Comparison of glucagon-like peptide-1 receptor (GLP-1R) PET/CT, SPECT/CT and 3T MRI for the localisation of occult insulinomas: evaluation of diagnostic accuracy in a prospective crossover imaging study.

Antwi, Kwadwo; Fani, Melpomeni; Heye, Tobias; Nicolas, Guillaume; Rottenburger, Christof; Kaul, Felix; Merkle, Elmar; Zech, Christoph J; Boll, Daniel; Vogt, Deborah R; Gloor, Beat; Christ, Emanuel; Wild, Damian (2018). Comparison of glucagon-like peptide-1 receptor (GLP-1R) PET/CT, SPECT/CT and 3T MRI for the localisation of occult insulinomas: evaluation of diagnostic accuracy in a prospective crossover imaging study. European journal of nuclear medicine and molecular imaging, 45(13), pp. 2318-2327. Springer-Verlag 10.1007/s00259-018-4101-5

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PURPOSE Benign insulinomas are the most prevalent cause of endogenous hyperinsulinaemic hypoglycaemia (EHH) in adults, and because of their small size are difficult to localise. The purpose of the study was to test the diagnostic accuracy and clinical impact of glucagon-like peptide-1 receptor (GLP-1R) PET/CT using Ga-DOTA-exendin-4 in consecutive adult patients referred for localisation of insulinomas. The results were compared with In-DOTA-exendin-4 SPECT/CT, study-MRI and previously performed external CT and/or MRI (prior external CT/MRI). METHODS We prospectively enrolled patients with neuroglycopenic symptoms due to EHH. GLP-1R PET/CT, SPECT/CT and study-MRI were performed in a randomised, crossover order within 3-4 days. The reference standard was surgery with histology and treatment outcome. RESULTS From January 2014 until March 2017, 52 patients were recruited. All imaging and invasive procedures before recruitment identified suspicious lesions in 46.2% of patients. GLP-1R PET/CT, SPECT/CT and study-MRI detected suspicious lesions in 78.8%, 63.5% and 63.4% of patients, respectively. In 38 patients, conclusive histology was available for final analysis. Accuracy (95% confidence interval) for PET/CT, SPECT/CT, study-MRI and prior external CT/MRI was 93.9% (87.8-97.5%), 67.5% (58.1-76.0%), 67.6% (58.0-76.1%) and 40.0% (23.9-57.9%), respectively (all P values < 0.01, except comparison of SPECT/CT and study-MRI with a P value = 1.0). Impact on clinical management was 42.3%, 32.7% and 33.3% for PET/CT, SPECT/CT and study-MRI, respectively. Percentage reading agreement was 89.5%, 75.7%, and 71.1% for PET/CT, SPECT/CT and study-MRI, respectively. CONCLUSION Ga-DOTA-exendin-4 PET/CT performed significantly better than In-DOTA-exendin-4 SPECT/CT and MRI in the localisation of benign insulinomas and should be considered in patients where localisation fails with CT/MRI ( ClinicalTrials.gov , NCT02127541).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

Gloor, Beat

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1619-7070

Publisher:

Springer-Verlag

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

27 Mar 2019 13:54

Last Modified:

23 Oct 2019 00:22

Publisher DOI:

10.1007/s00259-018-4101-5

PubMed ID:

30054698

Uncontrolled Keywords:

68Ga-DOTA-exendin-4 GLP-1R PET/CT GLP-1R SPECT/CT Glucagon-like peptide-1 receptor Insulinoma MRI

BORIS DOI:

10.7892/boris.125775

URI:

https://boris.unibe.ch/id/eprint/125775

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