Service Central de Biophysique et de Médecine Nucléaire, Centre Hospitalo-Universitaire Timone, 13385 Marseille Cedex 5, France.
J Clin Endocrinol Metab. 2010 Jan;95(1):303-7. doi: 10.1210/jc.2009-1357. Epub 2009 Nov 13.
Fluorine-18-L-dihydroxyphenylalanine positron emission tomography (18F-FDOPA PET) imaging is increasingly used in the workup of neuroendocrine tumors. It has been shown to be an accurate tool in the diagnosis of congenital hyperinsulinism, but limited information is available on its value in adult disease. OBJECTIVE, PATIENTS, AND DESIGN: The objective of this study was to review our experience with 18F-FDOPA PET imaging in six consecutive patients with hyperinsulinemic hypoglycemia (HH) (four solitary insulinomas, one diffuse beta-cell hyperplasia, one malignant insulinoma). 18F-FDOPA uptake was also evaluated in 37 patients (43 procedures) without HH or other pancreatic neuroendocrine tumors, which acted as a control group.
Using visual analysis, 18F-FDOPA-PET proved positive in only one case (a multiple endocrine neoplasia type 1 related insulinoma). In diffuse beta-cell hyperplasia, the pancreatic uptake was similar to controls. In the patient with liver metastases, the extent of disease was underestimated. The pancreatic uptake was not statistically different between controls and hyperinsulinemic patients. The main limitation for identifying insulinomas or beta-cell hyperplasia in adults appears to be to the 18F-FDOPA uptake and retention in the whole pancreas. This drawback is potentially circumvented in focal hyperplasia in newborns due to a lower aromatic amino acid decarboxylase expression in the extralesional pancreatic parenchyma.
18F-FDOPA PET is of limited value in localizing pancreatic insulin secreting tumors in adult HH. Our results contrast with the referential study and require further analysis.
氟代-18-左旋二羟苯丙氨酸正电子发射断层扫描（18F-FDOPA PET）成像在神经内分泌肿瘤的检查中越来越多地被应用。它已被证明是诊断先天性高胰岛素血症的一种准确工具，但关于其在成人疾病中的价值的信息有限。目的、患者和设计：本研究的目的是回顾我们在 6 例高胰岛素血症性低血糖（HH）患者（4 例单发胰岛素瘤、1 例弥漫性β细胞增生、1 例恶性胰岛素瘤）中使用 18F-FDOPA PET 成像的经验。还评估了 37 例（43 例）无 HH 或其他胰腺神经内分泌肿瘤的患者（作为对照组）的 18F-FDOPA 摄取情况。结果：使用视觉分析，只有 1 例（多发性内分泌肿瘤 1 型相关胰岛素瘤）18F-FDOPA-PET 呈阳性。在弥漫性β细胞增生中，胰腺摄取与对照组相似。在肝转移患者中，疾病的范围被低估了。对照组和高胰岛素血症患者的胰腺摄取无统计学差异。在成人中识别胰岛素瘤或β细胞增生的主要限制似乎是整个胰腺中 18F-FDOPA 的摄取和保留。由于新生儿中芳香族氨基酸脱羧酶在病变外胰腺实质中的表达较低，因此这种缺陷在局灶性增生中可能被规避。结论：18F-FDOPA PET 在定位成人 HH 中的胰腺胰岛素分泌肿瘤方面价值有限。我们的结果与参考研究结果相反，需要进一步分析。
