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The role of multimodal imaging in guiding resectability and cytoreduction in pancreatic neuroendocrine tumors: focus on PET and MRI

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Abstract

Pancreatic neuroendocrine tumors (pNETs) are rare neoplasms that secrete peptides and neuro-amines. pNETs can be sporadic or hereditary, syndromic or non-syndromic with different clinical presentations and prognoses. The role of medical imaging includes locating the tumor, assessing its extent, and evaluating the feasibility of curative surgery or cytoreduction. Pancreatic NETs have very distinctive phenotypes on CT, MRI, and PET. PET have been demonstrated to be very sensitive to detect either well-differentiated pNETs using 68Gallium somatostatin receptor (SSTR) radiotracers, or more aggressive undifferentiated pNETS using 18F-FDG. A comprehensive interpretation of multimodal imaging guides resectability and cytoreduction in pNETs. The imaging phenotype provides information on the differentiation and proliferation of pNETs, as well as the spatial and temporal heterogeneity of tumors with prognostic and therapeutic implications. This review provides a structured approach for standardized reading and reporting of medical imaging studies with a focus on PET and MR techniques. It explains which imaging approach should be used for different subtypes of pNET and what a radiologist should be looking for and reporting when interpreting these studies.

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Abbreviations

ADC:

Apparent diffusion coefficient

AJCC:

American Joint Committee on Cancer

APUD:

Amine precursor uptake and decarboxylation

CEUS:

Contrast-enhanced ultra sound examination

CT:

Computed tomography

DOPA:

Dihydroxyphenylalanine

DOTATOC:

DOTA0-Phe1-Tyr3 octreotide

DWI:

Diffusion-weighted imaging

ENETs:

European Neuroendocrine Tumor Society

EUS:

Endoscopic ultrasound examination

18F-FDG:

18Fluoro-Fluorodeoxyglucose

68Ga:

Gallium-68

99mTc:

Technetium 99m

GLP-1:

Glucagon-like peptide 1

IACIG:

Intra-arterial injection of calcium

IOUS:

Intraoperative ultrasound examination

LM:

Liver metastases

MEN:

Multiple endocrine neoplasia syndrome

MRI:

Magnetic resonance imaging

NANETS:

North American Neuroendocrine Tumor Society

NF:

Neurofibromatosis

NET:

Neuroendocrine tumors

OS:

Overall survival

PDAC:

Pancreatic ductal adenocarcinoma

pNET:

Pancreatic tumor

SSTR:

Somatostatin receptor

SSTR-PET:

Somatostatin receptor PET

SSTR scintigraphy:

Somatostatin receptor scintigraphy

SUV:

Standard uptake value

TSC:

Tuberous sclerosis complex

US:

Ultrasound examination

VHL:

Von Hippel–Lindau syndrome

WHO:

World Health Organization

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Funding

L Dercle’s work was funded by a grant from Fondation Philanthropia, Geneva, Switzerland, and the Fondation Nuovo-Soldati.

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  1. Laura Rozenblum and Fatima-Zohra Mokrane contributed equally to the manuscript.

Authors and Affiliations

  1. Sorbonne Université, Service de Médecine Nucléaire, AP-HP, Hôpital La Pitié-Salpêtrière, 75013, Paris, France

    Laura Rozenblum

  2. Radiology Department, Toulouse University Hospital, 1 Avenue du Professeur Jean Poulhes, 31059, Toulouse, France

    Fatima-Zohra Mokrane, Paul Revel-Mouroz & Philippe Otal

  3. Department of Radiology, New York Presbyterian Hospital, Columbia University, New York, NY, USA

    Fatima-Zohra Mokrane, Binsheng Zhao, Lawrence H. Schwartz & Laurent Dercle

  4. Memorial Sloan Kettering Cancer Center, Molecular Imaging and Therapy Service, New York, NY, USA

    Randy Yeh

  5. Department of Imaging and Nuclear Medicine, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France

    Mathieu Sinigaglia

  6. Paris Sud University, Kremlin Bicêtre Hospital, Paris, France

    Florent Besson

  7. Department of Nuclear Medicine, Institut Curie-René Huguenin, Saint-Cloud, France

    Romain-David Seban

  8. Department of Endocrine Oncology, Hôpital Saint Louis, Paris, France

    Cecile N Chougnet

  9. UMR 1015, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, 94805, France

    Laurent Dercle

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Rozenblum, L., Mokrane, FZ., Yeh, R. et al. The role of multimodal imaging in guiding resectability and cytoreduction in pancreatic neuroendocrine tumors: focus on PET and MRI. Abdom Radiol 44, 2474–2493 (2019). https://doi.org/10.1007/s00261-019-01994-5

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