Assessment of contrast-enhanced ultrasonography in diagnosis and preoperative localization of insulinoma

An, Lichun; Li, Wenxiu; Yao, Ke-chun; Liu, Rong; Lv, Faqin; Tang, Jie; Zhang, Sunxin

doi:10.1016/j.ejrad.2010.09.014

Cited by 24 publications

(21 citation statements)

References 25 publications

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“…20 Four previous canine reports have described the use of dual-phase computed tomographic angiography for diagnosis of insulinomas. 10,11 Among them, three of the four nodules were markedly hyperattenuating compared with the normal pancreas during the arterial phase, whereas one was hypoattenuating during the arterial phase.…”

Section: Discussionmentioning

confidence: 99%

“…[33][34][35] The detection rate of pancreatic insulinoma improves from 24% to 89% with CEUS. 20 The criteria for inclusion in the current study required that a nodule be identified with conventional ultrasonography, therefore it remains unknown whether contrast-enhanced ultrasonography can improve the detection rate of pancreatic insulinoma in dogs. However, the observation that all lesions in the present study became more clearly demarcated following CEUS suggests that pancreatic insulinoma conspicuity may be improved using this technique in dogs.…”

Section: Discussionmentioning

confidence: 99%

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Contrast‐enhanced Ultrasonographic Findings in Three Dogs With Pancreatic Insulinoma

Nakamura

Lim

Ochiai

et al. 2014

Vet Radiology Ultrasound

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Abdominal ultrasonography is one of the most common diagnostic imaging modalities used for dogs with suspected insulinoma; however, pancreatic masses are clearly identified in fewer than half of affected dogs and benign pancreatic nodules can be difficult to differentiate from malignant ones. The purpose of this prospective study was to describe contrast-enhanced ultrasonography (CEUS) characteristics of confirmed pancreatic insulinoma in a group of dogs. Inclusion criteria were as follows: (1) repeated hypoglycemia (blood glucose levels <60 mg/dl, twice or more); (2) elevated blood insulin levels with hypoglycemia; (3) pancreatic nodules detected with conventional ultrasonography; and (4) histological confirmation of pancreatic islet cell carcinoma. Immediately following conventional ultrasonography of the entire abdomen, CEUS of the pancreatic nodule and adjacent parenchyma was performed using contrast-specific technology pulse inversion imaging and perflubutane microbubble contrast agent. Three dogs met inclusion criteria. Pancreatic nodules in all the three dogs became more clearly demarcated after injection of the contrast agent. Each nodule showed different enhancement patterns: markedly hyperechoic for 5 s, slightly hyperechoic for 1 s, and clearly hypoechoic for over 30 s. These results were not in complete agreement with previously reported CEUS findings in human patients with insulinoma. All nodules were surgically resected and histopathologically confirmed as malignant insulinomas. Findings from the current study indicated that contrast-enhanced ultrasound may help to increase conspicuity of pancreatic insulinomas in dogs and that enhancement characteristics may be more variable in dogs than in humans.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Contrast‐enhanced Ultrasonographic Findings in Three Dogs With Pancreatic Insulinoma

Nakamura

Lim

Ochiai

et al. 2014

Vet Radiology Ultrasound

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“…15 Also contrast-enhanced ultrasound may work as an effective and non-invasive localization modality and presents the advantage of being inexpensive. 16 If a pre-operative invasive radiological investigation is needed, the choice of angiography with hepatic venous sampling after calcium stimulation versus endoscopic ultrasound is driven by the availability of the procedure and the experience of the investigators. No studies aiming to compare the sensitivity of these two techniques for insulinoma localization have been carried out.…”

Section: Discussionmentioning

confidence: 99%

Anatomical localization of insulinomas: still a need to combine a set of diagnostic procedures

Tamagno¹,

O’Shea²

2012

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The diagnosis of insulinoma is based on universally defined clinical and laboratory parameters (Whipple triad and fasting test). Pre-operative tumor localization is the main challenge in the diagnostic management of insulinomas. The pre-operative and/or intra-operative localization of the tumor is required for the optimal surgical approach. We describe two cases of insulinoma characterized by a typical clinical presentation, a positive diagnosis on fasting test, and computerized tomography failure in localizing the tumor. In the first patient, angiography with hepatic venous sampling after calcium stimulation correctly localized pre-operatively the region of the pancreas where the tumor was and, following intra-operative investigations, the lesion was successfully enucleated. In the second patient, angiography with hepatic venous sampling after calcium stimulation failed to identify the region of the insulinoma, which was detected by intra-operative ultrasound and successfully enucleated. Invasive pre-operative procedures for tumor regionalization and/or localization (angiography with hepatic venous sampling after calcium stimulation, endoscopic ultrasound) should be performed in cases where the tumor cannot be localized with enough certainty by non-invasive imaging. However, a careful intra-operative study should be performed in all patients undergoing surgery to complete the information obtained pre-operatively and to exclude the presence of other smaller lesions.

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“…Major drawbacks include its dependence on operator expertise, difficulties in evaluating intra-abdominal structures in the obese patient and declining sensitivity with small diameter lesions (<2 cm) and with tumors located in the tail of the pancreas. 16,17 However, in certain high-volume centers detection by contrast-enhanced transabdominal US has been reported to be comparable to detection by conventional CT. 18 CT is the most commonly used non-invasive preoperative localization test. Contrast enhancement is routinely used and insulinomas are usually visualized as rounded, well-defined lesions.…”

Section: Localization Of the Tumormentioning

confidence: 99%

Laparoscopic surgery for pancreatic insulinomas: an update

Aggeli¹,

Nixon²,

Karoumpalis³

et al. 2016

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Insulinomas are the most common functioning neuroendocrine tumors of the pancreas, occurring in almost 1-4 per 1 million persons each year. In contrast to other pancreatic neuroendocrine tumors, they are usually benign and solitary at the time of diagnosis. Due to their benign nature, surgical excision is the treatment of choice, with excellent long-term results. The introduction of minimally invasive techniques in the surgical treatment of insulinoma has been gaining popularity due to shorter length of hospital stay and better cosmetic results, with serious complications being comparable to those of open surgery. Preoperative localization is of paramount importance in the determination of the appropriate surgical approach. Many invasive and non-invasive methods exist for localization of an insulinoma. A combination of these modalities is usually adequate to preoperatively localize the vast majority of tumors. Laparoscopic ultrasound is mandatory to localize these tumors intraoperatively. Despite extensive experience in highly specialized centers producing encouraging results, no randomized trials have been realized to conclusively validate these case series, this partly due to the rarity of insulinoma in the population. In this article we present the current state of laparoscopic management of insulinoma delineating still unanswered issues and we underscore some of the technical details of the most common laparoscopic procedures employed.

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Assessment of contrast-enhanced ultrasonography in diagnosis and preoperative localization of insulinoma

Cited by 24 publications

References 25 publications

Contrast‐enhanced Ultrasonographic Findings in Three Dogs With Pancreatic Insulinoma

Contrast‐enhanced Ultrasonographic Findings in Three Dogs With Pancreatic Insulinoma

Anatomical localization of insulinomas: still a need to combine a set of diagnostic procedures

Laparoscopic surgery for pancreatic insulinomas: an update

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