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Pancreatic Neuroendocrine Neoplasms.
Ananya Panda1, Malak Itani2, Joyce Mhlanga2
1Department of Radiology, University of Iowa Health Care, Iowa City, IA.
Seminars in Ultrasound, CT, and MR
|June 9, 2026
Summary
Pancreatic neuroendocrine neoplasms (PNENs) are diverse tumors increasingly detected by advanced imaging. Multimodality imaging is crucial for accurate diagnosis, staging, and guiding treatment of these complex pancreatic cancers.
Area of Science:
- Oncology
- Radiology
- Nuclear Medicine
Background:
- Pancreatic neuroendocrine neoplasms (PNENs) are a heterogeneous group of tumors with increasing incidence.
- PNENs range from indolent neuroendocrine tumors to aggressive neuroendocrine carcinomas.
- Most PNENs are non-functional and incidentally detected, while functional tumors cause distinct clinical syndromes.
Purpose of the Study:
- To review the role of multimodality imaging in the diagnosis and management of PNENs.
- To highlight the utility of various imaging techniques for characterizing PNENs and guiding therapy.
- To discuss current challenges and future directions in PNEN imaging.
Main Methods:
- Review of cross-sectional imaging (CT, MRI) for anatomic assessment.
- Discussion of functional imaging techniques including somatostatin receptor (SSTR) PET/CT and PET/MRI.
- Exploration of dual tracer imaging (SSTR PET and ¹⁸F FDG) for prognostic insights.
- Consideration of emerging radiomics and AI tools.
Main Results:
- Multimodality imaging is essential for accurate diagnosis, staging, and management of PNENs.
- MRI with specific contrast agents enhances detection of hepatic metastases.
- SSTR PET/CT or PET/MRI is vital for identifying SSTR-expressing disease and guiding peptide receptor radionuclide therapy.
- Dual tracer imaging aids in prognosis and detecting dedifferentiated components.
Conclusions:
- Accurate diagnosis and staging of PNENs rely heavily on multimodality imaging.
- Functional imaging and advanced techniques like radiomics and AI are crucial for personalized management.
- Standardized surveillance and response assessment remain areas for improvement.
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