Альманах клинической медицины. 2018; 46: 289-295
Диффузионно-взвешенная магнитно-резонансная томография в диагностике инсулиномы поджелудочной железы: клинический случай
https://doi.org/10.18786/2072-0505-2018-46-3-289-295Аннотация
Топическая диагностика инсулиномы остается актуальной проблемой вследствие низкого уровня выявляемости опухоли (около 75%), противоречивости данных о ее локализации при применении разных методов визуализации (более чем в 50%), отсутствия единого алгоритма диагностики. В клинической практике проводится множество различных визуализирующих исследований, в том числе с введением контрастных веществ и обладающих лучевой нагрузкой, а также инвазивных исследований, которые ассоциированы с риском различных осложнений, имеют высокую стоимость и характеризуются длительным обследованием. Таким образом, представляется необходимым проведение поиска высокочувствительных и безопасных методов топической диагностики инсулинпродуцирующей опухоли поджелудочной железы. В описанном клиническом наблюдении диагноз инсулиномы верифицирован при помощи диффузионно-взвешенной магнитно-резонансной томографии – точного и неинвазивного метода, не оказывающего ионизирующего воздействия и не требующего введения контрастных веществ. Данная технология на основании микроструктурных патологических изменений позволяет выявить опухоль малых размеров и провести дифференциальную диагностику доброкачественных и злокачественных новообразований. Вместе с тем в настоящее время опыт применения диффузионно-взвешенной магнитно-резонансной томографии в диагностике инсулинпродуцирующей нейроэндокринной опухоли ограничен; для оценки перспективы внедрения метода в клиническую практику требуется изучение его эффективности на большой когорте пациентов.
Список литературы
1. Anaye A, Mathieu A, Closset J, Bali MA, Metens T, Matos C. Successful preoperative localization of a small pancreatic insulinoma by diffusion-weighted MRI. JOP. 2009;10(5): 528–31.
2. McAuley G, Delaney H, Colville J, Lyburn I, Worsley D, Govender P, Torreggiani WC. Multimodality preoperative imaging of pancreatic insulinomas. Clin Radiol. 2005;60(10): 1039–50. doi: 10.1016/j.crad.2005.06.005.
3. Padhani AR, Liu G, Koh DM, Chenevert TL, Thoeny HC, Takahara T, Dzik-Jurasz A, Ross BD, Van Cauteren M, Collins D, Hammoud DA, Rustin GJ, Taouli B, Choyke PL. Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia. 2009;11(2): 102–25.
4. Китаев СВ, Попова ТА. Принципы визуализации диффузионного тензора и его применение в неврологии. Анналы клинической и экспериментальной неврологии. 2012;6(1): 48–54.
5. Wang Y, Miller FH, Chen ZE, Merrick L, Mortele KJ, Hoff FL, Hammond NA, Yaghmai V, Nikolaidis P. Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas. Radiographics. 2011;31(3):E47–64. doi: 10.1148/rg.313105174.
6. Taieb D, Legmann P, Prat F, Chevallier P, Tenenbaum F; French Endocrine Society. Topographic diagnosis: respective roles of morphological and functional imaging. Ann Endocrinol (Paris). 2013;74(3): 185–90. doi: 10.1016/j.ando.2013.05.008.
7. Tamm EP, Bhosale P, Lee JH, Rohren EM. Stateof-the-art Imaging of Pancreatic Neuroendocrine Tumors. Surg Oncol Clin N Am. 2016;25(2): 375–400. doi: 10.1016/j.soc.2015.11.007.
8. De Robertis R, Onofrio MD, Tinazzi-Martini P, Pregarz M, Crosara S, Canestrini S, Demozzi E, Pozzi Mucelli R. Diffusion weighted imaging: an additional value for the magnetic resonance study of pancreatic neoplasms [Internet]. 2014. doi: 10.1594/ecr2014/C-0053.
9. Sundin A, Arnold R, Baudin E, Cwikla JB, Eriksson B, Fanti S, Fazio N, Giammarile F, Hicks RJ, Kjaer A, Krenning E, Kwekkeboom D, Lombard-Bohas C, O'Connor JM, O'Toole D, Rockall A, Wiedenmann B, Valle JW, Vullierme MP; Antibes Consensus Conference participants. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Radiological, Nuclear Medicine & Hybrid Imaging. Neuroendocrinology. 2017;105(3): 212–44. doi: 10.1159/000471879.
10. Farchione A, Rufini V, Brizi MG, Iacovazzo D, Larghi A, Massara RM, Petrone G, Poscia A, Treglia G, De Marinis L, Giordano A, Rindi G, Bonomo L. Evaluation of the Added Value of Diffusion-Weighted Imaging to Conventional Magnetic Resonance Imaging in Pancreatic Neuroendocrine Tumors and Comparison With 68Ga-DOTANOC Positron Emission Tomography/Computed Tomography. Pancreas. 2016;45(3): 345–54. doi: 10.1097/MPA.0000000000000461.
11. Kartalis N, Mucelli RM, Sundin A. Recent developments in imaging of pancreatic neuroendocrine tumors. Ann Gastroenterol. 2015;28(2): 193–202.
12. d'Assignies G, Fina P, Bruno O, Vullierme MP, Tubach F, Paradis V, Sauvanet A, Ruszniewski P, Vilgrain V. High sensitivity of diffusion-weighted MR imaging for the detection of liver metastases from neuroendocrine tumors: comparison with T2-weighted and dynamic gadolinium-enhanced MR imaging. Radiology. 2013;268(2): 390–9. doi: 10.1148/radiol.13121628.
Almanac of Clinical Medicine. 2018; 46: 289-295
Diffusion-weighted magnetic resonance imaging in the diagnosis of pancreatic insulinoma: a clinical case
https://doi.org/10.18786/2072-0505-2018-46-3-289-295Abstract
The topical diagnosis of insulinoma continues to be an actual problem of modern medicine due to low detection rate of the tumor (about 75%) and inconsistent data on its localization when using various methods of visualization (more than in 50% of cases), as well as the lack of a single diagnostic algorithm. In the clinical practice, many different imaging assessments are conducted, including those with the administration of contrast agents and associated with radiation load, as well as invasive studies, associated with risk of various complications, high costs and duration of the examination. Thus, the search for highly sensitive and safe methods of topical diagnosis of the insulin-producing pancreatic tumor seems relevant. In the presented clinical case, the diagnosis of insulinoma is verified by diffusion-weighted magnetic resonance imaging (DW-MRI). It is an accurate and non-invasive method that does not involve exposure to ionizing radiation and does not require any administration of contrast agents. This technology, based on microstructural pathological changes, allows to identify small tumors and to make a differential diagnosis of benign and malignant neoplasms. However, at present the experience of DW-MRI use for the diagnosis of an insulin-producing neuroendocrine tumor is limited. Evaluation of its effectiveness in a large patient cohort would be necessary to assess the prospects for its introduction into clinical practice.
References
1. Anaye A, Mathieu A, Closset J, Bali MA, Metens T, Matos C. Successful preoperative localization of a small pancreatic insulinoma by diffusion-weighted MRI. JOP. 2009;10(5): 528–31.
2. McAuley G, Delaney H, Colville J, Lyburn I, Worsley D, Govender P, Torreggiani WC. Multimodality preoperative imaging of pancreatic insulinomas. Clin Radiol. 2005;60(10): 1039–50. doi: 10.1016/j.crad.2005.06.005.
3. Padhani AR, Liu G, Koh DM, Chenevert TL, Thoeny HC, Takahara T, Dzik-Jurasz A, Ross BD, Van Cauteren M, Collins D, Hammoud DA, Rustin GJ, Taouli B, Choyke PL. Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia. 2009;11(2): 102–25.
4. Kitaev SV, Popova TA. Printsipy vizualizatsii diffuzionnogo tenzora i ego primenenie v nevrologii. Annaly klinicheskoi i eksperimental'noi nevrologii. 2012;6(1): 48–54.
5. Wang Y, Miller FH, Chen ZE, Merrick L, Mortele KJ, Hoff FL, Hammond NA, Yaghmai V, Nikolaidis P. Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas. Radiographics. 2011;31(3):E47–64. doi: 10.1148/rg.313105174.
6. Taieb D, Legmann P, Prat F, Chevallier P, Tenenbaum F; French Endocrine Society. Topographic diagnosis: respective roles of morphological and functional imaging. Ann Endocrinol (Paris). 2013;74(3): 185–90. doi: 10.1016/j.ando.2013.05.008.
7. Tamm EP, Bhosale P, Lee JH, Rohren EM. Stateof-the-art Imaging of Pancreatic Neuroendocrine Tumors. Surg Oncol Clin N Am. 2016;25(2): 375–400. doi: 10.1016/j.soc.2015.11.007.
8. De Robertis R, Onofrio MD, Tinazzi-Martini P, Pregarz M, Crosara S, Canestrini S, Demozzi E, Pozzi Mucelli R. Diffusion weighted imaging: an additional value for the magnetic resonance study of pancreatic neoplasms [Internet]. 2014. doi: 10.1594/ecr2014/C-0053.
9. Sundin A, Arnold R, Baudin E, Cwikla JB, Eriksson B, Fanti S, Fazio N, Giammarile F, Hicks RJ, Kjaer A, Krenning E, Kwekkeboom D, Lombard-Bohas C, O'Connor JM, O'Toole D, Rockall A, Wiedenmann B, Valle JW, Vullierme MP; Antibes Consensus Conference participants. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Radiological, Nuclear Medicine & Hybrid Imaging. Neuroendocrinology. 2017;105(3): 212–44. doi: 10.1159/000471879.
10. Farchione A, Rufini V, Brizi MG, Iacovazzo D, Larghi A, Massara RM, Petrone G, Poscia A, Treglia G, De Marinis L, Giordano A, Rindi G, Bonomo L. Evaluation of the Added Value of Diffusion-Weighted Imaging to Conventional Magnetic Resonance Imaging in Pancreatic Neuroendocrine Tumors and Comparison With 68Ga-DOTANOC Positron Emission Tomography/Computed Tomography. Pancreas. 2016;45(3): 345–54. doi: 10.1097/MPA.0000000000000461.
11. Kartalis N, Mucelli RM, Sundin A. Recent developments in imaging of pancreatic neuroendocrine tumors. Ann Gastroenterol. 2015;28(2): 193–202.
12. d'Assignies G, Fina P, Bruno O, Vullierme MP, Tubach F, Paradis V, Sauvanet A, Ruszniewski P, Vilgrain V. High sensitivity of diffusion-weighted MR imaging for the detection of liver metastases from neuroendocrine tumors: comparison with T2-weighted and dynamic gadolinium-enhanced MR imaging. Radiology. 2013;268(2): 390–9. doi: 10.1148/radiol.13121628.
