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Fluorine-18-L-Dihydroxyphenylalanine (¹⁸F-DOPA) Positron Emission Tomography as a Tool to Localize an Insulinoma or ß-Cell Hyperplasia in Adult Patients

Turku PET Centre (S.K., M.S., A.S., R.P., P.N.), and Departments of Surgery (S.K., R.G.), Oncology and Radiotherapy (H.M.), and Pathology (K.A.), Turku University Hospital, FIN-20520 Turku, Finland; Turku PET Centre (O.S., J.B.), Radiopharmaceutical Chemistry Laboratory, University of Turku, FIN-20520 Turku, Finland; Department of Medicine (T.S., M.V.), Helsinki University Hospital, FIN-00029 Helsinki, Finland; and Department of Medicine (J.S.), Tampere University Hospital, FIN-33014 Tampere, Finland

Address all correspondence and requests for reprints to: Pirjo Nuutila, M.D., Turku PET Centre, Turku University Hospital, P.O. Box 52, FIN-20521 Turku, Finland. E-mail: pirjo.nuutila{at}tyks.fi.

Context and Objective: Fluorine-18-L-dihydroxyphenylalanine (¹⁸F-DOPA) positron emission tomography (PET) is a promising method in localizing neuroendocrine tumors. Recently, it has been shown to differentiate focal forms of congenital hyperinsulinism of infancy. The current study was set up to determine the potential of ¹⁸F-DOPA PET in identifying the insulin-secreting tumors or ß-cell hyperplasia of the pancreas in adults.

Patients and Methods: We prospectively studied 10 patients with confirmed hyperinsulinemic hypoglycemia and presumed insulin-secreting tumor using ¹⁸F-DOPA PET. Anatomical imaging was performed with computed tomography (CT) and magnetic resonance imaging (MRI). All patients were operated on, and histological verification was available in each case. Semiquantitative PET findings in the pancreas using standardized uptake values were compared to standardized uptake values of seven consecutive patients with nonpancreatic neuroendocrine tumors.

Results: By visual inspection of ¹⁸F-DOPA PET images, it was possible in nine of 10 patients to localize the pancreatic lesion, subsequently confirmed by histological analysis. ¹⁸F-DOPA uptake was enhanced in six of seven solid insulinomas and in the malignant insulinoma and its hepatic metastasis. Two patients with ß-cell hyperplasia showed increased focal uptake of ¹⁸F-DOPA in the affected areas. As compared to CT or MRI, ¹⁸F-DOPA PET was more sensitive in localizing diseased pancreatic tissue.

Conclusion: ¹⁸F-DOPA PET was useful in most patients with insulinoma and negative CT, MRI, and ultrasound results. In agreement with previous findings in infants, preoperative ¹⁸F-DOPA imaging seems to be a method of choice for the detection of ß-cell hyperplasia in adults. It should be considered for the detection of insulinoma or ß-cell hyperplasia in patients with confirmed hyperinsulinemic hypoglycemias when other diagnostic work-up is negative.

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