Zhang Hongzhe, Pan Qingqing, Liu Silu, Feng Jie, Yu Miao, Li Naishi, Xu Qiang, Han Xianlin, Li Fang, Luo Yaping
Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.
State Key Laboratory of Common Mechanism Research for Major Diseases, Beijing, P. R. China.
Eur J Nucl Med Mol Imaging. 2025 May 1. doi: 10.1007/s00259-025-07298-9.
Accurate preoperative localization is imperative for the treatment of insulinomas. Glucagon-like peptide-1 receptor (GLP-1R) imaging has demonstrated remarkable efficacy in localization of insulinomas. The aim of this study was to assess the diagnostic performance of GLP-1R PET/CT with Ga-exendin-4 in localization of insulinoma, and to provide evidence for clinical practice from a real-world study.
This is a retrospective analysis of our prospective cohort study of Ga-exendin-4 PET/CT in insulinoma (NCT02560376). Patients with endogenous hyperinsulinemic hypoglycemia and definite final diagnosis were enrolled. Results of contrast-enhanced CT (CECT) with pancreatic perfusion scan, MRI, endoscopic ultrasound, and Tc-HYNIC-TOC SPECT/CT were collected. The gold standard for diagnosis was histopathology (for insulinoma) or a definite clinical diagnosis of the etiology of hyperinsulinemic hypoglycemia after hospitalization in the endocrinology department (for non-insulinomatous hypoglycemia).
A total of 357 patients (including 296 insulinoma patients and 61 non-insulinoma patients) with were included. The overall sensitivity, specificity, accuracy, PPV, and NPV of Ga-exendin-4 PET/CT in localizing insulinoma were 94.93% (95%CI, 91.78%˜97.14%), 100.00% (95%CI, 94.13%˜100%), 95.79% (95%CI, 93.16%˜97.63%), 100.00% (95%CI, 98.32%˜100%), 80.26% (95%CI, 71.29%˜86.94%), respectively. The area under the ROC of Ga-exendin-4 PET/CT for diagnosing insulinoma was 0.975 (95%CI, 0.953 ˜ 0.988), which was superior to that of CECT (AUC = 0.873 [95%CI, 0.833 ˜ 0.906]), MRI (AUC = 0.825 [95%CI, 0.773 ˜ 0.869]), EUS (AUC = 0.746 [95%CI, 0.652 ˜ 0.825]) and Tc-HYNIC-TOC SPECT/CT (AUC = 0.618 [95%CI, 0.562 ˜ 0.672]). The lesion-based sensitivity of Ga-exendin-4 PET/CT in sporadic benign insulinoma was 95.47% (95%CI, 92.22%˜97.64%), and the PPV was 99.61% (95%CI 99.60%˜99.62%). In contrast, the diagnostic efficacy of Ga-exendin-4 PET/CT was found to be less effective in cases of sporadic malignant insulinoma or inherited syndromes, yielding a lesion-based detection rate of 66.43% and 68.04%, respectively.
Ga-exendin-4 PET/CT is a preferred imaging modality in diagnosing insulinoma, particularly in sporadic benign insulinomas.
准确的术前定位对于胰岛素瘤的治疗至关重要。胰高血糖素样肽-1受体（GLP-1R）成像已在胰岛素瘤定位中显示出显著疗效。本研究的目的是评估Ga-艾塞那肽-4 PET/CT在胰岛素瘤定位中的诊断性能，并从一项真实世界研究中为临床实践提供证据。
这是一项对我们关于Ga-艾塞那肽-4 PET/CT用于胰岛素瘤的前瞻性队列研究（NCT02560376）的回顾性分析。纳入内源性高胰岛素血症性低血糖且最终诊断明确的患者。收集胰腺灌注扫描增强CT（CECT）、MRI、内镜超声及Tc-HYNIC-TOC SPECT/CT的结果。诊断的金标准是组织病理学（针对胰岛素瘤）或内分泌科住院后对高胰岛素血症性低血糖病因的明确临床诊断（针对非胰岛素瘤性低血糖）。
共纳入357例患者（包括296例胰岛素瘤患者和61例非胰岛素瘤患者）。Ga-艾塞那肽-4 PET/CT在胰岛素瘤定位中的总体敏感性、特异性、准确性、阳性预测值和阴性预测值分别为94.93%（95%CI，91.78%～97.14%）、100.00%（95%CI，94.13%～100%）、95.79%（95%CI，93.16%～97.63%）、100.00%（95%CI，98.32%～100%）、80.26%（95%CI，71.29%～86.94%）。Ga-艾塞那肽-4 PET/CT诊断胰岛素瘤的ROC曲线下面积为0.975（95%CI，0.953～0.988），优于CECT（AUC = 0.873 [95%CI，0.833～0.906]）、MRI（AUC = 0.825 [95%CI，0.773～0.869]）、内镜超声（AUC = 0.746 [95%CI，0.652～0.825]）和Tc-HYNIC-TOC SPECT/CT（AUC = 0.618 [95%CI，0.562～0.672]）。Ga-艾塞那肽-4 PET/CT在散发性良性胰岛素瘤中基于病灶的敏感性为95.47%（95%CI，92.22%～97.64%），阳性预测值为99.61%（95%CI 99.60%～99.62%）。相比之下，发现Ga-艾塞那肽-4 PET/CT在散发性恶性胰岛素瘤或遗传性综合征病例中的诊断效果较差，基于病灶的检出率分别为66.43%和68.04%。
Ga-艾塞那肽-4 PET/CT是诊断胰岛素瘤的首选影像学检查方法，尤其是在散发性良性胰岛素瘤中。
