Pancreatic MRI — Cystic Lesions, Tumours & the Duct

Pancreatic MRI

Between soft-tissue contrast and a built-in duct map (MRCP), MRI is the problem-solver for the pancreas — especially the increasingly common incidental cyst.

Cystic lesions

Incidental pancreatic cysts are frequent, and the key job is risk-stratifying them. MRI/MRCP characterises the lesion and its communication with the pancreatic duct — central to diagnosing intraductal papillary mucinous neoplasm (IPMN) — and looks for worrying features (mural nodules, main-duct dilatation, size).

Duct communication + no worrisome features points to a branch-duct IPMN suitable for surveillance; high-risk features prompt referral.

Solid tumours

Adenocarcinoma: a hypoenhancing mass with upstream duct dilatation; MRI helps detect small tumours and assess vascular involvement for resectability (with CT).
Neuroendocrine tumours: typically hypervascular; MRI with DWI aids detection and characterisation.
Autoimmune pancreatitis: a mass-forming mimic MRI can suggest.

Duct & inflammation

MRCP maps the duct in chronic pancreatitis (side-branch changes, strictures, stones) and after acute pancreatitis for complications. Secretin-enhanced MRCP can improve duct visualisation and assess exocrine drainage.

Reference: European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018;67:789–804.

Educational summary for clinicians; management is multidisciplinary. Not medical advice.