP. 11(5):427-33, 2010
                              16. D'Onofrio M et al: Imaging techniques in pancreatic tumors. Expert Rev Med Devices. 7(2):257-73, 2010
                              17. D'Onofrio M et al: Comparison of contrast-enhanced sonography and MRI in displaying anatomic features of cystic pancreatic masses. AJR Am J Roentgenol. 189(6):1435-42, 2007
                              18. Sahani DV et al: Cystic pancreatic lesions: a simple imaging-based classification system for guiding management. Radiographics. 25(6):1471-84, 2005