Pancreatic Neuroendocrine Tumors in Patients with Multiple Endocrine Neoplasia Type 1: Diagnostic Value of Different MRI Sequences

Francesco Verde; Roberta Galatola; Valeria Romeo; Teresa Perillo; Raffaele Liuzzi; Luigi Camera; Michele Klain; Roberta Modica; Antongiulio Faggiano; Vincenzo Napolitano; Annamaria Colao; Arturo Brunetti; Simone Maurea

doi:10.1159/000509647

Pancreatic Neuroendocrine Tumors in Patients with Multiple Endocrine Neoplasia Type 1: Diagnostic Value of Different MRI Sequences

Neuroendocrinology. 2021;111(7):696-704. doi: 10.1159/000509647. Epub 2020 Jun 24.

Affiliations

¹ Department of Advanced Biomedical Sciences, University of Naples "Federico II,", Naples, Italy.
² Department of Advanced Biomedical Sciences, University of Naples "Federico II,", Naples, Italy, valeria.romeo@unina.it.
³ Institute of Biostructures and Bioimaging of the National Council of Research (CNR), Naples, Italy.
⁴ Department of Clinical Medicine and Surgery, University of Naples "Federico II,", Naples, Italy.
⁵ Department of Translational Medical Sciences, University of Campania "L. Vanvitelli,", Naples, Italy.

PMID: 32580192
DOI: 10.1159/000509647

Abstract

Background: MRI is a useful imaging modality to assess the presence of pancreatic neuroendocrine tumors (PNETs), allowing repeat monitoring examinations in multiple endocrine neoplasia type 1 (MEN-1) patients.

Objectives: We aimed to compare the diagnostic accuracy of conventional MRI sequences to identify which sequence better depicts the presence of PNETs in MEN-1 patients.

Method: We performed a retrospective analysis of consecutive MEN-1 patients who underwent a conventional MRI protocol to monitor previously proven PNETs. MRI sequences T1-w chemical shift (CS), T2-w HASTE, fat-suppressed (FS) T2-w HASTE, diffusion-weighted imaging (DWI), and pre- and post-contrast FS T1-w sequences were independently analyzed by 2 experienced radiologists using a 3-grade score (no lesion, uncertain lesion, and certain lesion); lesion size and signal intensity were recorded. A Friedman ANOVA and a Wilcoxon pairwise test for the post hoc analysis were used. The sensitivity of each sequence was measured, and the results were analyzed with the χ2 test.

Results: We included 21 patients with a total of 45 PNETs proven by histology, endoscopic ultrasonography-guided fine-needle aspiration, CT, and nuclear medicine studies. A statistically significant (p < 0.01) difference was observed in the detection performance of each MRI sequence, particularly between DWI (91%) and T2-w FS (85%) sequences in comparison to the others (T1-w CS, T2-w, and pre- and post-contrast FS T1-w, ≤56% for all); no significant (p = 0.5) difference was found between the detection performance of DWI and T2-w FS sequences. No correlation was observed between the qualitative score of each sequence and lesion tumor size.

Conclusions: DWI and T2-w FS sequences proved to be the most accurate in the detection of PNETs, thus suggesting a role for an abbreviated MRI protocol without contrast medium administration for monitoring MEN-1 patients.

Keywords: Imaging; Magnetic resonance imaging; Multiple endocrine neoplasia type 1; Pancreas; Pancreatic neuroendocrine tumors.

MeSH terms

Adult
Aged
Female
Humans
Magnetic Resonance Imaging / methods
Magnetic Resonance Imaging / standards*
Male
Middle Aged
Multiple Endocrine Neoplasia Type 1 / diagnostic imaging*
Pancreatic Neoplasms / diagnostic imaging*
Retrospective Studies
Young Adult