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The role of multimodal imaging in guiding resectability and cytoreduction in pancreatic neuroendocrine tumors: focus on PET and MRI

  • Laura Rozenblum
  • Fatima-Zohra Mokrane
  • Randy Yeh
  • Mathieu Sinigaglia
  • Florent Besson
  • Romain-David Seban
  • Cecile N Chougnet
  • Paul Revel-Mouroz
  • Binsheng Zhao
  • Philippe Otal
  • Lawrence H. Schwartz
  • Laurent DercleEmail author
Review

Abstract

Pancreatic neuroendocrine tumors (pNETs) are rare neoplasms that secrete peptides and neuro-amines. pNETs can be sporadic or hereditary, syndromic or non-syndromic with different clinical presentations and prognoses. The role of medical imaging includes locating the tumor, assessing its extent, and evaluating the feasibility of curative surgery or cytoreduction. Pancreatic NETs have very distinctive phenotypes on CT, MRI, and PET. PET have been demonstrated to be very sensitive to detect either well-differentiated pNETs using 68Gallium somatostatin receptor (SSTR) radiotracers, or more aggressive undifferentiated pNETS using 18F-FDG. A comprehensive interpretation of multimodal imaging guides resectability and cytoreduction in pNETs. The imaging phenotype provides information on the differentiation and proliferation of pNETs, as well as the spatial and temporal heterogeneity of tumors with prognostic and therapeutic implications. This review provides a structured approach for standardized reading and reporting of medical imaging studies with a focus on PET and MR techniques. It explains which imaging approach should be used for different subtypes of pNET and what a radiologist should be looking for and reporting when interpreting these studies.

Keywords

Neuroendocrine tumors PET-CT Theranostics Somatostatin receptors 

Abbreviations

ADC

Apparent diffusion coefficient

AJCC

American Joint Committee on Cancer

APUD

Amine precursor uptake and decarboxylation

CEUS

Contrast-enhanced ultra sound examination

CT

Computed tomography

DOPA

Dihydroxyphenylalanine

DOTATOC

DOTA0-Phe1-Tyr3 octreotide

DWI

Diffusion-weighted imaging

ENETs

European Neuroendocrine Tumor Society

EUS

Endoscopic ultrasound examination

18F-FDG

18Fluoro-Fluorodeoxyglucose

68Ga

Gallium-68

99mTc

Technetium 99m

GLP-1

Glucagon-like peptide 1

IACIG

Intra-arterial injection of calcium

IOUS

Intraoperative ultrasound examination

LM

Liver metastases

MEN

Multiple endocrine neoplasia syndrome

MRI

Magnetic resonance imaging

NANETS

North American Neuroendocrine Tumor Society

NF

Neurofibromatosis

NET

Neuroendocrine tumors

OS

Overall survival

PDAC

Pancreatic ductal adenocarcinoma

pNET

Pancreatic tumor

SSTR

Somatostatin receptor

SSTR-PET

Somatostatin receptor PET

SSTR scintigraphy

Somatostatin receptor scintigraphy

SUV

Standard uptake value

TSC

Tuberous sclerosis complex

US

Ultrasound examination

VHL

Von Hippel–Lindau syndrome

WHO

World Health Organization

Notes

Funding

L Dercle’s work was funded by a grant from Fondation Philanthropia, Geneva, Switzerland, and the Fondation Nuovo-Soldati.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Sorbonne Université, Service de Médecine Nucléaire, AP-HP, Hôpital La Pitié-SalpêtrièreParisFrance
  2. 2.Radiology DepartmentToulouse University HospitalToulouseFrance
  3. 3.Department of Radiology, New York Presbyterian HospitalColumbia UniversityNew YorkUSA
  4. 4.Memorial Sloan Kettering Cancer CenterMolecular Imaging and Therapy ServiceNew YorkUSA
  5. 5.Department of Imaging and Nuclear MedicineInstitut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - OncopoleToulouseFrance
  6. 6.Paris Sud University, Kremlin Bicêtre HospitalParisFrance
  7. 7.Department of Nuclear MedicineInstitut Curie-René HugueninSaint-CloudFrance
  8. 8.Department of Endocrine OncologyHôpital Saint LouisParisFrance
  9. 9.UMR 1015, Gustave Roussy Institute, Université Paris-SaclayVillejuifFrance

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