RT Journal Article SR Electronic T1 Radioguided surgery of focal congenital hyperinsulinism using Ga-68 Exendin: Proof of concept JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP P958 OP P958 VO 64 IS supplement 1 A1 Prasad, Vikas A1 Prasad, Sonal A1 Rothe, Karin A1 Huang, Kai A1 Arsenic, Ruza A1 Hauptmann, Kathrin A1 Boss, Marti A1 Beindorff, Nicola A1 Lechner, Lara A1 Christian, Furth A1 Gotthardt, Martin A1 Blankenstein, Oliver A1 Kuehnen, Peter A1 Brenner, Winfried YR 2023 UL http://jnm.snmjournals.org/content/64/supplement_1/P958.abstract AB P958 Introduction: Congenital hyperinsulinism (CHI) is associated with high morbidity and if untreated can cause death. Surgery is the only curative option. However intraoperative exact localization of a small intrapancreatic beta cell mass producing insulin is often a challenge. With this background we investigated a new radioguided surgical (RGS) approach to localize the focus with the help of 68Ga ExendinMethods: 12 CHI patients (age 2.4 - 43.3 months) were injected with approx. 25 MBq of 68Ga Exendin intravenously after standard surgical preparation of the pancreas. Detection rate of hand held positron- and gamma-radiation probe for intrapancreatic localization of the focus was evaluated. In addition, duration of radioguided surgery (defined as the time from first incision until the final sutures has been placed and abdomen closed) was compared with data of patients operated without RGS. Efficacy of the approach was determined by long term (mean 3 years) follow-up data on blood sugar control retrieved from patient´s medical files.Results: Hand held probe detected 11/12 (92%) pre-oparatively localized foci on 68Ga Exendin PET. Only one lesion in the vicinity of left kidney could not be detected. Histopathology confirmed all lesions as CHI foci. The signal-to-noise-ratio of the focus was > 10 times compared to normal pancreatic tissue. Radioguided surgery resulted in reduction of duration of surgery from median 5.5 (CI 4 to 6.7) to 4.7 (CI 3.5 to 6.7) hours. All patients remained euglycemic for a median follow-up period of 3 years (range 2 to 4.5).Conclusions: In this explorative proof of concept analysis, we demonstrated a high precision of 68Ga Exendin for intraoperative localization of intrapancreatic CHI foci. By directing the surgeons to the correct position, RGS can potentially decrease surgery duration by approximately 45 minutes, thereby reducing the risk of perioperative complications.