PT - JOURNAL ARTICLE AU - Boss, Marti AU - Rottenburger, Christof AU - Brenner, Winfried AU - Blankenstein, Oliver AU - Prasad, Vikas AU - Prasad, Sonal AU - Coppi, Paolo de AU - Kühnen, Peter AU - Buitinga, Mijke AU - Nuutila, Pirjo AU - Otonkoski, Timo AU - Hussain, Khalid AU - Brom, Maarten AU - Eek, Annemarie AU - Bomanji, Jamshed AU - Shah, Pratik AU - Gotthardt, Martin TI - <sup>68</sup>Ga-NODAGA-Exendin-4 PET/CT Improves the Detection of Focal Congenital Hyperinsulinism AID - 10.2967/jnumed.121.262327 DP - 2022 Feb 01 TA - Journal of Nuclear Medicine PG - 310--315 VI - 63 IP - 2 4099 - http://jnm.snmjournals.org/content/63/2/310.short 4100 - http://jnm.snmjournals.org/content/63/2/310.full SO - J Nucl Med2022 Feb 01; 63 AB - Surgery with curative intent can be offered to congenital hyperinsulinism (CHI) patients, provided that the lesion is focal. Radiolabeled exendin-4 specifically binds the glucagonlike peptide 1 receptor on pancreatic β-cells. In this study, we compared the performance of 18F-DOPA PET/CT, the current standard imaging method for CHI, and PET/CT with the new tracer 68Ga-NODAGA-exendin-4 in the preoperative detection of focal CHI. Methods: Nineteen CHI patients underwent both 18F-DOPA PET/CT and 68Ga-NODAGA-exendin-4 PET/CT before surgery. The images were evaluated in 3 settings: a standard clinical reading, a masked expert reading, and a joint reading. The target (lesion)-to-nontarget (normal pancreas) ratio was determined using SUVmax. Image quality was rated by pediatric surgeons in a questionnaire. Results: Fourteen of 19 patients having focal lesions underwent surgery. On the basis of clinical readings, the sensitivity of 68Ga-NODAGA-exendin-4 PET/CT (100%; 95% CI, 77%–100%) was higher than that of 18F-DOPA PET/CT (71%; 95% CI, 42%–92%). Interobserver agreement between readings was higher for 68Ga-NODAGA-exendin-4 than for 18F-DOPA PET/CT (Fleiss κ = 0.91 vs. 0.56). 68Ga-NODAGA-exendin-4 PET/CT provided significantly (P = 0.021) higher target-to-nontarget ratios (2.02 ± 0.65) than did 18F-DOPA PET/CT (1.40 ± 0.40). On a 5-point scale, pediatric surgeons rated 68Ga-NODAGA-exendin-4 PET/CT as superior to 18F-DOPA PET/CT. Conclusion: For the detection of focal CHI, 68Ga-NODAGA-exendin-4 PET/CT has higher clinical sensitivity and better interobserver correlation than 18F-DOPA PET/CT. Better contrast and image quality make 68Ga-NODAGA-exendin-4 PET/CT superior to 18F-DOPA PET/CT in surgeons’ intraoperative quest for lesion localization.