Method | Advantages | Disadvantages |
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Ultrasound |
No exposure to ionising radiation Repeatability Transabdominal ultrasound – wide availability EUS – primary method for pancreatic tumour assessment (EUS + CEUS, elastography) EUS-FNA – possibility of cytological verification EUS-RFA – possibility to treat focal lesions of the pancreas CEUS, elastography – improved sensitivity for focal lesion assessment, evaluation of unclear lesions on CT/MRI IOUS – possibility of intraoperative lesion assessment IDUS – thorough assessment of intraductal lesions |
Assessment dependent on the skills and experience of the examiner and the class of the device Poorer sensitivity of the classic method EUS, IOUS, IDUS, CEUS – access only at specialised centres, invasive procedures |
Computed tomography |
High spatial resolution (min. 2–4 mm) Thorough anatomical assessment of abdominal organs Multiplanar imaging, 3D reconstruction Disease staging Assessment of intestinal focal lesions (enteroclysis, enterography, CT colonoscopy) Aid in surgery planning Availability, quick results, repeatability |
Exposure to ionising radiation Exposure to iodine contrast agent and the associated complications (renal failure, allergic reactions, hyperthyroidism) Vasculature assessment dependent on the phase and dose of contrast Difficult reassessment of both small and too large lesions in terms of volume Difficult assessment of response to treatment if necrosis, haemorrhage or fibrosis are present with no reduction in lesion size Difficult assessment in slowly growing lesions |
Magnetic resonance imaging |
High spatial resolution (min. 2–4 mm) Best differentiation between soft tissues Multiplanar imaging, 3D reconstruction Disease staging The best method for the assessment of hepatic and pancreatic focal lesions Assessment of bile duct and pancreatic duct – MRI cholangiopancreatography No exposure to ionising radiation Gadolinium contrast – fewer allergic reactions, no kidney damage Repeatability |
High costs Limited availability Long duration of procedure Patient cooperation required Contraindication: metal parts in the body Difficult reassessment of both small and too large lesions in terms of volume Difficult assessment of response to treatment if necrosis, haemorrhage or fibrosis are present with no reduction in lesion size Difficult assessment in slowly growing lesions |
99mTc-SPECT |
Functional examination Full-body scan CT imaging possible Assessment of primary lesion location, stage of the disease Evaluation for appropriate forms of treatment, assessment of treatment response, evaluation for PRRT Monitoring, reassessment 1-day procedure, SPECT 4 hours after tracer administration |
Exposure to ionising radiation Low resolution, poor assessment of lesions <1 cm High background hinders midgut NEN assessment on gastrointestinal examination Low sensitivity in insulinoma detection Possible interference with cold somatostatin analogues |
68Ga-DOTA-PET |
Functional examination Full-body scan Multiplanar imaging, high resolution 4–6 mm, imaging together with CT Possibility to calculate the level of uptake – standardised uptake value (SUV) Good anatomical assessment Assessment of primary lesion location, stage of disease, evaluation for appropriate forms of treatment, assessment of treatment response, monitoring, reassessment Assessment for PRRT 1-day procedure, images obtained quickly, after 2 hours |
Uptake in normal tissues (pituitary gland, spleen, kidneys, adrenal glands) or in inflammatory foci may be mistaken for a tumour Possible interference with cold somatostatin analogues Lack of complete validation |
18FDG-PET |
Functional examination Full-body scan Multiplanar imaging, high resolution 4–6 mm, imaging together with CT Good anatomical assessment Disease staging, assessment of treatment response, prognostic factor, monitoring For the assessment of poorly differentiated NEN Prognostic value in highly and medium differentiated NEN |
Exposure to radiation Poor uptake in NEN G1 and G2 Procedure available in specialised centres |
131I-MIBG-SPECT |
Functional examination Full-body scan High specificity for phaeochromocytoma, paraganglioma, neuroblastomas Assessment for treatment with 131I-MIBG |
High background Poor anatomical assessment Interference from many pharmaceuticals Need for preparation with organic iodine in order to block the thyroid gland before the procedure Procedure 24–72 hours after tracer administration |
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Abdominal
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Abdominal and pelvic
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