Year: 2023
Type: article
Abstract: Ziel/Aim Precise anatomical localization of insulinomas is crucial for surgical treatment. The current routine non-invasive imaging techniques CT, MRI, 68 Ga-DOTA-somatostatin analog PET/CT (SSA-PET/CT) have limited sensitivity. In this prospective multicenter study we compared the diagnostic accuracy of 68 Ga-NODAGA-exendin-4 PET/CT (Exendin PET/CT) with all routine non-invasive imaging procedures for the localization of insulinomas. In contrast to previous studies, we used the chelator NODAGA instead of DOTA for radiolabeling of exendin, resulting in higher specific activities and administration of lower peptide doses. Methodik/Methods Sixty-nine adults with biochemically proven adult endogenous hyperinsulinemic hypoglycemia (AHH) underwent Exendin PET/CT and current routine imaging. Images were evaluated in clinical reading and in an expert reading. Image quality was determined by quantitative analysis. Ergebnisse/Results Patients experienced less adverse events than in previous studies with 68 Ga-DOTA-exendin (nausea in 3% vs. 27% of patients). Based on clinical readings, the accuracy of Exendin PET/CT (94.4% (CI 84.6-98.8%)) was higher than SSA-PET/CT (64.8% (CI 50.6-77.3%)), CT/MRI (83.3% (CI 70.7-92.1%) and EUS (82.8% (CI 64.1-94.1)) In 13% of patients, a correct diagnosis was only reached after Exendin PET/CT. Interobserver agreement between readings was higher for Exendin PET/CT than for SSA PET/CT and CT/MRI (Cohens kappa 1.0 vs. 0.5 and 0.55). Exendin PET/CT provided higher insulinoma-to-background ratios (15.3±6.7 vs. 5.2±3.0) and contrast-to-noise ratios (22.6±11.1 vs. 5.1±3.7) than SSA-PET/CT. Schlussfolgerungen/Conclusions This study, in which Exendin PET/CT was for the first time compared to all current routine non-invasive imaging modalities, demonstrates the superior performance of Exendin PET/CT for pre-operative localization of benign insulinomas. It shows that Exendin PET/CT has the potential to be used as the primary diagnostic imaging modality in patients with AHH. Publication History Article published online: 30 March 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany
Source: Nuklearmedizin - NuclearMedicine
Institutions: Radboud University Nijmegen, Radboud University Medical Center, Uppsala University, University of Turku, Turku PET Centre, University Medical Center Groningen, University of Bern, Centre Hospitalier Universitaire de Lille, University Hospital of Basel, Assistance Publique – Hôpitaux de Paris, Hôpital Tenon, Erasmus MC
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Akademiska Sjukhuset, Uppsala Universitet
OpenAlex ID: W4366486271