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Figure 12b. Recurrence of IPMT. (a) Postsecretin MR image, obtained 3 years after surgery with the Whipple procedure for IPMT, shows cystic dilatation of the duct in the remnant pancreatic tail (arrow). Low-signal-intensity foci with diameters of 23 mm (arrowheads), features likely due to viscid mucus, are seen within the duct. (b) Axial T2-weighted MR image shows a distended duct in the pancreatic tail (arrowheads) and the postsurgical site of pancreatojejunostomy (arrow). IPMT recurrence was found at pathologic analysis of a resected specimen. Right-sided hydronephrosis due to a ureteropelvic junction obstruction (not shown) was an incidental finding.