Table 1.

Differential diagnosis table for pancreatoblastoma

	Local morphology	X-Ray	US	CT	MRI	Contrast enhancement
Pancreatoblastoma	No predilection for head, body or tail. Large with partially circumscribed and lobulated margins.	Sometimes small, punctate, clustered, or rim like Ca2+	Mixed echogenicity solid mass	Solid mass with low attenuation multiloculated elements	Solid mass presenting areas with low to intermediate signal intensity on T1-wi and high signal on T2-wi	Enhancement in arterial and portal venous phases
Solid Pseudo-papillary tumor	Tail (43%)	Sometimes curvilinear Ca2+	Very large, encapsulated, heterogeneous (hypoechoic solid and anechoic cystic areas)	Well-circumscribed, encapsulated, round or lobulated lesion Variable internal architecture depending on the degree of hemorrhage	Hemorrhage: high SI onT1-wi, low or inhomogeneous SI on T2-wi Solid component: low SI on T1-wi, high SI on T2-wi	Early, peripheral enhancement Progressive heterogeneous fill-in
Non-functioning endocrine neoplasm	Small or large in size	May contain Ca2+	Homogeneously hypoechoic lesion	Isoattenuating to the parenchyma, but may appear cystic Distant metastasis	Low SI or isointensity on T1-wi High to isointense on T2-wi	Enhancement in arterial phase
Serous cystadenoma	Head Innumerable small cyst	Central calcified scar	Multiple millimetric hypoechoic or anechoic cysts	Honeycomb pattern of multiple millimetric cysts	Hypointense on T1 and hyperintense on T2-wi clustered cysts	Parietal enhancement
Ductal adenocarcinoma	Head Ill-defined lesion with contour deformity of the gland	Ca2+ very rare	Hypoechoic lesion Dilated pancreatic duct Atrophic gland	Isodense to the parenchyma Dilated pancreatic duct and atrophic gland Obliteration of peripancreatic fat Contiguous organ invasion, vascular invasion and distant metastases	Low SI on T1-wi Variable SI on T2-wi Contiguous organ invasion and distant metastases	Poor or non-enhancing lesion
Mucinous cystic neoplasm	Tail Uni/multilocular cyst	Sunburst Ca2+	Hypoechoic macrocystic (cystadenoma) and with pancreatic duct dilatation (IPMN)	Hypodense uni- or multilocular, peripheral calcification (cystadenoma) pancreatic duct dilatation (IPMN) metastasis (mucinous adenoCa)	High SI on T2 and low on T1-wi (but variable with mucin concentration) Fluid-fluid level from hemorrhage can exist.	Enhancement of the internal septa and cyst wall typically delayed
Pancreatic pseudocyst	Tail and body	May be calcified peripherally	Anechoic or hypoechoic, pancreatic calcifications might be seen	Hypodense, pancreatic calcifications and inflammatory changes in the peripancreatic fat might be seen	T1: hypointense, T2: hyperintense, Debris or hemorrhage can change the intensity	Might have mild enhancement of the thin fibrous capsule, no inner enhancement
Acinar cell carcinoma	Can be very large, well circumscribed and necrotic	Ca2+ usually not evident	Hypoechoic lesion	Mild hypodense appearance with a focal cystic/necrotic component	Predominantly T1 hypointense and T2 iso to hyperintense, with central cystic areas when large	Hypovascular lesion