Preliminary Diagnosis: Pancreatic Pseudocyst

I. What imaging technique is first-line for this diagnosis?

  • CT scan of the abdomen and pelvis with oral and intravenous contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of pancreatic pseudocyst.

Advantages

  • Highly sensitive and specific in detecting a primary abnormality, such as a pseudocyst, and detecting and characterizing any secondary complications

  • May help guide treatment and therapy

  • Offers exquisite detail of the surrounding anatomical structures

Disadvantages

  • Exposes patients to ionizing radiation.

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

  • MR of the abdomen and pelvis with IV contrast

  • Ultrasound

  • Endoscopic retrograde cholangiopancreatography (ERCP)

  • Magnetic resonance cholangiopancreatography (MRCP)

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of pancreatic pseudocyst.

MR of the abdomen and pelvis with IV contrast
Advantages

  • Does not expose patients to ionizing radiation

  • Offers exquisite detail of the surrounding soft tissues and helps characterize the extent of soft tissue invasion and extension

  • More sensitive and specific in characterizing the internal pseudocyst fluid content than CT

Disadvantages

  • Offers poor evaluation of the surrounding vascular and soft tissues

  • Less adept in guiding treatment

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize artifact

Ultrasound
Advantages

  • Highly portable imaging modality

  • May help guide percutaneous treatment and therapy

  • Offers exquisite visualization of any surrounding vascularity

Disadvantages

  • Less adept in detailing the surrounding anatomical structures

ERCP
Advantages

  • Offers the opportunity for diagnostic evaluation and therapeutic treatment simultaneously

  • May provide better anatomical detail of the pancreatic process and surrounding soft tissues than other imaging modalities

Disadvantages

  • Invasive procedure associated with greater morbidity and mortality

MRCP
Advantages

  • Offers exquisite anatomical detail of the intrahepatic and extrahepatic biliary tree and pancreatic ducts

  • Does not expose patients to ionizing radiation

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize artifact

VI. What are the contraindications for the alternative imaging techniques?

MR of the abdomen and pelvis with IV contrast

  • Contraindicated in patients with non–MR-compatible hardware

Ultrasound

  • No specific contraindications exist

ERCP

  • Contraindicated in patients with a severe hypocoagulable state

MRCP

  • Contraindicated in patients with non–MR-compatible hardware

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