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Differential and prognostic MRI features of gallbladder neuroendocrine tumors and adenocarcinomas

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

Abstract

Objectives

To identify MRI features that are helpful for the differentiation of gallbladder neuroendocrine tumors (GB-NETs) from gallbladder adenocarcinomas (GB-ADCs) and to evaluate their prognostic values.

Methods

Between January 2008 and December 2018, we retrospectively enrolled patients who underwent MRI for GB malignancy. Two radiologists independently assessed the MRI findings and reached a consensus. Significant MRI features, which distinguish GB-NETs from GB-ADCs, were identified. Cox regression analyses were performed to find MRI features that were prognostic for overall survival.

Results

There were 63 patients with GB-NETs (n = 21) and GB-ADCs (n = 42). Compared with GB-ADCs, GB-NETs more frequently demonstrated the following MRI features: well-defined margins, intact overlying mucosa, and thick rim contrast enhancement and/or diffusion restriction (ps < 0.001). Liver metastases were more common and demonstrated thick rim contrast enhancement and diffusion restriction in GB-NETs (ps < 0.001). Lymph node (LN) metastasis showed thick rim diffusion restriction more often in GB-NETs than in GB-ADCs (p = 0.009). On quantitative analysis, the sizes of the GB mass and metastatic LNs in GB-NETs were larger than those in GB-ADCs (p = 0.002 and p = 0.010, respectively). The ratio of apparent diffusion coefficient values between the lesion and the spleen was lower in the GB mass, liver metastases, and LN metastases of GB-NETs than those of GB-ADCs (p < 0.001, p = 0.017, and p < 0.001, respectively). Survival analysis revealed that a large metastatic LN (hazard ratio 1.737; 95% confidence interval, 1.112–2.712) was the only poor prognostic factor (p = 0.015).

Conclusion

Several MRI features aided in differentiating between GB-NETs and GB-ADCs. A large metastatic LN was associated with poor survival.

Key Points

• Compared with gallbladder adenocarcinomas (GB-ADCs), neuroendocrine tumors (GB-NETs) and their metastases to the liver and lymph nodes more frequently demonstrated a thick rim appearance on contrast-enhanced MRI and diffusion-weighted images.

• The ratio of apparent diffusion coefficient values between the lesion and the spleen was significantly lower for the primary mass, liver metastases, and lymph node metastases of GB-NETs than for those of GB-ADCs.

• A large metastatic lymph node was the only poor prognostic factor for overall survival in patients with GB-NETs and GB-ADCs.

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Abbreviations

ADC:

Adenocarcinoma

GB:

Gallbladder

LN:

Lymph node

NET:

Neuroendocrine tumor

OS:

Overall survival

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Funding

This research was supported by Basic Science Research Program through the National Research Foundation of Korea [NRF] funded by the Ministry of Science, ICT& Future Planning (NRF-2019R1F1A1060131) and by Seoul National University Hospital Research Fund No. 03-2019-0070.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jae Seok Bae, Se Hyung Kim, Jeongin Yoo & Joon Koo Han

  2. Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jae Seok Bae, Se Hyung Kim, Jeongin Yoo & Joon Koo Han

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Se Hyung Kim & Joon Koo Han

  4. Department of Pathology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Haeryoung Kim

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Correspondence to Se Hyung Kim.

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Guarantor

The scientific guarantor of this publication is Joon Koo Han.

Conflict of interest

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Among the 63 patients comprising our study population, 10 patients had been reported in Outcome and CT differentiation of gallbladder neuroendocrine tumours from adenocarcinomas (PMID 27225621).

Methodology

• retrospective

• case-control study

• performed at one institution

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Bae, J.S., Kim, S.H., Yoo, J. et al. Differential and prognostic MRI features of gallbladder neuroendocrine tumors and adenocarcinomas. Eur Radiol 30, 2890–2901 (2020). https://doi.org/10.1007/s00330-019-06588-9

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  • DOI: https://doi.org/10.1007/s00330-019-06588-9

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