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Sporadic insulinomas on volume perfusion CT: dynamic enhancement patterns and timing of optimal tumour–parenchyma contrast

  • Computed Tomography
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Abstract

Objectives

To assess enhancement patterns of sporadic insulinomas on volume perfusion CT (VPCT), and to identify timing of optimal tumour–parenchyma contrast.

Methods

Consecutive patients who underwent VPCT for clinically suspected insulinomas were retrospectively identified. Patients with insulinomas confirmed by surgery were included, and patients with familial syndromes were excluded. Two radiologists evaluated VPCT images in consensus. Tumour–parenchyma contrast at each time point was measured, and timing of optimal contrast was determined. Time duration of hyperenhancement (tumour–parenchyma contrast >20 Hounsfield units, HU) was recorded. Perfusion parameters were evaluated.

Results

Three dynamic enhancement patterns were observed in 63 tumours: persistent hyperenhancement (hyperenhancement time window ≥10 s) in 39 (61.9%), transient hyperenhancement (hyperenhancement <10 s) in 19 (30.2%) and non-hyperenhancement in 5 (7.9%). Timing of optimal contrast was 9 s after abdominal aorta threshold (AAT) of 200 HU, with tumour–parenchyma contrast of 77.6 ± 57.2 HU. At 9 s after AAT, 14 (22.2%) tumours were non-hyperenhancing, nine of which had missed transient hyperenhancement. Insulinomas with transient and persistent hyperenhancement patterns had significantly increased perfusion.

Conclusions

Insulinomas have variable enhancement patterns. Tumour–parenchyma contrast is time-dependent. Optimal timing of enhancement is 9 s after AAT. VPCT enables tumour detection even if the hyperenhancement is transient.

Key points

• Enhancement patterns of insulinomas are variable and tumour–parenchyma contrast is time-dependent.

• An optimized single-phase scan found 77.8% tumours to be hyperenhancing.

• Hyperenhancing tumours increase to 84.1% and 87.3% with biphasic/triphasic scan.

• Volume perfusion CT enables detection of insulinomas with missed transient hyperenhancement.

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Abbreviations

AAT:

abdominal aorta threshold

DLP:

dose–length products

HU:

Hounsfield units

MEN:

multiple endocrine neoplasia

MDCT:

multidetector CT

ROI:

region of interest

VPCT:

volume perfusion CT

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Acknowledgements

The scientific guarantor of this publication is Professor Zheng-yu Jin. 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 from the National Natural Science Foundation of China (General Program, No.81371608) and Health Industry Special Scientific Research Project (Nos. 201402001 and 201402019). 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. None of the 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, Peking Union Medical College Hospital, Shuaifuyuan No.1, Dongcheng District, Beijing, China

    Liang Zhu, Hua-dan Xue, Wei Liu, Xuan Wang, Hao Sun, Ping Li & Zheng-yu Jin

  2. Department of General Surgery, Peking Union Medical College Hospital, Shuaifuyuan No.1, Dongcheng District, Beijing, China

    Wen-ming Wu & Yu-pei Zhao

Authors
  1. Liang Zhu
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  2. Wen-ming Wu
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  3. Hua-dan Xue
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  4. Wei Liu
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  5. Xuan Wang
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  6. Hao Sun
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  7. Ping Li
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  8. Yu-pei Zhao
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  9. Zheng-yu Jin
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Correspondence to Hua-dan Xue.

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Zhu, L., Wu, Wm., Xue, Hd. et al. Sporadic insulinomas on volume perfusion CT: dynamic enhancement patterns and timing of optimal tumour–parenchyma contrast. Eur Radiol 27, 3491–3498 (2017). https://doi.org/10.1007/s00330-016-4709-4

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  • DOI: https://doi.org/10.1007/s00330-016-4709-4

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