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Quantitative analysis of enhanced CT in differentiating well-differentiated pancreatic neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To identify quantitative CT features for distinguishing well-differentiated pancreatic neuroendocrine tumors (PNETs) from poorly differentiated pancreatic neuroendocrine carcinomas (PNECs).

Materials and methods

Seventeen patients with PNECs and 131 patients with PNETs confirmed by biopsy or surgery were retrospectively included. General demographic (sex, age) and CT quantitative parameters (arterial/portal absolute enhancement, arterial/portal relative enhancement ratio, arterial/portal enhancement ratio) were collected. Univariate and multivariate logistic regression analyses were performed to confirm independent variables for differentiating PNECs from PNETs. Receiver operating characteristic (ROC) curves for each quantitative parameter were generated to determine their diagnostic ability.

Results

PNECs had a much lower mean arterial/portal absolute enhancement value (19.5 ± 11.0 vs. 78.8 ± 47.2; 28.1 ± 15.8 vs. 77.0 ± 39.4), arterial/portal relative enhancement ratio (0.57 ± 0.36 vs. 2.03 ± 1.31; 0.80 ± 0.52 vs. 1.99 ± 1.13), and arterial/portal enhancement ratio (0.62 ± 0.27 vs. 1.22 ± 0.49; 0.74 ± 0.19 vs. 1.21 ± 0.36) than PNETs (all p < 0.001). After multivariable analysis, arterial absolute enhancement (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.93, 0.99) and portal absolute enhancement (OR: 0.96, 95% CI: 0.92, 0.99) were independent factors for differentiating PNECs from PNETs. For each quantitative parameter, arterial lesion enhancement yielded the highest diagnostic performance, with an area under the curve (AUC) of 0.922 (95% CI: 0.867–0.960), followed by portal absolute enhancement.

Conclusions

Arterial/portal absolute enhancements were independent predictors with good diagnostic accuracy for differentiating between PNETs and PNECs. Quantitative parameters of enhanced CT can distinguish PNECs from PNETs.

Key Points

• PNECs were hypovascular and had a much lower enhanced CT attenuation in both arterial and portal phases than well-differentiated PNETs.

• Quantitative parameters derived from enhanced CT can be used to distinguish PNECs from PNETs.

• Arterial absolute enhancement and portal absolute enhancement were independent predictive factors for differentiating between PNETs and PNECs.

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Abbreviations

AUC:

Area under the curve

CI:

Confidence interval

G1:

Grade 1

G2:

Grade 2

G3:

Grade 3

HPF:

High-power fields

HU:

Hounsfield unit

ICC:

Intraclass correlation coefficient

NENs:

Neuroendocrine neoplasms

OR:

Odds ratio

PanNENs:

Pancreatic neuroendocrine neoplasms

PNECs:

Pancreatic neuroendocrine carcinomas

PNETs:

Pancreatic neuroendocrine tumors

ROC:

Receiver operating characteristic

ROI:

Region of interest

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Funding

This study was supported by funding from the National Natural Science Foundation of China (82072032), Major Medical and Health Science and Technology Projects in Zhejiang Province (WKJ-ZJ-2002), and Key R&D Projects in Zhejiang Province (2019C03058).

Author information

Author notes

  1. Hai-Yan Chen and Yao Pan contributed equally and should be considered as co-first authors.

Authors and Affiliations

  1. Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, China

    Hai-Yan Chen, Jie-Yu Chen, Lu-lu Liu, Yong-Bo Yang & Kai Li

  2. Institue of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, 310018, China

    Hai-Yan Chen, Jie-Yu Chen, Lu-lu Liu, Yong-Bo Yang, Kai Li & Guo-Liang Shao

  3. Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, Hangzhou, 310009, China

    Yao Pan & Ri-Sheng Yu

  4. Department of Interventional Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, China

    Guo-Liang Shao

  5. Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Qingchun Road 79#, Hangzhou, 310006, China

    Guo-Liang Shao

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  1. Hai-Yan Chen
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Correspondence to Ri-Sheng Yu or Guo-Liang Shao.

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The scientific guarantor of this publication is Guo-Liang Shao.

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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.

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• retrospective

• observational

• multicenter study

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Chen, HY., Pan, Y., Chen, JY. et al. Quantitative analysis of enhanced CT in differentiating well-differentiated pancreatic neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas. Eur Radiol 32, 8317–8325 (2022). https://doi.org/10.1007/s00330-022-08891-4

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  • DOI: https://doi.org/10.1007/s00330-022-08891-4

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