Glucagon-like peptide-1 receptor imaging for the localisation of insulinomas: a prospective multicentre imaging study
Glucagon-like peptide-1 receptor imaging for the localisation of insulinomas: a prospective multicentre imaging study
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DOI：
10.1016/s2213-8587(13)70049-4
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发表时间：
2013-10-01
影响因子：
44.5
通讯作者：
Forrer, Flavio
中科院分区：
文献类型：
--
作者：
Christ, Emanuel;Wild, Damian;Forrer, Flavio
小的良性胰岛素瘤很难定位，导致手术干预计划的困难。我们的目的是前瞻性地评估胰岛素瘤的检出率的单光子发射CT结合CT（SPECT/CT）与胰高血糖素样肽-1受体亲和放射性示踪剂，并比较检测率与传统的CT/MRI techniques.Methods在我们的前瞻性成像研究中，我们招募了25-81岁的成年人在德国，瑞士和英国的中心。合格患者经临床和生化证实存在内源性高胰岛素低血糖，常规影像学检查无转移性疾病证据。根据标准方案，在转诊中心进行CT/MRI成像。在三个三级核医学中心，我们使用全身平面图像和SPECT/CT腹部注射111 In-[Lys（40）（Ahx-DTPA-In-111）NH 2]-exendin-4（In-111-DTPA-exendin-4）后168小时，以确定胰岛素瘤。结果2008年10月1日至2011年12月31日，我们招募了30例患者。所有患者均接受In-111-DTPA-exendin-4成像，25例患者接受手术（组织学分析），27例患者接受CT/MRI评估。In-111-DTPA-exendin-4 SPECT/CT正确检测到19个胰岛素瘤和4个额外的阳性病变（2个胰岛细胞增生和2个未定性病变），阳性预测值为83%（95%CI 62-94）。通过In-111-DTPA-exendin-4 SPECT/CT在不同患者中确定了一个真阴性（胰岛细胞增生）和一个假阴性（恶性胰岛素瘤）结果。7例患者（23%）仅根据In-111-DTPA-exendin-4成像进行手术。对于23名可评估的患者，In-111-DTPA-exendin-4 SPECT/CT的灵敏度（95% [95%CI 74-100]）高于CT/MRI（47% [27-68]; p=0.011）。解释In-111-DTPA-exendin-4 SPECT/CT可为CT/MRI初始成像结果为阴性的患者提供良好的二线成像策略。
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 111In-[Lys(40)(Ahx-DTPA-In-111)NH2]-exendin-4 (In-111-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 In-111-DTPA-exendin-4 imaging, 25 patients underwent surgery (with histological analysis), and 27 patients were assessed with CT/MRI. In-111-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 In-111-DTPA-exendin-4 SPECT/CT. Seven patients (23%) were referred to surgery on the basis of In-111-DTPA-exendin-4 imaging alone. For 23 assessable patients, In-111-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 In-111-DTPA-exendin-4 SPECT/CT could provide a good second-line imaging strategy for patients with negative results on initial imaging with CT/MRI.