Imaging of Pancreatic Neuroendocrine Neoplasms

Abstract

Pancreatic neuroendocrine neoplasms (panNENs) represent the second most common pancreatic tumors. They are a heterogeneous group of neoplasms with varying clinical expression and biological behavior, from indolent to aggressive ones. PanNENs can be functioning or non-functioning in accordance with their ability or not to produce metabolically active hormones. They are histopathologically classified according to the 2017 World Health Organization (WHO) classification system. Although the final diagnosis of neuroendocrine tumor relies on histologic examination of biopsy or surgical specimens, both morphologic and functional imaging are crucial for patient care. Morphologic imaging with ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) is used for initial evaluation and staging of disease, as well as surveillance and therapy monitoring. Functional imaging techniques with somatostatin receptor scintigraphy (SRS) and positron emission tomography (PET) are used for functional and metabolic assessment that is helpful for therapy management and post-therapeutic re-staging. This article reviews the morphological and functional imaging modalities now available and the imaging features of panNENs. Finally, future imaging challenges, such as radiomics analysis, are illustrated.

Laparoscopic treatment for an intrapancreatic accessory spleen: A case report

“…Although the intensity of both pNETs and IPASs shows a low T1 and high T2, pNETs can have a ring-like enhancement (6). However, pNETs with high fibrosis have no significant or delayed intensity changes between sequences, which makes it difficult to distinguish them from IPASs (7). Val-bernal et al reported 4 cases of pancreatic tail lesions, all of which were diagnosed as pNETs by CT and MRI.…”

Preoperative Prediction of Pancreatic Neuroendocrine Tumor Grade based on 68Ga-DOTATATE PET/CT

“…When there was a difference in opinion, they concluded after discussing it in detail. The image features (23) include: tumor location: pancreatic head and neck (non uncinate process area), pancreatic uncinate process, pancreatic body/tail, or multiple parts in the pancreas; Size: Represented by the maximum diameter line of the tumor measured in cross-section, in cm; calci cation; texture of pancreatic tumors: According to the proportion of cystic and solid components, they are divided into solid type, cystic solid type, and cystic type (24); pancreatic duct dilation:the widest part of the pancreatic duct with a diameter exceeding 0.35 cm is de ned as pancreatic duct dilation; Bile duct dilation: Measure the widest part of the common bile duct at the upper edge of the pancreas, with a diameter greater than 0.9 cm is de ned as expansion; Peripheral organ invasion: whether it affects the spleen, duodenum, and stomach; Lymph node metastasis: Regional lymph node metastasis occurs; Distant metastasis:…”

“…Imaging examination is an important means for the diagnosis, localization, staging, and e cacy evaluation of PNETs, and can assist in the qualitative and differential diagnosis of tumors (14). Traditional imaging examinations such as CT and MRI can be used for the diagnosis of PNETs, but they provide limited information to re ect the heterogeneity and predict the pathological grading of tumors (15).…”

Risk Assessment and Pancreatic Cancer: Diagnostic Management and Artificial Intelligence

“…Most primary pancreatic cancers are pancreatic ductal adenocarcinomas (PDACs); only a small proportion are pancreatic neuroendocrine tumors [46][47][48][49][50][51][52][53] and, even rarer, malignancies [54][55][56][57][58][59]. PDACs normally rise through a process that involves several stages, from pancreatic intraepithelial neoplasia (PanIN) [60].…”