Prospective Comparison of Biphasic Contrast-Enhanced CT, Volume Perfusion CT, and 3 Tesla MRI With Diffusion-Weighted Imaging for Insulinoma Detection

Purpose: To evaluate the diagnostic performance of biphasic contrast-enhanced CT (CECT), volume perfusion CT (VPCT) and 3 Tesla MRI with diffusion-weighted imaging (DWI), in patients with clinically suspected insulinomas. Materials and Methods: This prospective study was approved by the institutional review board. Sixty-four patients with clinically suspected insulinomas underwent biphasic CECT, VPCT, and 3T MR with DWI. Two radiologists independently determined the presence/absence of tumor using a 5-scale confidence level. Conspicuity of the lesion and clarity of tumor-to-pancreatic duct distance were graded. Receiver operating characteristic analysis was performed to compare diagnostic performance. Results: Forty-seven patients were tumor positive, with 51 tumors. The differences between the areas under the curve values for tumor detection were as follows: 0.715 (CECT), 0.903 (VPCT), 0.832 (MRI without DWI) and 0.955 (MRI with DWI) for reader 1, and 0.738 (CECT), 0.895 (VPCT), 0.841 (MRI without DWI), and 0.956 (MRI with DWI) for reader 2. MRI with DWI and VPCT were significantly more accurate than CECT for insulinoma detection (P=0.01 and 0.02 for reader 1, and P=0.01 and 0.03 for reader 2). Lesion conspicuity was better on MRI compared with VPCT (P=0.01), and both were better than CECT (both P<0.01). Tumor-to-pancreatic duct distance was better appreciated on MRI, compared with CECT and VPCT (both P<0.01). The weighted k values indicate good to excellent agreement between observers for determining tumor presence/absence (k=0.64-0.84). Conclusion: The 3T MRI with DWI and VPCT are significantly more accurate than CECT for insulinoma detection. MRI demonstrates higher tumor conspicuity and is superior in depicting the tumor-to-duct distance.