With contrast medium, the wall of the cystadenoma is clearly enhanced, and partitions separating the cysts of a multilocular MC can be sometimes visualized. This examination is usually performed as a second line and is preferable under general anaesthesia. Interpretation of the images depends largely on the experience of the operator in the field of pancreatic pathology. Using EUS, MC are shown to be well defined isolated lesions. Small mural cysts are sometimes visible and should not be erronously mistaken for serous cystadenomas.
Cystic contents are usually hyperechogenic due to the presence of mucus.
A careful examination of the cyst with respect to the pancreatic duct needs to be undertaken, particularly in cases where IPMT are suspected. In MC, EUS is also useful in defining papillary projections and mural nodules or irregularities, features suggestive of malignant transformation. Occasionnally, a tissue sample of the cystic wall is obtained and this along with the cystic fluid can be examined using histology and cytology respectively. Complications of EUS-guided fine needle aspiration are rare. As MC rarely communicates with the MPC, ERCP is not an important adjunct in its diagnosis.