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Table 1 Summary of typical and atypical aspects during imaging of pancreatic neuroendocrine neoplasms (P-NENs)

From: Imaging presentation of pancreatic neuroendocrine neoplasms

 

US

CEUS

CT

MR

Typical P-NENs

Well-marginated hypoechoic with sharp margins

Hypervascular with rapid and intense enhancement

Isodense or slightly hypodense, well-defined, hyperdense in arterial phase, hyperdense or isodense in portal phase

Well-defined, hypointense on T1W and hyperintense on T2W (better conspicuity in FAT-SAT)

Clear restriction signal at DWI

Hypervascular in arterial phase and isointense or slightly hyperintense in portal phase

Atypical P-NENs

Hypoenhancing pattern

 

Hypovascular

Hypodense in arterial phase, possible enhancement in portal and late phases

Isointense or slightly hyperintense on T2-weighted sequences

No strong restriction at DWI

Hypointense in arterial phase, possible enhancement in portal and late phase

Calcified pattern

Hyperechoic areas with prominent posterior acoustic shadowing

 

Hyperdense areas with high HU values

Signal void artefact

Intraductal growth

   

Filling defect at MRCP

Possible enhancement after contrast media

Intravessel growth

 

Intravessel vascularized thrombus

Intravessel vascularized thrombus

Absence of flow void artefact

Intravessel vascularized thrombus

Cystic pattern

Anechoic lesion delimited by wall and possible inner septa

Hypervascular enhancement of wall and septa

Hypodense cystic portion

Hypervascular enhancement of wall and septa

Hypointense in T1W, hyperintense in T2W

Hypervascular enhancement of wall and septa

  1. Small neoplasms are usually more homogeneous, before and after contrast media injection
  2. Large neoplasms are usually more inhomogeneous, both before and after contrast media, due to the possible presence of necrotic and/or hemorrhagic areas