Kauhanen Saila, Seppänen Marko, Minn Heikki, Gullichsen Risto, Salonen Anna, Alanen Kalle, Parkkola Riitta, Solin Olof, Bergman Jörgen, Sane Timo, Salmi Jorma, Välimäki Matti, Nuutila Pirjo
Turku PET Centre, Department of Surgery, Turku University Hospital, P.O. Box 52, FIN-20521 Turku, Finland.
J Clin Endocrinol Metab. 2007 Apr;92(4):1237-44. doi: 10.1210/jc.2006-1479. Epub 2007 Jan 16.
Fluorine-18-L-dihydroxyphenylalanine (18F-DOPA) positron emission tomography (PET) is a promising method in localizing neuroendocrine tumors. Recently, it has been shown to differentiate focal forms of congenital hyperinsulinism of infancy. The current study was set up to determine the potential of 18F-DOPA PET in identifying the insulin-secreting tumors or beta-cell hyperplasia of the pancreas in adults.
We prospectively studied 10 patients with confirmed hyperinsulinemic hypoglycemia and presumed insulin-secreting tumor using 18F-DOPA PET. Anatomical imaging was performed with computed tomography (CT) and magnetic resonance imaging (MRI). All patients were operated on, and histological verification was available in each case. Semiquantitative PET findings in the pancreas using standardized uptake values were compared to standardized uptake values of seven consecutive patients with nonpancreatic neuroendocrine tumors.
By visual inspection of 18F-DOPA PET images, it was possible in nine of 10 patients to localize the pancreatic lesion, subsequently confirmed by histological analysis. 18F-DOPA uptake was enhanced in six of seven solid insulinomas and in the malignant insulinoma and its hepatic metastasis. Two patients with beta-cell hyperplasia showed increased focal uptake of 18F-DOPA in the affected areas. As compared to CT or MRI, 18F-DOPA PET was more sensitive in localizing diseased pancreatic tissue.
18F-DOPA PET was useful in most patients with insulinoma and negative CT, MRI, and ultrasound results. In agreement with previous findings in infants, preoperative 18F-DOPA imaging seems to be a method of choice for the detection of beta-cell hyperplasia in adults. It should be considered for the detection of insulinoma or beta-cell hyperplasia in patients with confirmed hyperinsulinemic hypoglycemias when other diagnostic work-up is negative.
氟-18-L-二羟基苯丙氨酸（18F-DOPA）正电子发射断层扫描（PET）是一种在定位神经内分泌肿瘤方面很有前景的方法。最近，它已被证明可区分婴儿期先天性高胰岛素血症的局灶性形式。本研究旨在确定18F-DOPA PET在识别成人胰腺胰岛素分泌肿瘤或β细胞增生方面的潜力。
我们前瞻性地研究了10例确诊为高胰岛素血症性低血糖且推测为胰岛素分泌肿瘤的患者，使用18F-DOPA PET进行检查。采用计算机断层扫描（CT）和磁共振成像（MRI）进行解剖成像。所有患者均接受手术治疗，且每例均有组织学验证结果。将胰腺中使用标准化摄取值的半定量PET结果与7例连续的非胰腺神经内分泌肿瘤患者的标准化摄取值进行比较。
通过对18F-DOPA PET图像的目视检查，10例患者中有9例能够定位胰腺病变，随后经组织学分析得到证实。7例实性胰岛素瘤中的6例、恶性胰岛素瘤及其肝转移灶的18F-DOPA摄取增强。2例β细胞增生患者在受累区域显示18F-DOPA的局灶性摄取增加。与CT或MRI相比，18F-DOPA PET在定位病变胰腺组织方面更敏感。
18F-DOPA PET对大多数胰岛素瘤患者且CT、MRI和超声检查结果为阴性的情况很有用。与先前在婴儿中的研究结果一致，术前18F-DOPA成像似乎是检测成人β细胞增生的首选方法。当其他诊断检查为阴性时，对于确诊为高胰岛素血症性低血糖的患者，应考虑使用该方法来检测胰岛素瘤或β细胞增生。
