MRI MRCP - Cyst (IPMN) - Newbie

A side branch IPMN commonly abbreviated BD-IPMN for branch duct tend to be the benign form of this cystic neoplasm. They rarely become malignant whereas the main duct IPMN (MD-IPMN) has a higher tendency to go from pre-malignant to a malignant form. There is a protocol that is used for surveillance of IPMN’s. Generally IPMN’s are surveilled and watched for growth that could lead to ductal dilation, changes in shape or content and size. BD-IPMN’s are monitored and if the diameter reaches 3 cm regardless if benign, surgical intervention is used to prevent severe bouts of acute pancreatitis and the prevention of chronic pancreatitis which could result further into pancreatic cancer. MD-IPMN’s and one’s located where it is communicating closely between a branch duct and the main duct are more likely to have surgical intervention when they reach 1 cm because of their likelihood to transform into malignancy.

The next step for you is to meet with a surgical oncologist that specializes in IPMN’s and pancreas surgery. A surveillance schedule/frequency will be determined where a pancreas protocol CT or MRI is used to do the monitoring. In the majority of patients, IPMN’s remain stable and never cause problems. I was diagnosed with a likely BD-IPMN in the tail several years ago and it has remained at just under 8mm and causes no symptoms. My surveillance is done by an MRI pancreas protocol every 6 months since I had been diagnosed with pancreatic cancer over 10 years ago. So I get routine surveillance scans every six months to detect signs of reoccurrence and the IPMN status has been incorporated into the scan.

There is a National clinical study recruiting patients with IPMN’s. There are numerous sites around the USA in nearly every State and you may be interested in participating in the study. The following link describes the scope of the study, eligibility criteria and locations-

Good morning and thank you so much for replying. Your reply and experience is the most helpful information that I have read on these cyst.

I will look into this trial as well. I just finished a 6 month trial for Gulf War Illness.

Thank you and many years of continued health.

@chasenkw, did you hear back about the results of your recent magnetic resonance cholangiopancreatography (MRCP)? Any updates to share?

Happy Sunday and thanks for asking. I had my fillip this past Friday. He said it wasn’t a concern until it was 4x my current size of .6 cm, no monitoring or nothing. Not sure if I like that reply. A second opinion?

Meanwhile I await a biopsy result of a very deep aggressive and probable squamous cell carcinoma. Not sure I like getting older, 54 this week 😉

Thank you and everyone for all you do on this board.

I was already a six year survivor of metastatic pancreatic cancer when a 0.8mm IPMN was discovered by routine MRI surveillance in 2018. I was familiar with the guidelines for IPMN surveillance on size and location. Since mine was in the tail of the pancreas and not in a branch duct directly communicating with the main duct, the international guidelines were propose for surveillance. My concern was that I already had pancreatic cancer and I couldn't find anything specific to that scenario. So I sought additional opinions from three surgical oncologists at three ivy-league affiliated medical centers with pancreas programs. All consults were covered by insurance and I did not require referral or prior authorization for seeking additional opinions.

What resulted is six month surveillance scans for the foreseeable future. Since its discovery four years ago, no growth has been observed. The most recent scan indicated 0.7mm which is within the measurement margin of error and not necessarily shrinkage.

Hello @chasenkw,

I trust that by now you have heard from your doctor and that you have some idea as to what sort of follow-up will be needed to track the IPMN. I have had this diagnosis for a number of years, with little change in the cysts. I have a follow-up MRI every other year at this point.

Will you post again with updates?

Yesterday I had my MCRP. Sutter Hospital releases the results to the patient before the doctor has reviewed the same. I see that there are no obvious masses, but really do not understand the significance of the results. I also completed some lab work and have inquired about the ongoing platelet count. I thought I was well versed with regard to my condition; however, I have lost 25 lbs since March, continue to have chronic pain in my upper right quadrant as well as ongoing nausea and lack of appetite. I am not constipated, so unsure about that finding.
Thank you
Impression
IMPRESSION:
Mild intra and extrahepatic ductal dilatation is stable with no intraductal filling defects.
Mild dilatation of the main pancreatic duct 5 mm is stable as well with no intraductal lesions.
These ductal dilatation fibula to a stricture at the sphincter of Oddi, for example. No masses are identified.
Multiple tiny hepatic cysts are again seen.
No acute findings.
Moderate constipation suggested.

Narrative
PROCEDURE: MRI CHOLANGIOPANCREATOGRAM, 8/5/2022 2:16 PM
COMPARISON: April 2022 ultrasound abdomen, CT abdomen pelvis February 2021
TECHNIQUE: Multiplanar multiecho sequences performed without contrast using MRCP protocol.
CLINICAL INDICATION: Abdominal pain and abnormal US of the pancreatobiliary system.

FINDINGS:
No worrisome liver lesions are present with multiple tiny hepatic cysts identified. Mildly dilated common bile duct to 1.1 cm without intraductal filling defect and with normal distal tapering again seen. Mild dilatation of the central intrahepatic biliary ductal system is also stable. Main pancreatic duct is mildly dilated as well with maximum caliber of 5 mm. Normal gallbladder. Normal spleen. Normal adrenals. Normal kidneys. Moderate constipation suggested. No adenopathy. No free or focal fluid. Pelvis was not imaged.

Images
Scan
Component Results
There is no component information for this result.

Yes I will post again after hearing from my doctor this week. I have also located a doctor in San Francisco who is doing a study on those with my condition, and I intend to contact her. What I find most bothersome is that my doctor suggested that I get a second opinion, however no Sutter doctor in my area will provide me with one. I have never heard of a doctor telling a patient to get a second opinion as I thought it was the other way around. In any event, once I hear from the doctor I will provide an update. Mostly I am concerned with my weight loss and overall lack of energy, along with protein deficiency and malnutrition that were revealed during recent labs.

Hello @frances007

I'm so glad that you posted an update. Your doctor suggesting a second opinion should be very encouraging to you. Your doctor obviously knows their limits of experience and knowledge. I would not think of this as bothersome but find it very encouraging.

If you are not living in an area where you can get a second opinion, then going to a university medical center or a facility like Mayo Clinic is certainly in your best interests. The fact that you found a doctor in San Francisco who is studying this condition must be heartening. Do you have an appointment scheduled with this doctor?

Thank you very much for your reply, it is encouraging.
Regarding the doctor telling me to get a second opinion threw me off as I have not heard of a doctor suggesting the same. Since I cannot get a second opinion from Sutter Hospital anywhere in Sacramento, Davis, Roseville, Auburn or other areas nearby, I will contact the doctor in San Francisco who is doing the study. I am simply exhausted from whatever is going on with me and also having to contact so many people just to get the right treatment. The MCRP was especially stressful as Medtronic had to ship me a new control device because the representative had locked the device when he programmed it after my recent surgery to remove and replace the device which enabled me to finally get the exam. It took a long time for the technicians to contact the representative and get the device programmed for the MCRP so that I could finally have the exam.
I thank you for your interest and comments. The medical system needs to go back to "slow medicine" per my OB/GYN, but she does not see this happening any time soon and that is a sad thing. I will keep you apprised.