Imaging and localization of pancreatic insulinomas

Chatziioannou, Achilles; Kehagias, Dimitrios; Mourikis, D; Antoniou, Aris; Limouris, Georgios S.; Kaponis, Apostolos; Kavatzas, Nikolaos; Tseleni, Sophia; Vlachos, L.

doi:10.1016/s0899-7071(01)00290-x

Cited by 47 publications

(37 citation statements)

References 33 publications

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“…90% of insulinomas are less than 2 cm in diameter. 7 Endoscopic ultrasound scan (EUS) has a blind spot at the splenic hilum which could explain why it was missed on this imaging. Biphasic thin-section helical CT scan and EUS combined has a sensitivity of almost 100% in localising insulinomas.…”

Section: Discussionmentioning

confidence: 99%

Lesson of the month 2: An unusual presentation of hyperinsulinaemic hypoglycaemia with possible underlying diagnosis of glucose-sensitive insulinoma or islet cell hyperplasia

Maguire

2015

Clinical Medicine

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Lesson of the month 2: An unusual presentation of hyperinsulinaemic hypoglycaemia with possible underlying diagnosis of glucose-sensitive insulinoma or islet cell hyperplasia Postprandial hypoglycaemia can occur in islet cell hyperplasia and in reactive hypoglycaemia. Less commonly, it can occur with insulinoma. A case is described where the differential diagnosis was glucose-sensitive insulinoma or islet cell hyperplasia. Typical provocation was prolonged exertion or fasting followed by ingestion of sugary snacks resulting in hypoglycaemic seizures and collapse. Biochemistry and computerised tomography imaging were consistent with an insulinoma in the pancreatic tail, but this was not confirmed on endoscopic ultrasound. Selective intra-arterial calcium stimulation with hepatic venous sampling results suggested a diagnosis of islet cell hyperplasia. Ten years later, repeat imaging was consistent with a neuroendocrine tumour. Surgical resection has resulted in remission of symptoms. The patient will be monitored long term to ensure no recurrence.

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Section: Discussionmentioning

confidence: 99%

Lesson of the month 2: An unusual presentation of hyperinsulinaemic hypoglycaemia with possible underlying diagnosis of glucose-sensitive insulinoma or islet cell hyperplasia

Maguire

2015

Clinical Medicine

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“…In insulinomas, the sensitivity of [ 111 In-DTPA 0 ]-octreotide is below 50% (7) because somatostatin receptor subtype 2 is expressed by less than 60% of insulinomas (8). The conventional imaging methods also have limited sensitivity because of the small size of insulinomas (9,10). The amine precursor 6-18 F-fluoro-Ldopa shows controversial results, with sensitivities ranging from 17% up to 90% (11,12).…”

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confidence: 99%

Exendin-4–Based Radiopharmaceuticals for Glucagonlike Peptide-1 Receptor PET/CT and SPECT/CT

et al. 2010

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Tc/EDDA)NH 2 ]-exendin-4 did not result in inferior tumor-to-organ ratios or reduced image quality. All radiopeptides tested showed a high tumor-to-background ratio, resulting in the visualization of small tumors (maximum diameter between 1.0 and 3.2 mm) by SPECT and PET. The only exception was the kidneys, which also showed high uptake. This uptake could be reduced by 49%278% using poly-glutamic acid, Gelofusine, or a combination of the 2. The estimated effective radiation dose was 3.7 mSv/MBq for [Lys 40

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“…New techniques, such as spiral CT, with dual phase contrast enhancement, have improved the sensitivity of detection of PETs in humans compared with conventional CT (85 versus 16-72%). 25,29 The introduction of these techniques to veterinary medicine also could improve the accuracy of the identification of canine insulinoma.…”

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confidence: 99%

Comparison of Ultrasonography, Computed Tomography, and Single‐Photon Emission Computed Tomography for the Detection and Localization of Canine Insulinoma

Robbena

Pollak

Kirpensteijn

et al. 2005

Veterinary Internal Medicne

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Accurate preoperative detection, localization, and staging of the primary tumor and metastases are essential for the selection of appropriate candidates for surgery. In dogs with insulinoma, preoperative assessment usually is performed with transabdominal ultrasonography (US). There are no reports on the use of computed tomography (CT) for this purpose. The preoperative use of somatostatin receptor scintigraphy (SRS) recently has been advocated for the identification of insulinoma and gastrinoma in dogs, but its accuracy remains to be established. In this report US, CT, and single-photon emission computed tomography (SPECT) with [ 111 In-DTPA-D-Phe 1 ]-octreotide (a specific form of SRS) were compared for their effectiveness in detecting and localizing primary and metastatic insulinoma in dogs. Findings at surgery or postmortem examination served as control. Of 14 primary insulinomas, 5, 10, and 6 were correctly identified by US, CT, and SPECT, respectively. No lymph node metastases were detected by US or SPECT. CT identified 2 of 5 lymph node metastases but also identified 28 false-positive lesions. Two of 4 livers were found to be positive for metastases by 1 of the imaging techniques. US can be used for the initial evaluation of dogs with hypoglycemia. Although CT identifies most primary tumors, intraoperative inspection and palpation of the pancreas is still superior. SPECT appears as effective as US and CT in detecting insulinomas. Future developments in preoperative imaging techniques might improve current methods of canine insulinoma detection.Key words: Abdominal ultrasonography; Computed tomography; Diagnostic imaging; Dog; Pancreatic endocrine tumor; Somatostatin receptor scintigraphy. Insulin-producing pancreatic endocrine tumor, or insulinoma, is the most common of the 3 types of pancreatic endocrine tumor (PET) described in the dog (insulinoma, gastrinoma, and glucagonoma).1-3 Over 95% of insulinomas in dogs are malignant, and 40-50% have visibly metastasized at the time of surgery.2,4,5 Insulinomas are identified and staged by means of preoperative transabdominal ultrasonography (US) and, to a lesser extent, by computed tomography (CT) and by inspection and palpation during exploratory laparotomy.Data on the effectiveness of preoperative imaging techniques in dogs with insulinoma are limited to uncontrolled studies of transabdominal US. [6][7][8] In human medicine, several imaging techniques have been described and evaluated for preoperative identification and staging of PETs. Somatostatin receptor scintigraphy (SRS) has become an important and often 1st-line imaging method in humans with malignant PETs. [9][10][11][12] This imaging modality has a high sensitivity and a high specificity. [13][14][15] Additional advantages of this technique are whole-body scanning for extra-abdominal metastases, gamma probing for intraoperative identification of tumor foci, and selection of subjects suitable for treatment with a radiolabeled somatostatin analogue. otide was described for identification of insulinoma...

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Imaging and localization of pancreatic insulinomas

Cited by 47 publications

References 33 publications

Lesson of the month 2: An unusual presentation of hyperinsulinaemic hypoglycaemia with possible underlying diagnosis of glucose-sensitive insulinoma or islet cell hyperplasia

Lesson of the month 2: An unusual presentation of hyperinsulinaemic hypoglycaemia with possible underlying diagnosis of glucose-sensitive insulinoma or islet cell hyperplasia

Exendin-4–Based Radiopharmaceuticals for Glucagonlike Peptide-1 Receptor PET/CT and SPECT/CT

Comparison of Ultrasonography, Computed Tomography, and Single‐Photon Emission Computed Tomography for the Detection and Localization of Canine Insulinoma

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