Abdominal Radiology

, Volume 44, Issue 3, pp 992–999 | Cite as

Differentiation of pancreatic neuroendocrine tumors from pancreas renal cell carcinoma metastases on CT using qualitative and quantitative features

  • Christian B. van der PolEmail author
  • Stefanie Lee
  • Scott Tsai
  • Natasha Larocque
  • Abdullah Alayed
  • Phillip Williams
  • Nicola Schieda



To assess qualitative and quantitative imaging features on enhanced CT that may differentiate pancreatic neuroendocrine tumors (PNETs) from pancreatic renal cell carcinoma (RCC) metastases.


This IRB-approved multi-center retrospective case–control study compared 43 resected PNETs and 28 resected RCC metastases with pre-operative enhanced CT identified consecutively between 2003 and 2017. Two blinded radiologists (R1/R2) independently assessed tumor location, attenuation (relative to pancreas), composition (solid/cystic/mixed), homogeneity (homogeneous/heterogeneous), calcification, multiplicity, and for main pancreatic duct (MPD) dilation. Tumors were segmented for quantitative texture analysis. Data were analyzed with Chi square, logistic regression, and receiver operating characteristic (ROC). Inter-observer agreement was assessed (Cohen’s kappa).


There was no difference in age, gender, location, attenuation, or composition (P > 0.05) between groups. PNETs were larger than RCC metastases (37 ± 23 mm vs. 26 ± 21 mm, P = 0.038), more frequently solitary (P < 0.001), subjectively more heterogeneous (P = 0.033/0.144, R1/R2), and associated with calcification (P = 0.002/0.004) and MPD dilation (P = 0.025/0.006). Agreement for subjective features was moderate-to-almost perfect (K = 0.4879–0.9481). Quantitative texture analysis showed higher entropy in PNETs (6.32 ± 0.49 versus 5.96 ± 0.53; P = 0.004) with no difference in other features studied (P > 0.05). Entropy had ROC area under the curve for diagnosis of PNET of 0.77 ± 0.06, with optimal sensitivity/specificity of 71.4/79.1%.


Compared to pancreatic RCC metastases, PNETs are larger, more frequently solitary, contain calcification, show MPD dilation, and are subjectively and quantitatively more heterogeneous tumors.


Pancreatic neuroendocrine tumor Renal cell carcinoma Pancreas X-ray computed tomography 



Contrast-enhanced CT


Digital imaging and communications in medicine


Endoscopic ultrasound


Fine needle aspiration


Journal of Magnetic Resonance Imaging


Main pancreatic duct


Pancreatic neuroendocrine tumor


Renal cell carcinoma


Region of interest



All authors have no grants, disclosures, or other assistance to acknowledge.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This retrospective image review study was approved by the institution review boards with a waiver of informed consent for retrospective image analysis.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health SciencesMcMaster UniversityHamiltonCanada
  2. 2.Department of Diagnostic ImagingThe Ottawa Hospital- Civic CampusOttawaCanada
  3. 3.Department of Pathology and Molecular Medicine, Juravinski Hospital and Cancer Centre, Hamilton Health SciencesMcMaster UniversityHamiltonCanada

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