Doppman J L, Chang R, Fraker D L, Norton J A, Alexander H R, Miller D L, Collier E, Skarulis M C, Gorden P
Diagnostic Radiology Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182, USA.
Ann Intern Med. 1995 Aug 15;123(4):269-73. doi: 10.7326/0003-4819-123-4-199508150-00004.
To determine the sensitivity of calcium injected into pancreatic arteries in localizing insulin-secreting tumors to regions of the pancreas.
To stimulate the release of insulin, 25 patients with surgically proven insulinomas (average diameter, 15 mm) had calcium gluconate (0.025 mEq Ca++/kg body weight) injected before surgery into the arteries supplying the pancreatic head (gastroduodenal and superior mesenteric arteries) and the body and tail (splenic artery) of the pancreas.
Tertiary referral hospital.
Insulin levels were measured in samples taken from the right and left hepatic veins before and 30, 60, and 120 seconds after calcium injection. A twofold increase in insulin level in the sample taken from the right hepatic vein 30 or 60 seconds after injection localized the insulinoma to the segment of the pancreas supplied by the selectively injected artery. Localization done using calcium stimulation was compared with localization done using transcutaneous ultrasonography (n = 22), computed tomography (n = 23), magnetic resonance imaging (n = 21), arteriography (n = 25), and portal venous sampling (n = 9).
Calcium stimulation localized 22 of 25 insulinomas (sensitivity, 88% [95% CI, 68% to 97%]) to the correct region of the pancreas. The sensitivities of the other imaging methods were 9% for ultrasonography (CI, 1% to 23%), 17% for computed tomography (CI, 5% to 39%), 43% for magnetic resonance imaging (CI, 22% to 66%), 36% for arteriography (CI, 18% to 57%), and 67% for portal venous sampling (CI, 30% to 93%). Calcium stimulation added only a few minutes to the time needed for pancreatic arteriography and caused no morbid conditions.
Intra-arterial calcium stimulation with right hepatic vein sampling for insulin gradients is the most sensitive preoperative test for localizing insulinomas.
确定注入胰动脉的钙在将胰岛素分泌肿瘤定位到胰腺区域方面的敏感性。
为刺激胰岛素释放，25例经手术证实患有胰岛素瘤（平均直径15毫米）的患者在手术前被注入葡萄糖酸钙（0.025毫当量Ca++/千克体重），分别注入供应胰头（胃十二指肠动脉和肠系膜上动脉）以及胰体和胰尾（脾动脉）的动脉。
三级转诊医院。
在注入钙之前以及注入后30、60和120秒，从左右肝静脉采集样本测量胰岛素水平。注入后30或60秒从右肝静脉采集的样本中胰岛素水平增加两倍，可将胰岛素瘤定位到由选择性注入动脉供应的胰腺节段。将使用钙刺激进行的定位与使用经皮超声检查（n = 22）、计算机断层扫描（n = 23）、磁共振成像（n = 21）、动脉造影（n = 25）和门静脉采样（n = 9）进行的定位相比较。
钙刺激将25例胰岛素瘤中的22例（敏感性88%[95%CI，68%至97%]）定位到胰腺的正确区域。其他成像方法的敏感性分别为：超声检查9%（CI，1%至23%）、计算机断层扫描17%（CI，5%至39%）、磁共振成像43%（CI，22%至66%）、动脉造影36%（CI，18%至57%）、门静脉采样67%（CI，30%至93%）。钙刺激仅使胰腺动脉造影所需时间增加几分钟，且未引起任何病态情况。
动脉内钙刺激联合右肝静脉采样检测胰岛素梯度是定位胰岛素瘤最敏感的术前检查。
