Improved Localization of Insulinomas Using68Ga-NODAGA-Exendin-4 PET/CT
Year: 2024
Type: article
Study design: Observational Study
Abstract: Precise anatomic localization of insulinomas is crucial for surgical treatment. Current routine noninvasive imaging techniques, including CT, MRI, and 68Ga-DOTA-somatostatin analog (DOTA-SSA) PET/CT, have limited sensitivity. Endoscopic ultrasound is highly sensitive but invasive. In this prospective multicenter study, we compared the diagnostic accuracy of 68Ga-NODAGA-exendin-4 (exendin) PET/CT with all routine imaging procedures for the localization of insulinomas. Methods: Sixty-nine adults with biochemically proven adult endogenous hyperinsulinemic hypoglycemia underwent exendin PET/CT and current routine imaging. Images were evaluated in a clinical reading and in an expert reading. Image quality was determined by quantitative analysis. Results: Based on clinical readings, the accuracy of exendin PET/CT (94.4%; 95% CI, 84.6%–98.8%) was greater than that of DOTA-SSA PET/CT (64.8%; 95% CI, 50.6%–77.3%), contrast-enhanced CT/contrast-enhanced diffusion-weighted imaging-MRI (83.3%; 95% CI, 70.7%–92.1%), and endoscopic ultrasound (82.8%; 95% 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 DOTA-SSA PET/CT and contrast-enhanced CT/contrast-enhanced diffusion-weighted imaging-MRI (Cohen κ, 1.0 vs. 0.5 and 0.55). Exendin PET/CT provided a higher insulinoma-to-background ratio (15.3 ± 6.7 vs. 5.2 ± 3.0) and contrast-to-noise ratio (22.6 ± 11.1 vs. 5.1 ± 3.7) than did DOTA-SSA PET/CT. Conclusion: This study demonstrates the superiority of exendin PET/CT in a unique prospective comparison to all current routine imaging modalities for preoperative localization of benign insulinomas, providing the level of evidence needed for clinical implementation.
Source: Journal of Nuclear Medicine
Authors: Marti Boss, Olof Eriksson, Kirsi Mikkola, Annemarie Eek, Maarten Brom, Mijke Buitinga, Adrienne H. Brouwers, Irina Velikyan, Beatrice Waser, Saila Kauhanen, Olof Solin, Camille Marciniak, Barbro Eriksson, Jean-Claude Reubi, Cyrielle Aveline, Damian Wild, Francois Pattou, Jean-Noel Talbot, Johannes Hofland, Anders Sundin, Pirjo Nuutila, John Hermans, Martin Gotthardt
Institutions: Radboud University Nijmegen, Radboud University Medical Center, Uppsala University, Science for Life Laboratory, University of Turku, Turku PET Centre, University Medical Center Groningen, Turku University Hospital, Université de Lille, Centre Hospitalier Universitaire de Lille, University of Bern, Assistance Publique – Hôpitaux de Paris, Hôpital Tenon, University of Basel, University Hospital of Basel, Erasmus MC
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Funders: Akademiska Sjukhuset, Uppsala Universitet
OpenAlex ID: W4403512164