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. 2014 Apr;16(4):304-11.
doi: 10.1111/hpb.12139. Epub 2013 Aug 29.

Pancreatic neuroendocrine tumours: hypoenhancement on arterial phase computed tomography predicts biological aggressiveness

David J Worhunsky  1 , Geoffrey W Krampitz, Peter D Poullos, Brendan C Visser, Pamela L Kunz, George A Fisher, Jeffrey A Norton, George A Poultsides
Affiliations

Pancreatic neuroendocrine tumours: hypoenhancement on arterial phase computed tomography predicts biological aggressiveness

David J Worhunsky et al. HPB (Oxford). 2014 Apr.

Abstract

Background: Contrary to pancreatic adenocarcinoma, pancreatic neuroendocrine tumours (PNET) are commonly hyperenhancing on arterial phase computed tomography (APCT). However, a subset of these tumours can be hypoenhancing. The prognostic significance of the CT appearance of these tumors remains unclear.

Methods: From 2001 to 2012, 146 patients with well-differentiated PNET underwent surgical resection. The degree of tumour enhancement on APCT was recorded and correlated with clinicopathological variables and overall survival.

Results: APCT images were available for re-review in 118 patients (81%). The majority had hyperenhancing tumours (n = 80, 68%), 12 (10%) were isoenhancing (including cases where no mass was visualized) and 26 (22%) were hypoenhancing. Hypoenhancing PNET were larger, more commonly intermediate grade, and had higher rates of lymph node and synchronous liver metastases. Hypoenhancing PNET were also associated with significantly worse overall survival after a resection as opposed to isoenhancing and hyperenhancing tumours (5-year, 54% versus 89% versus 93%). On multivariate analysis of factors available pre-operatively, only hypoenhancement (HR 2.32, P = 0.02) was independently associated with survival.

Discussion: Hypoenhancement on APCT was noted in 22% of well-differentiated PNET and was an independent predictor of poor outcome. This information can inform pre-operative decisions in the multidisciplinary treatment of these neoplasms.

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Figures

Figure 1
Figure 1
Representative images of the 5 types of enhancement pattern on arterial phase computed tomography. Two images are shown for each type. Hyperenhancing, solid (a); Cystic with hyperenhancing rim (b); Isoenhancing or no mass visualized (c); Homogeneously hypoenhancing (d); Heterogeneous but mostly hypoenhancing with some peripheral enhancement (e)
Figure 2
Figure 2
Distribution of enhancement pattern on arterial phase computed tomography for 118 patients with pancreatic neuroendocrine tumor
Figure 3
Figure 3
Overall survival after resection of pancreatic neuroendocrine tumors, stratified by their degree of enhancement on arterial phase computed tomography
See this image and copyright information in PMC

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