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MRI of pancreatic neuroendocrine tumours

Departments of ¹Diagnostic Imaging and ²Endocrinology, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK

View larger version (108K): [in a new window]   Figure 1. A 51-year-old man with an insulinoma in the tail of the pancreas, showing the commonest signal intensity changes for islet sell tumours on the various MR sequences. (a) The T1 weighted spin echo image (TR/TE 500/14 ms) shows the typical low signal intensity pattern (curved black arrow). (b) On the T2 weighted fast spin echo image (TR/TE 6315/105 ms) the insulinoma (curved black arrow) shows typical high signal intensity for this sequence. (c) The fat saturated axial T1 weighted spin echo image (TR/TE 500/14 ms) shows the characteristic high signal ofthe pancreatic parenchyma using this sequence, resulting in increased conspicuity of the insulinoma (arrow). (d) Following iv gadolinium, the insulinoma (curved white arrow) shows enhancement greater than the pancreatic parenchyma on the fat saturated axial T1 weighted spin echo image (TR/TE 500/14 ms). Note adjacent splenic enhancement. (e) CT shows a vascular lesion (open arrow) with rim calcification, a feature not appreciated on MRI.

View larger version (130K): [in a new window]   Figure 2. A small non-functioning islet cell tumour in a patient with multiple endocrine neoplasia type 1. (a) Axial T1 weighted spin echo image, (b) axial T2 weighted fast spin echo image, and fat suppressed T1 weighted spin echo axial images before (c) and after (d) iv gadolinium, showing the typical signal intensity pattern for an islet cell tumour (arrow) on the various sequences, in addition to the marked enhancement following gadolinium.

View larger version (110K): [in a new window]   Figure 3. A 72-year-old man with an insulinoma in the tail of the pancreas. This lesion shows the unusual signal intensity pattern, with high signal on the fat saturated T1 weighted spin echo image. (a) Fat saturated T1 weighted spin echo image (TR/TE 500/16 ms) shows high signal intensity in this insulinoma (curved white arrow). (b) T2 weighted fast spin echo image (TR/TE 6000/102 ms) shows the insulinoma has a low intensity rim with an intermediate intensity centre (curved black arrow). (c) Contrast enhanced CT shows a markedly vascular tumour (arrow) in the tail of the pancreas.

View larger version (113K): [in a new window]   Figure 4. A 41-year-old man with an insulinoma in the body of the pancreas. This lesion shows the uncommon low signal intensity pattern on the T2 weighted fast spin echo image. (a) T1 weighted spin echo image (TR/TE 400/14 ms). The tumour (arrow) appears as a low signal bulge in the contour of the pancreas. (b) T2 weighted fast spin echo image (TR/TE 4000/105 ms) shows the tumour (curved black arrow) is of low signal intensity, isointense to the pancreatic parenchyma. (c) Fat saturated T1 weighted image (TR/TE 400/14 ms) shows the tumour (curved white arrow) as low signal in the surrounding high signal pancreatic parenchyma. (d) Contrast enhanced fat saturated T1 weighted image (TR/TE 400/14 ms) shows that the tumour (white arrow) has become isointense to the pancreas. (e) Contrast enhanced CT shows the tumour only as a bulge (white arrow) in the pancreatic contour.

View larger version (70K): [in a new window]   Figure 5. A 42-year-old woman with multiple endocrine neoplasia type 1 (MEN 1) and multiple cystic islet cell tumours. (a) Axial fat saturated T1 weighted spin echo image (TR/TE 600/14 ms) and (b) axial fat saturated T2 weighted fast spin echo image (TR/TE 4000/105 ms) show the lesion in the neck of the pancreas (between the arrowheads) to have solid and cystic components, while the two lesions (arrows) in the tail of the pancreas are predominantly cystic.