ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Radiological, Nuclear Medicine and Hybrid Imaging

Anders Sundin, Rudolf Arnold, Eric Baudin, Jaroslaw B. Cwikla, Barbro Eriksson, Stefano Fanti, Nicola Fazio, Francesco Giammarile, Rodney J. Hicks, Andreas Kjaer, Eric Krenning, Dik Kwekkeboom, Catherine Lombard-Bohas, Juan M. O'Connor, Dermot O'Toole, Andrea Rockall, Bertram Wiedenmann, Juan W. Valle, Marie Pierre Vullierme

Research output: Contribution to journalArticlepeer-review

Abstract

Contrast-enhanced computed tomography (CT) of the neck-thorax-abdomen and pelvis, including 3-phase examination of the liver, constitutes the basic imaging for primary neuroendocrine tumor (NET) diagnosis, staging, surveillance, and therapy monitoring. CT characterization of lymph nodes is difficult because of inadequate size criteria (short axis diameter), and bone metastases are often missed. Contrast-enhanced magnetic resonance imaging (MRI) including diffusion-weighted imaging is preferred for the examination of the liver, pancreas, brain and bone. MRI may miss small lung metastases. MRI is less well suited than CT for the examination of extended body areas because of the longer examination procedure. Ultrasonography (US) frequently provides the initial diagnosis of liver metastases and contrast-enhanced US is excellent to characterize liver lesions that remain equivocal on CT/MRI. US is the method of choice to guide the biopsy needle for the histopathological NET diagnosis. US cannot visualize thoracic NET lesions for which CT-guided biopsy therefore is used. Endocopic US is the most sensitive method to diagnose pancreatic NETs, and additionally allows for biopsy. Intraoperative US facilitates lesion detection in the pancreas and liver. Somatostatin receptor imaging should be a part of the tumor staging, preoperative imaging and restaging, for which 68Ga-DOTA-somatostatin analog PET/CT is recommended, which is vastly superior to somatostatin receptor scintigraphy, and facilitates the diagnosis of most types of NET lesions, for example lymph node metastases, bone metastases, liver metastases, peritoneal lesions, and primary small intestinal NETs. 18FDG-PET/CT is better suited for G3 and high G2 NETs, which generally have higher glucose metabolism and less somatostatin receptor expression than low-grade NETs, and additionally provides prognostic information.

Original languageEnglish
Pages (from-to)212-244
Number of pages33
JournalNeuroendocrinology
Volume105
Issue number3
DOIs
Publication statusPublished - Sep 1 2017

Keywords

  • Computed tomography
  • Magnetic resonance imaging
  • Neuroendocrine tumor
  • Positron emission tomography
  • Scintigraphy
  • Single photon emission computed tomography
  • Somatostatin receptor imaging
  • Ultrasound

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Endocrine and Autonomic Systems
  • Cellular and Molecular Neuroscience

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