Farchione Alessandra, Rufini Vittoria, Brizi Maria Gabriella, Iacovazzo Donato, Larghi Alberto, Massara Roberto Maria, Petrone Gianluigi, Poscia Andrea, Treglia Giorgio, De Marinis Laura, Giordano Alessandro, Rindi Guido, Bonomo Lorenzo
From the Institutes of *Radiology and †Nuclear Medicine, Department of Radiological Sciences; ‡Division of Endocrinology; §Digestive Endoscopy Unit; ∥Institute of Pathology; and ¶Institute of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy; and #Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Pancreas. 2016 Mar;45(3):345-54. doi: 10.1097/MPA.0000000000000461.
The aims of this study were to investigate the added value of diffusion-weighted imaging (DWI) in pancreatic neuroendocrine tumor (pNET) evaluation and to compare magnetic resonance imaging (MRI) to Ga-DOTANOC positron emission tomography/computed tomography (PET/CT) results.
Morphological MRI (T2-weighted [T2-w] + contrast-enhanced [CE] T1-w) and DWI (T2-w + DWI) and Ga-DOTANOC PET/CT in 25 patients/30 pNETs were retrospectively evaluated. Per-patient and per-lesion detection rates (pDR and lDR, respectively) were calculated. Apparent diffusion coefficient values were compared among pNET and surrounding and normal pancreas (control group, 18 patients). Apparent diffusion coefficient and standardized uptake value (SUV) values were compared among different grading and staging groups.
No statistically significant differences in PET/CT and MRI session detection rates were found (morphological MRI and DW-MRI, 88% pDR and 87% lDR; combined evaluation, 92% pDR and 90% lDR; Ga-DOTANOC PET/CT, 88% pDR and 80% lDR). Consensus reading (morphological/DW-MRI + PET/CT) improved pDR and lDR (100%). Apparent diffusion coefficient mean value was significantly lower compared with surrounding and normal parenchyma (P < 0.01). The apparent diffusion coefficient and SUV values of pNETs among different grading and staging groups were not statistically different.
Conventional MRI, DW-MRI + T2-w sequences, and Ga-DOTANOC PET/CT can be alternative tools in pNET detection. Diffusion-weighted MRI could be valuable in patients with clinical suspicion but negative conventional imaging findings. However, the consensus reading of the 3 techniques seems the best approach.
本研究旨在探讨扩散加权成像（DWI）在胰腺神经内分泌肿瘤（pNET）评估中的附加价值，并比较磁共振成像（MRI）与镓 - DOTANOC正电子发射断层扫描/计算机断层扫描（PET/CT）的结果。
回顾性评估25例患者/30个pNET的形态学MRI（T2加权[T2-w] + 对比增强[CE] T1-w）、DWI（T2-w + DWI）和镓 - DOTANOC PET/CT。计算每位患者和每个病灶的检测率（分别为pDR和lDR）。比较pNET与周围及正常胰腺（对照组，18例患者）的表观扩散系数值。比较不同分级和分期组之间的表观扩散系数和标准化摄取值（SUV）。
PET/CT和MRI检查的检测率无统计学显著差异（形态学MRI和DW-MRI，pDR为88%，lDR为87%；联合评估，pDR为92%，lDR为90%；镓 - DOTANOC PET/CT，pDR为88%，lDR为80%）。一致性读片（形态学/DW-MRI + PET/CT）提高了pDR和lDR（100%）。与周围和正常实质相比，表观扩散系数平均值显著降低（P < 0.01）。不同分级和分期组的pNET的表观扩散系数和SUV值无统计学差异。
传统MRI、DW-MRI + T2-w序列和镓 - DOTANOC PET/CT可作为pNET检测的替代工具。扩散加权MRI对临床怀疑但传统影像学检查结果阴性的患者可能有价值。然而，三种技术的一致性读片似乎是最佳方法。
