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Sporadic insulinomas on volume perfusion CT: dynamic enhancement patterns and timing of optimal tumour–parenchyma contrast

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess enhancement patterns of sporadic insulinomas on volume perfusion CT (VPCT), and to identify timing of optimal tumour–parenchyma contrast.

Methods

Consecutive patients who underwent VPCT for clinically suspected insulinomas were retrospectively identified. Patients with insulinomas confirmed by surgery were included, and patients with familial syndromes were excluded. Two radiologists evaluated VPCT images in consensus. Tumour–parenchyma contrast at each time point was measured, and timing of optimal contrast was determined. Time duration of hyperenhancement (tumour–parenchyma contrast >20 Hounsfield units, HU) was recorded. Perfusion parameters were evaluated.

Results

Three dynamic enhancement patterns were observed in 63 tumours: persistent hyperenhancement (hyperenhancement time window ≥10 s) in 39 (61.9%), transient hyperenhancement (hyperenhancement <10 s) in 19 (30.2%) and non-hyperenhancement in 5 (7.9%). Timing of optimal contrast was 9 s after abdominal aorta threshold (AAT) of 200 HU, with tumour–parenchyma contrast of 77.6 ± 57.2 HU. At 9 s after AAT, 14 (22.2%) tumours were non-hyperenhancing, nine of which had missed transient hyperenhancement. Insulinomas with transient and persistent hyperenhancement patterns had significantly increased perfusion.

Conclusions

Insulinomas have variable enhancement patterns. Tumour–parenchyma contrast is time-dependent. Optimal timing of enhancement is 9 s after AAT. VPCT enables tumour detection even if the hyperenhancement is transient.

Key points

• Enhancement patterns of insulinomas are variable and tumour–parenchyma contrast is time-dependent.

• An optimized single-phase scan found 77.8% tumours to be hyperenhancing.

• Hyperenhancing tumours increase to 84.1% and 87.3% with biphasic/triphasic scan.

• Volume perfusion CT enables detection of insulinomas with missed transient hyperenhancement.

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Abbreviations

AAT:

abdominal aorta threshold

DLP:

dose–length products

HU:

Hounsfield units

MEN:

multiple endocrine neoplasia

MDCT:

multidetector CT

ROI:

region of interest

VPCT:

volume perfusion CT

References

  1. Noone TC, Hosey J, Firat Z, Semelka RC (2005) Imaging and localization of islet-cell tumours of the pancreas on CT and MRI. Best Pract Res Clin Endocrinol Metab 19:195–211

    Article  PubMed  Google Scholar 

  2. Mohseni S (2001) Hypoglycemic neuropathy. Acta Neuropathol 102:413–421

    CAS  PubMed  Google Scholar 

  3. Munir A, Choudhary P, Harrison B, Heller S, Newell-Price J (2008) Continuous glucose monitoring in patients with insulinoma. Clin Endocrinol (Oxf) 68:912–918

    Article  CAS  Google Scholar 

  4. Metz DC, Jensen RT (2008) Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology 135:1469–1492

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Mehrabi A, Fischer L, Hafezi M et al (2014) A systematic review of localization, surgical treatment options, and outcome of insulinoma. Pancreas 43:675–686

    Article  PubMed  Google Scholar 

  6. Sa Cunha A, Beau C, Rault A et al (2007) Laparoscopic versus open approach for solitary insulinoma. Surg Endosc 21:103–108

    Article  PubMed  Google Scholar 

  7. Rockall AG, Reznek RH (2007) Imaging of neuroendocrine tumours (CT/MR/US). Best Pract Res Clin Endocrinol Metab 21:43–68

    Article  CAS  PubMed  Google Scholar 

  8. Graziani R, Brandalise A, Bellotti M et al (2010) Imaging of neuroendocrine gastroenteropancreatic tumours. Radiol Med 115:1047–1064

    Article  CAS  PubMed  Google Scholar 

  9. Horton KM, Hruban RH, Yeo C, Fishman EK (2006) Multi-detector row CT of pancreatic islet cell tumors. Radiographics 26:453–464

    Article  PubMed  Google Scholar 

  10. Van Hoe L, Gryspeerdt S, Marchal G, Baert AL, Mertens L (1995) Helical CT for the preoperative localization of islet cell tumors of the pancreas: value of arterial and parenchymal phase images. AJR Am J Roentgenol 165:1437–1439

    Article  PubMed  Google Scholar 

  11. King AD, Ko GT, Yeung VT et al (1998) Dual phase spiral CT in the detection of small insulinomas of the pancreas. Br J Radiol 71:20–23

    Article  CAS  PubMed  Google Scholar 

  12. Gusmini S, Nicoletti R, Martinenghi C et al (2007) Arterial vs pancreatic phase: which is the best choice in the evaluation of pancreatic endocrine tumours with multidetector computed tomography (MDCT)? Radiol Med 112:999–1012

    Article  CAS  PubMed  Google Scholar 

  13. Ichikawa T, Peterson MS, Federle MP et al (2000) Islet cell tumor of the pancreas: biphasic CT versus MR imaging in tumor detection. Radiology 216:163–171

    Article  CAS  PubMed  Google Scholar 

  14. Lin XZ, Wu ZY, Tao R et al (2012) Dual energy spectral CT imaging of insulinoma—value in preoperative diagnosis compared with conventional multi-detector CT. Eur J Radiol 81:2487–2494

    Article  PubMed  Google Scholar 

  15. Zhu L, Xue HD, Sun H et al (2016) Isoattenuating insulinomas at biphasic contrast-enhanced CT: frequency, clinicopathologic features and perfusion characteristics. Eur Radiol 10:3697–3705

    Article  Google Scholar 

  16. Khashab MA, Yong E, Lennon AM et al (2011) EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors. Gastrointest Endosc 73:691–696

    Article  PubMed  Google Scholar 

  17. Funama Y, Taguchi K, Utsunomiya D et al (2015) Simultaneous achievement of accurate CT number and image quality improvement for myocardial perfusion CT at 320-MDCT volume scanning. Phys Med 31:702–707

    Article  PubMed  Google Scholar 

  18. Gordic S, Puippe GD, Krauss B et al (2016) Correlation between dual-energy and perfusion CT in patients with hepatocellular carcinoma. Radiology 280:78–87

    Article  PubMed  Google Scholar 

  19. Thaiss WM, Haberland U, Kaufmann S et al (2016) Iodine concentration as a perfusion surrogate marker in oncology: further elucidation of the underlying mechanisms using volume perfusion CT with 80 kVp. Eur Radiol 9:2929–2936

    Article  Google Scholar 

  20. Fletcher JG, Wiersema MJ, Farrell MA et al (2003) Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology 229:81–90

    Article  PubMed  Google Scholar 

  21. Fidler JL, Fletcher JG, Reading CC et al (2003) Preoperative detection of pancreatic insulinomas on multiphasic helical CT. AJR Am J Roentgenol 181:775–780

    Article  CAS  PubMed  Google Scholar 

  22. Tatsumoto S, Kodama Y, Sakurai Y, Shinohara T, Katanuma A et al (2013) Pancreatic neuroendocrine neoplasm: correlation between computed tomography enhancement patterns and prognostic factors of surgical and endoscopic ultrasound-guided fine-needle aspiration biopsy specimens. Abdom Imaging 38:358–366

    Article  PubMed  Google Scholar 

  23. Cappelli C, Boggi U, Mazzeo S et al (2015) Contrast enhancement pattern on multidetector CT predicts malignancy in pancreatic endocrine tumours. Eur Radiol 25:751–759

    Article  PubMed  Google Scholar 

  24. Kim DW, Kim HJ et al (2015) Neuroendocrine neoplasms of the pancreas at dynamic enhanced CT: comparison between grade 3 neuroendocrine carcinoma and grade 1/2 neuroendocrine tumour. Eur Radiol 25:1375–1383

    Article  PubMed  Google Scholar 

  25. Kim DW, Kim HJ et al (2016) Prognostic value of CT findings to predict survival outcomes in patients with pancreatic neuroendocrine neoplasms: a single institutional study of 161 patients. Eur Radiol 26:1320–1329

    Article  PubMed  Google Scholar 

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Acknowledgements

The scientific guarantor of this publication is Professor Zheng-yu Jin. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding from the National Natural Science Foundation of China (General Program, No.81371608) and Health Industry Special Scientific Research Project (Nos. 201402001 and 201402019). No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. None of the study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No.1, Dongcheng District, Beijing, China

    Liang Zhu, Hua-dan Xue, Wei Liu, Xuan Wang, Hao Sun, Ping Li & Zheng-yu Jin

  2. Department of General Surgery, Peking Union Medical College Hospital, Shuaifuyuan No.1, Dongcheng District, Beijing, China

    Wen-ming Wu & Yu-pei Zhao

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  1. Liang Zhu
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  3. Hua-dan Xue
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  4. Wei Liu
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  6. Hao Sun
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  7. Ping Li
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Correspondence to Hua-dan Xue.

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Zhu, L., Wu, Wm., Xue, Hd. et al. Sporadic insulinomas on volume perfusion CT: dynamic enhancement patterns and timing of optimal tumour–parenchyma contrast. Eur Radiol 27, 3491–3498 (2017). https://doi.org/10.1007/s00330-016-4709-4

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  • DOI: https://doi.org/10.1007/s00330-016-4709-4

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