he first experience of using magnetic resonance spectrometry in neuroendocrine neoplasia of the pancreas.

Purpose: Improving the accuracy of pancreatic tumor detection and differential diagnosis of neuroendocrine neoplasia (NEN) with pancreatic adenocarcinomas using a two‑dimensional (2D) multivoxel hydrogen MR spectrometry protocol. Materials and methods: The study included 76 patients, including 47 cases of pancreatic tumors and 29 cases without pancreatic pathology. Pancreatic tumors were represented by 24 NEN (G1 = 4, G2 = 19, G3 = 1) and 23 adenocarcinomas. The diagnosis was established based on morphological examination after surgery or tumor biopsy. The levels of the following metabolites obtained by multivoxel MR spectrometry were determined: choline (Cho), creatine (Cr), glutamine/glutamate (Glx), N‑acetylaspartate (NAA), lactate (Lac) and their ratios Cho/Cr, Lac/Cr, Cho/NAA, Glx/Cr. Results: The results of the study showed a higher level of creatine in unchanged tissue compared to pancreatic tumors (p = 0.032): in unchanged pancreatic tissue — from 6.01 to 23 (median 12.4), in tumors — from 3.04 to 13.55. (median 6.01). At a threshold signal level from creatine of less than 16.1, the sensitivity in detecting pancreatic tumor was 70.9 %, specificity — 61.9 %. The Cho/Cr level was higher in tumors compared to unchanged pancreatic tissue (p = 0.031). It was also found that the presence of glutamate and glutamine in the tumor, recorded by MR spectrometry data, is more common in NEN compared to pancreatic adenocarcinomas (p = 0.029): the presence of glutamate and glutamine was noted in 66.7 % of NEN and in 34.8 % of pancreatic adenocarcinomas. The Glx/Cr level in NEN was also higher compared to adenocarcinomas (p = 0.026). Conclusion: MR spectrometry may be a useful adjunctive tool in the detection of pancreatic tumors and differential diagnosis of pancreatic adenocarcinomas and NENs, to improve the accuracy of pancreatic tumor detection and differential diagnosis of NENs with pancreatic adenocarcinomas using a two‑dimensional (2D) multivoxel 1H‑magnetic resonance spectrometry (MRS) protocol.

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