Diagnostic value of imaging examinations in pancreatic cystic neoplasm

Objective To investigate the manifestations and diagnostic value of imaging examinations in pancreatic cystic neoplasm. Methods Clinical data of 95 patients with pancreatic cystic neoplasm who were admitted to the Second Affiliated Hospital, College of Medical Sciences, Zhejiang University between January 2014 and December 2015 were retrospectively analyzed. Among the patients, 37 were males and 58 were females, aged 10-80 years old with a median age of 54 years old. Sixteen cases were diagnosed with serous cystic neoplasm (SCN), 11 with mutinous cystic neoplasm (MCN), 21 with intraductal papillary mucinous neoplasm (IPMN), 12 with cystic solid pseudopapillary neoplasm (SPN), 24 with cystic pancreatic neuroendocrine neoplasm (PNEN) and 11 with cystic pancreatic adenocarcinoma. The informed consents of all patients were obtained and the local ethical committee approval was received. Computed tomography (CT) and magnetic resonance imaging (MRI) manifestations of the patients with pancreatic cystic neoplasm were analyzed, and the diagnostic accuracy was calculated. Results SCN was characterized with multiple small cysts. MCN was characterized with a clear border, single lumen and thick wall lesion, mainly occurred in the pancreatic body and tail. IPMN was characterized with lesions connected to the main pancreatic duct. Dilation of varying degrees in the main and branch pancreatic duct dilation were observed. Cystic SPN was characterized with gradual enhancement, but the enhancement intensity was lower than that of pancreatic parenchyma. Cystic PNEN was characterized with evident enhancement in arterial phase. Cystic pancreatic adenocarcinoma was characterized with insufficient blood supply complicated with surrounding tissue invasiveness or distal metastasis. The diagnostic accuracy of CT and MRI was the lowest for SCN (29% for CT and 14% for MRI), and highest for cystic PNEN (89% for CT and 100% for MRI). Conclusions Due to the nonspecific clinical manifestations of pancreatic cystic neoplasm, imaging examination remains the main method for the diagnosis. It has high value for the diagnosis of most pancreatic cystic neoplasms and the differential diagnosis between benign and malignant tumors. Key words: Pancreatic cyst; Neoplasms, cystic, mucinous, and serous; Diagnosis, differential