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Pancreatic neuroendocrine tumors (pNETs): the predictive value of MDCT characteristics in the differentiation of histopathological grades

  • Pancreas
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Abstract

Purpose

To investigate the correlation between multiple detector computed tomography (MDCT) features of pancreatic neuroendocrine tumors (pNETs) and histopathologic grade and find valuable imaging criteria for grade prediction.

Material and methods

MDCT of 61 patients with 65 masses, which pNETs were approved histopathologically, underwent revision retrospectively. Each MDCT was evaluated for various radiologic characteristics. Absolute and relative (R: tumor/pancreas, D: tumor–pancreas) tumor enhancements were calculated in multiple post contrast phases.

Results

61 patients [mean age = 50.70 ± 14.28 y/o and 30(49.2%) were male] were evaluated and classified into 2 groups histopathologically: G1: 32 (49.2%) and G2,3: 33 (50.8%). Significant relationships were observed between histopathologic tumor grade regarding age (p = 0.006), the longest tumor size (p = 0.006), presence of heterogeneity (p < 0.0001), hypodense foci in delayed phase (p = 0.004), lobulation (p = 0.002), vascular encasement (p < 0.0001), adjacent organ invasion (p = 0.01), presence (p < 0.0001) and number (0.02) of liver metastases, presence of lymphadenopathy with short axis of more than 10 mm (LAP) (p = 0.008), pathologic lymph node size (p = 0.004), relative (R and D) (p = 0.05 and 0.02, respectively), and percentage of arterial hyper-enhancing area (p = <0.0001). Tumor grades, however, had no significant relationship with gender, tumor location, tumor outline, calcification, cystic change, or pancreatic (PD) or biliary duct (BD) dilation (p = 0.21, 0.60, 0.05, 0.05 1, 0.10, and 0.51, respectively). Then, we suggested a novel imaging criteria consisting of six parameters (tumor size > 33 mm, relative (R) tumor enhancement in arterial phase ≤ 1.33, relative (D) tumor enhancement in arterial phase ≤ 16.5, percentage of arterial hyper-enhancing area ≤ 75%, vascular encasement, and lobulation), which specificity and accuracy of combination of all findings (6/6) for predicting G2,3 were 100% and 70.1%, respectively. The highest accuracy (84.21%) was seen in combinations of at least 4 of 6 findings, with 80.00% sensitivity, 87.5% specificity, 83.33% PPV, and 84.85% NPV.

Conclusion

We suggested reliable imaging criteria with high specificity and accuracy for predicting the histopathologic grade of pNETs.

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Acknowledgements

The authors are thankful to the patients and Imam Khomeini hospital staff for their collaboration.

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Authors and Affiliations

  1. Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, 1419733141, Iran

    Faeze Salahshour, Mohammad-Mehdi Mehrabinejad, Ali Zare Dehnavi, Mohammad-Ali Ataee & Niloofar Ayoobi Yazdi

  2. Hepatobiliary and Liver Transplantation Division, Department of General Surgery, Imam-Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Abbas Alibakhshi & Habibollah Dashti

  3. Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad-Mehdi Mehrabinejad & Ali Zare Dehnavi

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  1. Faeze Salahshour
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Correspondence to Niloofar Ayoobi Yazdi.

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Salahshour, F., Mehrabinejad, MM., Zare Dehnavi, A. et al. Pancreatic neuroendocrine tumors (pNETs): the predictive value of MDCT characteristics in the differentiation of histopathological grades. Abdom Radiol 45, 3155–3162 (2020). https://doi.org/10.1007/s00261-019-02372-x

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