Chavan A, Kirchhoff T D, Brabant G, Scheumann G F, Wagner S, Galanski M
Department of Diagnostic Radiology, Hannover Medical School, Germany.
Eur Radiol. 2000;10(10):1582-6. doi: 10.1007/s003300000428.
The aim of this study was determination of the significance of the arterial stimulation test with venous sampling (ASVS) in the preoperative localization of insulinoma. Eleven patients with endogenous hyperinsulinism underwent preoperative transabdominal US, spiral computer tomography (spiral CT), MRI, endoscopic ultrasound (EUS) as well as angiography (DSA) combined with ASVS. The results were compared with intraoperative findings, intraoperative ultrasound (IOUS) and histopathology. There were no complications related to the ASVS test. In 11 patients the tumor could be localized with the various modalities as follows: US 1 of 11 (9%), MRI 3 of 10 (30%), spiral CT 4 of 11 (36%), EUS 5 of 10 (50%), DSA 8 of 11 (73%), and ASVS 10 of 11 (91%). In 2 patients the tumors were intraoperatively neither palpable nor detectable by IOUS, and consequently the intraoperative management was governed by information provided by DSA combined with the ASVS test. Ten patients had solitary benign insulinomas and 1 patient with multiple endocrine neoplasia I had two tumors adjacent to each other in the pancreatic tail. Arterial stimulation test with venous sampling was the most sensitive preoperative test for regionalizing the insulinoma in our set of patients. It can be performed safely in the course of a regular DSA examination and may affect intra-operative management in patients in whom the tumors are not detectable by palpation or IOUS.
本研究的目的是确定动脉刺激试验联合静脉采血（ASVS）在胰岛素瘤术前定位中的意义。11例内源性高胰岛素血症患者接受了术前经腹超声、螺旋计算机断层扫描（螺旋CT）、磁共振成像（MRI）、内镜超声（EUS）以及血管造影（DSA）联合ASVS检查。将结果与术中发现、术中超声（IOUS）及组织病理学结果进行比较。未发生与ASVS检查相关的并发症。11例患者中，肿瘤可通过以下各种检查手段定位：超声11例中有1例（9%），MRI 10例中有3例（30%），螺旋CT 11例中有4例（36%），EUS 10例中有5例（50%），DSA 11例中有8例（73%），ASVS 11例中有10例（91%）。2例患者的肿瘤在术中既无法触及，IOUS也无法检测到，因此术中处理依据DSA联合ASVS检查提供的信息进行。10例患者患有孤立性良性胰岛素瘤，1例多发性内分泌腺瘤病I型患者在胰尾有两个相邻的肿瘤。在我们的一组患者中，动脉刺激试验联合静脉采血是术前定位胰岛素瘤最敏感的检查。它可在常规DSA检查过程中安全进行，并且可能会影响那些肿瘤无法通过触诊或IOUS检测到的患者的术中处理。
