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CT differentiation of poorly-differentiated gastric neuroendocrine tumours from well-differentiated neuroendocrine tumours and gastric adenocarcinomas

  • Gastrointestinal
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Abstract

Purpose

To evaluate the differential CT features of gastric poorly-differentiated neuroendocrine tumours (PD-NETs) from well-differentiated NETs (WD-NETs) and gastric adenocarcinomas (ADCs) and to suggest differential features of hepatic metastases from gastric NETs and ADCs.

Materials and methods

Our study population was comprised of 36 patients with gastric NETs (18 WD-NETs, 18 PD-NETs) and 38 patients with gastric ADCs who served as our control group. Multiple CT features were assessed to identify significant differential CT findings of PD-NETs from WD-NETs and ADCs. In addition, CT features of hepatic metastases including the metastasis-to-liver ratio were analyzed to differentiate metastatic NETs from ADCs.

Results

The presence of metastatic lymph nodes was the sole differentiator of PD-NETs from WD-NETs (P = .001, odds ratio = 56.67), while the presence of intact overlying mucosa with mucosal tenting was the sole significant CT feature differentiating PD-NETs from ADCs (P = .047, odds ratio = 15.3) For hepatic metastases, metastases from NETs were more hyper-attenuated than those from ADCs.

Conclusion

The presence of metastatic LNs and intact overlying mucosa with mucosal tenting are useful CT discriminators of PD-NETs from WD-NETs and ADCs, respectively. In addition, a higher metastasis-to-liver ratio may help differentiate hepatic metastases of gastric NETs from those of gastric ADCs with high accuracy.

Key Points

• Presence of metastatic LNs is a useful differentiator of PD-NETs from WD-NETs.

• Intact overlying mucosa with mucosal tenting suggests PD-NETs more than gastric ADCs.

• Metastatic LNs are larger in size and greater in necrotic volume in PD-NETs.

• Hepatic metastases from gastric NETs are more hyper-attenuated than those from ADCs.

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Abbreviations

NETs:

Neuroendocrine tumours

WHO:

World Health Organization

WD-NETs:

Well-differentiated neuroendocrine tumours

PD-NETs:

Poorly-differentiated neuroendocrine tumours

ADCs:

Adenocarcinomas

LNs:

Lymph nodes

MDCT:

Multi-detector computed tomography

HU:

Hounsfield units

ROI:

Region of interest

ROC:

Receiver operating characteristic

AUC:

Area under the curve

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Acknowledgments

The authors thank Chris Woo, B.A. for his English editorial assistance in preparing the manuscript.

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 study has received funding by the Basic Science Research Program through the National Research Foundation of Korea [NRF] funded by the Ministry of Science, ICT & Future Planning [2013R1A1A3005937]. 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. No study subjects or cohorts have been previously reported. 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, 110-744, Korea

    Seong Ho Kim, Se Hyung Kim, Cheong-il Shin, Joon Koo Han & Byung Ihn Choi

  2. Institute of Radiation Medicine, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea

    Seong Ho Kim, Se Hyung Kim, Cheong-il Shin, Joon Koo Han & Byung Ihn Choi

  3. Department of Pathology, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea

    Min-A Kim

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  1. Seong Ho Kim
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Correspondence to Se Hyung Kim.

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Kim, S.H., Kim, S.H., Kim, MA. et al. CT differentiation of poorly-differentiated gastric neuroendocrine tumours from well-differentiated neuroendocrine tumours and gastric adenocarcinomas. Eur Radiol 25, 1946–1957 (2015). https://doi.org/10.1007/s00330-015-3600-z

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  • DOI: https://doi.org/10.1007/s00330-015-3600-z

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