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World J Radiol. Nov 28, 2015; 7(11): 361-374
Published online Nov 28, 2015. doi: 10.4329/wjr.v7.i11.361
Role of magnetic resonance imaging in the detection and characterization of solid pancreatic nodules: An update
Najwa Al Ansari, Miguel Ramalho, Richard C Semelka, Valeria Buonocore, Silvia Gigli, Francesca Maccioni
Najwa Al Ansari, Valeria Buonocore, Silvia Gigli, Francesca Maccioni, Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I Hospital Rome, Sapienza University of Rome, 00161 Rome, Italy
Miguel Ramalho, Department of Radiology, Hospital Garcia de Orta, 2801-951 Almada, Portugal
Miguel Ramalho, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
Author contributions: All authors had contributed equally to this work in form of literature review, manuscript writing/editing, and figure collection/illustration/annotation/captioning.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other co-authors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Richard C Semelka, MD, Professor, Department of Radiology, University of North Carolina, UNC at Chapel Hill CB 7510 - 2001 Old Clinic Bldg., Chapel Hill, NC 27599-7510, United States. richsem@med.unc.edu
Telephone: +1-919-9669676 Fax: +1-919-8437147
Received: April 27, 2015
Peer-review started: April 28, 2015
First decision: August 4, 2015
Revised: September 8, 2015
Accepted: October 1, 2015
Article in press: October 8, 2015
Published online: November 28, 2015
Processing time: 217 Days and 11.1 Hours
Abstract

Pancreatic ductal adenocarcinoma is the most common malignant tumor of the pancreas. The remaining pancreatic tumors are a diverse group of pancreatic neoplasms that comprises cystic pancreatic neoplasms, endocrine tumors and other uncommon pancreatic tumors. Due to the excellent soft tissue contrast resolution, magnetic resonance imaging (MRI) is frequently able to readily separate cystic from noncystic tumors. Cystic tumors are often easy to diagnose with MRI; however, noncystic non-adenocarcinoma tumors may show a wide spectrum of imaging features, which can potentially mimic ductal adenocarcinoma. MRI is a reliable technique for the characterization of pancreatic lesions. The implementation of novel motion-resistant pulse sequences and respiratory gating techniques, as well as the recognized benefits of MR cholangiopancreatography, make MRI a very accurate examination for the evaluation of pancreatic masses. MRI has the distinctive ability of non-invasive assessment of the pancreatic ducts, pancreatic parenchyma, neighbouring soft tissues, and vascular network in one examination. MRI can identify different characteristics of various solid pancreatic lesions, potentially allowing the differentiation of adenocarcinoma from other benign and malignant entities. In this review we describe the MRI protocols and MRI characteristics of various solid pancreatic lesions. Recognition of these characteristics may establish the right diagnosis or at least narrow the differential diagnosis, thus avoiding unnecessary tests or procedures and permitting better management.

Keywords: Pancreatic nodules; Malignant; Lymphoma; Benign; Magnetic resonance imaging; Adenocarcinoma; Pancreas; Neuroendocrine; Solid pseudopapillary tumor; Metastases

Core tip: In addition to pancreatic ductal adenocarcinoma other solid pancreatic lesions occur. Less common solid primary pancreatic tumors and non-neoplastic disease processes that may be diagnosed with relatively high specificity employing magnetic resonance imaging (MRI). The radiologist must be familiar with their MRI appearance to correctly diagnose them, or suggest them in the differential diagnosis when appropriate, since it may change substantially the approach, prognosis and patient management.