Innovative imaging of insulinoma: the end of sampling? A review
Open accessAbstract
Receptors for the incretin glucagon-like peptide-1 (GLP-1R) have been found overexpressed in selected types of human tumors and may, therefore, play an increasingly important role in endocrine gastrointestinal tumor management. In particular, virtually all benign insulinomas express GLP-1R in high density. Targeting GLP-1R with indium-111, technetium-99m or gallium-68-labeled exendin-4 offers a new approach that permits the successful localization of small benign insulinomas. It is likely that this new non-invasive technique has the potential to replace the invasive localization of insulinomas by selective arterial stimulation and venous sampling. In contrast to benign insulinomas, malignant insulin-secreting neuroendocrine tumors express GLP-1R in only one-third of the cases, while they more often express the somatostatin subtype 2 receptors. Importantly, one of the two receptors appears to be always overexpressed. In special cases of endogenous hyperinsulinemic hypoglycemia (EHH), that is, in the context of MEN-1 or adult nesidioblastosis GLP-1R imaging is useful whereas in postprandial hypoglycemia in the context of bariatric surgery, GLP-1R imaging is probably not helpful. This review focuses on the potential use of GLP-1R imaging in the differential diagnosis of EHH.
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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].”
From An Uncommon Cause of Recurrent Presyncope, Dizziness, and Tachycardia: A Case Report of Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS) (2023) · cites this paper as [40]
The Introduction (page unavailable) describes SACST as an invasive test recommended when conventional imaging cannot localize an insulinoma; it samples hepatic venous blood for insulin to identify an arterial territory. The Conclusion (page unavailable) predicts that GLP-1R imaging could end the need for SACST. The review does not call SACST a past gold standard, and its recommendation is limited to cases not localized by conventional imaging. (LLM, conf=0.82)
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Self-citationDiagnosis and surgical management of insulinomas in 33 consecutive patients at a single institution
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Diagnostic yield of endoscopic ultrasound in patients with hypoglicemia and insulinoma suspected
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Molecular imaging for neuroendocrine tumours
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Self-citation68Ga-NODAGA-exendin-4 PET/CT for the localization of insulinomas
Boss, M., Mikkola, K., Buitinga, M., Brom, M., Wild, D., Prasad, V., Brouwers, A. H., Pattou, F. N., Nuutila, P., & Gotthardt, M. (2019) · Nuklearmedizin - NuclearMedicine · doi:10.1055/s-0039-1683525 · Cited by 12 · see citing works
Self-citationVolume Replacement Fluid Demarks Benign Insulinoma With 68Ga-DOTA-Exendin-4 PET/CT
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68Ga-DOTA-Exendin PET-MRI Fusion Imaging in a Case of Insulinoma
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Recurrent Syncope, Behavioral Changes and Weight Gain in an Elderly Filipino Woman
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Occult Abdominal Para-Aortic Ectopic Insulinoma Localized by 18F-NOTA-Exendin-4 PET/CT
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- Authors
- Christ, E., Antwi, K., Fani, M., & Wild, D.
- Affiliations
- University of Basel (CH)
- University Hospital of Basel (CH)
- Corresponding author
- Christ, Emanuel
- Venue
- Endocrine-Related Cancer
- Publisher
- Bioscientifica
- Published
- 2020-04
- Volume
- 27
- Issue
- 4
- Pages
- R79-R92
- ISSN
- 1351-0088 (ISSN-L)
- 1479-6821
- PMC
- PMC7040495
- OpenAlex
- W3000462399
- Cited by
- 78
- References
- 94
- Citations by year
- 2026: 3 · 2025: 15 · 2024: 11 · 2023: 18 · 2022: 15 · 2021: 9 · 2020: 6 · 2019: 1
- FWCI
- 1.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Endocrine Related Cancer (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Science Foundation
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (38912, 152938, 320030)
- Topics
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Health Sciences › Medicine › Oncology › Peptidase Inhibition and Analysis
- Keywords
- insulinoma, exendin-4, gallium-68, indium-111, technetium-99m, neuroendocrine tumors, somatostatin receptor 2, endogenous hyperinsulinemic hypoglycemia, multiple endocrine neoplasia type 1, nesidioblastosis, bariatric surgery, tumor localization, differential diagnosis
- MeSH terms
- Positron Emission Tomography Computed Tomography, Diagnostic Imaging, Female, Humans, Insulinoma, Male, Prospective Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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