Gastric neuroendocrine neoplasms: a primer for radiologists

Abdom Radiol (NY). 2022 Dec;47(12):3993-4004. doi: 10.1007/s00261-022-03509-1. Epub 2022 Apr 12.


Gastric neuroendocrine neoplasms are uncommon tumors with variable differentiation and malignant potential. Three main subtypes are recognized: type 1, related to autoimmune atrophic gastritis; type 2, associated with Zollinger-Ellison and MEN1 syndrome; and type 3, sporadic. Although endoscopy alone is often sufficient for diagnosis and management of small, indolent, multifocal type 1 tumors, imaging is essential for evaluation of larger, high-grade, and type 2 and 3 neoplasms. Hypervascular intraluminal gastric masses are typically seen on CT/MRI, with associated perigastric lymphadenopathy and liver metastases in advanced cases. Somatostatin receptor nuclear imaging (such as Ga-68-DOTATATE PET/CT) may also be used for staging and assessing candidacy for peptide receptor radionuclide therapy. Radiotracer uptake is more likely in well-differentiated, lower-grade tumors, and less likely in poorly differentiated tumors, for which F-18-FDG-PET/CT may have additional value. Understanding disease pathophysiology and evolving histologic classifications is particularly useful for radiologists, as these influence tumor behavior, preferred imaging, therapy options, and patient prognosis.

Keywords: Autoimmune atrophic gastritis; Computed tomography (CT); Gastric carcinoid; Gastric neuroendocrine neoplasm; Magnetic resonance imaging (MRI); Somatostatin receptor imaging; Zollinger–Ellison syndrome.

Publication types

  • Review

MeSH terms

  • Gallium Radioisotopes
  • Humans
  • Neuroendocrine Tumors* / pathology
  • Organometallic Compounds*
  • Positron Emission Tomography Computed Tomography / methods
  • Radiologists
  • Stomach Neoplasms*


  • Gallium-68
  • Gallium Radioisotopes
  • copper dotatate CU-64
  • Organometallic Compounds