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Poorly-differentiated colorectal neuroendocrine tumour: CT differentiation from well-differentiated neuroendocrine tumour and poorly-differentiated adenocarcinomas

  • Gastrointestinal
  • Published:
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Abstract

Objective

The differentiation of poorly-differentiated neuroendocrine tumours (PD-NETs), well-differentiated NETs (WD-NETs), and adenocarcinomas (ADCs) is important due to different management options and prognoses. This study is to find the differential CT features of colorectal PD-NETs from WD-NETs and ADCs.

Materials and methods

CT features of 25 colorectal WD-NETs, 36 PD-NETs, and 36 ADCs were retrospectively reviewed. Significant variables were assessed using univariate and multivariate analyses. Receiver operating characteristics analysis determined the optimal cut-off value of tumour and lymph node (LN) size.

Results

Large size, rectum location, ulceroinfiltrative morphology without intact overlying mucosa, heterogeneous attenuation with necrosis, presence of ≥3 enlarged LNs, and metastasis were significant variables to differentiate PD-NETs from WD-NETs (P < 0.05). High attenuation on arterial phase, persistently high enhancement pattern, presence of ≥6 enlarged LNs, large LN size, and wash-in/wash-out enhancement pattern of liver metastasis were significant variables to differentiate PD-NETs from ADCs (P < 0.05).

Conclusions

Compared to WD-NETs, colorectal PD-NETs are usually large, heterogeneous, and ulceroinfiltrative mass without intact overlying mucosa involving enlarged LNs and metastasis. High attenuation on arterial phase, presence of enlarged LNs with larger size and greater number, and wash-in/wash-out enhancement pattern of liver metastasis can be useful CT discriminators of PD-NETs from ADCs.

Key Points

• Compared to WD-NETs, PD-NETs more frequently accompany enlarged LNs and metastases.

• Metastatic LNs from PD-NETs are significantly larger than those from ADCs.

• Hepatic metastases from PD-NETs usually show early enhancement and delayed washout.

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Abbreviations

WD-NET:

Well-differentiated neuroendocrine tumour

PD-NET:

Poorly-differentiated neuroendocrine tumour

ADC:

Adenocarcinoma

CT:

Computed tomography

LN:

Lymph node

ROC:

Receiver operating characteristics

AUC:

Area under the curve

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Acknowledgements

The scientific guarantor of this publication is Se Hyung Kim, Associate Professor, Department of Radiology, Seoul National University Hospital. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This research was supported by Seoul National University Hospital Research Fund No. 04-2015-620 and was supported by the Basic Science Research Program through the National Research Foundation of Korea [NRF] funded by the Ministry of Science, ICT & Future Planning [NRF-2016R1A2B4007762]. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board.

Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea

    Ji Hee Kang, Se Hyung Kim & Joon Koo Han

  2. Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea

    Se Hyung Kim & Joon Koo Han

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea

    Joon Koo Han

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  1. Ji Hee Kang
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Correspondence to Se Hyung Kim.

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Kang, J.H., Kim, S.H. & Han, J.K. Poorly-differentiated colorectal neuroendocrine tumour: CT differentiation from well-differentiated neuroendocrine tumour and poorly-differentiated adenocarcinomas. Eur Radiol 27, 3867–3876 (2017). https://doi.org/10.1007/s00330-017-4764-5

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  • DOI: https://doi.org/10.1007/s00330-017-4764-5

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