ENETS standardized (synoptic) reporting for radiological imaging in neuroendocrine tumours

Abstract

This expert consensus document represents an initiative by the European Neuroendocrine Tumor Society (ENETS) to provide guidance for synoptic reporting of radiological examinations critical to the diagnosis, grading, staging and treatment of neuroendocrine neoplasms (NENs). Template drafts for initial tumor staging and follow-up by computed tomography (CT) and magnetic resonance imaging (MRI) were established, based on existing institutional and organisational reporting templates relevant for NEN imaging, and applying the RadLex lexicon of radiological information (Radiological Society of North America), for consistency regarding the radiological terms. During the ENETS Scientific Advisory Board meeting 2018, the template drafts were subject to iterative interdisciplinary discussions among experts in imaging, surgery, gastroenterology, oncology and pathology. Members of the imaging group stated a strong preference for a combination of limited and standardised options by way of drop-down menus. Separate templates were produced for the initial work-up and for follow-up, respectively. To provide a detailed description of the radiological findings of the primary tumor and its local extension and spread, different templates were developed for bronchial, pancreatic and gastrointestinal NENs for CT and MRI, respectively. Each template was structured in 10 sections: clinical details, comparative imaging modality, acquisition technique, primary tumor findings, regional lymph node metastases, distant metastases, TNM classification, reference lesions according to RECIST 1.1, additional findings and conclusion. Two templates were developed for follow-up, for CT and MRI, respectively, and were specifically focused on assessment of therapy response. These included a qualitative response assessment, such as decrease of vascularisation and presence of necrosis, and a quantitative assessment according to RECIST 1.1 and the modified RECIST (mRECIST) for assessing tumor response following transarterial chemoembolisation.

Keywords: CT; MRI; neuroendocrine neoplasia; synoptic reporting.

FIGURE 1

A 58 year‐old patient with abdominal pains, nausea and postprandial vomiting. Transverse computed tomography images on arterial (A) and portal (B) phase with coronal reconstruction (C) show a enhancing mass in the ileum (arrows) with mesenteric lymph node involvement (arrowhead)

FIGURE 2

Transverse computed tomography images on arterial phase (A) with sagittal reconstruction using maximal intensity projection (B) show an involvement of the distal mesenteric artery branches (arrows) stage 2

FIGURE 3

Transverse computed tomography images on portal phase in transverse (A) with coronal reconstruction (B) show a desmoplastic reaction of the mesentery (three arrows) and signs of ischemia, including vascular ectasia, bowel wall thickening with enhancement and target appearance (arrow)

FIGURE 4

Transverse image on arterial phase shows a retrograde filling of hepatic veins (arrows) suggestive of a carcinoid heart disease