• pancreas
• neuroendocrine pancreatic neoplasms
• multidetector CT

Introduction

Pre-operative suspicion of neuroendocrine pancreatic lesions nature arises both from clinical (presence and the type of secreted hormone) and imaging findings. However, imaging suggestion of lesion nature is based quite only on nodular dimension and on the presence of local and distant spreading. Aim of the study was to determine the nature of neuroendocrine pancreatic lesions by analysing lesions enhancement pattern at MDCT and by comparing it with histological findings, including the MVD.

Materials and Methods

We included 45 patients submitted to surgical resection for pancreatic neuroendocrine tumor. All preoperative CT examinations were performed by a multidetector CT. Post-contrastographic study included 4 phases: early arterial (delay 15-20”), pancreatic (delay 35”), venous (delay 70”) and late phases (delay 180”). Two different patterns of enhancement were defined: pattern A, including lesions showing early enhancement (during early arterial or pancreatic phase) and a rapid wash-out; pattern B, including lesions with wash-in in the early arterial or pancreatic phase with no wash-out nor in the late phase (pattern B1), and lesions showing enhancement only in the venous and/or late phases (pattern B2).

Results

66 lesions were detected (30 pattern A, 26 B1 and 10 B2). At pathology 28 lesions were adenomas, 14 borderline and 24 carcinomas: 24/30 lesions showing pattern A were benign, 5 borderline and 1 carcinoma; 23/36 lesions showing pattern B were carcinomas, 9 borderline and 4 adenomas. Among the 26 B1 lesions, 13 were carcinomas, 9 borderline and 4 adenomas, while all 10 B2 lesions were malignant. Pattern A showed PPV of benignancy of 80%, and pattern B NPV of benignancy of 89%. MVD was evaluated in 22 lesions obtaining significant differences among the 3 histological and the 3 enhancement pattern. Significant differences between B1 and B2 malignant lesions existed by considering metastases (only B2 lesions) and fibrosis (all B2 lesions).

Conclusion

The enhancement pattern at CT is related to MVD and the histological type, thus representing a further criterium for suggesting nature of neuroendocrine lesions. The low MVD of B2 lesions, associated with the presence of fibrosis, may justify the delayed enhancement of these lesions.