Neuroendocrine liver metastases: Vascular patterns on triple-phase MDCT are indicative of primary tumour location

Eur J Radiol. 2017 Apr:89:156-162. doi: 10.1016/j.ejrad.2017.02.007. Epub 2017 Feb 9.

Abstract

Purpose: To re-evaluate and compare CT features of neuroendocrine liver metastases (NLM) from pancreatic (p) and enteric (e) gastroenteropancreatic (GEP) tumours.

Material and methods: From 2006-2013, all patients with proven GEP-neuroendocrine tumours (NETs) with at least one NLM, no previous treatment were included. On unenhanced, arterial and portal phases, NLMs were characterized as hypo-, iso- or hyperattenuating in consensus by 2 radiologists blinded to clinical data. Enhancement patterns (EP) corresponded to the combination of arterial/portal CT attenuation.

Results: 78 patients (43 men, 55%, mean 56±13 yo) and 559NLMs were analyzed. pNLMs were more frequently hypoattenuating on unenhanced CT than eNLMs (72% vs. 57%, p<0.001). 70% of the lesions were hypervascular with no significant difference between pNLMs and eNLMs (p=0.32). eNLMs were more frequently hypoattenuating on portal phase than pNLMs (88% vs. 56%, p<0.001). eNLMs were more frequently hyper/hypo than pNLMs (56% vs. 28%, p<0.001). pNLMs were more frequently hyper/iso than eNLMs (33% vs. 8%, p<0.001). Other NLMs showed various patterns, including hypo/hypo in 12%.

Conclusion: Most NLMs of GEP tumours are hypervascular but the enhancement pattern on multiphasic CT depends on the primary tumour. These differences are helpful when the primary tumour has not been diagnosed.

Keywords: Enhancement pattern; Gastroenteropancreatic; Hypervascular; Metastasis; Neuroendocrine tumour; Oncology; Primary tumour.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Intestinal Neoplasms / chemistry*
  • Intestinal Neoplasms / secondary
  • Liver Neoplasms / blood supply*
  • Liver Neoplasms / pathology
  • Liver Neoplasms / secondary
  • Magnetic Resonance Angiography
  • Male
  • Middle Aged
  • Multidetector Computed Tomography
  • Multimodal Imaging
  • Neuroendocrine Tumors / blood supply*
  • Neuroendocrine Tumors / chemistry
  • Neuroendocrine Tumors / pathology
  • Neuroendocrine Tumors / secondary
  • Pancreatic Neoplasms / chemistry*
  • Pancreatic Neoplasms / secondary
  • Stomach Neoplasms / chemistry*
  • Stomach Neoplasms / secondary
  • Young Adult

Supplementary concepts

  • Gastro-enteropancreatic neuroendocrine tumor