Luo Yaping, Pan Qingqing, Yao Shaobo, Yu Miao, Wu Wenming, Xue Huadan, Kiesewetter Dale O, Zhu Zhaohui, Li Fang, Zhao Yupei, Chen Xiaoyuan
Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China.
Department of Endocrinology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China.
J Nucl Med. 2016 May;57(5):715-20. doi: 10.2967/jnumed.115.167445. Epub 2016 Jan 21.
Preoperative localization of insulinoma is a clinical dilemma. We aimed to investigate whether glucagon-like peptide-1 receptor (GLP-1R) PET/CT with (68)Ga-NOTA-MAL-cys(40)-exendin-4 ((68)Ga-NOTA-exendin-4) is efficient in detecting insulinoma.
In our prospective cohort study, patients with endogenous hyperinsulinemic hypoglycemia were enrolled. CT, MRI, endoscopic ultrasound, and (99m)Tc-hydrazinonicotinamide-TOC SPECT/CT were done according to standard protocols. GLP-1R PET/CT was performed 30-60 min after the injection of (68)Ga-NOTA-exendin-4. The gold standard for diagnosis was the histopathologic results after surgery.
Of 52 recruited patients, 43 patients with histopathologically proven insulinomas were included for the imaging studies. Nine patients did not undergo surgical intervention. (68)Ga-NOTA-exendin-4 PET/CT correctly detected insulinomas in 42 of 43 patients with high tumor uptake (mean SUVavg ± SD, 10.2 ± 4.9; mean SUVmax ± SD, 23.6 ± 11.7), resulting in sensitivity of 97.7%. In contrast, (99m)Tc-hydrazinonicotinamide-TOC SPECT/CT showed a low sensitivity of 19.5% (8/41) in this group of patients; however, it successfully localized the tumor that was false-negative with GLP-1R PET/CT. The sensitivities of CT, MR, and endoscopic ultrasonography were 74.4% (32/43), 56.0% (14/25), and 84.0% (21/25), respectively.
(68)Ga-NOTA-exendin-4 PET/CT is a highly sensitive imaging technique for the localization of insulinoma.
胰岛素瘤的术前定位是一个临床难题。我们旨在研究使用（68）Ga-NOTA-MAL-cys(40)-艾塞那肽-4（（68）Ga-NOTA-艾塞那肽-4）的胰高血糖素样肽-1受体（GLP-1R）PET/CT在检测胰岛素瘤方面是否有效。
在我们的前瞻性队列研究中，纳入了内源性高胰岛素血症性低血糖患者。根据标准方案进行了CT、MRI、内镜超声和（99m）Tc-肼基烟酰胺-TOC SPECT/CT检查。在注射（68）Ga-NOTA-艾塞那肽-4后30 - 60分钟进行GLP-1R PET/CT检查。诊断的金标准是手术后的组织病理学结果。
在52名招募的患者中，43名经组织病理学证实为胰岛素瘤的患者被纳入影像学研究。9名患者未接受手术干预。（68）Ga-NOTA-艾塞那肽-4 PET/CT在43名患者中的42名中正确检测到胰岛素瘤，肿瘤摄取高（平均SUVavg±标准差，10.2±4.9；平均SUVmax±标准差，23.6±11.7），敏感性为97.7%。相比之下，（99m）Tc-肼基烟酰胺-TOC SPECT/CT在该组患者中的敏感性较低，为19.5%（8/41）；然而，它成功定位了GLP-1R PET/CT呈假阴性的肿瘤。CT、MR和内镜超声的敏感性分别为74.4%（32/43）、56.0%（14/25）和84.0%（21/25）。
（68）Ga-NOTA-艾塞那肽-4 PET/CT是一种用于胰岛素瘤定位的高敏感性成像技术。
