Abstract
Objectives
To enhance diagnosis of gastrointestinal neuroendocrine carcinomas using CT and contrast-enhanced CT images.
Methods
A total of 44 patients with gastrointestinal neuroendocrine carcinomas, as confirmed by clinical pathology and immunohistochemistry in the Sixth Affiliated People’s Hospital of Shanghai Jiao Tong University Shanghai China, were included in the study. CT and enhanced CT scanning were performed, and the resulting images were reviewed and analyzed.
Results
Twenty-seven males and 17 females were enrolled. Gastrointestinal involvement included the following: 5 cases located in the middle or inferior segment of the esophagus; 5 in the gastric cardia, 15 in the body of stomach, 6 located in the gastric antrum; 5 located in the Vater papilla of the duodenum; and 8 located in the colon. Among the 44 cases 80%–90% of the lesions had homogeneous density. Totally 81.8% (36/44) cases demonstrated homogeneous enhancement in arterial phases, most of the cases (n = 33) moderately or obviously enhanced. Only 17.2% (8/44) cases appeared as heterogeneous enhancement. And 86.4% cases (n = 38) were further enhanced in the venous phase. The CT images also revealed some of the metastases. Some liver metastasis cases have obvious homogeneous enhancement.
Conclusions
CT and enhanced CT provide useful information regarding gastrointestinal neuroendocrine carcinomas’ location, density, enhancement pattern, and some metastasis. These features are helpful to increase the diagnostic accuracy.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00261-011-9836-4/MediaObjects/261_2011_9836_Fig1_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00261-011-9836-4/MediaObjects/261_2011_9836_Fig2_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00261-011-9836-4/MediaObjects/261_2011_9836_Fig3_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00261-011-9836-4/MediaObjects/261_2011_9836_Fig4_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00261-011-9836-4/MediaObjects/261_2011_9836_Fig5_HTML.jpg)
Similar content being viewed by others
References
Musialik JA, Kohut MJ, Marek T, Wodolazski A, Hartleb M (2009) Composite neuroendocrine and adenomatous carcinoma of the papilla of Vater. World J Gastroenterol 15(33):4199–4200
Helpap B, Kollermann J (2001) Immunohistochemical analysis of the proliferative activity of neuroendocrine tumors from various organs. Are there indications for a neuroendocrine tumor-carcinoma sequence? Virchows Arch 438(1):86–91
Kloppel G, Perren A, Heitz PU (2004) The gastroenteropancreatic neuroendocrine cell system and its tumors: the WHO classification. Ann N Y Acad Sci 1014:13–27
Schott M, Kloppel G, Raffel A, et al. (2011) Neuroendocrine neoplasms of the gastrointestinal tract. Dtsch Arztebl Int 108(18):305–312. doi:10.3238/arztebl.2011.0305
Fazio N, Cinieri S, Lorizzo K, et al. (2010) Biological targeted therapies in patients with advanced enteropancreatic neuroendocrine carcinomas. Cancer Treat Rev 36(Suppl 3):S87–S94. doi:10.1016/S0305-7372(10)70026-8
Cwikla JB, Nasierowska-Guttmejer A, Jeziorski KG, et al. (2007) Diagnostic imaging approach to gastro-entero-pancreatic carcinomas of neuroendocrine origin—single NET center experience in Poland. Neuro Endocrinol Lett 28(6):789–800
Formica V, Wotherspoon A, Cunningham D, et al. (2007) The prognostic role of WHO classification, urinary 5-hydroxyindoleacetic acid and liver function tests in metastatic neuroendocrine carcinomas of the gastroenteropancreatic tract. Br J Cancer 96(8):1178–1182. doi:10.1038/sj.bjc.6603699
Warren WH, Welker M, Gattuso P (2006) Well-differentiated neuroendocrine carcinomas: the spectrum of histologic subtypes and various clinical behaviors. Semin Thorac Cardiovasc Surg 18(3):199–205. doi:10.1053/j.semtcvs.2006.08.008
Haeubl M, Schuerz S, Svejda B, et al. (2010) Asymmetrically substituted cationic indole- and fluorene porphyrins inhibit tumor proliferation in small intestinal neuroendocrine tumors and medullary thyroid carcinomas. Eur J Med Chem 45(2):760–773. doi:10.1016/j.ejmech.2009.11.025
Auernhammer CJ, Goke B (2011) Therapeutic strategies for advanced neuroendocrine carcinomas of jejunum/ileum and pancreatic origin. Gut 60(7):1009–1021. doi:10.1136/gut.2009.204453
Owen NJ, Sohaib SA, Peppercorn PD, et al. (2001) MRI of pancreatic neuroendocrine tumours. Br J Radiol 74(886):968–973
Obuz F, Altay C, Sagol O, et al. (2011) Erratum to: MDCT findings in neuroendocrine carcinoma of the gallbladder: case report. Abdom Imaging. doi:10.1007/s00261-011-9715-z
Moran CA, Suster S (2007) Neuroendocrine carcinomas (carcinoid, atypical carcinoid, small cell carcinoma, and large cell neuroendocrine carcinoma): current concepts. Hematol Oncol Clin N Am 21(3):395–407. doi:10.1016/j.hoc.2007.04.011
Chang S, Choi D, Lee SJ, et al. (2007) Neuroendocrine neoplasms of the gastrointestinal tract: classification, pathologic basis, and imaging features. Radiographics 27(6):1667–1679. doi:10.1148/rg.276075001
Richards D, Davis D, Yan P, Guha S (2011) Unusual case of small cell gastric carcinoma: case report and literature review. Dig Dis Sci 56(4):951–957. doi:10.1007/s10620-010-1404-1
Panzuto F, Nasoni S, Falconi M, et al. (2005) Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization. Endocr Relat Cancer 12(4):1083–1092. doi:10.1677/erc.1.01017
Nagaraj N, Egwim C, Adler DG (2007) X-linked hyper-IgM syndrome associated with poorly differentiated neuroendocrine tumor presenting as obstructive jaundice secondary to extensive adenopathy. Dig Dis Sci 52(9):2312–2316. doi:10.1007/s10620-006-9702-3
Dong RZ, Shi YQ, Ye YW, Fu H, Zhao GF (2010) Clinicopathological and prognostic analysis of 23 poorly differentiated neuroendocrine carcinomas of the stomach. Zhonghua Wei Chang Wai Ke Za Zhi 13(8):583–586
Hedlund E, Karlsson JE, Starck SA (2010) Automatic and manual image fusion of In-pentetreotide SPECT and diagnostic CT in neuroendocrine tumor imaging—an evaluation. J Med Phys 35(4):223–228. doi:10.4103/0971-6203.71766
Kaltsas G, Rockall A, Papadogias D, Reznek R, Grossman AB (2004) Recent advances in radiological and radionuclide imaging and therapy of neuroendocrine tumours. Eur J Endocrinol 151(1):15–27
Pape UF, Berndt U, Muller-Nordhorn J, et al. (2008) Prognostic factors of long-term outcome in gastroenteropancreatic neuroendocrine tumours. Endocr Relat Cancer 15(4):1083–1097. doi:10.1677/ERC-08-0017
Carter JT, Grenert JP, Rubenstein L, Stewart L, Way LW (2009) Neuroendocrine tumors of the ampulla of Vater: biological behavior and surgical management. Arch Surg 144(6):527–531. doi:10.1001/archsurg.2009.80
Badea R, Seicean A, Diaconu B, et al. (2009) Contrast-enhanced ultrasound of the pancreas—a method beyond its potential or a new diagnostic standard? J Gastrointestin Liver Dis 18(2):237–242
Kim SY, Byun JH, Choi G, et al. (2008) A case of primary paraganglioma that arose in the pancreas: the Color Doppler ultrasonography and dynamic CT features. Korean J Radiol 9(Suppl):S18–S21. doi:10.3348/kjr.2008.9.s.s18
Putzer D, Gabriel M, Henninger B, et al. (2009) Bone metastases in patients with neuroendocrine tumor: 68 Ga-DOTA-Tyr3-octreotide PET in comparison to CT and bone scintigraphy. J Nucl Med 50(8):1214–1221. doi:10.2967/jnumed.108.060236
Kulke MH, Wu B, Ryan DP, et al. (2006) A phase II trial of irinotecan and cisplatin in patients with metastatic neuroendocrine tumors. Dig Dis Sci 51(6):1033–1038. doi:10.1007/s10620-006-8001-3
Debray MP, Geoffroy O, Laissy JP, et al. (2001) Imaging appearances of metastases from neuroendocrine tumours of the pancreas. Br J Radiol 74(887):1065–1070
Gillams A, Cassoni A, Conway G, Lees W (2005) Radiofrequency ablation of neuroendocrine liver metastases: the Middlesex experience. Abdom Imaging 30(4):435–441. doi:10.1007/s00261-004-0258-4
Acknowledgment
This research was partly supported by Science and Technology Commission of Shanghai Municipality (Grant No. 08411951200).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wang, D., Zhang, GB., Yan, L. et al. CT and enhanced CT in diagnosis of gastrointestinal neuroendocrine carcinomas. Abdom Radiol 37, 738–745 (2012). https://doi.org/10.1007/s00261-011-9836-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-011-9836-4