SpringerLink
Log in

Screening of pancreaticoduodenal endocrine tumours in patients with MEN 1: multidetector-row computed tomography vs. endoscopic ultrasound

Screening dei tumori endocrini pancreatico-duodenali nei pazienti con MEN-1: confronto tra TC multistrato ed eco-endoscopia

  • Abdominal Radiology / Radiologia Addominale
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

The authors compared multidetector-row computed tomography (MDCT) and endoscopic ultrasound (EUS) in the identification of pancreaticoduodenal endocrine tumours (PETs) in patients with multiple endocrine neoplasia type 1 (MEN 1).

Materials and methods

Fourteen consecutive patients (eight men and six women, aged 26–54 years) with MEN 1 underwent MDCT performed with a 4- (n=5) or 64- (n=9) detector-row system and EUS done with a radial transducer (7.5–20 MHz) within 7–28 days of each other. Prior to MDCT examination, patients were given 750 cc of water and asked to lie down in the right lateral decubitus for 15 min. Multiphase MDCT images were acquired both before and after the injection of nonionic iodinated contrast material (2 cc/kg) at an injection rate of 4 ml/s, with technical parameters and scan delay varying in relation to the system used. Images were all reconstructed at 3-mm intervals for the three phases (arterial, pancreatic and portal) and evaluated on a dedicated workstation.

Results

MDCT detected a total of 25 PETs (3–18 mm) in nine patients. Of these lesions, nine were situated within the duodenal wall and 16 in either the pancreatic head (n=3), body (n=7), or tail (n=6). Three additional lesions were detected retrospectively after EUS imaging. Most (18/22, 81%) were hypervascular nodules, and four appeared as either hypoattenuating or cystic lesions. EUS detected a total of 32 PETs (2–18 mm) in 11 patients. Most lesions (29/32, 90%) appeared hypoechoic and were situated in the duodenal wall (n=15) or in either the pancreatic head (n=10), body (n=6) or tail (n=1).

Conclusions

Our preliminary data indicate that MDCT is complementary to EUS in the identification of PETs in MEN-1 patients.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato confrontare la tomografia computerizzata (TC) multistrato (TCMS) e l’eco-endoscopia (EUS) nella identificazione dei tumori endocrini pancreatico-duodenali (TEPD) in pazienti affetti da multiple endocrine neoplasia tipo 1 (MEN-1).

Materiali e metodi

Quattordici pazienti consecutivi (8 maschi, 6 femmine; 26–54 anni) affetti da MEN-1 sono stati sottoposti sia a TCMS, eseguita con 4 (n=5) o 64 file di detettori (n=9), che ad EUS eseguita con strumento radiale (7,5–20 MHz) entro 7–28 giorni. Gli esami TC sono stati acquisiti con tecnica multifasica previa distensione gastro-duodenale con acqua ed assunzione del decubito laterale destro (15 min), prima e dopo iniezione a bolo (4 ml/s) di mezzo di contrasto (MdC) iodato idro-solubile non ionico (2 cc/kg) con parametri tecnici e ritardi di scansione variabili in funzione del tipo di apparecchiatura. Le immagini sono state ricostruite con spessori identici (3 mm) per le 3 fasi (arteriosa, pancreatica e portale) ed analizzate su workstation dedicata.

Risultati

Alla TCMS sono state riscontrate 16 lesioni nodulari (5–18 mm) a livello del pancreas (3 testa, 7 corpo e 6 coda) e 9 (3–7 mm) a carico della parete duodenale in 9 pazienti. Delle 25 formazioni nodulari, 22 sono state identificate prospetticamente (18 iper-, 4 ipo-ecogene o cistiche) e 3 alla luce del dato endoscopico. All’eco-endoscopia sono state riscontrate 32 formazioni nodulari (29 ipo-, 3 iso-ecogene) in 11 pazienti. Di queste, 17 (4–18 mm) a livello del pancreas (10 testa, 6 corpo, 1 coda) e 15 (2–12 mm) a livello della parete duodenale.

Conclusioni

La TCMS rappresenta un utile complemento all’eco-endoscopia nella identificazione dei TEPD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References/Bibliografia

  1. Thakker RD (2000) Multiple endocrine neoplasia type 1. Endocrinol Metab Clin North Am 29:541–567

    Article  PubMed  CAS  Google Scholar 

  2. Guo SS, Sawicki MP (2001) Molecular and genetic mechanisms of tumorigenesis in multiple endocrine neoplasia type-1. Mol Endocrinol 15:1653–1664

    Article  PubMed  CAS  Google Scholar 

  3. Brandi ML, Gagel RF, Angeli A et al (2001) Guidelines for diagnosis and therapy of MEN type 1 and type 2. J Clin Endocrinol Metab 12:5658–5671

    Article  Google Scholar 

  4. Benson L, Ljunghall S, Akerstrom G (1987) Hyperparathyroidism presenting as the first lesion in multiple endocrine neoplasia type 1. Am J Med 82:731–737

    Article  PubMed  CAS  Google Scholar 

  5. Doherty GM (2003) Multiple endocrine neoplasia type 1: duodenopancreatic tumors. Surg Oncol 12:135–143

    Article  PubMed  Google Scholar 

  6. Thomas-Marques L, Murat A, Delemer B et al (2006) Groupe des Tumeurs Endocrines (GTE) Prospective endoscopic ultrasonographic evaluation of the frequency of nonfunctioning pancreaticoduodenal endocrine tumors in patients with multiple endocrine neoplasia type 1. Am J Gastroenterol 101:266–273

    Article  PubMed  Google Scholar 

  7. Wamsteker EJ, Gauger PG, Thompson NW, Scheiman JM (2003) EUS detection of pancreatic endocrine tumors in asymptomatic patients with type 1 multiple endocrine neoplasia. Gastrointest Endosc 58:531–535

    Article  PubMed  Google Scholar 

  8. Langer P, Kann PH, Fendrich V et al (2004) Prospective evaluation of imaging procedures for the detection of pancreaticoduodenal endocrine tumors in patients with multiple endocrine neoplasia type 1. World J Surg 28:1317–1322

    Article  PubMed  Google Scholar 

  9. Kouvaraki M, Shapiro S, Cote GJ et al (2006) Management of pancreatic endocrine tumors in multiple endocrine neoplasia type 1. World J Surg 30:643–653

    Article  PubMed  Google Scholar 

  10. Helleman, Hennings J, Akerstrom G, Skogseid B (2005) Endoscopic ultrasonography for evaluation of pancreatic tumors in multiple endocrine neoplasia type 1. Br J Surg 92:1508–1512

    Article  Google Scholar 

  11. 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

    PubMed  CAS  Google Scholar 

  12. Gouya H, Vignaux O, Augui J et al (2003) CT, endoscopic sonography and a combined protocol for preoperative evaluation of pancreatic insulinomas. AJR Am J Roentegenol 181:987–992

    Google Scholar 

  13. Liu Y, Song Q, ** HT et al (2009) The value of multidetector-row CT in the pre-operative detection of pancreatic insulinomas. Radiol Med 114:1232–1238

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  15. Zimmer T, Scherubl H, Faiss S et al (2000) Endoscopic ultrasonography of neuroendocrine tumours. Digestion 62:45–50

    Article  PubMed  Google Scholar 

  16. Trump D, Farren B, Wooding C et al (1996) Clinical studies of multiple endocrine neoplasia type 1 (MEN1). Q J Med 89:653–659

    CAS  Google Scholar 

  17. Buscail L (1995) Endoscopic ultrasonography in pancreatobiliary disease using radial instruments. Gastrointest Endosc Clin N Am 5:781–787

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  19. Tublin ME, Tessler FN, Cheng SL et al (1999) Effect of injection rate of contrast medium on pancreatic and hepatic helical CT. Radiology 210:97–101

    PubMed  CAS  Google Scholar 

  20. Sandstede JJ, Tschammler A, Beer M et al (2001) Optimization of automatic bolus tracking for timing of arterial phase of helical liver CT. Eur Radiol 11:1396–1400

    Article  PubMed  CAS  Google Scholar 

  21. Kann PH, Wirkus B, Keth A et al (2003) Pitfalls in endosonographic imaging of suspected insulinomas: pancreatic nodules of unknown dignity. Eur J Endocrinol 148:531–534

    Article  PubMed  CAS  Google Scholar 

  22. Triponez F, Goudet P, Dosseh D et al (2006) Is surgery beneficial for MEN 1 patients with small (< 2cm), non-functional pancreaticoduodenal endocrine tumors? An analysis of 65 patients from the GTE. World J Surg 30:654–666

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dipartimento di Scienze Bio-Morfologiche e Funzionali, Sez. di Diagnostica per Immagini e Radioterapia (Ed. 10), Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131, Napoli, Italy

    L. Camera, S. Paoletta & M. Salvatore

  2. Istituto di Bioimmagini e Biostrutture (C.N.R.), Napoli, Italy

    C. Mollica

  3. Dipartimento di Endocrinologia e Oncologia Molecolare e Clinica, Università degli Studi di Napoli “Federico II”, Napoli, Italy

    F. Milone, A. Faggiano & A. Colao

  4. Dipartimento di Medicina Interna, Clinica e Sperimentale, Seconda Università di Napoli (SUN), Napoli, Italy

    V. Napolitano

  5. U.O.C. di Gastroenterologia ed Endoscopia Digestiva, P.O. dei Pellegrini, ASL NA1, Napoli, Italy

    L. De Luca

Authors
  1. L. Camera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Paoletta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Mollica
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Milone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. V. Napolitano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. De Luca
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Faggiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Colao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Salvatore
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Camera.

Additional information

The preliminary findings of this study were presented as an oral communication at the 2006 SIRM Congress. Radiol Med 111(Suppl 1) 2006

Rights and permissions

Reprints and permissions

About this article

Cite this article

Camera, L., Paoletta, S., Mollica, C. et al. Screening of pancreaticoduodenal endocrine tumours in patients with MEN 1: multidetector-row computed tomography vs. endoscopic ultrasound. Radiol med 116, 595–606 (2011). https://doi.org/10.1007/s11547-011-0636-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-011-0636-2

Keywords

Parole chiave

Search

Navigation