Multiple endocrine neoplasia type 1 CT

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

Overview

Abdominal CT scan may be helpful in the diagnosing pancreatic involvement of multiple endocrine neoplasia type 1. Findings on CT scan suggestive of pancreatic involvement of multiple endocrine neoplasia type 1 include thickened stomach rugal folds, multiple gastric nodules and calcified or cystic pancreatic tumors.

CT

Gastrointestinal Neuroendocrine Tumors

• CT is used for suspected gastric, enteric and pancreatic neuroendocrine tumors with pre and post IV iodinated contrast.
• Bowel distension with fluid, either by oral intake (CT enterography) or via an nasojejunal tube (CT enteroclysis), improves detection of primary gastrointestinal neuroendocrine tumors.

Zollinger-Ellison Syndrome

• Common CT findings of Zollinger-Ellison syndrome include the following:

• Negative contrast may be used to distend the stomach
• Thickened rugal folds
• Multiple gastric nodules/masses

Insulinoma

• They tend to be hyper-attenuating on arterial phase so arterial or pancreatic phased imaging may aid in better detection. Some may show calcification.

Pancreatic Islet Cell Tumors

• Multiphase contrast enhanced thin slice cross-sectional imaging is ideal.
• Tumors tend to be smaller, hypervascular and may be calcified or cystic.

Gastrinoma

• Gastinomas are usually malignant and as they are frequently multiple and often extrapancreatic (90% located in the gastrinoma triangle) they can be difficult to locate. As such multiphase contrast enhanced thin slice cross-sectional imaging is ideal.
• Tumor size is variable, but the size of pancreatic lesions varies from 3-4 cm.
• The lesions are often hypervascular, so they may be visible on arterial phase CT and angiography.

Glucagonoma

• Common CT findings of glucagonoma include the following:

• Tumor size is variable, but most of them are large and have metastasized at the time of diagnosis.
• Most of them are located in the distal pancreas and are vascular.
• Tumors may be solid or contain central low-attenuation areas on CT.