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Background: Pancreatic cystic lesions (PCLs) are frequent on MRI and are thought to be associated with pancreatic adenocarcinoma (PDAC) necessitating long-term surveillance based on older studies suffering from selection bias., Purpose: To establish the percentage of patients with PCLs on MRI with a present or future PDAC., Study Type: Systematic review, meta-analysis., Population: Adults with PCLs on MRI and a present or future diagnosis of PDAC were eligible. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus were searched to April 2022 (PROSPERO:CRD42022320502). Studies limited to PCLs not requiring surveillance, <100 patients, or those with a history/genetic risk of PDAC were excluded., Field Strength/sequence: ≥1.5 T with ≥1 T2-weighted sequence., Assessment: Two investigators extracted data, with discrepancies resolved by a third. QUADAS-2 assessed bias. PDAC was diagnosed using a composite reference standard., Statistical Tests: A meta-analysis of proportions was performed at the patient-level with 95% confidence intervals (95% CI)., Results: Eight studies with 1289 patients contributed to the percentage of patients with a present diagnosis of PDAC, and 10 studies with 3422 patients to the percentage with a future diagnosis. Of patients with PCLs on MRI, 14.8% (95% CI 2.4-34.9) had a PDAC at initial MRI, which decreased to 6.0% (2.2-11.3) for studies at low risk of bias. For patients without PDAC on initial MRI, 2.0% (1.1-3.2) developed PDAC during surveillance, similar for low risk of bias studies at 1.9% (0.7-3.6), with no clear trend of increased PDAC for longer surveillance durations. For patients without worrisome features or high-risk stigmata, 0.9% (0.1-2.2) developed PDAC during surveillance. Of 10, eight studies had a median surveillance ≥3 years (range 3-157 months). Sources of bias included retrospectively limiting PCLs to those with histopathology and inconsistent surveillance protocols., Data Conclusion: A low percentage of patients with PCLs on MRI develop PDAC while on surveillance. The first MRI revealing a PCL should be scrutinized for PDAC., Level of Evidence: 3 TECHNICAL EFFICACY: Stage 2., (© 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Purpose: To evaluate the efficacy of low-dose CT (LDCT) with deep learning image reconstruction (DLIR) for the surveillance of pancreatic cystic lesions (PCLs) compared with standard-dose CT (SDCT) with adaptive statistical iterative reconstruction (ASIR-V)., Methods: The study enrolled 103 patients who underwent pancreatic CT for follow-up of incidentally detected PCLs. The CT protocol included LDCT in the pancreatic phase with 40% ASIR-V, DLIR at medium (DLIR-M) and high levels (DLIR-H), and SDCT in the portal-venous phase with 40% ASIR-V. The overall image quality and conspicuity of PCLs were qualitatively assessed using five-point scales by two radiologists. The size of PCLs, presence of thickened/enhancing walls, enhancing mural nodules, and main pancreatic duct dilatation were reviewed. CT noise and cyst-to-pancreas contrast-to-noise ratio (CNR) were measured. Qualitative and quantitative parameters were analyzed using the chi-squared test, one-way ANOVA, and t-test. Additionally, interobserver agreement was analyzed using the kappa and weighted-kappa statistics., Results: The volume CT dose-indexes in LDCT and SDCT were 3.0 ± 0.6 mGy and 8.4 ± 2.9 mGy, respectively. LDCT with DLIR-H showed the highest overall image quality, the lowest noise, and the highest CNR. The PCL conspicuity in LDCT with either DLIR-M or DLIR-H was not significantly different from that in SDCT with ASIR-V. Other findings depicting PCLs also revealed no significant differences between LDCT with DLIR and SDCT with ASIR-V. Moreover, the results revealed good or excellent interobserver agreement., Conclusion: LDCT with DLIR has a comparable performance with SDCT for the follow-up of incidentally detected PCLs., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: To estimate the prevalence of incidental pancreatic cysts (IPCs) in asymptomatic patients addressed to magnetic resonance cholangiopancreatography (MRCP), and to correlate it with clinical and imaging features., Materials and Methods: Magnetic resonance cholangiopancreatography performed over 26-months on 152 patients with unsuspected/unknown pancreatic disease were reviewed to assess IPCs' features of presentation. Multivariate analysis was performed to evaluate the correlation of IPCs with clinical information and type of pancreaticobiliary findings at MRCP., Results: Prevalence of IPCs was 44.7%. Cysts sized 3-24 mm (mean, 6.08 mm), and were ≤4 in number in 83.8% of patients. Based on number, dimensions and relation with the main pancreatic duct, IPCs presented with intraductal-papillary-mucinous neoplasm (IPMN)-like or indeterminate patterns in 31.7% and 13.1% of patients, respectively. At follow-up on 24 patients, no evolution was found, except in one patient with proven IPMN showing increase in cysts number and dimensions (evolution rate of 4.1%). Features correlating with IPCs were age ≥60 years old, and history of autoimmune hepatobiliary disease, showing odds ratios of 5.95 (95% CI 2.77-12.79) and 0.13 (95% CI 0.04-0.44), respectively., Conclusions: Incidental pancreatic cysts represent a frequent finding at MRCP, correlating positively with increasing age, and negatively with biliary autoimmune disease. Cysts more frequently present with IPMN-like pattern.

Context: The increasing frequency of incidental pancreatic cysts at imaging is a challenging topic due to the uncertainty of the aggressiveness of these lesions, especially small ones. To date, no data exist about their prevalence in a population of liver-transplanted patients., Objective: To determine the prevalence of incidental pancreatic cysts in liver-transplanted patients using magnetic resonance cholangiopancreatography., Design: A retrospective, single center case series., Setting: A tertiary referral centre. Interventions and patients Seventy-two examinations were performed over a two-year period in 47 liver-transplanted patients suspected for biliary complications., Main Outcome Measures: Prevalence of incidental pancreatic cysts; proportion of cyst evolution over time; association of cysts with clinical and imaging features., Results: The prevalence of pancreatic cysts was 59.6%. Analysis showed a mean diameter of 5.4 mm and the presence of 1-3 cysts in 78.6% of patients (22/28). Communication with the main pancreatic duct was identified for 28 relatively larger cysts (up to 14 mm) in 14 subjects. An "intraductal papillary mucinous neoplasia-like pattern" was observed in 12 patients with cysts, based on the number of cysts, dimensions, and distribution. Out of the 15 patients who underwent additional MRCPs to monitor biliary findings, only one patient with proven intraductal papillary mucinous neoplasia showed modification of the cysts at follow-up. Among the evaluated pre- or post-transplantation factors (sex, age, etiology of cirrhosis, pre-transplant hepatocarcinoma, pancreatic abnormalities other than cysts, type of pancreaticobiliary channel/biliary anastomosis, presence of biliary complications, lithiasic biliary complications, transplant-examination interval), only the alcoholic etiology of cirrhosis was associated with the prevalence of pancreatic cysts (P=0.006)., Conclusions: Incidental pancreatic cysts are frequent in liver-transplanted patients. Clinical significance, relation to transplant, impact on patient management before and after transplant are still under debate and a matter for further investigation.

Objectives: The management of incidentally discovered pancreatic cystic lesions (PCLs) with surveillance or resection often requires shared decision-making. Patients with cirrhosis are more likely to have PCLs discovered due to increased imaging, and those undergoing liver transplantations (LTs) may be at increased risk of carcinogenesis due to immunosuppressive medications. Our study aimed to characterize the outcomes and risk of malignant progression of PCLs in post-LT patients., Methods: Multiple databases were searched for studies looking at PCLs in post-LT patients from inception until February 2022. Primary outcomes were the incidence of PCLs in LT recipients and progression to malignancy. Secondary outcomes included development of worrisome features, outcomes of surgical resection for progression, and change in size., Results: A total of 12 studies with 17,862 patients with 1411 PCLs were included. The pooled proportion of new PCL development in post-LT patients was 68% (95% confidence interval [CI], 42-86; I2 = 94%) over the follow-up of 3.7 (standard deviation, 1.5) years. The pooled progression of malignancy and worrisome features was 1% (95% CI, 0-2; I2 = 0%) and 4% (95% CI, 1-11; I2 = 89%), respectively., Conclusions: Compared with nontransplant patients, incidental PCLs do not carry a higher risk of malignancy., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Incidental premalignant pancreatic cystic lesions (pPCLs) are increasingly being detected in patients undergoing orthotopic liver transplantation (OLT). The impact of chronic immunosuppression upon pPCLs may elevate risk of progression to pancreatic cancer. This systematic review assesses prevalence, outcome, and management of pPCLs in patients undergoing OLT. Systematic literature searches were performed in accordance with Cochrane review guidelines. Data on 658 patients were identified from 13 articles. Median age was 59 years with a prevalence of 6.2%. Most studies focused on branch-duct intraductal papillary mucinous neoplasms. Average cyst size at diagnosis was 10.3 mm. Six patients (0.9%) underwent pancreatic resection, post-OLT, for suspected "worrisome features" on imaging. One death was due to pancreatic-related cancer, post-OLT. Based on the review, the authors suggest the following: (1) patients with pPCLs undergoing OLT, without "worrisome features," should be followed conservatively; (2) presence of pPCLs alone should not preclude eligibility for OLT, nor should chronic immunosuppression be altered; (3) follow-up should parallel standard approach applied in immunocompetent patients, as development of "worrisome features" of cancer is rare and does not appear to be hastened by immunosuppression; (4) resection is recommended for surgically fit patients without portal hypertension that develop "worrisome features.", Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Cystic pancreatic lesions (CPLs) are common and increasingly encountered in clinical radiology practice. The appropriate imaging surveillance strategy for lower-risk CPLs (branch duct-intraductal papillary mucinous neoplasms and indeterminant small cystic lesions) has been a topic of intense study and debate in recent years. MRI is considered the investigation of choice for initial characterisation and follow-up of CPLs. Follow-up intervals for CPLs vary from 6 months to 2 years and surveillance may be lifelong or until the patient is no longer considered fit for potential surgical intervention. This creates a significant burden on MRI resources as a standard protocol pancreatic MRI may have an acquisition time of up to 35-50 min. However, the necessity of contrast-enhanced sequences and diffusion weighted imaging (DWI) for routine follow-up of CPLs has been questioned in recent years., Methods: We reviewed the available evidence to determine whether an abbreviated MRI (A-MRI) protocol may be safely adopted for surveillance of CPLs, as has been implemented in other clinical scenarios., Results: A number of recent retrospective studies have indicated that an A-MRI, omitting contrast-enhanced and DWI, may be used for CPL surveillance without any suspicious features or cases of malignancy being missed. Although small number of cases may need to be recalled for additional MR sequences based on the A-MRI findings, there is still a significant overall timesaving., Conclusion: The best available evidence currently suggests that an A-MRI protocol should be considered for routine surveillance of CPLs. Prospective studies are required to ensure the findings reported in these retrospective case studies are backed up in ongoing clinical practice.

Background and Aim: Incidental pancreatic cystic lesions (PCLs) are being diagnosed more frequently. However, little is known about the prevalence of PCLs in the Chinese population. The aim of the study was to assess the crude prevalence of PCLs in individuals who underwent magnetic resonance imaging (MRI)., Methods: Data from consecutive patients who underwent MRI without pancreatic indications were included. MRI images were reviewed for the presence of pancreatic cysts. The prevalence of PCLs and high-risk PCLs in different gender and age groups was calculated. To assess the crude prevalence, the prevalence and demographic data were standardized on the basis of Chinese national population data in 2017., Results: A total of 10 987 individuals were included (7344 men). Incidental PCLs were identified in 212 individual (128 men). The prevalence of PCLs was 1.93%, and PCLs were more often discovered in women (1.74% vs 2.31%, P = 0.043). Prevalence increased with age (r = 0.804, P < 0.001). The prevalence of high-risk PCLs was 0.12% (n = 13). Gender predominance and age distribution showed no difference between high-risk PCLs and low-risk PCLs (P = 0.234 and P = 0.855), but cysts located in the pancreatic head were more likely to develop into high-risk PCLs (P = 0.001). After data standardization, the crude prevalence of PCLs was 1.31%, and PCLs were more often discovered in women (1.11% vs 1.5%, P < 0.001). The crude prevalence of high-risk PCLs was 0.07%., Conclusion: Pancreatic cystic lesions in the Chinese population are not rare. The prevalence of PCLs increased with age and is higher in the female population. The prevalence of high-risk PCLs should not be ignored., (© 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

The prevalence of pancreatic cysts has increased significantly over the last decade, partly secondary to increased quality and frequency of cross-sectional imaging. While the majority never progress to cancer, a small number will and need to be followed. The management of pancreatic cysts can be both confusing and intimidating due to the multiple guidelines with varying recommendations. Despite the differences in the specifics of the guidelines, they all agree on several high-risk features that should get the attention of any clinician when assessing a pancreatic cyst: presence of a mural nodule or solid component, dilation of the main pancreatic duct (or presence of main duct intraductal papillary mucinous neoplasm), pancreatic cyst size ⩾3–4 cm, or positive cytology on pancreatic cyst fluid aspiration. Other important criteria to consider include rapid cyst growth (⩾5 mm/year), elevated serum carbohydrate antigen 19-9 levels, new-onset diabetes mellitus, or acute pancreatitis thought to be related to the cystic lesion. [ABSTRACT FROM AUTHOR]

Objective: Asymptomatic pancreatic cysts are frequently diagnosed on cross-sectional imaging. Recently, the American Gastroenterological Association (AGA) has put forth guidelines regarding management of these cysts. To date, there is no strong data to indicate whether these guidelines will accurately identify malignancy and mitigate unnecessary endoscopic ultrasound (EUS) procedures. The aim of this investigation was to apply the 2015 AGA guidelines to a retrospective cohort of asymptomatic pancreatic cysts in a large regional referral center. Materials and Methods: This is a retrospective cohort study of patients with asymptomatic pancreatic cysts who underwent EUS with fine-needle aspiration (FNA) over a 3-year period. We applied current AGA guidelines to determine how many EUS procedures would be avoided, and further assessed whether the guidelines adequately identified cases of malignancy. Results: Forty-five patients were identified who underwent EUS FNA for an asymptomatic pancreatic cyst from 2011 to 2014. The mean age was 65 years, and the mean size cyst size was 2.8 cm. According to the 2015 AGA guidelines, EUS was indicated in 13 of the 45 patients and surveillance imaging in the remaining 32 patients. 3 of these 32 patients had atypical cytology on EUS FNA, and final histology showed adenocarcinoma in 2 patients and IMPN with high-grade dysplasia in 1 patient. Conclusion: Applying AGA guidelines in this study cohort would have prevented 32 out of 45 (71%) EUS procedures; however, 3 of these 32 patients had early occult malignancy. This data suggest that additional strategies are needed to identify those patients at high risk. [ABSTRACT FROM AUTHOR]

Background: Pancreatic cysts are related to the presence of ductal adenocarcinomas elsewhere in the pancreas, and are also associated with an increased risk of pancreatic adenocarcinoma in the future. Most of the previous studies that investigated the prevalence of pancreatic cysts focused on patients within a hospital or out-patient setting, which may not be representative of the general population. We investigated the prevalence and predictive factors for the presence of pancreatic cysts within a large number of subjects via general health examination.Methods: Between December 2007 and December 2013, a total of 5198 subjects were enrolled that underwent ultrasonography (US) on general health examination. We established a scoring system for predicting the presence of one or more pancreatic cysts using a split-sample method.Results: Among the enrolled subjects, the prevalence of a pancreatic cyst was 3.5 %. In multivariate analysis, the prevalence was significantly increased with older age, female sex, and the presence of gall bladder adenomyomatosis (GB-ADM). Based on multivariate analysis in the training sample (n = 2,599), we established the scoring system consisting of age, sex, and the presence of GB-ADM to predict the presence of pancreatic cysts. This scoring system was validated in the testing sample (n = 2,599) and produced an area under the curve of 0.711.Conclusions: The prevalence of pancreatic cyst detected by US was 3.5 % in the general population, and increased with age, female sex, and the presence of GB-ADM. A new scoring system developed in the present study may help to identify better candidates for further examination when the pancreas is not visible by US. [ABSTRACT FROM AUTHOR]