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

Figure 18  Atypical solid pseudopapillary tumor with extensive hemorrhagic cystic component. A: Axial T2-weighted image shows a well-defined heterogeneous mass in the pancreatic head, characterized by a large hyperintense cystic component with internal fluid–fluid level, consistent with hemorrhagic sedimentation; B: Axial T1-weighted magnetic resonance image demonstrates intrinsic high signal intensity of the cystic component, consistent with intralesional hemorrhage; C: Thin-slab magnetic resonance cholangiopancreatography confirms the presence of cystic components (arrow) within the lesion, without evidence of communication with the main pancreatic duct; D and E: Diffusion weighted imaging (b = 1000 second/mm²) shows high signal intensity of the solid components, with true diffusion restriction, confirmed by apparent diffusion coefficient (ADC) map which demonstrates moderate signal drop, and low ADC value (ADC = 1.42 × 10^-3 mm²/second).