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To identify MRI features that differentiate non-enhancing lesions from true mural nodules in pancreatic cystic lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We retrospectively evaluated 90 patients with pancreatic cystic lesions containing 101 nodular components (62 non-enhancing, 22 benign enhancing, 17 high-risk). Two experienced radiologists independently assessed multiple non-contrast MRI characteristics, including signal-intensity patterns, shape, and their cyst-wall relationship. The reference standard was the contrast-enhanced pattern, with histopathology for resected specimens or minimum 2-year stability for presumed mucin plugs. Diagnostic performance was evaluated in binary logistic regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Only the non-enhancing lesions (41.9%) showed the \u201ctarget sign\u201d (layered appearance due to different central- and peripheral-portion signal intensities), providing 100% specificity for identifying non-enhancing lesions. The non-enhancing lesions were predominantly oval-shaped (93.5%) with posterior-wall attachment (85.5%), whereas enhancing lesions showed a complex morphology. On diffusion-weighted imaging (DWI), 93.5% of the non-enhancing lesions showed low signal intensity and 95.2% showed high apparent diffusion coefficient\n                      <jats:bold>(<\/jats:bold>\n                      ADC) values, contrasting with high DWI signal (82.4%) and low ADC values (82.4%) in the high-risk lesions. A multiparameter model achieved excellent diagnostic performance with an area under the curve of 0.97 for differentiating non-enhancing from enhancing lesions and 0.92 for distinguishing non- or benign enhancing from high-risk lesions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Non-contrast MRI features, particularly the target sign, shape characteristics, and cyst-wall relationship can reliably differentiate mucin plugs from true mural nodules in pancreatic cystic lesions, potentially reducing unnecessary invasive procedures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11604-026-01975-x","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T06:54:46Z","timestamp":1774940086000},"page":"1189-1199","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Non-contrast MRI features of mucin plugs and mural nodules in pancreatic cystic lesions"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6330-2482","authenticated-orcid":false,"given":"Hideyuki","family":"Fukui","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Nakamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromitsu","family":"Onishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Ota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasunari","family":"Fukuda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Honda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakiko","family":"Ueno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feier","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Umezu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisaku","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidetoshi","family":"Eguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriyuki","family":"Tomiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"1975_CR1","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1016\/j.cgh.2010.05.017","volume":"8","author":"K de Jong","year":"2010","unstructured":"de Jong K, Nio CY, Hermans JJ, Dijkgraaf MG, Gouma DJ, van Eijck CHJ, et al. 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