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The relationship between cholecystokinin secretion and pancreatic [11C]methionine uptake in patients after partial pancreaticoduodenectomy

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Abstract

Objective

The pancreatic uptake of [11C]methionine ([11C]MET) is associated with beta-cell function and insulin secretion, but [11C]MET uptake and its relationship with exocrine pancreatic performance are less well studied. The postprandial release of cholecystokinin (CCK) depends on gastric emptying velocity and triggers exocrine pancreas secretion. Therefore, we assumed that high postprandial CCK concentrations stimulate the uptake of [11C]MET in the residual pancreas following pancreaticoduodenectomy.

Methods

Nineteen tumor-free patients after pancreaticoduodenectomy (median age: 64; 25/75 quantile: 56–67 years); ten males, nine females and ten healthy controls (median age: 24; 25/75 quantile: 23.8–26 years) were given a mixed meal. Plasma CCK, insulin and glucose concentrations were measured before and at 10, 20, 30, 60, 90, 150 and 180 min after ingestion. Simultaneously, 800 MBq of [11C]MET were administered and the activity [maximum tissue standardized uptake values (SUVmax)] over the pancreas was measured using PET-CT at 15, 30 and 60 min after injection.

Results

Integrated CCK (AUC30) correlated with SUVmax (AUC60, R2 = 0.45, p value = 0.0013). Multivariate analysis revealed postprandial insulin (AUC60) and CCK concentrations and young age as significant independent predictors of [11C] methionine uptake.

Conclusion

The association between CCK concentrations and pancreatic [11C]MET uptake might indicate a causal relationship. Further research should assess whether [11C]MET uptake could serve as a less invasive tool to assess exocrine pancreas activity.

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Acknowledgements

The authors thank the team of PET/CT imaging for their assistance and acknowledge the technical assistance of Harald Eidher, Andreas Krcal and Thomas Zenz with radiosynthesis. We thank Franz X. Felberbauer, MD, who passed away October 2017, for his contributions to this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Medical University of Vienna, 1090, Vienna, Austria

    Emanuel Steiner, Robert Breuer & Johannes Miholic

  2. Department of Internal Medicine I, Medical University of Vienna, 1090, Vienna, Austria

    Lukas Kazianka

  3. Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090, Vienna, Austria

    Marcus Hacker, Wolfgang Wadsak & Markus Mitterhauser

  4. Ludwig Boltzmann Institute Applied Diagnostics, 1090, Vienna, Austria

    Markus Mitterhauser

  5. Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, 2100, Copenhagen, Denmark

    Jens F. Rehfeld

  6. Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090, Vienna, Austria

    Georgios Karanikas

Authors
  1. Emanuel Steiner
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  2. Lukas Kazianka
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  3. Robert Breuer
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  4. Marcus Hacker
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  5. Wolfgang Wadsak
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  6. Markus Mitterhauser
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  7. Jens F. Rehfeld
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  8. Georgios Karanikas
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  9. Johannes Miholic
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Corresponding author

Correspondence to Georgios Karanikas.

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Conflict of interest

Author Wolfgang Wadsak is partially employed at CBmed (Center for Biomarker Research in Medicine) and has received research grants (non-personal) from the companies Ipsen Pharma, IASON, EZAG and Scintomics. All other authors declare that they have no conflicts of interest.

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Steiner, E., Kazianka, L., Breuer, R. et al. The relationship between cholecystokinin secretion and pancreatic [11C]methionine uptake in patients after partial pancreaticoduodenectomy. Ann Nucl Med 34, 691–695 (2020). https://doi.org/10.1007/s12149-020-01492-5

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  • DOI: https://doi.org/10.1007/s12149-020-01492-5

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