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Incidental Pancreatic Cyst (ACR)

Fill the fields; Findings, Impression, and the ACR surveillance Recommendation (Megibow et al., JACR 2017) generate below for copy/paste.

Applies only to incidentally detected cysts in asymptomatic adults (≥18 y). All incidental cysts are presumed mucinous unless an alternative histology (e.g. SCA) is proven. Cysts are measured as the single greatest long-axis diameter. Growth = a 20% increase in long-axis diameter (for cysts ≥1.5 cm). Surveillance generally runs 9–10 years and stops at age 80.

Encodes the ACR incidental pancreatic cyst algorithm (Megibow et al., JACR 2017, Figs 1–4). Recommendations, not standard of care: deviate as the imaging and patient warrant.

Patient & main lesion

largest lesion

Asymptomatic adult?

Age (years)

Location

Series / image #

Size (cm, long axis)

Morphology

Communication with pancreatic duct

Main pancreatic duct caliber (mm)

Change from prior

Worrisome features

size & duct caliber auto-flag from above

Cyst ≥3 cm Thickened / enhancing cyst wall Non-enhancing mural nodule Main PD caliber 7–9 mm

High-risk stigmata

Obstructive jaundice with cyst in pancreatic head Enhancing solid component Main PD caliber ≥10 mm (no obstruction)

Other lesions

Findings

Impression

Recommendation

Enter symptom status, age, and size to generate the recommendation.

Algorithm notes & source

High-risk stigmata / worrisome features (Table 1)

Worrisome features: cyst ≥3 cm; thickened or enhancing cyst wall; nonenhanced mural nodule; MPD 5–9 mm (the paper recommends a simple 7-mm threshold). High-risk stigmata: extrahepatic biliary obstruction from a pancreatic-head cyst; enhanced solid component; MPD ≥10 mm. Any of these (per the chart footnotes: mural nodule, wall thickening, MPD ≥7 mm, enhancing solid component, or biliary obstruction/jaundice) prompts immediate EUS/FNA and surgical evaluation, regardless of size or growth.

Size thresholds & charts

Chart 1: <1.5 cm (age-stratified <65 vs 65–79). Chart 2A: 1.5–2.5 cm with established MPD communication (BD-IPMN). Chart 2B: 1.5–2.5 cm without established MPD communication. Chart 3: >2.5 cm. Chart 4: patients ≥80 y at presentation. Follow-up imaging uses contrast-enhanced MRI or pancreas-protocol CT.

Scope

Excludes symptomatic patients and those with related signs/symptoms or abnormal labs (e.g. jaundice, weight loss, elevated amylase) — these warrant surgical/clinical consultation outside the algorithm. EUS/FNA at detection is an acceptable alternative to imaging follow-up throughout.

Megibow AJ, Baker ME, Morgan DE, et al. Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2017;14:911–923. Charts 1–4 (Figs 1–4) and Table 1.