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Early 18F-FDOPA PET/CT imaging after carbidopa premedication as a valuable diagnostic option in patients with insulinoma

  • Benjamin Leroy-Freschini
  • Vincent Amodru
  • Pietro Addeo
  • Frédéric Sebag
  • Michel Vix
  • Laurent Brunaud
  • Marc Klein
  • Thibault Bahougne
  • Philippe Bachellier
  • Frédéric Castinetti
  • Bernard Goichot
  • Elodie Chevalier
  • David Taieb
  • Alessio ImperialeEmail author
Original Article
  • 40 Downloads

Abstract

Purpose

Data on the diagnostic value of 18F-FDOPA PET/CT in patients with insulinoma are limited and are focused on small patient populations explored using different PET/CT protocols and the inconsistent use of carbidopa premedication. The aim of this study was to improve the current knowledge about the diagnostic value of 18F-FDOPA PET/CT combined with oral carbidopa premedication and early pancreatic imaging for tumour localization in patients with insulinoma-related hyperinsulinaemic hypoglycaemia (HH). The relationships among 18F-FDOPA quantitative uptake parameters, insulin secretion and tumour pathological features were also investigated.

Methods

Of 34 patients with suspicion of insulinoma-related HH examined by dual time-point carbidopa-assisted 18F-FDOPA PET/CT, 24 with histologically proven insulinoma were retrospectively included. One patient underwent two PET/CT examinations for relapsing insulinoma after surgical excision. Thus, 25 preoperative 18F-FDOPA PET/CT studies were finally retained and analysed. All studies were performed under carbidopa premedication (200 mg orally, 1–2 h prior to tracer injection). The PET/CT acquisition protocol included an early acquisition (5 min after 18F-FDOPA injection) over the upper abdomen and a delayed whole-body acquisition starting 20–30 min later. The cytological and/or histopathological diagnosis of insulinoma was the diagnostic standard of truth.

Results

18F-FDOPA PET/CT localized insulinoma in 21 of the 25 studies, leading to a primary lesion detection rate of 84%. Four lesions (19%) were detected only on early acquisitions. The false-negative tumour detection rates were, respectively, 22% and 12.5% in patients receiving and not receiving treatment for hypoglycaemic symptoms at the time of PET/CT. In benign insulinomas, the early maximum standardized uptake value (SUVmax) was significantly higher than the delayed SUVmax. Compared to the 21 benign lesions, four malignant insulinomas showed significantly higher 18F-FDOPA uptake. Lesion size, fasting-end insulin and C-peptide levels correlated with tumour 18F-FDOPA uptake, dopaminergic tumour volume and metabolic burden.

Conclusion

The present study showed that 18F-FDOPA PET/CT combined with carbidopa premedication and early pancreatic acquisitions is a valuable diagnostic option in patients with insulinoma when GLP1R-based imaging is not available. The results also provide new insights into the relationships between tumour secretion and imaging phenotype in insulinomas.

Keywords

18F-FDOPA PET Insulinoma Hyperinsulinism Carbidopa Neuroendocrine tumours 

Notes

Compliance with ethical standards

Conflicts of interest

None.

Ethical approval

All procedures performed in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Benjamin Leroy-Freschini
    • 1
  • Vincent Amodru
    • 2
  • Pietro Addeo
    • 3
  • Frédéric Sebag
    • 4
  • Michel Vix
    • 5
  • Laurent Brunaud
    • 6
  • Marc Klein
    • 7
  • Thibault Bahougne
    • 8
  • Philippe Bachellier
    • 3
  • Frédéric Castinetti
    • 2
  • Bernard Goichot
    • 9
  • Elodie Chevalier
    • 10
  • David Taieb
    • 11
    • 12
  • Alessio Imperiale
    • 1
    • 13
    • 14
    Email author
  1. 1.Biophysics and Nuclear MedicineUniversity Hospitals of StrasbourgStrasbourgFrance
  2. 2.Endocrinology, Diabetes and Metabolic Disorders, La Timone University HospitalAix-Marseille UniversityMarseilleFrance
  3. 3.Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Hospitals of StrasbourgUniversity of StrasbourgStrasbourgFrance
  4. 4.Endocrine Surgery, La Timone University HospitalAix-Marseille UniversityMarseilleFrance
  5. 5.General, Digestive, and Endocrine Surgery, IRCAD-IHUUniversity of StrasbourgStrasbourgFrance
  6. 6.Endocrine and General SurgeryUniversity Hospital of NancyNancyFrance
  7. 7.Endocrinology University Hospital of NancyNancyFrance
  8. 8.Diabetology, University Hospital of StrasbourgUniversity of StrasbourgStrasbourgFrance
  9. 9.Internal Medicine, Diabetes and Metabolic Disorders, University Hospitals of StrasbourgStrasbourg UniversityStrasbourgFrance
  10. 10.Nuclear MedicineUniversity Hospital of NancyNancyFrance
  11. 11.Nuclear Medicine, La Timone University HospitalAix-Marseille UniversityMarseilleFrance
  12. 12.European Center for Research in Medical ImagingAix-Marseille UniversityMarseilleFrance
  13. 13.ICube, UMR 7357 Strasbourg University / CNRS & FMTS, Faculty of Medicine of StrasbourgStrasbourgFrance
  14. 14.Department of Nuclear MedicineHautepierre University HospitalStrasbourg CedexFrance

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