DETECTION OF PANCREATIC NETS 1. CT technique for detection of pancreatic NETs

1. CT technique for detection of pancreatic NETs Optimal technique is essential for accurate detection of pancreatic NETs. The patient should be fasted to ensure that the stomach and duodenum are emptied of their contents. The stomach is distended with water, and intravenous (IV) or intramuscular (IM) hyoscine butylbromide or another anti-peristaltic agent is administered. An initial precontrast scan is performed to identify the level of the pancreas. Following IV administration of 150 ml of contrast medium at a rate of 3–5 ml/second, biphasic scanning is recommended. Late arterial-phase imaging of the pancreas should be obtained with a section thickness of 3–5 mm. In patients unlikely to have metastases (e.g. most insulinomas), the liver is not required to be included in the arterial phase, but if metastases are likely, it can be included. Portal venous phase imaging should include the entire liver and pancreas, down to the iliac crests. The section thickness should not exceed 5 mm. The images are then reconstructed to 1–2 mm in slice thickness, and coronal or sagittal reformats may be made. Images should also be viewed on narrow window settings in order to augment the difference between the enhancing tumour and the pancreas.[1]