Liang Zhu1, Hua-Dan Xue2, Wei Liu1, Xuan Wang1, Xin Sui1, Qin Wang1, Daming Zhang1, Ping Li1, Zheng-Yu Jin1. 1. Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China. 2. Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China. bjdanna95@hotmail.com.
Abstract
OBJECTIVES: To determine key MDCT features for characterizing pancreatic neuroendocrine tumours (PNET) from their mimics, which manifest as enhancing pancreatic mass with normal serum CA19-9 level. METHODS: This retrospective study had institutional review board approval and informed consent was waived. Preoperative multiphase MDCT of 74 patients with enhancing pancreatic masses and normal serum CA19-9 levels were included. Surgical pathologies were PNET (n = 42), microcystic serous cystadenomas (m-SCN, n = 12) and solid pseudopapillary epithelial neoplasms (SPEN, n = 20). Two radiologists independently evaluated CT images with a checklist of findings. Frequencies of findings with each disease entity were compared. Diagnostic accuracy was assessed using the key MDCT features alone and in combination. Inter-observer agreement was evaluated. RESULTS: The most common findings for PNET were mosaic morphological pattern (33/42, 78.6%) and enhancement peak in pancreatic arterial phase (PAP, 32/42, 76.2%), for m-SCN were honeycomb pattern (9/12, 75.0%) and enhancement peak in PAP (10/12, 83.3%) and for SPEN were melting icecream pattern (16/20, 80.0%) and hypo-enhancement in all phases (18/20, 90.0). Using a combination of morphological patterns and enhancement features, PNET was identified with 88% sensitivity and 81% specificity, m-SCN was identified with 83% sensitivity and 94% specificity, and SPEN was identified with 90% sensitivity and 91% specificity. Inter-observer agreement concerning CT findings was good to excellent (κ = 0.68 to 0.81, all p < 0.01). CONCLUSIONS: Morphological features and enhancement patterns on MDCT are key features for characterizing enhancing pancreatic mass with normal serum CA19-9. PNET could be differentiated from its mimics with high accuracy.
OBJECTIVES: To determine key MDCT features for characterizing pancreatic neuroendocrine tumours (PNET) from their mimics, which manifest as enhancing pancreatic mass with normal serum CA19-9 level. METHODS: This retrospective study had institutional review board approval and informed consent was waived. Preoperative multiphase MDCT of 74 patients with enhancing pancreatic masses and normal serum CA19-9 levels were included. Surgical pathologies were PNET (n = 42), microcystic serous cystadenomas (m-SCN, n = 12) and solid pseudopapillary epithelial neoplasms (SPEN, n = 20). Two radiologists independently evaluated CT images with a checklist of findings. Frequencies of findings with each disease entity were compared. Diagnostic accuracy was assessed using the key MDCT features alone and in combination. Inter-observer agreement was evaluated. RESULTS: The most common findings for PNET were mosaic morphological pattern (33/42, 78.6%) and enhancement peak in pancreatic arterial phase (PAP, 32/42, 76.2%), for m-SCN were honeycomb pattern (9/12, 75.0%) and enhancement peak in PAP (10/12, 83.3%) and for SPEN were melting icecream pattern (16/20, 80.0%) and hypo-enhancement in all phases (18/20, 90.0). Using a combination of morphological patterns and enhancement features, PNET was identified with 88% sensitivity and 81% specificity, m-SCN was identified with 83% sensitivity and 94% specificity, and SPEN was identified with 90% sensitivity and 91% specificity. Inter-observer agreement concerning CT findings was good to excellent (κ = 0.68 to 0.81, all p < 0.01). CONCLUSIONS: Morphological features and enhancement patterns on MDCT are key features for characterizing enhancing pancreatic mass with normal serum CA19-9. PNET could be differentiated from its mimics with high accuracy.
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