Nuclear medicine in the detection and management of pancreatic islet-cell tumours

Virgolini, Irene; Traub-Weidinger, Tatjana; Decristoforo, Clemens

doi:10.1016/j.beem.2004.09.001

Cited by 82 publications

(62 citation statements)

References 38 publications

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“…In the case of radiolabelled octreotide scanning, the octreotide uptake prevalence of 50% is less operator dependent, but instead the low localisation rate is contingent upon the majority of tumours lacking a high density of somatostatin receptors. Our findings are concordant with most of the published literature (24). The relative frequency of confusing results could suggest that this is a tool best kept in reserve for cases in which localisation is proving difficult, and requires the maximum possible weight of evidence, but even in such cases in our series, octreotide scanning added little in terms of localisation.…”

Section: Discussionsupporting

confidence: 81%

Diagnosis and localisation of insulinoma: the value of modern magnetic resonance imaging in conjunction with calcium stimulation catheterisation

Druce¹,

Muthuppalaniappan²,

O’Leary³

et al. 2010

European Journal of Endocrinology

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Context: Preoperative localisation of insulinoma improves cure rate and reduces complications, but may be challenging. Objective: To review diagnostic features and localisation accuracy for insulinomas. Design: Cross-sectional, retrospective analysis. Setting: A single tertiary referral centre. Patients: Patients with insulinoma in the years 1990-2009, including sporadic tumours and those in patients with multiple endocrine neoplasia syndromes. Interventions: Patients were identified from a database, and case notes and investigation results were reviewed. Tumour localisation by computed tomography (CT), magnetic resonance imaging (MRI), octreotide scanning, endoscopic ultrasound (EUS) and calcium stimulation was evaluated. Main outcome measure(s): Insulinoma localisation was compared to histologically confirmed location following surgical excision. Results: Thirty-seven instances of biochemically and/or histologically proven insulinoma were identified in 36 patients, of which seven were managed medically. Of the 30 treated surgically, 25 had CT (83.3%) and 28 had MRI (90.3%), with successful localisation in 16 (64%) by CT and 21 (75%) by MRI respectively. Considered together, such imaging correctly localised 80% of lesions. Radiolabelled octreotide scanning was positive in 10 out of 20 cases (50%); EUS correctly identified 17 lesions in 26 patients (65.4%). Twenty-seven patients had calcium stimulation testing, of which 6 (22%) did not localise, 17 (63%) were correctly localised, and 4 (15%) gave discordant or confusing results. Conclusions: Preoperative localisation of insulinomas remains challenging. A pragmatic combination of CT and especially MRI predicts tumour localisation with high accuracy. Radionuclide imaging and EUS were less helpful but may be valuable in selected cases. Calcium stimulation currently remains useful in providing an additional functional perspective.European Journal of Endocrinology 162 971-978

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Section: Discussionsupporting

confidence: 81%

Diagnosis and localisation of insulinoma: the value of modern magnetic resonance imaging in conjunction with calcium stimulation catheterisation

Druce¹,

Muthuppalaniappan²,

O’Leary³

et al. 2010

European Journal of Endocrinology

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“…Firstly, a significant percentage of insulinomas do not express significant densities of somatostatin receptors, especially subtypes 2 and 5. In addition, somatostatin receptors are not significantly expressed in non-malignant insulinomas further limiting SRS sensitivity [84] . However, malignant insulinomas are known to overexpress somatostatin receptors, and SRS has potential imaging roles in such tumors for prognostication and staging [85] .…”

Section: Functional Imaging Of Pancreatic Neuroendocrine Tumorsmentioning

confidence: 99%

Imaging of gastroenteropancreatic neuroendocrine tumors

Tan

Tan²

2011

WJCO

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Imaging of gastroenteropancreatic neuroendocrine tumors can be broadly divided into anatomic and functional techniques. Anatomic imaging determines the local extent of the primary lesion, providing crucial information required for surgical planning. Functional imaging, not only determines the extent of metastatic disease spread, but also provides important information with regard to the biologic behavior of the tumor, allowing clinicians to decide on the most appropriate forms of treatment. We review the current literature on this subject, with emphasis on the strengths of each imaging modality.

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“…Computed Tomography (CT), magnetic resonance imaging (MRI), and transabdominal ultrasonography detect approximately 75% of insulinomas (1,4,5). Somatostatin receptor scintigraphy is some-what less sensitive (6). Endoscopic pancreatic ultrasonography (EUS), with the option of fine-needle aspiration of a detected tumor, has a sensitivity of greater than 90% (7,8).…”

Section: Discussionmentioning

confidence: 99%

A Case of Insulinoma With Provoked Seizures for the Past Fourteen Years: A Case Report

Kadkhodazadeh¹,

Kazempour²,

Salevatipour³

2015

Arch Crit Care Med

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Introduction: Insulinoma is one of the most common neuro-endocrine tumors of the pancreas. Some cases with insulinoma present neuropsychiatric symptoms and are often misdiagnosed as psychosis thus patients may remain symptomatic from one week to as long as several decades before diagnosis. Case Presentation: A 68-year-old male patient, who presented episodic seizures and a normal Electroencephalography (EEG) recording for the past fourteen years, had referred for evaluation of hypoglycemia. His biochemical profile revealed blood glucose of 45mg/dL. His C-peptide and insulin levels were elevated. Endoscopic pancreatic ultrasonography (EUS) revealed two mass lesions in pancreatic head. Pathological evaluation revealed well-differentiated endocrine neoplasm and granulomatous reaction in lymph nodes. After resection of the tumor, his symptoms resolved and he became seizure free. Conclusions: Some cases with insulinoma that present neuropsychiatric symptoms might remain symptomatic for several decades before diagnosis. Therefore, it is important for physicians to be aware of presentations of insulinoma to avoid diagnostic delays.

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Nuclear medicine in the detection and management of pancreatic islet-cell tumours

Cited by 82 publications

References 38 publications

Diagnosis and localisation of insulinoma: the value of modern magnetic resonance imaging in conjunction with calcium stimulation catheterisation

Diagnosis and localisation of insulinoma: the value of modern magnetic resonance imaging in conjunction with calcium stimulation catheterisation

Imaging of gastroenteropancreatic neuroendocrine tumors

A Case of Insulinoma With Provoked Seizures for the Past Fourteen Years: A Case Report

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