Differentiation Between Mucinous Cystic Neoplasms and Simple Cysts of the Liver: A Systematic Review and Meta-Analysis Publisher



Manzari Tavakoli G¹ ; Afsharzadeh M² ; Mobinikhaledi M² ; Behzad S² ; Ghorani H² ; Salahshour F² Show Affiliations
Source: Abdominal Radiology Published:2025

Abstract

Differentiating between MCNs and HSCs based on imaging features can be challenging due to the overlapping in imaging findings and the absence of definitive serum tumor markers. Wall thickness, internal septation, mural nodule, intra-cystic debris, wall enhancement, and bile duct dilation are predictive factors for mucinous cystic neoplasms along with the left lobe location. Hepatic simple cysts are generally lesions with thin and regular walls that are often multiple and affect the right lobe of the liver. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025.; Purpose: Radiologic examinations frequently identify cystic liver lesions, which encompass various entities from simple benign cysts to malignant neoplasms. This work analyses the available data to compare diagnostic features of biliary cystic neoplasms and hepatic simple cysts. Methods: A systematic search of PubMed, Scopus, Embase, and Web of Science up to October 2024 was conducted. The characteristics were categorized into hepatic simple cysts (HSC) and mucinous cystic neoplasms (MCN), including biliary cystadenoma (BCA) and cystadenocarcinoma (BCAC) detected by imaging modalities including ultrasound, CT scans with IV contrast, or MRI. We analyzed biliary cystic neoplasms and hepatic simple cysts across multiple studies using Review Manager Ver. 5, calculating summary measures for each feature. Results: The study analyzed 577 lesions in 577 patients and 49 studies. Hepatic simple cysts were the most common finding, with 349 identified, mainly in the right hepatic lobe, presented with abdominal pain or incidentally. Intracystic septation was found in 50.1% of HSC lesions, with thick septation in 10.52% of lesions. 228 (49.9%) patients were diagnosed with MCN, with abdominal swelling and pain as the most common presentation. Septation was the most common radiological feature of MCNs, with thick septa in 50.61%. MCNs had internal septa, solid mural nodule, upstream bile duct dilation, presence in the left hepatic lobe, septal thickening, cystic wall enhancement, calcifications, and internal debris. The presence of a cyst in the left lobe was more related to MCNs. Conclusion: Characterizing cystic liver lesions necessitates a comprehensive evaluation of the lesions’ location, size, and complexity. Imaging and clinical findings are essential for a final diagnosis. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025.