Barthlen Winfried, Blankenstein Oliver, Mau Harald, Koch Martin, Höhne Claudia, Mohnike Wolfgang, Eberhard Traugott, Fuechtner Frank, Lorenz-Depiereux Bettina, Mohnike Klaus
Clinic for Pediatric Surgery, Institute for Pathology, Charité University Medicine Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Mittelallee 8, D-13353 Berlin, Germany.
J Clin Endocrinol Metab. 2008 Mar;93(3):869-75. doi: 10.1210/jc.2007-2036. Epub 2007 Dec 11.
In congenital hyperinsulinism (CHI), the identification and precise localization of a focal lesion is essential for successful surgery.
Our objective was to evaluate the predictive value and accuracy of integrated [18F]fluoro-L-DOPA ([18F]FDOPA) positron emission tomography (PET)-computed tomography (CT) for the surgical therapy of CHI.
This was an observational study.
The study was performed in the Department of Pediatric Surgery at a university hospital.
From February 2005 to September 2007, 10 children with the clinical signs of CHI and an increased radiotracer uptake in a circumscribed area of the pancreas in the [18F]FDOPA PET-CT were evaluated.
Guided by the [18F]FDOPA PET-CT report, all children underwent partial pancreatic resection, in two cases twice.
Correlation of the anatomical findings at surgery with the report of the [18F]FDOPA PET-CT, and the results of surgery and clinical outcome were determined.
In nine children the intraoperative situation corresponded exactly to the description of the [18F]FDOPA PET-CT. A limited resection of the pancreas was curative in eight cases at the first surgery, in one case at the second intervention. We observed no diabetes mellitus or exocrine insufficiency in the follow up so far. In one child, hypoglycemia persisted even after two partial resections of the pancreatic head. Histological analysis finally revealed an atypical intermediate form of CHI.
The integrated [18F]FDOPA PET-CT is accurate to localize the lesion in focal CHI and is a valuable tool to guide the surgeon in limited pancreatic resection.
在先天性高胰岛素血症（CHI）中，局灶性病变的识别和精确定位对于手术成功至关重要。
我们的目的是评估整合的[18F]氟-L-多巴（[18F]FDOPA）正电子发射断层扫描（PET）-计算机断层扫描（CT）对CHI手术治疗的预测价值和准确性。
这是一项观察性研究。
该研究在一家大学医院的小儿外科进行。
2005年2月至2007年9月，对10例有CHI临床体征且在[18F]FDOPA PET-CT中胰腺局限性区域放射性示踪剂摄取增加的儿童进行了评估。
在[18F]FDOPA PET-CT报告的指导下，所有儿童均接受了部分胰腺切除术，2例进行了两次手术。
确定手术中的解剖学发现与[18F]FDOPA PET-CT报告的相关性，以及手术结果和临床结局。
9例儿童的术中情况与[18F]FDOPA PET-CT的描述完全相符。首次手术时，8例患者通过有限的胰腺切除术治愈，1例在第二次干预时治愈。到目前为止，我们在随访中未观察到糖尿病或外分泌功能不全。1例儿童即使在两次胰头部分切除术后低血糖仍持续存在。组织学分析最终显示为CHI的非典型中间型。
整合的[18F]FDOPA PET-CT在局灶性CHI中对病变定位准确，是指导外科医生进行有限胰腺切除术的有价值工具。
