Pancreatic Neuroendocrine Tumors in Patients with Multiple Endocrine Neoplasia Type 1: Diagnostic Value of Different MRI Sequences

Background: MRI is a useful imaging modality to assess the presence of pancreatic neuroendocrine tumors (PNETs), allowing repeat monitoring examinations in multiple endocrine neoplasia type 1 (MEN-1) patients. Objectives: We aimed to compare the diagnostic accuracy of conventional MRI sequences to identify which sequence better depicts the presence of PNETs in MEN-1 patients. Method: We performed a retrospective analysis of consecutive MEN-1 patients who underwent a conventional MRI protocol to monitor previously proven PNETs. MRI sequences T1-w chemical shift (CS), T2-w HASTE, fat-suppressed (FS) T2-w HASTE, diffusion-weighted imaging (DWI), and pre- and post-contrast FS T1-w sequences were independently analyzed by 2 experienced radiologists using a 3-grade score (no lesion, uncertain lesion, and certain lesion); lesion size and signal intensity were recorded. A Friedman ANOVA and a Wilcoxon pairwise test for the post hoc analysis were used. The sensitivity of each sequence was measured, and the results were analyzed with the χ2 test. Results: We included 21 patients with a total of 45 PNETs proven by histology, endoscopic ultrasonography-guided fine-needle aspiration, CT, and nuclear medicine studies. A statistically significant (p < 0.01) difference was observed in the detection performance of each MRI sequence, particularly between DWI (91%) and T2-w FS (85%) sequences in comparison to the others (T1-w CS, T2-w, and pre- and post-contrast FS T1-w, ≤56% for all); no significant (p = 0.5) difference was found between the detection performance of DWI and T2-w FS sequences. No correlation was observed between the qualitative score of each sequence and lesion tumor size. Conclusions: DWI and T2-w FS sequences proved to be the most accurate in the detection of PNETs, thus suggesting a role for an abbreviated MRI protocol without contrast medium administration for monitoring MEN-1 patients.

[1]  B. Friedman,et al.  Multimodality Imaging of the Pancreatic Neuroendocrine Tumors. , 2019, Seminars in ultrasound, CT, and MR.

[2]  F. Izzo,et al.  The Multidisciplinary Team for Gastroenteropancreatic Neuroendocrine Tumours: The Radiologist’s Challenge , 2019, Radiology and oncology.

[3]  A. Isidori,et al.  Lanreotide therapy vs active surveillance in MEN1-related pancreatic neuroendocrine tumors <2 cm. , 2019, The Journal of clinical endocrinology and metabolism.

[4]  A. Kambadakone,et al.  MR Imaging of Pancreatic Neuroendocrine Tumors. , 2018, Magnetic resonance imaging clinics of North America.

[5]  H. Yin,et al.  Grading of pancreatic neuroendocrine neoplasms using pharmacokinetic parameters derived from dynamic contrast-enhanced MRI , 2018, Oncology letters.

[6]  J. Norton,et al.  Treatment of Pancreatic Neuroendocrine Tumors in Multiple Endocrine Neoplasia Type 1: Some Clarity But Continued Controversy. , 2017, Pancreas.

[7]  M. Falconi,et al.  ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours , 2017, Neuroendocrinology.

[8]  Jérôme Cros,et al.  Prediction of pancreatic neuroendocrine tumour grade with MR imaging features: added value of diffusion-weighted imaging , 2017, European Radiology.

[9]  P. Bhosale,et al.  State-of-the-art Imaging of Pancreatic Neuroendocrine Tumors. , 2016, Surgical oncology clinics of North America.

[10]  A. Larghi,et al.  Evaluation of the Added Value of Diffusion-Weighted Imaging to Conventional Magnetic Resonance Imaging in Pancreatic Neuroendocrine Tumors and Comparison With 68Ga-DOTANOC Positron Emission Tomography/Computed Tomography , 2016, Pancreas.

[11]  R. Jensen,et al.  Imaging in multiple endocrine neoplasia type 1: recent studies show enhanced sensitivities but increased controversies. , 2016, International journal of endocrine oncology.

[12]  A. Scarpa,et al.  Pancreatic Neuroendocrine Neoplasms: Clinical Value of Diffusion-Weighted Imaging , 2015, Neuroendocrinology.

[13]  J. Norton,et al.  Better Survival But Changing Causes of Death in Patients With Multiple Endocrine Neoplasia Type 1. , 2015, Annals of surgery.

[14]  P. Capelli,et al.  Non-hyperfunctioning neuroendocrine tumours of the pancreas: MR imaging appearance and correlation with their biological behaviour , 2013, European Radiology.

[15]  M. Reiser,et al.  Comparison of abdominal MRI with diffusion-weighted imaging to 68Ga-DOTATATE PET/CT in detection of neuroendocrine tumors of the pancreas , 2013, European Journal of Nuclear Medicine and Molecular Imaging.

[16]  J. Bilezikian,et al.  Clinical practice guidelines for multiple endocrine neoplasia type 1 (MEN1). , 2012, The Journal of clinical endocrinology and metabolism.

[17]  T. Metens,et al.  Pancreatic neuroendocrine tumor: added value of fusion of T2-weighted imaging and high b-value diffusion-weighted imaging for tumor detection. , 2012, European journal of radiology.

[18]  A. Tabarin,et al.  Magnetic resonance imaging versus endoscopic ultrasonography for the detection of pancreatic tumours in multiple endocrine neoplasia type 1. , 2012, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[19]  M. Salvatore,et al.  Simultaneous non-functioning neuroendocrine carcinoma of the pancreas and extra-hepatic cholangiocarcinoma. A case of early diagnosis and favorable post-surgical outcome. , 2011, JOP : Journal of the pancreas.

[20]  Yi Wang,et al.  Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas. , 2011, Radiographics : a review publication of the Radiological Society of North America, Inc.

[21]  Yi Wang,et al.  Diffusion‐weighted MR imaging in pancreatic endocrine tumors correlated with histopathologic characteristics , 2011, Journal of magnetic resonance imaging : JMRI.

[22]  M. Salvatore,et al.  Screening of pancreaticoduodenal endocrine tumours in patients with MEN 1: multidetector-row computed tomography vs. endoscopic ultrasound , 2011, La radiologia medica.

[23]  T. Baère,et al.  Endocrine pancreatic tumours: which are the most useful MRI sequences? , 2010, European Radiology.

[24]  B. Acunaş,et al.  Diffusion weighted MR imaging of pancreatic islet cell tumors. , 2010, European journal of radiology.

[25]  D. Bingham,et al.  Inherited pancreatic endocrine tumor syndromes: Advances in molecular pathogenesis, diagnosis, management, and controversies , 2008, Cancer.

[26]  T. Ichikawa,et al.  Islet cell tumor of the pancreas: biphasic CT versus MR imaging in tumor detection. , 2000, Radiology.

[27]  U. Mueller-Lisse,et al.  Detection of small, functional islet cell tumors in the pancreas: selection of MR imaging sequences for optimal sensitivity. , 2000, Radiology.