Nonhypervascular pancreatic neuroendocrine tumors: Spectrum of MDCT imaging findings and differentiation from pancreatic ductal adenocarcinoma. Issue 110 (January 2019)

• Record Type: Journal Article
• Authors: Karmazanovsky, Grigory; Belousova, Elena; Schima, Wolfgang; Glotov, Andrei; Kalinin, Dmitry; Kriger, Andrei
• Is Part Of: European journal of radiology. Issue 110(2019)
• Page Start: 66
• Page End: 73
• Publication Date: 2019-01
• Subjects: HU hounsfield units -- MVD microvascular density -- NPV negative predictive value -- PDAC pancreatic ductal adenocarcinoma -- PNEN pancreatic neuroendocrine neoplasm -- PNET pancreatic neuroendocrine tumor -- PPV positive predictive value -- ROC receiver operating characteristic -- ROI region of interest -- WHO World Health Organization; MDCT -- Pancreas -- Neuroendocrine tumor -- Pancreatic cancer; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2018.04.006
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Nonhypervascular PNETs are not rare and require differential diagnosis with PDAC. The most valuable contrast enhanced MDCT features to differentiate between nonhypervascular PNETs and PDACs are determined. Contrast enhanced MDCT information may be useful for therapeutic and surgery planning. Abstract: Purpose: The purpose of our study was to determine contrast-enhanced MDCT features to differentiate nonhypervascular pancreatic neuroendocrine tumors (PNETs) from pancreatic ductal adenocarcinomas (PDACs). Methods: and materials: We included 74 patients with PNETs and 80 patients with PDACs who underwent preoperative MDCT. Two radiologists evaluated the morphologic characteristic and enhancement patterns of the tumors. Quantitative and qualitative analysis was performed, including evaluation of tumor size, homogeneity, contrast enhancement pattern, presence of pancreatic duct dilatation and tumor invasion to the adjacent vessels and peripancreatic infiltration. Tumor-to-pancreas enhancement ratio was defined as the Hounsfield units (HU) value of the tumor divided by the HU value of the pancreas. the first group was hypervascular PNETs showing hyperenhancement on arterial phase images and nonhypervascular PNETs, showing iso- or hypoenhancement on arterial phase images. After that, two radiologists estimated the possibilities of PNET or PDAC were for nonhypervascular PNETs. Results: On the basis of arterial enhancement, 43 PNETs were hypervascular and 31 were nonhypervascular. When compared to PDAC, nonhypervascular PNETs more frequently had well-defined tumor margins, intratumoral cystic components, calcifications and blood vessels and less frequently had main pancreatic duct dilatation, peripancreatic infiltration and vascular invasion (p < 0.01 for all). Nonhypervascular PNETs had higher tumor-to-pancreas enhancement ratio in venous phase (1.02 vs. 0.78, p = 0.012). Nonhypervascular PNETs more often had portal-venous hyperenhancement or persistent isoenhancement, while PDAC more often had persistent hypoenhancement or gradual delayed enhancement (p < 0.001). The absence of pancreatic duct dilatation and portal-venous hyperenhancement or persistent isoenhancement were the independent predictors for nonhypervascular PNETs. (The most accurate MDCT-findings to predict nonhypervascular PNET were the absence of pancreatic duct dilatation and peripancreatic infiltration (79% and 92% accuracy), portal-venous phase hyperenhancement or persistent isoenhancement (77%), the presence of intratumoral blood vessels (77%) and relative enhancement intensity in venous phase >0.9 (76%). Using these criteria, the area under curve for differentiation of PNET from PDAC was 0.906–0.846. Conclusion: Combined assessment of the enhancement and morphologic characteristics can improve the differentiation between nonhypervascular PNETs and PDAC at contrast-enhanced MDCT.