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This version published online on January 16, 2007
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-1479
A more recent version of this article appeared on April 1, 2007
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Submitted on July 11, 2006
Accepted on January 5, 2007

18F-DOPA Positron Emission Tomography (PET) as a Tool to Localize an Insulinoma or {beta}-Cell Hyperplasia in Adult Patients

Saila Kauhanen MD, Marko Seppänen MD, Heikki Minn MD, Risto Gullichsen MD, Anna Salonen MD, Kalle Alanen MD, Riitta Parkkola MD, Olof Solin PhD, Jörgen Bergman PhD, Timo Sane MD, Jorma Salmi MD, Matti Välimäki MD, and Pirjo Nuutila MD*

Turku PET Centre, Turku University Hospital, Turku, Finland; Department of Surgery, Turku University Hospital, Turku, Finland; Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland; Department of Pathology, Turku University Hospital, Turku, Finland; Turku PET Centre, Radiopharmaceutical Chemistry Laboratory, University of Turku, Turku, Finland; Department of Medicine, Helsinki University Hospital, Helsinki, Finland; Department of Medicine, Tampere University Hospital, Tampere, Finland

* To whom correspondence should be addressed. E-mail: pirjo.nuutila{at}tyks.fi.

Context and Objective: 18F-DOPA PET is a promising method in localizing neuroendocrinological tumors (NETs). 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 {beta}-cell hyperplasia of the pancreas in adults.

Patients and Methods: We prospectively studied ten patients with confirmed hyperinsulinemic hypoglycemia and presumed insulin secreting tumor using 18F-DOPA PET. Anatomical imaging was done with CT and MRI. All patients were operated on and histological verification was available in each case. Semi-quantitative PET findings in the pancreas using standardized uptake values (SUVs) were compared to SUVs of seven consecutive patients with nonpancreatic NETs.

Results: By visual inspection of 18F-DOPA PET images, it was possible in nine of ten 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 {beta}-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. In agreement with previous findings in infants, preoperative 18F-DOPA imaging seems to be a method of choice for the detection of {beta}-cell hyperplasia in adults. It should be considered for the detection of insulinoma or {beta}-cell hyperplasia in patients with confirmed hyperinsulinemic hypoglycemias when other diagnostic work-up is negative.
Key words: insulinoma • islet cell hyperplasia • 18F-DOPA PET • hyperinsulinemic hypoglycemia • nesidioblastosis




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