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Abstract

The present study aimed to evaluate the diagnostic efficacy of pharmacokinetic parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in prospective evaluation of pancreatic neuroendocrine neoplasms (pNENs) grading. A total of 25 histologically proven patients with pNENs (30 lesions in total) who underwent DCE-MRI were enrolled. Lesions were divided into G1, G2 neuroendocrine tumor (NET) and G3 NET/neuroendocrine carcinoma (NEC) groups based on their histological findings according to 2017 World Health Organization Neuroendocrine Tumor Classification Guideline. In addition, the same numbers of tumor-free regions were selected using as normal control group. For each group, pharmacokinetic DCE parameters: volume transfer constant (Ktrans); contrast transfer rate constant (kep); extravascular extracellular space volume fraction (ve); and plasma volume fraction (vp) were calculated with Extended Tofts Linear model. Receiver operator characteristics analysis was conducted to assess the diagnostic efficacy of these parameters in pNENs grading. There were significant differences of Ktrans, kep, ve and vp between tumor-free areas and G1, G2 NET (P<0.001). The Ktrans and kep of G1 NET were significantly lower compared with those of G2 ones (P<0.005). The area under the curve of Ktrans and kep in differentiating G2 from G1 NET were 0.767 and 0.846, respectively. When Ktrans was >0.667 and kep >1.644, the sensitivity of diagnosing G2 NET was the lowest (53.85%), but the specificity was the highest (93.75%). When Ktrans was >0.667 or kep >1.644, the sensitivity of diagnosing G2 NET was 92.31%, but the specificity was 75.00%. Pharmacokinetic parameters of DCE-MRI, particularly the quantitative values of Ktrans and kep, are helpful for differentiating G2 NET from G1 ones.

Keywords: dynamic contrast-enhanced magnetic resonance imaging; pancreatic neuroendocrine neoplasms; pharmacokinetic parameters; quantitative evaluation; tumor grading.

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Figures

Figure 1.

Figure 1.

Flowchart showed the study enrollment.…

Figure 1.

Flowchart showed the study enrollment. Of all the 43 patients, 25 pNENs patients…

Figure 1. Flowchart showed the study enrollment. Of all the 43 patients, 25 pNENs patients confirmed by histopathology were finally included. pNENs, pancreatic neuroendocrine neoplasms.
Figure 2.

Figure 2.

Box plots showing significant difference…

Figure 2.

Box plots showing significant difference using ANOVA of (A) K trans and (B) …

Figure 2. Box plots showing significant difference using ANOVA of (A) Ktrans and (B) kep among tumor-free areas, G1 and G2 NET. Ktrans, volume transfer constant; kep, contrast transfer rate constant; NET, neuroendocrine tumor.
Figure 3.

Figure 3.

Representative imaging characteristics in a…

Figure 3.

Representative imaging characteristics in a 68-year-old female patient with G1 NET in the…

Figure 3. Representative imaging characteristics in a 68-year-old female patient with G1 NET in the tail of pancreas (white arrow). (A; contrast enhanced image) shows a markedly enhanced lesion in the tail of pancreas. (B) is Ktrans image (Ktrans=0.599). (C) is kep image (kep=1.441). (D) is ve image (ve=0.416). (E) is vp image (vp=0.463). NET, neuroendocrine tumor; Ktrans, volume transfer constant; kep, contrast transfer rate constant; ve, extravascular extracellular space volume fraction; vp, plasma volume fraction.
Figure 4.

Figure 4.

54-year-old female patient with G2…

Figure 4.

54-year-old female patient with G2 NET in the head of pancreas (white arrow).…

Figure 4. 54-year-old female patient with G2 NET in the head of pancreas (white arrow). (A; contrast enhanced image) shows two significantly enhanced masses in the head of pancreas. (B) is Ktrans image (Ktrans=0.722, 0.734). (C) is kep image (kep=1.783, 1.771). (D) is ve image (ve=0.406, 0.413). (E) is vp image (vp=0.438, 0.453). NET, neuroendocrine tumor; Ktrans, volume transfer constant; kep, contrast transfer rate constant; ve, extravascular extracellular space volume fraction; vp, plasma volume fraction.
Figure 5.

Figure 5.

Receiver operator characteristics (ROC) curves…

Figure 5.

Receiver operator characteristics (ROC) curves for K trans and k ep measurements in…

Figure 5. Receiver operator characteristics (ROC) curves for Ktrans and kep measurements in this study. The solid line represents the ROC curve of Ktrans, and the dotted line the ROC curve for kep. The area under the ROC curves (AUCs) for Ktrans and kep are 0.767 and 0.864 respectively. Ktrans, volume transfer constant; kep, contrast transfer rate constant.
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