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Imaging pancreatic islet cell tumours

Academic Department of Radiology, St Bartholomew's Hospital, London EC1A 7BE, UK

• Pancreatic islet cell tumours are rare neoplasms with varying malignant potential depending on the tumour type. They usually present with a recognizable syndrome due to hormonal hypersecretion.
  
• While a wide range of imaging modalities are employed for their detection and staging, none has proven universally successful.
  
• On ultrasound the lesions are usually homogeneous and hypoechoic relative to normal pancreas.
  
• Endoscopic and intraoperative ultrasound are more sensitive than transabdominal ultrasound but require experience to perform and interpret.
  
• On CT the tumours are often isodense with normal pancreas prior to contrast medium injection but usually enhance markedly on dynamic scanning as do metastases in the liver.
  
• On MRI the tumours are of low signal intensity on T₁ Weighted imaging but enhance with gadolinium, and are of high signal intensity on T₂ Weighted imaging relative to normal pancreas.
  
• On angiography the lesions are hypervascular. However, angiography and transhepatic portal venous sampling have been superseded by arterial stimulation with venous sampling, which localizes the tumour to an area of the pancreas by demonstrating hormonal response to a secretagogue.
  
• Somatostatin receptor scintigraphy is useful to detect metastases and otherwise occult neoplasms; PET scanning does not at present play an important role.
  

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