Tailored imaging of islet cell tumors of the pancreas amidst increasing options

Preoperative Assessment of the Pancreas in Multiple Endocrine Neoplasia Type 1

“…Nonetheless, our study corroborates EUS as providing the highest preoperative sensitivity and PPV in assessing the presence of PNETs in MEN 1 patients [33].…”

Imaging in Multiple Endocrine Neoplasia Type 1: Recent Studies Show Enhanced Sensitivities but Increased Controversies

“…Numerous recent studies support the conclusion that EUS, in both MEN1 patients and those with sporadic disease, is the most sensitive modality for detecting intrapancreatic pNETs, including both F-pNETs and NF-pNETs [46,96–98]. This includes EUS being more sensitive than cross-sectional imaging studies (MRI, CT and ultrasound) and SRS with 111 In-DPTA-octreotide (octreoscan); however, data from prospective comparisons with 68 Ga-DOTATOC-PET/CT are not yet available.…”

“…EUS has sufficient sensitivity to identify pNETs less than 0.5 cm in diameter in a number of studies [42,43,45]. EUS has additional added advantages over both 68 Ga-DOTATOC-PET/CT and 111 In-DPTA-octreotide because it also allows accurate assessment of pNETs size, can be used to assess serial changes in pNETs size and fine-needle aspiration can be used to assess grade and other tumoral characteristics [43,46,96,97]. Serial studies with EUS to assess changes in pNET size are possible because serial EUS assessments are reliable with a study showing repeated EUS measurement had a variation of only 5.5 ± 4.6% overall, with a 7.1 ± 6.3% in pNETs <5 mm, variation of 4.4 ± 2.6% in pNETs >5 mm, allowing calculation of a significant changes as 15.4% overall, for pNETs <5 mm a 19.9% change and >5 mm in size as 12.3% change [43].…”

“…In a previous study [119] in patients with sporadic pNETs ≤2cm, MRI had an 85% sensitivity; however, MRI’s detection rate for pNETs is size dependent [96,120] with detection rates less than 10% for pNETs ≤1 cm in diameter, 50% when 2 cm in diameter and 80–100% when at least 3 cm in diameter [96,119,120]. …”

Isoattenuating insulinomas at biphasic contrast-enhanced CT: frequency, clinicopathologic features and perfusion characteristics

“…A biphasic contrastenhanced CT proved to be optimal for tumour detection, since early, arterial-dominant phase and later phase images could provide complementary information concerning lesion conspicuity and image homogeneity [8,9]. The exact timing of scanning protocol differs slightly on an institutional basis; however, biphasic imaging is generally considered adequate [10][11][12].…”