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- Title
Differential and prognostic MRI features of gallbladder neuroendocrine tumors and adenocarcinomas.
- Authors
Bae, Jae Seok; Kim, Se Hyung; Yoo, Jeongin; Kim, Haeryoung; Han, Joon Koo
- Abstract
<bold>Objectives: </bold>To identify MRI features that are helpful for the differentiation of gallbladder neuroendocrine tumors (GB-NETs) from gallbladder adenocarcinomas (GB-ADCs) and to evaluate their prognostic values.<bold>Methods: </bold>Between January 2008 and December 2018, we retrospectively enrolled patients who underwent MRI for GB malignancy. Two radiologists independently assessed the MRI findings and reached a consensus. Significant MRI features, which distinguish GB-NETs from GB-ADCs, were identified. Cox regression analyses were performed to find MRI features that were prognostic for overall survival.<bold>Results: </bold>There were 63 patients with GB-NETs (n = 21) and GB-ADCs (n = 42). Compared with GB-ADCs, GB-NETs more frequently demonstrated the following MRI features: well-defined margins, intact overlying mucosa, and thick rim contrast enhancement and/or diffusion restriction (ps < 0.001). Liver metastases were more common and demonstrated thick rim contrast enhancement and diffusion restriction in GB-NETs (ps < 0.001). Lymph node (LN) metastasis showed thick rim diffusion restriction more often in GB-NETs than in GB-ADCs (p = 0.009). On quantitative analysis, the sizes of the GB mass and metastatic LNs in GB-NETs were larger than those in GB-ADCs (p = 0.002 and p = 0.010, respectively). The ratio of apparent diffusion coefficient values between the lesion and the spleen was lower in the GB mass, liver metastases, and LN metastases of GB-NETs than those of GB-ADCs (p < 0.001, p = 0.017, and p < 0.001, respectively). Survival analysis revealed that a large metastatic LN (hazard ratio 1.737; 95% confidence interval, 1.112-2.712) was the only poor prognostic factor (p = 0.015).<bold>Conclusion: </bold>Several MRI features aided in differentiating between GB-NETs and GB-ADCs. A large metastatic LN was associated with poor survival.<bold>Key Points: </bold>• Compared with gallbladder adenocarcinomas (GB-ADCs), neuroendocrine tumors (GB-NETs) and their metastases to the liver and lymph nodes more frequently demonstrated a thick rim appearance on contrast-enhanced MRI and diffusion-weighted images. • The ratio of apparent diffusion coefficient values between the lesion and the spleen was significantly lower for the primary mass, liver metastases, and lymph node metastases of GB-NETs than for those of GB-ADCs. • A large metastatic lymph node was the only poor prognostic factor for overall survival in patients with GB-NETs and GB-ADCs.
- Subjects
UNITED Kingdom; NEUROENDOCRINE tumors; GALLBLADDER cancer; GALLBLADDER; LIVER metastasis; CONTRAST-enhanced magnetic resonance imaging; DIFFUSION coefficients
- Publication
European Radiology, 2020, Vol 30, Issue 5, p2890
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-019-06588-9