title: CT differentiation of poorly-differentiated gastric neuroendocrine tumours from well-differentiated neuroendocrine tumours and gastric adenocarcinomas.
abstract: OBJECTIVE
  To evaluate the differential CT features of gastric poorly-differentiated neuroendocrine tumours (PD-NETs) from well-differentiated NETs (WD-NETs) and gastric adenocarcinomas (ADCs) and to suggest differential features of hepatic metastases from gastric NETs and ADCs.
  
  
  METHODS
  Our study population was comprised of 36 patients with gastric NETs (18 WD-NETs, 18 PD-NETs) and 38 patients with gastric ADCs who served as our control group. Multiple CT features were assessed to identify significant differential CT findings of PD-NETs from WD-NETs and ADCs. In addition, CT features of hepatic metastases including the metastasis-to-liver ratio were analyzed to differentiate metastatic NETs from ADCs.
  
  
  RESULTS
  The presence of metastatic lymph nodes was the sole differentiator of PD-NETs from WD-NETs (P = .001, odds ratio = 56.67), while the presence of intact overlying mucosa with mucosal tenting was the sole significant CT feature differentiating PD-NETs from ADCs (P = .047, odds ratio = 15.3) For hepatic metastases, metastases from NETs were more hyper-attenuated than those from ADCs.
  
  
  CONCLUSIONS
  The presence of metastatic LNs and intact overlying mucosa with mucosal tenting are useful CT discriminators of PD-NETs from WD-NETs and ADCs, respectively. In addition, a higher metastasis-to-liver ratio may help differentiate hepatic metastases of gastric NETs from those of gastric ADCs with high accuracy.
  
  
  CONCLUSIONS
  • Presence of metastatic LNs is a useful differentiator of PD-NETs from WD-NETs. • Intact overlying mucosa with mucosal tenting suggests PD-NETs more than gastric ADCs. • Metastatic LNs are larger in size and greater in necrotic volume in PD-NETs. • Hepatic metastases from gastric NETs are more hyper-attenuated than those from ADCs.
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Kim
authors.forename: Se Hyung
authors.initials: SH
authors.lastname: Kim
authors.forename: Min-A
authors.initials: MA
authors.lastname: Kim
authors.forename: Cheong-il
authors.initials: CI
authors.lastname: Shin
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Byung Ihn
authors.initials: BI
authors.lastname: Choi
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D011446:Prospective Studies; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D055815:Young Adult