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Year : 2017  |  Volume : 6  |  Issue : 1  |  Page : 49-54

B-mode and contrast-enhancement characteristics of small nonincidental neuroendocrine pancreatic tumors

1 Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
2 Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg, Germany
3 Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
4 Medical Department, Helios Klinikum Meiningen, Meiningen, Germany
5 SRH Wald-Klinikum Gera, Gera, Germany
6 Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
7 Medical Department, Caritas-Krankenhaus, Uhlandstr. 7 D-97980 Bad Mergentheim, Germany
8 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
9 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
10 Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
11 Medical Department, Caritas-Krankenhaus, Uhlandstr. 7 D-97980 Bad Mergentheim, Germany; Sino-German Research Center of Ultrasound in Medicine, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, China

Correspondence Address:
Christoph F Dietrich
Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Uhlandstr. 7, D-97980 Bad Mergentheim, Germany

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2303-9027.200213

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Background and Objectives: 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. Patients and Methods: 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. Results: 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. Conclusion: 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.

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