Atypical CT and MR imaging of insulinoma: A case report

Matondang, Sahat; Suwita, Benedicta Mutiara; Budianto, Taufik; Krisnuhoni, Ening

doi:10.1016/j.jecr.2020.100075

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…Atypical insulinomas, which are iso‐ or hypoattenuating to the pancreatic parenchyma on contrast images, have been reported in human medicine 23,25,35 . One report described a similar atypical appearance of a histopathologically confirmed insulinoma in CEUS and CECT where no CE was noted in any of the modalities 36 .…”

Section: Discussionmentioning

confidence: 99%

“…Atypical insulinomas, which are iso-or hypoattenuating to the pancreatic parenchyma on contrast images, have been reported in human medicine. 23,25,35 One report described a similar atypical appearance of a histopathologically confirmed insulinoma in CEUS and CECT where no CE was noted in any of the modalities. 36 This was not observed in our study, however, the lack of contrast enhancement in some insulinomas reported elsewhere means that the authors cannot exclude this possibility.…”

Section: Radiation Dosementioning

confidence: 95%

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Confirmed and presumed canine insulinomas and their presumed metastases are most conspicuous in the late arterial phase in a triple arterial phase CT protocol

Skarbek¹,

Fouriez-Lablee²,

Dirrig³

et al. 2023

Vet Radiology Ultrasound

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Arterial enhancement is the commonly described characteristic of canine insulinomas in contrast‐enhanced computed tomography (CECT). However, this finding is also reported as inconsistent. The main aim of this single‐center retrospective observational study was to describe the contrast enhancement (CE) pattern of canine presumed and confirmed insulinomas and presumed metastases in three consecutive (early, mid, and late) arterial phases. Included dogs had a medical‐record‐based clinical or cytological/histopathological diagnosis of insulinoma and quadruple‐phase CECT. The arterial phases were identified according to published literature. The arterial enhancement of confirmed and presumed lesions was assessed using a visual grading score. Twelve dogs with a total of 17 pancreatic nodules were analyzed. Three dogs had multiple pancreatic nodules and nine had solitary findings. Four insulinomas were histopathologically confirmed. Late arterial phase (LAP) images demonstrated the largest number of pancreatic nodules reaching the highest enhancement scores (n = 13, 76%). All analyzed dogs had CT evidence of arterially enhancing nodules in the liver (n = 12), seven in the hepatic, splenic, or colic lymph nodes, and three in the spleen. Three out of five sampled livers and three lymph nodes were metastatic. All sampled spleens were benign. Avid arterial enhancement was the most dominant feature of canine presumed and confirmed insulinomas and presumed metastases in quadruple‐phase CECT. The highest enhancement scores were observed primarily in LAP, followed by MAP. Authors, therefore, recommend including LAP in the standard CT protocol for dogs with suspected pancreatic insulinomas.

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Section: Discussionmentioning

confidence: 99%

Section: Radiation Dosementioning

confidence: 95%

Confirmed and presumed canine insulinomas and their presumed metastases are most conspicuous in the late arterial phase in a triple arterial phase CT protocol

Skarbek¹,

Fouriez-Lablee²,

Dirrig³

et al. 2023

Vet Radiology Ultrasound

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“…Localization of the insulinoma can be done through noninvasive studies (abdominal ultrasound, computed tomography, magnetic resonance imaging) with invasive studies (endoscopic ultrasonography and selective arterial calcium stimulation with hepatic venous sampling) with sensitivity approaching 100% in detection of Insulinoma in these combined approach [4,5].…”

Section: Introductionmentioning

confidence: 99%

Persistent hypoglycemia in the setting of metastatic malignant insulinoma to the liver treated with chemoembolization and bland embolization

Sheikhan¹,

Hardy²,

Trad³

et al. 2022

World J. Adv. Res. Rev.

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We are describing a patient with malignant insulinoma and unusual clinical and pathological features. The patient presented late in the course of the disease with history of abdominal pain and was found to have large tumor of the pancreas and metastasis to the liver. Also, he presented with acute diarrhea which is not a feature of Insulinoma. During the hospital stay the patient had sever hypoglycemia with very inappropriately high to the low blood glucose levels of Insulin, C- peptide and Proinsulin. On biopsy of the tumor it was found to be neuroendocrine tumor, but staining’s for Insulin were negative. The patient was treated with surgical resection of the distal pancreas when the insulinoma was located, splenectomy, cholecystectomy and appendectomy. Also, chemoembolization and embolization of the metastatic tumors of the liver were done and patient’s hypoglycemia was treated with Diazoxide and short course of Steroids and Octreotide. We underscore the need of combined clinical, laboratory, radiological and pathological approach while diagnosing malignant Insulinoma.

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MRI without contrast enhancement is a highly accurate method of imaging insulinoma

Yukina,

Troshina,

Nuralieva

et al. 2024

Endo Serg

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BACKGROUND: According to the literature, there are contradictory results regarding the diagnostic accuracy of magnetic resonance imaging (MRI) without contrast enhancement (CE) in insulinoma, and studies that analyze the factors influencing the obtaining of false negative results have not been described.AIM: Evaluation of the operational characteristics of MRI imaging of insulinoma without CE.MATERIALS AND METHODS: Imaging studies of the abdominal cavity and retroperitoneal space were performed in patients with suspected nondiabetic hypoglycemia (NDH): MRI without CE (index test) and CT with CE (first row reference test). Ultrasound examination was used as a reference test of the second row, and arteriostimulated venous blood sampling was used in the third row. The diagnosis of NDH and insulinoma was established based on the detection of hyperinsulinemic hypoglycemia during laboratory examination and confirmation of the presence of a pancreatic tumor.RESULTS: 125 patients with insulinoma and 55 patients with other causes of NDH were included. The sensitivity of MRI without CE in the diagnosis of insulinoma was 94%, 95% CI [89%; 98%], specificity — 98%, 95% CI [90%; 100%], prognostic value of a positive result — 99%, 95% CI [95%; 100%], prognostic value of a negative result is 87%, 95% CI [76%; 94%]. The Kappa index of agreement with the final diagnosis was 0.886 (95% CI [0.814; 0.958]), which corresponds to excellent agreement, with CT — 0.750 (95% CI [0.651; 0.850]), which corresponds to significant agreement.In a comparative analysis of the tomographic and pathomorphological characteristics of insulinoma, in cases with divergent results when using MRI without CE and CT with CE, significant differences in structure, shape, contour features, localization and degree of malignancy of the tumor, as well as the structure of its surrounding parenchyma were not revealed.In the presented sample, the insulinoma has a median size of 14–15 mm with the median optical density in the native phase of CT 42–44 units.H, hyperintensivity on T2-weighted MRI images in 89%, 95% CI [78%; 95%] cases and low Grade 1 malignancy in 70%, 95% CI [56%; 81%] cases.CONCLUSION: CT with CE and MRI without CE are characterized by significant agreement in the diagnosis of insulinoma. In this regard, as well as due to the lack of radiation exposure and the strict need for contrast agents, MRI without CE can be recommended as a first-line method on a par with abdominal ultrasound and CT with CE to detect insulinoma.

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Atypical CT and MR imaging of insulinoma: A case report

Cited by 3 publications

References 10 publications

Confirmed and presumed canine insulinomas and their presumed metastases are most conspicuous in the late arterial phase in a triple arterial phase CT protocol

Confirmed and presumed canine insulinomas and their presumed metastases are most conspicuous in the late arterial phase in a triple arterial phase CT protocol

Persistent hypoglycemia in the setting of metastatic malignant insulinoma to the liver treated with chemoembolization and bland embolization

MRI without contrast enhancement is a highly accurate method of imaging insulinoma

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