Common cystic pancreatic neoplasms: A comprehensive magnetic resonance imaging-based review of typical and atypical imaging features

Pancreatic cystic neoplasms are being identified with increasing frequency, largely because high-resolution cross-sectional imaging is now routinely performed in a wide variety of clinical settings. Among available imaging techniques, magnetic resonance imaging (MRI), especially when combined with magnetic resonance cholangiopancreatography, plays a central role in lesion characterization thanks to its excellent soft-tissue contrast and detailed evaluation of the pancreatic ductal system. The most common pancreatic cystic neoplasms include intraductal papillary mucinous neoplasms, serous cystic neoplasms, mucinous cystic neoplasms, and solid pseudopapillary neoplasms, which together account for the majority of cystic pancreatic tumors. Many of these lesions are detected incidentally during imaging examinations performed for unrelated indications, creating an increasingly common diagnostic challenge in routine radiological practice. This review summarizes both typical and atypical MRI findings of the most common cystic pancreatic neoplasms, with particular attention to imaging features that may support differential diagnosis and influence clinical management. In particular, MRI and magnetic resonance cholangiopancreatography are essential for evaluating lesion morphology, intracystic components, and communication with the pancreatic ductal system, all of which are important for lesion characterization and risk stratification. Familiarity with the broad spectrum of MRI appearances is crucial for radiologists in order to improve diagnostic accuracy, recognize atypical presentations, and guide appropriate patient management.