[Cystic lesions of the pancreas]

Due to the widespread use of computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen, the incidence of cystic pancreatic lesions as an incidental finding in asymptomatic patients is increasing; however, most of these lesions are less than 2 cm in size at the time of diagnosis making a correct classification difficult. A more differentiated understanding of the pathophysiology of these lesions has been developed during recent years. Technical improvements in imaging techniques have resulted in an increase in image resolution and has enabled radiologists to differentiate between intraductal papillary mucinous neoplasms (IPMN), serous cystic neoplasms (SCN) and mucinous cystic neoplasms (MCN). A correct classification, including the differentiation from malignant pancreatic tumors, can only be achieved by combining the knowledge of lesion pathophysiology and basic epidemiological data, such as age and sex distribution with modern imaging techniques. In conjunction with the correct diagnosis, the radiologist has to decide on the further management of the newly found lesion. This differs greatly depending on the biological behavior, especially the potential for malignant transformation, e.g. in main duct IPMN. This review gives an overview of the different cystic pancreatic lesions, their underlying pathophysiology and imaging characteristics along with recommendations for the further clinical management.