Modified intra-arterial calcium stimulation with venous sampling test for preoperative localization of insulinomas

Defreyne, Luc; König, Kerstin; Lerch, Markus M.; Hesse, Uwe; Rottiers, R.; Feifel, G.; Hemptinne, Bernard de; Kramann, B.; Kunnen, Marc

doi:10.1007/s002619900350

Cited by 25 publications

(28 citation statements)

References 36 publications

(50 reference statements)

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“…Others have described MRI detection rates of up to 65.5% [11,24,28,[30][31][32]. Short inversion-time recovery sequences and fat-suppressed T2-weighted TSE images seem to provide the best images [33][34][35][36][37], and the use of contrast agents is mandatory.…”

Section: Discussionmentioning

confidence: 93%

“…Nowadays the selective arterial calcium stimulation test with blood sampling from the right hepatic vein [11] should be performed. This test is an improvement on classic angiography, which has successfully localised insulinomas in 36-91% [11,23,24,28,[30][31][32] by superselective catheterisation of celiac, hepatic, splenic, superior mesenteric, gastroduodenal, dorsal pancreatic, superior and inferior pancreaticoduodenal arteries. At our institution the last angiography for detection of an insulinoma was performed in 1992.…”

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

The importance of preoperative localisation procedures in organic hyperinsulinism — Experience in 67 patients

Kaczirek

Ba‐Ssalamah

Schima

et al. 2004

Wien Klin Wochenschr

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 96%

The importance of preoperative localisation procedures in organic hyperinsulinism — Experience in 67 patients

Kaczirek

Ba‐Ssalamah

Schima

et al. 2004

Wien Klin Wochenschr

View full text Add to dashboard Cite

show abstract

“…The mean diameter of insulinomas is generally not more than 15 mm (2, 11, 15, 24), and non-invasive imaging modalities thus often fail to localize them. Non-invasive modalities such as US, CT, and MRI have shown low sensitivities (8, 9, 13, 14, 16, 21, 25), while CT and US will detect up to 60% of biochemically proven insulinomas.…”

Section: Discussionmentioning

confidence: 99%

“…A further point is that because catheterization of the left hepatic vein was technically more difficult, and also unnecessary, the right hepatic vein only was chosen (4, 8, 9, 19, 24). Thus, the amount of sampling required was also reduced.…”

Section: Discussionmentioning

confidence: 99%

Selective Intra-Arterial Calcium Stimulation with Hepatic Venous Sampling for Preoperative Localization of Insulinomas

et al. 2003

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ObjectiveTo determine the value of selective intra-arterial calcium stimulation with hepatic venous sampling using serum insulin and C-peptide gradients for the preoperative localization of insulinomas.Materials and MethodsSeven consecutive patients [three men and four women aged 15-77 (mean, 42.7) years] with hypoglycemia underwent selective intra-arterial calcium stimulation in conjunction with hepatic venous sampling. Insulin gradients were calculated by an individual blinded to all other preoperative imaging studies and operative findings. In all patients except one, C-peptide gradients were also analyzed. The results were compared with the preoperative findings of ultrasonography, computed tomography, arteriography and endoscopic ultrasonography, as well as with the intraoperative findings of ultrasonography and palpation at surgery.ResultsEight insulinomas (mean diameter, 12.5 mm) were diagnosed after surgery. In six patients, the calcium stimulation test with insulin gradients allowed accurate localization of the pathologic source of insulin secretion. Both C-peptide and insulin gradients substantially increased diagnostic accuracy. In one patient, C-peptide gradients were more helpful than insulin gradients for tumor localization.ConclusionSelective intra-arterial calcium stimulation with hepatic venous sampling is a highly accurate and safe method for the preoperative localization of insulinomas. Additional C-peptide gradients seem to be helpful in assessing tumor location, but further study is needed.

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“…However, as release of insulin is likely to depend on local concentrations of calcium within the artery, which should not be affected by weight, we have used a fixed dose of calcium in all cases. Previous reports have suggested a number of different ratios of stimulated over basal insulin levels to indicate a positive result [13,[16][17][18][19]. However, it has been difficult to extrapolate between studies due to differing doses of calcium administered.…”

Section: Introductionmentioning

confidence: 96%

The role of arterial stimulation and simultaneous venous sampling in addition to cross-sectional imaging for localisation of biochemically proven insulinoma

et al. 2009

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Insulinomas, although rare, cause considerable morbidity but are frequently amenable to surgical cure. Laparoscopic surgery can now be considered if the tumour is localised pre-operatively, but the optimal imaging approach has not been determined. The objective of this study was to evaluate the ability of different imaging investigations, including CT, MRI, endoscopic ultrasound, octreotide scintigraphy and arterial stimulation with simultaneous venous sampling (ASVS), to localise insulinomas. All patients with biochemically proven insulinoma at our institution underwent ASVS along with other imaging investigations as part of their routine investigation. The results of these investigations were compared with histological findings. Twenty-eight patients with biochemically proven insulinoma confirmed by histology were identified. Ultimately ASVS localised a lesion in all patients. Seventeen patients (61%) had laparoscopic surgery. Tumor-detection rates for other imaging investigations included 43.5% of cases using CT, 71% using MRI, 86% using endoscopic ultrasound and 33% using octreotide scintigraphy. In four patients, the ASVS was the only test to correctly localise the lesion. ASVS should be considered routinely before surgery to ensure accurate localisation of insulinomas.

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Modified intra-arterial calcium stimulation with venous sampling test for preoperative localization of insulinomas

Cited by 25 publications

References 36 publications

The importance of preoperative localisation procedures in organic hyperinsulinism — Experience in 67 patients

The importance of preoperative localisation procedures in organic hyperinsulinism — Experience in 67 patients

Selective Intra-Arterial Calcium Stimulation with Hepatic Venous Sampling for Preoperative Localization of Insulinomas

The role of arterial stimulation and simultaneous venous sampling in addition to cross-sectional imaging for localisation of biochemically proven insulinoma

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