Imaging of Pancreatic-Neuroendocrine Tumours: An Outline of Conventional Radiological Techniques

Author(s): Muhammad Affan Zamir, Wasim Hakim*, Siraj Yusuf, Robert Thomas.

Journal Name: Current Radiopharmaceuticals

Volume 12 , Issue 2 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Introduction: Pancreatic Neuroendocrine Tumours (p-NETs) are an important disease entity and comprise of peptide-secreting tumours often with a functional syndrome.

Accounting for a small percentage of all pancreatic tumours, they have a good overall survival rate when diagnosed early, with surgery being curative. The role of nuclear medicine in the diagnosis and treatment of these tumours is evident. However, the vast majority of patients will require extensive imaging in the form of conventional radiological techniques. It is important for clinicians to have a fundamental understanding of the p-NET appearances to aid prompt identification and to help direct management through neoplastic staging.

Methods: This article will review the advantages and disadvantages of conventional radiological techniques in the context of p-NETs and highlight features that these tumours exhibit.

Conclusion: Pancreatic neuroendocrine tumours are a unique collection of neoplasms that have markedly disparate clinical features but similar imaging characteristics. Most p-NETs are small and welldefined with homogenous enhancement following contrast administration, although larger and less welldifferentiated tumours can demonstrate areas of necrosis and cystic architecture with heterogeneous enhancement characteristics.

Prognosis is generally favourable for these tumours with various treatment options available. However, conventional radiological techniques will remain the foundation for the initial diagnosis and staging of these tumours, and a grasp of these modalities is extremely important for physicians.

Keywords: P-NET, pancreatic, tumour, pancreas, neuroendocrine tumour, radiology, imaging.

Öberg, K. Pancreatic endocrine tumors. Semin. Oncol., 2010, 37, 594-618.
Metz, D.; Jensen, R. Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterol., 2008, 135, 1469-1492.
Karakus, E.; Helvaci, A.; Ekinci, O.; Dursun, A. comparison of who 2000 and who 2010 classifications of gastroenteropancreatic neuroendocrine tumors. Turk. J. Gastroenterol., 2014, 25, 81-87.
Kloppel, G.; Perren, A.; Heitz, P.U. The Gastroenteropancreatic neuroendocrine cell system and its tumors: The who classification. Ann. N. Y. Acad. Sci., 2004, 1014, 13-27.
Hijioka, S.; Hosoda, W.; Mizuno, N.; Hara, K.; Imaoka, H.; Bhatia, V.; Mekky, M.; Tajika, M.; Tanaka, T.; Ishihara, M.; Yogi, T.; Tsutumi, H.; Fujiyoshi, T.; Sato, T.; Hieda, N.; Yoshida, T.; Okuno, N.; Shimizu, Y.; Yatabe, Y.; Niwa, Y.; Yamao, K. Does the who 2010 classification of pancreatic neuroendocrine neoplasms accurately characterize pancreatic neuroendocrine carcinomas? J. Gastroenterol., 2014, 50, 564-572.
DeLellis, R. Pathology and genetics of tumours of endocrine organs; IARC Press: Lyon, 2008.
Hruban, R.; Pitman, M.; Klimstra, D. Tumors of the pancreas. AFIP atlas of tumor pathology; American Registry of Pathology: Washington, D.C., 2004.
Buetow, P.; Parrino, T.; Buck, J.L.; Pantongrag-Brown, L.; Ros, P.R.; Dachman, A.H.; Cruess, D.F. Islet cell tumors of the pancreas: pathologic-imaging correlation among size, necrosis and cysts, calcification, malignant behavior, and functional status. AJR Am. J. Roentgenol., 1995, 165(5), 1175-1179.
Lewis, R.; Lattin, G.; Paal, E. Pancreatic endocrine tumors: radiologic-clinicopathologic correlation. Radiographics, 2010, 30(6), 1445-1464.
Horton, K.; Hruban, R.; Yeo, C.; Fishman, E.K. Multi-detector row CT of pancreatic islet cell tumors. Radiographics, 2006, 26(2), 453-464.
Jensen, R.; Cadiot, G.; Brandi, M.; de Herder, W.; Kaltsas, G.; Komminoth, P.; Scoazec, J.; Salazar, R.; Sauvanet, A.; Kianmanesh, R. ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms: Functional pancreatic endocrine tumor syndromes. Neuroendocrinol., 2012, 95, 98-119.
Allisy-Roberts, P.; Williams, J.; Farr, R. Farr’s physics for medical Imaging; Saunders: Edinburgh, 2008.
Bushberg, J. The essential physics of medical imaging; Lippincott Williams & Wilkins, 2012. (3rd ed.).
Mansour, J.; Chen, H. Pancreatic endocrine tumors. J. Surg. Res., 2004, 120(1), 139-161.
Pitre, J.; Soubrane, O.; Palazzo, L.; Chapuis, Y. Endoscopic ultrasonography for the preoperative localization of insulinomas. Pancreas, 1996, 13(1), 55-60.
Anderson, M.; Carpenter, S.; Thompson, N.; Nostrant, T.; Elta, G.; Scheiman, J. Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas. Am. J. Gastroenterol., 2000, 95, 2271-2277.
Bang, J.Y.; Hebert-Magee, S.; Navaneethan, U.; Hasan, M.K.; Hawes, R.; Varadarajulu, S. EUS-guided fine needle biopsy of pancreatic masses can yield true histology: results of a randomised trial. Gut, 2017, 67(12), 2081-2084.
Kopelman, Y.; Marmor, S.; Ashkenazi, I.; Fireman, Z. Value of EUS-FNA cytological preparations compared with cell block sections in the diagnosis of pancreatic solid tumours. Cytopathology, 2011, 22, 174-178.
Yang, Y.; Li, L.; Qu, C.; Liang, S.; Zeng, B.; Luo, Z. Endoscopic ultrasound-guided fine needle core biopsy for the diagnosis of pancreatic malignant lesions: A systematic review and meta-analysis. Sci. Rep., 2016, 6, 22978.
D’Onofrio, M. Contrast-Enhanced ultrasound of the pancreas. World J. Radiol., 2010, 2, 97.
Greis, C. Technology overview: Sonovue. Eur. Radiol. Suppl., 2004, 14, 11-15.
Malagò, R.; D’Onofrio, M.; Zamboni, G.A.; Faccioli, N.; Falconi, M.; Boninsegna, L.; Mucelli, R.P. Contrast-enhanced sonography of nonfunctioning pancreatic neuroendocrine tumors. AJR Am. J. Roentgenol., 2009, 192(2), 424-430.
D’Onofrio, M.; Crosara, S.; De Robertis, R.; Canestrini, S.; Mucelli, R.P. Contrast-Enhanced ultrasound of focal liver lesions. AJR Am. J. Roentgenol., 2015, 205, 56-66.
Richmond, C. Sir Godfrey Hounsfield. BMJ Brit. Med. J., 2004, 329(7467), 687-687.
Feldman, M.K.; Ganghi, N.S. Imaging evaluation of pancreatic cancer. Surg. Clin. North Am., 2016, 96, 1235-1256.
Chen, J.; Kachniarz, B.; Gilani, S.; Shin, J. Risk of malignancy associated with head and neck ct in children. Otolaryng. Head Neck, 2014, 151, 554-566.
Kobayashi, D.; Takahashi, O.; Ueda, T.; Deshpande, G.; Arioka, H.; Fukui, T. Risk factors for adverse reactions from contrast agents for computed tomography. BMC Med. Inform. Decis., 2013, 13, 18.
Javadi, S.; Menias, C.O.; Korivi, B.R.; Shaaban, A.M.; Patnana, M.; Alhalabi, K.; Elsayes, K.M. Pancreatic calcifications and calcified pancreatic masses: Pattern recognition approach on CT. AJR Am. J. Roentgenol., 2017, 209, 77-87.
Stoupis, C.; Taylor, H.M.; Paley, M.R.; Buetow, P.C.; Marre, S.; Baer, H.U.; Vock, P.; Ros, P.R. The rocky liver: Radiologic-pathologic correlation of calcified hepatic masses. Radiographics, 1998, 18, 675-685.
Stafford-Johnson, D.; Francis, I.; Eckhauser, F.; Knol, J.; Chang, A. Dual-phase helical CT of nonfunctioning islet cell tumors. J. Comput. Assist. Tomogr., 1998, 22(2), 335-339.
Woods, M.S.; Traverso, L.W.; Kozarek, R.A.; Brandabur, J.; Hauptmann, E. Successful treatment of bleeding pseudoaneurysms of chronic pancreatitis. Pancreas, 1995, 10, 22-30.
Laing, C.J.; Tobias, T.; Rosenblum, D.I.; Banker, W.L.; Tseng, L.; Tamarkin, S.W. Acute gastrointestinal bleeding: Emerging role of multidetector ct angiography and review of current imaging techniques. Radiographics, 2007, 27, 1055-1070.
Mujica, V.R.; Barkin, J.S.; Go, V.L.W. Acute pancreatitis secondary to pancreatic carcinoma. Pancreas, 2000, 21, 329-332.
Rinck, P. The history of MRI, 8th ed; Magnetic Resonance in Medicine, 2014. (8th ed.).
Thoeni, R.; Mueller-Lisse, U.; Chan, R.; Do, N.; Shyn, P. Detection of small, functional islet cell tumors in the pancreas: Selection of MR imaging sequences for optimal sensitivity. Radiology, 2000, 214(2), 483-490.
Huppertz, A.; Haraida, S.; Kraus, A.; Zech, C.J.; Scheidler, J.; Breuer, J.; Helmberger, T.K.; Reiser, M.F. Enhancement of focal liver lesions at gadoxetic acid-enhanced MR imaging: correlation with histopathologic findings and spiral CT-initial observations. Radiology, 2005, 234(2), 468-478.
Thoeni, R.; Mueller-Lisse, U.; Chan, R.; Do, N.; Shyn, P. Detection of small, functional islet cell tumors in the pancreas: Selection of MR imaging sequences for optimal sensitivity. Radiology, 2000, 214(2), 483-490.
Sommer, W.H.; Zech, C.J.; Bamberg, F.; Auernhammer, C.J.; Helck, A.; Paprottka, P.M.; Notohamiprodjo, M.; Reiser, M.F.; Herrmann, K.A. Fluid-fluid level in hepatic metastases: A characteristic sign of metastases of neuroendocrine origin. Eur. J. Radiol., 2012, 81(9), 2127-2132.
Beger, H.; Nakao, A.; Neoptolemos, J.; Peng, S.; Sarr, M. Pancreatic cancer, cystic neoplasms and endocrine tumors: Diagnosis and management; Wiley-Blackwell, 2015. 1st ed
Whipple, A.; Frantz, V. Adenoma of islet cells with hyperinsulinism. Ann. Surg., 1935, 101, 1299-1365.
Fidler, J.L.; Fletcher, J.; Reading, C.; Andrews, J.C.; Thompson, G.B.; Grant, C.S.; Service, F.J. Preoperative detection of pancreatic insulinomas on multiphasic helical CT. AJR Am. J. Roentgenol., 2003, 181(3), 775-780.
Chung, M.; Choi, B.; Han, J.; Chung, J.; Han, M.; Bae, S. Functioning islet cell tumor of the pancreas: Localization with dynamic spiral CT. Acta Radiol., 1997, 38(1), 135-138.
Zollinger, R.; Ellison, E. Primary peptic ulcerations of the jejunum associated with islet cell tumors of the pancreas. Ann. Surg., 1955, 142(4), 709-723. discussion, 724-728.
Stabile, B.; Morrow, D.; Passaro, E. The Gastrinoma Triangle: Operative Implications. Am. J. Surg., 1984, 147, 25-31.
Klöppel, G.; Anlauf, M. Pancreatic endocrine tumors. Pathol. Case Rev., 2006, 11(6), 256-267.
Semelka, R.; Custodio, C.; Cem Balci, N.; Woosley, J. Neuroendocrine tumors of the pancreas: spectrum of appearances on MRI. J. Magn. Reson. Imaging, 2000, 11(2), 141-148.
Chastain, M. The glucagonoma syndrome: a review of its features and discussion of new perspectives. Am. J. Med. Sci., 2001, 321(5), 306-320.
Bloom, S.; Polak, J.; Pearse, A. Vasoactive intestinal peptide and watery-diarrhoea syndrome. Lancet, 1973, 2(7819), 14-16.
Ghaferi, A.; Chojnacki, K.; Long, W.; Cameron, J.; Yeo, C. Pancreatic VIPomas: Subject review and one institutional experience. J. Gastrointest. Surg., 2008, 12(2), 382-393.
Verner, J.; Morrison, A. Islet cell tumor and a syndrome of refractory watery diarrhea and hypokalemia. Am. J. Med., 1958, 25(3), 374-380.
Soga, J.; Yakuwa, Y. Vipoma/diarrheogenic syndrome: a statistical evaluation of 241 reported cases. J. Exp. Clin. Cancer Res., 1998, 17(4), 389-400.
Soga, J.; Yakuwa, Y. Somatostatinoma/inhibitory syndrome: A statistical evaluation of 173 reported cases as compared to other pancreatic endocrinomas. J. Exp. Clin. Cancer Res., 1999, 18(1), 13-22.
Gullo, L.; Migliori, M.; Falconi, M.; Pederzoli, P.; Bettini, R.; Casadei, R.; Delle Fave, G.; Corleto, V.D.; Ceccarelli, C.; Santini, D.; Tomassetti, P. Nonfunctioning pancreatic endocrine tumors: A multicenter clinical study. Am. J. Gastroenterol., 2003, 98(11), 2435-2439.
Evans, D.B.; Pisters, P.W.; Abbruzzese, J.L. Pancreatic cancer; Springer-Verlag, 2002. (1st ed)
Ichikawa, T.; Federle, M.; Ohba, S.; Ohtomo, K.; Sugiyama, A.; Fujimoto, H.; Haradome, H.; Araki, T. Atypical exocrine and endocrine pancreatic tumors (anaplastic, small cell, and giant cell types): CT and pathologic features in 14 patients. Abdom. Imaging, 2000, 25(4), 409-419.
Case courtesy of Dr Natalie Yang [Available at:, rID: 7115].

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Page: [135 - 155]
Pages: 21
DOI: 10.2174/1874471012666190214165845
Price: $65

Article Metrics

PDF: 43
PRC: 1