The edition · Radiology
Pancreatic IPMN: MRI-led surveillance, and a case for stopping it in stable older patients
A Danish consensus sets size thresholds for surgical review and supports ending surveillance in selected patients. Plus AI risk classes on prostate MRI, spectral CT for intrapancreatic spleen, and breast imaging in pregnancy.
The edition in brief
Today's radiology edition ends on incidental pancreatic cysts. Danish multidisciplinary consensus recommendations (Acta Radiologica, 1 September) make MRI with MRCP the primary modality for diagnosing and following intraductal papillary mucinous neoplasms, use CT and endoscopic ultrasound selectively, refer cysts over 30 mm and main-duct or mixed-type lesions with high-risk features for surgical evaluation, and support stopping surveillance in selected patients with stable disease, especially older ones. International guidelines still differ on these points. A multicentre study of 787 men found a commercial AI risk classification on prostate MRI non-inferior to PI-RADS for patient-level sensitivity (97.6% vs 92.6%) but not lesion-level sensitivity (78.8% vs 88.8%); in PI-RADS 3 lesions it could support biopsy triage. A retrospective study of 85 patients found spectral CT from a single portal-venous phase raised radiologists' accuracy in separating intrapancreatic accessory spleen from hypervascular tumours from 60.7% to 88.1%. A RadioGraphics review sets out imaging in pregnant and lactating patients: mammography is safe but less sensitive, ultrasound is first for symptoms, and MRI is avoided in pregnancy but usable in lactation. The pearl is that breastfeeding need not stop after contrast.
AI risk classes on prostate MRI matched PI-RADS per patient but missed more lesions
Use AI risk classification on prostate MRI as support for PI-RADS 3 biopsy decisions, not as a replacement for lesion-by-lesion reading.
Breast imaging in pregnancy and lactation: ultrasound first for symptoms, MRI only after delivery
Investigate breast symptoms in pregnancy and lactation promptly with ultrasound first, and keep high-risk screening going during lactation.
Spectral CT separated intrapancreatic accessory spleen from tumour on a single phase
If spectral data exist, use iodine and effective atomic number maps to test whether a hypervascular pancreatic tail lesion behaves like spleen.
Breastfeeding does not need to stop after contrast
Tell breastfeeding mothers they can keep feeding after iodinated or gadolinium contrast.
IPMN surveillance: MRI-led, size-based, and stoppable in stable older patients
Follow IPMNs with MRI/MRCP, refer the high-risk ones for surgical review, and raise stopping surveillance for stable cysts in older patients.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for radiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free