Differentiation of duodenal gastrointestinal stromal tumors from hypervascular pancreatic neuroendocrine tumors in the pancreatic head using contrast-enhanced computed tomography
To determine useful contrast-enhanced computed tomography (CE-CT) features in differentiating duodenal gastrointestinal stromal tumors (duodenal GISTs) from hypervascular pancreatic neuroendocrine tumors in the pancreatic head (pancreatic head NETs).
Seventeen patients with pathologically confirmed duodenal GISTs and 25 with pancreatic NETs underwent preoperative CE-CT. CT image analysis included tumor size, morphology, and contrast enhancement. Receiver operating characteristic curves were performed, and cutoff values were calculated to determine CT findings with high sensitivity and specificity.
CT imaging showed duodenal GISTs with higher frequencies of tumor central location close to the duodenum and a predominantly solid tumor type when compared with pancreatic head NETs (p < 0.05 for both). Duodenal GISTs were larger than pancreatic head NETs (3.3 ± 0.9 cm vs. 2.5 ± 1.1 cm, p = 0.03). Duodenal GISTs had significantly lower CT attenuation values (112.9 ± 17.9HU vs. 137.4 ± 32.1HU, p < 0.01) at the arterial phase and higher CT attenuation values at the delayed phase (94.3 ± 7.9HU vs. 84.9 ± 10.4HU, p < 0.01) when compared with pancreatic head NETs. A CT attenuation value of ≤ 135 HU at the arterial phase (30 s) was 76% sensitive, 94.1% specific, and 83.3% accurate for the diagnosis of duodenal GISTs, while a CT attenuation value of ≥ 89.5 HU at the delayed phase (120 s) was 93.3% sensitive, 81.8% specific, and 76.2% accurate for the diagnosis of duodenal GISTs.
Tumor central location, size, texture, and contrast enhancement are valuable characteristics for the differentiation between duodenal GISTs and hypervascular pancreatic head NETs during preoperative examination.
KeywordsGastrointestinal stromal tumors Duodenum Neuroendocrine tumors Pancreas Computed tomography
We thank all authors for their continuous and excellent support with patient data collection, imaging analysis, statistical analysis, and valuable suggestions for the article.
Compliance with ethical standards
This study was supported by the Key Program of Research and Development of Jiangsu Province (BE2017772) and the National Natural Science Foundation of China (81471705; 81771899).
Conflict of interest
The authors declare that they have no conflict of interest.
Informed content statement
Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to CE-CT examinations by written consent.
- 6.Vasile D, Iancu G, Iancu RC, Simion G, Ciuluvică RC (2017) Duodenal gastrointestinal stromal tumor presenting as pancreatic head mass: a case report. Rom J Morphol Embryol 58:255–259Google Scholar
- 17.Singhal S, Prabhu NK, Sethi P, Moorthy S (2017) Role of multi detector computed tomography (MDCT) in preoperative staging of pancreatic carcinoma. J Clin Diagn Res 11:TC01–TC05Google Scholar
- 31.Xue HD, Liu W, Xiao Y, et al. (2011) Pancreatic and peri-pancreatic lesions mimic pancreatic islet cell tumor in multidetector computed tomography. Chin Med J (Engl) 124:1720–1725Google Scholar