E Belousova1, G Karmazanovsky2, A Kriger3, D Kalinin4, L Mannelli5, A Glotov4, N Karelskaya6, O Paklina7, A Kaldarov3. 1. Department of Radiology, A.V. Vishnevsky Institute of Surgery, Moscow, Russia; Department of Radiology, Faculty of Postgraduate Professional Training of Physicians, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. Electronic address: dr.elena.belousova@gmail.com. 2. Department of Radiology, A.V. Vishnevsky Institute of Surgery, Moscow, Russia; Department of Radiology, Faculty of Postgraduate Professional Training of Physicians, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. 3. Department of Abdominal Surgery, A.V. Vishnevsky Institute of Surgery, Moscow, Russia. 4. Department of Pathology, A.V. Vishnevsky Institute of Surgery, Moscow, Russia. 5. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 6. Department of Radiology, A.V. Vishnevsky Institute of Surgery, Moscow, Russia. 7. Department of Pathology, A.V. Vishnevsky Institute of Surgery, Moscow, Russia; Department of Pathology, S.P. Botkin City Clinical Hospital, Moscow, Russia.
Abstract
AIM: To identify the multidetector computed tomography (MDCT) features of pancreatic neuroendocrine tumours (pNETs), which correlate with tumour histology and enable preoperative grading. MATERIALS AND METHODS: Thirty-nine patients with histologically confirmed pNET who underwent preoperative contrast-enhanced MDCT were included in this study. Nineteen tumours were classified as Grade 1 (G1) and 20 as Grade 2 (G2). Histopathology slides were reviewed to assess the intratumoural microvascular density (MVD) and the amount of tumour stroma. Computed tomography (CT) image analysis included tumour size, margin delineation, calcifications, homogeneity, contrast enhancement (CE) pattern, tumour absolute and relative enhancement, presence of cystic changes, pancreatic duct dilatation, regional and distant metastases. The diagnostic ability to predict tumour grade was measured for each MDCT finding and their combinations. RESULTS: The mean arterial enhancement ratio had a mean±standard deviation of 1.53±0.45 in G1 and 1.01±0.33 in G2 pNETs (p=0.0003) and correlated with intratumoural microvascular density (MVD; r=0.55, p=0.0002). Tissue stroma percentage did not correlate with imaging findings. Late CE of the tumour (the peak attenuation observed in the venous phase) was significantly associated with G2. Tumour size >20 mm, arterial enhancement ratio <1.1, and late CE showed 74.4%, 79.5%, and 74.4% accuracy, respectively, in diagnosing G2 tumours, while the accuracy of at least two of these criteria used in combination was 82%. Based on these results, a diagnostic algorithm was proposed, which showed high interobserver agreement (k=0.82) in the prediction of tumour grade. CONCLUSION: Contrast-enhanced MDCT features correlate with histological findings and enable the differentiation between G1 and G2 pNETs during preoperative examination.
AIM: To identify the multidetector computed tomography (MDCT) features of pancreatic neuroendocrine tumours (pNETs), which correlate with tumour histology and enable preoperative grading. MATERIALS AND METHODS: Thirty-nine patients with histologically confirmed pNET who underwent preoperative contrast-enhanced MDCT were included in this study. Nineteen tumours were classified as Grade 1 (G1) and 20 as Grade 2 (G2). Histopathology slides were reviewed to assess the intratumoural microvascular density (MVD) and the amount of tumour stroma. Computed tomography (CT) image analysis included tumour size, margin delineation, calcifications, homogeneity, contrast enhancement (CE) pattern, tumour absolute and relative enhancement, presence of cystic changes, pancreatic duct dilatation, regional and distant metastases. The diagnostic ability to predict tumour grade was measured for each MDCT finding and their combinations. RESULTS: The mean arterial enhancement ratio had a mean±standard deviation of 1.53±0.45 in G1 and 1.01±0.33 in G2 pNETs (p=0.0003) and correlated with intratumoural microvascular density (MVD; r=0.55, p=0.0002). Tissue stroma percentage did not correlate with imaging findings. Late CE of the tumour (the peak attenuation observed in the venous phase) was significantly associated with G2. Tumour size >20 mm, arterial enhancement ratio <1.1, and late CE showed 74.4%, 79.5%, and 74.4% accuracy, respectively, in diagnosing G2 tumours, while the accuracy of at least two of these criteria used in combination was 82%. Based on these results, a diagnostic algorithm was proposed, which showed high interobserver agreement (k=0.82) in the prediction of tumour grade. CONCLUSION: Contrast-enhanced MDCT features correlate with histological findings and enable the differentiation between G1 and G2 pNETs during preoperative examination.
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