Pancreatic cystic lesions (PCLs) represent a spectrum of non-neoplasms and neoplasms with varying malignant potential, posing significant challenges in diagnosis and management. While some PCLs are precursors to pancreatic cancer, others remain benign, necessitating accurate differentiation for optimal patient care. Conventional approaches to PCL management rely heavily on radiographic imaging, and endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA), coupled with clinical and biochemical data. However, the observer-dependent nature of image interpretation and the complex morphology of PCLs can lead to diagnostic uncertainty and variability in patient management strategies. This review critically evaluates current PCL diagnosis and surveillance practices, showing features of the different lesions and highlighting the potential limitations of conventional methods. We then explore the potential of artificial intelligence (AI) to transform PCL management. AI-driven strategies, including deep learning algorithms for automated pancreas and lesion segmentation, and radiomics for analyzing heterogeneity, can improve diagnostic accuracy and risk stratification. These advanced techniques can provide more objective and reproducible assessments, aiding clinicians in decision-making regarding follow-up intervals and surgical interventions. Early results suggest that AI-driven methods can significantly improve patient outcomes by enabling earlier detection of high-risk lesions and reducing unnecessary procedures for benign cysts. Finally, this review emphasizes that AI-driven approaches could potentially reshape the landscape of PCL management, ultimately leading to improved pancreatic cancer prevention.

(1) Acute pancreatitis (AP) is a medical emergency associated with high mortality rates. Early and accurate prognosis assessment during admission is crucial for optimizing patient management and outcomes. This study seeks to develop robust radiomics-based machine learning (ML) models to classify the severity of AP using contrast-enhanced computed tomography (CECT) scans. (2) Methods: A retrospective cohort of 287 AP patients with CECT scans was analyzed, and clinical data were collected within 72 h of admission. Patients were classified as mild or moderate/severe based on the Revised Atlanta classification. Two radiologists manually segmented the pancreas and peripancreatic regions on CECT scans, and 234 radiomic features were extracted. The performance of the ML algorithms was compared with that of traditional scoring systems, including Ranson and Glasgow-Imrie scores. (3) Results: Traditional severity scoring systems produced AUC values of 0.593 (Ranson, Admission), 0.696 (Ranson, 48 h), 0.677 (Ranson, Cumulative), and 0.663 (Glasgow-Imrie). Using LASSO regression, 12 radiomic features were selected for the ML classifiers. Among these, the best-performing ML classifier achieved an AUC of 0.876 in the training set and 0.777 in the test set. (4) Conclusions: Radiomics-based ML classifiers significantly enhanced the prediction of AP severity in patients undergoing CECT scans within 72 h of admission, outperforming traditional severity scoring systems. This research is the first to successfully predict prognosis by analyzing radiomic features from both pancreatic and peripancreatic tissues using multiple ML algorithms applied to early CECT images.