Magnetic resonance imaging versus endoscopic ultrasonography for the detection of pancreatic tumours in multiple endocrine neoplasia type 1

Objective: In multiple endocrine neoplasia type 1, the main risk factor for metastases is pancreatic turnout size. We and others recommend limiting surgery to non-functioning pancreatic tumors >= 20 mm or growing, based on their size measured with endoscopic ultrasonography. Because endoscopic ultrasonography is invasive, we compared endoscopic ultrasonography (EUS) to non-invasive magnetic resonance imaging (MRI) for the detection of pancreatic tumors >= 10 mm in multiple endocrine neoplasia type 1 patients. Methods: A prospective study was performed in nine participating centres; 90 patients with multiple endocrine neoplasia type 1 underwent EUS and MRI with gadolinium infusion. Gastroenterologists and radiologists were blinded to the results, magnetic resonance images were reviewed centrally. Results: EUS detected 86 tumors >= 10 mm, and 48(53.3%) patients had at least one tumour >= 10 mm. MRI detected 67 tumors >= 10 mm, and 46(51.1%) patients had at least one tumour >= 10 mm. EUS and MRI agreement was moderate for detection of tumors >= 10 mm (Kappa coefficient = 0.49), and for selection of patients with tumours >= 10 mm (Kappa coefficient = 0.55). EUS and MRI missed 11/24 and 4/24 lesions >= 20 mm, respectively. EUS failed to identify 9/57 (15.7%) patients with pancreatic tumours >= 10 mm, and MRI failed to identify 11/57 (19.3%) patients with pancreatic tumors >= 10 mm. Conclusions: EUS and MRI are complementary and should be performed at initial evaluation in multiple endocrine neoplasia type 1 patients. Whether follow-up should be based on either technique or both, requires further evaluation. (C) 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.