Abdominal Radiology

, Volume 44, Issue 3, pp 867–876 | Cite as

Differentiation of duodenal gastrointestinal stromal tumors from hypervascular pancreatic neuroendocrine tumors in the pancreatic head using contrast-enhanced computed tomography

  • Shuai Ren
  • Xiao Chen
  • Jianhua Wang
  • Rui Zhao
  • Lina Song
  • Hui Li
  • Zhongqiu WangEmail author



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.


Gastrointestinal 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.

Supplementary material

261_2018_1803_MOESM1_ESM.doc (1.4 mb)
Supplementary material 1 (DOC 1401 kb)


  1. 1.
    Joensuu H, Hohenberger P, Corless CL (2013) Gastrointestinal stromal tumour. Lancet 382:973–983CrossRefGoogle Scholar
  2. 2.
    von Mehren M, Joensuu H (2018) Gastrointestinal stromal tumors. J Clin Oncol 36:136–143CrossRefGoogle Scholar
  3. 3.
    Sugase T, Takahashi T, Nakajima K, et al. (2016) Clinicopathological characteristics, surgery and survival outcomes of patients with duodenal gastrointestinal stromal tumors. Digestion 94:30–36CrossRefGoogle Scholar
  4. 4.
    Slavik T, Du Plessis J, Sparaco A, Van Der Merwe SW (2014) Duodenal gastrointestinal stromal tumor with epithelioid and neural features mimicking a primary pancreas head neuroendocrine tumor. Pancreas 43:482–483CrossRefGoogle Scholar
  5. 5.
    Kwon SH, Cha HJ, Jung SW, et al. (2007) A gastrointestinal stromal tumor of the duodenum masquerading as a pancreatic head tumor. World J Gastroenterol 13:3396–3399CrossRefGoogle Scholar
  6. 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
  7. 7.
    Shinya T, Inai R, Tanaka T, et al. (2017) Small bowel neoplasms: enhancement patterns and differentiation using post-contrast multiphasic multidetector CT. Abdom Radiol 42:794–801CrossRefGoogle Scholar
  8. 8.
    Zamboni GA, Ambrosetti MC, Zivelonghi C, et al. (2017) Solid non-functioning endocrine tumors of the pancreas: correlating computed tomography and pathology. HPB 19:986–991CrossRefGoogle Scholar
  9. 9.
    Kim JH, Eun HW, Kim YJ, et al. (2016) Pancreatic neuroendocrine tumour (PNET): staging accuracy of MDCT and its diagnostic performance for the differentiation of PNET with uncommon CT findings from pancreatic adenocarcinoma. Eur Radiol 26:1338–1347CrossRefGoogle Scholar
  10. 10.
    Bormann F, Wild W, Aksoy H, et al. (2014) A pancreatic head tumor arising as a duodenal GIST: a case report and review of the literature. Case Rep Med 2014:420295CrossRefGoogle Scholar
  11. 11.
    Uchida H, Sasaki A, Iwaki K, et al. (2005) An extramural gastrointestinal stromal tumor of the duodenum mimicking a pancreatic head tumor. J Hepatobiliary Pancreat Surg 12:324–327CrossRefGoogle Scholar
  12. 12.
    Kwon HJ (2010) Extra-gastrointestinal stromal tumor of the pancreas: report of a case. Ann Hepatobiliary Pancreat Surg 21:237–242CrossRefGoogle Scholar
  13. 13.
    Valsangkar N, Sehdev A, Misra S, et al. (2015) Current management of gastrointestinal stromal tumors: surgery, current biomarkers, mutations, and therapy. Surgery 158:1149–1164CrossRefGoogle Scholar
  14. 14.
    Sahani DV, Bonaffini PA, Fernández-Del Castillo C, Blake MA (2013) Gastroenteropancreatic neuroendocrine tumors: role of imaging in diagnosis and management. Radiology 266:38–61CrossRefGoogle Scholar
  15. 15.
    Beger HG (2018) Benign tumors of the pancreas—radical surgery versus parenchyma-sparing local resection—the challenge facing surgeons. J Gastrointest Surg 22:562–566CrossRefGoogle Scholar
  16. 16.
    Cloyd JM, Poultsides GA (2015) Non-functional neuroendocrine tumors of the pancreas: advances in diagnosis and management. World J Gastroenterol 21:9512–9525CrossRefGoogle Scholar
  17. 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
  18. 18.
    Kim C, Byun JH, Hong SM, et al. (2017) A comparison of enhancement patterns on dynamic enhanced CT and survival between patients with pancreatic neuroendocrine tumors with and without intratumoral fibrosis. Abdom Radiol 42:2835–2842CrossRefGoogle Scholar
  19. 19.
    Mönnings P, Belyaev O, Uhl W, et al. (2017) Criteria for determining malignancy in pancreatic intraductal papillary mucinous neoplasm based on computed tomography. Digestion 94:230–239CrossRefGoogle Scholar
  20. 20.
    Jang SK, Kim JH, Joo I, et al. (2015) Differential diagnosis of pancreatic cancer from other solid tumours arising from the periampullary area on MDCT. Eur Radiol 25:2880–2888CrossRefGoogle Scholar
  21. 21.
    Klimstra DS, Modlin IR, Coppola D, Lloyd RV, Suster S (2010) The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. Pancreas 39:707–712CrossRefGoogle Scholar
  22. 22.
    Belousova E, Karmazanovsky G, Kriger A, et al. (2017) Contrast-enhanced MDCT in patients with pancreatic neuroendocrine tumours: correlation with histological findings and diagnostic performance in differentiation between tumour grades. Clin Radiol 72:150–158CrossRefGoogle Scholar
  23. 23.
    Jeon SK, Lee JM, Joo I, et al. (2017) Nonhypervascular pancreatic neuroendocrine tumors: differential diagnosis from pancreatic ductal adenocarcinomas at MR imaging-retrospective cross-sectional study. Radiology 284:77–87CrossRefGoogle Scholar
  24. 24.
    Kim DW, Kim HJ, Kim KW, 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 25:1375–1383CrossRefGoogle Scholar
  25. 25.
    Raman SP, Hruban RH, Cameron JL, Wolfgang CL, Fishman EK (2012) Pancreatic imaging mimics: part 2, pancreatic neuroendocrine tumors and their mimics. Am J Roentgenol 199:309–318CrossRefGoogle Scholar
  26. 26.
    Verde F, Hruban RH, Fishman EK (2017) Small bowel gastrointestinal stromal tumors. J Comput Assist Tomogr 41:407–411CrossRefGoogle Scholar
  27. 27.
    Miettinen M, Kopczynski J, Makhlouf HR, et al. (2003) Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the duodenum: a clinicopathologic, immunohistochemical, and molecular genetic study of 167 cases. Am J Surg Pathol 27:625–641CrossRefGoogle Scholar
  28. 28.
    Cai PQ, Lv XF, Tian L, et al. (2015) CT characterization of duodenal gastrointestinal stromal tumors. Am J Roentgenol 204:988–993CrossRefGoogle Scholar
  29. 29.
    Park HS, Kim SY, Hong SM, et al. (2016) Hypervascular solid-appearing serous cystic neoplasms of the pancreas: differential diagnosis with neuroendocrine tumours. Eur Radiol 26:1348–1358CrossRefGoogle Scholar
  30. 30.
    Lee NK, Kim S, Kim GH, et al. (2010) Hypervascular subepithelial gastrointestinal masses: CT-pathologic correlation. RadioGraphics 30:1915–1934CrossRefGoogle Scholar
  31. 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
  32. 32.
    Takumi K, Fukukura Y, Higashi M, et al. (2015) Pancreatic neuroendocrine tumors: correlation between the contrast-enhanced computed tomography features and the pathological tumor grade. Eur J Radiol 84:1436–1443CrossRefGoogle Scholar
  33. 33.
    Fidler JL, Fletcher JG, Reading CC, et al. (2003) Preoperative detection of pancreatic insulinomas on multiphasic helical CT. Am J Roentgenol 181:775–780CrossRefGoogle Scholar
  34. 34.
    Dromain C, de Baere T, Lumbroso J, et al. (2005) Detection of liver metastases from endocrine tumors: a prospective comparison of somatostatin receptor scintigraphy, computed tomography, and magnetic resonance imaging. J Clin Oncol 23:70–78CrossRefGoogle Scholar
  35. 35.
    Jilesen APJ, Hoefnagel SJM, Busch ORC, et al. (2016) The influence of somatostatin receptor scintigraphy during preoperative staging of non-functioning pancreatic neuroendocrine tumours. Clin Radiol 71:537–542CrossRefGoogle Scholar
  36. 36.
    Koizumi S, Kida M, Yamauchi H, et al. (2016) Clinical implications of doubling time of gastrointestinal submucosal tumors. World J Gastroenterol 22:10015–10023CrossRefGoogle Scholar
  37. 37.
    Boutsen L, Jouret-Mourin A, Borbath I, van Maanen A, Weynand B (2018) Accuracy of pancreatic neuroendocrine tumour grading by endoscopic ultrasound-guided fine needle aspiration: analysis of a large cohort and perspectives for improvement. Neuroendocrinology 106:158–166CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
  2. 2.Department of PathologyThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina

Personalised recommendations