The term “pancreatic cysts” refers to a heterogeneous group of conditions including inflammatory, congenital and neoplastic diseases that have garnered the attention of multiple medical disciplines. Focusing specifically on cystic tumors of the pancreas, they include different neoplasms with specific clinical and pathological features, from benign serous cystic tumors (SCTs) to main-duct intraductal papillary mucinous neoplasms (IPMNs) that are associated with malignancy in up to 70% of cases [1]. In the last decade the diagnosis of pancreatic cysts has dramatically increased and most of these lesions are found incidentally in asymptomatic individuals. Therefore a growing number of patients with pancreatic cysts with no worrisome features are managed non-operatively, requiring a long-term follow-up. In this setting, the role of modern imaging techniques – computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS) – is of paramount importance in order to (a) characterize the cyst, (b) distinguish between neoplastic and non-neoplastic lesions and (c) categorize specific tumor types. Finally, in regard to pancreatic cystic tumors, imaging should provide information on the presence of malignancy-related features (i.e. nodules) or identify those lesions (i.e. main-duct IPMNs) that are associated with a high risk of being or become malignant over time [1,2]. All these data combined with an accurate clinical evaluation of the patient will help the clinician to decide the appropriate management, from surgical resection, with parenchyma-sparing or standard pancreatectomy, to observation over time.