Kühnen Peter, Prasad Sonal, Rothe Karin, Huang Kai, Hauptmann Kathrin, Boss Marti, Beindorff Nicola, Lankes Erwin, Warmann Steven W, Schneider Miriam, Taghavi Paniz Akbarzadeh, Lechner Lara, Lange Catharina, Furth Christian, Gotthardt Martin, Brenner Winfried, Blankenstein Oliver, Prasad Vikas
Department of Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
German Center for Child and Adolescent Health (DZKJ), partner site Berlin, Berlin, Germany.
EJNMMI Res. 2025 Aug 12;15(1):107. doi: 10.1186/s13550-025-01294-8.
Congenital hyperinsulinism (CHI) is a life threatening disease. Localization of affected intrapancreatic beta cells responsible for focal forms during surgery can be challenging. In this study we investigated a new radioguided surgical (RGS) approach using [Ga]Exendin to facilitate intraoperative focus detection. All patients were scanned initially with [F]-DOPA-PET followed by [Ga]Exendin PET to differentiate between focal and non-focal forms. Focal CHI patients were then operated. At the beginning of standard surgical dissection of the pancreas in CHI patients ( = 12), 46 MBq of [Ga]Exendin were injected intravenously. Intrapancreatic localization of the foci was determined by using a hand-held positron- and gamma-radiation probe. RGS was carried out as enucleation of CHI foci. Duration of surgery (defined as the time lapse from first incision until final suture placement) for RGS was compared with historical data of patients operated on without RGS. Long term follow-up data on euglycemic control were retrieved from patient´s medical files.
[F]-DOPA- and [Ga]Exendin PET findings were concordant in all patients. Overall, 12 CHI patients underwent RGS. In 11/12 children (92%) the CHI foci localized pre-operatively by [Ga]Exendin PET could be detected intraoperatively using the hand-held positron probe. There was a high correlation between PET imaging results and positron probe findings in respect to the identification of the affected pancreatic region. One pancreatic lesion in close proximity to the left kidney could not be detected by the positron probe. Histopathology confirmed all resected lesions as CHI foci. Intraoperatively, the signal of the focus was > 10 times higher than the signal of normal adjacent pancreatic tissue. Median duration of surgery was 4.7 h (CI 3.5–6.7) in RGS patients compared to 5.5 h (CI 4-6.7) in patients undergoing surgery without radio guidance. All patients remained euglycemic after surgery (median follow-up 3 years, range 2 to 4.5).
In this study, we demonstrated the use of [Ga]Exendin for intraoperative localization of intrapancreatic CHI foci. RGS facilitates localization of intrapancreatic CHI focus and thus potentially reduces duration of surgery and perioperative complications.
The online version contains supplementary material available at 10.1186/s13550-025-01294-8.
先天性高胰岛素血症（CHI）是一种危及生命的疾病。手术中定位导致局灶性形式的胰腺内受影响的β细胞可能具有挑战性。在本研究中，我们研究了一种使用[镓]艾塞那肽的新型放射性引导手术（RGS）方法，以促进术中病灶检测。所有患者最初均接受[氟]-多巴正电子发射断层扫描（PET），随后进行[镓]艾塞那肽PET扫描，以区分局灶性和非局灶性形式。然后对局灶性CHI患者进行手术。在CHI患者（n = 12）胰腺标准手术解剖开始时，静脉注射46 MBq的[镓]艾塞那肽。使用手持式正电子和γ辐射探头确定病灶在胰腺内的位置。RGS作为CHI病灶摘除术进行。将RGS手术的持续时间（定义为从第一次切口到最终缝合的时间间隔）与未进行RGS手术的患者的历史数据进行比较。从患者的医疗档案中检索血糖正常控制的长期随访数据。
所有患者的[氟]-多巴和[镓]艾塞那肽PET检查结果一致。总体而言，12例CHI患者接受了RGS。在11/12名儿童（92%）中，术前通过[镓]艾塞那肽PET定位的CHI病灶可在术中使用手持式正电子探头检测到。在识别受影响的胰腺区域方面，PET成像结果与正电子探头检查结果之间存在高度相关性。正电子探头未能检测到靠近左肾的一个胰腺病变。组织病理学证实所有切除的病变均为CHI病灶。术中，病灶的信号比相邻正常胰腺组织的信号高10倍以上。RGS患者的手术中位持续时间为4.7小时（CI 3.5 - 6.7），而未接受放射性引导手术的患者为5.5小时（CI 4 - 6.7）。所有患者术后均保持血糖正常（中位随访3年，范围2至4.5年）。
在本研究中，我们展示了[镓]艾塞那肽在术中定位胰腺内CHI病灶的应用。RGS有助于胰腺内CHI病灶的定位，从而有可能缩短手术时间和减少围手术期并发症。
在线版本包含可在10.1186/s13550 - 025 - 01294 - 8获取的补充材料。
