Braden Barbara, Jenssen Christian, D'Onofrio Mirko, Hocke Michael, Will Uwe, Möller Kathleen, Ignee Andre, Dong Yi, Cui Xin-Wu, Sãftoiu Adrian, Dietrich Christoph F
Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK.
Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg, Germany.
Endosc Ultrasound. 2017 Jan-Feb;6(1):49-54. doi: 10.4103/2303-9027.200213.
Imaging of the pancreas for detection of neuroendocrine tumors is indicated as surveillance in multiple endocrine neoplasia type 1 (MEN1) or if typical clinical symptoms combined with hormone production raise the suspicion of a neuroendocrine tumor. Endoscopic ultrasound (EUS) is considered the best imaging modality to detect small pancreatic tumors. However, little is known about how small pancreatic neuroendocrine tumors (pNETs) present on EUS.
In this multicenter study, we retrospectively analyzed the endosonographic characteristics of small pNETs which had been detected due to typical biochemistry and clinical symptoms or during surveillance of MEN 1. Only small pancreatic tumors ≤15 mm with histological confirmation as pNET were included. B-mode and contrast-enhanced ultrasound- and EUS patterns were analyzed.
Among 32 patients with histologically proven small pNETs, 7 patients had known MEN1. Among the pNETs, 20 were insulinoma, 2 gastrinoma, 3 glucagonoma, 6 nonfunctional in MEN1, and one PPoma. 94% of the pNET appeared hypoechogenic, only 1 isoechogenic and 1 hyperechogenic. After contrast injection, 90% of the pNETS showed hyperenhancement compared to the surrounding pancreatic parenchyma.
The high spatial resolution of EUS allows detection and even cytological confirmation of pNET <7 mm diameter. Hypoechogenicity in B-mode and hyperenhancement after injection of contrast agents are endosonographic characteristics of small pNET and present in >90% of pNETs.
胰腺成像用于检测神经内分泌肿瘤，适用于1型多发性内分泌腺瘤病（MEN1）的监测，或者当典型临床症状与激素分泌相结合引发神经内分泌肿瘤怀疑时。内镜超声（EUS）被认为是检测小胰腺肿瘤的最佳成像方式。然而，关于EUS上小胰腺神经内分泌肿瘤（pNETs）的表现知之甚少。
在这项多中心研究中，我们回顾性分析了因典型生化指标和临床症状或在MEN1监测期间检测到的小pNETs的内镜超声特征。仅纳入直径≤15mm且经组织学证实为pNET的小胰腺肿瘤。分析了B超、对比增强超声和EUS图像特征。
在32例经组织学证实的小pNETs患者中，7例患有已知的MEN1。在这些pNETs中，20例为胰岛素瘤，2例为胃泌素瘤，3例为胰高血糖素瘤，6例在MEN1中无功能，1例为胰多肽瘤。94%的pNET表现为低回声，仅1例等回声，1例高回声。注射造影剂后，90%的pNETs与周围胰腺实质相比表现为高增强。
EUS的高空间分辨率能够检测甚至细胞学确认直径<7mm的pNET。B超下低回声以及注射造影剂后的高增强是小pNET的内镜超声特征，且在>90%的pNETs中存在。
