Insulinoma on mri sag localizer9/5/2023 Tumors with a higher grade or poorly differentiated tend to show marked uptake 8-10. Neuroendocrine tumors are slow-growing tumors that usually have slow metabolic activity in their initial stages and, therefore, are not notably avid on F-18 FDG PET-CT 9. PET-CT is also useful in excluding additional pancreatic neuroendocrine tumors eventually not detected on CT or MRI, particularly, in inherited syndromes such as MEN1 8. The sensitivity of this study has been reported in up to 90% 8, when assessing insulinomas specifically, and ranging between 90-100% for pancreatic neuroendocrine tumors as whole 9. T1 C+ (Gd): typically shows enhancement, although contrast enhancement may not improve tumor visualization compared with non-contrast images 4Ībout 80% of insulinomas express the somatostatin receptors 2, and the Ga-68 DOTATATE scans have a high affinity for these receptors and, therefore, have high sensitivity in the detection of these tumors, particularly for low-grade and well-differentiated ones 8-10.MRIĭynamic MRI with fast gradient echo sequences following a bolus injection of contrast medium may aid in the detection of these tumors 4: They tend to be hyperattenuating on arterial phase and, therefore, dedicated protocols with arterial or pancreatic phase imaging may aid in better detection 6,7. Insulinomas are equally distributed between the head, body, and tail of the pancreas. These tumors can be relatively small and multiphase contrast-enhanced thin slice cross-sectional imaging is ideal. Most insulinomas are small (90% are <2 cm at presentation 3) and hypervascular.
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