Differentiation of pancreatic neuroendocrine carcinoma from pancreatic ductal adenocarcinoma using magnetic resonance imaging: The value of contrast-enhanced and diffusion weighted imaging
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Chuangen Guo1,*, Xiao Chen2,3,*, Zhongqiu Wang2, Wenbo Xiao1, Qidong Wang1, Ke Sun4 and Xiaoling Zhuge5
1Department of Radiology, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou 310003, China
2Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 2100029, China
3Division of Nephrology, Zhongshan Hospital Fudan University, Shanghai 200032, China
4Department of Pathology, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou 310003, China
5Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou 310003, China
*These authors have contributed equally to this work
Xiaoling Zhuge, email: email@example.com
Chuangen Guo, email: firstname.lastname@example.org
Keywords: pancreatic ductal adenocarcinoma, pancreatic neuroendocrine carcinoma, magnetic resonance imaging, diffusion-weighted imaging
Received: December 28, 2016 Accepted: April 05, 2017 Published: April 21, 2017
Pancreatic neuroendocrine carcinoma (PNEC) is often misdiagnosed as pancreatic ductal adenocarcinoma (PDAC). This retrospective study differentiated PNEC from PDAC using magnetic resonance imaging (MRI), including contrast-enhanced (CE) and diffusion-weighted imaging (DWI). Clinical data and MRI findings, including the T1/T2 signal, tumor boundary, size, enhancement degree, and apparent diffusion coefficient (ADC), were compared between 37 PDACs and 13 PNECs. Boundaries were more poorly defined in PDAC than PNEC (97.3% vs. 61.5%, p<0.01). Hyper-/isointensity was more common in PNEC than PDAC at the arterial (38.5% vs. 0.0), portal (46.2% vs. 2.7%) and delayed phases (46.2% vs. 5.4%) (all p<0.01). Lymph node metastasis (97.3% vs. 61.5%, p<0.01) and local invasion/distant metastasis (86.5% vs. 46.2%, p<0.01) were more common in PDAC than PNEC. Enhancement degree via CE-MRI was higher in PNEC than PDAC at the arterial and portal phases (p<0.01). PNEC ADC values were lower than those of normal pancreatic parenchyma (p<0.01) and PDAC (p<0.01). Arterial and portal phase signal intensity ratios and ADC values showed the largest areas under the receiver operating characteristic curve and good sensitivities (92.1%–97.2%) and specificities (76.9%–92.3%) for differentiating PNEC from PDAC. Thus the enhancement degree at the arterial and portal phases and the ADC values may be useful for differentiating PNEC from PDAC using MRI.
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