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Prediction of pancreatic neuroendocrine tumour grade with MR imaging features: added value of diffusion-weighted imaging

  • Gastrointestinal
  • Published:
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A Correction to this article was published on 04 June 2020

This article has been updated

Abstract

Objectives

To evaluate the value of MR imaging including diffusion-weighted imaging (DWI) for the grading of pancreatic neuroendocrine tumours (pNET).

Material and Methods

Between 2006 and 2014, all resected pNETs with preoperative MR imaging including DWI were included. Tumour grading was based on the 2010 WHO classification. MR imaging features included size, T1-w, and T2-w signal intensity, enhancement pattern, apparent (ADC) and true diffusion (D) coefficients.

Results

One hundred and eight pNETs (mean 40 ± 33 mm) were evaluated in 94 patients (48 women, 51 %, mean age 52 ± 12). Fifty-five (51 %), 42 (39 %), and 11 (10 %) tumours were given the following grades (G): G1, G2, and G3. Mean ADC and D values were significantly lower as grade increased (ADC: 2.13 ± 0.70, 1.78 ± 0.72, and 0.86 ± 0.22 10-3 mm2/s, and D: 1.92 ± 0.70, 1.75 ± 0.74, and 0.82 ± 0.19 10-3 mm2/s G1, G2, and G3, all p < 0.001). A higher grade was associated with larger sized tumours (p < 0.001). The AUROC of ADC and D to differentiate G3 and G1-2 were 0.96 ± 0.02 and 0.95 ± 0.02. Optimal cut-off values for the identification of G3 were 1.19 10-3 mm2/s for ADC (sensitivity 100 %, specificity 92 %) and 1.04 10-3 mm2/s for D (sensitivity 82 %, specificity 92 %).

Conclusion

Morphological/functional MRI features of pNETS depend on tumour grade. DWI is useful for the identification of high-grade tumours.

Key Points

• Morphological and functional MRI features of pNETs depend on tumour grade.

• Their combination has a high predictive value for grade.

• All pNETs should be explored by MR imaging including DWI.

• DWI is helpful for identification of high-grade and poorly-differentiated tumours.

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Change history

  • 04 June 2020

    The original version of this article, published on 19 August 2016, unfortunately contained a mistake.

Abbreviations

ADC:

apparent diffusion coefficient

D:

true diffusion coefficient

DWI:

diffusion-weighted imaging

ENETS:

European Neuroendocrine Tumour Society

G:

grade

(p)NET:

(pancreatic) neuroendocrine tumour

MRI:

magnetic resonance imaging

WHO:

World Health Organization

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Acknowledgments

The scientific guarantor of this publication is Maxime Ronot. 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. The authors state that this work has not received any funding. 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, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France

    Emad Lotfalizadeh, Maxime Ronot, Mathilde Wagner, Marie-Pierre Vullierme, Wassim Allaham & Valérie Vilgrain

  2. University Paris Diderot, Sorbonne Paris Cité, Paris, France

    Maxime Ronot, Jérôme Cros, Anne Couvelard & Valérie Vilgrain

  3. INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France

    Maxime Ronot, Mathilde Wagner & Valérie Vilgrain

  4. Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France

    Jérôme Cros & Anne Couvelard

  5. Department of Gastroenterology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France

    Olivia Hentic & Philippe Ruzniewski

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  1. Emad Lotfalizadeh
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Correspondence to Maxime Ronot.

Electronic supplementary material

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Supplemental Figure 1

Example of a G1 pNET of the head of the pancreas in a 58 yo female. MR imaging showed a small (< 2 cm) hypervascular tumour on arterial phase images (arrow in a) with high signal intensity on high b value diffusion-weighted images (b=600 s/mm2) (arrow in b), and a mean ADC value of 2.30 10-3 mm2/s (c). All features were consistent with a G1 tumour. The lesion was resected, and pathological analysis confirmed the tumour grade (Ki67 < 1%). (GIF 26 kb)

(GIF 23 kb)

(GIF 34 kb)

High resolution image (TIF 306 kb)

High resolution image (TIF 248 kb)

High resolution image (TIF 370 kb)

Supplemental Figure 2

Proposition of classification algorithm for the prediction of tumour grade. The right hand side column represents the mean (and standard deviation) of each box. (GIF 21 kb)

High resolution image (TIFF 181 kb)

ESM 1

(DOCX 15 kb)

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Lotfalizadeh, E., Ronot, M., Wagner, M. et al. Prediction of pancreatic neuroendocrine tumour grade with MR imaging features: added value of diffusion-weighted imaging. Eur Radiol 27, 1748–1759 (2017). https://doi.org/10.1007/s00330-016-4539-4

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  • DOI: https://doi.org/10.1007/s00330-016-4539-4

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