Although the recognition and treatment of primary gastroenteropancreatic neuroendocrine tumor (NET) has improved over the last decades, liver metastases (LMs) from NET (NETLMs) are common. . Radioembolization for neuroendocrine liver metastases: Safety, imaging, and long-term outcomes. (CT) scans and calcification findings in plain CT scans in patients undergoing surgery for neuroendocrine liver metastasis (NELM) . Fortunately, recent advances in diagnostic techniques and therapeutic strategies have improved the multidisciplinary management of this challenging condition. When feasible, surgical resection of NELM offers the best long-term outcomes. In the present work, we provide a narrative review of the current knowledge on liver-directed therapy for metastasis treatment, including both interventional radiology procedures and nuclear medicine options in NEN patients, taking into account the patient clinical context and both the strengths and limitations of each modality. Up to 90% of patients with gastroenteropancreatic neuroendocrine tumors develop liver metastases (NeLM) during their clinical course. The difference was Radiology: Volume 268: Number 2—August 2013 n radiology.rsna.org 393 GASTROINTESTINAL IMAGING: Detection of Liver Metastases from Neuroendocrine Tumors d'Assignies et al Table 2 Quality of MR Imaging Sequences Assessed by the Observers Observer 1 Observer 2 Quality DW Single-Shot Echo Planar T2-weighted FSE Dynamic . At our recent well attended "Liver Metastases Natter", we were joined by Mr Thomas Armstrong (Consultant Surgeon and Lead Clinician for the Wessex Neuroendocrine Tumour Group / Southampton Centre of Excellence). Indeed, as already mentioned, the arterial phase plays a major role to standardize the detection of endocrine liver metastases and must be systematically performed during CT and MR imaging in . Large metastases can outgrow their blood supply leading to central necrosis. 2012; 83(3):887-94 (ISSN: 1879-355X) . Mayo SC, de Jong MC, Bloomston M, et al. . Not a candidate for surgical resection based on unresectability, anatomy, anesthesia risk, patient preference. Multiple neuroendocrine metastases are hypervascular in the arterial phase, isodense in the portal venous and washout on the equilibrium phase. CT and MRI Imaging of Hepatic metastases 1. Chest radiography remains the primary imaging modality for the detection of lung cancer. Metastatic lesions absorb contrast during arterial phase and they look very bright on CT scan. Radioembolization for neuroendocrine liver metastases: safety, imaging, and long-term outcomes. Radioembolization for Neuroendocrine Liver Metastases: Safety, Imaging, and Long-Term Outcomes December 2011 International Journal of Radiation Oncology, Biology, Physics 83(3):887-94 Introduction. Automatized Hepatic Tumor Volume Analysis of Neuroendocrine Liver Metastases by Gd-EOB MRI—A Deep-Learning Model to . Ann . Hepatic artery chemoembolization for the treatment of liver metastases from neuroendocrine tumors: a long-term follow-up in 123 patients. Neuroendocrine tumors (NETs) (historically called APUDomas) represent a wide spectrum of disease. Radioembolization for neuroendocrine liver metastases: safety, imaging, and long-term outcomes. according to the most recent comprehensive studies, the incidence of neuroendocrine tumors (net) is clearly on the rise in a manner independent from that expected by a simple increased awareness or improvements in diagnostic technologies. . Neuroendocrine liver metastases (NELM) are heterogeneous in clinical presentation and prognosis. Med Oncol 2011;28(Suppl 1):S286-290. Athens University Medical Faculty, Nuclear Medicine Division, Radiology Department, Aretaieion University Hospital, Athens, Greece; Transhepatic radionuclide infusion has been introduced as a new treatment approach for unresectable liver neuroendocrine metastatic lesions with the prerequisite of a positive In-111 Pentetreotide (Octreoscan). Methods A total of 42 patients with hepatic metastases of neuroendocrine neoplasms were prospectively enrolled and underwent both dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and PET/CT, using either 18F-FDG or 68Ga-DOTATATE as tracer. The larger lesion washes out peripherally and has a central scar that enhances in the equilibrium phase. Ultrasound, CT, and MRI are typically all employed for characterization of these lesions but their . Neuroendocrine neoplasms (NENs) are rare and heterogeneous epithelial tumors most commonly arising from the gastroenteropancreatic (GEP) system. A systematic review of studies evaluating the use of ablative techniques for neuroendocrine liver metastases combining both percutaneous (26%) and surgical (74%) approaches for a total 595 patients showed local recurrence rates of approximately 20% on contrast-enhanced computed tomography (CT) of the thorax, abdomen, and pelvis within 2 years. Toxicity was assessed using National Cancer Institute Common . 90Y radioembolization for metastatic neuroendocrine liver tumors: preliminary results from a multi-institutional experience. 1 NETLMs frequently are responsible for symptoms because of hormone secretion, pressure on structures, or replacement of liver. Khairuddin Memon, . GEP-NENs account for approximately 60% of all NENs, and the small intestine and pancreas represent two most common sites of primary tumor development. Twenty patients with liver metastases from neuroendocrine tumors underwent T1-weighted DCE MR imaging of the liver before and at 2 months after intravenous 90 Y-DOTATOC treatment. Imaging of the liver assumes an important role in the initial identification of liver metastases and in the follow-up and treatment assessment of patients with confirmed metastases. Neuroendocrine tumors (NETs) are derived from neuroendocrine cells that are capable of producing functional peptide hormones. Simple Summary Quantification of liver metastases on imaging is of utmost importance in therapy response assessment, wherein gadoxetic acid (Gd-EOB)-enhanced magnetic resonance imaging (MRI) shows the highest accuracy. In cases of more disseminated hepatic disease, transarterial radioembolization with Yttrium-90- (90Y-) labeled microspheres has been demonstrated as a viable option for symptom and locoregional tumor control. At the time of diagnosis, 70% of patients with neuroendocrine tumors (NETs) have metastases primarily affecting the liver ().Surgical resection as a cure is only achievable in around 10% of patients with hepatic metastases ().Transarterial radioembolization (TARE) is based on a high-energy beta particle emitter that is administered intra-arterially to the hepatic lesions achieving reported . Approximately two-thirds of the cases had liver metastases ranging from grade 1 to grade 2 and/or to grade 3 based on the WHO 2010 classification of primary digestive neuroendocrine neoplasms. Metastases of NENB to the viscera are uncommon but well documented .A neuroendocrine neoplasm of the breast (NENB) is rare but may benefit from treatment according to guidelines applied to invasive breast carcinoma .Diagnosis of a NENB is challenging due to subtle morphology and lack . Toxicity was assessed using National Cancer Institute Common Terminology Criteria v3.0. Forty patients with hepatic neuroendocrine metastases were treated with (90)Y radioembolization at a single center. Compared with . Up to 90% of patients with NETs develop liver metastases, which are a major determinant of symptoms and survival. Well differentiated intestinal neuroendocrine tumor with at least one liver metastasis; The liver metastasis must be visible and measurable on CT scans or MRI; Patients monitored without invasive liver treatment : surgery, RF ablation / Trans-arterial chemoembolization Methods: We enrolled 149 patients with GEP tumors, 69 during initial staging and 80 in follow-up. 2006). Approximately 80% of metastatic patients have secondary liver lesions, and in approximately 50% of . GEP-NENs account for approximately 60% of all NENs, and the small intestine and pancreas represent two most common sites of primary tumor development. Read "Neuroendocrine liver metastases: Value of apparent diffusion coefficient and enhancement ratios for characterization of histopathologic grade, Journal of Magnetic Resonance Imaging" on DeepDyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. The aim of our study is to assess variability of measurements of liver metastases from neuroendocrine tumors (NET) on different magnetic resonance imaging (MRI) sequences. . Also referred to previously as carcinoids, the small intestine is a frequent location, particularly the terminal ileum. Liver transplantation (LT) for unresectable colorectal liver metastases has long been abandoned because of dismal prognoses. Chemotherapy has been effective in metastatic islet cell tumors with response rates of up to 60%; response rates are lower in patients with carcinoid (20%). MODALITY CHOICES AND TECHNIQUES Options for imaging the liver include ultrasound, CT, MRI, and positron emission tomography (PET) or PET/CT. for nen liver metastases, characteristic magnetic resonance imaging features have been described4including markedly hyperintense signal intensity on t2-weighted images and hypervascular- ity in the arterial phase after contrast agent administration.5,6whereas existing diagnostic imaging methods of contrast-enhanced mri or ct provide limited … However, although appendix is the most common location for midgut carcinoids it most unusually gives rise to hepatic spread. Thirty-seven consecutive patients with liver metastases from neuroendocrine tumors underwent 1.5-T MR imaging of the liver comprising T2-weighted fast spin-echo with respiratory monitoring, breath-hold T2-weighted single-shot fast spin-echo, and T1-weighted gradient-recalled echo sequences before and after the injection of gadoterate dimeglumine. Rhee TK, Lewandowski RJ, Liu DM, et al. diffusion-weighted imaging (DWI) with three b values (50, 400, 800), arterial, portal and late phases after gadolinium ), and during two distant separate sessions. Article: Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and yttrium-90 radioembolisation as treatment options using a propensity score analysis model. Blood flow of the Liver. 2012; 83(3):887-94 (ISSN: 1879-355X) . Int J Radiat Oncol Biol Phys. View Quiz Several imaging modalities are available to detect hepatic metastases and their primary neuroendocrine tumours. Well-differentiated neuroendocrine neoplasms most commonly originate from the small bowel, pancreas, and lung. Treatment Options for Liver Metastasis Surgery Resection of a limited number of intrahepatic metastases has been shown to provide long term benefit 5-yr Relapse Free Survival (RFS) after resection of isolated colorectal or neuroendocrine liver metastases is ~ 30% (20-46%) Treatment Options for Liver Metastasis Stringent eligibility criteria: The carcinoid is the most common neuroendocrine tumor causing liver metastases, especially when of midgut origin. The DCE-MRI was performed at 3 T with . Methods and Materials: This study was . So far, no standard procedure has become established for the early diagnosis of bone metastases from neuroendocrine tumor. Current guidelines recommend embolotherapy for progressive or symptomatic NET liver metastases, but the optimal technique among bland embolization, lipiodol chemoembolization . Numerous metastases from neuroendocrine tumor of the pancreas with variable appearance: Two large masses centrally in the liver and multiple small masses are to a variable degree solid and cystic: cystic components demonstrate fluid-debris levels on T2w and partial hyperintensity of T1w suggestive of necrosis. Jonathan R. Strosberg, Magnetic Resonance Imaging of Neuroendocrine Tumor Hepatic Metastases, Pancreas, 10.1097/MPA.0000000000000920, 46, 9, (1219-1224), (2017). The liver has a dual blood supply from both the hepatic artery (25% of the flow) and portal vein (70% of hepatic blood flow) Arterial blood is carried by the hepatic artery. The treatment of large-volume liver metastases originating from neuroendocrine tumors remains challenging. Neovascularity, vascular encasement, and arteriovenous shunting are rare. euroendocrine tumors are rare ma- lignancies that arise from the Kul- chitsky's enterochromaffin cells and that are characterized by positivity for chromo- The patient was followed up until 2020, and the primary pancreatic tumor was found, along with multiple liver metastases and portal vein thrombosis. ENETS Consensus Guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. After the dark ages, advances in chemotherapy and diagnostic imaging have enabled strict patient selection, and the pioneering study from the Oslo group has contributed to the substantial progress in this field. Neuroendocrine tumors are a rare subset of tumors that are increasing in incidence over the last 4 decades. 1997, Tomassetti et al. Resection and ablation can be associated with long-term survival, 2, 3 but the . In contrast hematogenous spread is the least common form of ovarian metastasis and is rarely present at the time of diagnosis. Conventional ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI) and somatostatin receptor scintigraphy (SRS) are the cornerstones for the localisation of neuroendocrine tumours with sensitivities of respectively 46%, 42%, 43% and 90% [20-23]. Surgical Approaches to the Management of Neuroendocrine Liver Metastases. Neuroendocrine tumours (NET) commonly metastasize to the liver 1.Neuroendocrine liver metastases (LM) frequently have an indolent clinical course, compared with hepatic metastases from non-endocrine gastrointestinal or pancreatic malignancies, and incapacitating clinical symptoms in the presence of a hormonally active tumour load. GI NETs frequently metastasize into the liver, though NETs of primary hepatic origin are extremely rare. neuroendocrine tumors, and renal cell carcinomas . 2008). Chemotherapy has been effective in metastatic islet cell tumors, with response rates of up to 60%; response rates are lower in patients with carcinoid (20%) (3) . Approximately 70 % of patients are found to have peritoneal metastases at the time of staging laparotomy. Somatostatin receptor scintigraphy is an accurate imaging modality for the diagnosis of neuroendocrine tumor. They are up to 18 times more frequent than primary neoplasms Liver is second to regional lymph nodes as a site of metastatic disease Some primary tumors are prone to cause a liver-dominant disease: - Colorectal cancer - Neuroendocrine tumors . Article: Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and yttrium-90 radioembolisation as treatment options using a propensity score analysis model. Surgery versus intra-arterial therapy for neuroendocrine liver metastasis: a multicenter international analysis. [ 1, 59, 60] Typically, on T1-weighted scans, metastases are of low signal intensity relative to the background . Overall, the appearances are highly suggestive of a small bowel neuroendocrine . . Overall, the appearances are highly suggestive of a small bowel neuroendocrine . Poorly differentiated NET and progressive neuroendocrine metastases in the liver (>25% volume increase on two CT scans within 3 months) further adversely affects survival among patients with hepatic metastasis ( Madeira et al, 1998 ). The U.S. Department of Energy's Office of Scientific and Technical Information Patients with liver metastases have a significantly worse prognosis and 5-year survival of patients with neuroendocrine liver metastases on supportive care is 0% to 20%. Diagnosis of metastatic neuroendocrine tumor to the liver is obtain through a contrast imaging CT scan or MRI. This study found improved prognosis with primary tumours <2.5 cm, absence of liver metastases, absence of carcinoid symptoms and a low Ki67 (Pape et al. The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. . Hepatic metastases of neuroendocrine tumors had a typical hypervas- cular pattern in 73% of patients. Two studies have identified that the prognosis of patients with MNETs is dependent on gender and presence of liver metastases (Burke et al. A routine liver biopsy (either percutaneous, endoscopic or laparoscopic) is not necessary in an obvious setting. . Neuroendocrine liver metastases: Value of apparent diffusion coefficient and enhancement ratios for characterization of histopathologic grade. 1 indeed, several studies from north america, europe and asia have also shown similar increases, although no … Patients with multiple liver neuroendocrine . In particular, MR imaging with liver-specific contrast agents is increasingly recommended in preoperative patients.20 PET Considering that 2-[18F]fluoro-20-deoxyglucose Therefore, it would be useful if imaging features of NEN tumors could be used to predict tumor behavior, particularly when an indication of surgical resection is considered. A plain abdominal radiograph plays only a minor role in the investigation of liver metastases. Neuroendocrine liver metastases are typically hypervascular, which may be elucidated on Doppler ultrasound and contrast-enhanced ultrasound (arterial enhancement) [] or particularly during the hepatic arterial phase of standard oncological computed tomography imaging, which depicts more liver lesions than contrast-enhanced ultrasound [].The highest degree of lesion detection can be obtained . Authors: Minh et al, December 2017, Volume 27, Issue 12, pp 4995-5005 Background Brain metastases (BM) are rarely reported in patients with neuroendocrine carcinoma (NEC) of non-lung origin and neuroendocrine tumors (NET) of the gastroenteropancreatic (GEP) or bronchopulmonary system. On the post-contrast imaging, some target-shaped liver lesions can be appreciated but the diffusion weighted series confirms the presence of innumerable restricted lesions within the liver, as well as markedly restricted diffusion of the mesenteric mass. Neuroendocrine neoplasms (NENs) are rare and heterogeneous epithelial tumors most commonly arising from the gastroenteropancreatic (GEP) system. Surgical excision remains the preferred treatment for resectable hepatic metastases of neuroendocrine tumors. Abstract Purpose: To present long-term outcomes on the safety and efficacy of Yttrium-90 radioembolization in the treatment of unresectable hepatic neuroendocrine metastases refractory to standard-of-care therapy. In an epidemiologic study of neuroendocrine tumours and their primary sources, Riihimäki and colleagues demonstrated that the most common primary source of neuroendocrine tumour metastases to the liver is the small intestine.10 In 1842 cases, 56% of liver metastases originated in the small intestine, whereas 8% originated in the lung.10 . Biopsy-proven neuroendocrine tumor. Biopsy confirmed low-grade neuroendocrine tumor with features suggesting GI tract origin. Approximately 80% of metastatic patients have secondary liver lesions, and in approximately 50% of . Hepatic arterial phase and fast spin-echo T2-weighed se- quences are the most sensitive. Int J Radiat Oncol Biol Phys. Forty patients with hepatic neuroendocrine metastases were treated with (90)Y radioembolization at a single center. Regions of interest were drawn around target lesions, as well as along liver outlines for each patient. (CT) with a multirow detector scanner, and diffusion-weighted (DW) magnetic resonance imaging (MRI) are currently considered the morphologic imaging modalities of choice for the detection of NE LMs. The most common sites for this form of dissemination are the colon, liver, intestine, and lung in 50, 48, 44, and . FDA News Release: FDA approves new diagnostic imaging agent to detect rare neuroendocrine tumors. . Mr Armstrong gave an excellent talk about the ways in which liver metastases are diagnosed and treated - including the factors that may influence choice of treatment. Measurable metastasis to liver with at least one dimension ≥ 1.0 cm. PET-CT. They consist of a large heterogeneous group of malignancies that are derived from embryonic neural crest tissue found in various organ such as the hypothalamus, pituitary gland, thyroid gland, adrenal medulla, and gastrointestinal tract. Although multiple modalities are available for the treatment of neuroendocrine liver metastases, optimal management is unclear. Neuroendocrine tumors (NETs) are the second most common gastrointestinal malignancy after colon cancer. Metastases are the most common malignant liver lesions and the most common indication for hepatic imaging. Of patients with metastatic neuroendocrine tumors (mNETs), 50-95% develop liver metastases; of those with advanced liver disease, 80% may die within 5 years of diagnosis . Recently, two large scale randomized placebo controlled studies have shown better progression-free survival and response outcomes in patients with advanced neuroendocrine tumors treated . Pavel M, Baudin E, Couvelard A, et al. long-term outcomes on the safety and efficacy of Yttrium-90 radioembolization in the treatment of unresectable hepatic neuroendocrine metastases refractory to standard-of-care therapy. Because detection of distant metastases has a major impact on treatment, early diagnosis of metastatic spread is of great importance. Toxicity was assessed using National Cancer Institute Common . Lung cancer is a frequent cause of liver metastases, and metastases to the lung from other primary sites alter the management of cancer considerably. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. On the post-contrast imaging, some target-shaped liver lesions can be appreciated but the diffusion weighted series confirms the presence of innumerable restricted lesions within the liver, as well as markedly restricted diffusion of the mesenteric mass. mography/computed tomography (PET/CT) in patients with liver metastases of neuroendocrine neoplasms. In a previous study, . Imaging techniques have a significant role in the diagnosis and management of patients with liver metastases, this includes somatostatin receptor scintigraphy, CT scan and MR imaging. A dual-input single-compartment model was used to compute . Standardization of imaging techniques is a key point of the sensibility, of both CT and MR imaging, in the detection of liver metastases from WDGEP ET. By MRI, the appearance of metastases varies based on the imaging sequence performed. On an outpatient basis, radioembolization can be utilized from early line to . Neuroendocrinology 2012; 95:157. The Ki-67 proliferative rate in liver metastases of gastroenteropancreatic NETs has been used as a prognostic factor as well as a guideline for . Liver transplantation (LT) for unresectable colorectal liver metastases has long been abandoned because of dismal prognoses. However, symptomatic brain metastases are associated with dismal prognosis, so early detection and treatment could be advisable. Postoperative pathology suggested a neuroendocrine tumor of the liver, and it was suggested to look for the primary tumor. Forty patients with hepatic neuroendocrine metastases were treated with (90)Y radioembolization at a single center. Neuroendocrine tumors resulting in metastases to the liver are associated with significant morbidity and mortality. Authors: Minh et al, December 2017, Volume 27, Issue 12, pp 4995-5005 The 5-year survival of patients with neuroendocrine tumor liver metastases is reported to be approximately 20%-30% ( 1 ). Methods We retrospectively analyzed 51 patients . These tumors occur along the gastrointestinal tract and bronchopulmonary tree and frequently metastasize. About 11-14% of metastates of an unknown primary are due to neuroendocrine tumours, typically low grade gastrointestinal tumours. Liver Metastases RolandHustinx, MD, PhDa,*,NancyWitvrouw,MDa, . In neuroendocrine liver metastases, the excess hormone production, the multitude of hepatic lesions, and ultimate liver disease has made the condition poor prognosis. Ultrasound We compared the diagnostic . The liver mass was surgically removed. In patients with gastroenteropancreatic (GEP) neuroendocrine tumors, we investigated the usefulness of somatostatin receptor scintigraphy (SRS) in the detection of liver metastasis, which represents the most important prognostic factor in these tumors, and in the management of affected patients. Endocrinol Metab Clin North Am 2018;47:627-43 . Pancreatic neuroendocrine tumors form in hormone-making cells (islet cells) of the pancreas. 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