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MRI of Islet Cell Tumors of the Pancreas

Steven Herwick1, Frank H. Miller1 and Ana L. Keppke1

1 All authors: Department of Radiology, Northwestern Memorial Hospital, Northwestern University, The Feinberg School of Medicine, 676 N St. Clair St., Ste. 800, Chicago, IL 60611.


Figure 1
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  		Fig. 1 —49-year-old man with known malignant islet cell tumor of pancreas. Axial T2-weighted HASTE MR image shows low-signal-intensity lobulated mass (arrow) in pancreatic tail.

 

Figure 2
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  		Fig. 2A —63-year-old man with hypoglycemia and biochemical evidence of insulinoma. Axial T1-weighted fat-suppressed spoiled gradient-echo MR image shows 1-cm hypointense lesion (arrow) in pancreatic head, which was surgically confirmed to be insulinoma. Note contrast of lesion relative to normal high-signal-intensity pancreas.

 

Figure 3
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  		Fig. 2B —63-year-old man with hypoglycemia and biochemical evidence of insulinoma. Axial T2-weighted HASTE MR image at same level shows nearly imperceptible lesion (arrow).

 

Figure 4
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  		Fig. 3A —35-year-old woman with liver and pancreatic lesions incidentally discovered at sonography. Histologic examination revealed hepatic focal nodular hyperplasia and benign pancreatic islet cell tumor. Axial T1-weighted fat-suppressed spoiled gradient-echo MR image shows low-signal-intensity lesion (arrow) in pancreatic body, which is well seen relative to normal hyperintense pancreas due to excellent soft-tissue contrast resolution of MRI. Lesion appearance is nonspecific and can be seen with adenocarcinoma as well.

 

Figure 5
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  		Fig. 3B —35-year-old woman with liver and pancreatic lesions incidentally discovered at sonography. Histologic examination revealed hepatic focal nodular hyperplasia and benign pancreatic islet cell tumor. Axial arterial phase T1-weighted fat-suppressed spoiled gradient-echo MR image shows lesion has marked enhancement (arrow) unlike adenocarcinoma, which tends to be hypovascular.

 

Figure 6
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  		Fig. 3C —35-year-old woman with liver and pancreatic lesions incidentally discovered at sonography. Histologic examination revealed hepatic focal nodular hyperplasia and benign pancreatic islet cell tumor. Axial venous phase gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image shows lesion (arrow) is essentially isointense to surrounding pancreas, emphasizing importance of arterial phase and optimal timing.

 

Figure 7
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  		Fig. 4A —52-year-old woman with history of hypoglycemia and clinical diagnosis of insulinoma, which could not be detected on multiple MDCT scans over preceding 3 years. Axial T1-weighted fat-suppressed spoiled gradient-echo MR image shows 1.4-cm lesion (arrow), which is hypointense relative to surrounding normal pancreas.

 

Figure 8
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  		Fig. 4B —52-year-old woman with history of hypoglycemia and clinical diagnosis of insulinoma, which could not be detected on multiple MDCT scans over preceding 3 years. Axial arterial phase gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image shows lesion (arrow) is now difficult to identify because it enhances to same degree as surrounding pancreas.

 

Figure 9
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  		Fig. 4C —52-year-old woman with history of hypoglycemia and clinical diagnosis of insulinoma, which could not be detected on multiple MDCT scans over preceding 3 years. Axial venous phase gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image also shows lesion (arrow) enhancing to same extent as surrounding pancreas.

 

Figure 10
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  		Fig. 5A —57-year-old man with history of gallstone pancreatitis and cystic lesion of pancreas thought to represent pseudocyst or cystic neoplasm at MDCT. Axial T1-weighted fat-suppressed spoiled gradient-echo MR image shows hypointense lesion (arrow) in tail of pancreas.

 

Figure 11
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  		Fig. 5B —57-year-old man with history of gallstone pancreatitis and cystic lesion of pancreas thought to represent pseudocyst or cystic neoplasm at MDCT. Axial gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image shows ring-enhancing lesion (arrow).

 

Figure 12
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  		Fig. 5C —57-year-old man with history of gallstone pancreatitis and cystic lesion of pancreas thought to represent pseudocyst or cystic neoplasm at MDCT. Coronal gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image shows ring-enhancing lesion (arrow) due to pancreatic islet cell tumor.

 

Figure 13
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  		Fig. 6 —52-year-old man with von Hippel-Lindau disease and pancreatic mass diagnosed as serous cystadenoma on basis of findings at previous fine-needle aspiration. Axial gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image shows 5-cm poorly marginated heterogeneously enhancing mass of pancreatic head (long arrows), which proved to be malignant islet cell tumor, and liver metastases (short arrows).

 

Figure 14
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  		Fig. 7 —49-year-old woman (same patient as in Fig. 1) with malignant islet cell tumor of pancreas. Coronal gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image shows irregular enhancement of mass (arrows) in pancreatic tail.

 

Figure 15
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  		Fig. 8A —56-year-old woman with multiple endocrine neoplasia type I and multiple surgically proven islet cell tumors of pancreas. Coronal venous phase gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image shows small (< 1 cm) hyperenhancing lesion (arrow) in pancreatic head.

 

Figure 16
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  		Fig. 8B —56-year-old woman with multiple endocrine neoplasia type I and multiple surgically proven islet cell tumors of pancreas. Coronal gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image shows similar small lesion (arrow) in pancreatic tail. Multiple lesions are more common in patients with multiple endocrine neoplasia type I and von Hippel-Lindau disease than in sporadic cases.

 

Figure 17
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  		Fig. 9A —33-year-old man with large neoplasm incidentally found at MDCT. Axial T2-weighted HASTE MR image shows lesion of intermediate signal intensity similar to that of muscle or liver. Center of lesion is high signal intensity due to necrosis (long arrow). Note dilatation of distal pancreatic duct (short arrows) with atrophy of this portion of gland.

 

Figure 18
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  		Fig. 9B —33-year-old man with large neoplasm incidentally found at MDCT. Axial gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image shows lesion with thick enhancing wall, which is typical of nonfunctioning islet cell tumor. Center of lesion lacked enhancement due to necrosis (arrow).

 

Figure 19
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  		Fig. 10A —62-year-old woman with cystic lesion of pancreatic tail seen at MDCT, which proved to be islet cell tumor at fine-needle aspiration biopsy. Axial T2-weighted HASTE MR image shows 1-cm lesion (arrow) in pancreatic tail with high signal intensity mimicking pseudocyst or cystic neoplasm of pancreas.

 

Figure 20
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  		Fig. 10B —62-year-old woman with cystic lesion of pancreatic tail seen at MDCT, which proved to be islet cell tumor at fine-needle aspiration biopsy. Axial arterial phase gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image shows rim enhancement of lesion (arrow).

 

Figure 21
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  		Fig. 11A —52-year-old man with epigastric pain. MDCT showed only dilatation of most distal pancreatic duct in tail. Coronal MR cholangiopancreatography image shows dilatation of pancreatic duct (arrow) in tail with normal-caliber pancreatic duct in remainder of gland (chevrons).

 

Figure 22
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  		Fig. 11B —52-year-old man with epigastric pain. MDCT showed only dilatation of most distal pancreatic duct in tail. Axial thin-section T2-weighted HASTE MR image shows subtle 1-cm minimally hypointense lesion (short arrows) causing pancreatic duct dilatation (long arrow). Subsequent fine-needle aspiration biopsy confirmed pancreatic islet cell tumor.

 

Figure 23
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  		Fig. 12A —46-year-old woman who presented with bleeding gastric varices and was found to have malignant islet cell tumor of pancreas with splenic vein (SV) and portal vein (PV) invasion. Axial T2-weighted HASTE MR image near portal vein origin shows heterogeneous mass expanding distal splenic vein and proximal portal vein.

 

Figure 24
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  		Fig. 12B —46-year-old woman who presented with bleeding gastric varices and was found to have malignant islet cell tumor of pancreas with splenic vein (SV) and portal vein (PV) invasion. Axial gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image at slightly more cephalad level than A shows enhancing tumor expanding main portal vein.

 

Figure 25
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  		Fig. 13A —52-year-old man with von Hippel-Lindau disease (same patient as in Fig. 6) and pancreatic islet cell neoplasm metastatic to regional lymph nodes and liver. Axial arterial phase gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image shows intense enhancement of multiple porta hepatis lymph nodes (chevrons) and multiple enhancing liver lesions (arrows).

 

Figure 26
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  		Fig. 13B —52-year-old man with von Hippel-Lindau disease (same patient as in Fig. 6) and pancreatic islet cell neoplasm metastatic to regional lymph nodes and liver. Axial T1-weighted fat-suppressed spoiled gradient-echo MR image at slightly more cephalad level than A shows multiple ring-enhancing hepatic metastases and smaller, homogeneously enhancing lesions (arrows).

 

Figure 27
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  		Fig. 14A —49-year-old woman (same patient as in Figs. 1 and 7) with MDCT reportedly showing focal nodular hyperplasia in liver. Axial arterial phase gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image shows 1.3-cm lesion (arrow) in liver.

 

Figure 28
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  		Fig. 14B —49-year-old woman (same patient as in Figs. 1 and 7) with MDCT reportedly showing focal nodular hyperplasia in liver. Axial venous phase gadolinium-enhanced T1-weighted fat-suppressed spoiled gradient-echo MR image does not show lesion.

 

Figure 29
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  		Fig. 14C —49-year-old woman (same patient as in Figs. 1 and 7) with MDCT reportedly showing focal nodular hyperplasia in liver. Coronal T1-weighted fat-suppressed spoiled gradient-echo MR image shows intensely enhancing lesion (arrow) in pancreas. This hypervascular pancreatic lesion is highly suggestive of islet cell tumor, which surgery confirmed. In addition, hypervascular metastases, as seen in this example, are not typical of adenocarcinoma of pancreas. Consequently, liver lesions were thought to represent metastases.

 

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