The utilization of imaging features in the management of intraductal papillary mucinous neoplasms

Intraductal papillary mucinous neoplasms (IPMNs) represent a group of cystic pancreatic neoplasms with large range of clinicalbehaviours, ranging from low-grade dysplasia or borderline lesions to invasive carcinomas. They can be grouped into lesionsoriginating from the main pancreatic duct, main duct IPMNs (MD-IPMNs), and lesions which arise from secondary branchesof parenchyma, denominated branch-duct IPMNs (BD-IPMNs).Management of these cystic lesions is essentially based on clinicaland radiological features.The latter have been very well described in the last fifteen years, with many studies published in literatureshowing the main radiological features of IPMNs. Currently, the goal of imaging modalities is to identify “high-risk stigmata” or“worrisome feature” in the evaluation of pancreatic cysts. Marked dilatation of the main duct (>1 cm), large size (3–5 cm), andintramural nodules have been associated with increased risk of degeneration. BD-IPMNs could be observed as microcystic ormacrocystic in appearance, with or without communication withmain duct. Their imaging features are frequently overlapped withcystic neoplasms. The risk of progression for secondary IPMNs is lower, and subsequently an imaging based follow-up is very oftenproposed for these lesions.