RT Journal Article SR Electronic T1 68Ga-NODAGA-Exendin-4 PET/CT Improves the Detection of Focal Congenital Hyperinsulinism JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP 310 OP 315 DO 10.2967/jnumed.121.262327 VO 63 IS 2 A1 Boss, Marti A1 Rottenburger, Christof A1 Brenner, Winfried A1 Blankenstein, Oliver A1 Prasad, Vikas A1 Prasad, Sonal A1 Coppi, Paolo de A1 Kühnen, Peter A1 Buitinga, Mijke A1 Nuutila, Pirjo A1 Otonkoski, Timo A1 Hussain, Khalid A1 Brom, Maarten A1 Eek, Annemarie A1 Bomanji, Jamshed A1 Shah, Pratik A1 Gotthardt, Martin YR 2022 UL http://jnm.snmjournals.org/content/63/2/310.abstract 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.