GASTROINTESTINAL Mucinous cystic neoplasms and serous cystadenomas arising in the body-tail of the pancreas: MR imaging characterization Riccardo Manfredi & Anna Ventriglia & William Mantovani & Sara Mehrabi & Enrico Boninsegna & Giuseppe Zamboni & Roberto Salvia & Roberto Pozzi Mucelli Received: 26 March 2014 /Revised: 10 October 2014 /Accepted: 10 November 2014 # European Society of Radiology 2014 Abstract Purpose To identify magnetic resonance (MR)/MR cholangiopancreatography (MRCP) imaging signs helpful in the differential diagnosis between serous cystadenomas (SCAs) and mucinous cystic neoplasms (MCNs), arising from the body/tail of the pancreas. Material and methods This retrospective study had institu- tional review board approval and informed consent was waived. Fifty-three patients with non-communicating cystic pancreatic neoplasm of the body/tail, undergoing MR/MRCP, were included. Qualitative image analysis assessed the mac- roscopic pattern, number of cysts, presence of central scar, contrast enhancement of peripheral wall, and mural nodules. Quantitative analysis assessed the maximum diameter of the neoplasm, thickness of the peripheral wall, and calibre of the upstream main pancreatic duct. Results Histopathology results revealed that 27/53 (51 %) were SCAs, 26/53 (49 %) were MCNs. Microcystic pattern was observed in 88.2 % of SCAs and 11.8 % of MCNs; macrocystic pattern was observed in 90.5 % of MCNs and 9.5 % of SCAs (p <0.0001). Central scar was detected in 29.6 % of SCAs and no MCNs (p =0.003). Contrast enhancement of the peripheral wall was evident in 99.5 % of MCNs and 11.5 % of SCAs (p <0.0001); mural nodules were depicted in 94.1 % of MCNs and 5.9 % of SCAs (p <0.0001). Median maximum diameter was 54 mm for MCNs, 32 mm for SCAs (p =0.001); median wall thickness was 4 mm for MCNs, 2 mm for SCAs (p <0.0001). Conclusions Macrocystic pattern, enhancement of a periph- eral wall and mural nodules are suggestive of MCNs; whereas microcystic pattern, lack of peripheral wall and central scar are suggestive of SCAs. Key Points • MCNs have macrocystic patterns, contrast enhancement of the peripheral wall and mural nodules • Microcystic pattern and central scar are suggestive of SCA • Mural nodules detected in MCNs correlate with epithelial dysplasia • Chronic obstructive pancreatitis is equally depicted in pa- tients with MCNs and SCAs Keywords Pancreas, cystic neoplasm . Pancreas, MR . Pancreatic ducts . Main pancreatic duct, MR . Obstructive chronic pancreatitis, MR Introduction Cystic neoplasms occurring in the pancreas are frequently asymptomatic and incidentally discovered by means of diag- nostic imaging [1–5]. These neoplasms show a different bio- logical behaviour and treatment; therefore lesion characteriza- tion represents a medical need in patient management. In this settings, non-operative histological diagnosis is inaccurate in approximately 25 % of the cases [6], and because of this limitation, diagnostic imaging plays a major role in this task. R. Manfredi (*) : A. Ventriglia : S. Mehrabi : E. Boninsegna : R. Pozzi Mucelli Department of Radiology, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy e-mail: riccardo.manfredi@univr.it W. Mantovani Department of Public Health and Prevention, Provincial Health Services, A. Degasperi 79, 38123 Trento, Italy G. Zamboni Department of Pathology, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy R. Salvia Department of Surgery, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy Eur Radiol DOI 10.1007/s00330-014-3493-2