Incidental pancreatic cysts: a frequent finding in liver-transplanted patients as assessed by 3D T2-weighted turbo spin echo magnetic resonance cholangiopancreatography

CONTEXT: The increasing frequency of incidental pancreatic cysts at imaging is a challenging topic due to the uncertainty of the aggressiveness of these lesions, especially small ones. To date, no data exist about their prevalence in a population of liver-transplanted patients. OBJECTIVE: To determine the prevalence of incidental pancreatic cysts in liver-transplanted patients using magnetic resonance cholangiopancreatography. DESIGN: A retrospective, single center case series. SETTING: A tertiary referral centre. Interventions and patients Seventy-two examinations were performed over a two-year period in 47 liver-transplanted patients suspected for biliary complications. MAIN OUTCOME MEASURES: Prevalence of incidental pancreatic cysts; proportion of cyst evolution over time; association of cysts with clinical and imaging features. RESULTS: The prevalence of pancreatic cysts was 59.6%. Analysis showed a mean diameter of 5.4 mm and the presence of 1-3 cysts in 78.6% of patients (22/28). Communication with the main pancreatic duct was identified for 28 relatively larger cysts (up to 14 mm) in 14 subjects. An "intraductal papillary mucinous neoplasia-like pattern" was observed in 12 patients with cysts, based on the number of cysts, dimensions, and distribution. Out of the 15 patients who underwent additional MRCPs to monitor biliary findings, only one patient with proven intraductal papillary mucinous neoplasia showed modification of the cysts at follow-up. Among the evaluated pre- or post-transplantation factors (sex, age, etiology of cirrhosis, pre-transplant hepatocarcinoma, pancreatic abnormalities other than cysts, type of pancreaticobiliary channel/biliary anastomosis, presence of biliary complications, lithiasic biliary complications, transplant-examination interval), only the alcoholic etiology of cirrhosis was associated with the prevalence of pancreatic cysts (P=0.006). CONCLUSIONS: Incidental pancreatic cysts are frequent in liver-transplanted patients. Clinical significance, relation to transplant, impact on patient management before and after transplant are still under debate and a matter for further investigation.