The role of radiological Imaging, the strength and limitations of radiology modalities as well as their key Imaging features will be discussed and presented.
Radiological Imaging has a role in the detection of primary NET, defining its local extent and anatomical relationship to adjacent structures, metastatic staging especially when surgical resection is being considered, monitoring for complication and response as well as assessment of recurrent disease.
The key radiology imaging modalities are Computed Tomography CT and Magnetic Resonance Imaging MRI, with ultrasound playing a supplementary role, often as the imaging tool to guide tissue biopsy of liver or nodal metastatic disease.
Contrast enhanced multi detector CT of the chest, abdomen and pelvis, including triple phase images of the liver, represents the primary imaging method for NET in various stages of its disease course. CT is widely available and image acquisition is fast, providing high resolution images in multiple planes. CT is limited in its ability to assess nodal and bony disease. The advent of dual energy CT provides the opportunity to obtain virtual precontrast images and has the potential to improve tumour-background contrast and sensitivity.
Contrast enhanced MRI provides better soft tissue contrast and is the radiology modality of choice in assessing the extent of liver metastatic disease, especially when hepatocyte-specific contrast agent and diffusion weighted Imaging are used. MR cholangio-pancreatography can also be performed to assess the biliary and pancreatic ducts.