Massachusetts General Hospital

Imaging in the CIST Center The Cyst Imaging Surveillance and Treatment (CIST) Center provides state-of-the-art imaging services for diagnosis and surveillance of pancreatic cystic lesions. Click the image on the left to watch a video illustrating one of our imaging technologies.

Magnetic resonance cholangiopancreatography

At MGH, the preferred imaging test for pancreatic cystic lesions is magnetic resonance cholangiopancreatography (MRCP). Advanced MRI techniques are used to obtained high resolution, 3-dimensional images of the pancreas and cystic lesions. The images are used to calculate the precise diameters and volume of cystic lesions. Growth of the cystic lesions is calculated over time. The presence of abnormal growths in the wall of cysts (mural nodules) is noted, along with other findings such as dilated pancreatic ducts.

MRCP demonstrating multiple side branch IPMNs (intraductal papillary mucinous neoplasms)		MRCP with a solitary cyst involving the pancreatic duct

MRCP showing main duct IPMN; note dilated main pancreatic duct with irregular mucosal border

Endoscopic ultrasound

Endoscopic ultrasound (EUS) provides high-resolution images of pancreatic cystic lesions and guides fine needle aspiration. At MGH, EUS has proven to be a strong tool for the evaluation of mural nodules and masses, and collection of cyst fluid. One of the most accurate markers for mucinous cysts, carcinoembryonic antigen (CEA), was developed at MGH in a large multi-center trial. Other markers of mucinous cysts and malignancy based on DNA mutations are being pioneered in the MGH Molecular Pathology Laboratory.

In selected patients, endoscopic ultrasound is used to aspirate pancreatic cysts. The aspirated fluid is analyzed for cytology (imaging of cells), tumor markers (CEA), and DNA markers of malignancy. KRAS is the most commonly used DNA marker and helps define the presence of a mucinous cyst. Advanced DNA analysis is performed in the MGH Molecular Pathology Laboratory, which has established itself as an important new resource for diagnostic studies in genetic mutations.

Endoscopic ultrasound image of an IPMN with mucin floating within the cyst		Endoscopic ultrasound showing a grossly malignant IPMN with a mass growing within the cyst and filling the lumen with malignancy