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Early 18F-FDOPA PET/CT imaging after carbidopa premedication as a valuable diagnostic option in patients with insulinoma

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Abstract

Purpose

Data on the diagnostic value of 18F-FDOPA PET/CT in patients with insulinoma are limited and are focused on small patient populations explored using different PET/CT protocols and the inconsistent use of carbidopa premedication. The aim of this study was to improve the current knowledge about the diagnostic value of 18F-FDOPA PET/CT combined with oral carbidopa premedication and early pancreatic imaging for tumour localization in patients with insulinoma-related hyperinsulinaemic hypoglycaemia (HH). The relationships among 18F-FDOPA quantitative uptake parameters, insulin secretion and tumour pathological features were also investigated.

Methods

Of 34 patients with suspicion of insulinoma-related HH examined by dual time-point carbidopa-assisted 18F-FDOPA PET/CT, 24 with histologically proven insulinoma were retrospectively included. One patient underwent two PET/CT examinations for relapsing insulinoma after surgical excision. Thus, 25 preoperative 18F-FDOPA PET/CT studies were finally retained and analysed. All studies were performed under carbidopa premedication (200 mg orally, 1–2 h prior to tracer injection). The PET/CT acquisition protocol included an early acquisition (5 min after 18F-FDOPA injection) over the upper abdomen and a delayed whole-body acquisition starting 20–30 min later. The cytological and/or histopathological diagnosis of insulinoma was the diagnostic standard of truth.

Results

18F-FDOPA PET/CT localized insulinoma in 21 of the 25 studies, leading to a primary lesion detection rate of 84%. Four lesions (19%) were detected only on early acquisitions. The false-negative tumour detection rates were, respectively, 22% and 12.5% in patients receiving and not receiving treatment for hypoglycaemic symptoms at the time of PET/CT. In benign insulinomas, the early maximum standardized uptake value (SUVmax) was significantly higher than the delayed SUVmax. Compared to the 21 benign lesions, four malignant insulinomas showed significantly higher 18F-FDOPA uptake. Lesion size, fasting-end insulin and C-peptide levels correlated with tumour 18F-FDOPA uptake, dopaminergic tumour volume and metabolic burden.

Conclusion

The present study showed that 18F-FDOPA PET/CT combined with carbidopa premedication and early pancreatic acquisitions is a valuable diagnostic option in patients with insulinoma when GLP1R-based imaging is not available. The results also provide new insights into the relationships between tumour secretion and imaging phenotype in insulinomas.

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Author information

Authors and Affiliations

  1. Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, Strasbourg, France

    Benjamin Leroy-Freschini & Alessio Imperiale

  2. Endocrinology, Diabetes and Metabolic Disorders, La Timone University Hospital, Aix-Marseille University, Marseille, France

    Vincent Amodru & Frédéric Castinetti

  3. Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France

    Pietro Addeo & Philippe Bachellier

  4. Endocrine Surgery, La Timone University Hospital, Aix-Marseille University, Marseille, France

    Frédéric Sebag

  5. General, Digestive, and Endocrine Surgery, IRCAD-IHU, University of Strasbourg, Strasbourg, France

    Michel Vix

  6. Endocrine and General Surgery, University Hospital of Nancy, Nancy, France

    Laurent Brunaud

  7. Endocrinology, University Hospital of Nancy, Nancy, France

    Marc Klein

  8. Diabetology, University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France

    Thibault Bahougne

  9. Internal Medicine, Diabetes and Metabolic Disorders, University Hospitals of Strasbourg, Strasbourg University, Strasbourg, France

    Bernard Goichot

  10. Nuclear Medicine, University Hospital of Nancy, Nancy, France

    Elodie Chevalier

  11. Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, Marseille, France

    David Taieb

  12. European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France

    David Taieb

  13. ICube, UMR 7357 Strasbourg University / CNRS & FMTS, Faculty of Medicine of Strasbourg, Strasbourg, France

    Alessio Imperiale

  14. Department of Nuclear Medicine, Hautepierre University Hospital, 1, Avenue Molière, 67098, Strasbourg Cedex, France

    Alessio Imperiale

Authors
  1. Benjamin Leroy-Freschini
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  2. Vincent Amodru
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Correspondence to Alessio Imperiale.

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All procedures performed in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Leroy-Freschini, B., Amodru, V., Addeo, P. et al. Early 18F-FDOPA PET/CT imaging after carbidopa premedication as a valuable diagnostic option in patients with insulinoma. Eur J Nucl Med Mol Imaging 46, 686–695 (2019). https://doi.org/10.1007/s00259-018-4245-3

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