Role of 68Ga somatostatin receptor PET/CT in the detection of endogenous hyperinsulinaemic focus: an explorative study

Prasad, Vikas; Sainz-Esteban, Aurora; Arsenić, Ruža; Plöckinger, Ursula; Denecke, Timm; Pape, Ulrich‐Frank; Pascher, Andreas; Kühnen, Peter; Pavel, Marianne; Blankenstein, Oliver

doi:10.1007/s00259-016-3331-7

Cited by 51 publications

(39 citation statements)

References 31 publications

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“…68 Ga-DOTATATE has a high affinity to somatostatin receptors 2 (SSTR2), which are commonly expressed in neuroendocrine tumors 15 . Prasad and colleagues found that SSTR2 expression in insulinomas is present in up to 80% of cases 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Different radioligands targeting somatostatin receptors, including 68 Ga-DOTATATE, 68 Ga-DOTATOC, and 68 Ga-DOTANOC, have been evaluated for detection of neuroendocrine tumors with promising results 10,11 . 68 Ga-DOTATATE/DOTATOC PET/CT has been described in the detection of insulinomas 12 . The aim of this study was to evaluate the accuracy of 68 Ga-DOTATATE PET/CT as compared to other anatomic imaging modalities, SASI, and IOUS and palpation for localizing insulinoma in patients who were biochemically cured of their insulinomas.…”

Section: Introductionmentioning

confidence: 99%

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Localization of Insulinoma Using 68Ga-DOTATATE PET/CT Scan

Nockel

Babic

Millo

et al. 2016

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context. The reliable localization of insulinoma is critical for the successful surgical treatment.Objective. This study compared the accuracy of 68 Gallium (Ga)-DOTATATE PET/CT to anatomic imaging modalities, selective arterial secretagogue injection (SASI), and intraoperative ultrasound (IOUS) and palpation for localizing insulinoma in patients who were biochemically cured. Design, Setting, and Patients. We conducted a retrospective analysis of 31 patients who had an insulinoma confirmed on histology and were biochemically cured. The results of CT, MRI, transabdominal US, IOUS, 68 Ga-DOTATATE PET/CT, SASI, and operative findings were analyzed. Intervention, Main Outcome Measures, Results: The insulinomas were correctly localized in 17 out of 31 (55%) of patients by CT, in 17 out of 28 (61%) by MRI, in 6 out of 28 (21%) by US, and in 9 out of 10 (90%) by 68 Ga-DOTATATE. IOUS was performed in 31 patients, and 29 of them had an insulinoma successfully localized (93.5%). Thirty patients underwent SASI, and the insulinoma was regionalized in 28 out of 30 patients (93%). In 19 out of 23 patients (83%), manual palpation identified insulinoma. In patients who had all four noninvasive imaging studies, CT was concordant with 68 Ga-DOTATATE in 6 out of 9 patients (67%); MRI in 8 out of 9 (78%); US in 0 out of 9; and in 1 out of 9 patients (11%) the lesion was only seen by 68 Ga-DOTATATE. Conclusions:68 Ga-DOTATATE PET/CT identifies most insulinomas and may be considered as an adjunct imaging study when all imaging studies are negative and when a minimally invasive surgical approach is planned.PRECIS: We studied 68Ga-DOTATATE PET/CT imaging in patients with insulinoma and found it identifies most tumors and should be considered as an adjunct imaging study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Localization of Insulinoma Using 68Ga-DOTATATE PET/CT Scan

Nockel

Babic

Millo

et al. 2016

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…The majority of metastatic insulinoma cases included in reported series demonstrate significant avidity on somatostatin receptor imaging (Schillaci et al 2000, van Schaik et al 2011, Costa et al 2013, Prasad et al 2016. In contrast with the results from studies of benign insulinomas, a molecular imaging study of 11 patients with metastatic insulinoma targeted SSTR2 ( 68 Ga DOTATATE PET/CT) and GLP-1 receptors ( 111 In-exendin-4 SPECT/CT) demonstrated relatively low GLP-1R targeting in only 4/11 metastatic cases, and higher than expected SSTR2 targeting in 8/11 cases (Wild et al 2011).…”

Section: :6mentioning

confidence: 99%

Molecular imaging in the investigation of hypoglycaemic syndromes and their management

Pattison¹,

Hicks²

2017

Endocrine-Related Cancer

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There has been recent progress in molecular imaging using a variety of cellular targets for the investigation of adult non-diabetic hypoglycaemic syndromes and its integration into patient management. These targets include peptide receptors (somatostatin receptors (SSTRs) and glucagon-like peptide-1 receptor (GLP-1R)) the amine precursor uptake and decarboxylation system utilising the diphydroxyphenylaline (DOPA) analogue 6-[ 18 F]-l-fluoro-l-3,4-dihydroxyphenylalanine ( 18 F-FDOPA), and glycolytic metabolism with 2-[ 18 F]fluoro-2-deoxy-d-glucose (FDG). Accurate preoperative localisation and staging is critical to enable directed surgical excision or enucleation with minimal morbidity and preservation of residual pancreatic function. Benign insulinoma has near ubiquitous dense GLP-1R expression enabling accurate localisation with radiolabelled-exendin-4 compounds (e.g. 68 Ga-NOTA-exendin-4 PET/CT), whilst the rarer and more difficult to manage metastatic insulinoma typically express SSTR and is preferably imaged with radiolabelled-SSTR analogues such as 68 Ga-DOTA-octreotate (DOTATATE) PET/CT for staging and assessment of suitability for peptide receptor radionuclide therapy (PRRT). Similar to other metastatic neuroendocrine tumours, FDG PET/CT is used in the setting of highergrade metastatic insulinoma to provide important prognostic information that can guide treatment and determine suitability for PRRT. Interestingly, these three tracers appear to represent a spectrum of differentiation, which we conceptually describe as the 'tripleflop' phenomenon, with GLP-1R > SSTR > FDG in benign insulinoma and the opposite in higher-grade disease. This paper will review the clinical syndromes of adult hypoglycaemia (including a practical overview of the differential diagnoses to be considered), comparison of techniques for insulinoma localisation with emphasis on molecular imaging before discussing its implications for management of metastatic insulinoma.

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“…With cohorts of 13 (although Prasad et al included patients with nesidioblastosis in their cohort) and 10 patients, these studies showed a sensitivity of somatostatin receptor PET/CT of 84.7% and 90%, respectively (22,23).…”

Section: Discussionmentioning

confidence: 99%

“…In two recent studies, Prasad et al (22) and Nockel et al (23) re-evaluated the diagnostic value of two somatostatin analog tracers 68 Ga-DOTA-(Tyr3)-octreotate and 68 Gaedotreotide in insulinoma detection. With cohorts of 13 (although Prasad et al included patients with nesidioblastosis in their cohort) and 10 patients, these studies showed a sensitivity of somatostatin receptor PET/CT of 84.7% and 90%, respectively (22,23).…”

Section: Discussionmentioning

confidence: 99%