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
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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 68 Ga-DOTA-exendin-4 in consecutive adult patients referred for localisation of insulinomas. The results were compared with 111 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 Conclusion 68 Ga-DOTA-exendin-4 PET/CT performed significantly better than 111 In-DOTA-exendin-4 SPECT/CT a…
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SACS was the gold standard in the past to detect an insulin gradient in the vessels supplying the pancreas, and this invasive method might be almost completely replaced by PET imaging in the future, e.g., with 68Ga DOTA-Exendin-4 PET/CT.
“While SACS was the gold standard in the past to detect an insulin gradient in the vessels supplying the pancreas, this invasive method might be almost completely replaced by PET imaging in the future, e.g., with 68 Ga DOTA-Exendin-4 PET/CT [38-41].”
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High agreement but low Kappa: I. the problems of two paradoxes
Feinstein, A. R., & Cicchetti, D. V. (1990) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(90)90158-l · Cited by 3,034 · see citing works
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Innovative imaging of insulinoma: the end of sampling? A review
Christ, E., Antwi, K., Fani, M., & Wild, D. (2020) · Endocrine-Related Cancer · doi:10.1530/erc-19-0476 · Cited by 78 · see citing works
Self-citationDieterle, M. P., Husari, A., Prozmann, S. N., Wiethoff, H., Stenzinger, A., Röhrich, M., Pfeiffer, U., Kießling, W. R., Engel, H., Sourij, H., et al. (2023) · Biomedicines · doi:10.3390/biomedicines11061741 · Cited by 5 · see citing works
- Authors
- Antwi, K., Fani, M., Heye, T., Nicolas, G., Rottenburger, C., Kaul, F., Merkle, E., Zech, C. J., Boll, D., Vogt, D. R., Gloor, B., Christ, E., & Wild, D.
- Affiliations
- University Hospital of Basel (CH)
- University of Basel (CH)
- University Hospital of Bern (CH)
- Corresponding author
- Wild, Damian
- ORCID
- Venue
- European Journal of Nuclear Medicine and Molecular Imaging
- Published
- 2018-07-28
- Volume
- 45
- Issue
- 13
- Pages
- 2318-2327
- ISSN
- 1619-7070 (ISSN-L)
- 1619-7089
- OpenAlex
- W2883162736
- Cited by
- 124
- References
- 1
- Citations by year
- 2025: 19 · 2024: 15 · 2023: 17 · 2022: 19 · 2021: 22 · 2020: 14 · 2019: 18
- FWCI
- 10.54
- Type
- journal article
- Language
- en
- Open access
- green
- boris.unibe.ch
- Licence
- other-oa
- www.springer.com/tdm (tdm)
- Locations
- European Journal of Nuclear Medicine and Molecular Imaging (publishedVersion)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, other-oa)
- Open Access CRIS of the University of Bern
- Funders
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (320030-152938)
- Desirée og Niels Ydes Fond (389-12)
- Topics
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Keywords
- magnetic resonance imaging, neuroglycopenia, diagnostic accuracy, occult insulinoma, radioligand imaging
- MeSH terms
- Glucagon-Like Peptide-1 Receptor, Positron Emission Tomography Computed Tomography, Single Photon Emission Computed Tomography Computed Tomography, Adult, Female, Humans, Insulinoma, Magnetic Resonance Imaging, Male, Middle Aged, Prospective Studies, Sensitivity and Specificity
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