Fluorine-18-L-Dihydroxyphenylalanine (18F-DOPA) Positron Emission Tomography as a Tool to Localize an Insulinoma or ß-Cell Hyperplasia in Adult Patients
Saila Kauhanen,
Marko Seppänen,
Heikki Minn,
Risto Gullichsen,
Anna Salonen,
Kalle Alanen,
Riitta Parkkola,
Olof Solin,
Jörgen Bergman,
Timo Sane,
Jorma Salmi,
Matti Välimäki and
Pirjo Nuutila
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 promisingmethod in localizing neuroendocrine tumors. Recently, it hasbeen shown to differentiate focal forms of congenital hyperinsulinismof infancy. The current study was set up to determine the potentialof 18F-DOPA PET in identifying the insulin-secreting tumorsor ß-cell hyperplasia of the pancreas in adults.
Patients and Methods: We prospectively studied 10 patients withconfirmed hyperinsulinemic hypoglycemia and presumed insulin-secretingtumor using 18F-DOPA PET. Anatomical imaging was performed withcomputed tomography (CT) and magnetic resonance imaging (MRI).All patients were operated on, and histological verificationwas available in each case. Semiquantitative PET findings inthe pancreas using standardized uptake values were comparedto standardized uptake values of seven consecutive patientswith nonpancreatic neuroendocrine tumors.
Results: By visual inspection of 18F-DOPA PET images, it waspossible in nine of 10 patients to localize the pancreatic lesion,subsequently confirmed by histological analysis. 18F-DOPA uptakewas enhanced in six of seven solid insulinomas and in the malignantinsulinoma and its hepatic metastasis. Two patients with ß-cellhyperplasia showed increased focal uptake of 18F-DOPA in theaffected areas. As compared to CT or MRI, 18F-DOPA PET was moresensitive in localizing diseased pancreatic tissue.
Conclusion:18F-DOPA PET was useful in most patients with insulinomaand negative CT, MRI, and ultrasound results. In agreement withprevious findings in infants, preoperative 18F-DOPA imagingseems to be a method of choice for the detection of ß-cellhyperplasia in adults. It should be considered for the detectionof insulinoma or ß-cell hyperplasia in patients withconfirmed hyperinsulinemic hypoglycemias when other diagnosticwork-up is negative.
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