Hayashi T, Honda H, Yasumori K, Kawashima A, Kaneko K, Fukuya T, Tateshi Y, Ro T, Masuda K
Department of Radiology, Faculty of Medicine, Kyushu University.
Nihon Igaku Hoshasen Gakkai Zasshi. 1995 Nov;55(14):952-6.
To elucidate whether noninvasive arterial stimulation venous sampling (ASVS) is helpful for localizing insulinomas, calcium gluconate (0.02-0.025 mEq Ca2+/kg) was injected directly into the gastroduodenal, splenic and superior mesenteric arteries of six patients with episodic hypoglycemia. In all six patients, there was a greater than 26-fold increase in serum insulin levels in blood samples obtained from the hepatic vein after the infusion of calcium into the artery supplying the tumor. However, in four of the six patients, such an injection into an artery not supplying the tumor resulted in a greater than twofold increase in insulin concentration. Accurate localization of the insulinomas was verified at surgery in all patients. We believe that these false positive results were caused mainly by the influx of calcium via branches of intrapancreatic anastomoses. In order to minimize false positive results, we have recommended the following new criteria for ASVS: maximum insulin concentrations exceeding 150 microU/ml in blood samples obtained from the hepatic vein, and greater than twofold increases in insulin concentration. We concluded that noninvasive ASVS is helpful in determining the location of insulinomas.
为阐明非侵入性动脉刺激静脉采血（ASVS）是否有助于胰岛素瘤定位，将葡萄糖酸钙（0.02 - 0.025 mEq Ca2+/kg）直接注入6例发作性低血糖患者的胃十二指肠动脉、脾动脉和肠系膜上动脉。在所有6例患者中，向供应肿瘤的动脉注入钙剂后，从肝静脉采集的血样中血清胰岛素水平升高超过26倍。然而，在6例患者中的4例中，向不供应肿瘤的动脉进行此类注射导致胰岛素浓度升高超过两倍。所有患者均在手术中证实了胰岛素瘤的准确位置。我们认为这些假阳性结果主要是由于钙通过胰腺内吻合支流入所致。为尽量减少假阳性结果，我们推荐了以下ASVS的新标准：从肝静脉采集的血样中最大胰岛素浓度超过150微单位/毫升，且胰岛素浓度升高超过两倍。我们得出结论，非侵入性ASVS有助于确定胰岛素瘤的位置。
