Contrast enhancement pattern on multidetector CT predicts malignancy in pancreatic endocrine tumours
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Preoperative suspicion of malignancy in pancreatic neuroendocrine tumours (pNETs) is mostly based on tumour size. We retrospectively reviewed the contrast enhancement pattern (CEP) of a series of pNETs on multiphasic multidetector computed tomography (MDCT), to identify further imaging features predictive of lesion aggressiveness.
Sixty pNETs, diagnosed in 52 patients, were classified based on CEP as: type A showing early contrast enhancement and rapid wash-out; type B presenting even (B1) or only (B2) late enhancement. All tumours were resected allowing pathologic correlations.
Nineteen pNETs showed type A CEP (5–20 mm), 29 type B1 CEP (5–80 mm) and 12 type B2 (15–100 mm). All tumours were classified as well differentiated tumours, 19 were benign (WDt-b), 15 with uncertain behaviour (WDt-u) and 26 carcinomas (WDC). None of A lesions were malignant (12 WDt-b; 7 WDt-u), all B2 lesions were WDC, 7 B1 lesions were WDt-b, 8 WDt-u and 14 WDC; 4/34 (12 %) lesions ≤2cm were WDC.
CEP showed correlation with all histological prognostic indicators.
Correlating with the lesion grading and other histological prognostic predictors, CEP may preoperatively suggest the behaviour of pNETs, assisting decisions about treatment. Moreover CEP allows recognition of malignant small tumours, incorrectly classified on the basis of their dimension.
• Neuroendocrine pancreatic tumours (pNETs) show different post-contrast behaviour on CT.
• P NETs can be classified on the basis of contrast enhancement into three categories.
• CT classification of pNETs shows strong correlation with histological prognostic factors.
• CT pattern may suggest the optimal management of pNETs.
KeywordsPancreas Neuroendocrine tumours Multidetector computed tomography Prognosis Neoplasm grading
The scientific guarantor of this publication is Salvatore Mazzeo M.D. 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 not required because our study is a retrospective review of standard preoperative CT examinations. Written informed consent was not required for this study because our study is a retrospective review of standard preoperative CT examinations. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.
Conflict of interest