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Enhancing pancreatic mass with normal serum CA19-9: key MDCT features to characterize pancreatic neuroendocrine tumours from its mimics

  • ABDOMINAL RADIOLOGY
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Abstract

Objectives

To determine key MDCT features for characterizing pancreatic neuroendocrine tumours (PNET) from their mimics, which manifest as enhancing pancreatic mass with normal serum CA19-9 level.

Methods

This retrospective study had institutional review board approval and informed consent was waived. Preoperative multiphase MDCT of 74 patients with enhancing pancreatic masses and normal serum CA19-9 levels were included. Surgical pathologies were PNET (n = 42), microcystic serous cystadenomas (m-SCN, n = 12) and solid pseudopapillary epithelial neoplasms (SPEN, n = 20). Two radiologists independently evaluated CT images with a checklist of findings. Frequencies of findings with each disease entity were compared. Diagnostic accuracy was assessed using the key MDCT features alone and in combination. Inter-observer agreement was evaluated.

Results

The most common findings for PNET were mosaic morphological pattern (33/42, 78.6%) and enhancement peak in pancreatic arterial phase (PAP, 32/42, 76.2%), for m-SCN were honeycomb pattern (9/12, 75.0%) and enhancement peak in PAP (10/12, 83.3%) and for SPEN were melting icecream pattern (16/20, 80.0%) and hypo-enhancement in all phases (18/20, 90.0). Using a combination of morphological patterns and enhancement features, PNET was identified with 88% sensitivity and 81% specificity, m-SCN was identified with 83% sensitivity and 94% specificity, and SPEN was identified with 90% sensitivity and 91% specificity. Inter-observer agreement concerning CT findings was good to excellent (κ = 0.68 to 0.81, all p < 0.01).

Conclusions

Morphological features and enhancement patterns on MDCT are key features for characterizing enhancing pancreatic mass with normal serum CA19-9. PNET could be differentiated from its mimics with high accuracy.

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Authors and Affiliations

  1. Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China

    Liang Zhu, Hua-dan Xue, Wei Liu, Xuan Wang, Xin Sui, Qin Wang, Daming Zhang, Ping Li & Zheng-yu Jin

Authors
  1. Liang Zhu
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  2. Hua-dan Xue
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  3. Wei Liu
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  4. Xuan Wang
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  5. Xin Sui
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  6. Qin Wang
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  7. Daming Zhang
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  8. Ping Li
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  9. Zheng-yu Jin
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Corresponding author

Correspondence to Hua-dan Xue.

Ethics declarations

This study was funded by the National Natural Science Foundation of China (General Program, No.81371608) and the Health Industry Special Scientific Research Project (No. 201402019).

Author-identifying information

Hua-dan Xue has received funding from the National Natural Science Foundation of China (General Program, No.81371608) and author Zheng-yu Jin has received funding from Health Industry Special Scientific Research Project (No. 201402019). The authors (L. Zhu, H. Xue, W. Liu,. Wang, X. Sui, Q. Wang, D. Zhang, P. Li and Z. Jin) declare no relationships with any companies, whose products or services may be related to the subject matter of this article.

Ethical approval

All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This retrospective study was approved by the institutional review board of Peking Union Medical College Hospital, and written informed consent was waived.

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Zhu, L., Xue, Hd., Liu, W. et al. Enhancing pancreatic mass with normal serum CA19-9: key MDCT features to characterize pancreatic neuroendocrine tumours from its mimics. Radiol med 122, 337–344 (2017). https://doi.org/10.1007/s11547-017-0734-x

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  • DOI: https://doi.org/10.1007/s11547-017-0734-x

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