Radiological technologies in the diagnosis of pancreatic cystic neoplasms: а review

Introduction: The frequency of detecting pancreatic cystic lesions (PCLs) has been increasing in recent years. Pancreatic cystic lesions represent a diverse group of changes with varying potential for malignancy. Despite advances in precision, modern diagnostic methods still require development and improvement for accurate identification, differentiation, and assessment of malignancy risk.

Objective: To clarify the diagnostic accuracy of various radiological methods in the detection and differentiation of pancreatic cystic lesions, as well as to assess their limitations based on an analysis of international literature data.

Materials and Methods: A search for scientific publications was conducted in the Google Scholar information-analytical system for the period 2009–2024 using the following keywords: «pancreatic cystic lesion», «pancreatic cystadenoma», «intraductal papillary mucinous neoplasm», «perfusion computed tomography of the pancreas», and «pancreatic radiomics». 44 publications were selected for analysis.

Results: Advanced diagnostic methods have increased the potential accuracy in assessing pancreatic cystic lesions, but differentiating their subtypes and detecting signs of malignancy remain challenging tasks. Existing clinical guidelines are characterized by variability and inconsistency regarding diagnosis and monitoring, highlighting the need for standardizing approaches to managing patients with pancreatic cystic lesions and the implementation of new diagnostic methods.

Discussion: Analysis of the available literature demonstrates that the similarity of radiological features among pancreatic cystic neoplasms complicates their accurate differentiation. Conventional imaging methods and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) are limited by low reproducibility of morphological criteria and insufficient cytological material, particularly in small cysts, highlighting the need for the implementation of novel diagnostic approaches. Quantitative imaging methods capable of assessing tissue characteristics and microcirculation, including dual-energy and perfusion CT, as well as radiomics, which enables statistical analysis of texture features and improves the accuracy of preoperative diagnosis, appear particularly promising.

Conclusion: The integration of quantitative imaging methods, including radiomics, may enhance the accuracy of characterizing pancreatic cystic lesions and facilitate the selection of optimal patient management strategies, especially in cases with a high risk of malignancy and recurrence. Further studies on large cohort populations are required to standardize the implementation of these technologies in clinical practice.

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