Common cystic pancreatic neoplasms: A comprehensive magnetic resonance imaging-based review of typical and atypical imaging features

Figure 10  Serous cystic neoplasm with intratumoral hemorrhage. A: Coronal single-shot T2-weighted image shows a markedly hyperintense microcystic lesion in the pancreatic tail with an associated macrocystic component; B: Axial single-shot T2-weighted image demonstrates a dependent hypointense layer within the macrocyst (arrow), consistent with sedimented hemorrhagic products; C and D: Diffusion weighted imaging (b = 1000 second/mm²) shows no true diffusion restriction, with minimal dependent hyperintensity (arrow) related to hemorrhagic debris. On apparent diffusion coefficient (ADC) maps, the lesion appears predominantly hyperintense with a small dependent hypointense component, at the level of which a high ADC value (ADC = 2.27 × 10^-3 mm²/second) confirms the absence of true diffusion restriction and supports hemorrhagic content rather than a solid component; E and F: Pre-contrast and post-contrast T1-weighted images show intrinsic T1 hyperintensity of the macrocyst and delayed septal enhancement, without enhancement of the hemorrhagic component; G: Magnetic resonance cholangiopancreatography thick-slab confirms the microcystic architecture and relative hypointensity of the macrocystic component due to intracystic hemorrhage.