Pancreatic metastases from renal neoplasms and neuroendocrine pancreatic tumours: is a differential diagnosis possible with CT?

Maria Chiara Ambrosetti, Giulia Angela Zamboni, Alessandro Fighera, Giancarlo Mansueto


Purpose: Both pancreatic metastases from renal cell carcinoma (pRCC) and pancreatic endocrine tumours (pNET) appear typically as hypervascular, well-defined lesions, and a differential diagnosis may be extremely difficult. Our purpose was to assess the value of CT and CT texture analysis in the differential diagnosis when considering only one lesion per patient, therefore excluding the added value of multiplicity.

Material and Methods: In this retrospective study, we compared the MDCTs performed on 31 patients with pRCC to 31 patients with pNET matched by size, performed at our institution in the last 6 years. We analysed margins, size, location, qualitative assessment of enhancement intensity and homogeneity in the arterial and venous phases, vascular invasion and dilatation of main pancreatic duct (MPD). Texture analysis was performed on a subgroup of 22 Patients with pNET and 22 Patients with pRCC.

Results: No significant difference was observed in lesion distribution. Twenty-nine pRCCs and 27 pNETs appeared hyperdense to the normal pancreatic parenchyma in the arterial phase (p=n.s.). Twenty-three pRCCs and 17 pNETs appeared hyperdense to the normal pancreatic parenchyma in the venous phase, again with no statistically significant difference (all p=n.s.). No significant difference was found on homogeneity both in arterial and venous phase. Regarding texture analysis, only skewness calculated in the arterial phase was significantly different between the two groups of patients.

Conclusions: Both pRCC and pNET are hypervascular lesions with sharp margins, usually not associated with MPD dilatation or vessel infiltration. We did not find significant imaging features or quantitative parameters to support the differential diagnosis. The best diagnostic clue for pRCC is a history of renal cell carcinoma.


Pancreatic renal cell metastases; Pancreatic neuroendocrine tumours; MDCT

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