Pancreatic Neuroendocrine Neoplasms: Clinical Value of Diffusion-Weighted Imaging

Robertis, Riccardo De; D’Onofrio, Mirko; Zamboni, Giulia; Martini, Paolo Tinazzi; Gobbo, Stefano; Capelli, Paola; Butturini, Giovanni; Girelli, R.; Ortolani, Silvia; Cingarlini, Sara; Pederzoli, Paolo; Scarpa, Aldo

doi:10.1159/000442984

Cited by 23 publications

(17 citation statements)

References 29 publications

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“…DWI appears to be a promising adjunct for the identification of PanNENs and liver metastases, as reported in previous studies[14,20-22]. An inverse correlation between the ADC value and tumor cellularity has been reported in a variety of neoplasms[23-26]: a probable explanation is that increased cellularity causes a decrease in extracellular spaces, which results in restriction of water diffusion.…”

Section: Discussionsupporting

confidence: 55%

“…Thirty subjects included in this study have been reported in a previous paper[14]; this prior article dealt with identification and characterization of PanNENs using MR and DW imaging, whereas in this manuscript we report on the correlation between MR and DW imaging findings, tumor grade and biological behavior expressed as the stage at diagnosis.…”

Section: Methodsmentioning

confidence: 99%

“…In fact, previous studies have identified several imaging features that could predict the malignancy of these tumors: beside well-established criteria such as infiltration of peri-pancreatic vessels and liver metastases, other features associated with malignancy are large size, irregular margins, and hypoenhancement during the arterial phase[7-10]. Moreover, some authors reported that diffusion-weighted (DW) imaging, a technique that depicts and quantifies the random motion of water molecules within biological tissues on magnetic resonance (MR) imaging, might have the capability of roughly distinguish high grade PanNENs from G1 tumors[11-14]. Nevertheless, these results are based on small study populations and the diagnostic accuracy of imaging features in predicting the biological behavior of PanNENs is still undefined; moreover, in most previous studies tumor grade was established by FNA rather than histopathological analysis of surgical specimens.…”

Section: Introductionmentioning

confidence: 99%

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Pancreatic neuroendocrine neoplasms: Magnetic resonance imaging features according to grade and stage

Robertis¹,

Cingarlini²,

Martini³

et al. 2017

WJG

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AIMTo describe magnetic resonance (MR) imaging features of pancreatic neuroendocrine neoplasms (PanNENs) according to their grade and tumor-nodes-metastases stage by comparing them to histopathology and to determine the accuracy of MR imaging features in predicting their biological behavior.METHODSThis study was approved by our institutional review board; requirement for informed patient consent was waived due to the retrospective nature of the study. Preoperative MR examinations of 55 PanNEN patients (29 men, 26 women; mean age of 57.6 years, range 21-83 years) performed between June 2013 and December 2015 were reviewed. Qualitative and quantitative features were compared between tumor grades and stages determined by histopathological analysis.RESULTSIll defined margins were more common in G2-3 and stage III-IV PanNENs than in G1 and low-stage tumors (P < 0.001); this feature had high specificity in the identification of G2-3 and stage III-IV tumors (90.3% and 96%, 95%CI: 73.1-97.5 and 77.7-99.8). The mean apparent diffusion coefficient value was significantly lower in G2-3 and stage III-IV lesions compared to well differentiated and low-stage tumors (1.09 × 10-3 mm2/s vs 1.45 × 10-3 mm2/s and 1.10 × 10-3 mm2/s vs 1.53 × 10-3 mm2/s, P = 0.003 and 0.001). Receiving operator characteristic analysis determined optimal cut-offs of 1.21 and 1.28 × 10-3 mm2/s for the identification of G2-3 and stage III-IV tumors, with sensitivity and specificity values of 70.8/80.7% and 64.5/64% (95%CI: 48.7-86.6/60-92.7 and 45.4-80.2/42.6-81.3).CONCLUSIONMR features of PanNENs vary according to their grade of differentiation and their stage at diagnosis and could predict the biological behavior of these tumors.

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Section: Discussionsupporting

confidence: 55%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pancreatic neuroendocrine neoplasms: Magnetic resonance imaging features according to grade and stage

Robertis¹,

Cingarlini²,

Martini³

et al. 2017

WJG

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“…Interestingly, the specificity of these 3 sequences was similar and ranged from 88.9 to 100% [37] . Recently, Moryoussef et al [38] and De Robertis et al [39] confirmed these results and also showed that DW-MR offered an excellent interreader agreement.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 77%

Morphological and Functional Imaging for Detecting and Assessing the Resectability of Neuroendocrine Liver Metastases

Ronot

Clift²,

Baüm³

et al. 2017

Neuroendocrinology

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This review evaluates the diagnostic efficacy of different morphological and functional imaging modalities (ultrasound [US], computed tomography [CT], magnetic resonance [MR] imaging, scintigraphy, and positron emission tomography [PET]) in detecting neuroendocrine liver metastases (NELM), assessing vascular and biliary involvement, and the presence of extrahepatic disease. MR imaging is superior for depicting NELM compared to US, CT, and somatostatin receptor scintigraphy. Diffusion-weighted MR imaging is more sensitive for detecting NELM than both T2-weighted and dynamic gadolinium-enhanced MR sequences, and should be systematically performed. Similarly, gadoxetic acid-enhanced MR imaging is more sensitive for detecting liver metastases than conventional extracellular gadolinium chelate-enhanced MR sequences. Its role in detecting NELM remains investigational but appears promising. Somatostatin receptor-targeted PET/CT is a highly effective approach in assessing the resectability of well-differentiated NELM due to very high specificity (and high sensitivity) and its ability to detect small volume extrahepatic disease; this molecular imaging modality is becoming increasingly available in and outside Europe after the recent approval of ⁶⁸68-DOTATATE in the US. In addition, the information from multiphase, contrast-enhanced CT with 3D reconstruction - obtained concurrently with the information on somatostatin receptor expression of the metastases - is very helpful in planning the extent and type of resection of NELM.

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“…MRI including DWI, which will be described below, yields additional tumor findings [38,39] but comparisons between DW-MRI studies are hampered by the use of different sets of b-values.…”

Section: Sensitivity Specificity and Detection Ratesmentioning

confidence: 99%

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Radiological, Nuclear Medicine and Hybrid Imaging

et al. 2017

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Contrast-enhanced computed tomography (CT) of the neck-thorax-abdomen and pelvis, including 3-phase examination of the liver, constitutes the basic imaging for primary neuroendocrine tumor (NET) diagnosis, staging, surveillance, and therapy monitoring. CT characterization of lymph nodes is difficult because of inadequate size criteria (short axis diameter), and bone metastases are often missed. Contrast-enhanced magnetic resonance imaging (MRI) including diffusion-weighted imaging is preferred for the examination of the liver, pancreas, brain and bone. MRI may miss small lung metastases. MRI is less well suited than CT for the examination of extended body areas because of the longer examination procedure. Ultrasonography (US) frequently provides the initial diagnosis of liver metastases and contrast-enhanced US is excellent to characterize liver lesions that remain equivocal on CT/MRI. US is the method of choice to guide the biopsy needle for the histopathological NET diagnosis. US cannot visualize thoracic NET lesions for which CT-guided biopsy therefore is used. Endocopic US is the most sensitive method to diagnose pancreatic NETs, and additionally allows for biopsy. Intraoperative US facilitates lesion detection in the pancreas and liver. Somatostatin receptor imaging should be a part of the tumor staging, preoperative imaging and restaging, for which ⁶⁸Ga-DOTA-somatostatin analog PET/CT is recommended, which is vastly superior to somatostatin receptor scintigraphy, and facilitates the diagnosis of most types of NET lesions, for example lymph node metastases, bone metastases, liver metastases, peritoneal lesions, and primary small intestinal NETs. ¹⁸FDG-PET/CT is better suited for G3 and high G2 NETs, which generally have higher glucose metabolism and less somatostatin receptor expression than low-grade NETs, and additionally provides prognostic information.

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Pancreatic Neuroendocrine Neoplasms: Clinical Value of Diffusion-Weighted Imaging

Cited by 23 publications

References 29 publications

Pancreatic neuroendocrine neoplasms: Magnetic resonance imaging features according to grade and stage

Pancreatic neuroendocrine neoplasms: Magnetic resonance imaging features according to grade and stage

Morphological and Functional Imaging for Detecting and Assessing the Resectability of Neuroendocrine Liver Metastases

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Radiological, Nuclear Medicine and Hybrid Imaging

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