The value of gadoxetic acid-enhanced and diffusion-weighted MRI for prediction of grading of pancreatic neuroendocrine tumors

Jang, Kyung Mi; Kim, Seong Hyun; Lee, Soon Jin; Choi, Dong Il

doi:10.1177/0284185113494982

Cited by 68 publications

(60 citation statements)

References 24 publications

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“…Similarly, some PanNENs may present intratumoral fibrosis, and even if well differentiated, they can demonstrate low ADC values. On the other hand, G2 and G3 PanNENs with loose or no fibrosis could present relatively higher ADC values [17]. This aspect was explained well by Wang et al [18]; in their study, there was a difference in mean ADCs between well-differentiated endocrine tumors and endocrine carcinomas, but a significant inverse correlation between ADC values and the cellularity of endocrine tumors was only observed after excluding three well-differentiated endocrine tumors with benign behavior and marked fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is increasingly being used in body applications for the detection and characterization of pancreatic lesions and for the assessment of hepatic metastases. Despite this fact, relatively few studies, including small numbers of patients, have been conducted regarding its usefulness in the evaluation of patients with PanNENs [13,14,15,16,17,18,19,20,21], and they provided somehow contradictory results.…”

Section: Introductionmentioning

confidence: 99%

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Pancreatic Neuroendocrine Neoplasms: Clinical Value of Diffusion-Weighted Imaging

et al. 2015

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Background/Aims: Diffusion-weighted imaging (DWI) can depict random motions of water molecules in biological tissues during magnetic resonance (MR) examinations. Few papers have tested its application to pancreatic neuroendocrine neoplasms (PanNENs). The aim of this paper is to assess the clinical value of DWI regarding the identification and characterization of PanNENs and diagnosis of liver metastases. Methods: Preoperative MR examinations of 30 PanNEN patients were retrospectively reviewed; 30 patients with pathologically proven pancreatic ductal adenocarcinoma (PDAC) were included to compare the imaging features. Qualitative and quantitative MR features were compared between histotypes. A blinded-reader comparison of diagnostic confidence for PanNENs and liver metastases was conducted on randomized image sets. All results were compared with pathological data. Results: PanNEN conspicuity was higher on DW images compared to conventional MR sequences. DWI had higher detection rates for PanNENs than had conventional sequences (93.3 vs. 71.1%). Sharp margins and absence of main pancreatic duct/common bile duct dilation and chronic pancreatitis were more common among PanNENs as compared to PDACs. Arterial iso- or hyperenhancement and portal hyperenhancement were more frequent within PanNENs as compared to PDACs. No differences between histotypes were found for quantitative features. Arterial-phase images had the highest interobserver agreement for the diagnosis of PanNEN (Cohen's κ = 0.667). DWI provided the highest detection rate for liver metastases as well as excellent interobserver agreement for the diagnosis of liver metastases (κ = 0.932), with good accuracy (AUC = 0.879-0.869). Conclusion: DWI has clinical value regarding the identification of PanNENs and the diagnosis of liver metastases, while conventional MR sequences are fundamental for their characterization.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pancreatic Neuroendocrine Neoplasms: Clinical Value of Diffusion-Weighted Imaging

et al. 2015

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“…Interestingly, the newly introduced hybrid technique PET/MRI has not yet resulted in an increased sensitivity compared to the stand-alone techniques [89]. DWI for oncologic imaging is based on the restricted diffusion of water molecules in highly cellular tissue such as tumors and has shown potential for distinguishing exocrine and endocrine pancreatic tumors [90] and G1 from G2-G3 pancreatic neuroendocrine lesions by means of quantifying the tumor's apparent diffusion coefficient (ADC) in the images (ADC map) [91]. ADC has been shown to correlate with Ki67 [92].…”

Section: Novel Techniques and Strategiesmentioning

confidence: 99%

The Status of Neuroendocrine Tumor Imaging: From Darkness to Light?

et al. 2014

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Diagnostic imaging plays a pivotal role in the diagnosis, staging, treatment selection and follow-up for neuroendocrine tumors. The available diagnostic strategies are morphologic imaging, including computed tomography, magnetic resonance imaging (MRI) and ultrasound techniques, and molecular imaging, including scintigraphy with ¹¹¹In-pentetreotide and positron emission tomography with ⁶⁸Ga-DOTA-peptides, ¹⁸F-DOPA and ¹¹C-5-HTP. A combination of anatomic and functional techniques is routinely performed to optimize sensitivity and specificity. The introduction of diffusion-weighted MRI and dynamic contrast-enhanced techniques represents a promising advance in radiologic imaging, whereas new receptor-binding peptides, including somatostatin agonists and antagonists, represent the recent most favorable innovation in molecular imaging. Future development includes the short-term validation of these techniques, but in extension also a more comprehensive multilevel integration of biologic information pertaining to a specific tumor and patient, possibly encompassing genomic considerations, currently evolving as a new entity denoted ‘precision medicine'. The ideal is a diagnostic sequence that captures the global status of an individual's tumor and encompasses a multidimensional characterization of tumor location, metabolic performance and target identification. To date, advances in imagery have focused on increasing resolution, discrimination and functional characterization. In the future, the fusion of imagery with the parallel analysis of biological and genomic information has the potential to considerably amplify diagnosis.

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“…Details regarding ADC measurements correlations with the grade of differentiation are reported in Table 2. Overall, it seems that ADC values are correlated with the Ki67 labeling index: G3 PanNETs tend to present lower mean ADC values compared to well-differentiated PanNETs [58][59][60] . As for PDACs, staging plays a fundamental for treatment planning and prognostication of PanNETs.…”

Section: Pancreatic Tumorsmentioning

confidence: 93%

“…Etchebehere et al [67] compared WBDWI with 68 Ga-DOTATATE PET-CT and 99mTc-HYNICOctreotide SPECT-CT: WBDWI had a similar accuracy when compared to molecular imaging techniques for lung and liver lesions, while showed a higher false-negative rate for bone lesions. Schraml et al [68] reported that PET-CT and WBDWI had comparable overall detection rates for NETs metastases but Wang et al [43] 21 0, 500 PDAC 2.10 (WD-MD); 1.46 (PD) Legrand et al [44] 22 Wang et al [58] 18 0, 50, 500 PanNET 1.75 (G1); 1.00 (G3) Jang et al [59] 20 0, 800 PanNET 1.48 (G1-G2); 1.04 (G3) Hwang et al [60] 44 significantly differed in organ-based detection rates with superiority of PET-CT for lymph node and pulmonary lesions and of WBDWI for liver and bone metastases. Experimental applications of pCT to PanNETs reported interesting results.…”

Section: Pancreatic Tumorsmentioning

confidence: 99%

Prognostication and response assessment in liver and pancreatic tumors: The new imaging

Robertis¹,

Martini²,

Demozzi³

et al. 2015

WJG

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Diffusion-weighted imaging (DWI), dynamic contrastenhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for posttreatment assessment, even at an early stage. or altered cellular membranes will present diffusion restriction, which is depicted as signal hyperintensity areas on high b-value DW images and hypointensity on the apparent diffusion coefficient (ADC) maps; ADC measurement can also quantify water molecules' diffusion. As dedifferentiation or therapies may induce microscopic changes in neoplastic tissues that could modify water molecules' diffusion, DWI can distinguish between different degrees of malignancy and can be also proposed for post-treatment monitoring. Moreover, DWI can be performed in a single session with DCE-MRI, thus providing a comprehensive "one-step" morphological and functional evaluation of hepatobilio-pancreatic tumors.Perfusion imaging techniques evaluate changes in signal intensity (DCE-MRI) or density (pCT) after contrast medium injection, being therefore able to assess microvascularization through the evaluation of the dynamics of contrast medium distribution from vessels to the neoplastic tissue. Perfusion parameters are therefore theoretically good candidates for the evaluation of microscopic vascular differences between lesions with different pathological grade and for the assessment of treatment response, especially after chemoembolization or during treatments with antiangiogenic drugs.This editorial analyzes up-to-date literature data regarding the application of functional imaging techniques, apart from molecular imaging, to hepatic and pancreatic tumors, with particular emphasis on correlations to pathological features, prognostic stratification and therapeutic response assessment. FUNCTIONAL IMAGING TECHNIQUES: TECHNICAL BASESIn 1965 Stejskal and Tanne...

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The value of gadoxetic acid-enhanced and diffusion-weighted MRI for prediction of grading of pancreatic neuroendocrine tumors

Abstract: Abdominal MRI with DWI may be useful for differentiating benign pancreatic NETs from non-benign pancreatic NETs, which might be helpful for determination of parenchyma-preserving resection.

Cited by 68 publications

References 24 publications

Pancreatic Neuroendocrine Neoplasms: Clinical Value of Diffusion-Weighted Imaging

Pancreatic Neuroendocrine Neoplasms: Clinical Value of Diffusion-Weighted Imaging

The Status of Neuroendocrine Tumor Imaging: From Darkness to Light?

Prognostication and response assessment in liver and pancreatic tumors: The new imaging

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