Insulinoma MRI: Difference between revisions

Jump to navigation Jump to search
(Mahshid)
 
(23 intermediate revisions by 3 users not shown)
Line 5: Line 5:
==Overview==
==Overview==


 
MRI has better [[sensitivity]] than CT scan. It is still considered as the second line of investigation due to cost and availability. Insulinoma shows low intensity on T1 weighted and high intensity on T2 weighted signals, having better visualization on T1 and T2 weighted images with [[fat]] suppression. They exhibit typically homogenous enhancement when small and ring enhancement when more than 2 cm. A similar pattern is seen in [[metastatic]] lesion as of primary tumor.
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


==MRI==
==MRI==


MRI is superior in detecting insulinoma in that it has greater sensitivity currently.
[[MRI]] is superior in detecting insulinoma in that it has greater [[Sensitivity (tests)|sensitivity]] of approximately 85%. In a study of 21 insulinomas by Owen et al, the [[Sensitivity (tests)|sensitivity]] was noted to be 94%.(19/21 cases). The 2 cases were of 5 and 7 mm size and in the [[pancreatic]] tail.<ref name="pmid11675319">{{cite journal| author=Owen NJ, Sohaib SA, Peppercorn PD, Monson JP, Grossman AB, Besser GM et al.| title=MRI of pancreatic neuroendocrine tumours. | journal=Br J Radiol | year= 2001 | volume= 74 | issue= 886 | pages= 968-73 | pmid=11675319 | doi=10.1259/bjr.74.886.740968 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11675319  }} </ref><ref name="pmid10671597">{{cite journal| author=Thoeni RF, Mueller-Lisse UG, Chan R, Do NK, Shyn PB| title=Detection of small, functional islet cell tumors in the pancreas: selection of MR imaging sequences for optimal sensitivity. | journal=Radiology | year= 2000 | volume= 214 | issue= 2 | pages= 483-90 | pmid=10671597 | doi=10.1148/radiology.214.2.r00fe32483 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10671597  }} </ref>
[[File:Insulin mri.gif|thumb|center|MRI Insulinoma- Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 10407]]


[[Image:insulinoma-men-type-1.jpg|thumb|center|350px|Insulinoma- Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 10407]]
*T1 and T2 relaxation times for [[islet cell tumor|islet cell tumor-]]<nowiki/>like insulinoma have lower [[protein]] and proton concentration time.<ref name="pmid16179163">{{cite journal| author=McAuley G, Delaney H, Colville J, Lyburn I, Worsley D, Govender P et al.| title=Multimodality preoperative imaging of pancreatic insulinomas. | journal=Clin Radiol | year= 2005 | volume= 60 | issue= 10 | pages= 1039-50 | pmid=16179163 | doi=10.1016/j.crad.2005.06.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16179163  }} </ref> 


*Abdominal [[MRI]] may be helpful in the diagnosis of insulinoma. Findings on [[MRI]] suggestive of Insulinoma include:<ref name="pmid15763695">{{cite journal| author=Noone TC, Hosey J, Firat Z, Semelka RC| title=Imaging and localization of islet-cell tumors of the pancreas on CT and MRI. | journal=Best Pract Res Clin Endocrinol Metab | year= 2005 | volume= 19 | issue= 2 | pages= 195-211 | pmid=15763695 | doi=10.1016/j.beem.2004.11.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15763695  }} </ref><ref name="pmid16179163">{{cite journal| author=McAuley G, Delaney H, Colville J, Lyburn I, Worsley D, Govender P et al.| title=Multimodality preoperative imaging of pancreatic insulinomas. | journal=Clin Radiol | year= 2005 | volume= 60 | issue= 10 | pages= 1039-50 | pmid=16179163 | doi=10.1016/j.crad.2005.06.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16179163  }} </ref>
**Low in signal intensity on fat-suppressed T1-weighted images.
**High on intensity on fat-suppressed T2-weighted images independent of lesion size.
**Enhancement patterns are due to hypervascularity. Homogeneous enhancement is exhibited commonly in insulinoma, ring enhancement if they are larger than 2 cm.
**Same pattern can be seen in [[metastatic]] [[lymph node]] as of the primary; homogeneous when small and ring enhancement if the tumor is more than 2 cm.


*[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include:
*Modern [[MRI]] has rapid tri-phasic, breath held T1 rapid [[gadolinium]]-enhanced sequences which help to reduce artifacts produced by motion.<ref name="pmid11675319">{{cite journal| author=Owen NJ, Sohaib SA, Peppercorn PD, Monson JP, Grossman AB, Besser GM et al.| title=MRI of pancreatic neuroendocrine tumours. | journal=Br J Radiol | year= 2001 | volume= 74 | issue= 886 | pages= 968-73 | pmid=11675319 | doi=10.1259/bjr.74.886.740968 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11675319  }} </ref><ref name="pmid16179163">{{cite journal| author=McAuley G, Delaney H, Colville J, Lyburn I, Worsley D, Govender P et al.| title=Multimodality preoperative imaging of pancreatic insulinomas. | journal=Clin Radiol | year= 2005 | volume= 60 | issue= 10 | pages= 1039-50 | pmid=16179163 | doi=10.1016/j.crad.2005.06.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16179163  }} </ref>
**[finding 1]
*[[MRI]] enables accurate location of the tumor in terms of resectability and involvement of vessels.<ref name="pmid11675319">{{cite journal| author=Owen NJ, Sohaib SA, Peppercorn PD, Monson JP, Grossman AB, Besser GM et al.| title=MRI of pancreatic neuroendocrine tumours. | journal=Br J Radiol | year= 2001 | volume= 74 | issue= 886 | pages= 968-73 | pmid=11675319 | doi=10.1259/bjr.74.886.740968 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11675319  }} </ref><ref name="pmid16179163">{{cite journal| author=McAuley G, Delaney H, Colville J, Lyburn I, Worsley D, Govender P et al.| title=Multimodality preoperative imaging of pancreatic insulinomas. | journal=Clin Radiol | year= 2005 | volume= 60 | issue= 10 | pages= 1039-50 | pmid=16179163 | doi=10.1016/j.crad.2005.06.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16179163  }} </ref>
**[finding 2]
**[finding 3]


==References==
==References==
Line 29: Line 28:
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Up-To-Date]]​​
[[Category:Radiology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Surgery]]

Latest revision as of 02:06, 27 November 2017

Insulinoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Insulinoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Staging

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

X-ray

Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Insulinoma MRI On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Insulinoma MRI

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Insulinoma MRI

CDC on Insulinoma MRI

Insulinoma MRI in the news

Blogs on Insulinoma MRI

Directions to Hospitals Treating Insulinoma

Risk calculators and risk factors for Insulinoma MRI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Overview

MRI has better sensitivity than CT scan. It is still considered as the second line of investigation due to cost and availability. Insulinoma shows low intensity on T1 weighted and high intensity on T2 weighted signals, having better visualization on T1 and T2 weighted images with fat suppression. They exhibit typically homogenous enhancement when small and ring enhancement when more than 2 cm. A similar pattern is seen in metastatic lesion as of primary tumor.

MRI

MRI is superior in detecting insulinoma in that it has greater sensitivity of approximately 85%. In a study of 21 insulinomas by Owen et al, the sensitivity was noted to be 94%.(19/21 cases). The 2 cases were of 5 and 7 mm size and in the pancreatic tail.[1][2]

MRI Insulinoma- Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 10407
  • Abdominal MRI may be helpful in the diagnosis of insulinoma. Findings on MRI suggestive of Insulinoma include:[4][3]
    • Low in signal intensity on fat-suppressed T1-weighted images.
    • High on intensity on fat-suppressed T2-weighted images independent of lesion size.
    • Enhancement patterns are due to hypervascularity. Homogeneous enhancement is exhibited commonly in insulinoma, ring enhancement if they are larger than 2 cm.
    • Same pattern can be seen in metastatic lymph node as of the primary; homogeneous when small and ring enhancement if the tumor is more than 2 cm.
  • Modern MRI has rapid tri-phasic, breath held T1 rapid gadolinium-enhanced sequences which help to reduce artifacts produced by motion.[1][3]
  • MRI enables accurate location of the tumor in terms of resectability and involvement of vessels.[1][3]

References

  1. 1.0 1.1 1.2 Owen NJ, Sohaib SA, Peppercorn PD, Monson JP, Grossman AB, Besser GM; et al. (2001). "MRI of pancreatic neuroendocrine tumours". Br J Radiol. 74 (886): 968–73. doi:10.1259/bjr.74.886.740968. PMID 11675319.
  2. Thoeni RF, Mueller-Lisse UG, Chan R, Do NK, Shyn PB (2000). "Detection of small, functional islet cell tumors in the pancreas: selection of MR imaging sequences for optimal sensitivity". Radiology. 214 (2): 483–90. doi:10.1148/radiology.214.2.r00fe32483. PMID 10671597.
  3. 3.0 3.1 3.2 3.3 McAuley G, Delaney H, Colville J, Lyburn I, Worsley D, Govender P; et al. (2005). "Multimodality preoperative imaging of pancreatic insulinomas". Clin Radiol. 60 (10): 1039–50. doi:10.1016/j.crad.2005.06.005. PMID 16179163.
  4. Noone TC, Hosey J, Firat Z, Semelka RC (2005). "Imaging and localization of islet-cell tumors of the pancreas on CT and MRI". Best Pract Res Clin Endocrinol Metab. 19 (2): 195–211. doi:10.1016/j.beem.2004.11.013. PMID 15763695.

Template:WH Template:WS​​