Emanuel Christ1, Damian Wild2, Susanne Ederer3, Martin Béhé4, Guillaume Nicolas3, Martyn E Caplin5, Michael Brändle6, Thomas Clerici7, Stefan Fischli8, Christoph Stettler1, Peter J Ell9, Jochen Seufert10, Beat Gloor11, Aurel Perren12, Jean Claude Reubi12, Flavio Forrer3. 1. Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Berne, Inselspital, Berne, Switzerland. 2. Department of Radiology, Division of Nuclear Medicine, University of Basel Hospital, Switzerland; Department of Nuclear Medicine, University Hospital Freiburg, Germany; Institute of Nuclear Medicine, University College Hospital, London, UK. Electronic address: damian.wild@usb.ch. 3. Department of Radiology, Division of Nuclear Medicine, University of Basel Hospital, Switzerland. 4. Department of Nuclear Medicine, University Hospital Freiburg, Germany; Center for Radiopharmaceutical Science ETH-PSI-USZ, Paul Scherrer Institute, Villingen, Switzerland. 5. Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK. 6. Division of Endocrinology, Diabetes and Osteology, Kantonsspital, St Gallen, Switzerland. 7. Division of Visceral Surgery, Kantonsspital, St Gallen, Switzerland. 8. Division of Endocrinology, Diabetes and Osteology, Kantonsspital Luzern, Switzerland. 9. Institute of Nuclear Medicine, University College Hospital, London, UK. 10. Division of Endocrinology and Diabetology, University Hospital Freiburg, Germany. 11. Division of Visceral Surgery, University Hospital of Berne, Inselspital, Berne, Switzerland. 12. Institute of Pathology, University of Berne, Berne, Switzerland.
Abstract
BACKGROUND: Small benign insulinomas are hard to localise, leading to difficulties in planning of surgical interventions. We aimed to prospectively assess the insulinoma detection rate of single-photon emission CT in combination with CT (SPECT/CT) with a glucagon-like peptide-1 receptor avid radiotracer, and compare detection rates with conventional CT/MRI techniques. METHODS: In our prospective imaging study, we enrolled adults aged 25-81 years at centres in Germany, Switzerland, and the UK. Eligible patients had proven clinical and biochemical endogenous hyperinsulinaemic hypoglycaemia and no evidence for metastatic disease on conventional imaging. CT/MRI imaging was done at referring centres according to standard protocols. At three tertiary nuclear medicine centres, we used whole body planar images and SPECT/CT of the abdomen up to 168 h after injection of (111)In-[Lys40(Ahx-DTPA-(111)In)NH2]-exendin-4 ((111)In-DTPA-exendin-4) to identify insulinomas. Consenting patients underwent surgery and imaging findings were confirmed histologically. FINDINGS: Between Oct 1, 2008, and Dec 31, 2011, we recruited 30 patients. All patients underwent (111)In-DTPA-exendin-4 imaging, 25 patients underwent surgery (with histological analysis), and 27 patients were assessed with CT/MRI. (111)In-DTPA-exendin-4 SPECT/CT correctly detected 19 insulinomas and four additional positive lesions (two islet-cell hyperplasia and two uncharacterised lesions) resulting in a positive predictive value of 83% (95% CI 62-94). One true negative (islet-cell hyperplasia) and one false negative (malignant insulinoma) result was identified in separate patients by (111)In-DTPA-exendin-4 SPECT/CT. Seven patients (23%) were referred to surgery on the basis of (111)In-DTPA-exendin-4 imaging alone. For 23 assessable patients, (111)In-DTPA-exendin-4 SPECT/CT had a higher sensitivity (95% [95% CI 74-100]) than did CT/MRI (47% [27-68]; p=0.011). INTERPRETATION: (111)In-DTPA-exendin-4 SPECT/CT could provide a good second-line imaging strategy for patients with negative results on initial imaging with CT/MRI. FUNDING: Oncosuisse, the Swiss National Science Foundation, and UK Department of Health.
BACKGROUND: Small benign insulinomas are hard to localise, leading to difficulties in planning of surgical interventions. We aimed to prospectively assess the insulinoma detection rate of single-photon emission CT in combination with CT (SPECT/CT) with a glucagon-like peptide-1 receptor avid radiotracer, and compare detection rates with conventional CT/MRI techniques. METHODS: In our prospective imaging study, we enrolled adults aged 25-81 years at centres in Germany, Switzerland, and the UK. Eligible patients had proven clinical and biochemical endogenous hyperinsulinaemic hypoglycaemia and no evidence for metastatic disease on conventional imaging. CT/MRI imaging was done at referring centres according to standard protocols. At three tertiary nuclear medicine centres, we used whole body planar images and SPECT/CT of the abdomen up to 168 h after injection of (111)In-[Lys40(Ahx-DTPA-(111)In)NH2]-exendin-4 ((111)In-DTPA-exendin-4) to identify insulinomas. Consenting patients underwent surgery and imaging findings were confirmed histologically. FINDINGS: Between Oct 1, 2008, and Dec 31, 2011, we recruited 30 patients. All patients underwent (111)In-DTPA-exendin-4 imaging, 25 patients underwent surgery (with histological analysis), and 27 patients were assessed with CT/MRI. (111)In-DTPA-exendin-4 SPECT/CT correctly detected 19 insulinomas and four additional positive lesions (two islet-cell hyperplasia and two uncharacterised lesions) resulting in a positive predictive value of 83% (95% CI 62-94). One true negative (islet-cell hyperplasia) and one false negative (malignant insulinoma) result was identified in separate patients by (111)In-DTPA-exendin-4 SPECT/CT. Seven patients (23%) were referred to surgery on the basis of (111)In-DTPA-exendin-4 imaging alone. For 23 assessable patients, (111)In-DTPA-exendin-4 SPECT/CT had a higher sensitivity (95% [95% CI 74-100]) than did CT/MRI (47% [27-68]; p=0.011). INTERPRETATION: (111)In-DTPA-exendin-4 SPECT/CT could provide a good second-line imaging strategy for patients with negative results on initial imaging with CT/MRI. FUNDING: Oncosuisse, the Swiss National Science Foundation, and UK Department of Health.
Authors: Scott M Thompson; Adrian Vella; Geoffrey B Thompson; Kandelaria M Rumilla; F John Service; Clive S Grant; James C Andrews Journal: J Clin Endocrinol Metab Date: 2015-08-27 Impact factor: 5.958
Authors: Angela Spanu; Orazio Schillaci; Bastiana Piras; Diego F Calvisi; Antonio Falchi; Roberta Danieli; Susanna Nuvoli; Franca Dore; Giuseppe Madeddu Journal: Am J Nucl Med Mol Imaging Date: 2017-09-01
Authors: T G K Breuer; H L Breuer; B A Menge; A Giese; W Uhl; W E Schmidt; A Tannapfel; D Wild; M A Nauck; J J Meier Journal: Internist (Berl) Date: 2016-04 Impact factor: 0.743
Authors: Samira M Sadowski; Vladimir Neychev; Candice Cottle-Delisle; Roxanne Merkel; Lily A Yang; Martha M Quezado; Richard Chang; Electron Kebebew Journal: Gland Surg Date: 2014-11