# Pancreatic Neuroendocrine Diagnostic Imaging Order and Reader Evaluation over Two Decades in a Tertiary Academic Center

## TL;DR

This study examines how imaging techniques for diagnosing pancreatic neuroendocrine tumors have evolved over two decades in a major hospital.

## Contribution

The study identifies a shift in imaging trends for pNETs and highlights the role of CT and MRI in diagnosis and staging.

## Key findings

- CT scans remained the primary initial imaging method for pNETs due to their availability and resolution.
- MRI usage increased, particularly for syndromic patients, due to its precision for follow-up and surgery planning.

## Abstract

Background/Objective: Identifying patterns of diagnostic imaging workflow parallel to the influence of certain variables, such as pathology guidelines over time, provides valuable insight for clinical decision making. This study presents a recurring trend of initial imaging orders and follow-ups, up to the diagnosis of pancreatic neuroendocrine tumors (pNETs), across two decades, with scans which led to pathological investigation. Methods: Three readers evaluated common conventional imaging among initial and follow-up studies for lesion detection and localization. Inter-reader and intra-reader analyses were controlled as contributing factors to the imaging diagnostic trend. Results: Our results show that CT was the prominent initial scan in pNET workup, likely due to their wide availability, high spatial resolution, and rapid acquisition, with a sufficient detection rate throughout both decades, regardless of technical advances. However, MRI scans also gained soaring popularity, especially among syndromic patients, likely due to follow-up and anatomical surgery precision. Conclusions: Newer modalities may be eventually useful and only requested for pNETs staging and further treatment.