Dual phase spiral CT in the detection of small insulinomas of the pancreas.

Abstract

Dual phase contrast enhanced spiral computed tomography (DPSCT) has the potential to improve detection of small insulin secreting islet cell tumours of the pancreas. Seven patients with biochemically proven insulinoma, who had previously undergone a range of negative radiological procedures, were referred for DPSCT. Images of the pancreas were obtained using 3 mm collimation in the arterial and arteriovenous perfusion phase following the rapid injection of contrast medium. Six tumours were localized in seven patients. The six insulinomas identified on DPSCT ranged in size from 6 mm to 18 mm and were located in the uncinate process (2), head (1), neck (2) and body (1). All six tumours were detected in the arterial phase and four in the arteriovenous phase. The four insulinomas detected on both perfusion phases were more conspicuous in the arterial phase in three patients and more conspicuous in the arteriovenous phase in one patient. In conclusion, high resolution arterial phase acquisition of the pancreas is very valuable in the detection of small insulinomas.

Morphological and functional investigations of neuroendocrine tumors of the pancreas

“…The results of King et al [66] were similar to those of Van Hoe et al [64]. In a series of 7 biochemically proven insulinomas, 6 of 7 with a size of 6-18 mm could be detected with dual-phase spiral CT; however, in all positive findings the tumor was visible in the arterial phase, and 4 of 6 detected tumors were visible at the arterio-venous phase.…”

Preoperative Localisation and Surgical Management of Insulinoma: Single Centre Experience

“…Despite some authors questioning the need to have a definite preoperative localisation, it is agreed by many to have a good imaging preoperatively to pinpoint the site of the lesion [3,9,24,25]. Early arterial phase of multidetector CT scan has a diagnostic sensitivity of 57–94%, compared to 29% with conventional CT scan [26,27,28]. CT scan had a diagnostic sensitivity of 62% in this study.…”

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Radiological Examinations

“…The mean detection rate for EPTs of a further 6 studies including 178 patients was 73% (range 39–94%) [6,7,8,9,10,11]. Based on these 11 studies that included 343 EPT patients the mean sensitivity and detection rate for an EPT was 73%, although with a considerably wide variation (39–94%), but a generally high specificity (mean 96%).…”